BACKGROUND AND OBJECTIVE: The aim of this study was to compare the residual diameter stenosis after PTCA with fractional flow reserve (FFR) and coronary flow reserve (CFR), and investigate the correlation between FFR and CFR in patients with acute myocardial infarction (AMI). MATERIALS AND METHOD: The study population consisted of twenty seven patients with myocardial infarction. Baseline and hyperemic average peak velocity (APV) were measured using Doppler wire 15 minutes after restoration of infarct-related artery (IRA). CFR was obtained by the ratio of distal hyperemic APV to baseline APV. Distal coronary arterial pressure (Pd) was measured with advancing the wire distal to the lesion of IRA. Simultaneous proximal aortic pressure (Pa) was measured using guiding catheter. Myocardial FFR was obtained by the ratio of hyperemic Pd to hyperemic Pa. RESULTS: Post-interventional CFR and FFR were 0.85+/-0.44, 0.91+/-0.09. CFR did not show significant correlation with luminal diameter stenosis (%ST). There was no significant correlation between FFR and CFR with a correlation coefficient of 0.29 (p=.25). But, significant correlation was found between %ST and FFR, %ST and hyperemic PG (hPG) with correlation coefficient of -0.70 (p=.0012) and 0.68 (p=.0018). CONCLUSION: In AMI patients, %ST has a significant correlation with FFR and hPG after PTCA. But, there was no significant correlation between FFR and CFR.
Arterial Pressure ; Arteries ; Catheters ; Constriction, Pathologic ; Humans ; Myocardial Infarction* ; Phenobarbital

Autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and primary biliary cirrhosis (PBC) are chronic autoimmune liver diseases. Overlap syndrome is defined as a condition in which the clinical, biochemical, and histological features of these autoimmune diseases are overlapped. Thus, it is difficult to appreciate overlap syndrome as an actual diagnostic entity. Only a few cases of the overlap syndrome of AIH and PSC have been reported, especially in children. Moreover, PSC is known to be the most frequent liver disorder associated with inflammatory bowel diseases such as ulcerative colitis. We report one case of AIH-PSC overlap syndrome in a child who was diagnosed as having ulcerative colitis.
Autoimmune Diseases ; Child ; Cholangitis, Sclerosing ; Colitis, Ulcerative ; Hepatitis, Autoimmune ; Humans ; Inflammatory Bowel Diseases ; Liver ; Liver Cirrhosis, Biliary ; Liver Diseases ; Ulcer

Vasculitic neuropathy is a clinical manifestation affecting peripheral nerve in necrotizing vasculitis. It is generally regarded that natural courses are poor as there are abundant histologic and electrophysiologic evidences of axonal destruction. In this study, authors collected 15 cases of vasculitic neuropathy these six years and analyzed the data retrospectively to understand the clinical course. In 15 cases, the diagnosis of vasculitic neuropathy was made by the prominent clinical features, electrophysiological findings and sural nerve biopsies. Four cases were associated with polyarterits nodosa, one with systemic lupus erythematosus, two with rheumatoid arthritis, and one with polyangiitis overlap syndrome. However in other seven- cases the underlying dignoses were not made completely, but suspected some vasculitic conditions, such as isolated PNS vasculitis or undefined connective tissue disease. Electrophysiological studies showed mononeuritis multiplex in six, sensonmotor polvneuropathy in seven, and overlapped mononeuritis multiplex and polyneuropathy in two. Typical necrotizing vasculitis was found in nine out of twelve sural nerve biopsies. During the follow up period for up to two years, there was much improvement in ten, slight in three, and no improvement in two. In ten out of twelve patients prednisolone or prednisolone plus cyclophosphamide regimens showed improvement. Therefore authors thought that the clinical outcome was relatively fair in vasculitic neu . Ropathy when the therapy was started very early and the tirne factor between the onset and the uutiation of immunosuppressant therapy could be very important and critical.
Arthritis, Rheumatoid ; Axons ; Biopsy ; Connective Tissue Diseases ; Cyclophosphamide ; Diagnosis ; Follow-Up Studies ; Humans ; Lupus Erythematosus, Systemic ; Mononeuropathies ; Peripheral Nerves ; Polyneuropathies ; Prednisolone ; Retrospective Studies ; Sural Nerve ; Vasculitis

PURPOSE: The purpose of this study was to identify the correlation between communication skills for emotional empathy and academic achievement on the Clinical Performance Examination (CPX). METHODS: One hundred twelve medical school students were observed to determine the extent to which they applied communication skills for emotional empathy (preparation stage: interview attitude, respect; rapport stage: encouragement, active listening, will for support; empathy stage: verbal expression empathy, nonverbal expression empathy, acceptance) to the CPX, as well as their level of understanding of these skills to calculate the Pearson r, which can be used to determine the correlation between communication skills and academic achievement (hematochezia, fatigue, abnormal menstruation, chest pain, alcohol problems). RESULTS: Male students had higher scores than females for all communicational skills except verbal expression empathy. Fourth-year students had statistically more significant correlations than third-year students with regard to the rapport stage 'active listening' and empathy stage 'nonverbal expression' and abnormal menstruation and chest pain. Correlations were also more significant for hematochezia in the preparation stage 'interview attitude,' rapport stage 'encouragement,' and empathy stages 'verbal and nonverbal expression' and 'acceptance.' The empathy stage 'nonverbal expressions' was more significant for fourth-year students with alcohol problems. Third-year students largely had negative correlations between emotional empathy communication skills and CPX academic achievement, especially between the preparation stage 'respect' and abnormal menstruation, and between the rapport stage 'encouragement' and hematochezia. CONCLUSION: There was a significant correlation between hematochezia, wherein MS students deliver bad news to patients, and communication skills for emotional empathy.
Achievement ; Chest Pain ; Clinical Competence ; Empathy ; Fatigue ; Female ; Gastrointestinal Hemorrhage ; Humans ; Male ; Menstruation ; Schools, Medical

A 12-year-old neutered male Golden Retriever presented with a progressively enlarging mass in the submandibular region. Histopathological diagnosis confirmed lymphangiosarcoma with metastasis to the liver and spleen. The pleomorphic neoplastic endothelial cells of the tumor grow directly on bundles of dermal collagen, forming numerous clefts and interconnecting channels that are devoid of conspicuous hematic elements. As lymphangiosarcoma is an uncommon malignant neoplasm, the number of previously reported cases and information of the tumor is limited. The present report describes the clinical history and histopathological diagnosis of a progressive lymphangiosarcoma in the submandibular region with metastases in a dog.

Spontaneous bilateral rupture of the quadriceps tendons without a significant history of trauma is an uncommon disease. It is generally associated with mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor trauma. We present a case of patient with chronic renal failure on hemodialysis for the past 9 years, who sustained this injury, and subsequently had surgical repair of both tendons. We performed a preoperative magnetic resonance imaging to confirm the diagnosis, then we repaired the ruptured quadriceps tendons and performing MRI postoperatively 1 yr later. He regained his normal knee joint functions 1 yr after the operation.
Humans ; Kidney Failure, Chronic ; Knee Joint ; Magnetic Resonance Imaging ; Quadriceps Muscle ; Renal Dialysis ; Rupture ; Rupture, Spontaneous ; Tendons

Food allergy is a state of immunologic reaction resulting from the exposure to food or food additive. The clinical symptoms and signs varied from localized symptoms at the site of direct contact such as contact urticaria, localized gastrointestinal symptoms with nausea, pain, vomiting and diarrhea to systemic symptoms occurring in remote organs, such as skin, respiratory system, cardiovascular system. We reported a case of 8 month-old girl with milk allergy who presented skin symptoms after cutaneous contact with milk protein. Developed after 15 minutes of milk contact challenge on forearm and followed by erythematous papules and wheals distributed throughout the face and neck area accompanied by edema and itching. The symptoms were continued for 2 hours and disappeared after an injection of pheniramine maleate.
Cardiovascular System ; Diarrhea ; Edema ; Female ; Food Additives ; Food Hypersensitivity ; Forearm ; Humans ; Infant ; Milk Hypersensitivity* ; Milk Proteins ; Milk* ; Nausea ; Neck ; Pheniramine ; Pruritus ; Respiratory System ; Skin ; Urticaria ; Vomiting

Crohn disease (CD) is rare, but the incidence of CD has been increasing over the past ten years. We found two cases of CD, associated with myelodysplastic syndrome (MDS), for the first time in children. In the first patient, MDS was diagnosed at three years of age and CD developed later at eight years of age. The patient presented with recurrent abdominal pain, diarrhea, bloody stools and failure to thrive. Colonoscopy revealed cobble stone like mucosa and mass like lesions with superficial ulceration and inflammatory exudates, observed from the cecum to ascending colon. Ileo-cecal biopsy samples showed ulcers with skipped areas and lymphoid infiltrations. The patient was started on treatment with mesalazine and deflazacort, and symptoms remitted. In the second patient, MDS was diagnosed at nine years of age and CD developed at 13 years of age. This patient has recurrent hematochezia, abdominal pain, vomiting and fever. Colonoscopy revealed a large, deep indurative ulceration on the cecal side of the ileo-cecal valve. Ileocecectomy was done, and histology revealed ulceration with transmural inflammation and lymphoid aggregates. Symptoms improved after ileocecectomy.
Abdominal Pain ; Biopsy ; Cecum ; Child* ; Colon, Ascending ; Colonoscopy ; Crohn Disease* ; Diarrhea ; Exudates and Transudates ; Failure to Thrive ; Fever ; Gastrointestinal Hemorrhage ; Humans ; Incidence ; Inflammation ; Mesalamine ; Mucous Membrane ; Myelodysplastic Syndromes* ; Ulcer ; Vomiting

The high cardiac output state and an increased incidence of atrial fibrillation are well-known cardiovascular complications of Graves' disease, whereas the valvular complications are less well recognized. With 2D color Doppler echocardiography, the cardiac and valvular function of 39 patients with Graves' disease were evaluated and our data were compared with previous Kage's study. The incidences of mitral regurgitation (MR) and tricuspid regurgitation (TR) in patients with Graves' disease were 54% and 51%, respectively. There was no correlation between the incidence of MR and ventricular dilatation. In patients with congestive heart failure (CHF), the incidences of severe TR and atrial fibrillation were significantly higher than in patients without CHF. The incidences of TR and MR in patients with Graves' disease were not different by thyroid function status (hyperthyroid vs. euthyroid). We suggest that the examination for TR and MR in patients with Graves' disease is important not only their high prevalence but also their clinical significance as a risk factor for CHF.
Atrial Fibrillation ; Cardiac Output, High ; Dilatation ; Echocardiography, Doppler, Color ; Graves Disease* ; Heart Failure ; Heart Valve Diseases ; Humans ; Incidence ; Mitral Valve Insufficiency ; Prevalence ; Risk Factors ; Thyroid Gland ; Tricuspid Valve Insufficiency

All complete monosomy 21 appear to be lethal early in their development in humans and only survive in mosaic forms. Complete monosomy 21 is a very rare and usually debilitating genetic disorder. Partial monosomy 21 is also rare and is thought to constitute a clinical syndrome consisting of peculiar faces, hypertonia, psychomotor retardation, and slow growth. We experienced a case of monosomy 21 mosaicism. Chromosome analysis demonstrated mosaicism for cell lines in the lymphocytes examined; 45, XX, -21/46, XX. The main clinical features were craniofacial dysmorphism including high arched palate, submucosal cleft, micrognathia and arthrogryposis-like symptoms including flexion deformity of fingers. And hematological findings were revealed dyserythropoiesis, thrombocytopenia and eosinophilia. Currently, the patient has nearly compatible growth, but a mild degree of mental retardation. We report here an 8 years old female child with apparent monosomy 21 mosaicism associated with dyserythropoiesis, thrombocytopenia and eosinophilia, with a review of the associated literatures.
Cell Line ; Child* ; Chromosome Deletion ; Congenital Abnormalities ; Eosinophilia ; Female ; Fingers ; Humans ; Intellectual Disability ; Lymphocytes ; Monosomy* ; Mosaicism* ; Palate ; Thrombocytopenia