No abstract available.

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a 56-year-old woman.

The isolated coronary ostial stenosis is a lesion of the aortic wall that encroaches on the orifice of the left main coronary artery, atherosclerosis is belived to be a common cause and premenopausal female patients are most commonly affected. Stenosis of the left coronary ostium is a critical lesion which requires urgent myocardial revascularization including a surgical intervention because this lesion jeopardizes such a large volume of left ventricular myocardium. We report the case of a patient in whom percutaneous transluminal coronary angioplasty (PTCA) was performed successfully for the stenotic lesion of distal anastomotic site after surgical ostioplasty with autologous pericardium.
Angioplasty, Balloon, Coronary ; Atherosclerosis ; Constriction, Pathologic* ; Coronary Vessels ; Female ; Humans ; Myocardial Revascularization ; Myocardium ; Pericardium*

Objective To study the feasibility and safety of transradial approach for coronary interventions Methods Coronary intervention was tried to be performed via transradial approach in 116 patients with coronary heart disease (96 males, 20 females, mean age 57 44?9 40 years) Results Transradial puncture failed in 5 cases and coronary interventions were performed via transfemoral approach instead Coronary intervention failed in 2 cases although transradial puncture succeeded Both transradial puncture and coronary intervention succeeded in the rest 109 cases One hundred and thirty five narrowed coronary arteries were dilated (69 LAD, 26 LCX, 39 RCA, 1 venous graft) One hundred and forty eight coronary lesions, including 15 type A, 106 type B and 27 type C lesions were treated One hundred and ten stents were implanted in 105 coronary arteries of 98 patients Rotablator was performed in one case and intracoronary ultrasound detected for another Changing guiding catheter was necessary for 25 cases during the procedure Transfusion was needed due to puncture site bleeding in one case Big hematoma was found in two cases Perforation of a branch of brachial artery happened in another case No surgery repair needed Conclusion Coronary intervention via transradial approach was feasible, but the radial artery puncture was somewhat difficult, and guiding catheter support is poor to some extent One must be cautious about vascular damages near the puncture site

No abstract available.
Aneurysm

Liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68. 2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. CONCLUSION: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.
Allopurinol* ; Follow-Up Studies ; Gout* ; Humans ; Liver Function Tests* ; Liver*

Torsades de pointes is characterized by paroxysms of ventricular tachycardia at rates typically greater than 200 beats/min in which QRS morphology shows alternating polarity in an undulating pattern so that the complexes appear to be twisting about the beseline;this arrhythmia is virtually always associated with prolongation of the QT interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administred. Torsades de pointes was diagnosed in 4 patients;the first with hypokalemia, the second with congenital QT prolongation syndrome, the third with amiodarone, the fourth with organophosphorous and hypokalemia. Treatment of these patients consisted of potassium supply, isoproterenol, lidocaine, phenobarbital, tenormin, phenytoin, cardioversion, atropine. Three patients improved successfully, but one patient died, as a direct result of the ensuing ventricular fibrillation and cardiac arrest on one hour after admission.
Amiodarone ; Arrhythmias, Cardiac ; Atenolol ; Atropine ; Electric Countershock ; Fatal Outcome ; Heart Arrest ; Humans ; Hypokalemia ; Isoproterenol ; Lidocaine ; Phenobarbital ; Phenytoin ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes* ; Ventricular Fibrillation

It is well known that undue pressure and prolonged use of tourniquets on an extremity can cause peripheral nerve palsy and vascular damage either from direct pressure or from acid metabolites accumulating in the tissues distal to the tourniquet applied. After release of a tourniquet that has been on for 2 hours, the acidotic changes in the limb take approximately half an hour to recover, and it has been suggested that two hours' ischemia should never be exceeded. The authors have conducted a study to clarify the effect of these acid metabolites on the systemic circulation upon release of tourniquet after 105 minutes (mean) use. In 12 orthopedic patients, 20~32 years of age, who underwent operations below the knee, anesthesia was induced by the intravenous thiopental-succinylcholine-endotracheal intubation sequence and maintained with nitrous oxide-oxygen-halothane in a semiclosed circle absorption system. Respiration was controlled throughout the procedure. Measurements of PO2, PCO2 and pH in the femoral vein and radial artery before inflation of a tourniquet and 15 minutes, 10 minutes, 20 minutes, and again 30 minutes were performed following the release of tourniquet. The results are as follows: 1) Femoral vein pH significantly decreased with concommitant increase in PCO2 reflecting severe metabolic acidcsis during the tourniquet time. 2) Femoral vein PO2 was significantly increased, suggesting the presence of A-V shunt in the extremity. 3) These changes continued to exist for approximately half an hour after release of tourniquet. 4) Analyses of radial arterial blood for PO2, PCO2 and pH revealed no significant changes throughout the study. 5) It is concluded that acid metabolites produced by tourniquet application do not seriously affect when tourniquet is released as long as the buffering capacity and blood volume are kept normal and the patient is kept alkalemic by controlled ventilation.
Absorption ; Anesthesia ; Blood Volume ; Extremities ; Femoral Vein ; Humans ; Hydrogen-Ion Concentration* ; Inflation, Economic ; Intubation ; Ischemia ; Knee ; Orthopedics ; Paralysis ; Peripheral Nerves ; Radial Artery ; Respiration ; Tourniquets* ; Ventilation

OBJECTIVE: Adult onset Still s disease is an acute systemic inflammatory disorder. There are no pathognomonic symptoms or specific laboratory abnormalities. In recent reports, serum ferritin concentration is increased in active disease phase and decreased after defervescence. Our purpose was to determine the clinical significance of serum ferritin as an indicator for disease activity. METHODS: Seven patients who were diagnosed as adult onset Still s disease at Samsung Medical Center between October 1994 and March 1997, were reviewed. In these patients we checked leukocyte count, ESR, CRP and serum ferritin concentrations at the time of diagnosis and during follow-up periods and recorded febrile events during follow-up periods. RESULTS: At the time of diagnosis and during febrile periods, the concentrations of ferritin were extremely high(927ng/ml to 96,650ng/ml normal 10-290.8 ng/ml). The values were unrelated to other manifestations of the disease or laboratory findings. The ferritin concentrations decreased rapidly after adequate treatment. Eleven febrile reattacks happened in 7 patients. Serum ferritin concentrations were increased in 8 febrile attacks, while leukocyte count, ESR, and CRP were increased in 5, 5, 6 febrile attacks respectively, There were 10 events of increased serum ferritin concentrations in 7 patients during follow-up periods and 8 events were related with fever. The increases of other laboratory tests were similar. CONCLUSIONS: In all patients, serum ferritin concentrations were increased at the time of diagnosis and closely related to fever. During follow-up periods, serum ferritin concentrations are helpful in monitoring disease activity and guiding decisions about treatment.
Adult* ; Diagnosis ; Ferritins* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Still's Disease, Adult-Onset*

No abstract available.