BACKGROUND: Left ventricular thrombus is a common complication after acute myocardial infarction. Methods and RESULTS: To Study the incidence of left ventricular thrombosis (LVT) after acute myocardial infarction, we performed serial two-dimensional echocardiography (2D-Echo) in 35 consecutive patients with acute myocardial infarction prospectively ; 10 patients had inferior wall myocardial infarction, 25 patients had anterior wall myocardial infarction. 2D-Echo was obtained within 3 days of acute myocardial infarction, at 4-10 days after symptom onset, and 2-4 weeks after symptom onset serially in each case. 19 out of 35 patients received thrombolytic therapy with urokinase. Left ventricular thrombi were identified in 9(25.7%) of the 35 study patients. The location of myocardial infarction was anterior and apical in all cases with left ventricular thrombi. The shape of thrombi was mural in 6 cases and protruding in 3 cases. The incidence of left ventricular thrombi in patients who received urokinase was not significantly different from that in patients who didn't(31.9% vs 18.8%,p=0.22). Wall motion score was significantly higher in patients who developed left ventricular thrombi than in patients who had no left ventricular thrombus(8.2+/-1.9 vs 5.8+/-2.6, p<0.005). All thrombi appeared within 10 days after myocardial infarction. CONCLUSIONS: Thus left ventricular thrombi develops within 10 days following myocardial infarction with large anterior and apical location. The thrombolysis therapy has no effect in the incidence of left ventricular thrombi in this study. But because of confounding effect of thrombolysis and location of myocardial infarction and extent of myocardial infarction, further investigation is needed.
Anterior Wall Myocardial Infarction ; Echocardiography ; Humans ; Incidence* ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

No abstract available.
Androgen-Insensitivity Syndrome* ; Male

The incidence of otogenic intracranial complication has decreased markedly following the advent of modern chemotherapy. Less is it a disease of children in association with acute otitis media. More often it is seen in the adult after a long history of chronic ear disease, especially cholesteatoma. In the modern literature on lateral sinus thrombosis, meningitis and cerebral abscess are listed as the most common concomitant complications and cerebellar abscess is poorer prognosis than any other complications. Recently we experienced a case of cerebellar abscess after treatment of lateral sinus thrombophlebitis associated with cholesteatoma, and reported this case along with literature survey.
Abscess* ; Adult ; Brain Abscess ; Child ; Cholesteatoma* ; Drug Therapy ; Ear Diseases ; Humans ; Incidence ; Lateral Sinus Thrombosis* ; Literature, Modern ; Meningitis ; Otitis Media ; Prognosis ; Transverse Sinuses*

BACKGROUND AND OBJECTIVES: Arrhythmia is known to be a major cause of death in acute myocardial infarction (AMI). Reperfusion arrhythmias (RA) may also occur during angioplasty or thrombolysis. As yet, the clinical significances of RA and angiographic characteristics of the patients who develop RA during primary angioplasty and stenting are not clearly defined. METHODS: The study group consisted of 60 patients treated with primary angioplasty or stenting for AMI (angioplasty 13, stenting 47 patients). The patients were classified into 2 groups according to RA [RA (-) N=36/RA(+) N=24]: demographic and angiographic characteristics including time to reperfusion and incidence of pre-infarct angina were analyzed. RESULTS: The RA occurred in 40% of patients undergoing primary angioplasty or stenting (24/60 patients). The minor arrhythmias were more common after reperfusion (transient bradycardia 14, accelerated idioventricular rhythm 11, premature ventricular contraction 4 cases): major arrhythmias were uncommon (ventricular tachycardia/fibrillation 5, asystole 1 case). In the two groups, baseline clinical characteristics were similar except for pain to reperfusion time [RA (-): RA (+)=490.8+/-291.7: 252.9+/-109.2 minutes, P=0.001]. There was a trend toward a greater incidence of RA in the right coronary infarct-related artery [RA (-): RA (+)=16.7: 41.7%, P=NS]. The RA occurred in totally occluded artery (TIMI 0) with a giant thrombus and first ballooning in 19/24 patients (79.2%). The RA disappeared with conservative managements including pacemaker insertion and cardiopulmonary resuscitation and there were no differences in major adverse cardiac events in the two groups during follow-up. CONCLUSIONS: These findings suggest that the RA are frequent events during primary angioplasty but unrelated to clinical and angiographic characteristics except for reperfusion time and do not influence short-term prognosis in AMI.
Accelerated Idioventricular Rhythm ; Angioplasty* ; Arrhythmias, Cardiac* ; Arteries ; Bradycardia ; Cardiopulmonary Resuscitation ; Cause of Death ; Follow-Up Studies ; Heart Arrest ; Humans ; Incidence ; Myocardial Infarction* ; Prognosis ; Prospective Studies* ; Reperfusion* ; Stents ; Thrombosis ; Ventricular Premature Complexes

BACKGROUND AND PURPOSE: Left ventricular hypertrophy (LVH) is a well known cardiovascular risk factor, independent of hypertension, even in the absence of epicardial coronary artery disease. Possible mechanisms have been proposed, including increased LV mass, reduced coronary flow reserve (CFR) and diastolic filling abnormalities. However, the relations among LV hypertrophy, diastolic function, hypertension and coronary flow reserve (CFR) in patients with chest pain and normal coronary angiograms have not been well defined. SUBJECTS AND METHOD: Twenty-six patients with chest pain and normal coronary angiograms were included. LV mass, isovolumic relaxation time (IVRT), deceleration time (DT) and E/A ratio were assessed by 2-D echo-cardiography. Coronary blood flow velocity before and after intracoronary adenosine were measured using intracoronary Doppler wire (FIoWire). CFR was defined as ratio of peak flow velocity after adenosine to baseline flow velocity. Subjects were devided into 4 groups according to presence of LVH and hypertension and the parameters were compared among groups. RESULTS: FR was lower (p<0.01) in the groups with either hypertension or LVH or both than in the groups without them. The decrement in CFR was not linearly related to the degree of LVH (r=0.31, p=0.135). Although there were modest increment in IVRT and DT and decrement in E/A ratio in the groups with hypertension or LVH or both, there was no statistical significance. CONCLUSION: These findings suggest that the underlying mechanism of impaired CFR in patients with LVH or hypertension may be the consequence of primary coronary microvascular lesion rather than the process of left ventricular hypertrophy.
Adenosine ; Blood Flow Velocity ; Chest Pain* ; Coronary Artery Disease ; Deceleration ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular ; Relaxation ; Risk Factors ; Thorax*

To evaluate the feasibility and usefulness of transthoracic Doppler echocardiography (TTDE) as a non-invasive method in recording distal anterior descending (LAD) coronary flow velocity, we compared coronary flow reserve (CFR) measured by TTDE with measurements by intracoronary Doppler wire (ICDW). Twenty-one patients without LAD stenosis were studied. ICDW performed at baseline and after intracoronary injection of 18 microg adenosine. TTDE was performed at baseline and after intravenous adenosine (140 microg/kgmin for 2 min). Adequate Doppler recordings of coronary flow velocities during systole were obtained in 14 of 21 study patients (67%) and during diastole in 17 (81%) patients. Baseline and hyperemic peak diastolic flow velocities measured by TTDE were significantly smaller than those obtained by ICDW (p<0.05). However, diminishing trends of diastolic and systolic velocity ratio after hyperemia were similarly observed in both methods. CFR obtained by TTDE (3.0+/-0.5), was higher than the value calculated by ICDW (2.5+/-0.4). There were significant correlations between the values obtained by the two methods (r=0.72, p<0.01). It is concluded that TTDE is a feasible method in measuring coronary flow velocity and appears to be a promising non-invasive method in evaluating CFR.
Adult ; Aged ; Blood Flow Velocity ; Comparative Study ; Coronary Angiography ; Coronary Circulation* ; Coronary Disease/ultrasonography* ; Echocardiography, Doppler/standards ; Echocardiography, Doppler/methods* ; Female ; Heart Rate ; Human ; Hyperemia/ultrasonography ; Linear Models ; Male ; Middle Age ; Prospective Studies ; Reproducibility of Results

Radiation-induced hemorrhagic gastritis is an intractable and dangerous condition. We describe a 59-year-old female patient with radiation-induced hemorrhagic gastritis. The patient underwent postoperative radiation therapy with a dose of 54 Gy in 30 fractions after a radical operation for a Klatskin tumor. Radiation volume included the gastric antrum. Approximately three months after radiation therapy, she was admitted for melena and anemia. Esophagogastroduodenoscopy showed an area of bleeding in the gastric antrum that was so diffuse that effective laser coagulation was not feasible. After failure of various treatments and transfusion of 7,040 mL of packed red blood cells, we successfully stopped the hemorrhage using oral prednisolone treatment. Based on this case, we think that oral prednisolone treatment can be tried as a first treatment for potentially life-threatening radiation-induced hemorrhagic gastritis.
Anemia ; Endoscopy, Digestive System ; Erythrocytes ; Female ; Gastritis* ; Hemorrhage* ; Humans ; Klatskin's Tumor ; Laser Coagulation ; Melena ; Middle Aged ; Prednisolone* ; Pyloric Antrum

Osmidrosis axillae is a distressing problem characterized by foul odor at the axillae due to excessive apocrine sweat gland secretion. We introduce a new non-surgical method using a specially insulated needle and high frequency electrocoagulator. From September 2001 to January 2005, 52 patients were treated with this procedure for osmidrosis axillae. In authors' procedure, insulated needle which was designed to protect skin and dermal layer was inserted into the deep dermis of axilla area and apocrine sweat glands were removed by electrocoagulation. Fifty two patients were evaluated more than 6 months after surgery. Among these patients, 48 patients received secondary coagulation procedure. After second operation, all patients were satisfied with postoperation results. We conclude that our method has several advantages such as 1) short operation time, 2) no necessity of postoperative immobilization of shoulder joints, 3) no need of hospitalization, 4) minimal scarring and no bleeding, 5) prevention of skin necrosis, 6) a safer operative method for recurred cases as a secondary method.
Apocrine Glands ; Axilla* ; Cicatrix ; Dermis ; Electrocoagulation ; Hemorrhage ; Hospitalization ; Humans ; Immobilization ; Necrosis ; Needles* ; Odors ; Shoulder Joint ; Skin ; Sweat Glands

Acinetobacter calcoaceticus-Acinetobacter baumannii (A. calcoaceticus-A. baumannii) complex, which includes A. calcoaceticus (genospecies 1), A. baumannii (genospecies 2), Acinetobacter genospecies 3 and 13, has been identified as A. baumannii by automated bacteria identification system. The purpose of this study is to develop rapid genospecies classification of A. calcoaceticus-A. baumannii complex by molecular techniques. Random amplified polymorphic DNA (RAPD) and restriction fragment length polymorphism (RFLP) were determined for 4 reference strains and 80 isolates of A. calcoaceticus-A. baumannii complex from clinical sources. Four and eleven RAPD patterns were observed among the reference strains and the isolates, respectively. RAPD might be useful for genomic typing but not for genospecies classification of Acinetobacter spp. RFLP of 16S-23S rRNA intergenic spacer gene with three selected restriction enzymes (ApaLI, SwaI, and SalI) showed only four RFLP patterns in the reference and the isolates. Of 80 isolates, 10 of A. calcoaceticus (12.5%), 50 of A. baumannii (62.5%), 11 of A. genospecies 3 (13.75%), and 9 of A. genospecies 13 (11.25%) were classified by RFLP. This result suggests that RFLP of 16S-23S rRNA intergenic spacer gene of A. calcoaceticus-A. baumannii complex might be useful for genospecies classification.
Acinetobacter ; Bacteria ; DNA ; Polymorphism, Restriction Fragment Length

PURPOSE: In order to avoid functional disability that may be caused by radical excision or amputation in extremity soft tissue sarcomas, authors employed limb-conserving surgery together with extemal radiation therapy plus interstitial brachytherapy. MATERIALS AND METHODS: From June 1995 to Febrary 1997, 10 extremity soft tissue sarcoma patients were treated with limb-conserving surgery and external radiation therapy plus interstitial brachytherapy. In six patients, whose histologic diagnoses were made at the time of surgery, wide or marginal excision and interstitial brachytherapy was done 4 weeks before postoperative external radiation therapy. In four patients whose histologic confinnations were done before definitive treatment, preoperative external radiation therapy was given 4 weeks before surgery and interstitial brachytherapy. The types of surgery were wide excision in five patients, and marginal excision in five patients. Gross or microscopic residual was left at the surgical resection margins in four patients. The brachytherapy dose ranged from 17.5 Gy to 24 Gy and external beam radiation did from 40 Gy to 45 Gy. RESULTS: With the median follow-up duration of 21.5 months(range: 13 to 29 months); one local recurrence, and three new distant metastases were observed. There were three patients with wound complications attributable to the current treatment regimen. CONCLUSION: Satisfactory local tumor control may be achievable with limb-conserving surgery and external radiation therapy plus brachytherapy in patients with extremity soft tissue sarcomas, while more caution should be used to avoid wound problems.
Amputation ; Brachytherapy* ; Diagnosis ; Extremities* ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Sarcoma* ; Wounds and Injuries