OBJECTIVE: Although cor pulmonale due to chronic lung disease was not uncommon, there was uncertainty in its diagnosis due to the difficulty in measuring functional and anatomical changes of right heart and pulmonary vascular system. Among various non-invasive diagnostic methods presented so far, no ideal standard diagnostic criterion has been established. The authors attempted to know positive diagnostic ratio of cor pulmonale and to study the presence of the relationship between these diagnostic criteria when electrocardiographic and echocardiographic diagnostic criteria for cor pulmonale were applied to the patients with chronic lung disease. And we investigated the usefulness of echocardiogaphic diagnostic criteria for the diagnosis. METHODS: One electrocardiographic and two echocardiographic diagnostic criteria were applied to 38 patients with chronic lung disease(21 pulmonary emphysema and 17 chronic advanced pulmonary tuberculosis) for the diagnosis of cor pulmonale. Comparison was also made in their relationship. Then pulmonary artery diameter, measurement of pulmonary function test and echocardiographic examination and radio-nuclear right ventricular ejection faction were compared between the groups to ensure each criterion was satisfied. RESULTS: 1) When the three diagnostic criteria for confirming the cor pulmonale, electrocardiographic rriterion(right ventricular hypertrophy), right ventricular dimension criterion(right ventricular end-diastolic dimension>25mm, RVDd>25mm), and right ventricular wall thickness criterion (right ventricular wall thickness>6mm, RVWT>6mm) were applied to the patients, the positive rate were 32%(12/37), 30%(10/33) and 17%(6/36) respectively. A statistically significant correlation between electrocardiographic criterion and right ventricular wall thickness criterion was found to exist. 2) Various parameters of pulmonary function test and echocardiographic examination were compared in the patient groups with and without cor pulmonale when each non-invasive diagnostic criterion was applied to all patients. Followings are the results. (1) In the positive group on electrocardiographic criteria, vital capacity, forced vital capacity, and arterial oxygen tension were significantly smaller than in the negative group on electrocardiographic criterion(p<0.05), and the echocardiographic parameters of right ventricle, ie. end-diastolic area, end-systolic area, end-diastolic dimension, end-systolic dimension, mid-ventricular short axis and maximal short axis in positive group were significantly larger than in the negative group. (2) In the positive group on right ventricular diastolic dimension criterion(RVDd>25mm), percentage forced expiratory volume in 1 second and forced expiratory flow 25-75% were significantly smaller than in the negative group on right ventricular diastolic dimension criterion. (3) In the positive group on right ventricular wall thickness criterion(RVWT>6mm), vital capacity, forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow 25-75% and arterial oxygen tension were significantly smaller than in the negative group on right ventricular wall thickness criterion. CONCLUSION: When several non-invasive diagnostic criteria for cor pulmonale were applied to the patients with chronic lung disease, there were some differences in its positive diagnostic ratio depending on the applied diagnostic criteria. There was also a statistically significant correlation between electrocardiographic criterion and right ventricular wall thickness criterion. When each diagnostic criterion was applied to the patients, significant differences were found in several parameters resulted from pulmonary function test and echocardiographic examination based on presence or nonpresence of cor pulmonale. But no difference in the ejection fraction measured by radio-nuclear method was shown between cor pulmonale group and non cor pulmonale group. Consequently it was suggested that applying echocardiographic criteria in addition to electrocardiographic criterion for the diagnosis of cor pulmonale in the patients with chronic lung disease is clinically useful.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography* ; Electrocardiography ; Forced Expiratory Volume ; Heart ; Heart Ventricles ; Humans ; Lung ; Lung Diseases ; Oxygen ; Pulmonary Artery ; Pulmonary Emphysema ; Pulmonary Heart Disease* ; Respiratory Function Tests ; Uncertainty ; Vital Capacity

In suicidal hanging, a death often occurs within minutes. f rescued, most victims later succumb to the respiratory failure secondary to pulmonary edema, bronchopneumonia, delayed airway obstruction, and acute respiratory distress syndrome(ARDS). Out of these, non-cardiogenic pulmonary edema is likely due to neurogenic factors or negative intrathoracic pressure. A 36-year-old female was brought to the Department of Emergency Medicine after the suicidal hanging attempt. She was unconscious but responsive to painful stimuli. A laryngeal stridor was present. The lung sound of the patient's was dear. Fourteen hours after admission, a chest X-ray showed bilateral diffuse interstitial infiltrates in both lung fields, which was compatible with ARDS. The patient was intubated and placed on a volume respirator with PEEP. She improved over the next 48 hours and a repeat chest X-ray aim showed marked clearing of the infiltrates. We report on the pathophysiologic results of this pulmonary complication and the implication of this finding, regarding the treatment of the patient.
Adult ; Airway Obstruction ; Bronchopneumonia ; Emergency Medicine ; Female ; Humans ; Lung ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Respiratory Sounds ; Thorax ; Ventilators, Mechanical

No abstract available.
Animals ; Cadmium Chloride* ; Cadmium* ; Nasal Mucosa* ; Rats*

No abstract available.
Acupuncture* ; Tattooing*

Inflammatory pseudotumor of the liver is a rare benign tumor with microscopic finding of fibrous stroma and chronic inflammatory cell infiltration. Predominance of plasma cells, histiocytes, lymphocytes, some eosinophils and whorled pattern of fibrosis is often characteristic. Due to similar radiologic appearance of hepatocellular carcinoma, inflammatory pseudotumor of the liver was often misdiagnosed and hepatic resection is often performed before preoperative tissue diagnosis. We report a case of inflammatory pseudotumor, which was a 47-year-old woman with fever, upper aMominal pain and weight loss, diagnosed by sonoguided liver biopsy and treated with antibiotic therapy only without surgery. After two weeks of treatment, the radiologic image of the mass was almost disappeared with improvement of previous symptoms. This opportunity and the possible effectiveness of antibiotic treatment should keep in mind in the differential diagnosis of the hepatic mass with similar radiologic appearance of hepatocellular carcinoma.
Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Eosinophils ; Female ; Fever ; Fibrosis ; Granuloma, Plasma Cell* ; Histiocytes ; Humans ; Liver* ; Lymphocytes ; Middle Aged ; Plasma Cells ; Weight Loss

Rectus sheath hematoma of the abdominal wall is a well-recognized, but uncommon condition, caused by a tear in an epigastric vessel and characterized by sudden onset of severe abdominal pain and palpable mass. In most cases, a precipitating cause can be demonstrated. Causes include external trauma, strenuous activities, coughing, lifting, sneezing, vomiting, straining while urinating or defecating, golfing, pregnancy and the puerperium, anticoagulation therapy, infection, chronic diesase, arteriosclerosis, hypertension, prior paracentesis or laparotomy, inadequate hemostasis or excessive retraction in surgery, and idiopathy. Unfortunately, the correct diagnosis often is missed, and the hematoma is found only during an exploratory laparotomy. Treatment should be conservative in most instances. Although the mortality rate for patients with rectus sheath hematoma is low, the condition may be fatal if the volume of the hemorrhage is large and if treatment is delayed. Hence, it should be included in the differential diagnosis of any patient who presents to the emergency department with acute onset of abdominal pain. Our purpose is to familiarlize emergency physicians with the pathophysiology, the diagnosis, and the treatment of rectus sheath hematoma. We describe a patient with fatal rectus sheath hematoma presenting to the emergency department and give a review of the literature.
Abdominal Pain ; Abdominal Wall ; Arteriosclerosis ; Cough ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; Golf ; Hematoma* ; Hemorrhage ; Hemostasis ; Humans ; Hypertension ; Hypovolemia* ; Laparotomy ; Lifting ; Mortality ; Paracentesis ; Postpartum Period ; Pregnancy ; Shock* ; Sneezing ; Vomiting

No Abstract Available.
Adenoviridae* ; Coinfection* ; Herpesvirus 3, Human* ; Humans ; Synovial Fluid* ; Synovitis*

No abstract available.
Blepharoptosis*

BACKGROUND : Lipoprotein(a)[Lp(a)] may be an independent risk factor for macrovascular disease in middle aged populations, but in elderly populations, Lp(a) levels to predict macrovascular risk is controversial. The purpose of this study is to evaluate the association of macrovascular disease with Lp(a) levels and lipid change in the elderly. METHODS : We have examined Lp(a) levels, lipid change and clinical, biochemical profile in 114 patients with macrovascular disease and 55 control subjects. Macrovascular disease was defined as ishemic heart disease and/or peripheral vascular disease, peripheral vascular disease was defined as arteriosclerosis obliterans, diabetic foot and/or cerebrovascular disease. RESULTS : Hypertension, diabetes were more prevalent and median Lp(a) levels, fasting blood glucose and HDL-cholesterol were significant higher in patients with macrovascular disease than control subjects, but there were no significant differences in age, body mass index, total cholesterol and triglycerides levels. Lp(a) levels were positively weak correlated with fibrinogen levels, but not correlated with age, body mass index, total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides levels. In logistic regression analysis, there was no independent risk factor for ischemic heart disease, whereas diabetes, hypertension and low HDL-cholesterol levels were independent risk factors for peripheral vascular disease. CONCLUSION : Serum Lp(a) levels was not independent risk factor for macrovascular disease, but diabetes, hypertension and low HDL-cholesterol levels were independent risk factors for peripheral vascular disease. Therefore, the relationship between Lp(a) and lipid change and macrovascular disease in the elderly were different from middle aged subjects.
Aged* ; Arteriosclerosis Obliterans ; Blood Glucose ; Body Mass Index ; Cholesterol ; Diabetic Foot ; Fasting ; Fibrinogen ; Heart Diseases ; Humans ; Hypertension ; Lipoprotein(a)* ; Logistic Models ; Middle Aged ; Myocardial Ischemia ; Peripheral Vascular Diseases ; Risk Factors ; Triglycerides

BACKGROUND: Chronic exposure to ultraviolet radiation(UVE) nduces photoaging characterized by dry, deeply wrinkled, inelastic, leathery, and irregulaity pigmented skin. UVR also induces solar keratosis and carcinoma, and is a contributing factor in melanoma. Sunscreens are used to prevent solar damage to skin and, if used on a daily lass should significantly reduce the incidence of the chronie photodamaging events. OBJECTIVE: We tried to evaulate the photoaging effects of UVR in the skin and the photoprotective effect of sunscreens. METHOD: We examined the gross and microscopic changes skin of albino hairless Skh : HR-1 mice exposed chronically to ultraviolet B(UVB) and suncreen-treated mice. RESULTS: The skin of the UVB-irradiated mouse shows chear, cteristic signs of photoaging, such as deep wrinkles across the back, and thickened and a hery skin. Histologically, the photoaged skin shows increased epidermal thickness, numeross fibroblasts and inflammatory cell infiltration in the upper dermis, and many enlarged keratering cysts in the lower dermis. By the 20th week, seven of the total of 9 mice(78%) in UVB irradiated mice developed at least one tumor. Histologically, the tumor is a papilloma, but the he are many dyskeratotic cells and loss of polarity in epidermis. Octyl methoxycinnamate or TiO ZnO Talc-treated mic show a significantly decreased wrinkling score, mimmal epidermal hyperplasia, slightly increased dermal cellularity, and lack of proliferation of cysts. The octyl dimethyl PABA-treatd mice shows significantly increased wrinkling score and marked inflammatory infiltration dermis. By the 20th week, only one mouse had developed a tumor in the octyl methoxy irmamate-treated group and no evidence of tumor was seen in the TiO ZnO Talc-treated group. In the octyl dimethyl PABA-treated group, five of 7 mice(71%) developed at least one tumor. CONCLUSION: The skin which is chronically exposed to UVB is subject to photoaging and photocarcinogenesis and regular use of an adequate sunscreen would prevent these photodamaging effects of UVB.
Animals ; Dermis ; Epidermis ; Fibroblasts ; Hyperplasia ; Incidence ; Keratosis ; Melanoma ; Mice ; Mice, Hairless ; Papilloma ; Skin* ; Sunscreening Agents*