To evaluate the change in valvular morphology and occurence and severity of mitral regurgitation produced by PMV, 45 patients(33 women and 12 men,mean age 38+/-10 years) were studied using two-dimensional(2-D) and Doppler echocaediography before and 1-2 days after this procedure. Mitral valve area after PMV increased in all patients, from 0.9+/-0.2 to 1.8+/-0.4cm2(P<0.0001). In valve area estimation, the correlation between Gorlin`s method and 2-Dechocardiography was better(r=0.61, p<0.0001) than that between Gorlin`s method and Doppler pressure halftime(r=0.38, P<0.01) before valvuloplasty, but after the procedure Gorlin`s and 2-D image valve area correlated less well(r=0.33, P<0.05) than Gorlin`s-Doppler pressure halftime correlation(r=0.46, P<0.002). Before PMV, 37 patients had no mitral regurgutation, 7 had grade 1 and 1 had grade 2 mitral regurgutation. After PMV, new mitral regurgutation occurred in 14 patients, increased in severity in 5 patients and so mitral regurgutation newly developed or increased in severity in 19(42%) patients. There were no differences between the patients with and those without an increase in mitral regurgutation after PMV, in age, sex, caediac rhythm, initial mitral valve area, increase in mitral valve area and fluoroscopic calcification. However, morphologic characteristics especially mobility(P<0.01) and thickening(P<0.05) of mitral leaflets were better pressured, and EBDA/BSA(effective balloon dilating area/body surface area) was significantly smaller(P<0.02) in patients without an increase in mitral regurgutation. Thus, an increase in mitral regurgutation after PMV might be related to the features of valve morphology especially and thickand EBDA/BSA.
Female ; Humans ; Mitral Valve ; Mitral Valve Insufficiency* ; Mitral Valve Stenosis

PURPOSE: To assess the value of CT for the differential diagnosis of malignant ovarian tumors. MATERIALS AND METHODS: We reviewed CT scans of 31 patients with surgically confirmed 46 malignant ovarian tumors. (29 epithelial tumors, 9 Krukenberg tumors, 6 germ cell tumors, and 2 sex cord-stromal tumors.) CT scans were evaluated for the mass (bilaterality, size, internal component, and margin), peritoneal spread pattern, ascites, invasion of adjacent organ, and lymphadenopathy. RESULT: Bilateral masses were seen in epithelial or Krukenberg tumor in 61.1%(11/18) and 80%(4/5) respectively. Epithelial tumors showed predominantly cystic mass(37.9%, 11/29), irregular margin(82.8%, 24/29) of mass, and accompanying peritoneal and omental spread (66.7%, 12/18), whileKrukenberg tumor showed predominantly solid mass(55.5%, 5/9), smooth margin of mass(100%, 5/5), and no peritoneal and omental spread. All cases with germ cell tumor or sex cord-stromal tumor showed unilateral mass. Relatively young aged, unilateral solid (66.7%, 4/6) tumors were germ cell tumor. Of these cases, septa within solid portionof mass were prominent in all dysgerminoma. (3/3) CONCLUSION: CT may be a valuable tool for the differential diagnosis of malignant ovarian tumors.
Diagnosis, Differential* ; Dysgerminoma ; Humans ; Krukenberg Tumor ; Lymphatic Diseases ; Neoplasms, Germ Cell and Embryonal ; Sex Cord-Gonadal Stromal Tumors ; Tomography, X-Ray Computed

PURPOSE: To evaluate the use of CT in patients with vocal cord paralysis due to extralaryngeal cause s ,andto use CT for the assessment of extralaryngeal diseases causing vocal cord paralysis. MATERIALS AND METHODS: Weprospectively studied the results of CT in 41 patients with vocal cord paralysis in whom laryngoscopy revealed nolaryngeal cause and physical examination demonstrated no definite extralaryngeal cause. The extralaryngeal causeof vocal cord palsy was determined after comprehensive clinical diagnosis. Enhanced CT scans were acquired fromthe skull base and continued to the level of the aorticopulmonary window. We used CT to assess the detection ratefor extralaryngeal causes and to extimate the extent of extralaryngeal disease and the distribution of lesions. RESULTS: CT revealed that in 20 of 41 patients(49%) the extralarygeal causes of vocal paralysis were as follows :thyroid cancer(n=10), nodal disease(n=6), esophageal cancer(n=2), neurogenic tumor(n=1), aortic aneurysm(n=1).Lesions were located on the left side in 13 patients(65%), and in the tracheoesophageal groove in 15(75%). CONCLUSION: In patients with vocal cord paralysis in whom no definite lesion is seen on physical examination, CT could be a useful primary imaging method for the assessment of extralaryngeal causes.
Diagnosis ; Humans ; Laryngoscopy ; Paralysis ; Physical Examination ; Skull Base ; Thyroid Gland ; Tomography, X-Ray Computed ; Vocal Cord Paralysis* ; Vocal Cords*

Lower gastrointestinal bleeding is difficult to localize despite advanced diagnostic procedures such as colonoscopy, small bowel series, mesenteric angiography and radionuclide scan. We had experienced a case of mantle cell lymphoma of small bowel. In this case, the cause of recurrent lower gastrointestinal bleeding and abdominal pain was not defined despite extensive preoperative evaluation. We diagnosed this case as mantle cell lymphoma after exploratory laparotomy.
Abdominal Pain ; Angiography ; Colonoscopy ; Hemorrhage* ; Laparotomy ; Lymphoma ; Lymphoma, Mantle-Cell*

BACKGROUNDS/AIMS: This study focuses on the pathogenesis of inflammatory reaction and cell necrosis in patients with chronic viral hepatitis and examines the possible effects of follicular dendritic cells, HLA-DR and CD8+ presenting lymphocytes by analyzing their expression and the histological activity index (HAI) in liver tissues. METHODS: Liver biopsy specimens were obtained from 59 patients with chronic hepatitis B and from 26 patients with chronic hepatitis C. The expressions of dendritic cells, HLA-DR and CD8+ presenting lymphocytes were determined by immunohistochemical stain. RESULTS: The incidence of lymphoid follicle and/or lymphoid aggregates in portal tracts of the liver was higher in chronic hepatitis C than it was in chronic hepatitis B (84.6% vs. 15.3%, p=0.000). Follicular dendritic cells were exclusively expressed within lymphoid follicles and/or lymphocyte aggregates in portal areas. HLA-DR restricted cells were mainly observed in portal and periportal areas as well as in the area of piecemeal necrosis. CD8+ lymphocytes were diffusely expressed in portal and periportal areas and within intralobular parenchymal sinusoids. The expression of dendritic cell and HLA-DR was more frequently observed in moderate chronic hepatitis than in mild chronic hepatitis. While that of CD8+ lymphocyte expression was more frequent in severe chronic hepatitis with a high HAI score. CONCLUSIONS: The follicular dendritic cells may trap viral antigens in intraportal lymphoid follicle and present them to HLA-DR and CD8+ presenting lymphocytes. It is suggested that the associated expression of dendritic cells, HLA-DR and CD8+ presenting lymphocytes in liver tissues may play one of the biological role in immune injury in chronic viral hepatitis.
Antigens, Viral ; Biopsy ; Dendritic Cells* ; Dendritic Cells, Follicular ; Hepatitis B, Chronic ; Hepatitis C, Chronic ; Hepatitis* ; Hepatitis, Chronic ; HLA-DR Antigens* ; Humans ; Incidence ; Liver ; Lymphocytes* ; Necrosis

BACKGROUND: It has been known that Asians are more likely to develop atherosclerosis of the intracranial arteries while Caucasians have more extracranial arterial diseases. Angiographic distribution and frequency of the carotid artery stenosis have not been well known in Korean patients with acute ischemic stroke. METHODS: From the Yonsei Stroke Registry, a total of 300 acute ischemic stroke patients, who were evaluated by a conventional cerebral angiography from July 1997 to September 2000, were enrolled for this study. Patients were divided into three groups: isolated intracranial internal carotid artery (ICA) stenosis (IICA group); isolated extracranial ICA stenosis (EICA group); and combined stenosis of intracranial and extracranial ICAs (combined group). The clinical and angiographical characteristics were investigated and compared among them. RESULTS: A total of 107 patients had stenotic lesions in the ICA. They were 45 patients with lesions in the intracranial ICA (IICA group), 42 in the extracranial ICA (EICA group), and 20 patients in the both intracranial and extracranial ICAs (combined group). No significant differences were found among the three groups in terms of the degree of stenosis (50.2%, 49.6%, 56.8% each: p= 0.34), risk factors of ischemic stroke, and frequency of combined stenosis in the other intracranial arteries. CONCLUSIONS: ICA stenosis was common in patients with acute ischemic stroke. Significant differences of the frequency and risk factors between intracranial and extracranial ICA stenosis were not found. ICA stenosis at the extracranial portion as well as at the intracranial portion should be considered as a common cause of ischemic stroke occurring in the carotid artery system.
Arteries ; Asian Continental Ancestry Group ; Atherosclerosis ; Carotid Arteries ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebral Angiography ; Constriction, Pathologic ; Humans ; Risk Factors ; Stroke*

BACKGROUNDS/AIMS: The therapeutic requirements of patients with non-erosive reflux disease (NERD) are similar to those with erosive esophagitis. The pharmacological action mechanism of prokinetics is quite different; domperidone is a peripheral dopamine D2-antagonist and cisapride is a HT4-agonist. This study was performed to evaluate the therapeutic effect of these two different prokinetics in patients with NERD. METHODS: 178 patients, with heartburn and/or regurgitation, without reflux esophagitis were enrolled and divided into 2 groups by randomization code. In this prospective multicenter trial, 178 patients (93 patients in cisapride group, 85 patients in domperidone group) received 10 mg of cisapride three times a day or 10 mg of domperidone three time a day for 2 or 4 weeks. Symptom assessment was performed in each patients before treatments, 2 and 4 weeks after treatment. RESULTS: Of the 133 patients available for final analysis, 65 were allocated to the cisapride group and 68 to the domperidone group. After 2 weeks treatment, heartburn was reduced in 81.1% of cisapride group, 56.7% of domperidone group (p < 0.05) and regurgitation was reduced in 89.7% of cisapride group, 77.7% of domperidone group. After 4 weeks treatment, heartburn was reduced in 94.3% of cisapride group, 88.7% of domperidone group and this difference was not significant. The proportion of adverse events in cisapride group was 9.4% and was 5.5% in domperidone group. CONCLUSIONS: Cisapride tartrate was more effective in relieving heartburn in NERD patients than domperidone maleate after 2 week treatment. However, this superior effect dose not persist longer than 2 weeks.
Cisapride* ; Domperidone* ; Dopamine ; Esophagitis ; Esophagitis, Peptic ; Heartburn ; Humans ; Prospective Studies ; Random Allocation ; Symptom Assessment

PURPOSE: There have been controversies about the management of small abdominal aortic aneurysm (AAA). This prospective study was performed to analyze the annual expansion rates and the clinical courses of small AAAs, and to we wanted to suggest some guidelines for the proper management of small AAAs in Koreans. METHOD: From 1991 to 2003, thirty-five patients who had an initial diagnosis of small AAA were enrolled into the study group. All the patients were assigned to undergo regular imaging studies with either ultrasonography or CT angiography every 6 months. At the end of the study, the twenty four patients who were followed up with at least three successive visits were included in the statistical analysis. The clinical symptoms and the size of their aneurysms were documented on each visit. Symptomatic aneurysms and aneurysms with a size greater than 5.5 cm were considered as candidates for surgical repair. The annual expansion rate, rupture rate and the requirements for aneurysm repair were analyzed. The overall aneurysm expansion rate was 0.33+/-0.22 cm/year. RESULT: The expansion rate of the aneurysms smaller than 4.0 cm (12 cases) was 0.32+/-0.26 cm/year and that of aneurysms between 4.0 cm and 5.0 cm in size (12 cases) were 0.34+/-0.19 cm/year (P=0.55). Only the presence of iliac artery involvement was significantly related with a higher aneurysm expansion rate (0.47+/-0.2 cm/year vs. 0.19+/-0.13 cm/year, respectively, P=0.001). There was no rupture of aneurysm during the study. 10 cases undergone aneurysm repair and there was no morbidity or mortality after the aneurysm repair. CONCLUSION: Small AAAs in Koreans can be safely managed with regular follow-up. Closer follow-up is recommended as the aneurysm size increases and for small aneurysms that involve the iliac artery.
Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal* ; Diagnosis ; Follow-Up Studies ; Humans ; Iliac Artery ; Mortality ; Prospective Studies ; Rupture ; Ultrasonography

Antibiotics associated colitis due to Clostridium difficile is a common nosocomial infection associated with significant morbidity. In severe cases, pseudomembraneous colitis may be associated with intraperitoneal fluid accumulation. However, the characteristics of the fluid are seldom described. This case report describes pseudomembraneous colitis patient who was presented with low serum-ascites albumin gradients and lymphocytic ascites, without the evidence of infection, malignancy, or inflammatory peritoneal disease.
Anti-Bacterial Agents ; Ascites* ; Clostridium difficile ; Colitis* ; Cross Infection ; Humans ; Peritoneal Diseases

Focal nodular hyperplasia (FNH) is a rare benign hepatic tumor occurring predominantly in women of childbearing age. Generally oral contraceptive is not associated with FNH but might accentuate the vascular abnormalities which may cause the lesion to enlarge and, very rarely, to rupture. FNH is typically asymptomatic and seldom bleeds. Often it is incidentally observed during imaging procedures performed for some other reasons. The histologic feature of FNH is characterized by areas of localized growth of mature hepatocytes and septal fibrosis. Surgical resection is seldom required because of the benign nature of the lesion and its lack of significant complication. We experienced a case of focal nodular hyperplasia without liver cirrhosis confirmed by surgical resection and histologic examination. in a 47-year-old man.
Female ; Fibrosis ; Focal Nodular Hyperplasia* ; Hepatocytes ; Humans ; Liver Cirrhosis ; Liver* ; Middle Aged ; Rupture