A 57-year-old man was admitted to the emergency room because of a chest pain for one hour that radiated to the shoulder and arm. The pain was similar to the chest pain he usually had experienced, except for the one hour's duration. Six months before admission, he experienced a chest pain with a squeezing nature, causing central, substernal discomfort. The pain lasted 2 to 5 min. The pain usually occurred between 2 a.m. and 7 a.m. during sleeping, once or twice per month, and was not caused by exertion. He was a heavy smoker. The blood pressure was 100/60mmHg and the pulse rate was 85/min. The remainder of physical examination was normal. Electrocardiogram showed tall and tented T waves in lead V1 through V4. Fourteen minutes after admission, the electrocardiogram changed and showed a left bundle branch block pattern with an ST elevation and tall T waves without P waves in lead V1 through V4. This rhythm was accelerated idioventricular rhythm. The electrocardiogram obtained 23 minutes after admission showed a right bundle branch block pattern with an ST elevation and tall T waves without P waves in lead V1 through V4. He was treated for variant angina with sublingual and intravenous nitroglycerine, with complete resolution of the chest pain. The electrocardiogram obtained after resolution of the chest pain was normal. At the emergency room, the creatine kinase(CK) level was 144 U/L (normal, 55~170) and the troponin T level was 0.033 ng/ml (normal, 0.000~0.100). Eight hours after admission, the CK level was 598 U/L. The coronary angiogram, performed on the fourth hospital day, showed 99% spasm on the proximal left anterior descending artery by intravenous ergonovine provocation test. He was treated with long-acting nitrate and calcium antagonist, and experienced no more chest pain. The final diagnosis of this patient was acute myocardial infarction by variant angina.
Accelerated Idioventricular Rhythm ; Arm ; Arteries ; Blood Pressure ; Bundle-Branch Block ; Calcium ; Chest Pain* ; Creatine ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Ergonovine ; Heart Rate ; Humans ; Middle Aged* ; Myocardial Infarction ; Nitroglycerin ; Physical Examination ; Shoulder ; Spasm ; Thorax* ; Troponin T

BACKGROUND: The relationship between infection of Chlamydia pneumoniae and atherosclerotic disease such as coronary artery disease has been studied because many epidemiologic studies using antibody detection reported positive correlation between them. But there are controversies in the role of Chlamydia pneumoniae to restenosis after angioplasty or stent insertion. This study was purposed on the prevalence of Chlamydia infection in the patients with restenosis after percutaneous coronary intervention (PCI) and the possible role of Chlamydia to restenosis in Korea. METHODS: Total 110 subjects were enrolled and age and sex adjusted subjects were divided into 4 groups, angioplasty-no restenosis group (n=2), angioplasty-restenosis group (n=0), stent-no restenosis group (n=2), stent-restenosis group (n=6). Serum total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C) were measured, LDL-cholesterol (LDL-C) was calculated. Serum anti-Chlamydia pneumoniae IgG were measured by ELISA method. RESULTS: There was no significant differences in clinial and lipid profiles between restenosis and non-restenosis groups regardless of balloon angioplasty or stenting. There was no statistical significance in positivity of anti-Chlamydia pneumoniae IgG between restenosis and non-restenosis groups after any PCI. CONCLUSION: This study could not demonstrate the relationship between Chlamydia infection and restenosis after angioplasty or stent insertion in Korea.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Chlamydia Infections ; Chlamydia* ; Chlamydophila pneumoniae* ; Cholesterol ; Coronary Artery Disease ; Enzyme-Linked Immunosorbent Assay ; Epidemiologic Studies ; Humans ; Immunoglobulin G ; Korea ; Percutaneous Coronary Intervention ; Pneumonia ; Prevalence ; Stents* ; Triglycerides

No abstract available.
Cryopreservation* ; Trachea*

The current understanding of the neurobioloby of anxiety is generally based on experimental animal model, empirical effective psychopharmacological agents, chemical and naturalistic challenge paradigms, and psychoendocinological assessment. This article focuses on reviewing neuroanantomical, neuroendocinological and neurofunctional research of anxiety disorder. In the decade ahead, we anticipate that extension of current research and the new integrated approach promise novel insight into mechanism of anxiety.
Anxiety Disorders ; Anxiety* ; Models, Animal ; Neuroanatomy ; Neurobiology* ; Neuroendocrinology ; Neuroimaging

Neurotoxicity in the workplace may occur with exposure to scores of chemicals. Although large acute outbreaks of the occupational neurological disease are rare, the incidence of occupational neurotoxicity in its subtler aspects is unknown. A working knowledge of both the major occupational neurotoxic solvents and the tools used by clinical neurologists and neurotoxicologists to evaluate neurotoxicity in working population is a necessity for the occupational physician. To investigate the effects of carbon disulfide(CS2) on the peripheral nerve system using the nervous conduction study, 105 male workers working in the spinning room of a viscose rayon factory were examined and compared with a sex and age matched, unexposed 105 male controls using t-test analysis. 72.4% of CS2-exposed workers complained of neurological symptoms, and the abnormal cases in nerve conduction study were 48.6%. The abnormal cases of nerve conduction study increased in number according as the age and duration of exposure increased. In this study, asymptomatic workers were confirmed to have subclinical neuropathy by nerve conduction study. Also as there were abnormal cases even in its duration of exposure below 4 years, nerve conduction study turned out to be ways of discovering of early peripheral neuropathy. In nerve conduction study, the amplitude, velocity, F-wave latency and H-reflex of the motor and sensory nerves in both upper and lower extremities were significant different between CS2-exposed workers and the controls. From the pathological viewpoint, both segmental and axonal degenerations were assumed in this study.
Axons ; Carbon Disulfide* ; Carbon* ; Disease Outbreaks ; H-Reflex ; Humans ; Incidence ; Lower Extremity ; Male ; Neural Conduction ; Peripheral Nerves ; Peripheral Nervous System Diseases* ; Solvents

Arteriovenous malformation of the pancreas is a rare disease, and it is manifested by gastrointestinal bleeding and/or portal hypertension. Surgery is definitely the treatment of choice at the early stage of the disease, and a transcatheter embolization is an alternative treatment for the control of bleeding and if the lesion is surgically inaccessible. We describe a 62-year-old man who had refractory ascites and esophageal variceal bleeding caused by a pancreatic arteriovenous malformation associated with portal hypertension; this was successfully treated by a transjugular intrahepatic portosytemic shunt.
Arteriovenous Malformations* ; Ascites ; Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal* ; Middle Aged ; Pancreas ; Portasystemic Shunt, Surgical* ; Rare Diseases

The size and configuration of the lumbar spinal canal constitute one of the important factors in the production of symptoms referable to cauda equina and nerve roots of the lumbar spine and the narrowness of the spinal canal. Numerous attempts have been made to measure the size of the lumbar spinal canal, but most of those are not sufficient to measure the oblique diameter of the lumbar spinal canal. Also, echographic diagnosis is much simple, safe, less expensive and non-invasive and furthermore demonstrates much more accuracy than other alternative and radiographic procedures. The purpose of this study is to establish the range of normal values of the oblique diameter of the lumbar spinal canal in Korean Army-aged group by echographic method in the interest of facilitating clinical evaluation of the lumbar spinal canal stenosis. The author measured oblique diamenter of the lumbar spinal canal in thirty healthy persons of both sexes of ages between nineteen and twenty-five years by ultrasound using sonolayergraphy model SSL-21A. Distance from the ligamentum flavum to the posterior longitudinal ligament was measured in millimeters with dial vernier caliper. Actual distance of oblique diameter of the lumbar spinal canal is obtained by multiplication of the distance of echogram by calibration factor 2.22. The results were as follows; 1. The mean values of the oblique diameter of the lumbar spinal canal in male and female between nineteen and twenty-five years of age were 14.77±0.85mm and 14.87±0.82mm in Ll, 13.99±0.87mm and 14.13±0.96mm in L2, 13.40±0.69mm and 13.71±0.75mm in L3, 12.88±0.69mm and 12.93±0.68mm in L4, 14.58±0.79mm and 14.42±0.84mm in L5 respectively. 2. The oblique diameter of the lumbar spinal canal was the widest at the first lumbar vertebra, the next at the fifth lumbar vertebra and the narrowest at the fourth lumbar vertebra. 3. There was no difference of diameter of the lumbar spinal canal between both sexes.
Calibration ; Cauda Equina ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Ligamentum Flavum ; Longitudinal Ligaments ; Male ; Methods ; Reference Values ; Spinal Canal ; Spine ; Ultrasonography

To assess the efficacy of 2 different mitral balloon valvotomy (PMV) techniques, PMV was performed using Inoue balloon (I) in 35 pts and double balloon (D) in 33 pts with mitral stenosis (male 27, female 41, mean age 42+/-12 years). The success rate of PMV was 89%(31/35 pts) in I group and 97%(33/33 pts) in D group. Mitral valve area after dilation increased equally effectively in both groups (I and D) from 0.9+/-0.2 and 0.8+/-0.2 to 1.9+/-0.2 and 1.9+/-0.3cm2 respectively (p<0.0001). There were no differences in degree of improvement of cardiac output, mitral gradient, left atrial pressure, pulmonary artery pressure and various doppler echocardiographic findings in both groups, but EF slope was more improved from 13+/-7 to 48+/-16 mm/sec in D group than those (from 15+/-6 to 39+/-15mm/sec) of I group. Increments of long and short diameters of mitral valve orifice by 2D-echocardiogram were 1.1+/-0.6 and 0.3+/-0.3cm in D group and 0.9+/-0.5, 0.4+/-0.3cm in I group. The ratio of long and short diameter increase was significantly larger in D than that of I group (long/short 2.8+/-0.7 vs 2.4+/-0.7, p<0.05) and short diameter of orifice after dilation was more improved in I than that of D group (1.1+/-0.2 vs 1.0+/-0.2cm p<0.05). Complications included deflation failure of Inoue balloon in 2, and cerebral embolic episode in 1 (D). Incidence of increased mitral regurgitation was 50% in D and 45% in I, development of ASD (Qp/Qs>1.2) was 20% in D, 13% in I group respectively and mean amount of left to right shunt (Qp/Qs) was 1.7+/-0.3 in D and 1.5+/-0.1 in I group. Total procedure and fluoroscopic time were 84+/-24 and 25+/-11 min. in D and 56+/-20 and 16+/-6 min. In I, which had statistically significant differences (p<0.002). Thus we concluded PMV using Inoue or double balloons was equally effective in selected patients. Total procedure and fluoroscopic time of Inoue balloon technique were significantly shorter than those of double balloons. Double balloon technique had more tendency of longitudinal splitting of the commissures.
Atrial Pressure ; Balloon Valvuloplasty* ; Cardiac Output ; Echocardiography ; Female ; Follow-Up Studies* ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Artery

No abstract available.
Audiometry*

Percutenous transluminal coronary angioplasty(PTCA) for total coronary occlusion was performed in 20 patients(mean age 51+11years, male 16, female 4) including 12 patients with recent myocardial infaction. Primary success rate of procedure was 71%(15 out of 21 lesions). The success rate with occlusion<3 months duration was 11 out of 13(85%) lesions vs 4 out of 8(50%) with occlusion>3 months duration(P=NS). There was no difference in success rate according to vessel dilated(left anterior descending and intermediate branch 70%, right coronary artery 83%, left circumflex 67%). All patients had well developled(>grade 2 in 15 patients) collateral flow to the occluded vessel. The leng of occluded lesion more than 1.5cm was in 4 out of 21, and 3 of them had procedural failure because of inability to cross with a guide wire. Six procedsural failures included inability to cross the lesion with a guide wire in 5 and one in inability to dilate the lesion due to recoiling. Complications included intimal dissection in 3(1.5%), prolonged chest pain in 1 1 and one death due to cardiogenic shock. Although the primary success rate is relatively lower than that associated with conventional stenotic lesions, coronary angioplasty could be performed safely and successfully in the majority of patients with coronary occlusion.
Angioplasty* ; Chest Pain ; Coronary Occlusion ; Coronary Vessels* ; Female ; Humans ; Male ; Shock, Cardiogenic