Acute pulmonary thromboembolism (PTE) is a common problem. In the emergency room, a substantial number of patients with chest discomfort have had an acute PTE. Presently, accepted diagnostic modalities for the confirmation of PTE include ventilation/perfusion (V/Q) scanning, chest computed tomography (CT), and standard angiography. However, each modality has important limitations. Although chest CT scanning has for the most part replaced lung scanning as the main diagnostic test for PTE, transthoracic echocardiography (TTE) is a noninvasive modality providing rapid results at the bedside. As well as being noninvasive modality, TTE avoids the contrast and radiation hazards of chest CT or conventional angiography. Thus echocardiography is an attractive imaging modality to diagnose PTE. TTE allows visualization of the aorta and the LV to evaluate for other etiologies of chest pain. Besides giving important diagnostic information, TTE can aid prediction of prognosis. Presence of RV dilatation and dysfunction is a poor prognostic sign and is the indicator for thrombolytic therapy. However, TTE has some limitations including poor imaging quality depending on the acoustic window and has a low sensitivity in detecting PTE.
Acoustics ; Angiography ; Aorta ; Chest Pain ; Diagnostic Tests, Routine ; Dilatation ; Echocardiography ; Emergencies ; Humans ; Lung ; Prognosis ; Pulmonary Embolism ; Thorax ; Thrombolytic Therapy

This study was aimed to elucidate the relationship between combinations of treadmill speed-grade and oxygen consumption(Vo2). Twenty athetic and 20 non-athletic male college students aged 19-24yr were employed to exercise on a treadmill using 4 speeds(4.02, 5.47, 6.76 and 8.05km/h) and 5 grades(0, 8, 12, 16 and 20%). A fixed speed was selected for each session with the grade increased every 3 min. The Vo2, heart rate, stride frequency and stride length were measured during the last min of each 3-min stage. Vo2increased linearly with increasing speed and grade showing significant multiple correlations in nonathletes(Vo2=3.64x+0.831y+0.031xy-7.03, R=0.98, P<0.01) and athletes(Vo2=3.48x+0.324y+0.112xy-5.74, R=0.99, P<0.01). Stride frequency and length tended to increase with increasing speed except for the transition from walking to runnig at 8.05Km/h at which the stride frequency ran up much higher with the stride length getting lower than at 6.76Km/h. Heart rate increased linearly with increasing Vo2. The rate of increase was higher during walking than during running. These results indicate that athletes have higher rate of increase in Vo2than nonathletes at near-maximal exercise and may be used as a guideline in predicting maximum oxygen comsumption and in prescribing exercise intensity.
Athletes* ; Heart Rate ; Humans ; Male ; Oxygen Consumption* ; Oxygen* ; Running ; Walking

Fracture of the femoral neck occurred after internal fixation of intertrochanteric fracture of the femur is very rare and have been described previously in terms of stress fracture, stress-riser fracture, Youngs modulus fracture or iatrogenic fracture in the literature. This fracture documented about 20 cases in the English literature and usually occurred in elderly patients with osteoporosis and it always occur in the subcapital region. We report a case of subcapital stress fracture of the femur occurred after internal fixation with compression hip screw of intertrochanteric femur fracture.
Aged ; Elastic Modulus ; Femur Neck ; Femur* ; Fractures, Stress* ; Hip ; Humans ; Osteoporosis

Measurement of left ventricular (LV) filling pressure is useful in decision making and prediction of outcomes in various cardiovascular diseases. Invasive cardiac catheterization has been the gold standard in LV filling pressure measurement, but carries the risk of complications and has a similar predictive value for clinical outcomes compared with non-invasive LV filling pressure estimation by echocardiography. A variety of echocardiographic measurement methods have been suggested to estimate LV filling pressure. The most frequently used method for this purpose is the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e'), which has become central in the guidelines for diastolic evaluation. This review will discuss the use the E/e' ratio in prediction of LV filling pressure and its potential pitfalls.
Cardiac Catheterization ; Cardiac Catheters ; Cardiovascular Diseases ; Decision Making ; Echocardiography ; Echocardiography, Doppler

Open carpal tunnel release surgery has heen the gold standard method of treatment for who did not respond to conservative treatment and whose neurologic symptoms were progressive. However, open carpal tunnel release using a standard incision frequently associated with delayed return of hand function, residual scar tenderness and pillar pain. So, two new alternative methods such as endoscopic carpal tunnel release and limited incision technique have developed. To define the role of the limited two incision technique, we anaiyzed the postoperative functional results of 40 cases in 33 patients. The patients were divided in two groups. Group A was standard incision group (23 cases in 19 patients) and Group B was limited two incision group (l7 cases in 14 patients). The postoperative functional results were analyzed statistically using chi-square test at postoperative 3, 6, 9 and l2 weeks. There were no significant differences in reliet of numbness and paresthesias in both groups. There was a statistically significant difference in relief of scar tenderness and pillar pain at postoperative 3 and 6 weeks in Group B. There was no significant complication in both groups. We can conclude that the limited two incision technique of carpal tunnel release is a safe procedure which allows rapid return of hand functions with reduced incidence of scar tenderness in the early postoperative stages.
Carpal Tunnel Syndrome ; Cicatrix ; Hand ; Humans ; Hypesthesia ; Incidence ; Neurologic Manifestations ; Paresthesia

Purpose: To investigate the effects of latanoprostene bunod (LBN) on nitric oxide (NO) production and permeability in human trabecular meshwork cells (HTMC). Methods: HTMC were treated with 50 and 100 µM LBN and latanoprost free acid (LAT) for 30 minutes. Additionally, 100 µM LBN was co-exposed to 0.5 mM L-NAME (N-Nitroarginine methyl ester). Cellular viability and NO production were measured using MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyltetrazolium bromide) and Griess assays. The permeability and resistance of the HTMC monolayer were evaluated by trans-endothelial electrical resistance (TEER) and carboxyfluorescein permeability. Results: Exposure to 100 µM LBN led to increased NO production, whereas co-exposure to L-NAME reduced NO production. Treatment with 100 µM LBN decreased the TEER of the HTMC monolayer. LBN exposure heightened carboxyfluorescein permeability, but co-exposure to 100 µM LBN and L-NAME reduced permeability. LAT treatment did not affect NO production or permeability. Conclusions LBN increased the permeability of the HTMC monolayer and increased NO production. Therefore, LBN might increase trabecular outflow in addition to promoting uveoscleral outflow.

The incidence of coronary artery disease requiring coronary intervention in patients with Kawasaki disease is high. Because coronary artery lesions in Kawasaki disease commonly involve severe calcification and aneurysmal changes which can progress with time, in contrast with adult atherosclerotic coronary artery lesions, the indication or technique of catheter intervention for adult patients cannot be directly applied. However, the experience of coronary intervention in Kawasaki disease is extremely limited compared to that with intervention in adults, which provides satisfactory therapeutic results. There are several kinds of percutaneous coronary intervention techniques in Kawasaki disease including balloon angioplasty, stent implantation, rotational ablation, and directional coronary atherectomy. Satisfactory acute results for coronary balloon angioplasty can be obtained in patients in a relatively short interval from the onset of disease, especially within 6 years. However, the incidence of restenosis after angioplasty is still high. Stent implantation acquires larger luminal area, less restenosis rate and less aneurysmal formation than balloon angioplasty. Rotational ablation is a good interventional option with high success rate for longstanding Kawasaki disease with severe calcification. Intravascular ultrasound imaging provides valuable information for the selection of the appropriate interventional procedure and the assessment of postprocedural outcomes. To obtain good result and optimal decision making, cooperation between pediatric and adult cardiologists is essential. Postprocedural anticoagulation or antiplatelet regimens are required for proper long-term management.
Adult ; Aneurysm ; Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Atherectomy, Coronary ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Decision Making ; Humans ; Incidence ; Mucocutaneous Lymph Node Syndrome* ; Percutaneous Coronary Intervention ; Phenobarbital ; Stents ; Ultrasonography

Midventricular obstructive hypertrophic cardiomyopathy (MOHCM) is a rare variant of hypertrophic cardiomyopathy. Apical dilatation and myocardial infarction can be complicated without significant coronary artery disease. We report a case of apical dilatation in a patient with MOHCM without atherosclerotic coronary artery disease. A 76-year-old woman was admitted for recent cerebral infarction and consulted to cardiologist for abnormal electrocardiographic findings. She had been suffering from exertional dyspnea (NYHA II) for about four years. Two dimentional-echocardiography revealed midventricular obstructive hypertrophy with an apical dilatation and paradoxical jet flow from the apical aneurysm to the left ventricular outflow tract during early diastole. Cardiac catheterization demonstrated dyskinesia in the apical wall with midventricular obstruction and a peak-to-peak intraventricular pressure gradient of 110 mmHg during pull-back from the apical high-pressure chamber to the subaortic low-pressure chamber in the left ventricle. Coronary angiograms showed no significant stenotic lesion of the coronary arteries. She was prescribed oral beta-adrenergic antagonist to decrease the intraventricular pressure gradient.
Aged ; Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cerebral Infarction ; Coronary Artery Disease ; Coronary Vessels ; Diastole ; Dilatation* ; Dyskinesias ; Dyspnea ; Electrocardiography ; Female ; Heart Ventricles ; Humans ; Hypertrophy ; Myocardial Infarction ; Ventricular Pressure

BACKGROUND AND OBJECTIVES : The transradial approach has been increasingly used as an alternative to conventional transfemoral intervention. However, there is little data on the efficacy of transradial coronary intervention (TRI) in left main coronary arterial (LMCA) disease. The purpose of this study was to evaluate the feasibility of TRI in selective patients undergoing percutaneous coronary intervention (PCI) for LMCA disease. SUBJECTS AND METHODS : Between Jan 2003 and May 2005, 83 patients with LMCA stenosis were treated with PCI. Of these, 40 selected patients having undergone TRI were included in this study. RESULTS : The patients included 30 males and 10 females, with a mean age of 61+/-12 years. There were 28 cases (70%) involving coronary arteries other than the LMCA and 24 cases (60%) with bifurcation lesion involvement. In 28 cases (70%), a 6 Fr sized guiding catheter was used. No case required crossover from TRI to TFI due to procedural failure. During hospitalization, 2 patients who underwent primary PCI in the setting of STEMI died, but there were no other clinical events. CONCLUSION : In selected patients with LMCA disease, TRI can be a feasible and safe approach for PCI.
Angioplasty, Balloon, Coronary ; Catheters ; Constriction, Pathologic ; Coronary Disease ; Coronary Vessels ; Female ; Hospitalization ; Humans ; Male ; Percutaneous Coronary Intervention ; Radial Artery

OBJECTIVES: Schizophrenia patients have deficits of prediction and learning related to dopaminergic dysfunction. It is hypothesized that there would be different characteristics in associative learning of reward approach and loss aversion between controls and patients. METHODS: Participants were 23 healthy participants and 20 out-patients fulfilling criteria for schizophrenia according DSM-IV-TR. Using a monetary incentive contingency reversal task, successful learning rates, numbers of trials and errors till learning, numbers of trials of maintaining learning, response times were measured. Characteristics of learning were compared between controls and patients. RESULTS: Physical anhedonia and PANSS negative symptom scores correlated with the number of trials while loss aversion was maintained. Overall correct response rates were decreased in patient group, particularly during reward approach learning. Patients required more trials and errors to learn reward approach than controls. There were no significant differences in learning performance and reaction times between groups during loss avoidance learning. CONCLUSION: These results support previous reports of deficits in reward-driven learning in schizophrenia. However, anhedonia and negative symptoms were associated with the preserved function of loss avoidance learning.
Anhedonia ; Avoidance Learning ; Humans ; Learning ; Motivation ; Outpatients ; Reaction Time ; Reinforcement (Psychology) ; Reward ; Schizophrenia