BACKGROUND AND OBJECTIVES: Doppler indexes of pulmonary venous flow (PVF) have been recognized to be useful in defining left ventricular filling characteristics, but their long-term prognostic value in patients with acute myocardial infarction (AMI) is not clear. The purpose of this study was to determine the prognostic significance of Doppler indexes of PVF after AMI. SUBJECTS AND METHODS: Doppler echocardiographic examination was performed in 122 patients with AMI between 7 to 10 days after attack, and followed for 30 months. Peak systolic velocity (PVs), peak diastolic velocity (PVd), and peak reverse flow velocity associated with atrial contraction (PVa) of PVF were measured by transthoracic echocardiography. End-points were cardiac death or readmission due to congestive heart failure (re-CHF). RESULTS: There were 9 deaths (7.4%) and 13 patients with re-CHF (10.7%) during the follow-up period. Patients with events had higher PVa (p=0.039). Subgroup analysis of patients with E/A ratio > 1 showed that they had lower PVs/PVd ratio (p=0.029) and higher PVa (p=0.069). Event-free survival was significantly lower in patients with PVs/PVd ratio < 1.3 (30-month survival rate 74% vs. 100% in those with PVs/PVd ratio > or =1.3). Multivariate Cox analysis revealed that Killip class II, and EF <50% were independent predictors of cardiac events; and PVa > or =25 cm/sec as well as age > or =65 years were independent predictors of cardiac mortality in patients with E/A ratio >1. CONCLUSION: PVa and PVs/PVd ratio of PVF were helpful indexes in predicting the prognosis in patients with AMI and an E/A ratio of >1.
Death ; Disease-Free Survival ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Mortality ; Myocardial Infarction* ; Prognosis ; Pulmonary Veins ; Survival Rate

We report a pigmented follicular cyst (PFC) in a 40-year-old male manifestated clinically as pigmented nevus. Histopathologic findings revealed an infundibular cyst in the mid dermis containing a small amount of keratinous material. The cystic wall consisted of four or five layers of squamous epithelium with a granular layer with abundant keratohyaline granules and the cyst wall contained one hair follicle. It must be differentiated from other pigmented lesions of over-lying skin such as eruptive vellus hair cyst, apocrine hydrocystoma and melanocytic nevus coexistance of an epidermoid cyst. Surgical excision and histopathological examination are necessary for an accurate diagnosis in pigmented lesions.
Adult ; Dermis ; Diagnosis ; Epidermal Cyst ; Epithelium ; Follicular Cyst* ; Hair ; Hair Follicle ; Humans ; Male ; Nevus, Pigmented ; Skin

Carcinsarcoma is an uncommon pulmonary malignancy characterized by carcinmatous parenchyma and sarcomatous stroma. The cytologic, immunohistochemical and ultrastructural features of a case of pulmonary carcinosarcoma suspected by fine needle aspiration cytology is presented. Only bizarre spindle cells arranged in loose groups, in microtissue fragments and in a dissociate fashion were present in the aspiration smears. They were markedly positive for vimentin. The epithelial component was not found, which was probably due to marked paucity of carcinomatous component that was proved by histologic examination of the resected tumor. The diagnosis of pulmonary carcinosarcoma should be conidered whenever poorly differentiated epithelial cell groups with a malignant mesenchymal component set in a myxoid background are seen in a pulmonary cytology specimen.
Biopsy, Fine-Needle ; Carcinosarcoma ; Child* ; Diagnosis ; Epithelial Cells ; Humans ; Interleukin-6* ; Nephritis* ; Purpura, Schoenlein-Henoch* ; Vimentin

No abstract available.
Breast Neoplasms* ; Breast*

Perinatal asphyxia can cause ischemic injury to immature kidney of neonates. Proximal renal tubule is the most sensitive area, showing various manifestations ranging from mild reversible injury to irreversible tubular necrosis. Aminoglycosides can be nephrotoxic in therapeutic range in immature or damaged kidney. Thess are the very important factors to be taken into corsideration on fluid therapy and nephrotoxic drugs in neonates. The purpose of this study is to detect renal dysfunction resulting from asphyxia and gentamicin treatment. The results were as follows; 1) Urinary 2-microglobulin concentration was significantly higher in neonatal asphyxia group irrespective of meconium stain (p<0.05). The group with neonatal asphyxia only (Ia) showed a gradual decline in urinary 2-microglobulin concentration and no significant difference shown when compared with control group on 7 days old (p>0.05). The group with neonatal asphyxia and meconium stain (Ib) received gentamicin for 7 days. Their urinary 2-microglobulin concentration dropped on 4 the day and increased again on 7 th day (p<0.05). The group with meconium stain only(3) showed no significant difference in urinary 2-microglobulin concentration when compared with control group (p>0.05). 2) No differences were shown in serum creatinine, serum sodium level and urinary creatinine concentrations between each group (p>0.05). 3) No differences were shown in creatinine clearance between each group (p>0.05).Fractional excretion of urinary sodium (FENa) was significantly higher on lst day in group, I, but no differences were shown afterwards (p>0.05). 4) There is no relationship between urinary 2-microglobulin concentration and serum creatinine level, creatinine clearance of FENa. 5) No differences were shown in incidence of renal dysfunction between each group. In conclusion, acute tubular injury by perinatal asphyxia recovered soon after birth. But nephrotoxic gentamicin worsened the recovering tubular injury. In case of mild fetal hypoxia without neonatal asphyxia, proximal tubular injury was not significant.
Aminoglycosides ; Asphyxia* ; Creatinine ; Fetal Hypoxia ; Fluid Therapy ; Gentamicins* ; Humans ; Incidence ; Infant, Newborn* ; Kidney ; Kidney Tubules, Proximal ; Meconium ; Necrosis ; Parturition ; Sodium

No abstract available.
Calcium* ; Child* ; Humans

No abstract available.
Female ; Humans ; Insemination* ; Pregnancy*

BACKGROUND: Platelet function is directly influenced by lipoproteins, and platelets from hypercholesterolemic patients display increased reactivity which is related to initiation, progression, and development of thromboembolic complications in atherosclerosis. But the exact mechanism of this effect is unclear. METHODS: In this study, total and activated numbers of platelet glycoprotein (Gp) IIb/IIIa were evaluated in twenty patients (7 men; age, 55.4+/-8.7 years) with hypercholesterolemia (plasma total cholesterol level over 240 mg/dL and normal triglyceride level) and twenty one subjects (8 men; 51.1+/-13.7 years) with normal plasma cholesterol and triglyceride levels. Flow cytometry was used to detect the binding of fluorescein isothiocyanate (FITC)-conjugated anti-CD41 or PAC1 to platelet Gp IIb<1/4>/<1/4>IIIa in whole blood. When whole blood was incubated with PAC1, platelets were also activated with adenosine diphosphate (ADP) or thrombin. RESULTS: PAC1 was more bound to unstimulated platelets from patients with hypercholesterolemia (p<0.005), and binding of PAC1 correlated significantly with plasma total cholesteol (r=0.48, p=0.002) and LDL-cholesterol (r=0.47, p=0.002) levels. Binding of PAC1 to unstimulated platelets increased as binding of anti-CD41 increased (r=0.40, p=0.01). On multivariate linear regression analysis, plasma total cholesterol level and binding of anti-CD41 were independent variables that determined binding of PAC1. After ADP- or thrombin-stimulation, binding of PAC1 to platelets and percentage of antibody positive cells were also greater in patients with hypercholesterolemia (p<0.05). There was a significant positive correlation between mean platelet volume and binding of anti-CD41 to unstimulated platelets (r=0.46, p<0.0050), but the latter was not different between hypercholesterolemia and control groups. CONCLUSION: Unstimulated platelets from patients with hypercholesterolemia had similar total number of Gp IIb/IIIa to those from control subjects, but had more activated Gp IIb/IIIa. After ADP- or thrombin-stimulation, platelet Gp IIb/IIIa was also more activated under hypercholesterolemia.
Adenosine Diphosphate ; Atherosclerosis ; Blood Platelets* ; Cholesterol ; Flow Cytometry ; Fluorescein ; Glycoproteins* ; Humans ; Hypercholesterolemia ; Linear Models ; Lipoproteins ; Male ; Mean Platelet Volume ; Plasma ; Thrombin ; Triglycerides

In recent years there has been an increase in the number of outpatient surgical procedures performed using local anesthesia with intravenous sedation. However, many patients are reluctant to undergo surgery because of their concerns about pain and pain-awareness during the operation. We performed a study to evaluate the effectiveness and safety of midazolam during outpatient surgical procedures. Between March 1997 and December 1998, 50 patients were anesthetized with bolus intravenous injection of 0.1mg/kg of midazolam, followed by local anesthesia. The blood pressure, pulse and oximeter values were monitored. There was no significant change of arterial oxygen saturation. Midazolam induced antegrade amnesia in most cases. All patients except three (94%) said they would willingly choose this anesthetic technique again. Major complications were not noted. We concluded that midazolam is a good sedative agent in providing favorable antegrade amnesia, as well as reduced anxiety and fear of pain during surgical procedures. This suggests that midazolam may be used routinely in outpatient surgical procedures. Monitoring of oxygen saturation, however is essential in preventing severe hypoxia during procedures.
Amnesia ; Anesthesia, Local* ; Anoxia ; Anxiety ; Blood Pressure ; Humans ; Injections, Intravenous ; Methods ; Midazolam* ; Outpatients ; Oxygen

BACKGROUND AND OBJECTIVES: Regular aerobic exercise plays a role in the prevention of cardiovascular diseases, but the risk of primary cardiac arrest transiently increases during vigorous exercise, particularly in sedentary men. There has been a controversy regarding the effect of exercise on platelet functional behavior, which is related to the pathogenesis of coronary ischemia. We evaluated the cytoplasmic free calcium concentration of platelets in healthy men after treadmill exercise. MATERIALS AND METHOD: Five physically active (group I: age, 24.2+/-2.3 years) and five sedentary men (group II: age, 22.4+/-1.4 years) were included in this study. Platelet calcium was measured with fluorescent dye, quin2 before and after treadmill exercise. RESULTS: Platelet calcium levels were increased from 86.8+/-11.8 nM to 128.8+/-15.0 nM in group I (p<0.05) and from 102.6+/-14.4 nM to 162.4+/-26.5 nM in group II (p<0.05) immediately after exercise. Thereafter, platelet calcium levels were decreased in group I, but continuously increased in group II. At fifteen minutes after exercise, platelet calcium concentrations were significantly higher than baseline values in group II (205.8+/-53.9 nM vs 102.6+/-14.4 nM: p<0.05), but not in group I (115.2+/-15.7 nM vs 86.8+/-11.8 nM). CONCLUSION: Cytoplasmic free calcium concentration in platelets were continuosly increased after treadmill exercise in sedentary men but not in physically active men.
Blood Platelets* ; Calcium* ; Cardiovascular Diseases ; Cytoplasm* ; Exercise ; Heart Arrest ; Humans ; Ischemia ; Male*