Severe myoclonic epilepsy of infancy(SMEI) is a condition beginning with recurrent, prolonged febrile convulsion in normal children, followed within months to 4 years by generalized tonic clonic seizures, partial seizures, atypical absences, myoclonic seizures and status epilepticus. The seizures are generally difficult to control. Carbamazepine which is appropriate for partial seizures, is not effective and may aggravate generalized seizures, but sodium valproate has been reported to be helpful. The evolution is always bad with persistent seizures and mental retardation. We experienced a severe myoclonic epilepsy of infancy in a 16-month-old male patient who had episodes of prolonged febrile convulsions followed by mixed type of seizures. We report a case of SMEI with a brief review of literatures.
Carbamazepine ; Child ; Epilepsies, Myoclonic* ; Humans ; Infant ; Intellectual Disability ; Male ; Seizures ; Seizures, Febrile ; Status Epilepticus ; Valproic Acid

No abstract available.
Aminosalicylic Acid* ; Cycloserine* ; Prothionamide* ; Retreatment* ; Tuberculosis, Pulmonary*

To evaluate the cardiac functions we examed the M-mode echocardiography with measurements of blood pressure, heart rate and body surface area in 55 normal Korean adults(male 30 persons, female 25 persons) of mean age, 41.7+/-12.3 years. (1) Interventricular septal thickness is 9.5+/-1.7mm and left ventricular posterior wall thickness are 8.6+/-1.5mm at end-diatole, 14.0+/-2.1mm at end-systole. (2) Diastolic and systolic left ventricular internal dimensions are 49.1+/-4.8mm and 31.3+/-5.0mm, respectively. (3) Left ventricular mass by Penn Convention method is 174.4+/-52.1g and left ventricular mass index is 103.2+/-28.8g/m2. (4) Relative wall thickness is 0.35+/-0.06. (5) Left ventricular volumes by Teichholz's method are 114.9+/-27.6ml at diastole and 40.2+/-17.2ml at systole. Therefore, stroke volume is 74.7+/-16.9ml and stroke volume index is 44.5+/-10.7 ml/m2. (6) Cardiac output is 4944+/-1058 ml/min and cardiac index is 2951+/-666 ml/min/m2. (7) Total peripheral resistance is 1454+/-356 dynes-sec-cm(-5) and total peripheral resistance index is 2472+/-623 dynes-sec-cm(-5).m2. (8) Fractional shortening is 36.5+/-6.0% and pressure-volume ratio is 3.27+/-1.19 mmHg/ml. (9) End-systolic wall stress is 61.3+/-19.7x10(3) dynes=cm2. (10) Atrial emptying index is 0.66+/-0.18.
Adult* ; Blood Pressure ; Body Surface Area ; Cardiac Output ; Diastole ; Echocardiography* ; Female ; Heart Rate ; Humans ; Stroke Volume ; Systole ; Vascular Resistance

BACKGROUND: Microalbuminuraia is a strong prognostic factor for cardiovascular morbidity and mortality in type I and II diabetics. Recent data suggest that microalbuminuria predicted cardiovascular disease independent of hypertension in one of two large-scale studies performed in non-diabetics. Additional possibilities could be a previously documented association with other major and interconnected cardiovascular risk factors, such as insulin resistance, and elevated cardiac mass, abnormal circulation lipid levels, and overweight. The object of this study os to investigat the incidence of microalbuminuria, and to define the pathophysiologic mechanism of microalbuminuria to contribute coronary heart disease in non-diabetic patients with angiographiclly documented coronary artery disease(CAD). METHODS: The study group comprised 31 patients(M;21, mean age 60+/-30 year) with angiographically documented CAD and 15 normal control(m;9, mean age 62+/-7 year). Urinary albumin excretion, blood pressure, echocardiographic left ventricular mass indes, plasma abdominal/hip circumference ratio, fasting glucose, insulin, and c-peptide were studied. The microalbuminuria was defined urinary albumin more than 20ug/min. RESULTS: 1) Six of 31 patients with CAD(19.4%) and none of 15 normal control had microalbuminuria. Hypertension were documented 13 of 31 patients with CAD, and none of 15 normal control(p<0.01). Five of 6 patients with CAD and microalbuminuria and 8 of 25 patients with non-microalbuminuric aptients had hypertension (p<0.05). 2) In the microalbuminuric subjects with CAD, body mass index(29.0+/-3.2vs 24.8+/-3.5), systolic blood pressure(138+/-31 vs 118+/-15mmHG), lipoprotein(a) (69+/-31vs 32+/-32mg/dl), fastion C-peptide(5.5+/-2.2 vs 2.7+/-1.6ng/ml), and microalbumin(221+/25 vs 9.6+/-7.9mg/day)were significantly greater than in normal control(p<0.05). But no difference in left ventricular mass, lipid profile, and abdominal/hip circumference ratio existed between the microalbminuric patients with CAD and normal control. 3) Between the microalbuminuric patients with CAD and without CAD, no signficant difference were noted excepr lipoprotein(a) lever(69+/-31 vs 29+/-29mg/dl), fasting C-peptide(5.5+/-2.4 vs 2.5+/-1.2ng/ml), and microalbumin(221+/-247 vs 8.6+/-6.7mg/day). CONCLUSION: Microalbuminuria was associated with history of hypertension or concurrent antihypertension therapy and insulin resistance in non-diabetics with CAD. But left ventricular cardiac mass, central obesity inedw, and lipid profile were not related with microalbuminuria. The underlying presence of a major risk factor such as hypertension and insulin resistance might be explain the previously reported predictive value of microalbuminuria for cardiac events.
Blood Pressure ; C-Peptide ; Cardiovascular Diseases ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Echocardiography ; Fasting ; Glucose ; Humans ; Hypertension ; Incidence ; Insulin ; Insulin Resistance ; Lipoprotein(a) ; Mortality ; Obesity, Abdominal ; Overweight ; Plasma ; Risk Factors

BACKGROUND: During and immediately after percutaneous transluminal coronary angioplasty(PTCA), reversible ischemic electrocardiographic change and/of left ventricular dysfunction are developed. But it is not investigated whether there are potential myocardial cell damages following PTCA or not, and the clinical Significance of myocardial cell damage following PTCA. Recently cardiac Troponin-T has been developed as a new myocardial specific marker, especially myocardial damage. The object of this study is to investigate whether potential Myocardial damage following PTCA was occurred and the utility of cardiac Tropoin-T for predicting the complications during and immediately after PTCA. METHODS: The study group comprised 12 patients(M/F;8/4mean age;60 +/- 4year,AMI in 6) undergoing PTCA, Samples for Troponin-T were obtained before, directly after, after 2 hours, 6 hours, and after 12 hours and was determined by enzyme immunoassay on an ES 300 analyzer(Boehringer Mannheim). Discrimination limit for myocardial cell damage is 0.1 ng/ml in normal baseline level but if the baseline level is elevated such as acute myocardial infarction or unstable angina, myocardial cell damage is defined with further increase of cardiac Troponin-T(>0.1 ng/ml) compare to baseline level. RESULTS: 1) The mean duration of total balloon inflation is 10.7 +/- 2(3-22) minutes and the mean duration of single maximal inflation is 3.9 +/- 0.6(1-8) minutes. There are no significant change in concentration of Troponin-T by inflation time. None of the patients showed electroca rdiographic evidence for myocardial infarction. 2) Troponin-T were increased in 2 patients with unstable angina(0.01 vs 0.11 ng/ml) which were developed major dissection including acute closure during PTCA, and 2 patients with acute myocardial infarction(2.37 vs 3.73 ng/ml) which didn't developed dcomplication. The increase of cardiac Troponin-T were observed in 2 of 10 patients with uncomplicated PTCA(20%). 3)The subacute complications were not developed. CONCLUSION: The cardiac Troponin-T were increased significantly in two AMI patients with uncomplicated PTCA(2/10,20%). The increase of cardiac Troponin-T following PTCA is associated with periprocedural complications but the prognostic significance to detect postprocedural complication did not define in this study because there were no subacute complications after PTCA and may be limited value due to time course of complication(usaully within 1 hour after PTCA) and relatively long analytic time.
Angina, Unstable ; Discrimination (Psychology) ; Electrocardiography ; Humans ; Immunoenzyme Techniques ; Inflation, Economic ; Myocardial Infarction ; Troponin T* ; Ventricular Dysfunction, Left

No abstract available.
Humans

BACKGROUND: The endothelium is an important regulator of vascular tone via release of relaxing and constricting substances. The regulatory effect of the endothelium has been shown to be impaired in atherosclerotic arteries in human and animal models of hypertension. But there are some debates on extent and developing time of endothelium dysfunction in patients with hypertension, and the determining factors for endothelium dysfunction also were not defined. The objects of this study are to determine whether endothelial function is impaired in coronary and peripheral arteries, and to investigate the predicting factors for endothelial dysfunction in patients with essential hypertension. METHODS: The study patients comprised 14 patients with essential hypertension(M : 7, Mean age : 50+/-2 year) and 6 normal control (M :2, Mean age : 45+/-4 year). We assessed the vasomotor response to acetylcholine and nitroglycerin by change of arterial diameter during the infusion of acetylcholine, from 10(-9M) to 10(-6M) in coronary artery and 7.5, 15, and 25ug/min in left superficial femoral artery, and on intracoronary injection of 200ug nitroglycerin after acetylcholine infusion. RESULTS: 1) There were no significant differences in sex, age, body mass index and ventricular mass index, except systolic(174+/-5 vs 118+/-7mmHg, p<0.001) and distolic blood pressure(106+/-5 vs 75+/-5mmHg,p<0.001) between patients with hypertension and normal control. 2) There were no significant differences in laboratory date of total cholesterol, HDL-cho-lesterol, lipoprotein(a), microaluminuria and von-Willebrand Factor but Fibrinogen level was raised significantly in patients with hypertension than normal control(299+/-26 vs 192+/-23ng/dl, p=0.04). 3) The vasoconstrictor response to acetylcholine, 10-8 to 10-6 M concentration, at proximal, mid, and distal left anterior descending coronary artery were increased significantly in hypertensive patients than normal control(p<0.05). At rest superficial femoral artery, the vasodilator response to acetylcholine, only 25ug/min, was decreased in patients with hypertension(p<0.05). There was no signficant difference in the vasodilator response to nitroglycerin at coronary artery between two groups but in superficial femoral artery, the vasodilator response to nitroglycerin was decreased significantly in hypertensive patients(p<0.05). CONCLUSIONS: The results of this study suggest that endothelium dependent vascular relaxation is impaired in both coronary and superificial femoral artery and it remained to be investigated the predicting factors for endothelial dysfunction in patients with essential hypertension.
Acetylcholine ; Arteries ; Body Mass Index ; Cholesterol ; Coronary Vessels ; Endothelium ; Femoral Artery ; Fibrinogen ; Humans ; Hypertension* ; Lipoprotein(a) ; Models, Animal ; Nitroglycerin ; Relaxation

BACKGROUND: Unstable angina is a critical phase of ischemic heart disease, but there are no reliable noninvasive methods of assigning patients to different prognostic actegories. Recently cardiac Troponin-T has been developed as a new myocardial specific marker, especially myocardial injury. We investigated the value of the Troponin-T in unstable angina to determine whether the increase of cardiac Troponin-T might be a useful predictor of prognosis. METHODS: Unstable angina is defined as Braunwald classification(Class I, II, III). CLass I is new onset of severe angina or accelerated angina and no rest pain, class II is angina at rest but not within preceding 48 hour, and class III is angina at rest within 48 hour. We studied 16 cases of unstable angina(male:10, mean age:57+/-2year). We measured Troponin-T and CK-MB at admission, after 6 hours, and every 8 hour for 2 days. For the determination of serum Troponin-T, an enzyme immunosorbent assay (Boehringer Mannheim, ES 300 analyzer) was used. Above 0.1ng/ml was regarded as positive. During the admission, we investigated the myocardial infartion, sudden death, and the need of emergency PTCA and CABG. RESULTS: 1) Among 16 unstable angina patients, there are 12 patients in Class I(range 0.001-0.13, mean SD 0.04 0.01, median 0.02ng/ml) and 4 patients in Class III(range 0.03-1.56, mean SD 0.39 0.2, median 0.27ng/ml) and 4 patients showed positive value of Troponin-T. One was in Class I and the others were in Class III. 2) During the admission, one patient expired due to cardiogenic shock preceding inferior myocardial infarction, and 2 patients progressed non-Q wave myocardial infarction(NQMI). These 3 patients were in unstable angina Class III and had positive Troponin-T value. In Class I, one patient performed emergency CABG due to consistent chest pain at the sixth hospital day. These patient had negative Troponin-T value. 3) CK-MB increased in one patient with NQMI, and the other patients were not increased. CONCLUSION: Cardiac Troponin-T in serum appears to be a more sensitive indicator of myocardial cell injury than serum creatine Kinase MD activity, and its detection in the circulation may be a useful porgnostic indicator in patients with unstable angina.
Angina, Unstable* ; Chest Pain ; Creatine Kinase ; Death, Sudden ; Emergencies ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Ischemia ; Prognosis ; Shock, Cardiogenic ; Troponin T*

Dural arteriovenous fistula (DAVF) of anterior cranial fossa is a rare entity. The authors report a 57 year-old man presented with retro-orbital headache caused by a large hematoma in the right frontal lobe. Angiography demonstrated a DAVF of anterior cranial fossa fed by branches of middle meningeal and anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was tried, however, was failed to occlude the fistula. After than, the lesion was successfully obliterated by surgical means. The therapeutic roles and pitfalls of endovascular treatment and surgical treatment for the anterior fossa DAVF are discussed.
Angiography ; Arteries ; Central Nervous System Vascular Malformations* ; Cranial Fossa, Anterior* ; Cyanoacrylates ; Fistula ; Frontal Lobe ; Headache ; Hematoma ; Humans ; Middle Aged

Authors performed angio-CT(portal &/or arterial CT) in 35 patients with various hepatic masses. We obtained portal CT in 32 and arterial CT in 13 patients. The contrast material was injected into superior mesenteric artery for portal CT and into hepatic artery for arterial CT after transfemoral cathetrization of these arteries. We concluded that portal CT was superior to other imaging modalities highly sensitive in detecting hepatic masses, especially, early hepatocellular carcinomas, daughter nodules, and subclinical metastatic hepatic malignancy, With this method, detection rate of early hepatocelluar carcinomas improved 62% in number of patients and 90% in number of masses. Detection rate of subclinical hepatic metastases improve 60% each in number of patients and in number of masses. It was also useful for the detection of portal vein invasion. Arterial CT was useful in differential of masses and in defining the characteristics of entire or part of the masses because this method revealed hemodynamic patterns more definitely.
Arteries ; Carcinoma, Hepatocellular ; Hemodynamics ; Hepatic Artery ; Humans ; Mesenteric Artery, Superior ; Methods ; Neoplasm Metastasis ; Nuclear Family ; Portal Vein