Hypertrophic cardiomyopathy (HCMP) is characterized myofiber hypertrophy and structural remodeling with changes in the proportion of the muscular, vascular, and interstitial compartments. A study was done to determine the structural remodeling patterns and the role of microvasculature of hearts in HCMP. Forty-two postmortem hearts were analyzed including 14 from patients who died of HCMP (group 1), 8 patients with HCMP but who died from extracardiac causes (group 2), 10 patients with ischemic heart disease (group 3), and 10 normal adult hearts (group 4). Macro- and microscopic examination, immunohistochemical study using CD34 antibody, and morphometric studies using image analyzer were performed. Mean cardiac weight and wall thickness were significantly higher in the HCMP group. Myocardial hypertrophy, and a variety of myocardial disarray and fibrosis involved the whole area of the left ventricles with HCMP. The percentage areas of microvessels were 6.40 0.7 in group 1, 5.90 0.6 in group 2, 4.98 0.3 in group 3, 4.85 0.4 in group 4, respectively, and the numbers of microvessels were 198.0 20.7 in group 1, 230.0 22.3 in group 2, 211.7 11.2 in group 3, and 236.4 11.4 in group 4, respectively (mean SE). The percentage area of microvessels was significantly higher in group 1 than in other groups. However, the number of microvessels in that group was lower than in the other groups, although it was statistically insignificant. Since flow-dependent vasodilation is preserved in HCMP, we considered flow-dependent vasodilation the cause of the discrepancy between the area and the number of microvessels. Ischemic changes observed in chronic HCMP and related heart failure were considesed to be due to the relative deficiency of the coronary flow compared to the increasing cardiac mass.
Adult ; Cardiomyopathy, Hypertrophic* ; Fibrosis ; Heart ; Heart Failure ; Heart Ventricles ; Humans ; Hypertrophy ; Microvessels ; Myocardial Ischemia ; Vasodilation

Purpose of this study was to investigate the biomechanical fates of the partial thickness tear of the rotator cuff in rabbit, and try to provide guideline of treatment for the partial thickness tear of the rotator cuff tendon. Infraspinatus tendons of fifty rabbits were used for study. The rabbits were divided into three groups, twenty for one-third resection(superficial partial resection group), twenty for two-thirds resection(deep partial resection group) and ten for control group. Extraarticular portion of the infraspinatus tendons of the rabbits were resected partially with one-third or two-thirds thickness for each experimental group. We sacrificed five rabbits of each experimental group at 3, 6, 9, and 12 weeks after the resections, and five rabbits for the control group at 6 and 12 weeks. Average maximal load per area of the infraspinatus tendons was measured by tension test. There was significant difference between the deep partial resection group, 5.3 and 6.3 N/emat 6 and 12 weeks respectively, and the control group, 13.2 N/mm(P<0.05). There was no difference between the control and superficial partial resection group, 12.8 and 14.1 N/mm at 6 and 12 weeks, respectively. Shallow partial tears might be healed spontaneously. Deep partial tears would not be healed naturally. When surgical treatment is indicated for deep partial tears of the rotator cuff, tendon repair, rather than debridement, would provide more predictable results.
Debridement ; Rabbits* ; Rotator Cuff* ; Shoulder ; Tendons

OBJECTIVES: The aim of this study was to observe the nystagmus of totally unilateral vestibular function loss on galvanic vestibular stimulation and the diagnostic value of galvanic vestibular stimulation. Additionally we wanted to evaluate which portions may be stimulated by galvanic vestibular stimulation. MATERIALS AND METHODS: We evaluated the three parameters of galvanic stimulation in fourteen patients with totally unilateral vestibular function loss, 1)spontaneous nystagmus, 2)galvanic stimulating nystagmus, 3)Post galvanic stimulating nystagmus through 3-dimensional video-oculography technique. RESULTS: When negative electrode was attached to the intact side, The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side in all patients and post galvanic stimulating nystagmus was directed to the opposite side but on functional loss side, we couldn't detect any nystagmus on galvanic vestibular stimulation and in 10 patients, post galvanic stimulating nystagmus was observed and directed to the intact side. CONCLUSIONS: Galvanic vestibular stimulation is very useful for evaluating the vestibular function and for diagnosing the vestibular disease.
Electrodes ; Humans ; Vestibular Diseases

PURPOSE: The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years. METHODS: A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately. RESULTS: The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%). CONCLUSIONS: The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.
Classification ; Congenital Abnormalities ; Fistula ; Hemorrhage ; Humans ; Inflammation ; Length of Stay ; Postoperative Complications ; Recurrence ; Retrospective Studies* ; Surgical Procedures, Operative ; Urinary Retention

To delineate the clinicopathological features of diffuse axonal injury in patients with diffuse cerebral injury, we reviewed 19 cases from a series of 726 brain autopsies performed during a recent ten-year period. The criteria for inclusion were loss of consciousness for more than 6 hours in closed head injury patients, and no development of a space-occupying lesion within 7 days of injury. The injury was more prevalent in males(70.6%), and in patients aged between 10 and 50 years(82.4%). The main cause was traffic accident(82.4%), and the patients, Glasgow coma scale score on admission after injury was between 3 and 7. CT or MRI performed within the first 7 days of injury disclosed either one or combined focal lesions in the cerebral white matter, corpus callosum and brain stem in 66.7% of cases, and no identifiable lesion in 33.3%. Axonal swellings are the histologic hallmark of diffuse axonal injury in closed head trauma. In this study, careful brain dissection and neuropathologic studies demonstrated these swellings in all autopsy brains. The immunohistochemical stain for neurofilament proteins(68kD, 160/200kD) is the most sensitive marker of axonal swelling, especially when a patient survives more than 12 hours after injury. However, a neurofilament protein(160/200kD) is also expressed in a few normal pyramidal neurons and axial dendrites. Bielschowsky stain also clearly delineates axonal swellings in patients who have survived more than 2 days after injury. Cerebral edema and the appearance of amyloid body are easily identifiable by Luxol fast blue-PAS stain. In patients who survive for 6 months after injury, axonal swellings are hardly identifiable; about 25% of cases are diagnosed by neuropathologic examination only. The above data indicate that for the diagnosis of diffuse axonal injury, careful gross examination and neuropathologic studies are important.
Amyloid ; Autopsy ; Axons ; Brain ; Brain Edema ; Brain Stem ; Corpus Callosum ; Craniocerebral Trauma* ; Dendrites ; Diagnosis ; Diffuse Axonal Injury* ; Glasgow Coma Scale ; Head Injuries, Closed ; Head* ; Humans ; Magnetic Resonance Imaging ; Neurons ; Unconsciousness

PURPOSE: We hoped to evaluate the possibility of substitution of the local anesthesia for the spinal anesthesia in hemorrhoidectomy. METHODS: We did Milligan-Morgan hemorrhoidectomy under local anesthesia for the sixty- eight patients from January 1998 to December 2005. These patients were compared with seventy-nine patients of spinal anesthesia, sampled with similar gender, age, a surgeon, retrospectively. We used a mixture of 0.5% lidocaine and 1:200,000 epinephrine into perianal skin and intersphincteric space. RESULTS: The male-to-female ratio was 1:1 in local anesthesia group and 1:0.84 in spinal anesthesia group. The mean age was 50 and 46 respectively. The number of excised pile was 3.9 and 3.8 respectively. The frequency of the analgegics injected within first 24 hours was 1.79 and 2.70 respectively (P=0.001). The frequency of the urinary catheterization was 0.07 and 0.69 respectively (P < 0.001). The first bowel movement after surgery was 1.2 days and 1.6 days respectively. The hospital stay was 6.4 days and 8.1 days respectively (P=0.06). CONCLUISIONS: Local anesthesia is simple, safe and effective in the hemorrhoidectomy.
Anesthesia, Local* ; Anesthesia, Spinal ; Epinephrine ; Hemorrhoidectomy* ; Hope ; Humans ; Length of Stay ; Lidocaine ; Retrospective Studies ; Skin ; Urinary Catheterization ; Urinary Catheters

Benign esophageal tumors are infrequently encountered. We report a case of a successfully managed esophageal schwannoma in a 52 year old woman who was presented with progressively worsening dysphagia. The tumor was enucleated via a right thoracotomy.
Deglutition Disorders ; Esophagus* ; Female ; Humans ; Middle Aged ; Neurilemmoma* ; Thoracotomy

No abstract available.
Breast Neoplasms* ; Breast* ; Lymph Node Excision* ; Lymph Nodes* ; Mastectomy, Segmental* ; Radiotherapy*

A case of neurenteric cyst within the cervical canal is reported. He has been suffered from gradual aggravated quardriparesis since 4 months. On spine C-T scan and cervical myelographic examination, intradural extramedullary mass was detected. And so total laminectomy of C4, C5 and C6 was performed. We could diagnose by the pathological findings.
Laminectomy ; Neural Tube Defects* ; Spinal Canal* ; Spine

OBJECTIVE: Although most of hypertensive intracerebral hematoma (HICH) are static after ictus, a minority of them can enlarge in the acute phase after onset. This study performs to find the predicting factors and signs of hematoma enlargement in patients with HICH. METHODS: Among 140 cases of HICH treated during 1.5 years, the authors selected 107 cases who underwent contrast enhanced and nonenhanced initial CT scanning within 12 hours after symptom onset and a follow-up CT scan in order to investigate the enlargement of hematoma. Those cases were divided into two groups:hematoma enlargement (group I) and non-enlargement group (group II). The comparison of predicting factors (bleeding tendency, abnormal liver function and blood pressure) and signs (enhanced focus in hematoma on CT) of hematoma enlargement between group I and II was performed. RESULTS: There were 8 cases in group I and 99 cases in group II. The incidence of an enhanced focus in hematoma on CT scan was higher in group I than group II (87.5% vs. 9.1%, p<0.05). The systolic blood pressure (BP) at 6 hours after symptom onset and at the time of the first CT scan was higher in group I than group II (172.5 vs. 152.0 mm Hg, and 182.5 vs. 158.6 mm Hg, respectively, p<0.05). There was no difference in the incidence of bleeding tendency and abnormal liver function between group I and II. CONCLUSION: Contrast enhanced brain CT scan to detect the enhanced focus in the hematoma is one of useful methods to predict the early enlargement of hematoma in patients with HICH. The continuance of a high BP in spite of medication of antihypertensive drugs during the acute period after the onset of symptoms is another predictive sign of hematoma enlargement in patients with HICH.
Antihypertensive Agents ; Blood Pressure ; Brain ; Follow-Up Studies ; Hematoma* ; Hemorrhage ; Humans ; Incidence ; Liver ; Tomography, X-Ray Computed*