In order to define the relation between echocardiographically determined left atrial size and atrial fibrillation(AF) in rheumatic mitral valvular heart disease, 44 patients with mitral valvular heart disease with AF, 29 patients with mitral valvular heart disease without AF, 24 patients with idiopathic AF and 24 normal controls were studied. In mitral valvular heart disease with AF group, AF was more common when the absolute left atrial internal diameter(LAID) was above 50 mm(86.4%) than in mitral valvular heart disease without AF group(41.4%). In addition, although the values of LAID, LA(left atrium)/Aortic Root ratio and LA/BSA(body surface area) are higher in mitral valvular heart disease with AF group than in mitral valvular heart disease without AF group(p<0.05), there was no correlation between LAID and BSA(r=0.06). These findings suggest that an absolute value of LAID is a more important factor in the development of AF in mitral valvular heart disease than LAID considered in conjunction with BSA and that an absolute LAID of 50 mm may be used as a reliable guide to therapeutic and prophylactic intervention in AF associated with mitral valular heart disease.
Atrial Fibrillation* ; Heart Diseases ; Heart Valve Diseases ; Humans

To investigate frequency of painful and/or silent myocardial ischemia(SMI) determined by ECG ST-segment depression(more than 1.0mm depression for 0.08 second after J point over 60 seconds) during unrestricted daily activities, 24-hour dynamic ECG was performed in 19 patients(11 males, 8 females) with chronic stable angina pectoris, aged 57.4 years(44 to 73 years). During 456 hours of recording, there were 154 episodes of SMI. Of these, 139 episodes(90.3%) were silent and 15 episodes(9.7%) accompaned chest pain. The higher incidence of SMI than previously published data is probably influenced by 1 patient who disclosed 56 episodes (excluding this, SMI 84.7%). Sixty one percent of episodes of SMI occurred during light activities such as slow walk, hand labor, eating or at rest(sitting at ease), smoking and sleep, and 39% during more strenuous activites such as walk, climbing stairs and physical exercise. In contrast, most of the painful myocardial ischemia(PMI) developed during climbing stairs, walk and physical exercise. Heart rate during episodes of SMI varied ranging from 85.2+/-13.7/min at rest to 115.5+/-19.2/ min druing climbing stairs. Mean ST-segment depressions during episodes of SMI and PMI were 2.0(1.0-4.0)mm and 2.6(1.2-7.0)mm, respectively, in 6 patients who disclosed both SMI and PMI on 24-hour ECG recordings. However, frequency of ischemic episodes was higher(9.0 vs 2.5/day) and duration was longer(13.8min vs 3.0min) in SMI. These findings indicate that transient SMI in patients with chronic stable angina pectoris occurs more frequently than painful myocardial ischemia. In addition, SMI develops during activities that increase heart rate(increased O2 demand) as well as during activites that do not increase heart rate(decreased O2 supply). Therefore, both O2 demand and supply mechanisms may be involved in the pathogenesis of transient SMI in Patients with chronic stable angina pectoris.
Angina, Stable* ; Chest Pain ; Depression ; Eating ; Electrocardiography ; Exercise ; Hand ; Heart ; Heart Rate ; Humans ; Incidence ; Male ; Myocardial Ischemia* ; Smoke ; Smoking

Inflammatory myofibroblastic tumor (IMT) of the biliary tree is extremely rare and is generally a benign condition, though malignant change is possible. Making a differential diagnosis between this lesion and other malignant conditions is very difficult on preoperative imaging studies. Hence, the final diagnosis of IMT may be made during or after operation depending on the pathologic examination. We treated a 63-year-old woman who received right hepatectomy with caudate lobectomy under the suspicion of hilar cholangiocarcinoma. Frozen biopsy during the operation showed carcinoma in situ and there were stromal cells in the bile duct's resection margins. The postoperative hospital course was uneventful except for minor bile leakage. At postoperative month 4, she developed jaundice, ascites and pleural effusion. Computed tomography images showed a mass-like lesion in the porta hepatis with portal vein thrombosis and a right chest wall mass. Excisional biopsy was done and the pathology report was malignant spindle cell tumor suggestive of an aggressive form of IMT. Her condition rapidly deteriorated regardless of the best supportive care and she expired at postoperative month 5. Further investigation is necessary to clarify the reasons for recurrence and infiltration of this disease.
Ascites ; Bile ; Bile Ducts ; Biliary Tract ; Biopsy ; Carcinoma in Situ ; Cholangiocarcinoma ; Diagnosis, Differential ; Female ; Hepatectomy ; Humans ; Jaundice ; Middle Aged ; Myofibroblasts ; Pleural Effusion ; Portal Vein ; Recurrence ; Stromal Cells ; Thoracic Wall ; Thrombosis

To assess the efficacy of amiodarone on chronic atral fibrillation(AF) and to evaluate the relation between the ability to convert AF to sinus rhythm (SR) with amiodarone therapy and left atrial(LA) size and atrial fibrillatory wave forms, 22 patients with AF, aged 40 to 60 years(mean 47.5 years), were studied. Nine patients(40.9%) had mitral valvaular heart disease, 6(27.3%) hypertension, 5(18.2%) lone AF and 2 (9.1%) cadiomyopathy. Amiodarone therapy with either 600mg for 1 week, 200mg for 4 weeks in 5 consecutive patients, or 800mg for 1 week, 400mg for 4 weeks and 200mg for 6 weeks in 17 patients, converted AF to SR in 9(40.9%) patients 3 to 6 weeks after amiodarone was started on. In either group, patients who achieved conversion had smaller LA size(mean 43.7mm) than those who failed conversion(mean50.2mm)(P<0.05). Those who had LA size less than 45mm achieved conversion of AF to SR in 70%, comparing to 16.7% in patients with LA size more than 46mm(P<0.05). Among patients who achieved conversion, LA size was less than 46mm in 77.8% comparing to 23.1% in patients who failed conversion on Amiodarone. Those with coarse AF(46.2mm), althogh the difference was not significant statistically. There was no converstion in patients with LA size greater then 58mm and in patients with coarse AF who concomittantly had MVD. These findings suggest that the efficacy of amiodarone was related to LA size, and to the atrial fibrillation wave form in patients with mitral valvular heart disease.
Amiodarone* ; Atrial Fibrillation* ; Heart Diseases ; Heart Valve Diseases ; Humans ; Hypertension

BACKGROUND: The two most commonly used drugs as a stressor during wtress echocardiography are dipyridamole and dobutamine. The purpose of this study was to compare diagnostic accuracies of dipyridamole and dobutamine stress echocardiography for fixed coronary artery disease and evaluate complications related to the two agents in the same patients. METHODS: 30(M : 5=19 : 11, age=56+/-8.8yr) consecutive patients without history of previous myocardial infarction underwent coronary angiography, dipyridamole and dobutamine stress echocardiography in random order. Dipyridamole was infused up to 0.84mg/Kg for 10 minutes during clinical, ECG and echocardiographic montioring. Dobutamine was infused in dose increments from 5 to 40microg/Kg/min under the same condition. Positive criteria for myocardial ischemia by echocardiography was now regional wall mation abnormatity or worsening of regional wall motion after stress. Significant coronary disease was defined as more than 70% stenosis by coronary angiography. RESULTS: The sensitivity and specificity of both stress echocardiography were same, 82% and 92% respectively. In a single vessel disease the sensitivity of dipyridamole echocardiography was 75% and dobutamine echocardiography was 83% without statistical difference. The correlation of ischemic free time during both stress test was 0.375. During dipyridamole infusion no test was prematurely terminated because of side effects, but 3 patients(10%) developed severe hypertension and ventricular arrytricular arrythmia during dobutamine infusion and test was terminated. CONCLUSION: Thus, by this prospective direct comparison of both stress test, dipyridamole and dobutamine stress echocardiography have similar diagnostic accuracies for the detection of coronary artery disease. But during dobutamine infusion, careful monitoring for hemodynamic changes arrythmia is required for possible serious complications.
Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Sensitivity and Specificity

No abstract available.
Foreign Bodies* ; Granuloma, Foreign-Body* ; Lipectomy*

Pigmented spindle cell nevus was described as a variant of spindle and epithelioid cell nevus (Spitz nevus). However, it hs been classified as a separate disease because of the presence of large pigmented cells confined to the epidermis and papillary dermis. Pigmented epithelioid cell nevus is considered as a counterpart to pigmented spindle cell nevus, because it has similar clinicopathologic features to those of pigmented spindle cell nevus, except for tumor cells being entirely composed of large epithelioid cells. Herein, we report a case of a 31 year-old woman with a deeply-pigmented nodule which was entirely composed of large epithelioid cells, and showed many histologic findings of pigmented epithelioid cell nevus.
Adult ; Dermis ; Epidermis ; Epithelioid Cells* ; Female ; Humans ; Nevus* ; Nevus, Epithelioid and Spindle Cell ; Nevus, Spindle Cell

No abstract available.
Blister ; Humans ; Necrosis ; Rhabdomyolysis

No abstract available.
Drug Hypersensitivity ; Isoxazoles

In an attempt to investigate which of the ST-segment parameters, e.g., ST-segment level, ST-segment slope, ST-segment index and ST-segment intergral obtained by mannual drawing can most sensitively indicate quantitatively the extent of exertional myocardial ischemia in patients with angina pectoris, 26 patients with angina pectoris underwent exrecise stress testing, using a bicycle ergometer and thallium-201 myocardial perfusion scintigraphy(Thallium-201 MPS). The exrecise was terminated either when symptoms or signs indicative of myocardial ischemia developed or when the heart rate reached the predicted maximal heart rate during exrecise. The myocardial ischemia region was quantitated by Thallium-201 MPS. The number of myocardial ischemia segments was similar in patients who had positive exrecise test(4.9+/-1.9) and in those who had negative result(3.7+/-2.2). However, it was greater in patients who showed pseudonormalization of the T wave in exercise ECG(6.3+/-2.6) than in those with negative exercise test(3.7+/-2.2)(P<0.05). The extent of myocardial ischemia region expressed by the number of myocardial ischemia segments correlates best with the ST-segment index(r=-0.83) among ST-segment slop(r=-0.60), ST-segment intergral(r=-0.59) and ST-segment(r=0.50). These data suggest that the ST-segment index is the most reliable indicator to reveal the extent of exertional myocardial ischemia among the ST-segment parameters and that pseudonormalization of T wave in exercise ECG is a finding indicative of exertional myocaridial ischemia in patients with angina pectoris.
Angina Pectoris ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Ischemia ; Myocardial Ischemia* ; Perfusion