BACKGROUND: Progression of coronary artery disease(CAD) is highly unpredictable, and follows a nonlinear course. In previous reports, progression was related to acute myocardial infarction and cardiac death. The present study was designed to assess the characteristics of progression of CAD and to ditermine the predictors for progression. METHODS: The present study included 41 patients(age 55+/-9 years ; male/female=36/5) with CAD who underwent coronary angiography at least twice(interval : mean 26 months), and patients who underwent coronary angioplasty of coronary bypass surgery before the 2nd angiograms were excluded from analysis. The coronary arterial bed was divided into 15 segments according to American Heart Association(AHA) committee report. We measured both % stenosis and minimal diameter of the lesions, and divided the lesions into four Ambrose's morphological categories. Progression was considered to be present if one of the following changes had occurred : increase in % stenosis of lesions by> or =20%, decrease in minimal diameter by> or =0.5mm, or any new occlusion. For the purpose of detecting predictors we investigated clinical history(smoking, hypertension, obesity, and DM), angiographic findings(numbers of diseased vessels and lesions), and biochemical study (total cholesterol, LDL, HDL, triglyceride, uric acid, and albumin). RESULTS: Altogether, 32 patients(78%) showed progression, and regression was present in 11 patients(27%). Six patients had both progressed lesions and regressed lesions. Progression occurred most frequently in segments with stenosis of 1% to 25% at initial arteriogram. Progression occured in increasing order in proximal right coronary artery, mid-LAD, and proximal LAD. There was no significant differences in progression among four Ambrose's morphologic categories. 59(10%) of the analyzable 589 segments had progressed, 19 them upto occlusion, and 7 segments became infarct related artery. In 5(71%) of 7 cases of new myocardial infarction it occurred in segments with< or =75% stenosis at initial arteriogram. The analysis selected two independent predictors for progression: uric acid and numbers of lesions> or =20% stenosis. CONCLUSION: The present study suggests that progression of CAD occurred most frequently in minimally stenotic lesions and that about two thirds of acute myocardial infarction occurred from insignificantly stenotic lesion. Uric acid level and numbers of lesions> or =20% stenosis were selelcted as the independent predictors of coronary disease progression.
Angioplasty ; Arteries ; Cholesterol, LDL ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Heart ; Humans ; Hypertension ; Myocardial Infarction ; Obesity ; Research Report ; Triglycerides ; Uric Acid

OBJECTIVE: The aim of this study was to determine whether fetuses delivered prematurely because of pregnancy complications had a different neonatal outcomes than that of those bom after either spontaneous preterm labor or after premature rupture of membrane. METHODS: The study design was a retrospective analysis of 150 very low birthweight(<1500 grams) infants and their mothers who delivered preterm neonates at Samsung Medical Center. Only singleton infants without major congenital anomalies were included. The primary reason for delivery was categorized as preterm delivery because of pregnancy complications(indicated preterm delivery) or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: There were some survival benefits in infants born to women who underwent indicated preterm delivery from univariate analyses. In the multiple logistic regression analysis, however, selected neonatal outcomes did not differ between the groups. CONCLUSION: We concluded that a "stressed" pregnancies confer negligible survival advantage to the very low birthweight infants.
Female ; Fetus ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Membranes ; Mothers ; Obstetric Labor, Premature ; Pregnancy Complications ; Pregnancy* ; Retrospective Studies ; Rupture

PURPOSE: To discuss the diagnosis and treatment of nonidiopathic carpal tunnel syndrome (CTS) caused by variable local lesions. MATERIALS AND METHODS: Fifteen patients who underwent surgery for CTS caused by local lesions were studied. The average age was 53.3 years. There were 5 men and 10 women. Plain radiographs including carpal tunnel view and ultrasonography were routinely performed, and magnetic resonance imaging and computed tomography were taken in selected cases. Carpal tunnel release were done by a single surgeon. RESULTS: Lesions causing CTS included calcification in five cases, ganglion in two, malunion after distal radius fracture in one, osteophyte of carpal bone in one, tuberculosis tenosynovitis in one, synovitis by foreign body in one, acute lunate dislocation in one, lipoma in two, median artery in one. Following surgery, all cases showed alleviation of symptoms. CONCLUSION: Prior to surgical decompression of CTS, it is important to assess any lesion around median nerve and carpal tunnel through physical examination, radiographs including carpal tunnel view and ultrasonography.
Arteries ; Carpal Bones ; Carpal Tunnel Syndrome ; Decompression, Surgical ; Dislocations ; Female ; Foreign Bodies ; Ganglion Cysts ; Humans ; Lipoma ; Magnetic Resonance Imaging ; Male ; Median Nerve ; Osteophyte ; Physical Examination ; Radius Fractures ; Synovitis ; Tenosynovitis ; Tuberculosis

PURPOSE: To report the causes of recurrent and persistent symptoms after carpal tunnel release and to evaluate the result of revision surgery. MATERIALS AND METHODS: wenty one patients who underwent surgery for recurrent or persistent carpal tunnel syndrome after carpal tunnel release were studied. The mean age was 59 years. There were 2 men and 19 women. The mean time interval between first operation and revision surgery was 29.8 months, and mean follow up period was 10.6 months. The operations were done by single surgeon. RESULTS: The most common cause of failed carpal tunnel release was scar adhesion, which was observed in nine cases. Other causes included incomplete release of transverse carpal ligament in six, scar adhesion with incomplete release in three, iatrogenic median nerve injury in two, and unrecognized calcification in one. Following revision surgery, 15 cases (71%) showed alleviation of symptoms. CONCLUSION: In cases of recurrent or persistent carpal tunnel syndrome following carpal tunnel release, evaluation of the causes is essential in performing revision surgery.
Carpal Tunnel Syndrome ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Ligaments ; Male ; Median Nerve

Progression of coronary artery disease after angioplasty seemed to be an important determinant of the long term efficacy of percutaneous transluminal coronary angioplasty(PTCA). In fifty seven patients who underwent coronary angiography beyond 1 month of PTCA, progression of coronary artery disease was evaluated and clinical and angiographic variables that might predict the progression after PTCA were sought. At the time of the repeat study, restenosis(>50% loss of PTCA gained diameter or >50% diameter stenosis) was found in 35 patients(61%) and progression(increasing >20% obstruction in coronary diameter or newly occurred total occlustion) was found in 20 patients(35%). Progression occurred similarly both in patients with restenosis(12 of 3, 35%) and in patients without restenosis(8 of 22, 36%). Within 6 months of PTCA, restenosis was found in 82%(23 of 28) and progression in 36%(10 of 28) and beyond 6 months, restenosis in 41%(12 of 29) and progression in 34%(10 of 29). Progression tended to occur more commonly in the artery which was dilated(10 of 60,17%) than in the artery that was not dilated(10 of 111, 9%), but this observation did not reach statistical significance. The influence of the risk factors on the progression was evaluated and progression appeared to be correlated with the initial extent of coronary artery disease and high low-density lipoprotein/high-density lipoprotein cholesterol ratio at follow-up study. Furthermore, the low-density lipoprotein/high-density lipoprotein cholesterol ratio at follow-up study was significantly higher in patients with progression in nondilated artery than that of those without progression, but there was no significant difference between patients with progression in dilated artery and patients without progression. In this study, we found that the incidence of progression was not rare within 6 months of PTCA as beyond 6 months. In addition, the incidence of progression in dilated vessels was not significantly higher than that in nondilated vessels, but high low-density lipoprotein/high-density lipoprotein cholesterol ratio was associated only with progression in non-dilated vessels, so trauma in dilated artery during PTCA might predispose the patients with low risk to the progression of coronary artery disease. Conclusively, PTCA may accelerate the progression of coronary artery disease. And the consistent relation between PTCA and progression of coronary artery disease requires further evaluation with more patients and prospective protocol.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Incidence ; Lipoproteins ; Risk Factors

Existence of the external branch of the superior laryngeal nerve containing afferent fibers is much of concern. In this study, it is the aim to identify the component of fibers by immunohistochemistry using choline acetyltransferase, the specific marker of the cholinergic motor neuron. Both side of external branch of superior laryngeal nerve were excised from 4 adult cats, and also obtained the great auricular nerve and the hypoglossal nerve for sensory control and motor control specimen, respectively. There were no fibers with immune reaction in the great auricular nerve while all of the fibers in the hypoglossal nerve were strongly stained with rabbit anti-choline acetyltransferase antibody. In the external branch of the superior laryngeal nerve, 12.7% of the fibers were not stained with immune reaction product. They are smaller than stained nerve fibers in cross sectioned diameter and peripherally located in the same fascicle. The identification of unstained fiber group in the external branch of the superior laryngeal nerve suggest that it is a mixed nerve and not purely motor, possibly containing the sensory nerve fiber.
Adult ; Animals ; Cats* ; Choline O-Acetyltransferase* ; Choline* ; Humans ; Hypoglossal Nerve ; Immunohistochemistry ; Laryngeal Nerves* ; Motor Neurons ; Nerve Fibers

PURPOSE: The incidence of thyroid cancer is increasing in Korea, partially owing to the development of diagnostic tools. Positron emission tomography (PET)-computed tomography (CT), in particular, has generally been used for evaluation of metastasis and follow-up of malignancy. METHODS: We retrospectively investigated 2,833 patients with PET-CT for metastasis work-up or cancer follow-up, which was performed between January 1998 and May 2008 at Inha University Hospital. Of them, abnormal thyroid findings were discovered in 181 patients and we studied the result of further evaluation or follow-up PET-CT. RESULTS: Thyroid cancer was diagnosed in 26 patients, including metastatic cancer in 3 patients, and non-operated primary cancer in 2 patients. Other 21 patients received operation, which in all histopathologically revealed papillary carcinoma. The mean age of the 21 patients was 55.4 years. Nine patients had a history of radiotherapy. The site of malignant nodule was discordant between PET-CT and histopathologic result in 6 patients. The mean size of malignant nodules was 9.45 mm (0.1~23 mm) with microcarcinoma in 10 patients (47.6%). The mean interval between diagnoses was 15.8 months, and in 4 patients operations for two malignancies were performed in a same day. The incidence of thyroid cancer was significantly high in female patients, but the differences of incidence among different cancer groups were not significant for female patients. CONCLUSION: Early diagnosis of synchronous or secondary thyroid cancer by PET-CT in cancer patients can make early treatment and better strategies for multiple malignancies possible.
Carcinoma, Papillary ; Diagnosis ; Early Diagnosis ; Female ; Follow-Up Studies* ; Humans ; Incidence ; Incidental Findings* ; Korea ; Neoplasm Metastasis ; Positron-Emission Tomography ; Radiotherapy ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms

Pulmonary lymphangiomatosis is a very rare pulmonary lesion with an aggressive potential that occurs mainly in newborns, infants and young children of both sexes. It is characterized by pulmonary abnormalities of lymphatic system, showing an increased number of complex anastomosing lymphatic channels in the pleura, in the subpleural interlobular septa, and along the bronchovascular lymphatic route and uniformly fatal. We report a case of lymphangiomatosis behaving like lymphangioleiomyomatosis in a 26-year-old woman.
Adult ; Child ; Female ; Humans ; Infant ; Infant, Newborn ; Lymphangioleiomyomatosis ; Lymphatic System ; Pleura

PURPOSE: To evaluate the accuracy and availability of Multidetector-Row Computed Tomography (MDCT) and Color Doppler Sonography as a method for making an early diagnosis of DVT after joint arthroplasty. MATERIALS AND METHODS: A total of 71 cases (63 patients) were selected. 32 cases (32 patients) underwent a THRA and 39 cases (31 patients) underwent a TKRA between April 2004 to August 2004. All cases underwent both Color Doppler Sonography and MDCT, before and after surgery. No prophylactic medications for DVT were given. Patients who previously had DVT or pulmonary embolism or a medication history of anticoagulation therapy were excluded. RESULTS: DVT was found by MDCT in 33 cases (46.5%) and by Color Doppler Sonography in 15 cases (21.1%). In the 33 cases of DVT diagnosed by MDCT, 24 cases developed in the calf vein, among them, only 4 cases were positive and remaining 20 were negative in Color Doppler Sonography. In the 15 cases of DVT diagnosed by Color Doppler Sonography, 13 cases were positive and only 2 cases were negative in MDCT. CONCLUSION: MDCT is effective in diagnosing DVT after joint arthroplasty in terms of the objectivity, efficacy and accuracy.
Arthroplasty* ; Early Diagnosis ; Humans ; Joints* ; Multidetector Computed Tomography ; Pulmonary Embolism ; Veins ; Venous Thrombosis*

PURPOSE: The objective of this study was to evaluate the findings of ultrasonography (US) in patients withis-chial bursitis. MATERIALS AND METHODS: Our study included 27 patients (mean age 62 years) who underwent US fora painful mass or tenderness in the buttock area. In six of these 27, serous fluid was obtained by needleaspiration, and in five cases, bursal excision permitted histologic confirmation. The other sixteen patients werefollowed up for one or two months with only NSAID medication; all showed some improvement or remission of symptoms. Using a 5-10 MHz linear array probe, US examination was performed while the patient was lying facedown. US images were analyzed with regard to location and size of the lesions, thickness of cyst wall, thepres-ence of internal septa or mural nodules, echogenicity of the cyst wall, fluid content, internal septa,compressibility by a probe, and Doppler signals within the cyst wall. RESULTS: In all 27 patients, ischialbursitis was located superficially to ischial tuberosity. Lesion size(maximum diameter) was 1.5-7(mean 3.8)cm, andthe cyst wall was 0.2-0.8cm thick. Internal septa and mural nodules were seen in 12 cases (44%) and 13 cases(48%), respectively. The cyst wall was identifiable in 21 cases (78%), appearing as a single layer with lowechogenicity (n=10) or with high echogenicity (n=1); it also appeared as two (n=6) or three (n=4) layers ofdifferent echogenicities. When internal septa were present, fluid within the cyst was low echoic in 59% of cases,high echoic in 30%, and of mixed echogenicity (so-called compartmentalization) in 15%. In all cases, the cystbecame deformed, when compressed by a probe. In all patients who underwent doppler examination, some vascularitywas found within the cyst wall. CONCLUSION: US helped to detect ischial bursitis; US findings were thin-walled cystic lesion located superficially to ischial tuberosity, with or without internal septa and mural nodules, andeasy compressibility.
Bursitis* ; Buttocks ; Deception ; Humans ; Ultrasonography