PURPOSE: We studied early rest/24 hour delay Tl-201 perfusion SPECT for prediction of wall motion improvement after reperfusion in patients with acute myocardial infarction. MATERIALS AND METHODS: Among 17 patients (male/female ll/6, age: 59+13) with acute myocardial infarction, 15 patients were treated with percutaneous transcoronary angioplasty (direct:2, delay:11) and intravenous urokinase (2). Spontaneous resolution occurred in infarct-related arteries of 2 patients. We confirmed TIMI 3 flow of infarct-related artery after reperfusion in all patients with coronary angiography. We performed rest Tl-201 perfusion SPECT less then 6 hours after reperfusion and delay Tl-201 perfusion SPECT next day. Tl-201 uptake was visually graded as 4 point score from norrnal (0) to severe defect (3). Rest Tl-201 uptake <2 or combination of rest Tl-201 uptake<2 or late reversibility were considered to be viable. Myocardial wall motion was graded as 5 point score from normal (1) to dyskinesia (5). Myocardial wall motion was considered to be improved when a segment showed an improvement > 1 grade in follow up echo compared with the baseline values. RESULTS: Among 98 segments with wall rnotion abnormality, the severity of myocardial wall motion decrease was as follow: mild hypokinesia: 18/98 (18%), severe hypokinesia: 28/98 (29%), akinesia: 5l/98 (52%), dyskinesia: 1/98 (1%), The wall rnotion improved in 85%. Redistribution (13%), and reverse redistribution (4%) were observed in 24 hour delay SPECT. Positive predictive value (PPV) and negative predictive value (NPV) of combination of late reversibility and rest Tl-201 uptake were 99%, and 54%. PPV and NPV of rest T1-201 uptake were 100% and 52% respectively. Predictive values of combination of rest Tl-201 uptake and late reversibility were not significantly different compared with predictive values of rest Tl-201 uptake only. CONCLUSION: We conclude that early Tl-201 perfusion SPECT predict myocardial wall motion improvement with excellent positive but relatively low negative predictive values in patients with acute myocardial infarction after reperfusion.
Angioplasty ; Arteries ; Coronary Angiography ; Dyskinesias ; Follow-Up Studies ; Humans ; Hypokinesia ; Myocardial Infarction* ; Perfusion* ; Reperfusion* ; Tomography, Emission-Computed, Single-Photon* ; Urokinase-Type Plasminogen Activator

Alveolar macrophages participate in the host defense against P. carinii, but the mechanisms in degradation and clearance of the organism from lung has not been well established. We observed the transmission and scanning electron microscopic features and evaluated the expression of TNF-alpha and Surfactant-D in the interaction of P. carinii with alveolar macrophages. Expression of TNF-alpha and Surfactant-D in the experimentally induced P. carinii pneumonia in rat was examined by immunohistochemistry and immunoelectron microscopy. Electron microscopically, the alveolar macrophages phagocytized trophozoites and cysts of P. carinii micro-organisms. Immunohistochemically TNF-alpha was strongly expressed in the cytoplasms of alveolar macrophages. Postembedding immunogold labeling for Surfactant-D protein was expressed on the pellicles of trophozoites and cysts, P. carinii micro-organisms in the cytoplasms of macrophages, free floating surfactant materials and multilamellar bodies of type II epithelial cells. We conclude that alveolar macrophages interacted with P. carinii micro-organisms respond with increased expression of TNF-alpha. TNF-alpha may bind to P. carinii and exert a direct toxic effect upon the micro-organisms. Surfactant-D protein may augment binding of P. carinii to the alveolar macrophages and enhance the clearance of the micro-organisms.
Animals ; Cytoplasm ; Epithelial Cells ; Immunohistochemistry ; Lung ; Macrophages ; Macrophages, Alveolar* ; Microscopy, Immunoelectron ; Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis* ; Rats ; Trophozoites ; Tumor Necrosis Factor-alpha*

Gastritis cystica profunda (GCP) is an uncommom hyperplastic lesion, which is located within the submucosa. GCP may occur several years after previous gastric surgery. In some reported cases, it was a premalignant condition and may lead to carcinoma of the stomach. We report a case of a 54-year-old man with epigastric pain and dyspepsia. He had undergone peritoneal dialysis for end stage renal disease about 13 years prior. An Upper gastrointestinal endoscopy showed elevated lesion at the gastric antrum, looking like an advanced gastric cancer or gastrointestinal stromal tumor. Endoscopic biopsy results were tubular adenoma with low-grade dysplasia. When followed up 9 months later, the lesion had increased in size and symptoms remained. We therefore performed a subtotal gastrectomy. The final biopsy was adenocarcinoma arising in GCP.
Adenocarcinoma ; Adenoma ; Biopsy ; Dyspepsia ; Endoscopy, Gastrointestinal ; Gastrectomy ; Gastritis ; Gastrointestinal Stromal Tumors ; Humans ; Kidney Failure, Chronic ; Middle Aged ; Peritoneal Dialysis ; Pyloric Antrum ; Stomach ; Stomach Neoplasms

One of the common serious consequences of trauma to the temporal bone is facial nerve paralysis. Several attempts have been made to evaluate the relationship between the radiological findings and traumatic facial paralysis. These works have demonstrated the usefulness of high-resolution computed tomogrphy in assessment of facial nerve pathway. The authors tried to clarify the significant factors contributing to the facial nerve paralysis due to temporal petrous fractures clinically and radiologically including the high resolution CT findings. Fifty eight patients with 66 petrous fractures were reviewed in this context. Various clinical factors including hearing disturbance, CSF otorrhea demonstrating the objective traumatic evidences were reviewed. Plain X-ray findings and CT findings were reviewed as radiologic evidences. The radiologic factors were fracture evidence and wide fracture gap(more than 1mm) in plain film. Among CT findings, evidence for blood in middle ear, blood in mastoid air cells, ossicular disruption, fracture line compromising the facial nerve pathway from internal acoustic canal to mastoid portion and multiplicity of fracture lines were reviewed. These factors were analyzed statistically. In this study, it was found that traumatic bony involvement in facial nerve pathway did not necessarily mean facial paralysis. The most relavent factor contributing to the traumatic facial paralysis was multiple petrous fractures.
Acoustics ; Ear, Middle ; Facial Nerve ; Facial Paralysis* ; Hearing ; Humans ; Mastoid ; Paralysis ; Temporal Bone

BACKGROUND: Intracoronary stent with various designs have been developed to treat dissections or acute closure after angioplasty. The efficacy of flexible coil stent as a bail-out device has been reported. However, the restenosis after stenting still remained as a main limitation like other devices. This study reports on the angiographic follow-up after successful intracoronary stenting with flexible coil stent. METHOD: From April 1993 through July 1994, coronary stenting was tried in 21 patients by a single operator for various indications(acute or threatened closure, suboptimal result after balloon angioplasty). The nineteen(95%) out of 20 patients in whom stent was successfully deployed underwent follow-up coronary angiography 7.6+/-3.0 months after coronary stenting. RESULT: Mean age was 54.7+/-11.3(33-73) years and 16 parients were men. Clinical diagnosis of patients were as follows : stable angina 7, unstable angina 6, old myocardial infarction with stable angina 6 and acute myocardial infarction in 1 patient, respectively. Stents were implanted at left anterior descending artery in 9, left circumflex artery in 5 and right coronary artery in 8. Ten out of 21 stents(47.6%) were found to be renarrowed more than 50% at follow-up coronary angiography. There was no significant difference in clinical and angiographic variables between restenosis group and no-restenosis group. Coronary artery bypass graft surgery was performed in 1 patient for the treatment of restenosis after stenting. Repeat PTCA was performed in 3 patients and remaining 5 patients were followed medically. CONCLUSION: Flexible coil(Gianturco-Roubin) coronary stent is a useful adjunct percutaneous intervention to prevent or minimize complicatioms associated with dissections. Despite favorable initial angiographic and clinical results, 47.6% of stents were found to be renarrowed significantly at follow-up coronary angiography. New techniques or more optimal characters of stents would be desired.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Diagnosis ; Follow-Up Studies* ; Humans ; Male ; Myocardial Infarction ; Stents* ; Transplants

BACKGROUND: Intracoronary stent with various designs have been developed to treat dissections or acute closure after angioplasty. The efficacy of flexible coil stent as a bail-out device has been reported. However, the restenosis after stenting still remained as a main limitation like other devices. This study reports on the angiographic follow-up after successful intracoronary stenting with flexible coil stent. METHOD: From April 1993 through July 1994, coronary stenting was tried in 21 patients by a single operator for various indications(acute or threatened closure, suboptimal result after balloon angioplasty). The nineteen(95%) out of 20 patients in whom stent was successfully deployed underwent follow-up coronary angiography 7.6+/-3.0 months after coronary stenting. RESULT: Mean age was 54.7+/-11.3(33-73) years and 16 parients were men. Clinical diagnosis of patients were as follows : stable angina 7, unstable angina 6, old myocardial infarction with stable angina 6 and acute myocardial infarction in 1 patient, respectively. Stents were implanted at left anterior descending artery in 9, left circumflex artery in 5 and right coronary artery in 8. Ten out of 21 stents(47.6%) were found to be renarrowed more than 50% at follow-up coronary angiography. There was no significant difference in clinical and angiographic variables between restenosis group and no-restenosis group. Coronary artery bypass graft surgery was performed in 1 patient for the treatment of restenosis after stenting. Repeat PTCA was performed in 3 patients and remaining 5 patients were followed medically. CONCLUSION: Flexible coil(Gianturco-Roubin) coronary stent is a useful adjunct percutaneous intervention to prevent or minimize complicatioms associated with dissections. Despite favorable initial angiographic and clinical results, 47.6% of stents were found to be renarrowed significantly at follow-up coronary angiography. New techniques or more optimal characters of stents would be desired.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Diagnosis ; Follow-Up Studies* ; Humans ; Male ; Myocardial Infarction ; Stents* ; Transplants

BACKGROUND: Total occlusion of the infrarenal abdominal aorta is a very rare disease in clinical practice. The clinical outcome may be poor unless management is attempted promptly. Surgical bypass has been recommended as the treatment of choice for these lesions. However, there was relatively high surgical mortality and morbidity associad with aorto-bifemoral bypass graft in patients with other systemic disease, especially coronary artery disease. As a result, the use of, thrombolysis with percutaneous transluminal angioplasty (PTA) has recently been extended to this disease as an alternative method to surgery. PTA is technically simpler with less morbidity and mortality than surgery.We report our experience with thrombolysis and balloon angioplasty of total aortic occlusion in 14 patients between March 1991 and December 1996. METHODS: Fourteen patients, whose mean age was 59+/-13 years (11 male, 3 female), serve as the study's patients. Aortography was introduced via transbrachial artery. The end hole multipurpose catheter with guidewire was introduced into the thrombotic portion of the total occlusion. Urokinase was infused into the thrombus through the catheter if there were no contraindications. in sysremic thrombolysis. Thrombolytic therapy was continued until the thrombi was resolved and flow was restored. Balloon dilatation was followed in residual stenotic lesions. Stents were implanted in case of suboptimal results after ballooning. RESULTS: Clinical findings were resting leg pain in 6 patients, gangrene in 5 patients, and claudication in 3 patients. The causes of aortic occlusion were thromboembolism in 4 patients and thrombosis of an atherosclerotic aorta in 10 patients. Location of obstruction was below the renal artery in all cases. The clinical outcome of interventional therapy was successful in all cases except one patients. Operative treatment was undertaken in 2 cases because they could not received thrombolytic therapy due to contraindication and complication of thrombolytic therapy (gastrointestinal bleeding). Near normal revascularization was achieved in 3 patients by thrombolytic therapy only. PTA was performed at the stenotic after thrombolytic therapy in 4 patients. Stenting were performed at the stenotic sites after balloon dilatation in another 4 patients. There was bleeding complication in one case. CONCLUSIONS: Interventional therapy such as thrombolytic therapy with PTA is an effective and safe treatment modality for abdominal aortic total occlusion in selected cases. These techniques were very useful in some high risk patients who received surgical bypass procedures.
Angioplasty ; Angioplasty, Balloon ; Aorta ; Aorta, Abdominal* ; Aortography ; Arteries ; Catheters ; Coronary Artery Disease ; Dilatation ; Gangrene ; Hemorrhage ; Humans ; Leg ; Male ; Mortality ; Rare Diseases ; Renal Artery ; Stents ; Thromboembolism ; Thrombolytic Therapy ; Thrombosis ; Transplants ; Urokinase-Type Plasminogen Activator

Contusions ; Facial Bones ; Facial Nerve ; Facial Nerve Injuries ; Facial Paralysis ; Humans ; Incidence ; Lacerations ; Orbit ; Salivary Glands ; Skin ; Soft Tissue Injuries ; Wounds and Injuries

OBJECTIVE: To evaluate common symptoms and severities of swallowing disorders in pediatric patients with a central nervous system disorder. METHOD: Twenty six pediatric patients with age ranging from 1 month to 3 years who had complained feeding and swallowing difficulties were studied. The subjects were divided into two groups according to the presence or absence of a central nervous system disorder. After taking the history and physical examination, a bedside swallowing test and a videofluoroscopic swallowing study were done. The parameters of oral preparatory phase, oral phase and pharyngeal phase were evaluated. RESULTS: In the bedside swallowing test, the patients with a central nervous system disorder showed a significantly higher incidence of decreased swallowing reflex, postural abnormality, tendency of poor secretion control and absent gag reflex. In the videofluoroscopic swallowing study, patients with a central nervous system disorder showed delayed oral transport time, poor oral control, pharyngeal triggering, aspiration, nasal regurgitation and esophageal reflux. Compared to the patients without a central nervous system disorder, the patients with a central nervous system disorder showed a significantly higher incidence of decreased pharyngeal peristalsis and delayed pharyngeal triggering. The patients with a central nervous system disorder also showed a more profound swallowing disorder than that of the patients without a central nervous system disorder, having more chances of a non-oral feeding than those without a central nervous system disorder. CONCLUSION: The children with a swallowing disorder and central nervous system disordershowed the different features from those without a central nervous system disorder in the bedside swallowing test and videofluoroscopic swallowing study. So that a complete swallowing evaluation including the videofluoroscopic a swallowing study will be helpful to children with swallowing disorder and central nervous system disorder for the evaluation and treatment of pharyngeal stage swallowing dysfunction.
Central Nervous System Diseases* ; Central Nervous System* ; Child ; Deglutition Disorders* ; Deglutition* ; Gastroesophageal Reflux ; Humans ; Incidence ; Peristalsis ; Physical Examination ; Reflex

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the residual diameter stenosis after PTCA with fractional flow reserve (FFR) and coronary flow reserve (CFR), and investigate the correlation between FFR and CFR in patients with acute myocardial infarction (AMI). MATERIALS AND METHOD: The study population consisted of twenty seven patients with myocardial infarction. Baseline and hyperemic average peak velocity (APV) were measured using Doppler wire 15 minutes after restoration of infarct-related artery (IRA). CFR was obtained by the ratio of distal hyperemic APV to baseline APV. Distal coronary arterial pressure (Pd) was measured with advancing the wire distal to the lesion of IRA. Simultaneous proximal aortic pressure (Pa) was measured using guiding catheter. Myocardial FFR was obtained by the ratio of hyperemic Pd to hyperemic Pa. RESULTS: Post-interventional CFR and FFR were 0.85+/-0.44, 0.91+/-0.09. CFR did not show significant correlation with luminal diameter stenosis (%ST). There was no significant correlation between FFR and CFR with a correlation coefficient of 0.29 (p=.25). But, significant correlation was found between %ST and FFR, %ST and hyperemic PG (hPG) with correlation coefficient of -0.70 (p=.0012) and 0.68 (p=.0018). CONCLUSION: In AMI patients, %ST has a significant correlation with FFR and hPG after PTCA. But, there was no significant correlation between FFR and CFR.
Arterial Pressure ; Arteries ; Catheters ; Constriction, Pathologic ; Humans ; Myocardial Infarction* ; Phenobarbital