No abstract available.
Colonoscopy*

No abstract available.
Pregnancy, Heterotopic*

Tuberculosis of the bone and joints is either one of the generalized manifestation or solitary localized lesion. The involvement of bone after Bacille Calmette Guerin (BCG) vaccination is very rare. We experienced a case of which developed tuberculous osteomyelitis after BCG vaccination. The case is a 14-month-old male. The patient had the history of BCG vaccination 1 year ago. The presenting symptoms were swelling, redness and discharge of the left shoulder. The lesion in the left proximal humerus was mainly erosive lesion with minimal periosteal reaction. We are going to report a case of 14-month-old child with tuberculous osteomyelitis after BCG vac-cination with brief review of literature.
Child ; Humans ; Humerus* ; Infant ; Joints ; Male ; Mycobacterium bovis* ; Osteomyelitis* ; Shoulder ; Tuberculosis ; Vaccination*

Congenital stapes fixation showing normal finding of external auditory canal and tympanic membrane causes non-progressive conductive hearing loss in the range of 40 to 60 dB since childhood. It is a rare disease, but most commonly found among the isolated ossicular anomalies. Patients with this disease are very suitable candidates for stapes surgery, and successful hearing improvement can be expected by an appropriate surgical procedure. We report 2 cases of congenital stapes fixation which had been operated improperly. One case showed interposed homologous ossicle between the stapes head and the incus, and the other case showed transposed incus between the malleus handle and the stapes head along with the anterior crus fracture. They showed hearing improvements of more than 30 dB after stapedotomy with placement of the Fisch type stapes prosthesis. We are reporting two cases of misdiagnosed congenital stapes fixation with a discussion.
Ear Canal ; Head ; Hearing ; Hearing Loss, Conductive ; Humans ; Incus ; Malleus ; Prostheses and Implants ; Rare Diseases ; Stapes Surgery ; Stapes* ; Tympanic Membrane

No abstract available.
Magnesium Sulfate* ; Magnesium* ; Torsades de Pointes*

Lymphoma is the second most common neoplasm in the head and neck, and is the most common cause of unilateral neck mass in patients between 21 and 40 years of age. This report is a retrospective review of histologically proven lymphomas in 42 patients regarding histologic type, clinical stage, and CT imaging patterns. CT imaging plays an important role in making diagnosis, planning treatment, and evaluating recurrence after treatment. CT imaging patterns are classified into 4 types: Type 1 is nodal lymphoma, Type 2 extranodal lymphoma, Type 3 combined nodal and extranodal lymphoma, and Type 4 multifocal extranodal lymphoma. In conclusion, Lymphoma should be considered when multiple, nonnecrotic, homogenous lymph nodes are located in deep lymphatic chains (especially when they are large and bilateral or when both are the superficial and deep lymph node chains are involved simultaneously) and no mucosal abnormality of the aerodigestive tract is observed. Additionary, when a large nasopharyngeal mass lesion shows limited or equivocal bone destruction or a mass is identified on two sides of a nasal bone without frank destruction and when multiple sites of disease are identified in extranodal tissues.
Diagnosis ; Head* ; Humans ; Lymph Nodes ; Lymphoma* ; Nasal Bone ; Neck* ; Recurrence ; Retrospective Studies

Intracoronary acetylcholine and intravenous ergonovine tests have been used to induce coronary artery spasm. To evaluate the usefulness of these provocative tests, acetylcholine and ergonovine tests were performed in 86 patients with normal or near normal coronary angiograms(clinically variant angina in 30, effort angina in 6, unstable angina in 5, myocardial infarction in 6, atypical chest pain in 39 patients). Acetylcholine was injected into each coronary artery in incremental doses (0.02, 0.05 and 0.1 mg into left coronary artery, 0.02 and 0.05 mg into right coronary artery) and ergonovin was given intravenously in graded doses of 0.05, 0.1 and 0.2 mg after completion of acetylcholine test. The results were as follow : 1) Among 86 patients, both acetylcholine and ergonovine tests were positive in 29 patients, both tests were negative in 50 patients, and acetylcholine test was positive but ergonovine test was negative in 7 patients ; The responses of acetylcholine and ergonovine tests were concordant in 92% of patients. The sensitvity and specificity of the acetylcholine test with reference to ergonovine test were 100% and 88% respectively. 2) In 7 patients(8%) acetylcholine test was positive but ergonovine test was negative, and this group may represent a spectrum of coronary spasm syndrome. CONCLUSION: Acetylcholine test is a safe and useful provocative test for coronary artery spasm, especially in the multivessel spasm.
Acetylcholine* ; Angina, Unstable ; Chest Pain* ; Coronary Vessels ; Ergonovine* ; Humans ; Myocardial Infarction ; Sensitivity and Specificity ; Spasm ; Thorax*

Intracoronary acetylcholine and intravenous ergonovine tests have been used to induce coronary artery spasm. To evaluate the usefulness of these provocative tests, acetylcholine and ergonovine tests were performed in 86 patients with normal or near normal coronary angiograms(clinically variant angina in 30, effort angina in 6, unstable angina in 5, myocardial infarction in 6, atypical chest pain in 39 patients). Acetylcholine was injected into each coronary artery in incremental doses (0.02, 0.05 and 0.1 mg into left coronary artery, 0.02 and 0.05 mg into right coronary artery) and ergonovin was given intravenously in graded doses of 0.05, 0.1 and 0.2 mg after completion of acetylcholine test. The results were as follow : 1) Among 86 patients, both acetylcholine and ergonovine tests were positive in 29 patients, both tests were negative in 50 patients, and acetylcholine test was positive but ergonovine test was negative in 7 patients ; The responses of acetylcholine and ergonovine tests were concordant in 92% of patients. The sensitvity and specificity of the acetylcholine test with reference to ergonovine test were 100% and 88% respectively. 2) In 7 patients(8%) acetylcholine test was positive but ergonovine test was negative, and this group may represent a spectrum of coronary spasm syndrome. CONCLUSION: Acetylcholine test is a safe and useful provocative test for coronary artery spasm, especially in the multivessel spasm.
Acetylcholine* ; Angina, Unstable ; Chest Pain* ; Coronary Vessels ; Ergonovine* ; Humans ; Myocardial Infarction ; Sensitivity and Specificity ; Spasm ; Thorax*

To assess the likelihood of procedural success in patients with multivessel coronary artery disease, 46 consecutive patients (male 34, female 12, mean age 60+/-9 years) umderwent single or multiple site angioplasty. The clinical diagnosis of unstable angina was in 20(44%), stable angina in 10 and acute or old myocardial infarction in 16. Coronary angiographic findings of 2 vessel disease was in 38(83%), triple vessel disease in 8. Left ventricular function was generally well preserved (mean ejection fraction 65+/-12%, range 30-82%) and mean 2.0 stenosis per patient angic, lasty had attempted. Single vessel angioplasty (SVA) was performed in 13 and multivessel angioplasty (MVA) in 33. Procedural success was achieved in 79(86%) out of total 92 stenoses. Sixty-six(88%) out of 75 stenoses in MVA and 13(76%) out of 17 stenoses in SVA had procedural success respectively. According to angiographic morphology of lesions, procedural success of type A stenoses was 17/17(100%), type B stenoses 57/66(86%) and type C stenoses was 5/9(33%). In 13 failures included inability to pass the guide wire cross the lesion in 7, inability to guide the griding catheter in 2 and inability to dilate lesions in 4. Before and after angioplasty, treadmill test (modified Bruce protocol)could be performed in 29 patients. Total duration of exercise and maximal double product improved significantly from 8.5+/-2.3 minute 5188+/-2403 to 12.2+1.3 min., 23,062+/-4111 respectively (p<0.001). 17 out of 24 patients who had positive treadmill test before angioplasty showed negative conversion after procedure. Complications included dissection in 29, prolongd chest pain in 5, acute closure in 3, cardiac tamponade in 1 and ventricular fibrillation due to side branch oclusion in 1. Thus, coronary angioplasty in selected paients with multivessel coronary artery disease might be useful and have relatively good immediate results, but the long-term efficacies with other forms of treatment must be evaluated prospectively.
Angina, Stable ; Angina, Unstable ; Angioplasty* ; Cardiac Tamponade ; Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Exercise Test ; Female ; Humans ; Myocardial Infarction ; Ventricular Fibrillation ; Ventricular Function, Left

Recent studies suggest that coronary endothelial dysfunction in atherosclerosis may contribute to the predisposition both for coronary spasm as well as for thrombus formation. The integrity of at least one aspect of endothelial function can be assessed by the intracoronary administration of acetylcholine. Eleven(13.4%, mean age 48+13, male 11) out of 82 consecutive patients with acute myocardial infarction showed angiographically normal or near normal coronary arteries at 7~10 in-hospital days. Ten(91%) had history of heavy smoking and 7 patients(64%) had no history of previous angina. Anterior myocardial infarction was in 8 and inferior in 3 patients. After intracoronary administration of acetylcholine(incremental dose of 20, 50ug for the right and 20, 50, 100ug for the left), 9(82) of 11 infarct related arteries showed total or subtotal occlusion, but only in 3(17%) out of 18 non-infarct related arteries of 10 patients. Multivessel spasm was noticed in 3. Ergonovine test(graded doses of 0.05, 0.1 and 0.2 mg intravenously) was performed 30 minutes after completion of acetylcholine test in 5 patients. In 1 patients, acetylcholine test was positive and but ergonovine test was negative. Conclusion : 1) Eleven(13.4%) out of 82 patients with acute myocardial infarction had angiographically normal coronary arteries. 2) Ach positive responses of infarct-related arteries are more frequent(82%) than that of non-infarct related arteries(17%), suggesting that the infarction might be related to coronary artery spasm. 3) Positive Ach responses of non-infarct related arteries occurred in 30% of Patients. 4) Ach and Erg induced vasospasm developed at the same site in 5, which suggests that local hyperreactivity might be related to spasm.
Acetylcholine* ; Arteries ; Atherosclerosis ; Coronary Vessels* ; Ergonovine ; Humans ; Infarction ; Male ; Myocardial Infarction* ; Smoke ; Smoking ; Spasm* ; Thrombosis