BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

Castleman disease is a relatively rare disease of differential diagnostic interest in patients with lymphadenophathy. The etiology and pathogenesis of the Castleman disease are still not elucidated and the MRI findings of disease has not yet been reported. Two patients with Castleman disease studied by MRI are presented: one case presented with a localized anterior mediastinal mass and the other case, with a neck mass. The lesions were characterized by relatively high signal intensities on both T1 and T2 weighted images in both cases, and significant degree of enhancement was seen in the cervical Castleman disease.
Giant Lymph Node Hyperplasia* ; Humans ; Lymph Nodes* ; Magnetic Resonance Imaging* ; Neck ; Rare Diseases

Chordomas are maligaant tumors which arise in the remnants of the embryonic notochord, and exhibit a definite predilection for the extremes of the spinal axis, the great majority arising either in the basioccipital or in the sacrococcy geal regions. Particularly, complete surgical removal is almost impossible, therefore, local recurrence after the surgical removal of this tumor is common or rule. This report describes a csse of chordoma arising sacrococcygeal region treated with block resection.
Chordoma ; Notochord ; Recurrence ; Sacrococcygeal Region

The salt-sensitivity has been generally accepted as a mechnism of high blood pressure in elderly hypertensive patients, and so it may result in a difference of renal handling of sodium and potassium between normal healthy control and elderly hypertensive patient. So to evaluate an lbove difference, the amount of 24 hours' urinary excretion of Na+ & K+ were measured in healthy normotensive control (10 case) and elderly hypertensive group(10 case) according to normal diet (12-15gm of NaCl) for first 3 days and low salt diet (3~5)gm of NaCi) for next 3 days, also blood rewwure was mintored. The results were followed : 1) 24 hours' urinary excretion of NA+ was increased in hypertensive group more than control group at first day of normal diet and low salt diet significantly. 2) After a replacement of normal diet to low salt diet, a maximal decrement of 24 hours' urinary excretion of Na+ was 25% at first day in control but 40% at second day in hypertensive group only. 3) There was a similar pattern of urinary excretion of K+ as Na+ in hypertensive group, but it was not stastically significant. 4) There was no significant changes of blood pressure, serum electrolyte and BUN/creatinine according to salt intake in both group. From above findings. We can conclude that a urinary excretion of sodium is delayed in elderly hypertensive group, and it is suggested that a delayed excretion of sodium. is associated with retention of sodium in body. So a persistent restriction of sodium is recommended in elderly hypertensive patient.
Aged ; Blood Pressure ; Diet ; Humans ; Hypertension ; Potassium* ; Sodium*

OBJECTIVE: To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription Syste m' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). METHODS: The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. Indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was performed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. RESULTS: The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. CONCLUSION: The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.
Ambulatory Care ; Cost-Benefit Analysis* ; Elasticity ; Fees and Charges ; Humans ; Korea* ; Outpatients ; Pharmacists ; Prescription Fees ; Prescriptions* ; Transportation

BACKGROUND: In patients with myocardial infarction (MI) and chronic stable angina, the coronary flow reserve (CFR) is reduced not only in the region of myocardium perfused by the ischemia-related artery but also in the regions supplied by angiographically normal coronary arteries. The effect of myocardial stunning on the remote CFR is unknown, however. METHODS: In ten open-chest anesthetized dogs, left circumflex coronary artery was occluded for 15 minutes (myocardial stunning group, n=5) or for 30 minutes (MI group, n=5) and was followed by a reperfusion for 60 minutes. Before coronary occlusion and at 30 minutes and at 60 minutes after reperfusion, resting coronary blood flow (CBF) and maximal CBF after IV injection of each of adenosine (ADE) and acetylcholine (Ach) was measured with electromagnetic flow probe located in the proximal left anterior descending coronary artery. CFR was calculated as the ratio of maximal and resting CBF. RESULTS: At 30 minutes and 60 minutes after reperfusion, the remote resting CBF were significantly increased in both groups and the remote CFR was significantly decreased in both groups. The CFR of the MI group was lower than myocardial stunning group. The coronary vasodilator response to Ach was significantly lower than the response to ADE in both groups. CONCLUSION: After MI and myocardial stunning, there was severe coronary vasodilator abnormality in the remote myocardium and that was more marked after MI. The coronary vasodilator response to Ach was significantly lower than the response to ADE in both groups, suggesting endothelial dysfunction in remote myocardium.
Acetylcholine ; Adenosine ; Angina, Stable ; Animals ; Arteries ; Coronary Occlusion ; Coronary Vessels ; Dogs ; Humans ; Magnets ; Myocardial Infarction ; Myocardial Stunning* ; Myocardium ; Reperfusion

Multiple myeloma can usually be identified by non-traumatic vertebral fracture or signs of recurrent infection. Without these clinical signs, detection is unlikely. We briefly report a case of extraosseous multiple myeloma presenting as repeated intracranial bleeding and relapsing high fever. In doing so, we highlight the importance of subtle changes in laboratory findings. A 67-year-old man presented with spontaneous acute epidural hematoma, and hematoma evacuation was performed at the same site 3 times. A radiologic work-up failed to reveal any osseous lesions and he made a gradual recovery. In the meantime, he suffered unexplained fever up to 39oC despite normal chest and abdominal radiograms. Blood chemistry showed mild leukocytosis, high ESR and CRP, and a slightly elevated globulin. On his 15th hospital day, immunoglobulin studies confirmed the diagnosis of multiple myeloma. He was treated in the ICU for difficult breathing and uncontrolled fever. In spite of intensive critical care, his leukocyte count fell to below 2,000 and he died on postoperative day 28. Apparently normal laboratory and radiologic findings can hamper swift discovery and ultimate management of multiple myeloma. When there is unexplained repeated intracranial bleeding and accompanying fever, the possibility of hidden malignancy should be assessed to avoid delaying or missing treatment.
Aged ; Critical Care ; Fever ; Hematoma ; Hemorrhage ; Humans ; Immunoglobulins ; Leukocyte Count ; Leukocytosis ; Multiple Myeloma ; Respiration ; Respiratory Insufficiency ; Thorax

The pelvic ganglia provide autonomic innervations to the various urogenital organs, such as the urinary bladder, prostate, and penis. It is well established that both sympathetic and parasympathetic synaptic transmissions in autonomic ganglia are mediated mainly by acetylcholine (ACh). Until now, however, the properties of ACh-induced currents and its receptors in pelvic ganglia have not clearly been elucidated. In the present study, biophysical characteristics and molecular nature of nicotinic acetylcholine receptors (nAChRs) were studied in sympathetic and parasympathetic major pelvic ganglion (MPG) neurons. MPG neurons isolated from male rat were enzymatically dissociated, and ionic currents were recorded by using the whole cell variant patch clamp technique. Total RNA from MPG neuron was prepared, and RT-PCR analysis was performed with specific primers for subunits of nAChRs. ACh dose-dependently elicited fast inward currents in both sympathetic and parasympathetic MPG neurons (EC50; 41.4microliterM and 64.0microliterM, respectively). ACh-induced currents showed a strong inward rectification with a reversal potential near 0 mV in current-voltage relationship. Pharmacologically, mecamylamine as a selective antagonist for alpha3beta4 nAChR potently inhibited the ACh-induced currents in sympathetic and parasympathetic neurons (IC50; 0.53micrometer and 0.22micrometer, respectively). Conversely, alpha- bungarotoxin, alpha-methyllycaconitine, and dihydro-beta-erythroidine, which are known as potent and sensitive blockers for alpha7 or alpha4beta2 nAChRs, below micromolar concentrations showed negligible effect. RT-PCR analysis revealed that alpha3 and beta4 subunits were predominantly expressed in MPG neurons. We suggest that MPG neurons have nAChRs containing alpha3 and beta4 subunits, and that their activation induces fast inward currents, possibly mediating the excitatory synaptic transmission in pelvic autonomic ganglia.
Acetylcholine ; Animals ; Dihydro-beta-Erythroidine ; Ganglia ; Ganglia, Autonomic ; Ganglion Cysts* ; Humans ; Male* ; Mecamylamine ; Negotiating ; Neurons* ; Penis ; Prostate ; Rats* ; Receptors, Nicotinic ; Reverse Transcriptase Polymerase Chain Reaction ; RNA ; Synaptic Transmission ; Urinary Bladder

BACKGROUND: The risk of steroid-induced hyperglycemia is debated, and methylprednisolone is still used during spinal surgery. We have compared the blood glucose level in patients with metabolic syndrome treated with or without methylprednisolone. METHODS: This study was conducted in 68 adult patients who underwent elective spine surgery. Patients were classified into the following groups: methylprednisolone group (n = 39, group M), placebo group (n = 29, group P), group M patients with metabolic syndrome (n = 17, group MM), and group P patients without metabolic syndrome (n = 21, group NMP). Before and after injection of either 125 mg methylprednisolone or a placebo, we consecutively checked the blood glucose level every 30 minutes up to 4 hours. RESULTS: The blood glucose level was significantly increased in group M patients as compared to group P patients. The blood glucose level was more significantly increased in group MM as compared to group NMP patients. The increased blood glucose levels over 4 hours were 50 mg/dl in group MM and 35 mg/dl in group NMP patients. CONCLUSIONS: We recommend that close monitoring of the blood glucose level up to several hours after injection of a steroid should be seriously considered during spine surgery, particularly in patients with metabolic syndrome.
Adult ; Blood Glucose ; Humans ; Hyperglycemia ; Methylprednisolone ; Spine

STUDY DESIGN: Prospective controlled cohort study OBJECTIVE: To analyze the clinical outcome of video-assisted thoracoscopic surgery (VATS) between two different types of implants. SUMMARY OF LITERATURE REVIEW: The problem of correction loss has been reported with VATS, and different screws and rods have been developed to overcome this problem. Different implants will have varying effects in correctional outcome after VATS. MATERIALS AND METHODS: A total of 39 cases of idiopathic adolescent scoliosis treated with VATS between June 2001 and January 2005 were included in the study (mono-axial screws and a 4.5 mm rod: thin rod group=19 cases; poly-axial reduction screws and a 5.5 mm diameter rod: thick rod group=20 cases). All patients were followed for over 2 years postoperatively. For the comparison of surgical outcomes between the two groups, radiographic measurements were performed in the coronal and sagittal planes. RESULTS: Preoperative scoliosis angle (thin rod group 49.8degrees, thick rod group 47.1degrees), age, BMI, Risser stage, union time, operative time, and blood loss showed no statistical difference between the two groups. Postoperative average correction rate of scoliosis angle was 69% (15.8degrees) in the thin rod group and 70% (14.1degrees) in the thick rod group. However, correction rate after 2 years was 51% (24.5degrees) in the thin rod group and 60% (18.7degrees) in the thick rod group, showing statistically significant difference. There was a tendency toward correction loss in the thin rod group (8.7degrees vs. 4.6degrees p=0.0057). CONCLUSION: Postoperative correction rate was satisfactory in both groups. However, the thin rod group showed substantial correction loss. Therefore, poly-axial screws and thick rods are more suitable in VATS correction of scoliosis.
Adolescent ; Cohort Studies ; Humans ; Operative Time ; Prospective Studies ; Scoliosis ; Thoracic Surgery, Video-Assisted