To delineate the coronary anatomy and left ventricular function during early myocardial infarction, coronary arteriography and left ventriculogrphy were performed, prospectively in 23(22%) of 105 patients who were admitted to the coronary care unit at Masan Koryo Hospital from June 1986 to June 1988 within 4 weeks after the onset of symptoms(medium:21 days, range:18 days to 25 days). 1) Among 23 patients, male is 20 patients and female is 3 patients. The ratio of male to female was 6.6:1. The mean age was 55.4+/-10.3 years(range:34-77 years). 2) Coronary artery narrowing state which related to myocardial infarction was as follows; 2 patients(7%) had normal, 1 patients(4%) had insignificant narrowing(below 50%) 5 patients(22%) had moderate narrowing(50-75%), 10 patients(43%) had severe narrowing(75-99%), 5 patients(22%) had complete occlusion(100%). 3) The range of coronary artery disease was as follows; 9 patients had one vessel disease, 10 patients had two vessel disease, 1 patients had three vessel disease, and ejection fraction had no significant difference among 3 groups but lowest in three vessel disease. Among 23 patients, 13 patients had anterior infarction, 10 patients had inferior infarction. 4) Left ventricular ejection fraction and multiple vessel disease had no significant difference between i) the young(under 45 years old) and the old(over 45 years old) age groups, ii) presence or non presence of previous angina, iii) Killip classification I, II and III, IV) anterior infarction and inferior infarction. 5) In left ventriculography, akinesis and dyskinesis were shown at similar ratio in anterior infarction and inferior infaraction. Dyskinesis was shown in 27% of patients who have 0-1 vessel disease, 50% of patients who have 2-3 vessel disease, 62% of patients who have collateral circulation, 26% of patients who dose not have collateral circulation. 6) Collateral circulation was found in 8 patients(35%). Age and left ventricular ejection fraction were high in patients without collateral circulation than with collateral circulation, but there is no significant difference and collateral circulation exists regardless of infarction site and range of coronary artery disease. 7) As for the complication of angiocardiography in this study, there was ventricular tachycardia in 3 patients(13%) without mortality. It is concluded that coronary arteriography can be safely performed in early stage after acute myocardial infarction. Also good prognosis is anticipated since three vessel disease and complete occlusion were low in acute myocardiaol infarction of Korean People. Since these are not much case performed study, however more study on this area is required.
Angiocardiography ; Angiography* ; Classification ; Collateral Circulation ; Coronary Angiography ; Coronary Artery Disease ; Coronary Care Units ; Coronary Vessels ; Female ; Humans ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Prognosis ; Prospective Studies ; Stroke Volume ; Tachycardia, Ventricular ; Ventricular Function, Left

No abstract available.
Choledochal Cyst*

Carcinosarcoma is an uncommon pulmonary malignancy characterized by carcinomatous parenchyma and sarcomatous stroma. Pulmonary carcinosarcoma represented about 1% of the resected lung tumors. The predominant clinical features are productive cough, chest pain, dyspnea, hemoptysis, bronchiectasis, and atelectasis, but alternate atelectasis is rare. We report a case of pulmonary carcinosarcoma associated with alternate atelectasis of the right upper and lower lobe.
Bronchiectasis ; Carcinosarcoma* ; Chest Pain ; Cough ; Dyspnea ; Hemoptysis ; Lung ; Pulmonary Atelectasis*

PURPOSE: Cisplatin is highly effective for the treatment of solid tumors in children. However, the clinical use of cisplatin is limited by its ototoxicity. The aim of this study was to evaluate the ototoxicity in children treated with cisplatin. Method: We performed a single institution retrospective analysis of pediatric oncology patients who received cisplatin therapy between January 2001 and January 2008. Thirty-seven patients with sufficient medical and audiologic data were included in this study. RESULTS: The median age at the time of diagnosis was 10.7 (range 3.8-16.7) years. There were 16 males and 21 females. The underlying diseases were osteosarcoma (15 cases), medulloblastoma (14 cases), germ cell tumors (7 cases), and hepatoblastoma (1 case). The median individual dose was 100 mg/m2/cycle (56-200). The median cumulative dose was 480 mg/m2 (200-1,490). Sixteen patients (43%) received cranial radiotherapy. Of the 37 patients, 17 developed hearing loss, leading to an overall incidence of 46%. Logistic regression showed that age at treatment (P=0.04) and cumulative dose of cisplatin (P=0.005) were the significant risk factors in predicting hearing loss in children treated with cisplatin. In all the patients who had hearing loss, there was neither improvement nor aggravation during the follow-up (3-68 months). CONCLUSION: The cumulative dose of cisplatin (>500 mg/m2) and younger age at treatment (<12 years) were 2 most important risk factors for ototoxicity in patients treated with cisplatin. Serial audiometric evaluations are needed in the patients with risk factors during and after cisplatin treatment.
Adolescent ; Child ; Cisplatin ; Female ; Follow-Up Studies ; Hearing Loss ; Hepatoblastoma ; Humans ; Incidence ; Logistic Models ; Male ; Medulloblastoma ; Neoplasms, Germ Cell and Embryonal ; Osteosarcoma ; Retrospective Studies ; Risk Factors

No abstract available.
Hemorrhage* ; Intracranial Hemorrhage, Hypertensive ; Trigeminal Nerve Diseases

The incidence of mitral valve aneurysm in infective endocarditis is 9-10%. However, a huge giant mitral valve aneurysm larger than 3 cm in length associated with acute mitral regurgitation is very rare. The mitral valve aneurysm can be complicated with perforation, leading to severe mitral regurgitation and congestive heart failure, pending to surgical correction. We hereby report a case of twenty-three year-old female who suffered from sudden onset of chest pain and dyspnea due to acute left ventricular failure, which was developed after the perforation of huge, hanging, giant septic aneurysm on the mitral valve. The patient underwent mitral valvuloplasty and recovered uneventfully.
Aneurysm* ; Chest Pain ; Dyspnea ; Endocarditis ; Female ; Heart Failure ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency

Placental and fetal involvement by matenal malignancy is rare. We report a case of placental metastasis from advanced gastric carcinoma in a 27 year-old woman. The patient also had disseminated bone metastasis, bone marrow involvement, malignant ascites, multiple lymphadenopathy, and disseminated intravascular coagulopathy. Cut surface of the placental body showed many, variable-sized, grayish white nodules and plaques. Light microscopic finding showed sheets of poorly differentiated adenocarcinoma in intervillous spaces. Villi were not invaded. Despite palliative chemotherapy the patient died of massive gastric cancer bleeding. But the patients child is alive and doing well with age of 11 months. We suggest that the presence of malignancy in pregnancy demands complete evaluation of the placenta and adequate follow-up of the infant for the sign of involvement.
Adenocarcinoma ; Adult ; Ascites ; Bone Marrow ; Child ; Drug Therapy ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Infant ; Lymphatic Diseases ; Neoplasm Metastasis* ; Placenta ; Pregnancy ; Stomach Neoplasms

Primary pulmonary hypertension (PPH) is one of rare and fatal vascular disorder. The exact mechanisms for the increased pulmonary vascular resistance and pressure in PPH are unknown. The disease is advanced pro-gressively and patients naturally die within three years after the initial diagnosis. PPH is characterized with mean pulmonary artery pressure over 25-30 mmHg and intractable hypertension despite any intensive therapeutic maneuvers. Associated congenital anomaly is very rare. We report a 19 year-old female patient who diagnosed as PPH 10 years ago and suffered from severe pulmonary hypertension (100 mmHg of pulmonary arterial pressure) with the congenital absence of inferior vena cava. Her venous blood from lower body was drained through azygous vein into superior vena cava.
Diagnosis ; Female ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Pulmonary Artery ; Vascular Resistance ; Veins ; Vena Cava, Inferior* ; Vena Cava, Superior ; Young Adult

BACKGROUND AND OBJECTIVES: Coronary microvascular remodeling is one of the complications associated with diabetic cardiovascular disease. We investigated the effect of long-term treatment with ramipril, an angiotensin converting enzyme inhibitor, on coronary microvascular remodeling on a type II diabetic model, the Otsuka Long-Evans Tokushima Fatty (OLETF) rat. MATERIALS AND METHODS: Twenty OLETF diabetic, and twenty LETO non-diabetic rats at twenty-four weeks old, were randomized into 4 equal groups for treatment with either an aqueous solution of ramipril (5 mg/kg, n=10 for two groups) or saline (n=10 for two groups) for 24 weeks on a daily basis. The blood glucose levels, body weights and blood pressures of the rats were checked on a regular basis. Masson's trichrome and picrosirius red stains were used for the morphometric analysis of the thickening of the coronary arterial wall and the degree of perivascular fibrosis. The myocardial collagen content was determined by measuring the levels of myocardial hydroxyproline. RESULTS: Marked thickening of the coronary microvascular wall and prominent perivascular fibrosis were detected in the hearts of OLETF rats to a greater extent than in the LETO rats (p<0.01). Ramipril significantly prevented coronary microvascular remodeling in OLETF rats (p<0.01), but there was no significant difference in the collagen content/dry heart weight ratio between the groups. CONCLUSION: Long-term treatment with ramipril has an antifibrotic effect, and improves the coronary microvascular remodeling in diabetic OLETF rats.
Angiotensin-Converting Enzyme Inhibitors ; Animals ; Blood Glucose ; Body Weight ; Cardiovascular Diseases ; Collagen ; Coloring Agents ; Coronary Circulation ; Diabetes Mellitus ; Fibrosis ; Heart ; Hydroxyproline ; Microcirculation ; Peptidyl-Dipeptidase A ; Ramipril* ; Rats* ; Rats, Inbred OLETF

Herpes simplex esophagitis usually occurs in immunocompromised or severely debilitated patients. Odynophagia and dysphagia are major symptoms and the prognosis of immunocompromised patients is variable. We present the case of a cadeveric donor renal transplantation recipient who developed herpes simplex esophagitis shortly after anti-rejection therapy. A 43-years-old female had cadaveric renal transplantation and following treatment with cyclosporine, prednisolone, mycophenolate mofetile. Twelve months later, renal insufficieny and proteinuria were developed. Allograft kidney biopsy showed some evidence of acute rejection. She was treated with 3 successive days of intravenous methylpredinisolone (500 mg/d) therapy and continued tapering of steroids. Two weeks later, she had oral cavity ulceration, odynophagia, dysphagia, epigastric pain, and nausea. Esophagoscopy reveals multiple confluent ulceration in the whole part of esophagus and biopsies showed the epithelial cell were enlarged with prominent nuclei. Immunohistochemically, the epithelial cell were positive with a monoclonal antibody to herpes simplex virus type 1. Treatment was started on intravenous ayclovir and changed to oral agent for 10 days. After treatment, her symptoms and repeat endoscopic findings were improved.
Allografts ; Biopsy ; Cadaver* ; Cyclosporine ; Deglutition Disorders ; Epithelial Cells ; Esophagitis* ; Esophagoscopy ; Esophagus ; Female ; Herpes Simplex* ; Herpesvirus 1, Human ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney ; Kidney Transplantation* ; Mouth ; Nausea ; Prednisolone ; Prognosis ; Proteinuria ; Steroids ; Tissue Donors ; Ulcer