No abstract available.
Female ; Methotrexate* ; Pregnancy ; Pregnancy, Tubal*

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

This study was carried out to investigate the ultrastructural findings of rats after administration of 0.5% lead acetate with drinking water. The Sprague-Dawley rats were divided into control and experimental groups. The control group was composed of 12 rats and was orally administered with 0.5% sodium acetate. The experimental group was composed of 36 rats and orally administered with 0.5% lead acetate. Two rats in the control group and four rats in the experimental group were sacrificed on day 2, and week 1, 2, 4, 6 and 8 after administration. The kidney was extirpated and examined by electron microscopy. The results obtained were as follows: The blood lead concentration in the experimental group began to increase from the second day after administration and it increased gradually until the 6th week and it decreased at the 8 week. The urinary excretion of delta-ALA also increased from the secondary and gradually increased up to the 8th week. On electron microscopic examination, the proximal tubular cells showed fat droplets, dilatation of the endoplasmic reticulum, mitochondrial swelling, increased numbers of secondary lysosomes and myelin figure-like residual bodies and intranuclear inclusion bodies. All these findings peaked at the eighth week after administration. Ultrastructural findings after Timm sulphide silver reaction revealed the lead granules in the proximal tubular lumen and between the microvilli of the proximal tubular cells without membrane-bounded. It can be concluded that most of the changes of micro-organelles are compatible with degenerative changes of lead exposure and passive diffusion of lead granules are involved in the proximal tubular cells.
Rats ; Animals

Puromycin aminonucleoside (PAN) nephropathy was induced in a group of Sprague-Dawley rat by a single dose of intraperitoneal injection to study an ultrastructural alteration of glomerular anionic sites by stain with polyethyleneimine (PEI) as a cationic probe and to examine whether proliferation of podocytes occur by immunohistochemical stain for proliferating cell nuclear antigen (PCNA). The experimental rats developed proteinuria three days after PAN injection. Electron microscopic studies of glomeruli showed the loss of epithelial foot processes, formation of cytoplasmic vacuoles, microvillous formation and increased numbers of lyso- somes in the cytoplasm of podocytes. PEI method seems to selectively stain heparan sulfate proteogly-can in basement membrane and has been widely used to evaluate the changes of basement membrane in human disease as well as in experimental work. The anionic sites on the basement membrane with foot process fusion were mostly indistinguishable from those seen in control rats, but focal areas of loss or disarray of anionic sites were noted. The anionic sites were not seen on the basement membrane where the overlying epithelium was detached. It is strongly suggested that proteinuria in PAN nephrosis may be primarily due to a glomerular epithelial lesion, leading to focal disarray of anionic sites or focal defects in the epithelial covering of the basement membrane. The loss of anionic s'ites in the basement mernbrane may be resulted partially from the foot process fusion and mostly from the epithelial detachment. The increased numbers of PCNA positive cells after the injection of PAN is suggestive of possibility of podocytic proliferation or regeneration.
Animals ; Basement Membrane* ; Cytoplasm ; Epithelial Cells* ; Epithelium ; Foot ; Heparitin Sulfate ; Humans ; Injections, Intraperitoneal ; Nephrosis ; Podocytes ; Polyethyleneimine ; Proliferating Cell Nuclear Antigen ; Proteinuria ; Puromycin Aminonucleoside* ; Puromycin* ; Rats ; Rats, Sprague-Dawley ; Regeneration ; Vacuoles

Tsutsugamushi disease is an acute febrile disease caused by Rickettsia tsutsugamushi, and which has been reported with increasing frequency thorough the nation since 1986. We experienced 21 cases of Tsutsugamushi Disease diagnosed with serologic test occurring in Taegu city and Kyungpook province during October-November, 1989. The results of survey are as follow. 1) Of 21 cases, 12 (57%) were males and 9 (43%) were females, and the peak incidence was the 4th decade. 2) The outbreak was in October to November and the peak incidence was in October. 3) The most frequent symptoms were fever and chill (100%), myalgia (95%), headache (90%), Eschar and rash were observed in 18 patients (86%) and the eschar was detected in all over the body, especially thorax (33%) and lower extremity (22%). 4) Laboratory features were SGOT elevation (83%), SGPT elevation (61%), LDH elevation (67%), leukocytosis (38%). 5) Indirect immunofluorescent antibody test was done in 18 patients and the antibody titer was above 1:320 in all patients. 6) The chloramphenicol, tetracycline or doxycycline regimens were very effective and mean duration of defervescence from initiation of therapy was 1.3 days. 7) The complication such as meningitis or shock, was not seen.
Alanine Transaminase ; Aspartate Aminotransferases ; Chloramphenicol ; Daegu ; Doxycycline ; Exanthema ; Female ; Fever ; Gyeongsangbuk-do ; Headache ; Humans ; Incidence ; Leukocytosis ; Lower Extremity ; Male ; Meningitis ; Myalgia ; Orientia tsutsugamushi ; Scrub Typhus* ; Serologic Tests* ; Shock ; Tetracycline ; Thorax

Inflammatory pseudotumor of the liver is a rare benign tumor with microscopic finding of fibrous stroma and chronic inflammatory cell infiltration. Predominance of plasma cells, histiocytes, lymphocytes, some eosinophils and whorled pattern of fibrosis is often characteristic. Due to similar radiologic appearance of hepatocellular carcinoma, inflammatory pseudotumor of the liver was often misdiagnosed and hepatic resection is often performed before preoperative tissue diagnosis. We report a case of inflammatory pseudotumor, which was a 47-year-old woman with fever, upper aMominal pain and weight loss, diagnosed by sonoguided liver biopsy and treated with antibiotic therapy only without surgery. After two weeks of treatment, the radiologic image of the mass was almost disappeared with improvement of previous symptoms. This opportunity and the possible effectiveness of antibiotic treatment should keep in mind in the differential diagnosis of the hepatic mass with similar radiologic appearance of hepatocellular carcinoma.
Biopsy ; Carcinoma, Hepatocellular ; Diagnosis ; Diagnosis, Differential ; Eosinophils ; Female ; Fever ; Fibrosis ; Granuloma, Plasma Cell* ; Histiocytes ; Humans ; Liver* ; Lymphocytes ; Middle Aged ; Plasma Cells ; Weight Loss

No abstract available.
Amyloidosis*

No abstract available.
Necrosis*

No abstract available.
Glomerulonephritis, IGA* ; Immunoglobulin A*