We report a 58 year old man who complained that his nails didn't grow for a year and developed yellowish discoloration. On physical examination his nails showed yellow greenish discoloration, increased corvexity, loss of lunulae and cuticles. C]iest X ray revealed atelectasis on right lower lung field and bronchiectasis on left lower lung field. Mild restrictive pattern was observed in pulmoniry function test. We gave him 800IU of Vitamin E claily for 3 months, but rio remarkable changes have been observed as yet..
Bronchiectasis ; Humans ; Lung ; Middle Aged ; Physical Examination ; Pulmonary Atelectasis ; Vitamin E ; Vitamins ; Yellow Nail Syndrome*

A study was made of the differences in clinical features and immunological aspects between herpes zoster patients with malignancies and those without malignant tumors. The results obtained from the retrospective review of medical records are as follows: Herpes zoster occurred more frequently in younger patients(less than twenty) with malignanciee as compared with the control group of the same ages,' Male was dominant among zoster patients with malignancies as is the contrary to contral group; Tihere were no marked differences in primarilly involved dermatomes between the two groups; Generalized varicelliform eruptiona were more common in zoster pa,tients with malignaneies than in control group, It seemed that zoster patients with malignancies complained of milder degree of pain. Zoeter patienta associated with malignancies were more frequently DNCB-negative and had decreased OKT3+ pan T cells, OKT4+ helper/inducer T cells as compared with control group, which suggest impaired cell mediated immunity in the former.
Herpes Zoster* ; Humans ; Immunity, Cellular ; Male ; Medical Records ; Retrospective Studies ; T-Lymphocytes

We performed a clinicopathological study of nineteen patients with chronic inflammatory nodose lesions of the legs which responded to the treatment with isolniazid. The results were summarized as follows: 1. Seven patients had a personal or family history of tuberculcsis and all patients showed a high tuberculin sensitivity. But, no one showed the evidence of active pulmonary tuberculosis. 2. The inflammatory nodules and swelling of the legs were resolved within 12 months in all cases. Resolution of the nodules was more rapid than that of leg swelling. 3. The clinical characteristics of the patients with chronic inflanimatory nodules were the same as those of the cases with erythema nodosum or erytiema induratum reported previously in Korea. The basic histopathologic process of inflarr matory nodules seemed to be vasculitis.
Erythema Nodosum ; Humans ; Isoniazid* ; Korea ; Leg* ; Tuberculin ; Tuberculosis, Pulmonary ; Vasculitis

Penetrating atherosclerotic ulcer involving the aortic arch has rarely been reported on in the literature. Acute rupture of a penetrating atherosclerotic ulcer involving the distal arch and the proximal descending thoracic aorta was found in a 78-year-old male, and he originally presented with acute-onset shoulder pain and hoarseness. Patch repair of the perforated arch and the proximal descending thoracic aorta was successfully done under total circulatory arrest.
Aged ; Aorta, Thoracic* ; Atherosclerosis ; Hoarseness ; Humans ; Male ; Rupture ; Shoulder Pain ; Ulcer*

BACKGROUND: Despite the excellent early results after the repair of congenital bicuspid aortic valve (BAV) disease, the mid-term durability of the repaired valve has still controversies. MATERIAL AND METHOD: To evaluate the mid-term results of BAV repair, retrospective review of medical records and echocardiographic data were done. Between 1994 and 2003, twenty-two patients underwent reparative procedure for either regurgitant or stenotic congenital bicuspid aortic valve (BAV). RESULT: Mean age was 41+/-14 years with male predominance (Male=17, Female=5). The pathophysiologies of the BAV were regurgitation-dominant in 20 (91%) and stenosis-dominant in 2 (9%) cases. Various repair techniques were used for raphe, prolapsed leaflet, thickened leaflet, and commissures; 1) release of raphe in 19 (86%), 2) wedge resection and primary repair in 11 (50%), pericardial patch reinforcement after plication of the leaflet in 6 (27%), and plication of the leaflet in 3 (14%), 3) slicing of thickened leaflet was used in 12 (55%) cases, 4) commissuroplasty in 8 (36%), and commissurotomy in 6 (27%) cases. There was no in-hospital mortality. During the mean follow-up of 38+/-17 months, one patient underwent aortic valve replacement after developing acute severe regurgitation from dehiscence of the suture on postoperative 2 months. New York Heart Association functional class was improved from 1.9+/-0.6 to 1.2+/-0.5 (p<0.01). Left ventricular end-systolic and diastolic dimension (LVESD/LVEDD) were also improved from 45+/-9 and 67+/-10 to 37+/-10 and 56+/-10, respectively (p<0.01). The grade of aortic regurgitation (AR) was improved from preoperative (3.1+/-1.2) to post-bypass (0.9+/-0.7). However, the grade at last follow-up (1.7+/-1.1) was deteriorated during the follow-up period (p<0.01). Freedom from grade III and more AR at one, three, and four year were 89.7%, 89.7%, and 39.9% respectively. CONCLUSION: Midterm clinical result of the BAV repair was favorable. But, the durability of the repaired valve was not satisfactory.
Aortic Valve Insufficiency ; Aortic Valve* ; Bicuspid* ; Echocardiography ; Follow-Up Studies ; Freedom ; Heart ; Hospital Mortality ; Humans ; Male ; Medical Records ; Retrospective Studies ; Sutures

A left ventricular rupture might be one of the most disastrous complications after a mitral valve replacement. An acute atrioventricular groove rupture (type I) was detected in a 54-year-old female diagnosed with a mitral stenosis combined with severe tricuspid regurgitation. She had a prior medical history of an open mitral commissurotomy in Japan at 30 years ago. The surgical findings suggested that the previous procedure was not a simple commissurotomy but a commissurotomy combined with a posteromedial annuloplasty procedure. After a successful mitral valve replacement and a measured (De Vega type) tricuspid annuloplasty, the weaning from a cardiopulmonary bypass was uneventful. However, copious intraoperative bleeding from the posterior wall was detected and the cardiopulmonary bypass was restarted. Exposure of the posterior wall of the left ventricle showed bleeding from the atrioventricular groove 3 cm lateral to the left atrial auricle. Under the impression of a Type I left ventricular rupture, epicardial repair (primary repair of the Teflon felt pledgetted suture, continuous sealing suture using auto-pericardial patch and application of fibrin-sealant) was attempted. Successful local control was made and the patient recovered uneventfully. The patient was discharged at 14 postoperative days without complications. We report this successful epicardial repair of an acute type I left ventricular rupture after mitral valve replacement.
Cardiopulmonary Bypass ; Female ; Heart Ventricles ; Hemorrhage ; Humans ; Japan ; Middle Aged ; Mitral Valve Stenosis ; Mitral Valve* ; Polytetrafluoroethylene ; Rupture ; Sutures ; Tricuspid Valve Insufficiency ; Weaning

Takayasu's arteritis is occlusive disease of aorta, its main branches, and pulmonary artery. Its clinical manifestations are quite variable, but comes from mainly stenotic or aneurysmal change of the vascular wall. We experienced two cases of unusual presentations of Takayasu's arteritis, one with thorcoabdominal aortic aneurysm (Crawford type III) and the other with atypical coarctation of descending aorta. Surgical procedures were graft replacement of thoracoabdominal aortic aneurysm with implantation of inferior mesenteric artery supplying almost all abdominal vicera to the graft, and graft bypass of the coarctation. They survived postoperatively with improved clinical symptoms.
Aneurysm ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Mesenteric Artery, Inferior ; Pulmonary Artery ; Takayasu Arteritis ; Transplants

Pacemaker Runaway is a rare, but potentially lethal complication after pacemaker implantation. Pacemaker runaway was one of the common manifestations of malfunctioning pacemaker at the time of fixed rate pacemaker, but has been less common after the demand type pacemaker had replaced the fixed rate model. The early recognition of runaway pacemaker is very important because runaway pacemaker can cause bradyarrhythmia, ventricular tachycardia-fibrillation and asystole resulting in syncope or death. We report a clinical experience of runaway pacemaker in 68 year-old woman, who received permanent pacemaker implantation(fixed rate 72/min, VVI, Micropulse 22U, Edwards system) due to sick sinus syndrome eight years ago. She complained of sudden chest tightness and dyspnea 10 days prior to admission. On physical examination, increased jugular venous pressure, rapid heart beats, basal rales on both lung fields and three finger-breath tender hepatomegaly. Electrocardiogram showed a rapid pacemaker rhythm of 140 beats per minute. So, the malfunctioning pacemaker was removed and replaced with a new programmable demand type pacemaker(VVI, OPTIMA-MP, Telectronics) in the same pocket under the diagnosis of pacemaker runaway. Her subject symptoms were relieved and electrocardiogram showed a regular pacemaker rhythm of 71 BPM. She was discharged ten days after pacemaker replacement.
Aged ; Bradycardia ; Child ; Diagnosis ; Dyspnea ; Electrocardiography ; Female ; Heart ; Heart Arrest ; Hepatomegaly ; Homeless Youth* ; Humans ; Lung ; Physical Examination ; Respiratory Sounds ; Sick Sinus Syndrome ; Syncope ; Thorax ; Venous Pressure

BACKGROUND: Recent studies have demonstrated the benefits of off-pump coronary bypass grafting over the on-pump technique in patients with chronic kidney disease (CKD). To further reduce the risk of acute kidney injury and the need for renal replacement therapy, even in patients undergoing off-pump coronary artery bypass grafting, we adopted protocol-based perioperative management for patients with CKD. METHODS: From December 2012 to March 2015, 265 patients underwent isolated off-pump coronary artery bypass grafting. To analyze renal function in a stable condition, we excluded 12 dialysis-dependent end stage renal failure and 10 emergency or urgent cases. Among the remaining 243 patients, 208 patients had normal kidney function (normal group), and 35 patients had CKD (CKD group). Minimizing contrast exposure, ensuring adequate hydration, using strict drug dosage adjustment, and optimizing hemodynamic status were key elements of the protocol for the CKD group. RESULTS: The risk of acute kidney injury was about ×3 higher in the CKD group than in the normal group (p=0.01). Estimated glomerular filtration rates and serum creatinine levels deteriorated until the third postoperative day in the CKD group. However, by adopting protocol-based perioperative management, this transient renal dysfunction recovered to preoperative levels by the fifth postoperative day without requiring renal replacement therapy in all cases. CONCLUSION: Off-pump coronary bypass surgery combined with this protocol-based perioperative management strategy in patients with non-dialysis-dependent CKD could mostly be performed without renal replacement therapy.
Acute Kidney Injury ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Creatinine ; Emergencies ; Glomerular Filtration Rate ; Hemodynamics ; Humans ; Kidney ; Perioperative Care ; Renal Insufficiency ; Renal Insufficiency, Chronic* ; Renal Replacement Therapy ; Transplants*

BACKGROUND: Postinfarction ventricular septal rupture is associated with mortality as high as 85~90%, if it is treated medically. This report documents our experience with postinfarction ventricular septal rupture that was treated surgically. MATERIAL AND METHOD: We retrospectively reviewed the medical records of 11 patients who were operated on due to postinfarction ventricular septal rupture between August 1996 and August 2006. There were 4 men and 7 women, with a mean age of 70+/-11 years (age range: 50~84 years). The location of the rupture was anterior in 7 cases and posterior in 4 cases. The interval between the onset of acute myocardial infarction and the occurrence of the ventricular septal rupture was 2.0+/-1.3 days (range: 1~5 days). Operation was performed at an average of 2.4+/-2.7 days (range: 0~8 days) after the diagnosis of septal rupture. Preoperative intraaortic balloon pump therapy was performed in 10 patients. RESULT: The infarct exclusion technique was used in all cases. Coronary artery bypass grafting was done in 8 cases, with the mean number of distal anastomosis being 1.0+/-0.8. There was one operative death. In 2 patients, reoperation was performed due to a residual septal defect. The postoperative morbidities were transient atrial fibrillation (n=7), paroxysmal supraventricular tachycardia (n=1), low cardiac output syndrome (n=3), bleeding reoperation (n=2), delayed sternal closure (n=2), acute renal failure (n=2), pneumonia (n=1), intraaortic balloon pump-related thromboembolism (n=1), and transient delirium (n=2). Nine patients have been followed up for a mean of 38+/-40 months except for one follow-up loss. There have been 3 late deaths. At the latest follow-up, all 6 survivors were in a good functional class. CONCLUSION: We demonstrated satisfactory operative and midterm results with our strategy of preoperative intraaortic balloon pump therapy, early repair of septal rupture by infarct exclusion and combined coronary revascularization.
Acute Kidney Injury ; Atrial Fibrillation ; Cardiac Output, Low ; Coronary Artery Bypass ; Delirium ; Diagnosis ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Medical Records ; Mortality ; Myocardial Infarction ; Pneumonia ; Reoperation ; Retrospective Studies ; Rupture ; Secondary Prevention ; Survivors ; Tachycardia, Supraventricular ; Thromboembolism ; Ventricular Septal Rupture*