No abstract available.
Heart Septal Defects, Ventricular* ; Heart Ventricles* ; Pulmonary Atresia*

Although almost all cases of spontaneous aortic dissection originate in the thoracic aorta, dissections limited to the abdominal aorta occur very rarely. According to the previous literatures, localized abdominal aortic dissections account for 1~4% of all aortic dissections. The predisposing factors of spontaneous abdominal aortic dissection are similar to those of thoracic aortic dissection. Many patients have a history of hypertension and the incidence appears to be greater in patients with congenital heart diseases, pregnancy or Marfan's syndrome. And it occurs 3 times more frequently in men than in women. Histologically, atherosclerosis is the most common finding. In many cases, presenting symptoms and signs are not specific, so that this disease entity can be overlooked at bedsides. In our case, the patient was a 76-year-old man who had a vague periumbilical pain occurred one day before. He had no trauma history nor other illness. Abdomino-pelvic CT showed 4x7 cm sized dilatation of abdominal aorta from below the renal arteries to just above the aortic bifurcation site and compatible with aortic dissecting aneurysm. We performed aneurysmectomy and restored arterial continuity with an aorto-bifemoral bypass using dacron. The patient's postoperative course was relatively uneventful and he remains well one year after operation. In conclusion, because of its rarity and nonspecific symptoms and signs, spontaneous aortic dissection confined to the abdominal aorta may be misdiagnosed by physicians. And usually, untreated aortic dissections have a lethal course. So, more accurate diagnostic approaches and optimal managements are needed for good outcome.
Aged ; Aneurysm, Dissecting* ; Aorta, Abdominal* ; Aorta, Thoracic ; Atherosclerosis ; Causality ; Dilatation ; Female ; Heart Diseases ; Humans ; Hypertension ; Incidence ; Male ; Marfan Syndrome ; Polyethylene Terephthalates ; Pregnancy ; Renal Artery

PURPOSE: Kimura's disease is a relatively rare head and neck tumor that frequently occurs in young orientals accompanied by eosinophila. We shared our experience of two cases of Kimura's disease, treated by radical resection and post operative steroid therapy, so we report the correlation of eosinophil counts and disease progression. METHODS: A 25 years old male came to the clinic with a mass localized to the right cheek inferior to the right auricle. We could not resect the mass totally. During the follow up period, we checked the eosinophil counts, and steroid therapy was started 7 months after the surgery. A 34 year old female came to the clinic with a mass localized inferior to the left auricle reaching from the posterior portion of the auricle to the left temporal portion. We tried to remove as much tumor as possible, save the temporal region, in regard to the impairment of blood supply to the auricle. After the operation, steroid therapy was started. RESULTS: In the first case, the tumor was easily approachable, and radical resection of the tumor with post operative steroid therapy was an effective treatment. In tumors located at difficult regions to remove, as in the second case, optimal debulking and post operative steroid therapy was also effective in treating Kimura's. There were no recurrences in both cases. Eosinophil counts were always reduced after surgery and steroid therapy, and during the period with low eosinophil counts, there was no recurrence of Kimura's disease. CONCLUSION: Surgery and post operative steroid therapy were effective in treatment of Kimura's disease, and we could assume eosinophil counts as a good indicator for evaluation of the prognosis of Kimura's disease during the follow up period
Cheek ; Eosinophils ; Female ; Follow-Up Studies ; Head ; Humans ; Male ; Neck ; Porphyrins ; Prognosis ; Recurrence

BACKGROUND: In order to evaluate the effects of the duration of hemodialysis on cell mediated immunity, we studied cellular immune responses in vitro in 12 patients on chronic hemodialysis and in 6 healthy volunteers with normal kidney function. METHODS: The patients on maintenance hemodialysis were divided into two subgroups according to the duration of the hemodialysis: Group 1 (within 5 years, n=6) and Group 2 (>5 yr and < or =10 yr, n=6). Group 3 include the normal control (n=6). The peripheral blood lymphocytes of each group were cultured in RPMI medium 1640 without/or with 3 microgram of phytohemagglutinin (=PHA) for 7 days. RESULTS: CD4 /CD8 ratio at 48hours was totally comparable between the uremic patients (Group 1 and Group 2) and the controls (Group 3). The proportions of CD25 T lymphocytes after 48 hours culture were abnormally high: 7.1+/-0.5% and 7.0+/-1.3% in the uremic patients as compared to 2.5+/-0.6 in the normal controls at the basal state and 66.7+/-2.6% and 68.8+/-1.9% in the uremic patients as compared to 78.3+/-4.6% in the normal controls at the PHA-stimulated condition. The spontaneous production of IL-2 (mean pg SEM) was significantly lower in hemodialized patients (Group 1: 34.5+/-6.0 pg/ml, Group 2: 33.8+/-6.2 pg/ml) as compared to the normal patients (Group 3: 58.8+/-10.4 pg/ml). The PHA stimulated IL-2 production was also significantly reduced in the hemodialized patients (Group 1: 53.2+/- 13.3 pg/ml, Group: 53.0+/-10.3 pg/ml) as compared to the normal patients (Group 3: 150.0+/-24.5 pg/ml). The mean proliferative response to PHA at each point in the hemodialized patients were significantly lower than those of the controls. CONCLUSIONS: These data show that there is no significant correlation between the level of the cell mediated immune response and the duration of hemodialysis. Several defects in the cell mediated immune response associated with uremia might start at an early phase of the hemodialysis.
Healthy Volunteers ; Humans ; Immunity, Cellular* ; Interleukin-2 ; Kidney ; Kidney Failure, Chronic* ; Lymphocytes ; Renal Dialysis* ; T-Lymphocytes ; Uremia

PURPOSE: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothesis is that the syndrome represents a form of catecholamine surge due to stress or epinephrine-mediated acute myocardial stunning. METHODS: A 44-year-old woman had suffered premature ventricular contraction following a cardiogenic shock during a breast augmentation surgery under enflurane anesthesia and tumescent solution infiltration. She was treated with cardiopulmonary resuscitation at a local clinic. Then she was brought to the Emergency Department of the authors' hospital. RESULTS: The woman's echocardiogram showed an ejection fraction of 20~25% with associated basal hyperkinesis and left ventricular apical ballooning. The patient was admitted to the ICU and required inotropic support for two weeks. The patient's condition dramatically improved, and her ejection fraction returned to 70%. CONCLUSION: It is believed that there were multiple triggering factors of the onset of Takotsubo cardiomyopathy in the woman's social and family history, including infiltration of a large volume of the tumescent solution and VPCs induced by enflurane anesthesia without premedication. The importance of careful history-taking, careful pre-operative consultation on psychological suffering especially for breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was again seen in this case.
Adult ; Anesthesia ; Breast ; Cardiomyopathies ; Cardiopulmonary Resuscitation ; Emergencies ; Enflurane ; Female ; Humans ; Hyperkinesis ; Premedication ; Shock, Cardiogenic ; Stress, Psychological ; Takotsubo Cardiomyopathy ; Ventricular Premature Complexes

In augmentation surgery, one of the important considerations is the selection of artificial implants. Recently, medium-porosity and high-density expanded polytetrafluoroethylene(ePTFE), which has high biocompatibility without gradual loss of volume, has been used as an implant, however, there are not many cases and reports on the post-operative complications and patient satisfactions. Between 2006 and 2009, a total of 23 patients with a flat or depressed forehead/temple underwent augmentation with medium-porosity and high-density ePTFE at our hospital. During follow up periods, 15 patients visited the clinic to fill out a survey and receive a physical examination for any complications, whereas 8 patients underwent a survey on the phone. The patients were asked questions to score their satisfaction rates on a scale of 1 to 10 points. There were no post-operative complications, and, the average score of satisfaction rates on the survey was 8.3 points. Since there were no complications and high rates of satisfaction during follow up periods, this medium-porosity and high- density ePTFE could be considered as a durable implant.

Despite various methods of treating acute lower limb ischemia, the reported mortality continues to be in the 10% to 30% range. To evaluate the results according to etiology, location, time interval before starting treatment of acute lower extremities occlusive lesion, this study was done for 38 patients with acute arterial occlusive disease. The causes of acute lower limb occlusion were embolism (n=18, 47.4%) and thrombosis (n=20, 52.6%). The mortality rate was 11.1% (2/18) in embolism and 10% (2/20) in thrombosis. All the patients with embolic occlusion were treated by thromboembolectomy with Fogarty catheter, and thrombotic occlusive lesion were treated by intraarterial thrombolytic therapy only (n=3), followed by corrective procedure such as PTA only for short iliac arterial lesion (n=1), PTA and stent for long iliac arterial lesion (n=5), bypass operation (n=5). The amputation rate was higher (p,<0.05) in thrombotic group (6/20, 30%) than in embolic group (2/18, 11.1%), in longer duration group (>24 hr, 7/20, 35.0%) than in shorter duration (<24 hr, 1/18, 5.6%), and in multiple lesion (7/13, 53.7%) than single lesion (1/25, 10.0%). Even though advanced therapeutic modality for acute lower limb occlusive disease, mortality is still high, and limb salvage is dependent on various factors such as status of patients, etiology and number of lesion site, time interval before starting treatment.
Amputation ; Arterial Occlusive Diseases ; Catheters ; Embolism ; Humans ; Ischemia ; Limb Salvage ; Lower Extremity ; Mortality ; Stents ; Thrombolytic Therapy ; Thrombosis

Antihypertensive effect of Bunazosin was evaluated in 23 patients with essential hypertension. Systolic blood pressure decreased from 175.5+/-16.9mmHg to 167.5+/-30.2mmHg after 4 weeks and to 165.4+/-29.7mmHg(p<0.05) after 8 weeks of medication. Diastolic blood pressure decreased from 105.6+/-9.7mmHg to 98.6+/-11.6mmHg(p<0.05) after 4 weeks and to 98.1+/-12.2mmHg(p<0.05) after 8 weeks of medication. Heart rate and serum lipid profiles did not change significantly. Transient side effects such as nausea(two cases), headache (one case), and weakness(one case) were observed, but there were no significant side effects. Therefore Bunazosin seemed to be effective in lowering blood pressure without reflx tachycardia, changes of serum lipie profiles, and significant side effects.
Blood Pressure ; Headache ; Heart Rate ; Humans ; Hypertension* ; Tachycardia

No abstract available.
Dentin* ; Hypersensitivity*

BACKGROUND: Previous studies have suggested that chronic infection may play a role in the pathophysiology of restenosis after coronary angioplasty. The purpose of our study was to investigate the relation between Helicobacter pylori(H. pylori) or cytomegalovirus (CMV) infection, and restenosis. METHODS: Fifty nine patients with coronary artery disease underwent percutaneous transluminal coronary angioplasty (PTCA) and follow-up coronary angiography (59+/-13 years, 66% male). H. pylori and CMV IgG antibody titers were measured prospectively. The minimal luminal diameter and reference diameter before and immediately after angioplasty and at follow-up were measured with quantitative analysis. RESULTS: Restenosis occurred in 23 of the 59 (39%) patients. For H. pylori, patients with high antibody titer (upper half, > or =40 U/ml) had a higher restenosis rate than patients with low antibody titer (lower half, < 40 U/ml). Seventeen of the 29 (59%) patients with high antibody titer had restenosis, while 6 of the 30 (20%) patients with low antibody titer had restenosis (p=0.002, RR=2.39, 95% CI 1.35 to 6.37). After adjustment for covariates, including age, sex, body mass index, hypercholestrolemia, hypertension, diabetes mellitus, smoking, diagnosis at admission, modality of intervention, postprocedure minimal luminal diameter, lesion length, and lesion type, H. pylori antibody titer was independently predictive of restenosis (p=0.005). For CMV, patients with high antibody titer did not have a higher restenosis rate than patients with low antibody titer. CONCLUSION: High antibody titer against H. pylori may be an independent risk factor of restenosis after PTCA. However, there was no association between CMV antibody titer and the risk of restenosis.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Body Mass Index ; Coronary Angiography ; Coronary Artery Disease ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Diabetes Mellitus ; Diagnosis ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Hypertension ; Immunoglobulin G ; Phenobarbital ; Prospective Studies ; Risk Factors ; Smoke ; Smoking