Spinal cord tumors usually present themselves with severe pain without neurologic deficits during early stages. Cervical or thoracic spinal tumors can evoke anterior neck pain or chest pain without neurologic symptoms. As a result, when chest pain or anterior neck pain occurs initially, many physicians think its origin is a cardiac disorder such as angina. Eventually, during cardiac evaluation and treatment, myelopathy or radiculopathy develops to reveal spinal cord tumor. Even though it is rare, when anterior neck or chest pain is the presenting complaint, the possibility of spinal cord tumors should be considered. We report a case of spinal cord tumor with initial presentations of anginal chest pain and electrocardiographic myocardial ischemic changes (ST segment depression and T-wave inversion) in a 45 year old male patient who had no history of hypertension. It was later discovered that the cause was due to an A-V malformation.
Chest Pain* ; Depression ; Electrocardiography ; Humans ; Hypertension ; Male ; Neck ; Neck Pain ; Neurologic Manifestations ; Radiculopathy ; Spinal Cord Diseases ; Spinal Cord Neoplasms*

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) is one of the most widely used therapeutic procedures in the treatment of patients with coronary artery disease. However, acute closure and late restenosis remain a major limitation of PTCA despite extensive efforts to prevent. Coronary artery stents have been proposed as a treatment modality for acute closure and restenosis. We evaluated the initial success rate, complications, the restenosis rate, and the clinical outcomes after coronary artery stenting. METHODS: We implanted 56 stents(Palmaz-Schatz(PS) stent : 38 ; #3.0-14, #3.5-7, #4.0-17, Gianturco-Roubin(GR) stent : 18 ; #2.5-4, #3.0-10, #3.5-1, #4.0-3) in 51 patients(male : 40, mean age : 58+/-1 year). The clinical characteristics of the subjects were unstable angina in 26(51%), stable angina in 2, and myocardial infarction in 23(45%) patients(acute : 18). Follow-up angiography was done at a mean duration of 5.4 month(1-12) after coronary stenting for 34 lesions(61%) of 30 patients. RESULTS: 1) The indications of stenting(n=56) were De novo in 33(59%), bailout procedure in 15(27%), suboptimal result after PTCA in 6, and restenosis after PTCA in 2 stents. The location of lesions were LAD in 24, RCA in 27, and circumflex artery in 5 lesions. Angiographic morphologic characteristics were type B in 38(BI : 3, B2 : 35) and type C in 18 lesions. 2) The angiographic and clinical success rate was 96%(54/56) and 94%(52/56). There were no significant difference in stent modality, lesion site and morphology, and indication of stent. 3) Procedural complications were 1 acute closure which was recanalized by emergency coronary artery bypass graft(CABG), 1 death with subacute closure, 2 dissection, and 5 hemorrhages requiring transfusion. 4) The overall restenosis rate was 26%(9/34). The restenosis rate was reduced significantly in PS stent[PS : 9%(2/22) vs GR : 58%(7/12), P < 0.05], > or =3.5mm of stent size[> or =3.5mm : 6%(1/18) vs 3.5mm : 50%(8/16), p < 0305], and high pressure ballooning group(poststenting adjunct balloon dilation pressure > 12atm) [High pressure(+) : 7%(1/14) vs High pressure(-) : 40%(8/20), p<0.05]. 5) The restenosis sites were managed with re-PTCA in 4, elective CABG in 1, and medical follow-up in 4 patients. CONCLUSION: Coronary stenting is an effective and safe procedure for the management of coronary artery disease. The PS stent and GR stent are considered as a safe means for bail-out, and the PS stent can reduces the restenosis rate especially.
Angina, Stable ; Angina, Unstable ; Angiography ; Arteries ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels* ; Emergencies ; Follow-Up Studies* ; Hemorrhage ; Humans ; Myocardial Infarction ; Stents*

BACKGROUND: The endothelium is an important regulator of vascular tone via release of relaxing and constricting substances. The regulatory effect of the endothelium has been shown to be impaired in atherosclerotic arteries in human and animal models of hypertension. But there are some debates on extent and developing time of endothelium dysfunction in patients with hypertension, and the determining factors for endothelium dysfunction also were not defined. The objects of this study are to determine whether endothelial function is impaired in coronary and peripheral arteries, and to investigate the predicting factors for endothelial dysfunction in patients with essential hypertension. METHODS: The study patients comprised 14 patients with essential hypertension(M : 7, Mean age : 50+/-2 year) and 6 normal control (M :2, Mean age : 45+/-4 year). We assessed the vasomotor response to acetylcholine and nitroglycerin by change of arterial diameter during the infusion of acetylcholine, from 10(-9M) to 10(-6M) in coronary artery and 7.5, 15, and 25ug/min in left superficial femoral artery, and on intracoronary injection of 200ug nitroglycerin after acetylcholine infusion. RESULTS: 1) There were no significant differences in sex, age, body mass index and ventricular mass index, except systolic(174+/-5 vs 118+/-7mmHg, p<0.001) and distolic blood pressure(106+/-5 vs 75+/-5mmHg,p<0.001) between patients with hypertension and normal control. 2) There were no significant differences in laboratory date of total cholesterol, HDL-cho-lesterol, lipoprotein(a), microaluminuria and von-Willebrand Factor but Fibrinogen level was raised significantly in patients with hypertension than normal control(299+/-26 vs 192+/-23ng/dl, p=0.04). 3) The vasoconstrictor response to acetylcholine, 10-8 to 10-6 M concentration, at proximal, mid, and distal left anterior descending coronary artery were increased significantly in hypertensive patients than normal control(p<0.05). At rest superficial femoral artery, the vasodilator response to acetylcholine, only 25ug/min, was decreased in patients with hypertension(p<0.05). There was no signficant difference in the vasodilator response to nitroglycerin at coronary artery between two groups but in superficial femoral artery, the vasodilator response to nitroglycerin was decreased significantly in hypertensive patients(p<0.05). CONCLUSIONS: The results of this study suggest that endothelium dependent vascular relaxation is impaired in both coronary and superificial femoral artery and it remained to be investigated the predicting factors for endothelial dysfunction in patients with essential hypertension.
Acetylcholine ; Arteries ; Body Mass Index ; Cholesterol ; Coronary Vessels ; Endothelium ; Femoral Artery ; Fibrinogen ; Humans ; Hypertension* ; Lipoprotein(a) ; Models, Animal ; Nitroglycerin ; Relaxation

BACKGROUND: Insulin resistance syndrome has been proposed as a major promotor of atherosclerotic disease and earlier studies have implied the hyperinsulinemia itself may enhance coronary vasomotor tone. In patients with vasospastic angina, previous studies have been inconclusive whether to basal coronary artery tone is elevated at the spasm related and nonspasm related artery. This study was performed to investigate whether basal coronary artery tone is elevated ans insulin resistance syndrome correlates to vasospastic angina. If insulin resistance syndrome correlates to vasospastic angina, we also investigated whether insulin resistance syndrome correlates to basal coronary artery tone. METHODS: The study comprised 27 patients with vasospastic angina(M/F ; 19/8, mean age ; 52+/-2 year) and 21 control subjects with atypical chest pain(M/F ; 9/8, mean age ; 47+/-3 year). We assessed basal coronary artery tone by obtaining the percent increase in coronary artery diameter induced by nitroglycerin and also examined glucose and insulin response to an oral glucose load of 75g. RESULTS: 1) There were no significant differences in body surface area, abdominal hip ratio, body mass index, incidence of hypertension, lipid profile, von-Willebrand factor, fibrinogen, and microalbumin except smorking incidence [vasospastic angia ; 16(50%) vs control ; 5(24%), p<0.05)] between vasospastic angina group and control. 2) Basal coronary artery tone was greater at the nonspastic site of the spasm-related artery(28.1+/-2.2% vs 13.1+/-0.9%, p<0.0001) and non-spasm related artery(23.7+/-1.6% vs 13.1+/-0.9, p<0.0001) in the patients with vasospstic angina than in control subjects. In the patients with vasospastic angina, high activity group had a greater basal coronary artery tone than low activity group at the nonspastic site of the spasm-related artery(31.7+/-2.6 vs 20.4+/-2.7%, p<0.001) and non-spasm related artery(26.8+/-2.0 vs 19.4+/-5.8%, p<0.001). 3) Plasma glucose and serum insulin response to an oral glucose load were similar between vasospastic angina group and control subjects, and glucose area, insulin area, and insulinogenic index(delta sigma Glucose / delta sigma Insulin)(330+/-12 vs 328+/-20 mg/dl *hour, 107+/-14 vs 96+/-17uU/ml*hour, and 2.18+/-0.33 vs 2.63+/-0.46, respectively, p=NS) also did not between both groups. 4) Two group did not differ siginificantly in the prportion of glucose intolerance but glucose area and insulin area were significantly high in vasospastic angina patients with glucose intolerance than in control subjects with normal glucose tolerance(366+/-22 vs 257+/-17mg /dl*hour, 127+/-19 vs 52+/-15uU*hour, respectively, p<0.05), but basal coronary artery tone did not differ significantly between vasospastic angina patients with glucose intolerance and control subjects with normal glucose tolerance. CONCLUSION: 1) These results revealed that basal coronary artery tone is elevated at the nonspastic site of the spasm related artery and non-spastic vessel, and the disease activity associated with elevated basal coronary artery tone in vasospastic angina. 2) But these results did not reveal the correlation of hyperinsulinemia with vasospastic angina, and so we did not determine the role of hyperinsulinemia as a pathogenesis of coronary spasm and the relation between hyperinsulinemia and basal coronary artery tone.
Arteries ; Blood Glucose ; Body Mass Index ; Body Surface Area ; Coronary Vessels* ; Fibrinogen ; Glucose ; Glucose Intolerance ; Hip ; Humans ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Nitroglycerin ; Spasm ; Thorax

BACKGROUND: Recent restriction enclonuclease analysis studies hsve revealed that MCV DNA can be classified into two major types, designated MCV-1 and MCV-2, by th:ir restriction enzyme cleavsge patterns. In earlier reports of MCV DNA analysis, MCV-2 was the main virus type found in genital lesions. However many recent studies cienied the relationship between virus type and anatomical distribution. OBJECTIVE: The purpose of this study was to examine the ratio of MCV-l to MCV-2 in Korean isolates of MCV DNA and the relationship between MCV subtypes and with clinical features such as anatomical location, age, sex, numiber of lesions, and atopic dermatitis. METHODS: MCV DNA extrated from 112 cases of Korean patients waa examined by restriction endonuclease analysis using Brtm HI. RESULTS: 1. MCV-1 was found in 108 of 112 (96.4%) patients and MCV-2 in of 112 (3.6%) patients. The ratio of MCV-1 to MCV-2 wss 28:1. 2. There was no significant ciprrelation between MCV subtypes and the age, sex, number of lesions, atopic dermatitis, and anatoimic loction. 3. Lesions induced by MCV-1 MCV-2 were indistinguishable on the brsis of size and form. CONCLUSION: This study showis that the ratio of MCV-1 to MCV-2 was 28:1 in Korean molluscum contagiosum patients and there was no relationship between MCV subtyies and lesional morphology or snatomical distribution.
Dermatitis, Atopic ; DNA ; DNA Restriction Enzymes ; Humans ; Molecular Epidemiology* ; Molluscum contagiosum virus* ; Molluscum Contagiosum*

OBJECTIVE: Gestational diabetes mellitus is defined as carbohydrate intolerance of variable severity first diagnosed during pregnancy. It is associated with adverse outcomes of pregnancy including obstetrical complications such as increased rate of cesarean sections, preeclampsia, and birth trauma, and perinatal morbidities, such as macrosomia, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Therefore, screening for gestational diabetes mellitus and early diagnosis of this condition allows intervention to be carried out, thereby, the reduction of the untoward effects mentioned above can be minimized. METHODS: Screening for abnormal glucose metabolism was carried out in 489 pregnant women. A 50-g oral glucose load without regard to time of day or last meal, and a 1-hour plasma glucose determination with a threshold of 140mg/dl were used as a glucose screening test(GST). Patients with an abnormal GST underwent an oral glucose tolerance test(GTT). RESULTS: The overall incidence of gestational diabetes was 2.7%. The occurrence of this disorder was significantly related to the age of pregnant women, parity, or the presence of risk factors for gestational diabetes and obesity(Body Mass Index> or =26kg/m2). CONCLUSION: This study suggests that Korean pregnant women should be screened for gestational diabetes.
Blood Glucose ; Cesarean Section ; Diabetes, Gestational* ; Early Diagnosis ; Female ; Glucose Tolerance Test ; Glucose* ; Humans ; Hyperbilirubinemia ; Hypocalcemia ; Hypoglycemia ; Incidence ; Mass Screening* ; Meals ; Metabolism ; Parity ; Parturition ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Prenatal Diagnosis* ; Risk Factors

Bilateral inferior petrosal sinus sampling(IPSS) is known to be useful for the differential diagnosis of ACTH-dependent Cushing's syndrome and for the preoperative localization of pituitary microadenomas.To evaluate the usefulness of IPSS, we performed the procedure in the 17 cases of ACTH-dependent Cushing's syndrome including 2 cases of macroadenomas, 6 of them with CRH stimulation test. A inferior petrosal sinus-to-peripheral ACTH ratio of 2:1 or greater(3:1 after CRH stimulation) indicates a pituitary source of ACTH hypersecretion, and a ratio of the ACTH level in one inferior petrosal sinus to the ACTH level in the other of 1:4 or greater lateralizes the microadenomas to that half of the pituitary gland.With these criteria, we diagnosed Cushing's disease in 15 of 17 cases of ACTH-dependent Cushing's syndrome, and localized the lesion in 8 of 13 cases of microadenoma.In conclusion, IPSS with CRH stimulation has high diagnostic accuracy in the differential diagnosis of ACTH-dependent Cushing's syndrome, but still has the limitations on the localization of microadenoma.
Adrenocorticotropic Hormone ; Clinical Study ; Cushing Syndrome ; Diagnosis, Differential ; Petrosal Sinus Sampling

Torsade de Points is unique polymorphic ventricular tachycardia associated with QT interval prolongation. The mechanism of Torsade de Points was not defined exactly but triggered activity associated with afterdepolarization and/or dispersion of repolarization were known possible explanation. Torsade de points is most often induced by various drugs such as antiarrythmic agents, antipsychotic agents, antibiotis, and antihistamines. Astemizole(Hismanal(R)) and Terfenadine among antihistamines are reported that cause leading to a Torsade de Points. We experienced the case of Torsade de Points which was induced with Piprinhydrinate(Diphenylpyraline, Plokon(R)), antihistamine of ethanolamine derivatives, expressed recurrent syncope and dizziness in a young lady.
Antipsychotic Agents ; Dizziness ; Ethanolamine ; Histamine Antagonists ; Syncope ; Tachycardia, Ventricular* ; Terfenadine

BACKGROUND: Exercise induced ST-segment depression in patients after coronary angioplasty is frequently observed but the mechanism responsible for exercise induced myocardial ischemia early after successful coronary angioplasty is poorly understoodd. The object of this study is to investigate potential determinants of this phenomenon by analizing the clinical, exercise testing, and angiographic characteristics in patients with exercise induced ST-segment depression. METHODS: The study group comprised 13 patients with exercise induced ST-segment depression(Positive group,M:12, mean age:59+/-9year) and 26 patients without exercise induced ST-segment depression(Negative group, M; 22, mean age; 55+/-13 year) after succeessful coronary angioplasty in single vessel disease. We compared preangioplasty clinical, angiographic, and hemodynamic variables in group with positive and negative results on exercise testing after successful PTCA. RESULTS: 1) Clinical characteristics: The initial diagnosis were acute myocardial infarction in 5, unstable angina in 8 patients at positive group, and 16 and 10 patients at negative group, respectively. There were no significant different in initial diagnosis, risk factor for coronary artery disease, and medication used before exercise test at between two groups. 2) Cornary angiography and PTCA: The maximal ballooning size were significantly smaller in positive group than negative group(2.7+/-0.5 vs 3.1+/-0.4mm, 2.9+/-0.4mm, vs 3.2+/-0.4mm, respectively(p<0.05) but there were no significantly different in ejection fraction, end-diastolic volume, end-systolic volume before PTCA. degree of stenosis of lesion before and after PTCA, total ballooning time, balloon pressure, lesion site and infarction relation of lesion at between two groups. 3) Exercise test: The mean time from angioplasty to the performance of exercise testing were 9.5+/-4.0 days in positive group and 6.1+/-4.5 days in negative group. The mean depression of ST-segment was 1.5+/-0.5mm and was predominantly noted in lateral leads(V4-6)(9/13:69%). There were no significantly different in total exercise time, rate-pressure product, and metabolic equivalents-exercise time at positive and negative group. But positive results at follow up exercise test were significantly higher in positive group(p<0.05). CONCLUSION: There were no definite determinating factors for exercise induced ST-segment depression early after successful coronary angioplasty by analizing the clinical, angiographic, and exercise testing variables. The pathophysiologic mechanism of this findding remain to be elucidated, especially for association of microvascular functional alternation.
Angina, Unstable ; Angiography ; Angioplasty* ; Constriction, Pathologic ; Coronary Artery Disease ; Depression* ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction ; Myocardial Ischemia ; Risk Factors

The association between nephrotic syndrome and intravascular coagulation has been known for more than a century, but it was not until 1948 that a thrombotic diathesis in nephrotic patients was proposed. The prevalence of thrmbo-embolic complications is much higher in adult patients. Deep vein thrombosis of the leg is the most common complications in nephrotic adult and was responsible for one-third of the thrombo-embolic complications of nephrotic children. Arterial thrombosis occurs less frequently and is seen primarily in childern. We present a case of acute anterior myocardial infarction in a young man with nephrotic syndrome, secondary to minimal change glomerulonephritis, in which thrombosis of the proximal left anterior descanding artery was the actual cause of acute myocardial infarction.
Adult ; Arteries ; Child ; Disease Susceptibility ; Humans ; Leg ; Myocardial Infarction* ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Prevalence ; Thrombosis ; Venous Thrombosis