BACKGROUND AND OBJECTIVES: Unstable angina is an inhomogenous syndrome. A substantial percentage of patients, ranging from 12 to 30% in most series, develops acute myocardial infarction or dies suddenly soon after their hospitalization, while the remainder have a benign prognosis without adverse coronary events. Unstable angina is a complex condition such as angina at rest, crescendo angina, new onset angina and postinfarction angina. These variable clinical presentations suggest that unstable angina have a heterogenous pathogenesis and prognosis. We divided unstable angina into 5 groups and studied the relationship between clinical presentations and coronary angiographic morphology. METHODS: One hundred sixty six patients were selected from the patients who were diagnosed as an unstable angina between January 1989 and March 1991, at Hallym University Hospital. Angiography was performed in patient with typical angina symptoms and transient ECG changes of myocardial ischemia. Coronary angiogram was done as usual method. Calcification of coronary artery as well as the presence of collateral circulation were recorded. Ergonovine test was performed in patients with near normal or normal angiogram. Coronary lesions were morphologically classified as follows; type A is simple lesion such as symmetric, concentric narrowing and smooth border. and type B is complex lesion such as asymmetric, eccentric, ulcerated narrowing and irregular border. RESULTS: These groups were classified as follows; Group I(represented the patients with angina at rest but typical Prinzmetal angina was excluded) 30 patients, Group II(represented the patients with crescendo angina) 24 patients, Group III(represented the patients with new onset angina) 62 patients, Group IVA(represented the patients with early postinfarction angina within 2 weeks after AMI) 34 patients, Group IVB(represented the patients with delayed postinfarction angina) 16 patients, There were no significant differences in age and sex among the 5 groups. Locations of involved vessel were similar among the five groups, and left anterior descending artery was most frequently(mean 60%) involved. Single vessel disease was frequently observed in new onset angina and early postinfarction angina(Group III*, IVa** 48%, 65% VS Group II, IVB 25%, 19% respectively, *p<0.05, **p<0.005) whereas multivessel disease was frequent in crescendo angina and delayed postinfarction angina(Group II, IVB 51%, 76% VS Group II, IVA 16%, 27% respectively, p<0.005). More than two third of patients with unstable angina had complex B lesion of coronary artery (77%), but in new onset angina simple A lesion was frequently observed (Group III 45% VS Group I, IVA, IVB 16%, 10%, 13% respectively, p<0.05). The frequency of calcification increased in early postinfarction angina(Group IVA 18% VS Group III 3%, p<0.05). The frequency of coronary collateral circulation increased in cresendo angina, early postinfarction and delayed postinfarcion angina(Group II*, IVA*, IVB** 38%, 35%, 50% VS Group III 10% respectively, *p<0.005.**p<0.0001). Incidence of coronary vasospasm was higher in resting angina than the others(Group I*, III 30%, 19% VS Group II, IVA 4%, 6% respectively, *p<0.02). The coronary vasospasm was frequently observed in an insignificant lesion(insignificant lesion/total vasopasm: 12/24(50%)). Early postinfarction angina had frequent intracoronary thrombus in infact-related artery(incidence of thrombus : Group IVA*, IVB 21%, 13% VS Group I, II, III 3%, 4%, 5% respectively, *p<0.05). CONCLUSION: This study suggests that patients with unstable angina pectoris may be heterogeneous groups. Coronary angiography must be performed in patients with unstable angina, in order to classify the clinical correlates with each possible angiogrphic finding that could affect treatment modality and outcome of cardiac events.
Angina Pectoris, Variant ; Angina, Unstable* ; Angiography ; Arteries ; Collateral Circulation ; Coronary Angiography ; Coronary Vasospasm ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Hospitalization ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Ischemia ; Prognosis ; Thrombosis ; Ulcer

We described a giant chroioangioma of the placenta that caused premature rupture of membranes at 31 weeks of gestation in a 31-year-old primiparous woman and a subsequent neonatal death of the baby. The placental mass, weighing 820 gm and measuring 21.5x15x4.5 cm, was easily shelled out from a edematous 1280 gm-placenta. The mass had a thin fibrous capsule and a solid fibromatous appearance. The infant, weighed 2175 gm, appeared edematous oon the whole body and had Apgar scores of 4 and 5 at 1 and 5 minutes respectively. The baby expired 4 days after birth due to high output cardiac failure and respiratory failure. Postmortem examination revealed markedly dilatated umbilical vein, inferior vena cava and right atrium with patent froamen ovale, congestive hepatosplenomegaly, pulmonary hemorrhages, and meconium aspiration pneumonia. Microscopically, the mass revealed a variety of histologic patterns, reflecting entire spectrums of villous vasculogenesis from loose myxomatous connective tissue and undifferentiated hemangioblastic cell nests to well-developed capillaries with hematopoietic cells in the lumen.
Infant ; Male ; Female ; Infant, Newborn ; Humans

BACKGROUND: A clinical trial was done to evaluate the antihypertensive efficacy and side effects of captopril(Capril(R)), an angiotensin converting enzyme inhibitor, in patients with mild to moderate essential hypertension. METHOD: Captopril was given 25-50mg a day to 46 patients(mean age : 51.3+/-8.9 years, 21 males and 25 females) for 8 weeks. RESULT: The blood pressure dropped significantly in 2 weeks and well maintained throughout 8 weeks of study period(p<0.01). The mean pressure drop was 14.4/8mmHg at 8 weeks without any changes of heart rate. The blood pressure was not dropped in 13 cases(28.3%). There were no significant changes in CBC, urinalysis and blood chemistry(sugar, lipids, electrolytes, creatinine, protein, albumin, AST and ALT) during this trial. The side effects were observed in 20 cases(43.5%). The most frequent was cough(19 cases, 413%) and the others were dysgeusia, dry eyes and edema in each respectively. CONCLUSION: Captopril(Capril(R)) monotherapy with 25-50mg a day regimen was effective in patient with mild to moderate essential hypertension, but somewhat high episodes of cough were observed in this trial.
Blood Pressure ; Captopril ; Cough ; Creatinine ; Dysgeusia ; Edema ; Electrolytes ; Heart Rate ; Humans ; Hypertension ; Male ; Peptidyl-Dipeptidase A ; Urinalysis

Primary pericardial tumors are rare than those originating within the myocardium or endocardium and, moreover, primary benign pericardial tumors are much rare in occurrence. Fine(1986) was able to collect only 43 cases of lipoma. Most cases are diagnosed only at autopsy. One fourth of the cardiac lipoma arise subepicardially, where they suggest the presence of pericardial effusion with compression or displacement of the heart. A case of primary intrapericardial lipoma simulating pericardial effusion is presented. This tumor originated in left anterior aspect of pericardium. The tumor was measured 30x30x5cm in size and 2,200mg in weight. Total excision of the mass was accomplished by posterior lateral thoracotomy incision, resulting in complete cure. This is the first case of primary benign lipoma of the pericardium in literatures in our knowledge.
Autopsy ; Endocardium ; Heart ; Lipoma* ; Myocardium ; Pericardial Effusion* ; Pericardium ; Thoracotomy

No anstract available.
Magnetic Resonance Imaging* ; Spine*

No abstract available.
Cervix Uteri* ; Female ; Lymph Nodes* ; Neoplasm Metastasis* ; Risk Factors*

No abstract available.
Hyperlipidemias* ; Obesity* ; Risk Factors* ; Urolithiasis*

No abstract available.
Hyperlipidemias* ; Obesity* ; Risk Factors* ; Urolithiasis*

Constrictive pericarditis is caused by fibrosis of the pericardium leading to decrease in ventricular compliance. The diagnosis is often delayed due to nonspecific signs and symptoms. The authors experienced eight cases of constrictive pericarditis detected on chest CT scan while being treated for considerable length of time under the clinical impressions of intrathoracic tumor, tuberculous pleural effusion, liver cirrhosis, etc. Constrictive hemodynamics of these patients were confirmed by echocardiogram and cardiac catheterization. Among them five cases were due to tuberculosis. In four cases with pathologically proven tuberculous granuloma, the pericardium was markedly thickened and intensely enhanced. Associated pericardial effusion (n=3), and mediastinal lymphadenitis (n=3) were present, but pericardial calcifications were not seen. On the other hand, the fibrosis group (n=3) displayed mild pericardial thickening. All the three patients showed pericardial calcifications, mild or absent enhancement of pericardium, but no mediastinal lymphadenitis. The cardiovascular changes such as inferior or superior vena caval distension, left ventricular deformity, interventricular septum angulation, and biatrial enlargements were more severe than those in patients with active granuloma. In patients with constrictive pericarditis with nonspecific signs and symptoms, CT scan is very helpful in making the diagnosis and can give informations about the evolution of the disease.
Cardiac Catheterization ; Cardiac Catheters ; Compliance ; Congenital Abnormalities ; Diagnosis* ; Fibrosis ; Granuloma ; Hand ; Hemodynamics ; Humans ; Liver Cirrhosis ; Lymphadenitis ; Pericardial Effusion ; Pericarditis, Constrictive* ; Pericardium ; Pleural Effusion ; Tomography, X-Ray Computed ; Tuberculosis

Constrictive pericarditis is caused by fibrosis of the pericardium leading to decrease in ventricular compliance. The diagnosis is often delayed due to nonspecific signs and symptoms. The authors experienced eight cases of constrictive pericarditis detected on chest CT scan while being treated for considerable length of time under the clinical impressions of intrathoracic tumor, tuberculous pleural effusion, liver cirrhosis, etc. Constrictive hemodynamics of these patients were confirmed by echocardiogram and cardiac catheterization. Among them five cases were due to tuberculosis. In four cases with pathologically proven tuberculous granuloma, the pericardium was markedly thickened and intensely enhanced. Associated pericardial effusion (n=3), and mediastinal lymphadenitis (n=3) were present, but pericardial calcifications were not seen. On the other hand, the fibrosis group (n=3) displayed mild pericardial thickening. All the three patients showed pericardial calcifications, mild or absent enhancement of pericardium, but no mediastinal lymphadenitis. The cardiovascular changes such as inferior or superior vena caval distension, left ventricular deformity, interventricular septum angulation, and biatrial enlargements were more severe than those in patients with active granuloma. In patients with constrictive pericarditis with nonspecific signs and symptoms, CT scan is very helpful in making the diagnosis and can give informations about the evolution of the disease.
Cardiac Catheterization ; Cardiac Catheters ; Compliance ; Congenital Abnormalities ; Diagnosis* ; Fibrosis ; Granuloma ; Hand ; Hemodynamics ; Humans ; Liver Cirrhosis ; Lymphadenitis ; Pericardial Effusion ; Pericarditis, Constrictive* ; Pericardium ; Pleural Effusion ; Tomography, X-Ray Computed ; Tuberculosis