A2 D time, a time interval from aortic second heart sound to the D point of mitral valve echogram, was reported as a valuable index of the left ventricular relaxation in its early diastole. It was suggested, however, that A2D time is influenced by variable factors rather than single factor. This study was performed to evaluate the influences of several on the A2D time and to extend our understandings in A2D time. For this purpose, A2D time was measured in 4 groups whose hemodynamic states were different, i.e.31 normal subjects (group A), 32 patients with essential hypertension without decompensation (group B), 10 normotensive patients with clinically full blown congestive heart failure (group C), and 11 patients with hypertensive heart failure (group D), and the mean values of each group were compared between the groups. Concordantly systolic hemodynamic parameters were observed and the relationship of A2D time and each of these parameters were observed. A2D time was consistently influenced by the level of left ventricle impedance and it is well correlated with parameters representing left ventricular systolic performances. In hypertensive subiects, A2D time was increased before the deterioration of the left ventricular systolic function but shortened after clinical heart failure. These findings suggest that A2D time may be of value in longitudinal follow-up of the left ventricular function in the hypertensive patients even before the development of clinical heart failure.
Diastole ; Electric Impedance ; Heart Failure ; Heart Sounds ; Heart Ventricles* ; Hemodynamics ; Humans ; Hypertension ; Mitral Valve ; Relaxation ; Ventricular Function, Left

BACKGROUND: Several reports have demonstrated that TGFalpha and EGF are mitogenic for keratinocytes. Whenther its expression on epithelial tumors is a marker of malignancy or signifies an important step in the development of neoplasia is poorly understood. EGF receptors are also present in normal epidermis and epithelial tumors but their physiological roles are not yet understood. OBJECTIVE: Our purpose was to examine the staining patterns of TGFalpha, EGF and EGF receptors on the npithelial tumors of the skin, and to investigate kinetics of expression of EGF receptors. METHODS: We performed immunoperoxidase staining(ABC technique) with monoclonal anti-TGFalpha antibody, polyclonal anti-EGF antibody and polyclonal anti-EGF receptor antibody on the formalinfixed, paraffin-embedded tissue specimens of benign, premalignant and malignant skin tumors. RESULTS: The density of the expression of TGFalpha and EGF was not correlated with the degree of the malignancy of the epithelial tumors and is neither constant in any kind of the tumors. However the infiltrative type of basal cell carcinoma(BCC) is stronger that its solid type on the expression of TGFalpha and EGF. All benign tumors demonstrated a diffuse pattern within tumor lobules. pression of TGFalpha and EGF. All benign tumors demonstrated a diffuse pattern within tumor lobules. Focal TGFalpha immunostaining was seen in three of 10 squamous cell carcinomas(SCC) and four of 10 BCCs. TGFalpha immunostaining was absent from the outermost one to two layers of tumor lobules of all keratoacanthomas. The specimens which increased the expression of TGFalpha and EGF tended to decrease the expression of EGF receptor. CONCLUSION: These data suggest that the density of immunohistochemical expression of TGFalpha and EGF may be not dependent on the differentiation of tumor cells, and the pattern of immunohistochemical expression of TGFalpha can differentiate SCC from benign tumors such as keratoacanthoma. FGF receptor may be occupied by both of TGFalpha and EGF. With the receptors being occupied, a down regulation of the receptors may occur which results in decreased EGF receptor expression.
Down-Regulation ; Epidermal Growth Factor* ; Epidermis ; Keratinocytes ; Keratoacanthoma ; Kinetics ; Receptor, Epidermal Growth Factor* ; Receptors, Fibroblast Growth Factor ; Skin* ; Transforming Growth Factor alpha*

Eccrine spiradenoma is clinically characterized by a solitary, movable, tender nodule occurring most frequently on the ventral surface of the upper body. A striking symptom is paroxysmal pain. Occasionally multiple lesions may be present and may occur in a linear or zosteriform pattern. A 48-year-old female was seen with painful or tender, nomal skin colored, firm nodules distributed in a zosteriform pattern on the right thigh for 10 years, which had been slowly growing. The histopathological features were quite a characteristic of eccrine spiradenoma. We report a rare case of zosteriform network of eccrine spwadenoma occurred on the right thigh.
Female ; Humans ; Middle Aged ; Skin Pigmentation ; Strikes, Employee ; Thigh

Malignant fibrous histiocytoma, which is interesting because of its pleomorphic nature, is a rare soft tissue sarcoma possibly arising from histiocyte. The tumors are usually situated in the skin or subcutaneous tissues, especially of the extremities, but they may also involve deeper structures, such as the retroperitoneum or genital organs. Herin we report a case of malignant fibrous histiocytoma in the retroperitoneal space and discuss the pathologic and clinical features.
Extremities ; Genitalia ; Histiocytes ; Histiocytoma, Benign Fibrous ; Histiocytoma, Malignant Fibrous* ; Retroperitoneal Space ; Sarcoma ; Skin ; Subcutaneous Tissue

BACKGROUNDs: A retrospective study was performed to define objective radiologic parameters in diagnosing epiglottitis on soft-tissue lateral neck radiographic study. METHODS: Parameters of soft-tissue structures(epiglottis width, third vertebral body width, ratio of epiglottic width to third vertebral body width) in 30 adult patients compared with those of age and sex-matched controls with foreign body in throat whose radiographic reading was normal. RESULTS: Epiglottis width of more than 11mm, ratio of epiglottis width(EW) to the third vertebral body width(C3W) of more than 0.5 were, respectively, found to be 100% sensitive and specific in differentiating between patients with and without epiglottitis. CONCLUSION: These preliminary results suggest that EW/C3W ratio of more than 0.5, EW of more than 11mm, respectively, may be useful in the diagnosis of epiglottitis in adult patients.
Adult* ; Diagnosis* ; Epiglottis ; Epiglottitis* ; Foreign Bodies ; Humans ; Neck ; Pharynx ; Retrospective Studies

PURPOSE: To determine the plain film findings of acute neuropathic joint in diabetic foot. MATERIALS AND METHODS: Acute neuropathic joint in diabetic foot was considered when fragmentation of the articular ends of bone and subluxation of the affected joint developed within eight weeks after clinical onset of diabetic gangrene. Eight toes of six diabetics were satisfactory to our criteria. We analyzed plain radiographic findings of the affected joint and soft tissue, interval changes in follow-up radiographs, and deformities after healing. RESULTS: The time interval between clinical onset of gangrene and bone destruction ranged from 2 weeks to 4 weeks(mean 2.6 weeks). Plain radiographs showed fragmentation of the articular ends, subluxation, and soft tissue swelling of the metatarsophalangeal joint or interphalangeal joint. The significant feature of these patients was rapid progression of the lesions. Clinically, all patients had diabetic gangrene in affected toes, however, there was no evidence of osteomyelitis in our series. Amputation was done in 2 cases, and lesions in 3 of the remaining 4 cases were repaired spontaneously with regression of gangrene, leaving radiological residua such as pointed-end, tapered-end, and ball and socket deformity. CONCLUSION: Rapid disorganization of the joint with associated evidence of soft tissue gangrene in plain radiograph is believed to be valuable for the diagnosis of diabetic osteoarthropathy.
Amputation ; Congenital Abnormalities ; Diabetic Foot* ; Diagnosis ; Follow-Up Studies ; Gangrene ; Humans ; Joints* ; Metatarsophalangeal Joint ; Osteomyelitis ; Toes

This study was made to evaluate the effect of oral atenolol, a cardioselective beta-adrenergic blocking agent without intrinsic sympathomimetic activity, on left ventricular function in patient with essential hypertension. Atenolol, 100mg/day, was given to 11 hypertensive patients for 4 weeks, and its effects on arterial pressure, pulse rate, left ventricular dimensions and ejection phase indices of myocardial performance were examined by echocardiography. Echocardiographic studies were performed before treatment and after 4 weeks of atenolol therapy. Arterial pressure fell form 145/90 mmHg to 138/84mmHg after 4 weeks. Pulse rate fell significantly from 69/min to 58/min(p<0.05). Left ventricular end-diastolic and end-systolic dimensions and mean rate of circumferential fiber shortening(mVcf) did not change significantly. Ejection fraction increased significantly from 0.66 to 0.72(p=0.01). This results indicate that atenolol in the resting state has no depressant effect on left ventricular function in patients with essential hypertension.
Arterial Pressure ; Atenolol* ; Echocardiography ; Heart Rate ; Humans ; Hypertension* ; Ventricular Function, Left*

The aim of the spine fusion is to obtain the stability of the spine. Spinal fusion have been used for the treatment of tuberculosis and arrest of the progress of spinal deformity such as scoliosis. Nowadays the spine fusion is used often in conditions which present the instability; spondylosis, spondylolisthesis and the unstable postlaminectomy spine. Unilateral posterolateral fusion plus hemiposterior fusion were done only in the cases who had wide hemilaminectomy, while in rest of cases bilateral posterolateral fusion was indicated in this series. Fifty-two cases, treated with posterolateral lumber fusion during the period from June 1980 to Dec. 1985, were analysed clinically and radiologically and the following results were obtained. l. Among the 52 cases, 25 cases(48.1%) were male; and 27 cases(51.9%) were female; The youngest was 16 years of age and the oldest one was 63 years of age. Average age of the patient was 39.6 years. 2. Fifteen patients had spinal stenosis, 14 cases of spondylolisthesis, 11 cases of H.N.P., 6 cases of spondylolysis, 4 cases of tuberculous spondylitis and 2 cases of fracture-dislocation of lumbar spine. 3. As a method immobilization after operation, postoperatively hips spica cast was applied in 4 cases for 12 weeks, Norton-Brown back brace in 9 cases following 6 weeks of posloperative hip spica cast immobilization and Norton-Brown brace 39 cases following 2 weeks of postoperative bed rest. 4. In 41 cases bilateral posterolateral fusion was done, and in 11 cases unilateral posterolateral fusion plus hemiposterior fusion were done. The bony union was established within 4 months after bilateral posterolateral fusion in 37 cases and after unilateral posterolateral fusion in 9 cases. In 2 cases complete union was obtained within 6 months after fusion. 5. The union rate was 92.7% in bilateral posterolateral fusion and 90.9% in unilateral posterolateral fusion. There was no significant differences of the union rate between bilateral and unilateral fusion groups. Therefore, the unilateral posterolateral fusion is a suitable method in the treatment of mild spinal instability regardless of its causes. The procedure has benefits, such as short operation time, less blood loss, and less surgical burden to the patient.
Arthrodesis ; Bed Rest ; Braces ; Clinical Study ; Congenital Abnormalities ; Female ; Hip ; Humans ; Immobilization ; Male ; Methods ; Scoliosis ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylitis ; Spondylolisthesis ; Spondylolysis ; Spondylosis ; Tuberculosis

PURPOSE: To evaluate changes of pancreatic size with aging in control subjects and in non-insulin-dependent diabetic patients. MATERIALS AND METHODS: Two groups of non-insulin-dependent diabetic patients were examined; one had been treated with an oral hypoglycemic agent(n=59), and the other with insulin(n=56). The CT findings of 175 patients without clinical evidence of pancreatic disease were included as a normal control. RESULTS: In control subjects, pancreatic size and age correlated. The pancreas was smaller in non-insulin-dependent diabetics than incontrol subjects and smaller in insulin- treated non-insulin-dependent diabetics than in non-insulin treated patients. CONCLUSION: The pancreas was smaller in non-insulin-dependent diabetic patients than in control subjects within the same age range.
Aging ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Humans ; Pancreas* ; Pancreatic Diseases

BACKGROUND: Pravastatin, HMG-CoA reductase inhibitor, has been known to be the most effective drug in patients with hypercholesterolemia. We studied the effectiveness and side effects of this drug. METHODS: We studied twenty four patients(8 males, 16 females), with pravastatin 5mg bid for 8 weeks, whose fasting serum total cholesterol levels were higher than 240mg/dl on the first visit. Lipid profiles were checked at 2 weeks interval for 8 weeks and compared with baseline level individually. RESULTS: Among lipid profiles, pravastatin significantly decreased the total cholesterol from 282.8mg/dL to 224.5mg/dL(reduction rate, 21%), the LDL cholesterol from 197.2mg/dL to 143.8mg/dL(27%), the total cholesterol/HDL cholesterol ratio from 6.2 to 4.6(25%), and the LDL cholesterol/HDL cholesterol ratio from 4.1 to 2.7 (34%). These changes were statistically significant(p<0.05). Triglyceride and HDL cholesterol showed no significant changes compared to baseline levels during treatment. The clinical and laboratory findings after treatment did not show serious abnormalities except two patients who dropped out due to side effect such as constipation and skin eruption. CONCLUSION: Results from the present study show that short-term pravastatin therapy seems to be effective and safe in patients with hypercholesterolemia.
Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Constipation ; Fasting ; Humans ; Hypercholesterolemia ; Hyperlipidemias* ; Male ; Oxidoreductases ; Pravastatin* ; Skin ; Triglycerides