Microangiography is a very effective method in evaluating morphological changes of small vessels not onlybecause it shows subtle changes in microvasculature but also shows whole length of the vessels. Reccently many experimental studies on microagniography of normal and injured tissues are reported, but there's no report on microangiography of artificially induced cancer tissue. Authors artificially induced breast carinoma in rats withintravenous infusion of carcinogenic substance, N-methyl-N-Nitrosourea, and microangiography was done to evaluate vascularity and morphological changes of vessels of the cancer tissue. The results are as follows; 1.Distribtution of the tumor vessels showed tendency to form bolules. 2. Overall tumor vascularity was slightly hypervascular. 3. Variable sized, parallell arraged, tumor vessels surrounded the boundary of the lobules whilemore small vessels invaginated to the center of lobules in tortuous or straight fashion. 4. In overall, peripherayof the lobule was more vascular than center. 5. There was no evidence of cental tumor necrosis, and findings of extravasation of dye or venous lake formation were minimal. 6. Pathologically, the tumor tissue was well differentiated adenocarcinoma with tendency of lobule formation.
Adenocarcinoma ; Animals ; Breast Neoplasms ; Breast ; Lakes ; Methods ; Methylnitrosourea ; Microvessels ; Necrosis ; Rats

A 43-year-old female patient with a congenital right coronary artery to right atrial fistula presented as congestive heart failure and aortic valve infective endocarditis. The diagnosis was made on the basis of echocardiography, especially TEE and confirmed by tight heart catheterization & aortography. She underwent aortic valve replacement due to severe aortic valve regurgitation with vegetations, fistulectomy and coronary aneurysmorrhaphy. The postoperative course was uneventful. She was treated with antibiotics because of infective endocarditis for 6 weeks. At present she remains well and visits out patient clinic regularly for oral anticoagulation without problem.
Adult ; Anti-Bacterial Agents ; Aortic Valve* ; Aortography ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vessels ; Diagnosis ; Echocardiography ; Endocarditis* ; Estrogens, Conjugated (USP)* ; Female ; Fistula ; Heart Failure* ; Humans

BACKGROUND: Significant aortic stenosis of various underlying etiologies presents with similar clinical characteristics and is usually treated with aortic valve replacement. We performed a clinical study to evaluate the clinical characteristics, changes of echocardiographic parameters before and after aortic valve replacement in adult aortic stenosis patients. METHODS: From January 1991 through December 1995, 159 patients underwent aortic valve replacement at Sejong General Hospital. Sixty-two cases(39%) of those patients were pure or predominant aortic stenosis. We observed the clinical characteristics, etiology, operative procedure, perioperative complication and mortality, And we observed the changes of echocardiographic parameters such as mean and peak pressure gradients at aortic valve, ejection fraction, systolic and diastolic left ventricular internal dimensions, left ventricular wall thickness, left ventricular mass index retospectively at preoperative and postoperative periods regularly within 1 month, 1 yr, 3 yrs after operation(mean follow up period : 16 months, 1-36 months). RESULTS: 1) The age of patients ranged from 31 to 71 years(mean 55+/-11), and 60%(37 cases) of them were men. 2) Regarding underlying heart disease, the most common etiology of aortic stenosis was rheumatic valvular heart disease(32 cases, 52%), followed by congenital bicuspid aortic valve(16 cases, 25%) and degenerative change(14 cases,23%). 3) 44 cases(77%) of the patients had dyspnea,12 cases(19%) had chest pain, and 5 cases(8%) had history of syncope at the time of operation. Asymptomatic patient was only 1 case. 4) Seven patients(11%) had associated coronary artery disease, and only 1 case(about 2%) underwent concomitant coronary bypass surgery. 5) Post-operative complications which developed within 1 month were bleedings(8 cases, 13%), arrhythmias(7 cases, 11%) and infections(4 cases, 6%). After 1 month, bleedings related with anticoagulation were most common(7 cases, 11%). Other complications were hemolytic anemia(1 case), and aortic dissection(1 case). There was one surgery related mortality(2%) which happened during operatin due to myocardial ischemia. 6) The size of implanted prosthetic valves ranged from 19 to 25mm(mean 22+/-2mm). Larger valves(23-25mm) showed lower peak(p=0.839) and mean pressure gradients(p=0.019) than smaller valves(19-21mm). 7) We observed that peak and mean pressure gradient, left ventricular internal dimension, and left ventricular mass index had decreased significantly after aortic valve replacement. 8) The average preoperative functional class(2.3) had improved significantly at 1 month after surgery(1.2), and 1 year after surgery(1.0). CONCLUSIONS: In our series, the most common etiology of aortic stenosis was rheumatic valvular disease(52%). The incidence of combined coronary artery disease was 11%, lower than other reports. And only 1 case(2%) underwent concomitant coronary artey bypass graft surgery. The average size of implanted valves was 22mm, and the larger size had lower transaortic peak and mean pressure gradients after operation. The most common perioperative complication was bleeding and mortality rate was about 2%. Echocardiography was useful for evaluation of postoperative changes, such as transaortic peak and mean pressure gradient, left ventricular internal dimension and left ventricular mass index.
Adult* ; Aortic Valve Stenosis* ; Aortic Valve* ; Bicuspid ; Chest Pain ; Coronary Artery Disease ; Echocardiography ; Follow-Up Studies ; Heart ; Heart Diseases ; Hemorrhage ; Hospitals, General ; Humans ; Incidence ; Male ; Mortality ; Myocardial Ischemia ; Postoperative Period ; Surgical Procedures, Operative ; Syncope ; Transplants

OBJECTIVE: Systemic embolism related with left atrial thrombi is a well known complication of percutaneous ballon valveloplasty of the mitral valve stenosis. The presence of left atrial thtombi is believed to be a contraindication to balloon valvuloplasty. The purpose of this study was to determine whether balloon valvuloplasty is possible in mitral stenosis patients with left atrial thrombi after oral anticoagulation therapy. METHODS: We studied 13 consecutive patients(12 : female, 1 : male, mean age : 44+/-11) who had mitral stenosis and left atrial appendage thrombi by serial transesophageal echocardiography before balloon valvuloplasty of the stenotic mitral valve from May 1995 to January 1997. We started oral anticoagulation in those 13 patients with mitral stenosis and left atrial appendage thrombi to keep the INR 2-3. Regular follow up was performed by transesophageal echocardiagraphy to determine whether the left atrial appendage thrombi are resolved. Patients underwent percutaneous balloon valvuloplasty after complete resolution of left atrial appendage thrombi. RESULTS: 9 patients(69.2%) underwent balloon valvuloplasty after complete resolution of left atrial appendage thrombi with oral anticoagulation for average 6 months. Two (15.4%) patients had normal sinus rhythm. Three patients had coronary A-V fistular due to neovascularization to left atrial appendage thrombi. In four patients, oral antiocoagulation failed to resolve the left atrial appendage thrombi and they underwent balloon valvuloplasty under TEE guide with special caution to avoid systemic embolization. There were no complications such as systemic embolization in those 4 patients. CONCLUSION: Left atrial appendage thrombi in mitral stenosis could be resolved in high proportion(69.2%) by oral anticoagulation therapy. Percutaneous mitral balloon valvuloplasty could be a safe and effective treatment modality despite of the presence of left atrial appendage thrombi after adequate oral anticoagulation therapy.
Atrial Appendage* ; Balloon Valvuloplasty ; Echocardiography, Transesophageal ; Embolism ; Female ; Follow-Up Studies ; Humans ; International Normalized Ratio ; Male ; Mitral Valve ; Mitral Valve Stenosis

A 72-year-old man who had suffered several episodes of syncope was diagnosed as having hyperinsulinemic hypoglycemia. Although imaging studies and percutaneous transhepatic portal venous sampling did not reveal the existence of any tumors in the pancreas, distal pancreatectomy was performed because the possibility of a small pancreatic endocrine tumor could not be completely rejected. External examination of the surgically removed pancreas did not reveal any tumors. Microscopically, the pancreas exhibited diffuse islet cell hyperplasia without nesidioblastosis. The patient remains euglycemic and has tolerated 24-hour fasting without any medication for a period of 10 months after the operation.
Aged ; Case Report ; Human ; Hyperinsulinemia/etiology* ; Hyperplasia ; Hypoglycemia/etiology* ; Islets of Langerhans/surgery ; Islets of Langerhans/pathology* ; Male ; Pancreatectomy/methods ; Treatment Outcome

Gastritis cystica polyposa (GCP) is a rare lesion characterized by hyperplastic and cystic dilatation of the gastric mucosal glands infiltrating into the underlying submucosa. In most cases, it develops in patients who have undergone a gastroenterectomy, but can occasionally be found in an unoperated stomach. GCP may present as a submucosal tumor or polyp, and rarely as a giant gastric mucosal fold. We experienced a case of GCP that presented as a hyperplastic polyp, and it was unrelated to any gastric surgery. Upper endoscopy revealed the presence of a subpedunculated polyp in the posterior wall of the antrum. The lesion was successfully removed by endoscopic mucosal resection and diagnosed as a GCP.
Dilatation ; Endoscopy ; Gastritis ; Humans ; Polyps ; Stomach

PURPOSE: To determine the therapeutic effect of stent grafting in the treatment of saccular aneurysms of the peripheral artery. MATERIALS AND METHODS: Eight patients [M:F=7:1 ; age:22-72(mean, 47) years] with ten saccular aneurysms of the peripheral artery who underwent stent grafting were included in this study. The etiologies of the aneurysms were Behcet's disease in four patients, atherosclerosis in two, trauma in one and 'uncertain' in one; they were located at the common iliac artery in three cases, the renal artery in two, the subclavian artery in two, the anterior tibial artery in one, and at both the proximal and distal anastomotic sites of the common carotid-internal carotid bypass graft. In two cases, stent grafting and coils were used to embolize collateral vessels. Post-procedural evaluations involved the use of computed tomography, Doppler sonography and magnetic resonance imaging. The mean follow-up period was 14.7(range, 4-36) monthes. RESULTS: The saccular aneurysms were successfully excluded in all cases. Post-procedural angiography revealed minor leakage in two cases, but at follow-up these showed complete exclusion. Follow-up evaluation also revealed complete resolution in five cases and complete thrombosis accompanied by size reduction in three. In patients with aneurysms of the proximal and distal ends of a common carotid-internal carotid bypass graft, total occlusion occurred in the stent graft. CONCLUSION: Percutaneous stent-graft insertion is an effective and convenient method for the treatment of peripheral arterial aneurysms, and is an alternative to vascular surgery.
Aneurysm* ; Angiography ; Arteries ; Atherosclerosis ; Blood Vessel Prosthesis ; Follow-Up Studies ; Humans ; Iliac Artery ; Magnetic Resonance Imaging ; Renal Artery ; Subclavian Artery ; Thrombosis ; Tibial Arteries ; Transplants

Case 1: A 39-year-old man underwent orthotopic heart transplantation on November 1994 for dilated cardiomyopathy. His postoperative course was unevenful and medications included daily cyclosporin A, Immuran and prednisone. On December 13.1994, he developed cough and sore throat. Chest radiographs revealed multiple patch growing lesions. Sputum fungus culture revealed Aspergillus Fumigatus. The patient was treated with daily infusion of amphotericin B. He remains well without evidence of relapse of Aspergillus, Case 2: This 39-year-old man had undergone orthotopic heart transplantation on November 16 1994 for dilated cardiomyopathy. In December 7.1994. he developed recurrent syncope. Chest radiographs revealed fungus ball like lesion on right lung field. On open lung biopsy and wedge resection of the mass was performed. Aspergillosis and CMV infection was demonstrated in the biopsy specimen. The patient was treated with conventional amphotericin B therapy for over 7weeks and Ganciclovir for over 2weeks. At the end of therapy chest X-ray showed only small residual scar in the area of previous mass.
Adult ; Amphotericin B ; Aspergillosis* ; Aspergillus ; Aspergillus fumigatus ; Azathioprine ; Biopsy ; Cardiomyopathy, Dilated ; Cicatrix ; Cough ; Cyclosporine ; Fungi ; Ganciclovir ; Heart Transplantation* ; Heart* ; Humans ; Lung ; Pharyngitis ; Prednisone ; Radiography, Thoracic ; Recurrence ; Sputum ; Syncope ; Thorax

OBJECTIVES:We performed a prospective observation for the patients with chronic nonvalvular atrial fibrillation who underwent electrical cardioversion after failed pharmacological cardioversion with amiodarone. The aim of this study was to look at the immediate sinus conversion rate, the maintenance rate of sinus rhythm at long-term follow-up, and the clinical and echocardiographic parameters that influence on the rate of immediate sinus conversion and maintenance of sinus rhythm. At simultaneously, we intended to evaluate the efficacy of electrical cardioversion for the patients with chronic nonvalvular atrial fibrillation. METHODS: After anticoagulation therapy with coumadine for four weeks before cardioversion, we tried pharmacological cardioversion with amiodarone first. Failed cases included in this study. The direct current cardioversion was performed under transesophageal echocardiography monitoring to exclude the left atrial thrombus and to measure various echocardiographic parameters. After successful sinus cardioversion, we prescribed amiodarone with maintenance doses and coumadine at least 4 weeks. Transthoracic echocardiography was performed before cardioversion and one day, one month, 3 months, 6 months, and 9 months after sinus conversion. The minimum duration of atrial fibrillation was one month before the trial of pharmacological cardioversion. RESULTS: 1) The total number of patients was forty three (male: 28, female: 15, average age: 60+/-9). The initial success rate of sinus conversion was 88 %. 2) The maintenance rate of sinus rhythm with maintenance dose of amiodarone was 52 % after 9 months follow-up. 3) The direct current cardioversion was performed to 10 patients among 17 patients who recurred atrial fibrillation after sinus conversion. Among 10 patients, 5 patients of them were converted to sinus rhythm and maintained sinus rhythm after 9 months follow-up. 4) The initial success rate of sinus conversion was significantly higher in patients with lone atrial fibrillation compared with those patients with other associated heart disease (100 % vs. 83 %, p < 0.05), but the long-term maintenance rate of sinus rhythm was not influenced by the presence of associated disease. 5) The duration of atrial fibrillation before cardioversion was shorter in patients who were naintained sinus rhythm than that of those who were recurred atrial fibrillation. 6) The initial energy requirement at sinus conversion was lower in the patients who were maintained sinus rhythm than that of those who were recurred atrial fibrillation at 9 months follow-up. CONCLUSIONS: Direct current cardioversion was an effective treatment modality for patients with chronic nonvalvular atrial fibrillation after failure of pharmacological cardioversion with amiodarone.
Amiodarone ; Atrial Fibrillation* ; Echocardiography ; Echocardiography, Transesophageal ; Electric Countershock* ; Female ; Follow-Up Studies* ; Heart Diseases ; Humans ; Prospective Studies ; Thrombosis ; Warfarin

Segmental defects of the tibia after open fractures, sepsis and a tumor surgery are among the most difficult and challenging clinical problems. Tibia defects in these situations are complicated with infection and are resistant to conventional bone grafting techniques. The aim of this study is to report the results and discuss the role of free flap followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of tibia defects. Ten patients had free flap followed by IVFT in the period 1989~2007. Mean age was 25.3 years. The patients were followed for an average of 3.4 years. All flaps were survived including 1 case with venous thrombosis requiring additional surgery. The average time to union of proximal and distal end was 5.2 months, 8.2 months, each other. All transposed fibula were viable at last follow-up. IVFT offers the advantages of a vascularized graft. In patients with large bone and soft tissue defects combined with infection, free flap followed by IVFT is an useful and reliable method without microvascular anastomosis.
Bone Transplantation ; Fibula ; Follow-Up Studies ; Fractures, Open ; Free Tissue Flaps ; Humans ; Sepsis ; Tibia ; Transplants ; Venous Thrombosis