Giant cell myocarditis(GCM) is a rare inflammatory heart disease which is characterized by multinucleated giant cells and a granulomatous reaction. It usually progresses rapidly and results in a fatal course. We report a patient with giant cell myocarditis who was treated by cardiac transplantation. A 35-year-old male was admitted with dyspnea which had developed 4 months before. On echocardiography, the right and left ventricles were markedly dilated and severe global hypokinesia was noted. He was diagosed with dilated cardiomyopathy with secondary severe mitral regurgitation. His cardiac function deteriorated progressively. He underwent orthotopic heart transplantation. Grossly the heart was enlarged, weighing 420gm and round with a blunt apex. Both right and left ventricles were markedly dilated. There were numerous white patches, measuring up to 4cm, throughout the epi- and myocardium. Microscopically, extensive fibrosis and multiple exuberant granulomas with numerous scattered multinucleated giant cells were seen. Lymphocytes and eosinophils were also frequent. Coronary arteries were unremarkable. Neither microorganisms nor foreign materials were found. By serial endomyocardial biopsies of the transplanted heart, only mild perivascular lymphocytic infiltration was occasionally observed without any evidence of rejection or recurrence of giant cell myocarditis. The patient's postoperative course has been uneventful so far(postoperative 21 months). The etiology of GCM remains to be clarified, although various factors are suspected. No matter what the cause, our experience suggests that this grave disease might be treated well by heart transplantation.
Male ; Humans ; Biopsy

BACKGROUND AND OBJECTIVES: Empirical evidence is lacking on the cumulative disease burden of obesity and hypertension and its impact on cardiac function and exercise capacity. The purpose of this study was to determine whether the presence of obesity and hypertension together was associated with cardiac dysfunction and exercise capacity. SUBJECTS AND METHODS: Using a retrospective study design, medical records were reviewed for echocardiographic and treadmill exercise stress test data. Subjects were grouped according to four categories: normal control, obese, hypertensive, or obese and hypertensive. RESULTS: Obese, hypertensive persons showed significantly lower Ea and E/A ratio and greater E/Ea ratio, deceleration time, left ventricular (LV) mass, and LV mass index compared to their counter parts (normal control, obese and/or hypertensive) (all p<0.05), after controlling for age and sex. After controlling for age and sex, significant differences in exercise capacity indices were found, with the obese group having shorter exercise time, lower metabolic equivalents, and lower maximal oxygen uptake than the normal control, hypertensive, or both groups (all p<0.05). The hypertensive or obese and hypertensive group had greater maximal blood pressure compared with the normal control group (all p<0.001). Obese and hypertensive persons were approximately three times more likely to have diastolic dysfunction (odd ratio=2.96, p=0.001), when compared to the reference group (normotensive, non-obese, or hypertensive only persons). CONCLUSION: Diastolic dysfunction was associated with obesity and/or hypertension. The cumulative risk of obesity and hypertension and their impact on diastolic dysfunction which could be modifiable could reduce exercise capacity.
Blood Pressure ; Deceleration ; Echocardiography ; Exercise Test ; Humans ; Hypertension* ; Medical Records ; Metabolic Equivalent ; Obesity* ; Oxygen ; Retrospective Studies

In the article, the 3rd author's affiliation was misspelled.

The role of nitric oxide (NO) in the ocular surface remains unknown. We investigated the conditions leading to an increase of NO generation in tear and the main sources of NO in ocular surface tissue. We evaluated the dual action (cell survival or cell death) of NO depending on its amount. We measured the concentration of nitrite plus nitrate in the tears of ocular surface diseases and examined the main source of nitric oxide synthase (NOS). When cultured human corneal fibroblast were treated with NO producing donor with or without serum, the viabilities of cells was studied. We found that the main sources of NO in ocular surface tissue were corneal epithelium, fibroblast, endothelium, and inflammatory cells. Three forms of NOS (eNOS, bNOS, and iNOS) were expressed in experimentally induced inflammation. In the fibroblast culture system, the NO donor (SNAP, S-nitroso-N-acetyl-D, L-penicillamine) prevented the death of corneal fibroblast cells caused by serum deprivation in a dose dependent manner up to 500 micrometer SNAP, but a higher dose decreased cell viability. This study suggested that NO might act as a doubleedged sword in ocular surface diseases depending on the degree of inflammation related with NO concentration.
Animals ; Apoptosis/drug effects/physiology ; Aqueous Humor/metabolism ; Blood Proteins/pharmacology ; Cell Survival/drug effects/physiology ; Cells, Cultured ; Epithelium, Corneal/*cytology/*enzymology ; Fibroblasts/cytology/enzymology ; Humans ; Nitric Oxide/biosynthesis/*physiology ; Nitric Oxide Donors/pharmacology ; Nitric Oxide Synthase/metabolism ; Nitric Oxide Synthase Type I ; Nitric Oxide Synthase Type II ; Nitric Oxide Synthase Type III ; Penicillamine/*analogs & derivatives/pharmacology ; Peroxynitrous Acid/biosynthesis ; Rabbits ; Tears/metabolism ; Uveitis/metabolism

The role of nitric oxide (NO) in ocular surface diseases remains unknown. We investigated the conditions leading to increase NO generation in tears and the main sources of ocular surface tissue. We evaluated the possibility of a dual action (cell survival or cell death) depending on the amount of NO. The concentration of nitrite plus nitrate, the stable end-product of NO, was measured in the tears of various ocular surface diseases. We also examined the main source of nitric oxide synthase (NOS) using immunohistochemical staining & Western blot analysis. When cultured human corneal fibroblasts were treated with NO producing donor with or without serum, the viability of cells was studied. We found that sources of NO in ocular surface tissue primarily included corneal epithelium, fibroblasts, endothelium and inflammatory cells. Three forms of NOS (eNOS, bNOS, & iNOS) were expressed in experimentally induced inflammation. Cell death by NO revealed TUNEL positive staining, however in the EM finding, this NO specific cell death was an atypical necrosis showing perinuclear large vacuolization and mitochondrial swelling. In the fibroblasts culture system, the NO donor (SNAP, S-nitroso-N-acetyl-D, L-penicillamine) prevented the death of corneal fibroblasts caused by serum deprivation in a dose dependent manner up to 500 m SNAP, although a higher dose decreased cell viability. This study suggested that NO might act as a double-edged sword in ocular surface disease depending on the degree of inflammatory condition related with NO concentration.
Animal ; Cells, Cultured ; Cornea/metabolism ; Eye Diseases/*physiopathology ; Human ; Nitric Oxide/*metabolism ; Tears/metabolism

PURPOSE: The purpose of this study was to report medical care activities of Disaster Medical Assistance Team (DMAT) and medical facilities that responded to the Goyang Bus Terminal fire on May 26, 2014, and to draw improvement of the current disaster medical response system. METHODS: We retrospectively reviewed emergency medical service (EMS) run sheet and medical records of patients who visited the emergency department the day of the fire. We also interviewed the officials involved in disaster response. RESULTS: A total of 73 patients participated in this study. Among them, 9 were classified as Emergency, 60 as Non-Emergency, and 4 as Death on arrival (DOA). Fifty one patients visited the nearest hospital, and 17 patients were transported by EMS. DMAT arrived at the scene in 58 minutes, however there was little medical activity. CONCLUSION: Initial Triage and distribution of patients was rather inadequate and DMAT arrived late. For the future, we recommend constant training of the paramedics and leaders of 119, and to mend DMAT requesting and response system.
Allied Health Personnel ; Disasters* ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Fires* ; Humans ; Mass Casualty Incidents ; Medical Assistance ; Medical Records ; Retrospective Studies ; Triage

A 67-year-old male visited Pusan Veterans Hospital due to general weakness and weight loss for 6 months. Physical examination showed non-tender 4 finger breaths sized splenomegaly and both inguinal and cervical lymphadenopathy. The white blood cell count was 25,300/uL with 91% morphologically mature lymphocytes. Bone marrow aspirate revealed hypercellularity with 74.5% lymphocytes morphologically similar to peripheral lymphocytes. The immunophenotpying study of lymphocytes displayed the phenotype of CD19(+), CD20(+), HLA-DR(+), sIg(+) but CD5(-). We concluded that this patients's diagnosis is CD 5 negative B-cell chronic lymphocytic leukemia.
Aged ; B-Lymphocytes* ; Bone Marrow ; Busan ; Diagnosis ; Fingers ; Hospitals, Veterans ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell* ; Leukocyte Count ; Lymphatic Diseases ; Lymphocytes ; Male ; Phenotype ; Physical Examination ; Splenomegaly ; Weight Loss

PURPOSE: To evaluate the CT findings of pulmonary tuberculosis in patients with diabetes mellitus (MD),according to the diabetic control state. MATERIALS AND METHODS: We retrospectively studied 34 cases of pulmonarytuberculosis accompanied by DM. We divided the right lung three lobes and ten segments and the left into two lobesand eight segments and analyzed CT findings of bronchogenic spread, cavitary lesion, ill-defined nodule, lobularconsolidation, lobar and segmental consolidation, atelectasis, interlobular septal thickening, fibrotic band, andassociated findings such as lymph node enlargement, pleural effusion and empyema. We also tried to determine thetypical CT findings of pulmonary tuberculosis according to diabetic duration and controlled state of DM focusingby FBS 160 and HbA1C 8.0. RESULT: Among 34 CT scans, bronchogenic spread was seen on 29 (85.3%), cavitary lesionon 26 (76.5%), ill-defined nodules on 11 (32.4%), lobular consolidation on 14 (41.2%), lobar and segmentalconsolidation on 12 (35.3%), atelectasis on four (14.7%), and fibrotic band on eight (23.5%). Multiple cavitieswere present in 76.9% of total cavitary lesions, and consolidation with bronchogenic spread in 75%; associatedfindings were as follows: lymph node enlargement (n=1), pleural effusion (n=10), empyema (n=2), and pericardialeffusion (n=2). In 46.7% of cases, general tubercular lesions were in an unusual location, but among cases ofsecondary pulmonary tuberculosis, 73.9% of lesions were in the usual location. More lobular consolidation was seenin patients with less than FBS 160 on admission, and this result was statistically significant (p<0.05); CTfindings did not, however, differ according to diabetic duration and HbA1C. CONCLUSION: In patients with DM,general fubercular lesions were found infrequently, but in secondary tubereulosis, multiple cavitary lesions-inthe usual location-were very frequent. In patients with DM, CT findings of pulmonary tuberculosis did not varyaccording to the diabetic control state, except that in patients with less than FBS 160 on admission, there was agreater degree of lobular consolidation.
Diabetes Mellitus* ; Empyema ; Humans ; Lung ; Lymph Nodes ; Pleural Effusion ; Pulmonary Atelectasis ; Retrospective Studies ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary*

Endovascular aneurysm repair (EVAR) is a safe alternative to open surgical repair for an abdominal aortic aneurysm. However, unfavorable aortic anatomy of the aneurysm has restricted the widespread use of EVAR. Anatomic limitation is most often related to characteristics of the proximal neck anatomy. In this report, we described a patient with a severely angulated proximal neck who underwent EVAR, but required repeat intervention because of thrombotic occlusion of stent graft limbs.
Aneurysm ; Aortic Aneurysm, Abdominal* ; Blood Vessel Prosthesis* ; Extremities* ; Humans ; Neck* ; Stents*

BACKGROUND: Coronary artery bypass grafting(CABG) has been established as an effective treatment modality in improving the symptoms of ischemic heart disease as well as in preventing sudden death. Since the relatively wide use of arterial grafting in the 80's, an improvement in long term patency rates compared with saphenous vein grafting has been suggested. We have been using multiple arterial grafts since 1998, and we attempted to compare our early results with those of saphenous vein grafting. MATERIAL AND METHOD: Out of the 355 patients that received CABG at our center between June,1998 and May,1999, 153 patients that used cardioplegia were reviewed. 76 had received single arterial graft(Group I) and 77 had received more than 2 arterial grafts(Group II). Preoperative clinical data, ecohocardiography, and angiographic studies were analyzed retrospectively. RESULT: Preoperatively, there were statistically significant differences between Group I and Group II with respect to age and smoking history. There was one early postoperative mortality in each group. The number of anastomoses constructed per patient showed a statistical difference. There were no other differences in operative and postoperative results. CONCLUSION: Even in our learning period, there was no difference in our early results between arterial grafting and saphenous vein grafting. These early results suggest that arterial grafting may afford patients as improving in late survival. Futhermore, these results suggest that complete arterial revasularization may serve to prolong life expectancy.
Coronary Artery Bypass* ; Coronary Vessels* ; Death, Sudden ; Heart Arrest, Induced ; Humans ; Learning ; Life Expectancy ; Mortality ; Myocardial Ischemia ; Retrospective Studies ; Saphenous Vein ; Smoke ; Smoking ; Transplants*