Carotid endarterectomy is superior to medical treatment in preventing secondary stroke in patients with symptomatic high grade carotid stenosis. Transluminal angioplasty is a promising procedure as an alternative treatment for these patients. We report two cases of carotid angioplasty with Palmaz-Schatz stent in patients with carotid artery occlusive disease. One patient presented with decreased right visual acuity because of retinal arterial embolism. The angiogram demonstrated a discrete tight stenosis of right internal carotid artery carotid stenting with Palmaz-Schatz coronary stent was performed without any significant complications. The other patient presented with recurrent episodes of cerebral infarction, for which he had undergone left carotid erdarterectomy 3-years ago. The carotid angiogram demonstrated tight stenoses of both internal carotid arteries. Carotid artery stenting was performed at left and right internal carotid arteries without any complications. We suggest that stenting may be an effective and safe therapeutic alternative to surgical treatment in some selected patients with carotid artery occlusive disease.
Angioplasty* ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Cerebral Infarction ; Constriction, Pathologic ; Embolism ; Endarterectomy, Carotid ; Humans ; Retinaldehyde ; Stents* ; Stroke ; Visual Acuity

PURPOSE: Carnitine plays a key role in the oxidation of fatty acids by facilitating their transport. As very low birth weight(VLBW) infants receiving total parenteral nutrition(TPN) with limited oral intake are likely to be carnitine-deficient state, they require exogenous supplementation of carnitine, however, effects of it remains controversial. To demonstrate effects of parenteral camitine supplementation on fat metabolism, weight gain and clinical outcome. We analyzed plasma levels of biochemical markers, changes of weight, and incidence of complications in 23 VLBW infants receiving TPN. METHOD: We randomly assigned 23 VLBW infants(<32 wks of gestational age) receiving TPN to carnitine-supplemented(100mg/kg per day) group(n=10) and control(n=13). Plasma total (TC), free(FC), and acyl carnitine(AC) levels and serum cholesterol, triglyceride and free fatty acid levels were measured before and 2 weeks after carnitine supplementation. RESULT: Decrements in TC for 2 weeks were significantly lower in carnitine group(41.6umol/l->32.3umol/l) than control group(46.3umol/l->25.2umol/l)(p<0.05). Changes of FC and AC were similar in both groups. Levels of cholesterol and triglyreride were similar in both groups. Days of regaining birth weight were faster in carnitine group than control group(15.3+/-3.4 vs 20. 8+/-11.1 days)(p<0.05). Rate of weight gain for two weeks were significantly faster than carnitine group than control group(p<0.05). No significant differences in clinical outcome were found. CONCLUSIONS: Carnitine supplementation in VLBW infants receiving TPN has an supportive nutritional regimen in that it reduces decrement in carnitine level and facilitate weight gain.
Biomarkers ; Birth Weight ; Carnitine* ; Cholesterol ; Fatty Acids ; Humans ; Incidence ; Infant* ; Infant, Very Low Birth Weight* ; Metabolism ; Parenteral Nutrition, Total ; Parturition ; Plasma ; Triglycerides ; Weight Gain

Follicular adenoma is a benign encapsulated tumor with evidence of follicular cell differentiation. It is the most common thyroid neoplasm, usually solitary and has a well-defined fibrous capsule. We experienced a case of follicular adenoma occurring in congenital goiter and reported with the brief review of related literature
Adenoma* ; Cell Differentiation ; Goiter* ; Thyroid Neoplasms

Chylous ascites in neonates is an unusual and etiologically poor understood entity. We report a male newborn who suffered from abdominal distension and respiratory distress after birth. Paracentesis was performed and ascitic fluid was obstained. Analysis of the fluid revealed cell count (RBC 10,000/mm3, WBC 800/mm3: segmented form-72%, lymphocyte form- 28%), protein 4,100 mg/dl, glucose 57 mg/dl, cholesterol 53 mg/dl, triglyceride 28 mg/dl. Culture of ascitic fluid grew no bacteria. A plain film of abdomen and abdominal sonogram showed massive ascites. On the 4th hospital day, gastrografin enema showed microcolon and ileal atresia. On the 6th hospital day, ileocolostomy has been performed and operative findings sho- wed blind pouch in terminal ileum, massive inflammation and extensive adhesion on peritoneum. After operation, he gained weight by continuous gavage feeding. He discharged on the 36th hospital day.
Abdomen ; Ascites ; Ascitic Fluid ; Bacteria ; Cell Count ; Cholesterol ; Chylous Ascites* ; Diatrizoate Meglumine ; Enema ; Glucose ; Humans ; Ileum ; Infant, Newborn ; Inflammation ; Lymphocytes ; Male ; Paracentesis ; Parturition ; Peritoneum ; Triglycerides

Pheochromocytoma is a rare, but an important cause of surgically curable hypertension. Pheochromocytoma is a highly vascular tumor and not infrequently undergoes hemorrhagic necrosis and pseudocyst formation. Such cystic pheochromocytoma may be accompanied by shock and sepsis and commonly invade adjacent organs, in which cases its diagnosis and management may be difficult. Herein we present a case of adrenal cystic pheochromocytoma which was accompanied by sepsis and hypertension and mimicked pararenal abscess with a review of literatures.
Abscess ; Diagnosis ; Hypertension ; Necrosis ; Pheochromocytoma* ; Sepsis ; Shock

OBJECTIVES: This study was conducted to validate a simple, rapid and sensitive reverse-phase high-performance liquid chromatographic method with UV detector (HPLC-UV) and present the plasma level of di(2-ethylhexyl)phthalate (DEHP) in some Korean male workers. METHODS: HPLC-UV for quantification of plasma DEHP was validated by the following guideline from the Center for Drug Evaluation and Research (CDER)-calibration/standard curve, precision, accuracy and recovery. Plasma DEHP from 255 healthy Korean male workers aged from 30 to 60 years was analyzed by validated HPLC-UV method. RESULTS: The calibration curve over the range 0~150 microgram/liter for the plasma DEHP standard solution showed linearity(r2=0.999). The limit of detection (LOD) and limit of quantification (LOQ) of plasma DEHP were 5.22 microgram/liter and 15.81 microgram/liter, respectively. The accuracy and precision for 2.5 microgram/liter of DEHP were acceptable in CDER guideline on the second and third day but not first day, and those for 50 microgram/liter and 150 microgram/liter of DEHP were acceptable on all three days(Ed-confirm this addition). The distribution of plasma DEHP level was skewed to the left and ranged from 0 to 18.9 microgram/liter. The plasma DEHP level was lower than 10 microgram/liter for 98 % of subjects and lower than 5 microgram/liter for 85 %. The geometric mean and standard deviation of plasma DEHP were 0.4 +/- 1.5 microgram/liter. CONCLUSIONS: The HPLC-UV method for quantification of plasma DEHP was acceptable by CDER guideline. The plasma DEHP of 255 Korean male workers ranged from 0 to 18.9 microgram/liter and the distribution was skewed to the left.
Calibration ; Diethylhexyl Phthalate ; Drug Evaluation ; Humans ; Limit of Detection ; Male* ; Plasma*

In patients with chronic aortic regurgitation, irreversible left ventricular dysfunction, which is associated poor longterm prognosis, often develops before onset of severe symtoms. To determine whether evidence of left ventricular dysfunction could be detected before it appeared at rest, 48 patients with chronic aortic regurgition were studied using exercise echocardiography, and 25 patients were followed-up for 16.1 months in average by serial echocardiographical and clinical examination to evaluate the prognostic value of exercise-echocardiographic data. Among 41 patients with normal resting ejection fraction, left ventricular ejection fraction increased more than 5% with exercise(big up tri, DeltaEF> or =5%) in 14 patients (Group I), while in 27 patients ejection fraction change with exercise was less than normal (big up tri, DeltaEF <5%) (Group II). In the remaining 7 patients with subnormal resting ejection fraction, the exercise response was also subnormal (big up tri, DeltaEF<5%)(Group III). 1) There was no significant difference in radius-thickness ratio, ejection fraction at rest, work capacity, exercise duration and NYHA functional class between group I, II and III. But left ventricular internal dimension and wall stress were greater in group II than in group I. Group III had the largest left ventricualr internal dimension and stress. 2) Among the 15 patients with left vnetricular end-systolic dimension(LVESD) greater than 55mm, only one patient belong to group I. The other 14 patients belonged to group II(7 patients) and group III(7 patients). In contrast, in 22 patients with LVESD less than 50mm, 13 patients were group I, 9 patients were group II. In 26 patients with LVESD greater than 50 mm, only one patient showed normal exercise response, but the remaining 25 patients showed subnormal response. 3) Serial echocardiographic and clinical follow-up study for average 16.1 months showed group I the best, group II better than group III, group III the poorest clinical course and prognosis. Left ventricular functional status of group II patients seemed to be intermediate stage between group I and group III. 4) Total work duration and work capacity were more reduced in NYHA functional class II and III than in class I. But, using NYHA functional classification there were no differences in left ventricular internal dimension, ejection fraction at rest, exercise change in ejection fraction(big up tri, DeltaEF), wall stress and radius-thickness ratio between class I, II and III. According to the above results the classification based on the resting ejection fraction and big up tri, DeltaE.F., seemed to be useful for identification of patients with different clinical course and prognosis, especially in asymptomatic cases. The consideration of indices obtained by exercise-echocardiography, such as, LVESD, resting ejection fraction, big up tri, DeltaE.F. and wall stress, as well as the clinical status of patient, would be a useful guideline for follow-up and determining the optimal time for surgical intervention in patients with chronic aortic regurgitation.
Aortic Valve Insufficiency* ; Classification ; Echocardiography* ; Follow-Up Studies* ; Humans ; Prognosis ; Stroke Volume ; Ventricular Dysfunction, Left

To increase the survival area of the venous flap, we studied the arterialized venous flap in a rabbit ear model. The ears of 12 New Zealand white rabbits(n=24) were randomized into three groups, group A receiving arterio-venous anastomosis 14 days before the arterialized venous flap elevation; group B receiving bipedicled flap elevation 14 days before arterialized venous flap elevation; group C receiving no pretreatment before the arterialized venous flap elevation. Tc -pertechnetate scan was performed on all groups immediately after the arterialized venous flap elevation to evaluate the blood flow of the flap. The survival area of the flap was measured 14 days after the arterialized venous flap elevation. Average ratio of survival area was 92% in Group A, 88% in group B, which were comparatively higher than the 12% in group C. The entire flap was visualized in groups A and B on scan images, however, only the proximal area of the anterior and posterior marginal vein was visualized in group C. Flap survival pattern was similar to that of the scan image and the slope of time-activity curve of groups A and B was much steeper than that of group C. High survival rate of group A, which received the arterio-venous anastomosis as a pretreatment, may be due to the decrease of resistance of outflow during the 14 days. Anticipated mechanisms involved are, valve insufficiency due to high pressure arterial inflow, development of vascular collaterals in the flap, and opening of arteriovenous(A-V) shunt. Bipedicled flap elevation as a pretreatment may not effect on valves, however, may impair the sympathetic nerve and cause ischmic stimuli which in turn may develop vascular collaterals and make an opening of the A-V shunt.
Ear ; New Zealand ; Survival Rate ; Veins

Primary hyperparathyroidism is a relatively rare disease entity in Korea. It is characterized by severe skeletal and renal changes due to hypersecretion of parathyroid hormone and rarely shows peptic ulceration, hypertension, pancreatitis and impaired mentality. Primary hyperparathyroidism is most commonly caused by an adenoma, or hyperplasia and rarely by cancer of the parathyroid gland. The authors experienced a case involving a giant parathyroid adenoma in a 62-year-old female. The main symptoms were general weakness, anorexia, and constipation. We detected the giant parathyroid adenoma on the anterior neck by using preoperative localization methods, such as ultrasonography, and a thallium-technetium subtraction scan. A parathyroidectomy was carried out, and the parathyroid adenoma measured 5.0 cm 3.2 cm in size and 12 gm in weight. Clinical laboratory reports and symptoms were normalized with no sequelae. We report this case with a review of the literature related to sizes and weights of adenomas.
Adenoma ; Anorexia ; Constipation ; Female ; Humans ; Hyperparathyroidism, Primary* ; Hyperplasia ; Hypertension ; Korea ; Middle Aged ; Neck ; Pancreatitis ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Parathyroidectomy ; Peptic Ulcer ; Rare Diseases ; Ultrasonography ; Weights and Measures

This study was performed to evaluate the method of quantification of exercise thallium-201(201Tl) myocardial perfusion imaginges(M.P.I.) for the detection of coronary artery disease. Exercise 201 Tl MPI were interpreted objectively, reproducibly, quantitatively and easily by a computer assisted technique-Circumferential profile method. Exercise 201Tl MPI and redistribution images were taken in 32 patients(9 cases of post infarction angina, 13 cases of angina pectoris, 8 cases of atypical chest pain, 1 case of arrhythmial and 1 case of caridac neurosis). The results obtained were as follows: 1) Exercise 201Tl MPI of 3 cases of angina pectoris demonstrated transient perfusion defect in 5 cases, persistent perfusion defect in 2 cases, transient and persistent perfusion defect in 1 cases and no perfusion defect in 5 cases. Exercise 201Tl MPI of 9 case of post-infarction angina revealed persistent perfusion defect in 7 cases and transient and persistent perfusion defect in 2 cases. 201Tl MPI of 8 cases of atypical chest pain showed transient perfusion defect in 1 case and no perfusion defect in 7 cases. There was no perfusion defect in 1 case of arrhythmia and another case of cardiac neurosis. 2) The location of persistent perfusion defects in several views of 201Tl MPI in 9 case of postinfarction angina were consistent with those of infarction area in the electrocardiogram. 3) While visual analysis interpreted three cases to have no perfusion defect and one case to have transient perfusion defect respectively, objective analysis revealed that one of them had transient perfusion defect, another of them had persistent perfusion defect and the other had transient and persistent perfusion defect. 201Tl MPI of three cases could be done easily by circumferential profile method, which were difficult to interprete by subjective visual analysis. The results indicate that Exercise 201Tl MPI interpreted by circumferential profile analysis would be an objective, quantitative and noninvasive method for the detection of ischemic change and location in coronary artery disease.
Angina Pectoris ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Artery Disease ; Electrocardiography ; Infarction ; Myocardial Ischemia* ; Neurocirculatory Asthenia ; Perfusion