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

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*

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

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

PURPOSE: We performed invasive thermometry to verify the elevation of local temperature in the liver during hyperthermia. MATERIALS AND METHODS: Three 40-kg pigs were used for the experiments. Under general anesthesia with ultrasonography guidance, two glass fiber-optic sensors were placed in the liver, and one was placed in the peritoneal cavity in front of the liver. Another sensor was placed on the skin surface to assess superficial cooling. Six sessions of hyperthermia were delivered using the Celsius TCS electro-hyperthermia system. The energy delivered was increased from 240 kJ to 507 kJ during the 60-minute sessions. The inter-session cooling periods were at least 30 minutes. The temperature was recorded every 5 minutes by the four sensors during hyperthermia, and the increased temperatures recorded during the consecutive sessions were analyzed. RESULTS: As the animals were anesthetized, the baseline temperature at the start of each session decreased by 1.3degrees C to 2.8degrees C (median, 2.1degrees C). The mean increases in temperature measured by the intrahepatic sensors were 2.42degrees C (95% confidence interval [CI], 1.70-3.13) and 2.67degrees C (95% CI, 2.05-3.28) during the fifth and sixth sessions, respectively. The corresponding values for the intraperitoneal sensor were 2.10degrees C (95% CI, 0.71-3.49) and 2.87degrees C (1.13-4.43), respectively. Conversely, the skin temperature was not increased but rather decreased according to application of the cooling system. CONCLUSION: We observed mean 2.67degrees C and 2.87degrees C increases in temperature at the liver and peritoneal cavity, respectively, during hyperthermia. In vivo real-time thermometry is useful for directly measuring internal temperature during hyperthermia.
Anesthesia, General ; Animals ; Fever* ; Glass ; Liver* ; Peritoneal Cavity ; Skin ; Skin Temperature ; Swine ; Thermometry ; Ultrasonography

We performed 1st day Tc-99m-sestamibi gated SPECT with dipyridamole/rest T1-201 SPECT and 2nd day 24 hour delay T1-201 SPECT/rest Tc-99m-sestamibi gated SPECT in 27 patients with coronary artery disease(24) or having chest pain(3). Stress and rest Tc-99m- sestamibi gated SPECT was acquired at 60min post-injection. A 4-point scoring system(0 to 3 for normal to absent tracer uptake) for 17 segments was used. Wall motion was scored on another 4 point scale(0 to 3 for normal to dyskinesia) in the lst day post-stress gated and the 2nd day rest gated SPECT. Post-stress gated SPECT showed wall motion abnormality in 94 segments(20%). Fifty-five segments among these 94 showed the same wall motion between post-stress and rest gated SPECT:i.e. 1-1: 23 segments, 2-2: 29 segments, 3-3: 3 segments. Re-maining 39 segments (41.5%) showed different wall motion between post-stress and rest Tc-99m-sestamibi gated SFECT. Twenty one segments with wall motion abnormality had normal perfusion(rest:15 segments, 24 hour delay: 6 segments) at either rest or 24 hour delay. Fifteen among these 21 segments showed persistent post-stress and the 2nd day rest wall motion abnormality(persistent stunning). However, in 6 segments with prolonged (1 hour after stress) stunning, abnormal wall motion did improve in the 2nd day rest Tc-99m-sestamibi gated SPECT(transient prolonged stunning). These 6 segments had normal perfusion at rest(n=4) or at 24 hour delay(n=2). Post stress wall motions showed significantly higher scores in persistent stunning than in prolonged transient stunning(P value<0.05). It was concluded that we could find stunned myocardium with gated Tc-99m-sestamibi SPECT at either post-stress or rest and that some myocardial walls of post-stress 1 hour gated SPECT did not show truly rest wall motion. So, we should be cautious if we use post-stress Tc-99m-sestamibi wall motion to assess rest wall motion.
Coronary Vessels ; Dipyridamole* ; Humans ; Myocardial Stunning ; Perfusion ; Thorax ; Tomography, Emission-Computed, Single-Photon*

Left ventricular(LV) diastolic filling is abnormal at rest in many patients with coronary arery disease, even in the presence of normal resting LV systolic function. To determine the effects of improved myocardial perfusion on impaired LV diastolic filling and to detect the most sensitive parameter to assess LV diastolic function, gated radionuclide ventriculography were performed in 14 patients with coronary artery disease before and after successful percutaneous transluminal coronary angioplasty(PTCA). All patients had no previous myocardial infarction and no abnormal wall motion in gated radionuclide and contrast ventriculography. The following results were obtained; 1) There were no significant differences in the parameters of LV systolic function, such as peak ejection rate(PER, time to peak ejection rate(TPER), ejection fraction(EF) after successful PTCA. 2) Peak filling rate(PFR) and time to peak filling rate(TPFR), indexes of LV diastolic function, had no significant changes after successful PTCA. 3) The percent contribution of late diastolic filling to stroke volume(%LDF/SV) decreased from 26.5+/-6.8% to 19.1+/-6.6%(p<0.005 by paired t-test). These data suggest that in many patients with angina and normal LV systolic function, impaired global diastolic filling is a reversible manifestation of impaired coronary flow, and percent contribution of late diastolic filling to stroke volume(%LDF/SV) can be a sensitive parameter to evaluate impaired LV diastolic filling in coronary artery disease.
Angina Pectoris* ; Angioplasty, Balloon, Coronary* ; Coronary Artery Disease ; Gated Blood-Pool Imaging ; Humans ; Myocardial Infarction ; Perfusion ; Radionuclide Ventriculography ; Stroke