No abstract available.
Mitral Valve* ; Quinidine*

The clinical presentation of pheochromocytoma is variable. The classic symptoms are headache, diaphoresis, and tachycardia, with paroxysmal hypertension. Other less common cardiovascular manifestations, such as arrhythmias, angina pectoris, acute myocardial infarction, dilated cardiomyopathy, and acute heart failure, have been reported occasionally. We present the case of a middle-aged woman who had stress-induced cardiomyopathy with a left ventricular thrombus, due to the pheochromocytoma. The thrombus was embolized to the aorto-iliac bifurcation during hospitalization. We removed the thrombus by a catheter thromboembolectomy and performed a surgical left adrenalectomy. After the operation, all of her symptoms and the underlying diseases (hypertension, hyperglycemia, heart failure, dyslipidemia) resolved.
Adrenalectomy ; Angina Pectoris ; Arrhythmias, Cardiac ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Catheters ; Female ; Headache ; Heart Failure ; Hospitalization ; Humans ; Hyperglycemia ; Hypertension ; Myocardial Infarction ; Pheochromocytoma* ; Tachycardia ; Thrombosis*

BACKGROUND: The efficient collection of peripheral blood stem cells (PBSC) from donors who donate for allogeneic transplants as well as from patients undergoing autologous transplants is essential for a successful transplant. Recently, the Amicus cell separator and the associated MNC collection computer software program for PBSC collection were introduced in Korea. METHODS: Two apheresis machines (Amicus, Baxter Healthcare; and CS-3000 plus, Baxter Healthcare) were compared retrospectively. A total number of 144 procedures were performed on 14 donors and 28 patients. The pre- and post-apheresis complete blood cell (CBC) counts and the number of hematopoietic progenitor cells (HPC) were determined in the peripheral blood from the subjects. The CBC, HPC, CD34+ cell counts and the level of colony-forming unit-granulocyte-macrophages (CFU-GM) were measured in the PBSC product collected from both machines. RESULTS: Both machines collected a similar number of CD34+ cells from the donors and patients. On the other hand, the Amicus collected significantly more nucleated cells, MNCs, HPCs and CFU-GM in the patients with significantly less RBC contamination than those with CS-3000 plus. The decrease in the peripheral blood platelet counts in the donors and patients was more prominent after apheresis using the CS-3000 plus (117.00+/-42.75 x 10(3)/microliter, 61.22+/-43.62 x 10(3)/microliter) than Amicus (26.04+/-18.68 x 10(3)/microliter, 22.15+/-28.66 x 10(3)/microliter)(p<0.05). CONCLUSION: PBSC collection can be performed successfully using CS-3000 plus and Amicus. Amicus is superior to CS-3000 plus in avoiding apheresis-induced thrombocytopenia, and is expected to prevent unnecessary platelet transfusion.
Autografts ; Blood Cells ; Blood Component Removal ; Cell Count ; Delivery of Health Care ; Granulocyte-Macrophage Progenitor Cells ; Hand ; Hematopoietic Stem Cells ; Humans ; Korea ; Platelet Count ; Platelet Transfusion ; Retrospective Studies ; Stem Cells* ; Thrombocytopenia ; Tissue Donors

OBJECTIVE: Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). METHODS: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. RESULTS: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2+/-13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1+/-12.6 seconds and 63.3+/-14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2+/-13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2+/-41.7 seconds and 38.5+/-29.6 seconds for the first inflation and the second, respectively(P<0.05). CONCLUSION: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Animals ; Coronary Stenosis ; Electrocardiography* ; Heart ; Humans ; Hypertrophy ; Inflation, Economic ; Ischemia ; Ischemic Preconditioning ; Myocardial Infarction ; Myocardial Ischemia ; Reperfusion

This study is an analysis of types of patients and distribution of implant site and survival rate of Xive(R) implant. The following results on patient type, implant distribution and survival rate were compiled from 324 implant cases of 140 patients treated at the periodontal dept. of Yonsei University Hospital and G dental clinic between February 2003 and April 2006. 1. There are no dissimilarities between men and women, with patients in their 30, 40, 50s accounting for 80% of patients and accounted for 82% of implant treatments; the largest share of patients and implant treatments. 2. Mn. posterior area accounted for 57% of implant treatments followed by Mx. posterior area(29%), Mx. anterior area(8%) and Mn. anterior area(6%). 3. Partial edentulous patients treated by single crown and bridge-type prosthesis accounted for 96% and fully edentulous patient accounted for the remaining 4%. 4. The major cause of tooth loss is periodontal disease, followed by dental caries, trauma and congenital missing. 5. The distribution of bone quality for maxillae was 54.2% for typeIII, followed by 30.8% for type II, 15% for typeIV and 0% for typeI. As for mandible, the distribution was 63% for typeII, followed by 34% for typeIII, 2.5% for typeI and 0.5% for typeIV. 6. The distribution of bone quantity for maxillae was 55% for type C, followed by 35% for type B, 8% for type D and 2% for type A. As for mandible, the distribution was 60% for type B, followed by 32% for type C, 7% for type A and 0% for type D. 7. The majority of implants were those of 9.5-13 mm in length(95%) and regular diameter in width(82%). 8. The total survival rate was 98%. The survival rate was 97% in the maxillae region and 99% in the mandible region. 9. The survival rate in typeI was 83%, in typeII was 99%, in typeIII was 97% and in typeIV was 100%. As for the bone quantity, the survival rate in type A and D(100%) was most, followed by type B(99%) and type C(96%). The results showed that Xive(R) implant could be used satisfactorily compare for the other implant system. But we most to approach carefully in certain extreme condition especially with poor bone quality and quantity.
Crowns ; Dental Caries ; Dental Clinics ; Female ; Humans ; Male ; Mandible ; Maxilla ; Periodontal Diseases ; Prostheses and Implants ; Retrospective Studies* ; Survival Rate* ; Tooth Loss

Acute pulmonary embolism is considered a cardiovascular emergency and is one of the most important causes of morbidity and mortality in hospitalized patients. Tumor embolism is a rare and unique complication of malignancies, and detached thrombi or tumors may cause massive pulmonary embolism in patients with malignancies. The identification of the type of pulmonary embolism is critical because treatment and prognosis vary considerably. We report an unusual presentation of a tumor embolism that was misdiagnosed as a pulmonary thromboembolism in a young woman. The patient was initially treated with the anti-coagulants warfarin and aspirin, but her symptoms were aggravated after two months and she required emergency surgery. Histology revealed a pulmonary embolism due to metastatic chondrosarcoma. Following surgery, her condition deteriorated, and she did not survive. This case highlights the need to investigate the cause of pulmonary embolism should the patient not respond to anti-coagulatant therapy.
Aspirin ; Chondrosarcoma ; Emergencies ; Female ; Humans ; Neoplasm Metastasis ; Neoplastic Cells, Circulating ; Prognosis ; Pulmonary Embolism ; Warfarin

We compared the histological diagnosis and activity between the right and left lobes in order to assess the sampling variability in HBsAg(+) chronic liver diseases. From May 1987 to September 1991, we prospectively evaluated 23 patients(male 19, female 4, mean age: 32.0+8.8)with HBsAg(-) chronic liver diseases. (continue...)
Diagnosis* ; Female ; Humans ; Laparoscopy ; Liver Diseases* ; Liver* ; Prospective Studies

Flecainide acetate is a potent class Ic anti-arrhythmic drug with a major sodium channel-blocking effect. Flecainide toxicity can cause myocardial impairment and precipitate circulatory collapse, particularly in patients with renal failure. Electrical and hemodynamic deterioration during flecainide toxicity may not respond to conventional treatments. We report the successful management of flecainide toxicity using extracorporeal membrane oxygenation (ECMO), hemoperfusion, and bicarbonate administration maintaining alkalinity.
Extracorporeal Membrane Oxygenation ; Flecainide* ; Hemodynamics ; Hemoperfusion ; Humans ; Renal Insufficiency ; Shock ; Sodium ; Tachycardia, Supraventricular*

Fabry disease is a progressive X-linked disorder of glycosphingolipid metabolism caused by a deficiency of the alpha-galactosidase lysosomal enzyme. The partial or complete deficiency of the lysosomal enzyme leads to an accumulation of neutral glycosphingolipids in the vascular endothelium and visceral tissues throughout the body. In the heart, glycosphingolipids deposition causes progressive left ventricular hypertrophy (LVH). We report a case of Fabry disease which was suspected based upon two-dimensional echocardiographic finding of LVH. A 44-year-old man was admitted to evaluation of aggravated exertional dyspnea of two weeks duration. He had been diagnosed with end-stage renal disease of unknown etiology at age 41 followed by renal transplantation that year. He had been treated with oral immunosuppressive agents. On hospital day two, transthoracic echocardiography revealed concentric LVH. Left ventricular systolic function was preserved but diastolic dysfunction was present. Fabry disease was confirmed by demonstration of a low plasma alpha-galactosidase A (alpha-Gal A) activity. Analysis of genomic DNA showed alpha-Gal A gene mutation. The patient was diagnosed with Fabry disease.
alpha-Galactosidase ; Cardiomyopathies ; DNA ; Dyspnea ; Echocardiography ; Endothelium, Vascular ; Fabry Disease ; Genes, vif ; Glycosphingolipids ; Heart ; Humans ; Hypertrophy, Left Ventricular ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Kidney Transplantation ; Neutral Glycosphingolipids ; Plasma

BACKGROUND: Acute intracranial large-artery occlusions (AILAOs) are detected frequently and cause severe neurological disabilities. Most studies in this field do not focus on the natural history of AILAOs, but on the individual prognosis for each intervention. The aim of this study was to elucidate the clinical profiles and outcomes of AILAOs. METHODS: A consecutive series of patients hospitalized between January 2004 and October 2007 due to AILAO within 24 hours from onset were recruited. Based on a prospective stroke registry, their clinical profiles were collected. AILAO was defined as an intracranial internal carotid artery (ICA), middle cerebral artery (MCA), or basilar artery (BA) occlusion that could be confirmed by angiography, with relevant lesions on diffusion-weighted imaging (DWI). The modified Rankin Scale (MRS) score at 3 months and the recanalization rate within 14 days were recorded as outcomes. RESULTS: Among 1,047 patients with acute ischemic stroke who were examined within 24 hours of onset, 189 [18.1%; 101 men, 88 women; age 68.6+/-13.0 years (mean+/-SD); median National Institutes of Health Stroke Scale (NIHSS) score=11]. Occlusion sites were MCA M1, MCA M2, distal ICA, and BA in 99 (52.4%), 50 (26.5%), 20 (10.6%), and 20 (10.6%) of cases,respectively. Embolic sources were found in 103 (54.5%) cases. MRS scores were available for 184 (97.4%) of the patients, of which 78 had a favorable outcome (MRS: 0.2). Follow-up angiography was performed in 122 (64.6%) cases, with recanalization observed in 88 (72.1%) of these. Thrombolysis, occlusion site, presence of an embolic source, and initial glucose level were predictors of early recanalization (p<0.001). Recanalization status and initial NIHSS score were strongly correlated with a favorable outcome (p<0.005). CONCLUSIONS: This is the first report of the clinical profiles, outcomes, and their predictors in a cohort of Korean patients with AILAO.
Angiography ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Cohort Studies ; Follow-Up Studies ; Glucose ; Humans ; Intracranial Embolism and Thrombosis ; Male ; Middle Cerebral Artery ; National Institutes of Health (U.S.) ; Natural History ; Prognosis ; Prospective Studies ; Stroke