Bleomycin, a tumoricidal antibiotic agent, may produce unusual cutaneous manifestations such as pigmentation scleroderma, and gangrene. We report a case of the development of linear streaky pigmentation and cutaneous scleroderma in a patient treated with bleomycin for choriocarcinoma of undescented testis. The patient was 45-year-old male presented with linear brown and slate gray streaking over the trunk and extremities after three cycles of chemotherapy(bleomycin, etoposide, cisplatine). After the fourth cycle of the same chemotherapy, 18 weeks after initiation of bleomycin, the development of cutaneous scleroderma-like conditions was observed involving the same sites. Histopathologic examination showed increased basal pigmentation and thick collagen bundles through the entire dermis, extending to the subcutis. Herein, we describe a case of streaky pigmentation and scleroderma in association with bleomycin anticancer chemotherapy simultaneously in a patient.
Bleomycin* ; Choriocarcinoma ; Collagen ; Dermis ; Drug Therapy ; Etoposide ; Extremities ; Female ; Gangrene ; Humans ; Hyperpigmentation ; Male ; Middle Aged ; Pigmentation* ; Pregnancy ; Testis

BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been proposed as a noninvasive means for assessing endothelial function. The present study is designed to assess the influence of aging on endothelial function and when vasoactivity developed initially, peaked. MATERIALS AND METHOD: We measured brachial artery diameter for 60 seconds continuously using 7.5 MHz ultrasound following 5 minutes of lower arm occlusion in 22 normal volun-teers (young group: 10 volunteers, 26.5+/-1.9 years; old group: 12 volunteers, 55.9+/-3.3 years). After sublingual administration of 0.6 mg nitroglycerine, 240 seconds continuously. And then we measure vasoactivity every 3 seconds. RESULTS: Flow-mediated vasodilation (FMD) was started earlier in young group (24.3+/-2.8 sec; old group 28.8+/-3.6 sec, p=0.017). After release of occlusion, peak vasoacitivity time was at 35.5+/-4.7 seconds and peak vasoactivity was 8.4+/-1.7% in young group (old group 6.9+/-1.5%, p=0.099). Endothelial independent vasodilation (EID) was started at 80.7+/-13.3 seconds after sublingual nitroglycerine in young group (vs 80.0+/-19.0 sec), peaked at 177.5+/-16.9 seconds (vs 171.3+/-13.8 sec). Peak vasoactivity was higher in young group (19.1+/-3.1%; old group 15.9+/-2.5%, p=0.033). CONCLUSION: We conclude that 1) Aging has influence on endothelial function about initiating time of vasoactivity as well as peak vaso- activity. 2) FMD can be measured around 50 seconds after release of brachial artery occlusion and EID at 180 seconds after application of sublingual nitroglycerine. 3) The initiating time of vasoactivity (under 30 seconds) can be used for evaluation of endothelial function.
Administration, Sublingual ; Aging* ; Arm ; Brachial Artery ; Nitroglycerin ; Ultrasonography* ; Vasodilation ; Volunteers

Tuberculous spondylitis is not rare disease. Today the posterior instrumentation and posterior or posterolateral fusion concomitant with the anterior decompression and anterior interbody fusion have been used for the treatment of spinal tuberculosis. The authors experienced a case of tuberculous spondylitis complicated with descending aortic pseudoaneurysm. An aneurysm is defined as a localized dilatation of an artery that is at least one-half the size greater than is expected for that artery. Pseudoaneurysm occurring after previous operation, trauma, and infection. Erosion of the thoracic aorta with the development of an fistula in the presence of infection is an unusual and difficult problem to manage. We report a case and review related articles briefly.
Aneurysm ; Aneurysm, False* ; Aorta, Thoracic ; Arteries ; Decompression ; Dilatation ; Fistula ; Rare Diseases ; Spondylitis* ; Tuberculosis, Spinal

BACKGROUND: Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult. METHODS: Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997. RESULTS: During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases). CONCLUSION: These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.
Abdominal Pain ; Abscess ; Appendectomy ; Barium ; Cecum* ; Colon, Ascending* ; Diagnosis ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Enema ; Female ; Humans ; Male ; Rare Diseases ; Surgical Procedures, Operative ; Tomography, X-Ray Computed ; Ultrasonography

Primary fish-odor syndrome (FOS) is a genetic disorder caused by defective flavin-containing monooxygenase 3 gene (FMO3) with deficient N-oxidation of trimethylamine (TMA), causing trimethylaminuria (TMAU). By contrast, secondary FOS can be acquired by decreased FMO activities in patients with chronic liver diseases, but the underlying mechanisms are unknown. In the present study, we examined plasma NOx concentrations and viral DNA contents as well as in vivo FMO activities and their correlations in chronic viral hepatitis (CVH) patients. Plasma concentration of NOx was significantly increased by 2.1 fold (56.2+/-26.5 vs. 26.6+/-5.4micrometer, p< 0.01), and it was positively correlated with plasma hepatitis B virus (HBV) DNA contents (r2=0.2838, p=0.0107). Furthermore, the elevated plasma NOx values were inversely and significantly correlated with in vivo FMO activities detected by ranitidine-challenged test (8.3% vs. 20.0%, r2=0.2109, p=0.0315). TMA N-oxidation activities determined in CVH patients without challenge test were also significantly low (73.6% vs. 95.7%, p< 0.05). In conclusion, these results suggested that secondary FOS could be acquired by the endogenously elevated NO in patients with CVH.
DNA ; DNA, Viral ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Liver Diseases ; Nitric Oxide ; Plasma ; Ranitidine

BACKGROUND: Noninvasive measurements that relate to the extent and severity of coronary atherosclerosis have long been sought for clinical screening of patients with chest pain syndromes and for use in clinical trials. Intima-media thickeness (IMT) of the carotid artery has been suggested to be associated with coronary artery atherosclerosis. In this study, we tried to assess the relation of carotid artery atherosclerosis by B-mode ultrasonography with presence and severity of coronary artery disease. METHOD: We studied 57 patients (36 men, 21 women) with ischemic heart disease, mean age 65+/-8 yrs (48 to 83 yrs), who underwent both coronary angiography and carotid ultrasonography with 10 MHz transducer. The patients who had received revascularization procedure were excluded. We classified the patients into two groups, the control group without significant coronary stenosis (18 patients) and the coronary artery disease (CAD) group (39 patients) with significant luminal stenosis (> or =50%). The CAD group was divided into single vessel disease group (SVD, 19 patients) and multivessel disease group (MVD, 20 patients). IMT was measured in far wall of common carotid artery (CCA) at 10 mm proximal to carotid bulb and abnormal IMT was defined if the measurement was greater than mean IMT+2SD of control group. Serum total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglyceride (TG), Lipoproteinp (a)(Lp(a)) were measured and history of hypertension, diabetes mellitus, and smoking were investigated. RESULTS: A significant difference in IMT of the CCA was found between control and CAD group (0.76+/-0.09 mm vs. 0.97+/-0.20 mm; p<0.0001). Also a significant difference in the number of atherosclerotic plaque was found between the two groups (control; 0.67+/-1.14 vs. CAD; 1.87+/-1.75; p<0.005). In the CAD group, both mean IMT and numbers of athero-sclerotic plaque tended to increase in MVD group compared with SVD group (1.03 mm vs. 0.91 mm; p=NS, 2.65 vs. 1.05; p<0.05). The sensitivity of IMT for prediction of significant CAD was 66.7%, the specificity 83.3%, the positive predictive value 89.7%, and the negative predictive value 53.6%. The sensitivity of plaque presence on the carotid artery for prediction of CAD was 71.8%, the specificity 61.3%, the positive predictive value 80.3% and the negative predictive value 50.5%. Among risk factor, diabetes mellitus and Lp (a) were correlated well with IMT of CCA, Hypertension was correlated with atherosclerotic plaque. History of smoking was correlated with coronary artery disease. CONCLUSION: Increases in IMT and plaque of the carotid artery, as measured noninvasively by ultrasonography, can be used as a predictor of significant coronary artery stenosis.
Atherosclerosis ; Carotid Arteries* ; Carotid Artery, Common ; Chest Pain ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypertension ; Lipoproteins ; Male ; Mass Screening ; Myocardial Ischemia ; Phenobarbital ; Plaque, Atherosclerotic* ; Risk Factors ; Sensitivity and Specificity ; Smoke ; Smoking ; Transducers ; Triglycerides ; Ultrasonography

Vascular complications such as hematoma, pseudoaneurysm and arteriovenous fistula that occur after intracoronary or intracardiac procedures are responsible for considerable morbidity and some mortality. Iatrogenic aneurysms are usually postcatheterization pseudoaneurysms of the femoral artery. Nowadays, it is not uncommon as a consequence of more complex interventional procedures, larger catheters and prolonged anticoagulation treatment. Surgical repair has been mainstay of treatment for pseudoaneurysm. However, recently has it been shown that color Doppler ultrasound-guided direct, noninvasive compression of the pseudoaneurysm stops the blood flow in the communication and lead to pseudoaneurysm clotting and obliteration. We report a case of pseudoaneurysm in femoral artery, which was developed at the right inguinal puncture site in 74 year old male patient with myocardial infarction who had received continuous intravenous infusion of heparin and had undergone primary percutaneous coronary angioplasty and temporary pacemaker insertion treated successfully with color Doppler ultrasound guided direct compression.
Aged ; Aneurysm ; Aneurysm, False* ; Angioplasty ; Arteriovenous Fistula ; Cardiology* ; Catheters ; Femoral Artery* ; Hematoma ; Heparin ; Humans ; Infusions, Intravenous ; Male ; Mortality ; Myocardial Infarction ; Punctures ; Ultrasonography

The anorectal function was evaluated in 25 patients with rectal cancer who underwent a low anterior resection (LAR). The result of anorectal manometry was analyzed with respect to the bowel habit. Patients were examined preoperatively and 3, 6, 9, and 12 months postoperatively by both anorectal manometry and interview. The examinations included information on defecation frequency, incontinence, and inability of deferment. The defecation frequency was significantly increased until 6 months postoperatively (p < 0.05). The maximum resting pressure (MRP) was significantly decreased until 1 year after surgery (p < 0.05). However, the maximum squeezing pressure (MSP) and the length of high pressure zone (HPZ) were not significantly decreased postoperatively. There was no significant difference in the sensation of balloon between the preoperative period and the postoperative period. The sensation of fullness was markedly decreased until 6 months postoperatively (p < 0.05). The rectoanal inhibitory reflex (RAIR) was positive in all patients preoperatively, and 24 out of 25 patients showed a positive reflex postoperatively with various sensitivity. The appearance of an external sphincter assist was not correlated with bowel habit. Patients with the lowest anterior resection (LLAR) had a higher incidence of early phase incontinence than patients with the low anterior resection. In conclusion, the increased defecation frequency during the postoperative period appeared to be related with the decreased MRP and the sensation of fullness based on a manometric assessment. Although the manometric finding did not normalize with respect to every manometric factor evaluated, the bowel habit was generally recovered clinically in 12 months postoperatively. We should always consider other variables, such as postoperative rectal mucositis or respective bowel habit, in addition to the result of anorectal manometry for the postoperative evaluation.
Defecation ; Humans ; Incidence ; Manometry ; Mucositis ; Postoperative Period ; Preoperative Period ; Rectal Neoplasms ; Reflex ; Sensation

Collagenous colitis is an uncommon condition charaeterized clinically by diarrhea and weight loss and histologically by thickening of the subepithelial collagen band with chromic inflammation. Laboratory tests of blood, urine and stool, and colonscopic findings are usually normal. The etiology of collagenous colitis is unknown. We report a case of collagenous colitis improved after treatment with sulfasalazine with review of literatures.
Colitis, Collagenous* ; Collagen* ; Diarrhea ; Inflammation ; Sulfasalazine ; Weight Loss

BACKGROUND: QT dispersion(QTD : QTmax-QTmin) or JT dispersion(JTD:JTmax-JT-min)in 12 leads ECG has been known to reflect regional variations in ventricular repolarization and has been reported to bel one of the marker of regional myocardial ischemia. To evaluate the significance of QTD or JTD of exercise ECG in diagnosis of coronary artery disease, we studied 106 patients(mean age, 56.9 years old, male 63) who were referred for the evaluation of chest pain on exertion. METHOD: Treadmill exercise stress test with modified Bruce protocol and coronary angiography were performed in 106 patients with chest pain on exertion. ST-segment depression by >1.0 mm 0.08 second after J-point during or after exercise in exercise test and >50% stanosis of epicardial artery in coronary angiogram were defined as positive. Of 106 patients, 41 had positive exercise ECG and positive coronary angiogram(true positive, TP), 20 had positive exercise ECG and negative coronary angiogram(false positive, FT), 20 had negative exercise ECG and positive coronary angiogram(faalse negative, FN), and 23 had negative exercise ECG and negative coronary angiogram(true negative, Tn). QT and JT interval in 12 leads were measured at baseline and peakexercise and were corrected for heart rate using Bazett's formula. QTD and JTD were measured by calculation the difference between the maximum QT and mininum QT and that between maximum JT and minumum JT. RESULTS: QTD at baseline for TP(72.8ms)was prolonged compared to Tn(52.2ms,P<0.01), but was not different from that for FT(70.2 ms). At peak exercise, QTD for TP(81.3 msec) was significantly prolonged(p<0.01), while QTD for FP(71.2 msec) was not different from that for TN(56.8 msec). JTD at baseline(78.4 msec) and at peak exercise(88.2 msec) for TP were significantly prolonged compared to those for TN(55.2msec and 55.1msec p<0.01,p<0.01, respectively), but those for FP were not porlonged(77.0msec and 79.0msec, respectively). QTD and JTD at peak exercise were more markedly prolonged in patients with sever stenosis of coronary artery(p=0.053 and p<0.05, repectively) and multivessels diseases(p<0.01, 0<0.05) than those with less severe disease and single vessel disease. Patients with left anterior descending artery lesion had greater QTD and JTD at peak exercise than those with other vessels lesion(p<0.01). In addition to standard criteria with ST segment displacement in exercise EGC, inclusion of exercise induced QTD of more than 60msec increased the sensitivity of exercise ECG from 66.7% to 83.3%, and JTD of more than 70msec increased the specificity from 52% to 76.0%. CONCLUSION: Measurement of QT dispersion and JT dispersion of exercise ECG may be useful method to identify the severity of coronary artery disease and to improve diagnostic accuracy of exercise ECG in coronary artery disease.
Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Depression ; Diagnosis ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Sensitivity and Specificity