Objective To explore the operative treatment of severe acromioclavicular joint dislocation.Methods 15 cases of severe acromioclavicular joint dislocation were diagnosed as type Ⅲ injury according to Allman classification system.11 cases had the fibrocartilage removed,reconstruction of the coracoacromial ligament was done in 7 cases,in 3 cases a cancellous screw was inserted between the clavicle and aromion process and complete reconstruction of the acromio-clavicular ligament was performed and fixation was done with 2 K wires.Results The follow-up ranged from 10 months to 6 years,reviewuation of the results was done according to Karlsson.12 cases were graded as A,3B,all patients resumed their preoperative activities.Soft tissue calcification in the coracoclavicular gap in 10 cases,the acromial joint movement was not affected.Conclusion The patients with severe acromiocavicular joint dislocation should be treated with surgery as early as possible.Cross internal fixation with K wires is a simple and effective method,the final outcome is not affected by the resection of fibrocartilage and restoration of coracoacromial ligament.

No abstract available.
Echocardiography, Three-Dimensional* ; Heart Septal Defects, Atrial*

Objective - To analyze the effect of using vibration tools on the prevalence of work related musculoskeletal disorders （ ） Methods ， - WMSDs in automobile factory workers. By judgment sampling method front line workers with more than one year of working experience in an automobile factory were selected as the research subjects. Musculoskeletal Disorders Questionnaire was used for investigation. The workers were divided into the control group and the vibration tool group. The propensity score ∶ ， matching method was used to balance the confounding factors of the two groups of workers by 1 1 and 568 people were Results included in each group. The prevalence of WMSDs was compared between the two groups after matching. After ， ， ， ， ， ， matching the prevalence of WMSDs in the shoulder elbow hand/wrist upper back waist hip/buttock and knee of workers in ， （ P ） the vibration tool group was higher than that in the control group and the differences were statistically significant all <0.05 .， The prevalence of WMSDs in different body parts of workers in the vibration tool group ranking from high to low was waist ， ， ， ， ， ， ， ， ， ， neck shoulder hand/wrist upper back knee ankle/foot elbow and hip/buttock with the rate of 74.3% 61.3% 54.2% ， ， ， ， ， （P ） Conclusions 54.0% 50.9% 39.4% 35.2% 31.0% and 27.1% respectively <0.01 . The use of vibration tools can ， ， ， ， ， increase the risk of WMSDs in shoulder elbow hand/wrist upper back waist hip/buttock and knee of automobile factory workers. Corresponding measures should be taken to reduce vibration intensity and reduce contact time to protect workers'

Among the congenital coronary artery fistulae, multiple coronary artery microfistulae arising from the left and right coronary artery and emptying into the left ventricle are very rare and little is known of their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. A 67-year- old woman was referred for the evaluation of chest pain at exertion, and shortness of breath. Electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic color Doppler echocardiography, using a high frequency transducer with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.
Aged ; Cardiomyopathy, Hypertrophic/*complications/diagnosis ; Coronary Angiography ; Coronary Vessel Anomalies/*complications/diagnosis/*ultrasonography ; Echocardiography ; Electrocardiography ; Female ; Heart Defects, Congenital/*complications/diagnosis/*ultrasonography ; Heart Ventricles ; Human ; Hypertrophy, Left Ventricular/complications/diagnosis

Glycogen storage diseases are a heterogeneous group of metabolic disorder affecting multiple organ system: liver, skeletal muscle, heart and brain. Clinical features include: short status, hepatomegaly, hypoglycemia, dyslipidemia and rare involvement of the myocardium except in the case of type III, glycogen storage diseases with hypertrophic cardiomyopathy in adult, which is extremely rare. We treated a case of hypertrophic cardiomyopathy with hepatomegaly that was unknown etiology. The patient was diagnosed as having glycogen storage disease. This 46-year old women was transferred with dyspnea on exertion and abnormal LFTs. She was diagnosed with hypertrophic cardiomyopathy by echocardiography but there was no specific cause for hypertrophic cardiomyopathy. A liver biopsy was performed. The result showed glycogen storage disease possible type III, IV or IX. In conclusion, patients with hypertrophic cardiomyopathy of unknown etiology and abnormal LFTs should be evaluated for glycogen storage disease.
Adult ; Biopsy ; Brain ; Cardiomyopathy, Hypertrophic* ; Dyslipidemias ; Dyspnea ; Echocardiography ; Female ; Glycogen Storage Disease* ; Glycogen* ; Heart ; Hepatomegaly ; Humans ; Hypoglycemia ; Liver ; Middle Aged ; Muscle, Skeletal ; Myocardium

Of the congenital coronary artery fistulae, the multiple coronary artery microfistulae, arising from the left and right coronary artery emptying into the left ventricle, are very rare. Little is known about their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. The clinical findings are heterogeneous, but include, in most cases, a history of typical or atypical angina pectoris. A 67 year old woman was referred for evaluation of chest pain on exertion, and a shortness of breath. The electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic Doppler echocardiography, using a high frequency transducer, with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.
Aged ; Angina Pectoris ; Angiography ; Cardiomyopathy, Hypertrophic ; Chest Pain ; Coronary Vessels ; Dyspnea ; Echocardiography ; Echocardiography, Doppler* ; Electrocardiography ; Female ; Fistula ; Heart Ventricles ; Humans ; Transducers ; Vascular Fistula

Libman-Sacks endocarditis is characterized by noninfectious vegetations on the cardiac valves of patients with systemic lupus erythematosus (SLE). Valvular abnormalities are found in about one third of patients with primary anitiphospholipid syndrome. SLE patients, with antiphospholipid antibodies, have a higher prevalence of valvular involvement than those without these antibodies. A 29 year old man was referred for evaluation of severe orthopnea. He presented with the clinical features of multi-organ failure (heart, lung and kidney). His serological and immunological findings were typical of a SLE flare up. His level of anticardiolipin antibody (IgG) was highly increased and his lupus anticoagulant was positive. A blood culture revealed no growth of bacterial organism. Transthoracic and transesophageal echocardiography showed non-mobile, verrucous vegetations on the anterior leaflet of the mitral valve, with moderate mitral regurgitation.
Adult ; Antibodies ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Echocardiography, Transesophageal ; Endocarditis* ; Heart Valves ; Humans ; Lung ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic ; Mitral Valve ; Mitral Valve Insufficiency* ; Prevalence

BACKGROUND: The number of patients suffering from acute myocardial infarction is on the increase in Korea due to the westernization of life style. Recent improvement of therapeutic stratigies have shown early mortality benefits in acute myocardial infarction. But we don't have data how many patients died and what's the cause of death in these patients. This study aimed to find out the mortality rate, cause of death and it's relevant prognostic factors of myocardial infarction (MI) patients who admitted alive, and to construct a database which will be used to develop a risk stratification strategy for the implementation of new preventive therapeutic modalities, such as implantable cardioverter-defibrillator (ICD). METHODS: Seven hundred and forty two MI patients admitted to our hospital from March, 1999 to August, 2002 were included in this study. The risk factors and survivals were evaluated by medical record searching and telephone survey in these patients. RESULTS: The average age was 64 years-old and 67% was male. During the mean follow up 20.7+/-15.4 months, total 105 cardiac death (14.2%) was occurred and cumulative mortality rate at 1 year and 2 year was 5.69% and 10.80%, respectively. Of the total 129 death, in-hospital death was 68 (cardiac death 48, non-cardiac death 20) and out of hospital death was 60 (cardiac death 57, non-cardiac death 4). When it comes to cause of death, most common cause of cardiac death was malignant arrhythmia. The proportion of malignant arrhythmia in cardiac death was 81.3% and 72% of in-hospital and out of hospital death, respectively. Multivariate analysis showed that old age, low LV ejection fraction and no percutaneous coronary intervention (PCI) treatment were independent risk factors for cardiac mortality. CONCLUSIONS: Myocardial infarction shows still high mortality rate despite the recent development of therapeutic strategy. As post-MI patients with low LVEF or no PCI shows high mortality, the early reperfusion therapy should be encouraged. Additionally, because malignant arrhythmia was one of the most in cause of cardiac death, ICD therapy to prevent sudden cardiac death should be considered in an active manner.
Arrhythmias, Cardiac ; Cause of Death* ; Death ; Death, Sudden, Cardiac ; Defibrillators, Implantable ; Follow-Up Studies ; Humans ; Korea ; Life Style ; Male ; Medical Records ; Middle Aged ; Mortality* ; Multivariate Analysis ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Reperfusion ; Risk Factors ; Telephone

Postinfarction ventricular septal rupture (VSR) is a rare but fatal complication of acute myocardial infarction. In many cases, postinfarction VSR leads to hemodynamic instability and urgent surgical treatment is necessary. Here we describe a case of a patient with right ventricular (RV) dysfunction caused by acute RV infarction and with cardiogenic shock, whose condition improved after development of postinfarction VSR, but the patient died after corrective surgery.
Hemodynamics ; Humans ; Infarction ; Myocardial Infarction* ; Shock, Cardiogenic ; Ventricular Dysfunction, Right ; Ventricular Septal Rupture*