Behcet's disease is an inflammatory condition of multiple organ systems in witch recurrent oral and genital ulcers are the most typical signs. Less common clinical features include cerebral vasculitis, arterial aneurysm, deep vein phlebitis, aseptic meningitis, and discrete bowel ulcers. The most serious complication of Behcet's disease is arterial involvement especially ruptured arterial aneurysm. The aneurysm of sinus of Valsalva in Behcet's disease is a rare condition. There is no report about it in Korea. We report a case of a aneurysm of the sinus of valsalva with Behcet's disease. The patient had complete AV block and a right coronary sinus of Valsalva aneurysm which ruptured into the left ventricle. The diagnosis was made with transesophageal echocardiography. The patient was implanted with permanent pacemaker for relief of congestive heart failure due to complete atrioventricular (AV) block. He discharged and he is still follow-up in outpatient clinic.
Ambulatory Care Facilities ; Aneurysm ; Aneurysm, Ruptured* ; Atrioventricular Block* ; Behcet Syndrome* ; Coronary Sinus ; Diagnosis ; Echocardiography, Transesophageal ; Follow-Up Studies ; Heart Failure ; Heart Ventricles* ; Humans ; Korea ; Meningitis, Aseptic ; Phlebitis ; Sinus of Valsalva* ; Ulcer ; Vasculitis, Central Nervous System ; Veins

OBJECTIVE: To investigate the electrophysiologic and histopathologic changes of the prheral nerve from hyperthermal nerve injury and to observe the difference of these changes according to the level of temperature and the duration of heat application. METHOD: The experimental rats (Sprague-Dawley) were divided into four groups according to the degree of temperature and the duration of heat application : Group 1, 43degrees C for 15 min; Group 2, 43degrees C for 30 min; Group 3, 45degrees C for 15 min; Group 4, 45degrees C for 30 min. A segment of 5 mm of the sciatic nerve was exposed and treated in vivo with local hyperthermia using a thermostatically controlled heating unit. For the electrophysiologic examination, both sciatic nerve conduction study and needle electromyographic examination were performed immediately before, and at 1 day, 3 days, 1 week, 2 weeks, and 4 weeks after the hyperthermia. For the histopathologic study, a sciatic nerve biopsy was performed at 1 day, 1 week, 2 weeks, and 4 weeks after the hyperthermia and the changes were investigated under the light microscopic and electronmicroscopic examinations. RESULTS: In experimental groups, the compound muscle action potentials (CMAPs) showed a significant reduction compared to the control group (p<0.05). Amplitudes of CMAPs following the heat application to the nerve were inversely related with the degree and duration of hyperthermia. A significant recovery of CMAPs was observed at 4 weeks after the hyperthermia in all experimental groups. The motor conduction latencies, however, did not show any significant changes. The needle electromyography of the gastrocnemius began to reveal fibrillation potentials on the 3rd day after the hyperthermia and continued to appear until the second week and then completely disappeared at 4 weeks after the hyperthermia. The histopathologic findings began to show the degeneration of axon and myelin within 24 hours and a remarkable regeneration at 4 weeks after the hyperthermia. CONCLUSION: The results revealed that the hyperthermia of peripheral nerve within the range of 43~45degrees C for 15~30 min is likely to cause a significant acute, but not necessarily permanent nerve injury, and the severity of nerve injuries is related to the temperature and duration of heat applications. Whether the results can be clinically applied to human beings would require further exploration.
Action Potentials ; Animals ; Axons ; Biopsy ; Electromyography ; Electrophysiology ; Fever ; Heating ; Hot Temperature ; Humans ; Hyperthermia, Induced ; Myelin Sheath ; Needles ; Peripheral Nerves* ; Rats ; Regeneration ; Sciatic Nerve

During 1 year and 9 month period, from September, 1980 to June, 1983, retrospective study was performed on 35 patients with Mitral Valve Prolapse at Kyung Hee University Medical Center. And the following results were obtained; 1) The mitral valve prolapse syndrome presents with various cardiovascular symptoms including dyspnea(63%), palpitation(49%), chest pain(34%), syncope and dizziness(11%). 2) Of 35 patients with MVP, 17 cases were isolated MVP, 13 cases were associated with cardiovascular disorders and 5 cases were associated with non-cardiovascular disorders. 3) Electrocardiographic abnormalities were found in 20 patients with MVP. The most common abnormality was ST-T change and atrial fibrillation, VPB, RBBB, first degree A-V block and W-P-W syndrome were also noted. 4) QTc interval prolongation was more common in serverely symptomatic patients with MVP. 5) 18 cases in 35 patients showed systolic click or murmur on phonocardiography. 6) Of 35 patients with MVP, 19 patients demonstrated prolapse of the anterior leaflet, 11 patients demonstrated prolapse of posterior leaflet and 5 patients demonstrated prolapse of the both leaflets. 7) There were severe derangement on echocardiography in severely symptomatic patients were MVP.
Academic Medical Centers ; Atrial Fibrillation ; Echocardiography ; Electrocardiography ; Humans ; Mitral Valve Prolapse* ; Mitral Valve* ; Phonocardiography ; Prolapse ; Retrospective Studies ; Syncope ; Thorax

We report a case of an erythrodermic form of mycosis fungoides in a 68-year-old male, who showed generalized erythroderma with scales for 3 months. Lymphadenopathies in the inguinal and neck areas were present. Histopathological findings showed epidermotropism, perivascular atypical lymphocyte infilteration in the upper dermis, and dermatopathic lymphadenopathy in the inguinal lymph node. T cell markers were positively stained in the immunohistochemical study. These clinicopathological features were consistent with an erythrodermic form of mycosis fungoides(TNM IIl). The patient was treated with PUVA therapy and low dose chemotherapy.
Aged ; Dermatitis, Exfoliative ; Dermis ; Drug Therapy ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphocytes ; Male ; Mycosis Fungoides* ; Neck ; PUVA Therapy ; Weights and Measures

Pheochromocytoma is a hazardous and dramatic cause of hypertension. This potentially lethal neoplasm originates in most cases in the adrenal medulla and less frequently in the cells of the extraadrenal paraganglion system which are disseminated along the paravertebral axis from the pelvis to the base of the skull. The organ of Zuckerkandl is paraganglia lying the abdominal aorta with highest incidence in the region of the inferior mesenteric artery and usually degenerate shortly after birth. In the literature, and additional one case of pheochromocytoma arising from the organ of Zuckerkandl associated with intracerebral hemorrhage which was treated recently in the Kyung Hee University Hospital is presented in this report.
Adrenal Medulla ; Aorta, Abdominal ; Axis, Cervical Vertebra ; Cerebral Hemorrhage* ; Deception ; Hypertension ; Incidence ; Mesenteric Artery, Inferior ; Para-Aortic Bodies* ; Parturition ; Pelvis ; Pheochromocytoma* ; Skull

BACKGROUND: The goal of antihypertensive therapy will be to extended the life expectancy of hypertensive patients to that of subjects without high blood pressure. Hypertension treatment in the 1990s will focus on the mechanisms by which blood pressure is lowered by various antihypertensive agents, as will as individualization of drug therapy. In recognition of their lack of adverse lipid effects and their tolerability, first line therapy with alpha blocker, angiotensin converting enzyme inhibitors and calcium antagonists will become increasingly commom. We studied a new dihydropyridine calcium antagonist barnidipine to evaluate the efficacy and safety in patients with essential hypertension. METHODS: The rabit aortic rings were cut and mounted on the force transducer to record an isometric tension on polygraph. To elucidate the mechanism of saponin effect on vascular smooth muscle, the contractility of the vascular smooth muscle were measured under vatying experimental condition. RESULTS: 1) The baseline sitting systolic and diastolic blood pressure after 4 weeks washout period were 154.+/-15.9mmHg and 1.0+/-8.2mmHg. At the end of 8 weeks of therapy sitting systolic and diastolic blood pressure were 126+/-9.5mmHg and 84.5+/-4.6mmHg which declined statistically significant(p<0.05). 2) The pulse rates did not change significantly during treatment period(70.0+/-6.6 beats / min at baseline, 70.9+/-7.2 beats / min at 2 weeks, 71.2+/-5.0 beats / min at 4 weeks, 72.8+/-8.5 beats / min at 6 weeks, and 71.9+/-6.8 beats / min). 3) The adverse reactions due to branidipine were reported in 2 patients(6.5%) with headache, 2 patients(6.5%) with facial flushing, 1 patient(3.4%) with dizziness and 1 patients(3.4%) with nausea and vomiting). 4) The abnormal laboratory findings due to barnidipine were reported in 1 patient with increased total bilirubin and GPT, 1 patient with increased transaminase and 1 patient with CK but another findings were normal. CONCLUSION: These results indicate that barnidipine is effective and safe antihypertensive agent in the treatment of essential hypertension.
Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents ; Bilirubin ; Blood Pressure ; Calcium ; Dizziness ; Drug Therapy ; Flushing ; Headache ; Heart Rate ; Humans ; Hypertension* ; Life Expectancy ; Muscle, Smooth, Vascular ; Nausea ; Saponins ; Transducers

PURPOSE: To assess the usefulness of Gd-DTPA MRI in the evaluation of the characteristics of intracranial meningiomas and in the correlation with their histopathologic pattern. MATERIALS AND METHODS: We retrospectively analyzed the Gd-DTPA MRI findings in 22 cases of histologicalty-proven intracranial meningiomas. The images were assessed for signal intensity, internal texture, peritumoral edema, and enhancement characteristics. Computed tomograms were obtained in 18 cases and compared with MRI findings. RESULTS: Tl-weighted images were not particularly useful for discriminating pathologic subtype, but signal intensity on T2-weighted images were relatively well correlated with histopathologic findings. A heterogeneous texture produced by tumor vascularity, calcification, cystic foci, hemorrhagic necrosis, or psammoma body was relatively well shown on Gd-DTPA Tl-weighted image compared with that on T1- or T2-weighted image. Gd-DTPA Tl-weighted images revealed a dural tail sign in 19 cases(83%). Angioblastic type was slightly hypointense on Tl-weighted image and markedly hyperintense on T2-weighted image. Psammomatous type and firboblastic type were isointense on both T1- and T2-weighted image. Fibroblastic type was more densely enhanced than the other. The transitional, atypical, and papillary types showed tendency of heterogeneous enhancement. CONCLUSION: Gd-DTPA MRI was a useful imaging modality in evaluation of the characteristics of meningiomas and correlated well with the pathologic patterns.
Edema ; Fibroblasts ; Gadolinium DTPA* ; Magnetic Resonance Imaging* ; Meningioma ; Necrosis ; Retrospective Studies

PURPOSE:To find out the differential points between spinal neurilemmomas and neurofibromas. MATERIALS AND METHODS: Fourteen patients with pathologically proven neurilemmomas(n--6) and neurofibromas(n=8) of spinal canal were studied using magnetic resonance(MR) imaging. Contrast enhancement was performed with Gd-DTPA in all 14 patients. The size and shape of the tumor, absence or presence of adjacent bone erosion, location and extent of the tumor, signal intensity, degree and pattern of Gd-DTPA enhancement of the tumor were retrospectively analyzed. RESULTS: Rim enhancement was seen in five of six patients(83%) with neurilemmomas and three of eight patients(38%) with neurofibromas. Neurilemmomas showed moderate to marked enhancement in five of six patients(83%), whereas neurofibromas showed moderate to mild enhancement in all 8 cases(100%). The average size in longest diameter of the tumors was 2.8cm in neurilemmomas, while 5.4cm in neurofibromas. Neurilemmomas showed ovoid shape in 5 of 6 patients, no extra- or intradural extension, and erosion of adjacent bone in one patient, whereas neurofibromas showed Iobular shape in 6 of 8 patients, extra- or intradural extension in 6 of 8 patients, and erosion of adjacent bone in 4 of 8 patients. CONCLUSION: In differentiating neurofibroma from neurilemmoma, size, shape, extent of the tumor, absence or presence of adjacent bone erosion, and pattern and degree of enhancement of the tumor may be helpful.
Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging* ; Neurilemmoma* ; Neurofibroma* ; Retrospective Studies ; Spinal Canal

BACKGROUND: Tourniquet hypertension (TH) may develop from an autonomic reflex consequent to the sensitization of the central nervous system (CNS) due to ischemia of the affected limb and noxious surgical stimulation. TH could be preventable when anesthetic depth is sufficient enough to block plastic changes of the CNS during an operation. This study was aimed to evaluate the efficacy of the bispectral index (BIS) to predict development of TH by assessing correlations between BIS changes and hemodynamic changes during the skin incision. METHODS: Sixty patients who had undergone a total knee arthroplasty with a pneumatic tourniquet during isoflurane anesthesia were selected, and the samples were randomly divided into two groups: BIS 30 (30 - 39) and BIS 40 (40 - 49). Several variables such as BIS, mean arterial pressure (MAP), heart rate (HR) and end tidal concentraion of isoflurane were monitored during the operation. TH was defined as more than a 30% increase in MAP compared with the baseline values during the skin incision. The correlation between BIS changes and MAP and HR changes, and the incidence of TH between BIS groups were compared. RESULTS: The MAP and HR were meaningfully increased in both the BIS 30 and the BIS 40 groups (P < 0.05), but no significant correlations were found between the BIS changes and the MAP and HR changes during the skin incision. The incidence of intraoperative hypertension was not different between the BIS groups. The BIS of the patients who had TH was not different from those who did not have TH. CONCLUSIONS: BIS may not reflect the changes of the CNS and autonomic nervous system induced by noxious surgical stimulation during an operation, and BIS changes during a skin incision cannot be a predictor of TH.
Anesthesia ; Arterial Pressure ; Arthroplasty* ; Autonomic Nervous System ; Central Nervous System ; Extremities ; Heart Rate ; Hemodynamics ; Humans ; Hypertension* ; Incidence ; Ischemia ; Isoflurane ; Knee* ; Plastics ; Reflex ; Skin ; Tourniquets*

We present a case of a patient who had undergone human allograft cardiac transplantation 5 months before ascending aorta replacement. A pseudoaneurysm at the anastomotic site of ascending aorta with periaortic hematoma compressing the superior vena cava (SVC) had been revealed by chest CT, and after the median sternotomy, paraaortic abscess was revealed as the cause of this patient's SVC syndrome. The ascending aorta replacement was performed under deep hypothermic circulatory arrest. The anesthetic management of this patient included the use of a sterile technique, slow cautious induction, and the maintenance of adequate intravascular volume.
Abscess ; Allografts ; Aneurysm, False ; Aorta* ; Circulatory Arrest, Deep Hypothermia Induced* ; Heart Transplantation ; Heart* ; Hematoma ; Humans ; Sternotomy ; Tomography, X-Ray Computed ; Vena Cava, Superior