The Marfan syndrome is classified as a heritable disorder of connective tissue with clinical and pathological alterations involving supporting elements. In its classic form, the Marfan syndrome is associated with abnormalities of the eye(ectopia lentis), aorta(aortic dilatation and aortic regurgitation) and skeleton(dolichostenomelia, arachnodactyly and pectus deformity). The authers have experienced a case of marfan syndrome recently. The patient was 30-years-old male complaining of anterior chest pain radiating to upper back. Physical examination showed tall status, increased length of the limbs as compared with the trunk and arachnodactyly. On auscultation, heart sound was normal without murmur. He wore glasses because of moderate myopia. Roentgenogram of the chest P-A revealed normal cardiac and aortic contours and lung fields. Left lateral view of chest X-ray revealed concave depression of sternum showing mild pectus excavatum, fusiform dilatation of aorta from aortic root to mid portion of thoracic aorta and resulting in obliteration of retrosternal clear space. Echocardiogram demonstrated moderate dilatation of aortic root A-P diameter(4.5cm) without aortic or mitral valvular abnormalities and normal size of left ventricular cavity(EDD:5.3cm). These data coupled with a distinct family history could permit the diagnosis of Marfan syndrome.
Aorta ; Aorta, Thoracic ; Arachnodactyly ; Chest Pain ; Connective Tissue ; Depression ; Diagnosis ; Dilatation ; Extremities ; Eyeglasses ; Funnel Chest ; Glass ; Heart Auscultation ; Humans ; Lung ; Male ; Marfan Syndrome* ; Myopia ; Physical Examination ; Sternum ; Thorax

Primary hyperparathyroidism (PHPT) with concomitant thyroid cancer is rare and is usually caused by a parathyroid adenoma rather than parathyroid carcinoma. Although an association between PHPT and well-differentiated thyroid carcinoma has been reported, it is often considered coincidental. We report a case of a 50-year-old female presenting with tingling, shoulder pain, muscle weakness, and elevated serum calcium and parathyroid hormone levels. Neck ultrasonography revealed a hypoechoic nodule in the left inferior region to the thyroid gland and thyroid nodules in both lobes. A Tc99m-MIBI parathyroid scan showed a focal hot nodule, and fine-needle aspiration confirmed papillary thyroid carcinoma, later verified by histopathology. The patient underwent surgery and was diagnosed with PHPT and papillary thyroid carcinoma. This case highlights the importance of evaluation for concomitant thyroid malignancy in PHPT patients with suspicious thyroid nodules.

A 78-year-old woman presented to our hospital with progressive dyspnea (NYHA class I-II) and epigastric discomfort that had developed after a traffic accident. She had a history of hypertension and cerebral infarction, but no history of cardiovascular disease. Her blood pressure was 130/70 mmHg and her heart rate was 66 beats/min and regular. The electrocardiogram showed normal sinus rhythm. The chest X-ray revealed bilateral pleural effusions. Transthoracic echocardiography (TTE) demonstrated an aneurysm of the descending thoracic aorta compressing the left atrium (LA). Left and right ventricular systolic function was preserved. Whole-body computed tomography (CT) angiography revealed that a focal 40-mm-diameter saccular aneurysm in the descending aorta at the level of T7-8, with an intramural hematoma, was compressing the LA and left pulmonary vein. After surgical management, follow-up TTE and CT showed decompression of the LA and left pulmonary vein.
Accidents, Traffic ; Aged ; Aneurysm* ; Angiography ; Aorta, Thoracic* ; Aortic Aneurysm ; Blood Pressure ; Cardiovascular Diseases ; Cerebral Infarction ; Decompression ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Atria* ; Heart Rate ; Hematoma ; Humans ; Hypertension ; Pleural Effusion ; Pulmonary Veins ; Thorax

The anesthetic management of patients with pheochromocytoma presents many difficult problems, such as hypertension, cardiac arrhythmias, and hypotension. A 21 year-old male underwent resection of pheochromocytoma under general anesthesia with isoflurane and fentanyl. Hypertensive crisis during induction of anesthesia and surgical manipulation of the tumor were managed with phentolamine and sodium nitroprusside drips. Anesthesia was maintained wtih nitrous oxide : oxygen, 50% : 50%, isoflurane, 0.5-2% and supplemented with fractional doses of fentanyl and vecuronium for muscular relaxation. We also used propranolol for the cardiac arrhythmia. An endotracheal semi-closed circle absorption technique with controlled ventilation was employed. Fentanyl does not release histamine, and has stable hemodynamics. Isoflurane has also advocated on the grounds that arrhythmias are less esaily provocated by circulating catecholamines than with other volatile agents, and has been shown to be a satisfactory agent. Vecuronium does not provoke catecholamine release, does not release histamine, has no autonomic effects at clinical plasma concentrations, and is clearly the neuromuscular blocking agent of choice in this case. Optimal pre-operative preparation, smooth induction of anesthesia, adequate alveolar ventilation, proper cardiovascular control, and good communication between surgeon and anesthesiologist are most important for the anesthetic management of pheochromocytoma.
Absorption ; Anesthesia ; Anesthesia, General ; Arrhythmias, Cardiac ; Autonomic Agents ; Catecholamines ; Fentanyl ; Hemodynamics ; Histamine ; Humans ; Hypertension ; Hypotension ; Isoflurane ; Male ; Neuromuscular Blockade ; Nitroprusside ; Nitrous Oxide ; Oxygen ; Phentolamine ; Pheochromocytoma* ; Plasma ; Propranolol ; Relaxation ; Vecuronium Bromide ; Ventilation ; Young Adult

Laminar flow within large vessels or organs can cause artifact that may simulate thrombus during computed tomographic study. The degree of venous enhancement depends on the size of blood pool and cardiac output in relation to the time of scanning. When venous structures are scanned too fast after injection of contrast material, poor mixing of enhanced and unenhanced blood creates flow artifact that gives an appearance of deep venous thrombosis. As compared with dynamic computed tomography (CT), because of a shorter acquisition time of spiral CT, vascular and organ enhancement on spiral CT scan are more dependent on factor that affect delivery of contrast material into the blood stream. Differentiation from true thrombus can be made by use of delayed scan as well as increased density and finding of relatively poor margination of artifact. In addition, both angiography and echocardiography could complement CT to assure that false-positive results are minimized. We experienced a case of artifact mistaken for intracardiac mass on spiral CT, but it was not noted on echocardiography.
Angiography ; Artifacts* ; Cardiac Output ; Complement System Proteins ; Echocardiography ; Heart Neoplasms* ; Rivers ; Thrombosis ; Tomography, Spiral Computed ; Venous Thrombosis

PURPOSE: Interest in peptic ulcer in children has been relatively low because the disease is rarer in children than in adults and there were restrictions in the application of endoscopy to children, but the recent development of pediatric endoscopy is activating research on pediatric peptic ulcer. Thus, this study compared the H. pylori infection rate and clinical and endoscopic findings among pediatric patients diagnosed with peptic ulcer. METHODS: We analyzed retrospectively 58 pediatric patients for whom whether to be infected with H. pylori was confirmed selected out of pediatric patients diagnosed with gastric ulcer or duodenal ulcer through upper gastrointestinal endoscopy at the Department of Pediatrics of Gachon University Gil Hospital during the period from January 2002 to December 2007. A case was considered H. pylori positive if H. pylori was detected in the Giemsa stain of tissue or the results of UBT (urea breath test) and CLO (rapid urease test) were both positive. RESULTS: Of the pediatric patients, 37 were infected with H. pylori and 21 were not. The H. pylori infection rate increased with aging and the result was statistically significant (p<0.05). However, H. pylori infection was not in a statistically significant correlation with sex, chief complaint, and gastroduodenal ulcer (p>0.05). CONCLUSION: H. pylori infection increased with aging, but was not significantly correlated with gastroduodenal ulcer. Further research may need to examine prospectively the relation between H. pylori and gastroduodenal ulcer in the Incheon area.
Adult ; Aging ; Azure Stains ; Child ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Gastrointestinal ; Helicobacter ; Helicobacter pylori ; Humans ; Pediatrics ; Peptic Ulcer ; Retrospective Studies ; Stomach Ulcer ; Urease

No abstract available.
Umbilical Cord*

In effort to determine whether aircraft noise can have health effects such as hearing loss, hypertension and psychological stress, a total of 111 male professors and administrative officers working a college near a military airport in Korea(exposed group) and a total of 168 males and 112 females matched by age groups(control groups) were analyzed. Personal noise exposure and indoor and outdoor sound level of jet aircraft noise were measured at the exposed area. And pure tone, air conduction test and measurement of blood pressure were given to the exposed(males) and matched control groups(males and females). BEPSI(Brief Encounter Psychological Instrument) and psychological response to aircraft noise were examined for the exposed group. The noise dosimetry results revealed time-weighted averages(TWAs) that ranged from 61 to 68 dBA. However the levels encountered during taking off jet airplanes reached 126 dBA for two half minutes time period. The audiometric test showed that mean values of HTL(hearing threshold level) in exposed group at every frequency(500, 1,000, 2,000, 4,000, and 8,000 Hz were much lower than them of male and female control groups. And in old age groups, interaction of age and noise was observed at 8,000 Hz in both ears(p< 0.05). Conclusively, aircraft noise does not appear to induce hearing loss directly, but may decreased hearing threshold level by interaction of aging process and noise exposure. However, difference of mean values of exposed and control groups on blood pressure was not significantly. In psychological test, annoyance was the most severe psychological response to noise in exposed group, but mean value of BEPSI was not correlated with job duration in exposed group
Aging ; Aircraft* ; Airports ; Blood Pressure* ; Female ; Hearing Loss* ; Hearing* ; Humans ; Hypertension ; Male ; Military Personnel ; Noise* ; Presbycusis ; Psychological Tests ; Stress, Psychological*

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal* ; Prognosis*

No abstract available.
Hepatolenticular Degeneration*