We report the case of a 42-year-old male who was admitted to the hospital with progressive dyspnea. Cardiomegaly and diffuse pulmonary edema were visible on chest X-ray and multiple oral and genital ulcers on physical examination. On admission, echocardiography revealed mitral valve prolapse (MVP) predominantly involving a basal portion of the posterior leaflet, with severe mitral regurgitation. A successful mitral valve replacement with St. Jude #29 was performed, after pre-treatment with prednisolone for 2 weeks. Fifteen months following the operation, the patient expired from severe pulmonary edema and secondary pneumonia. This case demonstrates, for the first time in the literature, an unusual feature of mitral prolapse in the basal portion with severe mitral regurgitation in a patient with Behcet's disease. As suggested by this case, we should consider an atypical type of MVP as a possible inflammatory involvement of the heart in patients with Behcet's disease.
Adult ; Behcet Syndrome ; Cardiomegaly ; Dyspnea ; Echocardiography ; Heart ; Heart Valve Prolapse ; Humans ; Inflammation ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Physical Examination ; Pneumonia ; Prednisolone ; Prolapse ; Pulmonary Edema ; Thorax ; Ulcer

BACKGROUND AND OBJECTIVES: Intracardiac pathology results in 15 - 20% of ischemic stroke, but transthoracic echocardiography (TTE) has a number of limitations because of suboptimal precordial windows or ultrasound interference with prosthetic materials. Transesophageal echocardiography (TEE) provides superior resolution of basal structures such as the left atrium, left atrial appendage, mitral valvular apparatus, atrial septum, and aorta. The purpose of this study was to describe the various TEE findings which were sources of cerebral emboli. MATERIALS AND METHOD: The study population was comprised of 122 patients (mean age:54.5, male 83, female 39) who were admitted to Severance Hospital because of ischemic stroke from 1991 to 1997. All patients underwent TEE with agitated saline contrast administration. Patients without a definitive cardiac source of embolism underwent Holtor monitoring, internal carotid and cerebral angiography, as well as transcranial Doppler. RESULTS: 1) The number of patients diagnosed as cardioembolic stroke was 55 (45.1%). Atrial fibrillation was noted in 31 patients of cardioembolic stroke and it was the most frequent finding. Among these patients, 16 did not have any other cardiac problem. 2) We were able to find the possible source of embolism in 49 (40.2%) patients with TEE. Among these patients, 12 did not have dysrhythmia or any known previous heart problem. We found spontaneous echo contrast in the left atrium and left atrial appendage in 33 cases. There were 8 patients who had intracardiac thrombus. Among these patients, 6 patients had thrombi in the left atrial appendage, 1 in left atrium and 1 in left ventricular apex. We found patent foramen ovale in 3 cases and atrial aneurysm in 1 case. We found atheromatous plaque and/or thrombi of the aorta in 16 cases, while there were 4 cases where lesions located in the ascending aorta and aortic arch and which were considered as the source of embolism. Small thrombi in the left atrial appendage and left atrium were only detectable with TEE. CONCLUSIONS: We described TEE findings in ischemic stroke patients. And we assert TEE is a useful diagnostic tool in detecting the source of cardioembolic stroke and it may be used as a primary diagnostic tool in patients who are being evaluated for ischemic stroke.
Aneurysm ; Aorta ; Aorta, Thoracic ; Atrial Appendage ; Atrial Fibrillation ; Atrial Septum ; Cerebral Angiography ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Female ; Foramen Ovale, Patent ; Heart ; Heart Atria ; Humans ; Intracranial Embolism ; Male ; Pathology ; Stroke* ; Thrombosis ; Ultrasonography

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

Effective management of rheumatoid arthritis (RA) necessitates the accurate measurement of disease activity using a treat-totarget strategy established as a cornerstone approach. Disease activity assessment tools such as the Disease Activity Score in 28 joints (DAS28), Simplified Disease Activity Index, Clinical Disease Activity Index, and Routine Assessment of Patient Index Data 3 have been internationally validated and recognised. In Korea, the government initiated a quality assessment program mandating routine measurement of DAS28 to ensure high-quality RA management. However, whether the DAS28 is the most suitable disease activity measurement tool in the Korean clinical environment is a topic worth considering. In this review, we comprehensively examined disease activity measurement tools and their performance in the Korean context. We also propose a new strategy for measuring RA disease activity, tailored to the different situations encountered by physicians in routine clinical practice. This review may contribute to the improvement of the quality of care for patients with RA in Korea.

No abstract available.
Mitral Valve*

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the age-related differences in clinical features, coronary anatomy, risk factors, hospital courses, and long-term prognosis of acute myocardial infarction(AMI) in women. MATERIALS AND METHODS: Total 513 female patients with AMI were divided into 3 groups ; group 1(n=3, 50 years old or less), group 2(n=02, between 51 years and 70 years old), and group 3(n=68, older than 70 years). Clinical follow-up including cardiac events was performed for mean duration of 26 months(1~155 months). Cardiac events include cardiac death, reinfarction, CABG, PTCA, CHF, stroke, and recurrent angina. RESULTS: Minimal lesion(<50% stenosis) in infarct-related artery was more prevalent in group 1 than in group 3(p<0.05). In group 2, the number of low high density lipoprotein(HDL) was significantly more than in group 3(p<0.01). During hospitalization, death and shock were more prevalently observed in group 3 than group 1(p<0.005) and group 2(p<0.001). Group 3 had more heart failures than group 1(p<0.001) and group 2(p<0.001) and group 2 had more heart failures than group 1(p<0.05). The younger age group showed a significantly higher survial rate(7 years : group 1; 76.1%, group 2; 60.6%, group 3; 34.2%, p<0.0001, Log Rank Stat =49.4) and cardiac event-free survival rate(7 years : group 1; 48.4%, group 2; 32.3%, group 3; 16.0%, p<0.0001, Log Rank Stat =37.5) for each 3 comparisons. In Cox proportional harzard analysis, LV systolic function influenced the group 2 survival (odds ratio 3.8, 95% CI 1.7 to 8.3, p<0.005) and the group 3 survival (odds ratio 2.2, 95% CI 1.1 to 4.5, p<0.05). The cardiac event free survival was influenced by age(odds ratio 1.6, 95% CI 1.2 to 2.1, p<0.005) and LV systolic function(odds ratio 1.8, 95% CI 1.3 to 2.5, p<0.001). CONCLUSION: Younger female patients with AMI had a more favorable prognosis compared with older female patients. LV systolic fuction was important as a prognostic factor for long-term survival except younger female AMI patients.
Arteries ; Death ; Disease-Free Survival ; Female ; Follow-Up Studies ; Heart ; Hospitalization ; Humans ; Middle Aged ; Myocardial Infarction* ; Prognosis* ; Risk Factors ; Shock ; Stroke

Since endocrine disrupting chemicals (EDCs) may interfere with the endocrine system(s) of our body and have an estrogenicity, we evaluated the effect(s) of bisphenol A (BPA) on the transcriptional levels of altered genes in estrogen receptor (ER)-positive BG-1 ovarian cancer cells by microarray and real-time polymerase-chain reaction. In this study, treatment with 17beta-estradiol (E2) or BPA increased mRNA levels of E2-responsive genes related to apoptosis, cancer and cell cycle, signal transduction and nucleic acid binding etc. In parallel with their microarray data, the mRNA levels of some altered genes including RAB31_MEMBER RAS ONCOGENE FAMILY (U59877), CYCLIN D1 (X59798), CYCLIN-DEPENDENT KINASE 4 (U37022), IGF-BINDING PROTEIN 4 (U20982), and ANTI-MULLERIAN HORMONE (NM_000479) were significantly induced by E2 or BPA in this cell model. These results indicate that BPA in parallel with E2 induced the transcriptional levels of E2-responsive genes in an estrogen receptor (ER)-positive BG-1 cells. In conclusion, these microarray and real-time polymerase-chain reaction results indicate that BPA, a potential weak estrogen, may have estrogenic effect by regulating E2-responsive genes in ER-positive BG-1 cells and BG-1 cells would be the best in vitro model to detect these estrogenic EDCs.
Anti-Mullerian Hormone ; Apoptosis ; Benzhydryl Compounds ; Cell Cycle ; Cyclin D1 ; Cyclin-Dependent Kinase 4 ; Endocrine Disruptors ; Estrogens ; Genes, ras ; Humans ; Insulin-Like Growth Factor Binding Protein 4 ; Microarray Analysis ; Ovarian Neoplasms ; Phenols ; Receptors, Estrogen ; RNA, Messenger ; Signal Transduction

BACKGROUND AND OBJECTIVES: Determining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of acute myocardial infarction (AMI). The aim of this study was to assess the ability of dobutamine echocardiography (DE) to detect viable myocardium and predict the late improvement of regional left ventricular dysfunction after AMI. METHODS: Twenty-five patients (male 24, mean age 57+/-9.6) with AMI underwent DE (dobutamine: 0, 5, 10 and 20 microgramm/kg/min) in 4.8+/-2.2 days after infarction. Revascularization of infarct related artery was performed in 20 patients (percutaneous coronary angioplasty 18, coronary artery bypass graft surgery 2). A follow-up 2D-echocardiography was performed at 7.1+/-2.3 months after AMI. RESULTS: 1. Improvement of regional wall motion abnormality (RWMA) was observed in 12 patients during DE[DE (+) group]. Thirteen patients showed no improvement of RWMA[DE (-) group]. 2. In follow-up 2D-echocardiography 10 patients showed improvement of RWMA among DE (+) group (positive predictive value= 83.3%). Two patients showed improvement of RWMA among DE (-) group (negative predictive value=84.6%). Sensitivity and specificity of DE in predictiong late recovery of RWMA were 83.3% and 84.6% each. DE performed in the early stage of AMI seems to be useful in prediction of late recovery of regional left ventricular dysfunction.
Angioplasty ; Arteries ; Coronary Artery Bypass ; Dobutamine* ; Echocardiography* ; Follow-Up Studies ; Humans ; Infarction ; Myocardial Infarction* ; Myocardium ; Sensitivity and Specificity ; Transplants ; Ventricular Dysfunction, Left

Congenital syphilis occurs when Treponema pallidum crosses the placenta during pregnancy or from contact with an infectious genital lesion during delivery. Cutaneous manifestations of congenital syphilis are relatively common, occurring in approximately 30% to 70% of patients. Maculopapular lesions, vesiculobullous lesions, condylomata lata lesions, annular lesions, and erythema multiforme-like targetoid lesions have been reported. We report on a premature newborn with congenital syphilis who presented with generalized bullous and pustular eruption and desquamation at birth.
Blister ; Erythema ; Humans ; Infant, Newborn ; Parturition ; Placenta ; Pregnancy ; Syphilis ; Syphilis, Congenital ; Treponema pallidum