A case of extrapulmonary silicosis involving abdominal lymph nodes in a 62-year-old man is presented. The patient underwent subtotal gastrectomy and regional lymph nodes dissection for gastric adenocarcinoma of clinical stage III. On gross examination, two separate gastric adenocarcinomas and multiple enlarged lymph nodes mimicking metastatic lesion were noted. Microscopic examination of the enlaged lymph nodes revealed characteristic sclerohyaline silicotic nodules without metastatic adenocarcinoma. Chest roentgenogram showed diffusely scattered multiple tiny nodular lesions in the entire lung fields, particularly the posterior side of both upper lung fields. He had worked in a mine for 18 years and had been exposed to silica for 5 of those years. We report incidentally found, unusual case of extrapulmonary silicosis.
Adenocarcinoma ; Gastrectomy ; Humans ; Lung ; Lymph Nodes ; Middle Aged ; Silicon Dioxide ; Silicosis* ; Thorax

BACKGROUND AND OBJECTIVES: Perfluorocarbon exposed sonicated dextrose albumin (PESDA) microbubbles has been suggested to facilitate thrombus disruption under the transcutaneous ultrasound (US). Thus, we investigated whether such a noninvasive approach could augment thrombolytic effect of fibrinolytic agent in an experimental thrombotic model. MATERIALS AND METHODS: Thrombus formation was induced with electrical injury in the rabbit iliofemoral arteries (n=20): Thrombus occlusion was documented by angiography in all arteries. In the control group, only tissue plasminogen activator (t-PA, 3 mg/kg) was administered intrav-enously in five rabbits. In the Group 1 (n=9), injured arteries were exposed to transcutaneous US (20 kHz, 30 W/cm2, continuous mode) with t-PA (3 mg/kg). In the Group 2 (n=6), the same treatment was given while administering PESDA continuously (10 ml/min, intravenous). Angiographic results were evaluated at 10 minute interval for 1 hour respectively. RESULTS: In the control group, two of five iliofemoral arteries (40.0%) were recanalized and one of nine iliofemoral arteries (11.1%) was recanalized in Group 1. In contrast, four of six iliofemoral arteries (66.7%) were recanalized angiographically in Group 2 (p=0.392 vs. control group: p=0.047 vs. Group 1). However, late reocclusion occurred in all iliofemoral arteries of Group 2. CONCLUSION: Although PESDA with transcutaneous US significantly enhanced initial angiographic patency rate of t-PA, it was associated with high rate of reocclusion. Further studies will be necessary for clinical application of this noninvasive method in acute arterial occlusion.
Angiography ; Arteries ; Glucose* ; Microbubbles ; Rabbits ; Thrombolytic Therapy* ; Thrombosis ; Tissue Plasminogen Activator ; Ultrasonography*

The interstitial lung diseases(ILD) comprises a large, heterogeneous group of disorders characterized by derangement of alveolar walls and alveolar capillary unit causing restrictive pulmonary dysfunction and disordered gas exchange. It is rare, especially in children, and the opinions on investigation and treatments are controversial. The classification of adult ILD is applied to that of children. But considering occurrence during the developing state of lung and immune systems, we should be more cautious because the clinical manifestations and prognosis will be different from those of adults. In 1995, Katzenstein named a unique type of ILD, chronic pneumonitis of infancy (CPI) for the first time. CPI is characterized by marked alveolar septal thickening, striking type II pneumocyte hyperplasia, and eosinophilic alveolar exudate containing numerous macrophages. We report a 14 month-old girl, who had continuing respiratory difficulty and cyanosis after upper respiratory infection, could not sustain oxygen saturation and was finally diagnosed as CPI by histologic examination.
Adult ; Capillaries ; Child ; Classification ; Cyanosis ; Eosinophils ; Exudates and Transudates ; Female ; Humans ; Hyperplasia ; Immune System ; Infant ; Lung ; Lung Diseases, Interstitial* ; Macrophages ; Oxygen ; Pneumocytes ; Pneumonia* ; Prognosis ; Strikes, Employee

Early gastric cancer (EGC) is a "curable" disease with a high cure rate made possible through proper surgical treatment; nonetheless, some patients sustain a disease recurrence after curative resection. The aim of this study was to identify the clinicopathological characteristics of recurrent EGC and determine predictable immunohistochemical markers for recurrence. We investigated the clinicopathological features of 1,786 EGC cases, and using tissue microarray, the expression of c-erbB-2, EGFR, MLH1, MSH2, p53, and AQP1 was examined in group with recurrence and control group without recerrence. In the clinical analysis, 32 of 1,786 (1.79%) patients showed recurrence, with a 2.04% five-year cumulative recurrence rate. Age, submucosal invasion, and lymph node metastasis significantly correlated with tumor recurrence (P=0.044, 0.019, and <0.001, respectively). Multivariate analysis showed lymph node status and old age (> or =57 yr) as independent risk factors of recurrence. In a case-control study, immunopositivity for c-erbB-2 was significantly associated with disease recurrence (P=0.024). There is the probability that EGC patients with old age (> or =57 yr), lymph node metastasis, submucosal invasion, and c-erbB-2 immunopositivity will experience recurrence; therefore, it is critical that patients with these risk factors be followed-up closely and considered candidates for adjuvant treatment.
Adult ; Aged ; Animals ; Female ; Genes, erbB-2 ; Humans ; Immunohistochemistry/methods ; Male ; Microarray Analysis/methods ; Middle Aged ; Multivariate Analysis ; *Neoplasm Recurrence, Local/metabolism/pathology ; Prognosis ; Risk Factors ; *Stomach Neoplasms/metabolism/pathology ; Tumor Markers, Biological/*metabolism

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

In hypertrophic cardiomyopathy, the distribution and extent of left ventricular hypertrophy is known to be variable. Among the subtypes of hypertrophic cardiomyopathy, midventricular obstruction is a rare variant of obstructive hypertrophic cardiomyopathy. This variant is at higher risk of apical wall motion abnormality and/or infarction. We report 4 patients with midventricular obstructive hypertrophic cardiomyopathy who presented with chest pain. Significant systolic pressure gradients between basal and apical chamber of left ventricle were documented by cardiac catheterization and Doppler echocardiography in all patients, and left ventricular apical infarction was noted in one of them. During mean follow-up period of 32 months(21 months to 5 years), one patient with apical infarction died of malignant ventricular arrhythmia.
Arrhythmias, Cardiac ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Chest Pain ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Infarction

In hypertrophic cardiomyopathy, the distribution and extent of left ventricular hypertrophy is known to be variable. Among the subtypes of hypertrophic cardiomyopathy, midventricular obstruction is a rare variant of obstructive hypertrophic cardiomyopathy. This variant is at higher risk of apical wall motion abnormality and/or infarction. We report 4 patients with midventricular obstructive hypertrophic cardiomyopathy who presented with chest pain. Significant systolic pressure gradients between basal and apical chamber of left ventricle were documented by cardiac catheterization and Doppler echocardiography in all patients, and left ventricular apical infarction was noted in one of them. During mean follow-up period of 32 months(21 months to 5 years), one patient with apical infarction died of malignant ventricular arrhythmia.
Arrhythmias, Cardiac ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Chest Pain ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Infarction

Double-outlet left ventricle with ventricular septal defect and pulmonary stenosis was conventionally repaired with extracardiac conduit or pulmonary artery translocation. Here, we report an anatomically repaired double-outlet left ventricle without extracardiac conduit or pulmonary artery translocation in an 11 month old patient who had undergone palliative systemic-pulmonary shunt at a nonatal period. The location of ventricular septal defect, both great arteries and coronary arteries made it possible to reconstruct the right ventricular outflow tract using on-lay patch after incision and undercutting the tissue between the ventriculotomy and the pulmonary arteriotomy.
Arteries ; Coronary Vessels ; Heart Septal Defects, Ventricular* ; Heart Ventricles* ; Humans ; Infant ; Pulmonary Artery ; Pulmonary Valve Stenosis*

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

BACKGROUND: It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. Recently, advances have made possible the imaging of the cardiac adrenergic nervous system with metaiodobenzylguanidine (MIBG) labeled with iodine-123. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation by iodine-123-metaiodobenzylguanidine single-photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of iodine-123-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm. METHOD: Coronary arteriography and provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (21 men, 5 women, mean age 49.1+/-9.3, range: 26-59) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups ; Group 1 comparised of 18 patients subjects to the positive provocative test, Group 2 comparised of 8 patients subjects to the negative provocative test. Four healthy subjects served as control. All patients also underwent iodine-123-MIBG SPECT for the evaluation of cardiac sympathetic integrity. The SPECT findings were qualitatively evaluated by two experienced physicians who were blind to the clinical data. RESULTS: Abnormal sympathetic nervous innervation using iodine-123-MIBG SPECT was observed either as a reduced uptake or defect pattern in the perfused areas in 13 of the 18 vessels of ergonovine induced vasospasm. Normal sympathetic innervation as evidenced by normal iodine-123-MIBG uptake was noted in all of the 60 segments of normal vessel territories. Reduced uptake of iodine-123-MIBG was not detected in the perfused areas of five vasospasm-induced vessels (perfusion territory of LAD in 2 and the RCA in 3 patients). The sensitivity and specificity of iodine-123-MIBG for detection coronary artery spasm were 72.2% (95% confidence interval [CI] 55% to 89%) and 100%, respectively. The positive predictive value and negative predictive value were 100% and 92.3% (95% CI 91% to 93%), respectively. CONCLUSION: Iodine-123-MIBG SPECT is a feasible method to noninvasively evaluate and localize the territories of coronary arteries with spasms. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for the diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan, but abnormal iodine-123-MIBG SPECT.
Administration, Intravenous ; Angiography ; Coronary Vessels* ; Diagnosis* ; Ergonovine ; Exercise Test ; Female ; Humans ; Male ; Mass Screening* ; Myocardial Perfusion Imaging* ; Nervous System ; Neurons* ; Perfusion ; Sensitivity and Specificity ; Spasm* ; Sympathetic Nervous System ; Thallium ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon