BACKGROUND: Propafenone is effective in the treatment of ventricular arrhythmias and paroxysmal supraventricular tachycardia. Propafenone has been shown to be also useful in preventing the recurrence of atrial fibrillation. But to date, date concerning the efficacy of propafenone for patients experiencing paroxysmal and chronic atrial fibrillation have not been examined in Korea. METHODS: In patients with paroxysmal atrial fibrillation propafenone was given at a dose of 450mg daily without dose titration and symptomatic recurrences were evaluated by patient interview during follow-up. In patients with chronic atrial fibrillation, who had no previously attempted cardioversion, propafenone was given at a dose of 450~675mg daily without dose titration, and after a minimum of 3 days pharmacological cardioversion was assessed. Those patients in whom sinus rhythm had been restored pharmacologically or by combined direct current cardioversion were followed with maintaining propafenone therapy also at a dose of 450~675mg daily. RESULTS: Of 7 patients with paroxysmal atrial fibrillation, 4 (57%) patients had marked symptomatic improvement and they were followed for 197 to 460 (mean 286) days Of 13 patients with chronic atrial fibrillation, 7 patients incuding 4 pharmacologically converted patients were initially controlled to sinus rhythm. In 5 (38%) patients maintenance of sinus rhythm was followed for 90 to 415 (mean 224) days. CONCLUSION: Although these observations were made in small number of patients and are so limited, the results are comparable to the previous studies which showed the potential role of propafenone in the management of atrial fibrillation.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Electric Countershock ; Follow-Up Studies ; Humans ; Korea ; Propafenone* ; Recurrence ; Tachycardia, Supraventricular

The bony spur formation without degenerative change in the lumbar spines in the young age group is quite interesting and not uncommon. This bony spur is different from the degenerative spur in the old age group in shape and mechanism of formation. The authors analyzed 111 patients with such posterior lumbar bony spur for recent 3 years and 9 months. The authors concluded that posterioly located Schmorl's node is a main cause of the bony spur without degenerative change at lumbar region. The authors advocated 'Juvenile spur' as a new disease entity.
Humans ; Lumbosacral Region ; Spine*

The usefulness of E-cadherin immunostaining as a marker of malignancy in the body fluids was investigated in the present study. Thirty-three histologically proven cases of cell blocks from the pleural, peritoneal, and pericardial fluids were studied by immunocytochemistry for E-cadherin antibody using LSAB method. These cases were cytologically diagnosed as adenocarcinoma (25 cases) and atypical cells (8 cases). Tumor cells showed strong positive membranous staining for E-cadherin antibody in 21 out of 25 cases (84%) of adenocarcinoma. E-cadherin staining was not found in 6 of 8 cases of suspicious maligancy. The sensitivity and specificity were 84% and 75%, respectively. Reactive mesothelial cells and inflammatory cells scattered were all negative. In conclusion, E-cadherin is an useful adjunctive marker to distinguish reactive mesothelial cells from the carcinoma cells in the body fluids.
Sensitivity and Specificity ; Adenocarcinoma ; Neoplasm Metastasis

Arteriovenous malformation of the pancreas is a rare disease, and it is manifested by gastrointestinal bleeding and/or portal hypertension. Surgery is definitely the treatment of choice at the early stage of the disease, and a transcatheter embolization is an alternative treatment for the control of bleeding and if the lesion is surgically inaccessible. We describe a 62-year-old man who had refractory ascites and esophageal variceal bleeding caused by a pancreatic arteriovenous malformation associated with portal hypertension; this was successfully treated by a transjugular intrahepatic portosytemic shunt.
Arteriovenous Malformations* ; Ascites ; Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal* ; Middle Aged ; Pancreas ; Portasystemic Shunt, Surgical* ; Rare Diseases

We report a case of tuberculosis verrucosa cutis in a 34-year-old male patient who presented with asymptomatic verrucous plaque over the right buttock, right inner thigh and right inguinal area. The Mantoux test revealed a strong positive reaction. The histologic picture consists of hyperkeratosis, acanthosis and papillomatosis overlying an inflammatory infiltrate in the upper dermis. Tuberculoid granulomas without caseation necrosis are seen in the dermis. Tubercle hacilli were not demonstrated. The patient was treated with INAH, Rifampicin and Ethambutol for 6 months. To date, the skin lesions have markedly improved.
Adult ; Buttocks ; Dermis ; Ethambutol ; Granuloma ; Humans ; Male ; Necrosis ; Papilloma ; Rifampin ; Skin ; Thigh ; Tuberculosis*

BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Anesthesia* ; Animals ; Arrhythmias, Cardiac ; Dogs* ; Epinephrine* ; Halothane* ; Hemostasis ; Myocardium ; Ventricular Premature Complexes

BACKGROUND: Determination of left ventricular(LV) myocardial mass with echocardioraphy is feasible and validated. American society of echocardiography(ASE) issued recommendations for the quantitation of the left ventricle by M-mode and 2-dimensional echocardiography in 1978 and 1989, respectively. Although some controversies exist regarding the relative accuracy of M-mode and 2-dimensional techniques, many workers now agree that 2-dimensional methods are more accurate and can be applied to a higher percentage of patients. But sometimes the validated methods are not optimal when parasternal short axis view is difficult to obtain, when the ventricle is distorted, or when scar tissue constitutes a portion of the myocardial volume. METHODS: We measured left ventricular mass in 72 normal subjects using three different methods-ASE cube method with correction in M-mode(method A), area-length method from parasternal short axis view and apical four chamber view(method B), and the method using Simpson's rule from apical four chamber view(method C). RESULTS: 1) LV mass(index) was 161.8+/-30.3g(98.7+/-15.6g/m2) by method A, 166.2+/-32.8g(101.2+/-16.5g/m2) by method B, and 161.2+/-31.8g(98.2+/-15.5g/m2) by method C. 2) LV mass or index by method B was significantly different from that by method A(p<0.001) and from that by method C(p<0.001). However there was no significant difference in LV mass or index between by method A and C(p>0.05). 3) There was a strong correlation between LV mass or index by the method A and B(r=0.873, p<0.001), by the method B and C(r=0.923, p<0.001), and by the A and C(r=0.945, p<0.001). CONCLUSIONS: It is suggested that the method using Simpson's rule can reliably assess LV mass, although it results in smaller value that that by area-length method.
Axis, Cervical Vertebra ; Cicatrix ; Echocardiography* ; Heart Ventricles ; Humans

BACKGROUND: Balloon mitral valvuloplasty is a favorable procedure as a therapy for mitral stenosis because it minimizes morbidity and shorten hospital stay compared with surgical mitral commissurotomy or mitral valve replacement. Recent reports about concomitant transesophageal echocardiography guide in addition to fluoroscopy suggest that transesophageal echocardiograpy can provide additional benefits during balloon mitral valvuloplasty especially in transseptal puncture, balloon positioning, evaluation of immediate result, and early detection of complications. We performed this study to identify the potential benefits of on-line transesophageal echocardiography guide during balloon mitral valvuloplasty. METHOD: We performed balloon mitral valvuloplasty under on-line transesophageal echocardiography guide in addition to fluoroscopy in 70 patients(male:14, female:56, mean age:44+/-13) with rheumatic mitral stenosis from May 1995 to May 1996. Thirty-two(46%) patients had atrial fibrillation. Included patients were symptomatic with more than NYHA class 2 symptom. Patients with mitral valve score more than 11 and mitral regurgitation more than 2/4 were excluded. Inoue balloons were utilized in all cases. RESULTS: The average mitral valve area increased from 0.9+/-0.2cm2 before valvuloplasty to 1.8+/-0.4cm2 after valvuloplasty(p<0.0001). The averagetransmitral pressure gradient measured by continuous wave Doppler decreased from 14+/-6mmHg before valvuloplasty to 5+/-2mmHg after valvuloplasty(p<0.0001), and the average left atrial pressure measured by catheterization decreased form 22+/-8 mmHg before valvuloplasty to 11+/-5mmHg after valvuloplasty(p<0.0001). The average procedure time was 64+/-22 minutes(ranged from 13 to 150 minutes) and the average fluoroscopy time was 19+/-15 minutes(ranged from 1 to 94 minutes). Two patients underwent surgery due to severe mitral regurgitation associated with papillary muscle rupture which developed after valvuloplasty. In one patient, transesophageal echocardiography detected pericaridal tamponade during the procedure and the transducer was quickly switched to transthoracic transducer to guide the pericardial puncture site. The pericardial tamponade was drained with pigtail catheter and the patient underwent balloon mitral valvuloplasty successfully a week later. Four patients were pregnant at the time of the valvuloplasty procedure and the valvuloplasty was successfully performed with minimal fluoroscopy time(1-3 minutes) without complications in all four patients. Five patients had thrombus in left atrial appendage, but the transesophageal echocardiography was useful in monitoring the ballon position during the procedure and the valvuloplasty was successfully performed without embolic complications in all five patients. CONCLUSION: The transesophageal echocardiography is a very useful guiding adjunct during balloon mitral valvuloplasty in transseptal puncture, balloon positioning, evaluation of immediate result, early detection of complications, and shortening fluoroscopy time especially in pregnant women.
Atrial Appendage ; Atrial Fibrillation ; Atrial Pressure ; Cardiac Tamponade ; Catheterization ; Catheters ; Echocardiography, Transesophageal* ; Female ; Fluoroscopy ; Humans ; Length of Stay ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Papillary Muscles ; Pregnant Women ; Punctures ; Rupture ; Thrombosis ; Transducers

BACKGROUND: Percutaneous mitral balloon valvuloplasty(PMV) is a good treatment modality for patient with mitral stenosis(MS). But it is considered relatively contraindicated in patients with left artrial thrombi because of high risk of embolism. Limitted studies have suggested the feasibility of PMV in patients with left atrial appendage(LAA) thrombi. This study was performed to evaluate the feasibility and safty of PMV in patients with LAA thrombi using Inoue balloon under the transesophageal echocardiographic (TEE) monitoring. METHOD: PMV was performed in 5 patients diagnosed as MS with LAA thrombi from October, 1995 to July, 1996. Four cases were female, and one case was male. Their mean age was 525(46-58years old). Two of them had history of cerebrovascular accident(CVA). The duration of anticoagulant treatment was 6-49 moths. All patients underwent PMV using Inoue balloon catheter under the TEE monitoring. RESULTS: EKG finding of all 5 patients were atrial fibrillation(Af). Their mitral valve score were 5-10(Mean score was 82). Transmitral mean pressure gradient was decreased from 14.62.1 to 5.82.0mmHg, and mitral valve increased from 0.840.43 to 1.720.19 after PMV. There was no procedure related complication. In 3 cases of them LAA thrombi diappeared in the follow up TEE. In two patients, the LAA thrombi were calcified and remained unresolved at the time of follow up TEE( 6month-and 12 month-F/U, eath). CONCLUSION: Although the reported number of PMV in patients with LAA thrombi is small in this study, we believe that, with special precaution and TEE monitoring, LAA thrombi is no longer an absolute contraindication to PMV.
Atrial Appendage* ; Balloon Valvuloplasty* ; Catheters ; Echocardiography ; Electrocardiography ; Embolism ; Female ; Follow-Up Studies ; Humans ; Male ; Mitral Valve ; Moths

Congenital smooth musele hamartomas appear at birth as hypertrichotic patches or plaques with or without hyperpigmentation. Histologic characteristic is hyperplasia of dermal smooth muscle bundles. We report a case of congenital smooth muscle harnartoma in 5-year-old female, who showed localized excessive-hairy, skin-colored patch on the lateral surface of left. elbow, which were found at birth. Biopsy specimen showed hyperpigmentation of the basal layers of epidermis, melanophages in upper dermis, and hyperplasia of smooth muscle bundles in lower dermis.
Biopsy ; Child, Preschool ; Dermis ; Elbow ; Epidermis ; Female ; Hamartoma* ; Humans ; Hyperpigmentation ; Hyperplasia ; Hypertrichosis ; Muscle, Smooth* ; Parturition