No abstract available.
Krukenberg Tumor*

Systemic lupus erythematosus is a connective tissue disease which can affect every organ system. Neurologic abnormalities are common, occuring in approximately half of all patients at some time during the course of their illness. But symptoms of nervous system as the sole presenting symptoms occur in less than 1% of lupus patients. In patients initially presenting with neurologic symptoms and signs, differential diagnosis is difficult and sometimes it may be misdiagnosed. Therefore extensive laboratory investigations should be carried out in all patients with unusual neurological symptoms, since early diagnosis of lupus can help in providing effective treatment. We report a patient with systemic lupus erythematosus who presented with dysarthria and dysphagia resembling multiple sclerosis.
Connective Tissue Diseases ; Deglutition Disorders ; Diagnosis, Differential ; Dysarthria ; Early Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Multiple Sclerosis* ; Nervous System ; Neurologic Manifestations

BACKGROUND AND OBJECTIVES: In acute myocardial ischemia, the conduction velocity of action potential is decreased by several electrophysiological and physical factors. The ventricular activation time(VAT) is a time duration of electrical impulse propagating from endocardium to epicardium. The goal of this study is to determine whether the reduction in conduction velocity in acute myocardial ischemia can lead a change in VAT. MATERIALS AND METHOD: Thirty patient, 18 males and 12 females, who had received percutaneous balloon coronary angioplasty(PTCA) were enrolled. The mean age was 59 years old. A twelve lead surface electrocardiogram(ECG) were obtained before, during, 1 minute, 5 minutes, and 10 minutes after the PTCA as digitized data by using Cardiolab EP 4.1 program. The magnitude of the QRS wave was amplified 3 to 4 folds and the speed was increased to 200mm/sec in order to get the VAT easily and accurately. The data was the mean of three consecutive VATs. The number of vessel treated with PTCA included left anterior descending artery(12), left circumflex artery(9), and right coronary artery(9). Among twelve chronic stable angina, sixteen unstable angina, and two acute myocardial infarction patients, twenty six had single and four had two vessel diseases. RESULTS: The significant increase in VAT during PTCA compared to that before PTCA was observed in eight of 12 leads. In addition, the significant decrease in VAT of 1, 5, and 10 minutes after PTCA compared to that during PTCA were noted. Furthermore, 10 minutes after PTCA, VAT decreased significantly compared to that before PTCA. The leads did not show a significant change of VAT depending on target vessels. The ECG of 16 patients showed changes of the ST segment during PTCA. The changes of VAT were not related to the ST segment change. CONCLUSION: The conduction delay from endocardium to epicardium in acute myocardial ischemia was presented as a prolongation of VAT in surface ECG. In addition, the conduction delay was recovered within 5 minutes after relief of ischemia. Therefore, the changes of VAT can possibly be used as one of the noninvasive parameters of myocardial ischemia.
Action Potentials ; Angina, Stable ; Angina, Unstable ; Electrocardiography ; Endocardium ; Female ; Humans ; Ischemia ; Male ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia* ; Pericardium ; Thoracic Surgery, Video-Assisted

It is the purpose of this study to compare the postoperative results of 168 patients with exotropia of basic and simulated divergence excess type over 40 prism diopters; 86 patients had bilateral rectus muscle recessions and 82 patients underwent lateral rectus muscle recession and medial rectus muscle resection. The patients in the former group had averaged 13.7 years of age and 8.2 months of postoperative follow-up period. Those in the latter group averaged 22.9 years and had been followed up for 7.1 months. The postoperative success rates are as follows: 66.7%(57/86) in the bilateral rectus muscle recession group and 68.1%(58/82) in the lateral rectus muscle recession and medial rectus muscle resection group(P>0.05). And the success rates of those older than 16 years without amblyopia are 60.0%(18/30) in the former group and 75.0%(24/32) in the latter group(P>0.05). The lateral rectus muscle recession and medial rectus muscle resection group showed somewhat higher rates of success even though it proved statistically insignificant.
Amblyopia ; Exotropia* ; Follow-Up Studies ; Humans

BACKGROUND: The known etiologies of atrial fibrillation(AF) were valvular heart disease, coronary artery disease, hypertension(left ventricular hypertrophy), hypertrophic cardiomyopathy, dilated cardiomyopathy, and congenital heart disease and so on. Mitral stenosis, mitral regurgitation, and tricuspid regurgitation account for more than 2/3 of AF related to valvular heart disease. We evaluated the effect of mitral stenosis and mitral regurgitation on development of AF respectively, and the relation between mitral valve disease and that. METHOD: The medical records of patients who was performed transthoracic echocardiography at Dongsan medical center between January 1997 and July 1998 were reviewed retrospectively. Among them, we analyzed the 222 patients who had isolated mitral valve disease without any other cardiac disease. We divided them to 4 group according to left atrial size (group 1: <4.0cm, group 2: >4.0cm and (5.0cm, group 3: (3) 5.0cm and <6.0cm, group 4: (3)6.0cm), then evaluated the effects of disease entity. RESULTS: 1) 94 out of 222(42.3%) patients had atrial fibrillation. The mean age was 51.8+/-15.1 years old. The number of men was 55. 2) The mean left atrial size in the group of AF and sinus rhythm were 5.14+/-0.93cm and 4. 44+/-0.66cm respectively. The mean age in the groups were 57.0+/-11.9 and 48.1+/-16.1 respecitvely. The differences between them were statistically significant(p<0.05). 3) The prevalences of AF in each groups were 12.5%(group 1), 35.6%(group 2), 60.8%(group 3), 86.7%(group 4). More increased the left atrial size, the prevalance of AF was increased significantly(p<0.05). 4) The prevalence of AF was not related to the severity of mitral regurgitation. However, the relation between the severity of mitral stenosis and the prevalence of AF was statistically significally(p<0.01). 5) Increasing the age, the prevalence of AF was increased significantly(p<0.01). 6) The effect of mitral stenosis and regurgitation on the development of AF did not differ significantly in group 1, 2, 3. But in group 4, the AF was present in 100% of patients who had mitral stenosis and 60% of mitral regurgitation. The difference was significant. CONCLUSION: In patients with mitral valve disease, the development of AF was related to age and the size of left atrium. The relation between the severity of mitral regurgiation and the development of AF was not evident, but in mitral stenosis, the relation was significant. If the size of left atrium is similar, the effect of mitral stenosis and regurgitation itself seem to be not related to the development of atrial fibrillation.
Atrial Fibrillation* ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic ; Coronary Artery Disease ; Echocardiography ; Heart Atria ; Heart Defects, Congenital ; Heart Diseases ; Heart Valve Diseases ; Humans ; Male ; Medical Records ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Prevalence ; Retrospective Studies ; Tricuspid Valve Insufficiency

In order to evaluate antitumor rnechanisms of interleukin (IL)-12/IL-2 that has been shown significant tumor suppressive activity on established primary and metastatic Renca tumor, we studied chemokine gene expression induced by direct action of IL- 12/IL-2 or cytokine cascade. IL-12/IL-2 induced gene expression of interferon gamma (IFN-r) and granulocyte monocyte-colony stimulating factor (GM-CSF) in splenocytes, and it induced gene expression of monokine induced by IFN-r (Mig), interferon inducible protein 10 (IP- 10), SDF-1, macrophage inflammatory protein (MIP)-1a, MIP-1B, MIP-2, monocyte chemotactic protein (MCP)-1, and Rantes in tumor mass. However IL-12/IL-2 could not induce these chemokines in tumor mass of GKO mice and Renca cell in vitro. IL- 12 also did not increased chemokine gene expression in Renca cell in vitro, but IFN-r induced gene expression of Mig, IP-10, MCP-1 in Renca cell in vitro. In the chemotaxis assay, culture supernatant of Renca cell stimulated with IFN-r increased splenocyte migration in vitro. All these data suggest IL-12/IL-2 can induce IFN-r-chemokine cascade in tumor mass, and Mig, IP-10, MCP-1 produced from tumor cell may play an important role for initial immune cell migration into tumor mass.
Animals ; Cell Movement ; Chemokine CCL5 ; Chemokine CXCL10 ; Chemokines ; Chemotaxis ; Gene Expression* ; Granulocytes ; Interferons ; Interleukins ; Macrophages ; Mice ; Monocytes

OBJECTIVES: Radiofrequency(RF) ablation is an effective and low risk curative treatment for supraventricular arrhythmias. Catheter ablation produced cardiac lesions primarily through formation of coagulation necrosis. We evaluated the degree of myocardial injury after RF catheter ablation by means of serial measurement of myocardial enzyme. METHODS: Fifty-one patients with symptomatic supraventricular tachycardia were included. There were 32 men and 19 women(mean age. 39.5+/-15.4 years)All patients underwent electrophysiologic study to detect accessary pathway and ablation with radiofreguency current. A mean of 18.3+/-14.2 radiofrequency pulses were delivered. The pulses were at a power of 50 to 60 Volts for a duration of 20 to 30 seconds. Unipolar method and a 6F or 7F catheter with a 4 mm tip electrode was used. LDH, CPK and Ck-MB as a kind of cardiac enzyme were measured before and after ablation. RESULTS: 1) The concentration of LDH and CPK were elecated at 8 hours and 16 hours after ablation (p<0.05). 2) The concentration of CK-MB was elevated at 8 hours, 16 hours, 24 hours and 72 hours after ablation(p<0.05). 3) There was no correlation between the number of applications and amounts of radiofrequency current and rise in LDH, CPK, CK-MB concentration. CONCLUSION: The concentration of LDH, CPK and CK-MB were elevated after ablation but they were within normal limits. RF catheter ablation produced myocardial damage inevitably but were within normal limits. RF catheter ablation produced myocardial damage inevitably but minimally, then RF ablation is an effective and safe therapeutic modality for patients with symptomatic tachyarrhythmias.
Arrhythmias, Cardiac ; Catheter Ablation* ; Catheters ; Electrodes ; Humans ; Male ; Necrosis ; Tachycardia ; Tachycardia, Supraventricular*

PURPOSE: Horizontal visual field defects are generally caused by lesions before the optic chiasm, but we report a case with bilateral inferior altitudinal defects secondary to bilateral occipital lobe infarction. CASE SUMMARY: A 57-year-old male with a history of diabetes and hypertension presented with a month of blurring in the inferior visual field. His corrected visual acuity was 1.0 in the right eye and 0.63 in the left eye, and the intraocular pressure was normal in each eye. Pupillary response, ocular movement, and color vision tests were normal in both eyes. There was no specific finding of the optic disc and macula on fundus examination. Visual field examination revealed an inferior congruous homonymous hemianopia with horizontal meridian sparing and a left incongruous homonymous quadrantanopia. Optical coherence tomography for peripapillary retinal nerve fiber layer thickness revealed a mild decrease in the inferior disc of both eyes. Brain magnetic resonance imaging confirmed the presence of an acute infarction confined with upper medial calcarine fissures of bilateral occipital lobe and the right splenium of the corpus callosum, which were consistent with inferior altitudinal hemianopia and left superior incongruous quadrantanopia, respectively. Brain magnetic resonance angiography showed multiple stenosis of bilateral posterior cerebral arteries. CONCLUSIONS: The altitudinal visual field defects could be caused by the occipital lesion medial to the calcarine fissure, and unusual visual defects could be due to a combination of multiple lesions.
Brain ; Color Vision ; Constriction, Pathologic ; Corpus Callosum ; Hemianopsia ; Humans ; Hypertension ; Infarction ; Infarction, Posterior Cerebral Artery ; Intraocular Pressure ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nerve Fibers ; Occipital Lobe ; Optic Chiasm ; Posterior Cerebral Artery ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity ; Visual Fields

Myasthenia gravis(MG) is an autoimmune disorder characterized by the presence of anti-acetylcholine receptor antibody and weakness of voluntary muscles. The pathogenesis of MG is decreased numbers of acetylcholine receptors at postsynaptic membranes of neuromuscular junctions. It has been reported that MG often coexists with other autoimmune disorders. This is a case report of systemic lupus erythematosus coexisting with MG in a 23 year old female patient presenting with dysarthria, dysphagia, and limb weakness. We report the case with relevant literature review.
Deglutition Disorders ; Dysarthria ; Extremities ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Membranes ; Muscle, Skeletal ; Myasthenia Gravis* ; Neuromuscular Junction ; Receptors, Cholinergic ; Young Adult

Delayed cerebral necrosis is a well-known complication of radiation therapy (RT). Because of its irreversible nature, it should be avoided if possible, but avoidance occurs at the expense of potentially compromised tumor control, despite the use of the modern advanced technique of conformal RT that minimizes radiation to normal brain tissue. Risk factors for radiation-induced cerebral necrosis include a higher dose per fraction, larger treatment volume, higher cumulative dose, and shorter time interval (for re-irradiation). The same principle can be applied to proton beam therapy (PBT) to avoid delayed cerebral necrosis. However, conversion of PBT radiation energy into conventional RT is still short of clinical support, compared to conventional RT. Herein, we describe two patients with excessively delayed cerebral necrosis after PBT, in whom follow-up MRI showed no RT-induced changes prior to 3 years after treatment. One patient developed radiation necrosis at 4 years after PBT to the resection cavity of an astroblastoma, and the other developed brainstem necrosis that became symptomatic 6 months after its first appearance on the 3-year follow-up brain MRI. We also discuss possible differences between radiation changes after PBT versus conventional RT.