BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

BACKGROUND: The safety of ergonovine provocation for coronary vasospasm (CVS) performed outside the catheterization laboratory has been questioned. We sought to address the issues of safety, feasibility and clinical impact of noninvasive diagnosis of CVS. METHOD AND RESULTS: We retrospectively analyzed the results of bedside ergonovine provocation testing with monitoring of left ventricular regional wall motion abnormalities (RWMAs) by 2-dimensional echocardiography (ergonovine echocardiography, Erg Echo). After confirmation of no significant fixed epicardial coronary artery disease, 1,504 Erg Echo were performed in 1,372 patients from July 1991 to December 1997. Erg Echo was prematurely terminated in 13 patients (0.9%) due to limiting side effects unrelated with myocardial ischemia. Among 1,491 completed tests, 32% (477) showed positive results with development of RWMAs in 467 tests (98%) or ST displacement in ECG in 10 tests (2%). During the test, transient arrhythmias developed in 1.7% (26/1491) including transient ventricular tachycardia (2) and atrioventricular block (4), which were promptly reversed with nitroglycerin. There were no procedure-related death or development of myocardial infarction. On the basis of angiographic criteria in 218 patients, who also underwent invasive spasm provocation test during coronary angiography, the sensitivity and specificity of Erg Echo for the diagnosis of CVS were 93% and 91% respectively. From 1990 to 1997, total 2,073 spasm provocation tests were performed either during invasive coronary angiography in the catheterization or in the echocardiography laboratory. Since 1994, noninvasive Erg Echo became a more popular diagnostic method and comprised more than 95% of all spasm provocation tests in recent 3 years. Erg Echo was also performed safely in outpatient clinic setting without hospital admission in 34% (500/1491). CONCLUSIONS: Erg Echo is highly feasible, accurate and safe for diagnosis of CVS and can replace the invasive spasm provocation test during coronary angiography in the catheterization laboratory.
Ambulatory Care Facilities ; Arrhythmias, Cardiac ; Atrioventricular Block ; Catheterization ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Diagnosis* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Ergonovine* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Nitroglycerin ; Retrospective Studies ; Sensitivity and Specificity ; Spasm ; Tachycardia, Ventricular

Huntington's Disease (HD), an autosomal dominant disorder of mid-life onset, is characterized by progressive involuntary choreiform movement, psychological change and dementia. We present here two cases of Huntington's disease. One case has family history, but the other has none.
Chorea ; Dementia ; Humans ; Huntington Disease*

Twenty-three isolates of Fusarium spp. were obtained from decayed citrus fruits in the fields and storages in 1998-1999. Of them, six and five isolates belonged to F. proliferatum and F. moniliforme, respectively, which were the most common. F. solani and F. sambucinum had each two isolates, F. equiseti had one isolate and seven isolates were unidentified. They produced symptoms of two types in pathogenicity test: those with leathery, beige to light or dark brown, and sunken lesions without surface mycelium (type-1) and those with lesions covered with white, beige or pink surface mycelium (type-2). Four of six isolates identified to F. proliferatum and two unidentified isolates produced type-1 lesions, and all isolates identified to F. moniliforme, F. solani, F. sambucinum, F. equiseti and five unidentified isolates produced type-2 lesions.
Citrus* ; Fruit* ; Fusarium* ; Mycelium ; Virulence

CHAP syndorme consists of choreoathetosis, orofacial dyskinesia, affective change, hypotonia, and pseudobulbar signs. CHAP syndrome was firstly des- cribed with onset 1 to 7 days after induced profound hypothermia and complete circulatory arrest for con- genital heart lesion repair. Since then, only a few cases have been reported until now. Case We report a patient who demonstrated all of the elements of the CHAP syndrome in severe cachexic state. Brain SPECT(99mTC-ECD) shows decreased perfusion in left fronto-parieto-temporal lobe. Comments The pathogenesis of CHAP syndrome is obscure. However our case led us to suggest that more essential component pre- disposing to the CHAP syndrome is hypoxia rather than hypothermia. Furthermore, it seems to be related with circulatory insufficiency in extrapyramidal nervous systems.
Anoxia ; Brain ; Heart ; Humans ; Hypothermia ; Movement Disorders ; Muscle Hypotonia ; Nervous System ; Perfusion

No abstract available.
Down Syndrome* ; Humans ; Twins, Monozygotic*

A wide variety of cancers metastasize to the ovaries. In a majority of instances the primary site is the gastrointestinal tract, breast, or other gynecologic organs. The best known tumor of this type is signet-ring cell adenocarcinoma. The gallbladder and bile duct are rare sources of these metastases. The authors have had an experience of a case that was presented of Krukenberg tumor metastatic from the gallbladder and report the case with brief review of literature.
Adenocarcinoma ; Bile Ducts ; Breast ; Female ; Gallbladder* ; Gastrointestinal Tract ; Krukenberg Tumor* ; Neoplasm Metastasis* ; Ovary

PURPOSE: In this retrospective study, we attempted to evaluate the treatment outcome and the prognostic factors of thymoma treated with surgery, radiotherapy and chemotherapy. METHODS AND MATERIALS: Between 1979 and 1998, 55 patients with thymoma were treated at the Seoul National University Hospital. Of these, 11 patients underwent surgery only, 33 patients received postoperative radiotherapy and 11 patients received radiotherapy only. Twenty-three patients had gross total resection and 21 patients subtotal resection. For postoperative radiotherapy, the radiation dose consisted of 41.4-55.8 Gy. The average follow-up was 64 months, and ranged from 2 to 160 months. The sex ratio was 1:1 and the median age was 48 years (15-74 years). Overall survival and disease-free survival were determined via the Kaplan-Meier method, and the log-rank was employed to evaluate for differences in prognostic factor. RESULTS: The five- and 10-year survival rates were 87% and 65% respectively, and the median survival was 103 months. By univariate analysis, only stage ( p=0.0017) turned out to be significant prognostic factors of overall survival. Also, stage ( p=0.0007) was significantly predictive for overall survival in mutivariated analysis. CONCLUSION: This study showed the stage was found to be important prognostic factors, which influenced survival. Especially, as incomplete resection is related with poor results, complete resection is important to cure the invasive thymoma.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies ; Seoul ; Sex Ratio ; Survival Rate ; Thymoma* ; Treatment Outcome*

Vascular changes in the periodontal ligament of the rat incisors following application of experimental orthodontic forces were examined by the India ink perfusion method. 57 rats were used for this experiment. The rats were divided into experimental group (54 rats) and control group (3 rats). 54 experimental rats were divided into group I (27 rats) and group II (27 rats). The right and left upper incisors of group. I and group II rats were separated distally with forces of 20gm, 70gm respectively. The vascular changes of periodontal ligament were observed histologically by means of light microscope after 1,2 and 3 days of tooth movement and 1,3,5,8,14, and 21days after removal of orthodontic force. The results were as follows; 1. After one day of tooth movement, occlusion of blood vessels, hyalinization of periodontal ligament and resorption of alveolar bone adjacent to the alveolar crest on pressure side were observed. Above the tissue changes on the pressure side of group II were more severe than those of group I. Especially, septal bone of group II was separated after 2 days of tooth movement. 2. In tension zones, periodontal space was widened and periodontal fibers were orientated in the direction of pull. The blood vessels of periodontal ligament were distended. New bone deposition was seen along the inner surface of the alveolus after 2 days of tooth movement. 3. After 3 days of tooth movement, deposition of new bone was seen along the periosteal surface of alveolar bone on pressure side, progressing with increasing after removal of orthodontic force. Remodelling of the new bone was occurred 5 days after removal of orthodontic force. 4. 3 days after removal of orthodontic force, invasion of blood vessels into the marginal periodontal ligament on pressure side was observed clearly and the vessels below the epithelial attachment were increased. 5. After removal of orthodontic force, hyalinized structures disappeared concomittantly with an invasion of blood vessels from the neighboring periodontal ligament. 14 days after removal of orthodontic force, the vessels in the periodontal ligament of group I were finished the vascular rearrangement. 21 days after removal of orthodontic force, the vessels in the periodontal ligament of group II were finished the vascular rearrangement.
Animals ; Blood Vessels ; Epithelial Attachment ; Hyalin ; Incisor* ; India ; Ink ; Perfusion ; Periodontal Ligament ; Rats* ; Tooth Movement* ; Tooth*

A cephalometric radiographic cross sectional comparative study was undertaken to invertigate craniofacial growth in cleft lip and palate individuals. The material for this study consisted of 43 subjects with operated cleft lip and palate.(29 males, 14 females). The range of age was from 6 years to 12 years. The roentgenocephaometric values of cleft individuals were compared with values of normal individuals reported by Lee. 28) The following conclusions were obtained ; 1) The pattern of cranial base of the clegt subjects was almost the same as that prviously reported for the normal individuals. 2) Anterio-posterior length of the mandible did not show any significant difference but in the cleft subjects, that od the males was larger than that of the females. 3) The maxilla of the cleft subjects was very retruded and showed very concave profile. 4) Gonial angle of the cleft subjects was very high, especially in the female clefts. 5) The hegth of ramus was very poor in the cleft subjects. 6) The facial length was almost the same, but the facial depth of the cleft subjects was smaller than that of the normal individuals. 7) Maxillary and mandibular incisorswere severely retroclined. 8) The range of values in the cleft subjects was very variable and the female clefts showe more distured growth than the male clefts.
Cleft Lip* ; Female ; Humans ; Male ; Mandible ; Maxilla ; Palate* ; Skull Base