In complication of infective endocaditis splenomegaly and splenic infarction are not uncommon but splenic rupture is very rare. We report a case of splenic rupture complicated by infective endocarditis in 1 71-yr-old man who had been suffered from rheumatic heart disease (aortic regurgitation and stenosis and mitral regurgitation). The patient was admitted to mild fever and generalized weakness for 20 days. Diagnosis of infective endocarditis due to Staphylococcus epidermidis was made by clinical manifestaions and blood culture study.On 34th day of admissionthe patient suddenly displayed the symptoms and signs of massive intraperitoneal hemorrhage. Splenic rupture was revealed by paracentesis and radiologic studies. Rupture of spleen is an uncommon and usually fatal complication of infective endocarditis. Therefore early diagnosis and prompt treatment must be performed.
Constriction, Pathologic ; Diagnosis ; Early Diagnosis ; Endocarditis* ; Fever ; Hemorrhage ; Humans ; Paracentesis ; Rheumatic Heart Disease ; Rupture ; Spleen ; Splenic Infarction ; Splenic Rupture* ; Splenomegaly ; Staphylococcus epidermidis

BACKGROUND: Intermittent rhythmic delta activity (IRDA) is classified as a nonspecific abnormal EEG pattern. IRDA is clinically associated with alteration of consciousness, hydrocephalus, cerebral edema, deep midline lesions, subcortical lesions, and tumors of the posterior fossa and the third ventricle. Frontal IRDA(FIRDA) is usually seen in patients over age 15 years, whereas occipital IRDA(OIRDA) occurs mainly in children. We have investigated the clinical feature and significance of IRDA in children. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 36 children with IRDA of EEG concerning diagnosis, neurologic examination, classification of epilepsy, and CT & MRI findings. RESULTS: 1) The location of the IRDA was frontal(FIRDA) in 11 of 36(30.5%), occipital(OIRDA) in 20 of 36(55.6%) and mixed in 5 of 36(13.9%) patients. 2) Thirty of 36(83.3%) have epilepsy (including 1 each with MELAS and tuberous sclerosis), 4 of 36(11.1%) have migraine and 2 of 36(11.1%) patients have meningitis. 3) Sixteen of 30(53.3%) have partial or partial with secondary generalized seizure, 10 of 30(33.3%) have generalized seizure and 4 of 30(13.3%) patients with epilepsy have absence seizure. 4) Neuroimaging studies (CT or MRI scan) were performed in 27 cases. Among 27 cases of studies, 6 cases(22.2%) were abnormal including; two cases of infections, and each case of infarction, venous angioma, arachnoid cyst, cortical atrophy, and tuberous sclerosis, respectively. CONCLUSIONS: IRDA may be considered an epileptiform pattern in childhood and FIRDA is frequently seen in children than previous reports.
Arachnoid ; Atrophy ; Brain Edema ; Child* ; Classification ; Consciousness ; Diagnosis ; Electroencephalography ; Epilepsy ; Epilepsy, Absence ; Hemangioma ; Humans ; Hydrocephalus ; Infarction ; Magnetic Resonance Imaging ; Medical Records ; MELAS Syndrome ; Meningitis ; Migraine Disorders ; Neuroimaging ; Neurologic Examination ; Retrospective Studies ; Seizures ; Third Ventricle ; Tuberous Sclerosis

BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity

No abstract available.
Pneumonia* ; Radiography, Thoracic* ; Thorax*

No abstract available.
Cell Line* ; Humans*

No abstract available.
Pulmonary Edema*

PURPOSE: Spiculation pathologically correlated with irregular fibrosis, localized lymphatic spread of tumor, or an infiltrative growth pattern of tumor, and the spiculation was Observed in malignant mass. But the spiculation was also observed in benign mass, particularly in tuberculoma. We retrospectively reviewed the length of spiculation under the hypothesis that the length of spiculation could be one of differential diagnostic points between lung cancer and tuberculoma. MATERIALS AND METHODS: We studied thirty seven patients (27 men and 10 women) ranging in age from 35 to 80 years (mean, 60 years). Analysis of spiculation included (a) the number of spicules (b) the mean length of spicules (c) the mean length of the longest spicule (d) the percentage of the mean length of spicules to the longest diameter of mass (e) the percentage of the mean length of spicules to the shortest dia, meter of mass. RESULTS: The mean length of spicules of tuberculoma was 13.8 mm (S. D. 6.7) and that of lung cancer was 5.7 mm (S. D. 3.5). The percentage of the mean length of spicules to the longest diameter of tuberculoma was 63.6% and that of lung cancer was 13.7%. The percentage of the mean length of spicules to the shortest diameter of tuberculoma was 90.4% and that of lung cancer w~s 18.3%. CONCLUSION: It is hard to differentiate lung cancer from tuberculoma on the basis of the spiculation being present or not, but we suggest that the longer spiculation be more highly suggestive of tuberculoma rather than lung cancer. The length of spiculation may help us differentiate lung cancer from tuberculoma.
Fibrosis ; Humans ; Lung Neoplasms ; Lung* ; Male ; Retrospective Studies ; Tuberculoma*

One of the serious and challenging problems confronting orthopaedic surgeons is an open un-united fracture of tibia. Especially, there are some difficulties in getting bone union on the condition of combining soft tissue defect with infection. In the management of infected un-united fracture of tibia with significant soft tissue loss we attempted a two-stage reconstruction : the first stage consisted of radical sequestrectomy, soft tissue reconstruction, and external fixation, and the 2nd stage consisted of various types of bone grafting and bone fixation. Fifteen patients with open infected un-united fractures of tibia treated with staged reconstruction from September 1982 to August 1987 at Department of Orthopaedic Surgery, Dae-Jeon's St. Mary's Hospital, Catholic University Medical College, were analyzed in clinical aspects and the results of treatment obtained were as follows : 1. Satisfactory bone union was obtained in an average of 6 months after bone graft with a range of 4 months to 12 months. 2. The duration from the injury to bone union was 13 months on an average with a range of 8 months to 19 months. 3. The soft tissue rer.onstruction at the first stage were performed with local flap in 11 cases and muscular flap in 2 cases and musculocuteneous flap in 2 cases. 4. The time interval between 1st stage and 2nd stage was from 1.5 months to 3 months. 5. At the 2nd stage, bone graft were performed with autogenous cancellous bone graft in 11 cases, vascularized osteocutaneous fibular graft in 2 cases and ipsilateral vascularized fibular transference in 2 cases. In summary, a two-stage reconstruction for open infected un-united fracture of tibia is a advisable procedure that leads to bone union with satisfactory return of function.
Bone Transplantation ; Fractures, Open ; Humans ; Surgeons ; Tibia ; Transplants ; United Nations

Two cases of exercise-induced atrial fibrillation were diagnosed in 68 years old female and 47 years old male. They complained palpitation during exercise, and emotional upset for the last 5 years. There was no evidence of organic heart disease except mild hypertension in female patient. The atrial fibrillation was induced repeatedly by treadmill exercise test and intravenous infusion of isoproterenol. The beta blocker(atenolol 50mg po dialy) prevented the induction of atrial fibrillation during treadmill exercise. We report two cases of exercise-induced atrial fibrillation which is very rare and might be related to catecholamine.
Aged ; Atrial Fibrillation* ; Exercise Test ; Female ; Heart Diseases ; Humans ; Hypertension ; Infusions, Intravenous ; Isoproterenol ; Male ; Middle Aged

STUDY DESIGN: Retrospective study OBJECTIVE: To analyze the treatment results of vertebroplasty in patients who suffered osteoporotic compression fractures during conservative treatments for pre-existing degenerative lumbar disease. SUMMARY AND LITERATURE REVIEW: Whilst spinal fusion has shown satisfactory clinical results, solid fusion has been reported to accelerate the degenerative changes at the unfused adjacent levels. Therefore, the level of spinal fusion in patients with compression fractures and pre-existing degenerative lumbar disease is controversial. Few studies have evaluated the outcomes of spinal fusion and adjacent segment vertebroplasty. MATERIALS AND METHODS: A retrospective review was carried out on 28 patients who suffered the osteoporotic compression fractures during conservative treatment for pre-existing degenerative lumbar disease. Posterolateral fusion and vertebroplasty were performed for degenerative disease and compression fractures. The average fusion level was 1.82. The mean compressed vertebral bodies were 1.68. The radiology results were evaluated to determine the progression of the compression rate and fractures in the adjacent segment. The clinical results were evaluated using the Denis pain scale for compression fractures and Katz satisfaction scale for degenerative lumbar disease. RESULTS: The average compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at the final follow-up. There was no fracture in the adjacent segment. Clinically, the preoperative Denis score was P3 and P4 in 8 and 20 patients, respectively. On the other hand, the postoperative Denis score was P1, P2 and P3 in 8, 19 and 1 patients, respectively. In regard to degenerative diseases, the overall satisfaction was 82.1%. CONCLUSION: The stability of fracture sites in vertebroplasty of patients with pre-existing lumbar disease was confirmed. However, further compression of the fractured vertebral body was observed after vertebroplasty in long fusion. Therefore, a followup study of more cases will be necessary to confirm the changes in the vertebroplasty site.
Follow-Up Studies ; Fractures, Compression ; Hand ; Humans ; Retrospective Studies ; Spinal Fusion ; Vertebroplasty