High output heart failure due to congenital arteriovenous fistula is a rare disease and is difficult to treat. A 27 year old man, suffering from dyspnea, palpitation, lower extremity edema, and abdominal distension admitted May, 1987. At admission there were continuous thrill and bruit at left supraclavicular and infraclavicular area. The heart sound was irregular and rapid, and grade IV/VI pansystolic murmur was audible at the apex. Chest PA showed marked cardiomegaly with pleural effusion and notching at superior aspect of left 2nd rib. Selective left subclavian artery angiogram showed extensive congenital arteriovenous fistula at the area of left subclavian artery and its branches. After setrial feeding artery embolization and palliative operation, the fistula size decreased much with clinical improvement.
Adult ; Arteries ; Arteriovenous Fistula* ; Cardiomegaly ; Dyspnea ; Edema ; Fistula ; Heart Failure ; Heart Sounds ; Humans ; Lower Extremity ; Pleural Effusion ; Rare Diseases ; Ribs* ; Subclavian Artery* ; Thorax

Analyses were done on one hudred and twenty caaes of bleeding gastric ulcers diagnosed by emergency endoscopy for the past five years. The reaults are as the following: Much more cases were found in male than female and the most prevalent age group was 6th decade. The body of stomach along the lesser curvature was the most common bleeding site. No age related difference was noted in bleeding sites. Most common type of ulcer was in the round and shallow form. Five of six cases with exposed vessels showed atrophic changes in surrounding mucosa. Among the probable precipitating factors, analgesica, alcohols and certicosteroids were found in such order,
Alcohols ; Emergencies ; Endoscopy ; Female ; Hemorrhage* ; Humans ; Male ; Mucous Membrane ; Precipitating Factors ; Stomach ; Stomach Ulcer* ; Ulcer

PURPOSE: To analyze CT and follow-up chest radiographic findings in patients with necrotizing pneumonia and to evaluate clinical significance of the extent of necrosis. MATERIALS AND METHODS: We reviewed medical records and retrospectively analysed CT scans and follow-up chest radiographs of 22 patients with necrotizing pneumonia, confirmed by biopsy(n=7) and culture (n=15). Inclusion criteria for necrotizing pneumonia was necrotic low attenuation, with or without cavitation on postcontrast enhanced CT scan. The study group included 15 men and seven women, aged 11-66 years (average: 47years). RESULTS: The pathogens of necrotizing pneumonia were Klebsiella spp(n=7), Enterobacter spp(n=5), Actinomyces spp(n=4), Pseudomonas spp(n=4), Nocardia spp(n=4), and others(n=5). Average duration of pneumonia was 4.1 months. On CT scan, pneumonic consolidations were well-marginated in 14 patients and there were cavities on initial CT scan in 16 cases. Margins of the necrotic portion on CT scan were well-demarcated in majority of the patients(16/22). Low attenuation areas on initial CT scan resulted in cavitation, fibrosis and volume loss as shown on follow-up chest radiographs. The larger the necrotic areas on CT, the more the volume loss was. CONCLUSION: CT findings of necrotizing pneumonia were well-marginated air-space consolidation with low attenuation area, with or without cavity. The extent of necrotic area was closely related with the degree of fibrotic change later on. CT is important tool for diagnosis and prediction of parenchymal damage in necrotizing pneumonia.
Actinomyces ; Diagnosis ; Enterobacter ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Klebsiella ; Male ; Medical Records ; Necrosis ; Nocardia ; Pneumonia* ; Pseudomonas ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To analyze CT and follow-up chest radiographic findings in patients with necrotizing pneumonia and to evaluate clinical significance of the extent of necrosis. MATERIALS AND METHODS: We reviewed medical records and retrospectively analysed CT scans and follow-up chest radiographs of 22 patients with necrotizing pneumonia, confirmed by biopsy(n=7) and culture (n=15). Inclusion criteria for necrotizing pneumonia was necrotic low attenuation, with or without cavitation on postcontrast enhanced CT scan. The study group included 15 men and seven women, aged 11-66 years (average: 47years). RESULTS: The pathogens of necrotizing pneumonia were Klebsiella spp(n=7), Enterobacter spp(n=5), Actinomyces spp(n=4), Pseudomonas spp(n=4), Nocardia spp(n=4), and others(n=5). Average duration of pneumonia was 4.1 months. On CT scan, pneumonic consolidations were well-marginated in 14 patients and there were cavities on initial CT scan in 16 cases. Margins of the necrotic portion on CT scan were well-demarcated in majority of the patients(16/22). Low attenuation areas on initial CT scan resulted in cavitation, fibrosis and volume loss as shown on follow-up chest radiographs. The larger the necrotic areas on CT, the more the volume loss was. CONCLUSION: CT findings of necrotizing pneumonia were well-marginated air-space consolidation with low attenuation area, with or without cavity. The extent of necrotic area was closely related with the degree of fibrotic change later on. CT is important tool for diagnosis and prediction of parenchymal damage in necrotizing pneumonia.
Actinomyces ; Diagnosis ; Enterobacter ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Klebsiella ; Male ; Medical Records ; Necrosis ; Nocardia ; Pneumonia* ; Pseudomonas ; Radiography, Thoracic ; Retrospective Studies ; Tomography, X-Ray Computed

In order to analyze academic achievement of medical students and its related factors, a total of 2,371 students who entered the premedical course of O university from 1987 were reviewed based on cohor t of their admission year. Those who did not promoted to medical college from premedical course in two years were 15% and those who did not graduate medical school in four years were 21%. The percentage of female students and outside Seoul residents has been growing. The percentage that students parents' occupation is medical profession has been decreasing. Those who failed during premedical course have higher conditional probability to fail during the medical studies. The results suggest that medical educators pay more attention to those who failed during the premedical course. Also the criteria whether students are failed or promoted to next grade is reasonable should be studied in depth.
Cohort Studies* ; Female ; Humans ; Occupations ; Schools, Medical ; Seoul ; Students, Medical*

OBJECTIVE: To compare the effects of raloxifene alone with a combination of raloxifene and fluoride in postmenopausal osteoporosis on bone mineral density, bone turnover and lipid profiles, at 2 year. METHOD: Fifty two women with postmenopausal osteoporosis (T-score < 2.5) were studied. Subjects were divided into two groups; Group I (n=23), treated with raloxifene and fluoride, and Group II (n=29), treated with raloxifene alone. Bone mineral density (BMD) at the lumbar spine and femur, osteocalcin, deoxypyridinoline and lipid profiles were measured at baseline and 2 years after treatment. RESULTS: BMD at the lumbar spine was increased in two groups, and BMD in Group I was increased more than that in Group II. Osteocalcin was increased in Group I, and was decreased in Group II. Deoxypyridinoline was decreased in two groups. Total cholesterol and LDL cholesterol were decreased in two groups, but HDL cholesterol and triglyceride showed no significant change in two groups. There were no significant differences between two groups in lipid profiles. CONCLUSION: The combined therapy with raloxifene and low- dose intermittent fluoride was more effective in postmenopausal women with osteoporosis than raloxifene alone, which would not influence on positive effect of raloxifene for lipid metabolism.
Bone Density ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Female ; Femur ; Fluorides* ; Humans ; Lipid Metabolism ; Osteocalcin ; Osteoporosis* ; Osteoporosis, Postmenopausal ; Raloxifene Hydrochloride* ; Spine ; Triglycerides

PURPOSE: To determine the different of enhancement patterns of hepatic hemangioma according to the lesionsize, using dual-phase spiral CT. MATERIALS AND METHODS: Fify-nine lesions in 45 patients with hepatichemangiomas were subjected to spiral Ct. According to size, the lesions were divided into two groups(< 2.5cm :n=34 ; >_2.5cm : n=25). The enhancement patterns of the lesions were classified as one of four types (homogeneoushyperdense, peripheral hyperdense, central hyperdense, or hypodense) during the early phase, and as one of fivetypes homogeneous hyperdense, peripheral hyperdense, central hyperdense, hypodense or isodense) during the delayedphase. We evaluated differences in enhancement patterns during the early and delayed phase according to lesionsize. RESULTS: During the early phase, the enhancement patterns of lesions large than 2.5cm were peripheralhyperdense(96%) or homogeneous hyperdense (4%);those of less than 2.5cm were peripheral hyperdense (53%),homogeneous hyperdense(26%), hypodense(18%), or central hyperdense(3%). Thus, hemangiomas in these two groupsusually showed a peripheral enhancement pattern during the early phase, but in those which were smaller than2.5cm, atypical enhancement patterns were more common. During the delayed phase, the enhancement patterns oflesions larger than 2.5cm were peripheral hyperdense (60%) or homogenous hyperdense (40%), while the patterns ofthose smaller than 2.5cm were homogeneous hyperdense (67%), peripheral hyperdense (24%), central hyperdense (3%),hypodense (3%), or isodense (3%). Thus, the enhancement patterns of lesions larger than 2.5cm were usuallyperipherally hyperdense during the delayed phase, while those smaller than 2.5cm showed a homogeneous enhancementpattern. CONCLUSION: The enhancement patterns of hepatic hemangiomas differ according to lesion size. A knowledgeof these differences is helpful in the diagnosis of hepatic hemangioma.
Diagnosis ; Hemangioma* ; Humans ; Tomography, Spiral Computed*

Adenocarcinoma of small intestine is rare disease, but its incidence of iluem is the least of small intestinal adenocarcinoma. Its rarity and vague symptoms results in delayed diagnosis, treatment and poor prognosis, Recently we experienced a 65 years old man of ileal adenocarcinoma with liver metastasis, which does not obstuct intestinal lumen, We treat the metastatic tumor with chemoembolization(lipiodol and doxorubicin) through the hepatic artery and so we report the case with review of literature.
Adenocarcinoma ; Aged ; Delayed Diagnosis ; Hepatic Artery ; Humans ; Incidence ; Intestine, Small ; Liver ; Neoplasm Metastasis* ; Prognosis ; Rare Diseases

Retrobulbar hemorrhage is a rare complication following cardiopulmonary bypass surgery, which has never been reported in Korea. Our cardiac surgery tearn diagnosed a case of 30 year-old female patient as atrial septal defect and performed direct closure for it. Proptosis of the right eye was developed during surgery and she was consulted to Department of Ophthalmology, St. Mary's Hospital, Catholic University Medical College. We confirmed the evidence of the proptosis of the right eye with Hertel's exophthalmo meter and diagnosed this case as retrobulbar hemorrhage that orbital CT showed a large ovoid shaped non-enhancing hyperdense mass shadow at superior portion of the right orbit. So we report our case with a brief review of the literature related to retrobulbar hemorrhage during cardiopulmonary bypass surgery.
Adult ; Cardiopulmonary Bypass* ; Exophthalmos ; Female ; Heart Septal Defects, Atrial ; Humans ; Korea ; Ophthalmology ; Orbit ; Retrobulbar Hemorrhage* ; Thoracic Surgery

Facial hyperhidrosis has a symptom of excessive sweating on the face with or without underlying disease. It can be surgically treated by video-assisted thoracic surgery (VATS). We encountered three cases of facial hyperhidrosis which we treated by VATS, which was performed by resection of the lower third of stellate ganglion and T2-T3 sympathetic ganglia with chains. Postoperative symptom was improved in all cases. There were no postoperative complications such as Horner's syndrome or postsympathectomy neuralgia.
Ganglia, Sympathetic ; Horner Syndrome ; Hyperhidrosis* ; Neuralgia ; Postoperative Complications ; Stellate Ganglion ; Sweat ; Sweating ; Sympathectomy* ; Sympathetic Nervous System ; Thoracic Surgery, Video-Assisted