Differentiation of lymph node from vessels or bowel wall with similar clearity is often difficult in conventional contrast-enhanced computed tomography (CCCT). For optimal differentiation of these structures, arterial-phase dominent CT images by IV bolus injection and rapid scan were obtained. The images were compared from those by CCCT in evaluation of lymphadenopathy. Seventy patients, diagnosed as stomach cancer by pathology, were selected for this study. There were 14 cases of equivocal lymphadenopathy on CCCT while IV bolus CT revealed lymphadenopathy in 9 of there and no lymphadenopathy in the rest. Among the 38 cores without lymphadenopathy on CCCT, IV bolus CT detected 4 lymphadenopathy. In 30 node dissection cases, when we decided 1cm as CT criterion for lymphatic enlargement, the sensitivity and the specificity that there were lymphatic enlargement in gross of lymphatic infiltration above one fourth in pathology even though no lymphatic enlargement in gross were 100%. On conclusion, IV bolus CT is more helpful method to evaluate lymphadenopathy than CCCT and compatible with pathologic findings when we decide 1cm as CT criterion for lymphadenopathy. In conclusion, IV bolus CT is superior to CCCT in evaluation of metastatic Lymphadenopathy when using CT Criferion of 1cm as the diameter of enlarged lymph node.
Humans ; Lymph Nodes ; Lymphatic Diseases* ; Methods ; Pathology ; Sensitivity and Specificity ; Stomach Neoplasms* ; Stomach*

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

BACKGROUND: It has been demonstrated that within 2 weeks following acute myocardial infarction (AMI), exercise-induced ST-segment depression (STD) indicates subendocardial ischemia in the viable myocardium within infarcted or remote area from the infarction. Exercise-induced ST-segment elevation (STE) in leads with abnormal Q wave is associated with left ventricular dysfunction or aneurysm rather than transmural ischemia. We studied whether each pattern of ST-segment shift on exercise ECG during recovery phase following AMI is correlated with the perfusion status of infarcted myocardium evaluated by myocardial contrast echocardiog-raphy (MCE), regardless of findings of coronary angiography (CAG). METHOD: Study population was consisted of 25 patients with AMI (anteior wall: 11 patients, inferior wall: 14 patients, mean age=57.3+/-8.9years). Patients underwent exercise ECG and coronary angiography at 10 days post-AMI. After CAG, sonicated Hexabrix was injected into both coronory arteries alternatively and 2-D echocardiography was taken in parasternal short axis, apical 4, and 2 chamber views. To analyze the echocardiographic image semiquantitively, left ventricle was divided into 20 segments and perfusion status was graded as good, partial, and no opacification. RESULT: All patients with exercise-induced STE (n=8) in Q-leads had patent infarcted-related artery and poor collaterals on CAG, which was associated with poor or no opacification of infarcted myocardium on MCE. Patients with exercise-induced STD (n=9) frequently had closed infarct-related artery (67%), but good opacification of infarcted myocardium was shown by retrograde perfusion via collaterals, which was commonly seen in patients with multivessel disease. CONCLUSION: In early recovery phase of acute myocardial infarction, exercise-induced ST elevation in Q leads was associated with poor perfusional status in infarcted myocardium, even with patent infarct-related artery on CAG, while exercise-induced ST depression was frequently seen in the good perfusional status despite of closed infarted-related artery, which was commonly observed in patients with multivessel disease.
Aneurysm ; Arteries ; Axis, Cervical Vertebra ; Coronary Angiography ; Depression ; Echocardiography ; Electrocardiography ; Heart Ventricles ; Humans ; Infarction ; Ioxaglic Acid ; Ischemia ; Myocardial Infarction* ; Myocardium* ; Perfusion* ; Ventricular Dysfunction, Left

BACKGROUND: In acute myocardial infarction, left ventricular remodeling, which was influenced by infarct size, location, and patency of infarct related artery(IRA), is a important prognostic factor for chronic heart failure and survival. Recently, several reports suggested that patent IRA does not always mean true myocardial reperfusion, and myocardial contrast echocardiography(MCE) may be a useful tool for assessing infarct size and viability of infarcted myocardium. So, we investigated the association between the degree of myocardial reperfusion assessed by MCE and long term change of left ventricular volume in acute anterior wall myocardial infarction patients who had patent IRA. METHODS: The study population was consisted of 17 patients with first acute anterior wall myocardial infarction patients who had patent left anterior descending artery by thrombolytic therapy or rescue PTCA. MCE was done immediately after coronary angiography within two weeks of myocardial infarction onset and analyzed by semiquantitative method to get opacification index. For analysis of left ventricular ejection fraction, wall motion abnormality and left ventricular volume, echocardiogram was taken within 2 weeks of myocardial infarction oneset and 9 months later in each case. Wall motion abnormality was quantified as wall motion index. According to serial changes of left ventricular volume, patients were divided into two groups ; group 1(less than 10% increase of LV volume at follow-up compared to intial echocardiographic exam) and group 2(more than 10% increase of left ventricular volume). We compared the opacification index of infarcted myocardium, wall motion abnormality, and ejection fraction between the two groups. RESULTS: Initial left ventricular volume and ejection fraction were not different between group 1 and group 2, but the opacification index was lower and initial wall motion index higher in group 2 than group 1. Opacification index, wall motion index, ejection fraction and left ventricular volume were closely correlated in the whole cases. By multivariate ananlysis, opacification index was the only significant factor predicting left ventricular volume increment. CONCLUSION: Myocardial reperfusion, which is closely correlated with ejection fraction and wall motion abnormality, acts as a independent predictor of left ventricular dilatation after acute anterior wall myocardial infarction. This result suggests that assessment of microvascular integrity with myocardial contrast echocardiography may be a valuable indicator to predict long-term change of left ventricular volume, although this is suggestive result in a limited number of patients.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Angiography ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Reperfusion* ; Myocardium ; Stroke Volume ; Thrombolytic Therapy ; Ventricular Remodeling

To evaluate the feasibility and usefulness of transthoracic Doppler echocardiography (TTDE) as a non-invasive method in recording distal anterior descending (LAD) coronary flow velocity, we compared coronary flow reserve (CFR) measured by TTDE with measurements by intracoronary Doppler wire (ICDW). Twenty-one patients without LAD stenosis were studied. ICDW performed at baseline and after intracoronary injection of 18 microg adenosine. TTDE was performed at baseline and after intravenous adenosine (140 microg/kgmin for 2 min). Adequate Doppler recordings of coronary flow velocities during systole were obtained in 14 of 21 study patients (67%) and during diastole in 17 (81%) patients. Baseline and hyperemic peak diastolic flow velocities measured by TTDE were significantly smaller than those obtained by ICDW (p<0.05). However, diminishing trends of diastolic and systolic velocity ratio after hyperemia were similarly observed in both methods. CFR obtained by TTDE (3.0+/-0.5), was higher than the value calculated by ICDW (2.5+/-0.4). There were significant correlations between the values obtained by the two methods (r=0.72, p<0.01). It is concluded that TTDE is a feasible method in measuring coronary flow velocity and appears to be a promising non-invasive method in evaluating CFR.
Adult ; Aged ; Blood Flow Velocity ; Comparative Study ; Coronary Angiography ; Coronary Circulation* ; Coronary Disease/ultrasonography* ; Echocardiography, Doppler/standards ; Echocardiography, Doppler/methods* ; Female ; Heart Rate ; Human ; Hyperemia/ultrasonography ; Linear Models ; Male ; Middle Age ; Prospective Studies ; Reproducibility of Results

BACKGROUND AND OBJECTIVES: To evaluate the association between chronic infection with Chlamydia pneumoniae, as measured by Immunoglobulin G and A, and acute myocardial infarction (AMI) in Korea. MATERIALS AND METHODS: A total of 136 patients [normal control 65 cases (male:female 27:8, mean age 55.1+/-11.7 years), AMI 71 cases (male:female 54:17, mean age 58.9+/-12.7 years)] had immunoglobulin G, A, and M antibody titers measured against Chlamydia pneumoniae by microimmunoflorescence assay and had coronary angiography performed. We investigated the incidence of major adverse cardiac events (MACE) at 6 month follow-up. Controls were defined as patients with no significant stenosis on coronary angiography. RESULTS: 1) AMI patients were more likely to be male (76.1: 41.5%) and smokers (67.6: 16.9%) compared with the controls. >2) In AMI patients, there was a weak correlation with IgG and IgA antibody titers (r=0.39, p=0.001).> 3) After adjusting for gender and smoking status, IgG and IgA antibody titers were similar between two groups.> 4) Increased IgG and IgA titers did not affect the MACE during follow-up. CONCLUSION: Chronic Chlamydia pneumoniae infection detected by immunoglobulin assay is not significantly associated with AMI. Further studies, such as polymerase chain reaction, immunocytochemistry, or culture of the atheromatous plaques, are needed to better define the association.
Chlamydia* ; Chlamydophila pneumoniae* ; Constriction, Pathologic ; Coronary Angiography ; Follow-Up Studies ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulins ; Immunohistochemistry ; Incidence ; Korea* ; Male ; Myocardial Infarction* ; Plaque, Atherosclerotic ; Polymerase Chain Reaction ; Risk Factors* ; Smoke ; Smoking

Primary thyroid lymphomas constitute of up to 5% of all thyroid malignancies. Recently, mucosa-associated lymphoid tissue (MALT) lymphoma are relatively recognized as a B cell subset of non-Hodgkin's lymphoma. MALT-lymphomas are thought to develop from acquired lymphocytic tissue during the course of a chronic inflammatory or autoimmune process. In the thyroid , which is normally devoid of lymphocytic tissue, chronic autoimmune thyroiditis (Hashimoto's disease) has been associated with an increased risk of lymphoma, including MALT type. The clinical presentations include the enlarging of the neck mass, dysphagia, hoarsenes and choking or cold thyroid nodule. We report a case of MALToma of the thyroid accompanied by Hashimoto's thyroiditis with a review of the literature.
Airway Obstruction ; Deglutition Disorders ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Lymphoma, Non-Hodgkin ; Neck ; Thyroid Gland* ; Thyroid Nodule ; Thyroiditis* ; Thyroiditis, Autoimmune

PURPOSE: The p21(Waf1/Cip1) protein inhibits the cell cycle by inhibiting the phosphorylation at the G1-->S check point, and the p27(Kip1) protein similarly performs the suppressor function by controlling the p27-mediated G1 arrest. In this study, we analysed the clinical status and survival rates in correlations with p21 and p27 expression patterns in gastric cancer. MATERIALS AND METHODS: Between 1993 and 1997, 192 patients who underwent surgeries in Catholic Medical Center were analysed retrospectively in this study. Immunohistochemical staining was performed and if the nuclei of the tumor cells were stained, we assumed those as positive results. Statistical analysis was based on clinicopathological findings and differences in survival rates. RESULTS: The expression rate of p27 was 28.1% and 15.6% in p21 each. The ratio of T1-2(80.0%) was significantly high in p21 (+), but the ratio of T3-4 (50.6%) was slightly high in p21 (-). There was no statistical significance regarding other factors. The results in p27 was not much different from expression rate of p21 in T-stage. In addition, p27 expression in diffuse type (91.3%) was higher than in intestinal type (62.7%) by Lauren's classification (P <0.05). Also, there was no statistical significance in other factors. In the correlation of p21 and p27, p27 was positive when p21 was positive (53.5%). Conversely, p27 was negative when p21 was negative (76.5%, p <0.05). In the p21 and p27 combination test, there was higher rate of T1-2 (87.5%) in p21 (+)/p27 (+), and higher rate of T3-4 (58.1%) in p21 (-)/p27 (-) (P <0.05). Results showed higher rate of intestinal type (100%) in p21 (+)/p27 (+), and diffuse type (87.0%) was dominant in p21 (-)/p27 (-) (P <0.05) by Lauren's classification. Moreover, there was no statistical significance in the 5-year survival rate in the expression of p21 and p27, and the 5-year survival rate was highest in the case of p21 (+)/p27 (+) without statistical significance. CONCLUSION: In our study, p21(Waf1/Cip1) and p27(Kip1) expressed similar patterns. The expression of p21(Waf1/Cip1) and p27(Kip1) affected the degree of invasiveness of the tumor, and. Combined examination result revealed the correlation of p21(Waf1/Cip1) and p27(Kip1) with Lauren's classification and depth of invasion of the tumor. However, we assumed that little difference between the survival rates depending on expression of p21(Waf1/Cip1) and p27(Kip1) has limited their value as predictable prognostic indicators.
Cell Cycle ; Classification ; Humans ; Phosphorylation ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

Mucin-producing tumors of the pancreas were first reported by Ohhashi and Takagi in 1980. Since then, many cases of intraductal papillary mucinous tumor (IPMT) of the pancreas, which is almost homonymous to mucin-producing tumors of the pancreas, have been reported. IPMTs are generally regarded as tumors with a favorable prognosis. Some IPMTs have invasiveness and this is always associated with a poor prognosis. Most IPMTs arise from the main pancreatic duct and IPMTs arising from the accessory pancreatic duct are relatively rare. Only 6 cases have been reported in the literature so far. Our patient was a 43-year old man who was admitted to the hospital due to recurrent pancreatitis. An endoscopic retrograde pancreatography revealed a patulous minor papilla orifice extruding mucin and a cystic lesion in a branch of the accessory duct. A pancreaticoduodenectomy was performed and a pathologic examination of the resected specimen showed intraductal papaillary mucinous neoplasm, low grade malignancy, in the accessory pancreatic duct and its branch. We herein report this interesting case with a review of the literature.
Adult ; Humans ; Mucins* ; Pancreas ; Pancreatic Ducts* ; Pancreaticoduodenectomy ; Pancreatitis ; Prognosis

BACKGROUND AND OBJECTIVES: Myocardial infarction in young age is an uncommon condition and has few risk factors than old aged group. Hyperhomocysteinemia, which is an independent risk factor for vascular disease, is associated with myocardial infarction (MI). Therefore, we evaluate that hyperhomocysteinemia is associated with myocardial infaction in young age. MATERIALS AND METHODS: A total 64 patients [normal control 23 (young:old 13:10 mean age 54.2+/-13.8), M.I 41 (young:old=13:28 mean age 53.9+/-14.1)] measured plasma levels of total homocysteine, folate, vitamine B6, and vitamine B12 and performed coronary angiography and echocardiography. Young aged group was defined male <45 years old and premenopausal wemen. RESULTS: 1) Homocysteine concentration was higher in MI patients than in controls (control 6.35+/-1.7 mmol/L, MI 11.3+/-4.9 mmol/L, p<0.001). 2) Levels of homocysteine were not significantly correlated with vitamine B6, B12, and folate, but were correlated with vitamine B12 in myocardial infarction (r=0.388, p<0.001). 3) Homocysteine levels were correlated with age, apoprotein B, BUN (r=0.374 0.52, p=0.05, 0.689 p=0.001) but correlated inversely with gobal function (r= - 0.672, p=0.001). 4) After adjusting for age factor in MI patients, homocysteine concentration was not significantly higher in young aged than in old aged group (young age 6.78+/-2.07, old age 10.2+/-4.17 mmol/L p=0.351 by ANCOVA). CONCLUSION: Hyperhomocysteinemia is an independent risk factor of MI, but is not clear association with MI in young age.
Age Factors ; Apoproteins ; Coronary Angiography ; Echocardiography ; Folic Acid* ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Male ; Myocardial Infarction* ; Plasma* ; Risk Factors ; Vascular Diseases ; Vitamins*