We report a case of 86-year-old woman with coronary artery fistula connecting the right coronary artery and left bronchial artery accompanied with cystic lung disease presenting with dyspnea and chest pain. Coronary angiography revealed that right coronary artery was anastomosed with the collaterals of left bronchial artery at the right hilum and tortuously ascended along the aortic arch and descended connecting with left pulmonary lobar artery at a certain site which is faintly opcified showing to and pro phasic movement. Chest CT scan shows the multicystic changes of the left lower lobe of the lung and hypertrophied bronchial artery of left lobar bronchus. Under the diagnosis of coronary artery fistula, hypertensive heart disease and multicystic lung disease, patient's symptoms and signs were improved by conservative treatment without surgical intervention.
Aged, 80 and over ; Aorta, Thoracic ; Arteries ; Bronchi ; Bronchial Arteries* ; Chest Pain ; Coronary Angiography ; Coronary Vessels* ; Diagnosis ; Dyspnea ; Female ; Fistula* ; Heart Diseases ; Humans ; Lung Diseases* ; Lung* ; Tomography, X-Ray Computed

BACKGROUND: With the recent development in arterial reconstructive procedure such as percutaneous transluminal coronary angioplasty or atherectomy, the incidence of vascular complications involving femoral artery is increasing due to greater use of larger percutaneous instruments(including arterial sheath) and periprocedural anticoagulant therapy. Femoral pseudoaneurysm requires rapid diagnosis and management to prevent limb ischemia, worsening of the arterial injury or repair of the arterial defect. Recently, accurate diagnosis of these injuries can be made nonivasively with duplex sonography and Doppler color flow imaging, and nonsurgical treatment may be possible by using external compression guided by ultrasound even in patients requiring prolonged anticoagulant therapy. METHOD: Three patients, one undergoing coronary angiography and two undergoing percutaneous transluminal coronary angioplasty, developed expansile groin masses at the vascular access sites diagnosed as femoral artery pseudoaneurysm s by Doppler ultrasound. All patients were hypertensives, taking aspirin and two patients who underwent PTCA received intravenous heparin after procedure. After diagnosis of femoral pseudoaneurysm, all patients underwent mechanical(C-clamp) external compression guided by ultrasound for 3 hours. RESULT: Follow up color flow scans were obtained after 24 hours and in one patients, blood flow in the tract was eliminated but persistent blood flow was observed in two patients who underwent PTCA. Before closure of pseudoaneurysm, one patient needed another 6 hours of ultrasound guided compression and the other needed more 12 hours. All patients were discharged without complication or recurrence of pseudoaneurysm. CONCLUSION: These cases suggest that nonsurgical closure of femoral pseudoaneurysms is feasible even in patients requiring prolonged antiplatelet and anticoagulant therapy.
Aneurysm, False* ; Angioplasty, Balloon, Coronary ; Aspirin ; Atherectomy ; Cardiac Catheterization* ; Cardiac Catheters* ; Coronary Angiography ; Diagnosis ; Extremities ; Femoral Artery ; Follow-Up Studies ; Groin ; Heparin ; Humans ; Incidence ; Ischemia ; Recurrence ; Ultrasonography

Ulnar lengthening, one of the operative treatment methods for Kienbock's disease, is based on the theory that ulnar minus variance is a significant causative factor of Kienbock's disease. It is considered that this method can promote the revascularization of the devascularizied lunate by reducing the forces concentrated at the wrist joint and that over-all carpal collapse is halted or reversed when the ulnar part of the carpus is supported better. 4 patients with Kienbock's disease treated by ulnar lengthening with iliac bone graft were reviewed after follow-up ranging from12 months to 30months. In all of 4 patients, relief of pain was satisfactory and there was no remarkable complication.
Follow-Up Studies ; Humans ; Methods ; Osteonecrosis ; Transplants ; Wrist Joint

BACKGROUND: Lidocaine is a well known antiarrhythmic agent. However, recent reports indicate that indocaine has myocardial protective effects on acute myocardial ischemia and reperfusion. The exact mechanism of myocardial protection of lidocaine is still not clearly understood. In this study we intended to assess the effects of lidocaine on high energy phosphate metabolism in cats subjected to myocardial ischemia-reperfusion by using 31P MR spectroscopy. Effect of lidocaine on size of infarct will also be evaluated by 2, 3, 5-triphenyltetrazolium chloride(TTC) staining. METHODS: Twenty-seven cats were used for this study. The animals were divided into three groups : for group 1(n=10) and group 2(n=7), animals were subjected to a 90 min of LAD occlusion followed by a 90 min of reperfusion ; for group 3(n=10), a 20 min of occlusion followed by a 90 min of reperfusion. In group 2 and group 3, lidocaine(5mg/kg/hr) was infused continuously during the occlusion and reperfusion periods with an initial bolus injection(1mg/kg) before ligation of LAD. In-vivo MR spectroscopy was performed on a 4.7T Biospec System(Bruker, Switzerland). A home-made surface coil(diameter : 1.5cm) was used to receive31p signals from the myocardium underwent ischemic and reperfusion damage. RESULTS: Decrease of PCr during ischemic period was not different between each groups : PCr showed less than 30% of the baseline value at L-30 in group 1 and group 2 and at L-20 in group 3. More than 90% recovery of PCr was achieved at R-30 in group 2 and group 3, whereas less than 50% of PCr was recovered in group 1. Decrease of ATP during ischemic period was less pronounced in group 2 than in group 1 : in group 2 ATP depleted down to 25% of the baseline at L-90, whereas in group 1 ATP decreased to 50% of the baseline. Recovery of ATP during reperfusion period was not signiflcant in all three groups. On TTC staining, evidence of infarct was seen in all cases of group 1 : the area of infarct was 12.3+/-2.7% of the left ventricular mass and 23.9+/-6.1% of the area at risk. On the contrary, there was no evidence of infact in any case of group 2 and group 3. CONCLUSION: In this study, we found that lidocaine has myocardial protecitve effects on ischemia-reperfusion in cats. Lidocaine improves high energy phosphorous metabolism during ischemia and reperfusion as well as reduces infarct size.
Adenosine Triphosphate ; Animals ; Cats* ; Ischemia ; Lidocaine* ; Ligation ; Magnetic Resonance Spectroscopy ; Metabolism ; Myocardial Ischemia ; Myocardium ; Polymerase Chain Reaction ; Reperfusion ; Reperfusion Injury

BACKGROUND: Progression of coronary artery disease(CAD) is highly unpredictable, and follows a nonlinear course. In previous reports, progression was related to acute myocardial infarction and cardiac death. The present study was designed to assess the characteristics of progression of CAD and to ditermine the predictors for progression. METHODS: The present study included 41 patients(age 55+/-9 years ; male/female=36/5) with CAD who underwent coronary angiography at least twice(interval : mean 26 months), and patients who underwent coronary angioplasty of coronary bypass surgery before the 2nd angiograms were excluded from analysis. The coronary arterial bed was divided into 15 segments according to American Heart Association(AHA) committee report. We measured both % stenosis and minimal diameter of the lesions, and divided the lesions into four Ambrose's morphological categories. Progression was considered to be present if one of the following changes had occurred : increase in % stenosis of lesions by> or =20%, decrease in minimal diameter by> or =0.5mm, or any new occlusion. For the purpose of detecting predictors we investigated clinical history(smoking, hypertension, obesity, and DM), angiographic findings(numbers of diseased vessels and lesions), and biochemical study (total cholesterol, LDL, HDL, triglyceride, uric acid, and albumin). RESULTS: Altogether, 32 patients(78%) showed progression, and regression was present in 11 patients(27%). Six patients had both progressed lesions and regressed lesions. Progression occurred most frequently in segments with stenosis of 1% to 25% at initial arteriogram. Progression occured in increasing order in proximal right coronary artery, mid-LAD, and proximal LAD. There was no significant differences in progression among four Ambrose's morphologic categories. 59(10%) of the analyzable 589 segments had progressed, 19 them upto occlusion, and 7 segments became infarct related artery. In 5(71%) of 7 cases of new myocardial infarction it occurred in segments with< or =75% stenosis at initial arteriogram. The analysis selected two independent predictors for progression: uric acid and numbers of lesions> or =20% stenosis. CONCLUSION: The present study suggests that progression of CAD occurred most frequently in minimally stenotic lesions and that about two thirds of acute myocardial infarction occurred from insignificantly stenotic lesion. Uric acid level and numbers of lesions> or =20% stenosis were selelcted as the independent predictors of coronary disease progression.
Angioplasty ; Arteries ; Cholesterol, LDL ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Heart ; Humans ; Hypertension ; Myocardial Infarction ; Obesity ; Research Report ; Triglycerides ; Uric Acid

OBJECTIVES: To evaluate the spectrum of hysteroscopic surgery to be extended. METHODS: Forty-three women who underwent hysteroscopic procedures with Urione(R) solution or normal saline as distension media between March 2001 and March 2009 were randomized. The clinical characteristics, laboratory data, and post-operative results were retrospectively analyzed. RESULTS: The following hysteroscopic procedures were performed: endometrial biopsy, 26; endometrial polypectomy, 8; myomectomy, 7; ablation for dysfunctional uterine bleeding and endometrial hyperplasia, 1; and excision of an endometrial mass, 1. The mean size of the myomas was 3.2 cm. The average duration of hospitalization was 2 days. The average change in hemoglobin was 1.1 g/dl. The mean operative time was 36 minutes. CONCLUSION: The indications for hysteroscopic procedures can be extended. Pure intramural myomas, submucosal myomas, endometrial polyps, adenomyosis, endometrial hyperplasia, hydrometra, and abnormal uterine bleeding can be treated via a hysteroscope. Intra-operative transabdominal ultrasonographic guidance can be helpful during hysteroscopic procedures, and reduces the complication and morbidity rates.
Adenomyosis ; Biopsy ; Endometrial Hyperplasia ; Female ; Hemoglobins ; Hospitalization ; Humans ; Hysteroscopes ; Hysteroscopy ; Menopause ; Metrorrhagia ; Myoma ; Operative Time ; Polyps ; Retrospective Studies ; Uterine Hemorrhage

We experienced a rare clinical manifestation of a digoxin induced catatonic stupor without other features of digoxin toxicity. This case suggests that the neurological manifestation of digoxin toxicity can occur without the usual side effects. Also, a serum digoxin level should be checked in any elderly patient presenting with abnormal cerebral func-tions, irrespective of whether or not the dose of digoxin has been changed. (J Korean Neurol Assoc 19(4):438~439, 2001)
Aged ; Digoxin ; Humans ; Neurologic Manifestations ; Stupor*

Thymoma with psuedosarcomatous stroma is a recently described, rare variant of thymomas that are characterized by having a biphasic histologic pattern which consists of both an epithelial and a spindle cell stromal component. So far only 11 cases having similar histologic findings have been reported world wide. At this time we report a case of this rare variant of thymoma which occurred in a 53-year-old Korean man. This previously healthy patient presented with coughing and an anterior mediastinal mass was then detected radiographically. Mediastinal exploration revealed a 9 x 8 x 8 cm-sized well- encapsulated, ovoid, cystic mass. Histological examination showed a biphasic neoplasm composed of anastomosing nests of epithelial cells and somewhat cellular stromal spindle cells that had advanced degenerative changes. Immunohistochemical staining using the antibodies for cytokeratins, EMA, e-cadherin, and p75NGFR showed a strong expression of these markers in the epithelial component but no expression in the spindle stromal cells. The epithelial tumor cells showed no reactivity to CD5 and L26 and a high proportion of the infiltrated lymphocytes were the cortical type that expressed CD99 and terminal deoxynucleotidyl transferase. Ultrastructural examinations revealed tonofilaments in the spindle cells. Follow up has been done for 5 years after the surgical excision and the patient has been free of disease during that period. Similar to previous reports, this patient had a benign clinical course that was unassociated with myasthenia gravis which appears to be a characteristic of this histologic variant of thymoma. However, our case also showed advanced degenerative features and we could demonstrate ultrastructural evidence of epithelial differentiation in the stromal spindle cells that were not mentioned in the previously reported cases. Based on the results of our studies, we suggest this entity is a distinct type of organotypic thymoma that shows cortical differentiation and abundant cellular stroma.
Case Report ; Human ; Immunohistochemistry ; Male ; Microscopy, Electron ; Middle Age ; Sarcoma/*pathology ; Stromal Cells/*pathology ; Thymoma/*pathology/surgery ; Thymus Neoplasms/*pathology/surgery

PURPOSE: The purpose was to investigate the spontaneous apoptotic index (SAI) and p53 protein expression and to identify the role of SAI and p53 protein positivity. MATERIALS AND METHODS: Forty six patients with squamous cell carcinoma of the cervix, FIGO stage IIB, treated with curative radiotherapy alone between 1990 and 1993 were included in this study. Definitive radiotherapy including external beam and high-dose-rate brachytherapy was given. Pretreatment paraffin-embedded biopsy specimens of those patients were scored for apoptosis and p53 protein expression using mouse mondegrees Clonal antibody (DO-7) by immuno staining. Clinicopathologic characteristics were also studied in relation to SAI and p53 protein expression, and as prognostic factors for clinical outcome. RESULTS: SAI and p53 were not related to any clinical characteristics. The range of the SAI was 0.2~4.7% (median 1.1%, mean 1.5%). The rate of p53 protein expression was 65.2% (30/46). Patients whose tumors had high SAI and low p53 protein positivity had better treatment outcome than those with lower SAI. There was also a significant correlation between the SAI and p53 protein expression. CONCLUSION: The pretreatment SAI and p53 oncoprotein expression are clinically useful in predicting the clinical outcome of FIGO stage IIB squamous cell carcinoma of the uterine cervix patients treated with definitive radiotherapy.
Animals ; Apoptosis* ; Biopsy ; Brachytherapy ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Humans ; Mice ; Radiotherapy* ; Treatment Outcome ; Uterine Cervical Neoplasms

No abstract available.
Adenoma, Oxyphilic*