Coronary arteriovenous fistula is relatively rare disease and originates more commonly in the right than in the left cononary artery. We report one case of cononary arteriovrnous fistula which we have experienced recently in 22 years old female, who has complained of dyspnea on exertion and intermittent anterior chest pain radiating to the left shoulder for several years. It was detected by transthoracic and transesophageal echocardiography and confirmed by cardiac catheterization and coronary angiography. In this case, the fistula was originated from the right coronary artery and drained into the posterior wall of the right ventricle, the coronary artery was dilated(diameter=1.5cm) and tortuous and significant shunt was measured(Qp/Qs=2.31). The opening of the fistula draining into right ventricle was obliterated with sutures.
Arteries ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Dyspnea ; Echocardiography* ; Echocardiography, Transesophageal ; Female ; Fistula ; Heart Ventricles ; Humans ; Rare Diseases ; Shoulder ; Sutures ; Young Adult

In so-called primary osteoarthritic knees, there may be secondary osteoarthritis due to the instability from chronic cruciate ligament and/or meniscal tear. The purpose of this study is to compare the findings of bone single-photon emission computed tomography(SPECT) and those of simple radiography in osteoarthritic knees which we consider as primary on the status of anterior cruciate ligament(ACL). We reviewed the preoperative bone SPECT and simple radiography of forty-three osteoarthritic knees in 23 patients who underwent total knee arthroplasty between 1995 and l996. We divided the cases into two groups on the status of ACL: thirty intact ACLs(Group I), thirteen insufficient ACLs(Group II). Meniscal tear and/or ACL insufficiency were found in 38 of 43 knees, As regards with presence of osteophytes and sclerotic changes on simple radiograph, there was no significant differences between group I and II. Joint space narrowing was more prominent and diffuse in group I(medial 29, lateral 24) than group II(medial 7, lateral 6). Bone SPECT showed diffuse uptake in group I(medial 30, lateral 23), but less uptake on the lateral compartment(medial 13, lateral 3) in group II. In ACL-intact osteoarthritic knees, joint space narrowing on simple radiograph and hot uptake on bone SPECT were more prominent and diffuse than in ACL-insufficient knees. Clinical relevance is still uncertain and further investigation is needed.
Anterior Cruciate Ligament* ; Arthroplasty ; Humans ; Joints ; Knee* ; Ligaments ; Osteoarthritis ; Osteophyte ; Radiography* ; Tomography, Emission-Computed, Single-Photon*

To increase the survival area of the venous flap, we studied the arterialized venous flap in a rabbit ear model. The ears of 12 New Zealand white rabbits(n=24) were randomized into three groups, group A receiving arterio-venous anastomosis 14 days before the arterialized venous flap elevation; group B receiving bipedicled flap elevation 14 days before arterialized venous flap elevation; group C receiving no pretreatment before the arterialized venous flap elevation. Tc -pertechnetate scan was performed on all groups immediately after the arterialized venous flap elevation to evaluate the blood flow of the flap. The survival area of the flap was measured 14 days after the arterialized venous flap elevation. Average ratio of survival area was 92% in Group A, 88% in group B, which were comparatively higher than the 12% in group C. The entire flap was visualized in groups A and B on scan images, however, only the proximal area of the anterior and posterior marginal vein was visualized in group C. Flap survival pattern was similar to that of the scan image and the slope of time-activity curve of groups A and B was much steeper than that of group C. High survival rate of group A, which received the arterio-venous anastomosis as a pretreatment, may be due to the decrease of resistance of outflow during the 14 days. Anticipated mechanisms involved are, valve insufficiency due to high pressure arterial inflow, development of vascular collaterals in the flap, and opening of arteriovenous(A-V) shunt. Bipedicled flap elevation as a pretreatment may not effect on valves, however, may impair the sympathetic nerve and cause ischmic stimuli which in turn may develop vascular collaterals and make an opening of the A-V shunt.
Ear ; New Zealand ; Survival Rate ; Veins

It has been well documented that dysfunction of the Eustachian tube if the main cause of middle ear disease in most cleft palate patients. The middle ear disease is refractory to medical treatment and has frequent recurrences; the final results may end up with chronic otitis media and/or hearing loss. Currently, myringotomy with placement of ventilation tube in early infant stage have been widely accepted for treatment of otitis media in cleft palate patients. We calculated the frequency of the occurrence of otitis media in cleft palate patients who have received palatoplasty in our clinic. Preoperative otoscopic examination and tympanometric test were taken in all patients. We performed tympanostomy and ventilation tube insertion at the time of palatal repair on every patients who had evidence of otitis media in the preoperative otologic examinations. Since November 1996, 79 patients received palatoplasty and among these 63 patients(79.7%) received bilateral ventilation tube insertion simultaneously. We confirmed the previously documented high prevalence of otitis media in cleft palate patients and understood the importance of preoperative otologic examinations in the managements of cleft palate.
Cleft Palate* ; Ear, Middle* ; Eustachian Tube ; Hearing Loss ; Humans ; Infant ; Middle Ear Ventilation ; Otitis Media ; Prevalence ; Recurrence ; Ventilation

Treatment of Leptomeningeal carcinomatosis (LMC) from solid cancers has not advanced noticeably since the introduction of intra-cerebrospinal fluid (CSF) chemotherapy in the 1970's. The marginal survival benefit and difficulty of intrathecal chemotherapy injection has hindered its wide spread use. Even after the introduction of intraventricular chemotherapy with Ommaya reservoir, frequent development of CSF flow disturbance, manifested as increased intracranial pressure (ICP), made injected drug to be distributed unevenly and thus, the therapy became ineffective. Systemic chemotherapy for LMC has been limited as effective CSF concentration can hardly be achieved except high dose methotrexate (MTX) intravenous administration. However, the introduction of small molecular weight target inhibitors for primary cancer treatment has changed the old concept of 'blood-brain barrier' as the ultimate barrier to systemically administered drugs. Conventional oral administration achieves an effective concentration at the nanomolar level. Furthermore, many studies report that a combined treatment of target inhibitor and intra-CSF chemotherapy significantly prolongs patient survival. Ventriculolumbar perfusion (VLP) chemotherapy has sought to increase drug delivery to the subarachnoid CSF space even in patients with disturbed CSF flow. Recently authors performed phase 1 and 2 clinical trial of VLP chemotherapy with MTX, and 3/4th of patients with increased ICP got controlled ICP and the survival was prolonged. Further trials are required with newly available drugs for CSF chemotherapy. Additionally, new LMC biologic/pharmacodynamic markers for early diagnosis and monitoring of the treatment response are to be identified with the help of advanced molecular biology techniques.
Administration, Intravenous ; Administration, Oral ; Cerebrospinal Fluid ; Drug Therapy ; Early Diagnosis ; Humans ; Intracranial Pressure ; Meningeal Carcinomatosis* ; Methotrexate ; Molecular Biology ; Molecular Weight ; Perfusion

BACKGROUND: Descending necrotizing mediastinitis(DNM) is a serious complication originating in odontogenic or oropharyngeal infection with previously reported mortality rates of 25% to 40%. We retrospectively reviewed the 4 years of our surgical drainage and debridement in DNM. MATERIAL AND METHOD: We studied 7 cases diagnosed as DNM from 1997 through 2000. Primary oropharyngeal infection lead to DNM in four cases(57%) and odontogenic abscess in three cases(43%). All patients were received emergent cervicotomy and thoracotomy or sternotomy for debridement of necrotic tissue and mediastinal or pleural drainage. RESULT: Five cases were evolved well and were discharged after a mean of 42 days. Two patients(28.6%) died. Three patients required reoperation due to local surgical complication; empyema(two) and impending cardiac tamponade. One of these patients died on 12 post-reoperative day due to great vessel erosion, renal and respiratory insufficiency. The other patient died of broncho- esophageal fistula and asphyxia on 10 postoperative day without reoperation. CONCLUSION: On the basis of experience accrued in treating these patients, early diagnosis by cervicothoracic computed tomographic scan of neck and thorax aids in rapid indication of a surgical approach of DNM. We emphasize that performing early surgical drainage and debridement of necrotic tissues with intensive postoperative care can significantly reduce the mortality rate.
Abscess ; Asphyxia ; Cardiac Tamponade ; Debridement ; Drainage ; Early Diagnosis ; Esophageal Fistula ; Humans ; Mediastinitis* ; Mortality ; Neck ; Necrosis ; Postoperative Care ; Reoperation ; Respiratory Insufficiency ; Retrospective Studies* ; Sternotomy ; Thoracotomy ; Thorax

BACKGROUND AND OBJECTIVES: It has been recently reported that coronary artery disease (CAD) is more correlated with postprandial triglyceride (TG) levels than fasting TG levels. We performed this study to compare the patients with CAD to age- and sex-matched controls in regard to postprandial TG levels and to know the effects of fenofibrate on postprandial TG levels. MATERIALS AND METHOD: Serum TG, total cholesterol (C), HDL-C and LDL-C were measured before, and 2, 4, 6, 8, and 24 hours after a high-fat meal in 22 patients (mean: 60 yr) with CAD and 12 normal subjects (mean: 54 yr). The same parameters were also serially measured after the high-fat meal plus fibrate in 10 patients with CAD (mean: 59 yr). RESULTS: he patients group without fibrate showed that more prolonged and exaggerated hypertriglyceridemia following the meal than normal subjects, especially 4 to 8 hours after the meal and that lower HDL-C throughout the test duration. These changes were also persisted when hyperlipidemic patients were excluded out of the patients group. The patients with fibrate did not show such a significant elevation of TG levels 4 to 8hours after the meal compared when normal subjects. The time to reach the peak TG levels after the meal was 4, 6, and 4 hours after the meal in normal subjects, patients with CAD, and fibrate group, respectively. CONCLUSION: Coronary artery disease is clearly related with postprandial hypertriglyceridemia than fasting TG levels and postprandial hypertriglyceridemia can be somewhat prevented by fibrate.
Cholesterol ; Coronary Artery Disease* ; Coronary Vessels* ; Fasting ; Fenofibrate ; Humans ; Hypertriglyceridemia* ; Meals* ; Triglycerides

Recently, the incidence of hypertension (HT) and coronary artery disease is increasing because of the change of diet and life pattern. But, coronary artery disease is relatively uncommon in young women of pregnant age. The trend towards delayed marriage and child-bearing may results in an increasing number of women with coronary heart disease. Myocardial infarction complicates approximately 1 in 20,000 pregnancies. Myocardial infarction in pregnancy carries substantial maternal and fetal risks. Overall maternal mortality rate is 21% to 35% and the fetal mortality rate is 13%. Importantly, the maternal mortality rate approaches 50% when women deliver within 2 weeks of the initial MI event. We experienced a case of pregnancy with acute myocardial infarction (AMI) and chronic HT. The patient had a myocardial attack at gestational age 36(+5) weeks and medical treatment was administered. Labor inuction was begun at gestational age 39+3 weeks and the patient delivered by spontaneous vaginal delivery. We report this case with a brief review of the concerned literatures.
Coronary Artery Disease ; Coronary Disease ; Diet ; Female ; Fetal Mortality ; Gestational Age ; Humans ; Hypertension ; Incidence ; Marriage ; Maternal Mortality ; Myocardial Infarction* ; Pregnancy*

OBJECTIVE: The aim of this investigation was to analyze the association between a single nucleotide polymorphism (SNP) in L-myc gene (T3109G) and the cervical cancer susceptibility or invasiveness in Korean women. METHODS: The blood samples of 231 cervical cancer patients and 332 non-cancer control subjects who managed at Seoul National University Hospital from 1999 to 2002 were collected. Polymorphism in L-myc (T3109G) was determined using TaqMan method. Allele frequency and genotype distribution in the cervical cancer group were compared with those of the control group to determine whether this polymorphism elevates the susceptibility of Korean women to the cervical cancer. The relationship between this SNP and cancer invasiveness was also evaluated by collating clinicopathologic data of those in the cancer group, such as age, FIGO stage, histologic type, lymph node metastasis and parametrial invasion. RESULTS: In the cervical cancer group, the allele frequency of G was 47.6%, in the control group 48.5%, showing no significant difference (p=0.808). Similarly the genotypes with TG or GG showed no increased risk for the cervical cancer compared with TT genotype. A subgroup analysis of the clinicopathologic parameters in cancer group also showed no significant difference suggesting the lack of an association between SNP of the L-myc and the cervical cancer invasiveness. CONCLUSION: This study shows that Korean women with specific polymorphism in L-myc are neither more susceptible to develop the cervical cancer nor more vulnerable for the cancer progression.
Female ; Gene Frequency ; Genes, myc ; Genotype ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Polymorphism, Single Nucleotide* ; Seoul ; Uterine Cervical Neoplasms*

Oxygen free radical activity is elevated in diabetes mellitus and has been implicated in the etiology of vascular complications and diabetic nephropathy is a serious microvascular complication in patients with IDDM. Despite intensive investigation, the pathophysiology of diabetic renal disease has not been fully elucidated. However, several clinical and experimental studies have suggested that endothelial dysfunction and changes of peritubular microcirculation might deteriorate renal function in patients with IDDM. We performed this study to examine the oxidative stress and correlation between levels of serum creatinine and erythrocytic MDA, SOD, catalase, GPX in IDDM patients with diabetic nephropathy. Twenty one patients with IDDM(diabetic duration >5 years) and persistent albuminuria(albumin excretion>1000mg/day) and 15 normal healthy controls were investigated prospectively for erythrocytic MDA(thiobarbituric acid assay) and antioxidant enzymes[SOD(Hyland et al.), catalase(Nelson and Kiesow), GPX(Palgia and Valentine)] and correlation to serum creatinine levels. Levels of erythrocytic MDA were significantly higher in patients with diabetic nephropathy than in normal healthy controls(p<0.05) and levels of erythrocytic antioxidant enzymes were significantly lower in patients with diabetic nephropathy than in normal healthy controls(p<0.05). There was no significant correlation between serum levels of creatinine and erythrocytic MDA in group 1(r=0.12, p>0.05) and group 2(r=0.12,p>0.05) but there was significant correlation between serum levels of creatine and erythrocytic MDA in group 3(r=0.96, p<0.05). There was no significant correlation between serum levels of creatinine and erythrocytic antioxidant enzymes in all patients with diabetic nephropathy groups(group 1, group 2, and group 3; p>0.05). We concluded that increased oxidative stress and decreased antioxidative defense mechanism might be factors in the initiation of diabetic nephropathy and the oxidative stress correlated with higher serum levels of creatinine(more than 5mg/dL)(p<0.05).
Catalase ; Creatine ; Creatinine* ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetic Nephropathies* ; Humans ; Microcirculation ; Oxidative Stress ; Oxygen ; Prospective Studies