Aneurysms of the pulmonary artery are uncommon in general but have a potentially fatal prognosis. This is derived from the potential for rupture of the aneurysm from the fact that there is commonly underlying severe pulmonary hypertension. Most cases are documented in the large postmortem series. Aneurysms of the pulmonary artery can be classified as congenital or acquired. Possible symptoms include dyspnea on exertion, cough, hemoptysis, and thoracic pain. When a large aneurysm formation of the pulmonary artery is diagnosed, surgical intervention is indicated because conservative treatment of the aneurysm will undoubtedly result in rupture with fatal outcome. We report a case of 46-year old patient with a giant left pulmonary artery aneurysm associated with severe pulmonary hypertension. A Doppler echocardiogram and a computed tomographic scan showed a giant saccular aneurysm of the left pulmonary artery (12 cm in diameter) and estimated systolic right ventricular pressure of 80 mmHg.
Aneurysm* ; Cough ; Dyspnea ; Fatal Outcome ; Hemoptysis ; Humans ; Hypertension, Pulmonary* ; Middle Aged ; Prognosis ; Pulmonary Artery* ; Rupture ; Ventricular Pressure

Ischemic heart disease is a common complication of thyrotoxicosis, although the exact mechanism has not been defined. In patient with dextrocardia as a part of situs inversus, coronary heart disease may occur with similar frequency and manifestation as in the general population. A case is reported of angina and thyrotoxicosis in patient with situs inversus totalis in which the angina was manifested by ST-segment elevation during graded exercise, relieved by antithyroid treatment. This unusual case establishes an association between hyperthy-roidism and ischemic heart disease.
Coronary Disease ; Dextrocardia ; Humans ; Hyperthyroidism* ; Myocardial Ischemia ; Situs Inversus* ; Thyrotoxicosis

PURPOSE: The mechanism of hypoxic damage is mainly intracellular influx of calcium ions through the glutamate ionotropic receptor. This study was performed to determine alterations in distribution and expression of kainate receptor subunits after 1 hour of moderate hypoxia in the newborn piglet brain, as in a condition of mild to moderate perinatal hypoxic-ischemic encephalopathy. METHODS: Ten newborn piglets were ventilated at PaO2 over 80mmHg for 30min. Thereafter, the control group(n=5) was ventilated with 21% oxygen, and hypoxic group(n=5) with 6% oxygen at PaO2 below 25mmHg for 1 hour. Concentrations of protein, ATP and phosphocreatine were determined. The proteins were immunostained with anti-rat GluR6/7 and anti-rat KA2 antibody. RESULTS: Hypoxia(PaO2 20+/-1mmHg) and acidosis(pH 7.06+/-0.09) developed significantly in the hypoxic group compared to the control group(PaO2 104+/-4mmHg, pH 7.44+/-0.03, respectively, P<0.01). The concentrations of ATP(2.84+/-1.28micromol/kg brain, P<0.05) and phosphocreatine(0.78+/-1.07micromol/kg brain, P<0.001) were reduced compared to the control group(5.04+/-0.25micromol/kg brain, 4.03+/-0.31micromol/kg brain, respectively). The protein contents of GluR6/7 subunits were ordered; cerebral cortex>hippocampus, thalamus, hypothalamus>basal ganglia, cerebellum>white matter, and KA2 subunits were ordered : hippocampus, basal ganglia>cerebral cortex>thalamus, cerebellum>hypothalamus, white matter. The distribution of the subunits between the hypoxic group and control group were similar. CONCLUSION: Cerebral cortex, hippocampus and basal ganglia may be the most vulnerable to excitotoxic injury. Kainate receptor subunits did not change after 1 hour of moderate hypoxia.
Adenosine Triphosphate ; Anoxia ; Basal Ganglia ; Brain* ; Calcium ; Cerebral Cortex ; Ganglia ; Glutamic Acid ; Hippocampus ; Humans ; Hydrogen-Ion Concentration ; Hypoxia-Ischemia, Brain ; Infant, Newborn* ; Ions ; Oxygen ; Phosphocreatine ; Receptors, Kainic Acid ; Thalamus

PURPOSE: The mechanism of hypoxic damage is mainly intracellular influx of calcium ions through the glutamate ionotropic receptor. This study was performed to determine alterations in distribution and expression of kainate receptor subunits after 1 hour of moderate hypoxia in the newborn piglet brain, as in a condition of mild to moderate perinatal hypoxic-ischemic encephalopathy. METHODS: Ten newborn piglets were ventilated at PaO2 over 80mmHg for 30min. Thereafter, the control group(n=5) was ventilated with 21% oxygen, and hypoxic group(n=5) with 6% oxygen at PaO2 below 25mmHg for 1 hour. Concentrations of protein, ATP and phosphocreatine were determined. The proteins were immunostained with anti-rat GluR6/7 and anti-rat KA2 antibody. RESULTS: Hypoxia(PaO2 20+/-1mmHg) and acidosis(pH 7.06+/-0.09) developed significantly in the hypoxic group compared to the control group(PaO2 104+/-4mmHg, pH 7.44+/-0.03, respectively, P<0.01). The concentrations of ATP(2.84+/-1.28micromol/kg brain, P<0.05) and phosphocreatine(0.78+/-1.07micromol/kg brain, P<0.001) were reduced compared to the control group(5.04+/-0.25micromol/kg brain, 4.03+/-0.31micromol/kg brain, respectively). The protein contents of GluR6/7 subunits were ordered; cerebral cortex>hippocampus, thalamus, hypothalamus>basal ganglia, cerebellum>white matter, and KA2 subunits were ordered : hippocampus, basal ganglia>cerebral cortex>thalamus, cerebellum>hypothalamus, white matter. The distribution of the subunits between the hypoxic group and control group were similar. CONCLUSION: Cerebral cortex, hippocampus and basal ganglia may be the most vulnerable to excitotoxic injury. Kainate receptor subunits did not change after 1 hour of moderate hypoxia.
Adenosine Triphosphate ; Anoxia ; Basal Ganglia ; Brain* ; Calcium ; Cerebral Cortex ; Ganglia ; Glutamic Acid ; Hippocampus ; Humans ; Hydrogen-Ion Concentration ; Hypoxia-Ischemia, Brain ; Infant, Newborn* ; Ions ; Oxygen ; Phosphocreatine ; Receptors, Kainic Acid ; Thalamus

BACKGROUND: There has been reports which suggest that non-specific symptom of patients with mitral valve prolapse is associated with autonomic dysfunction. METHODS: To assess autonomic dysfunction of patients, we examined five cardiovascular reflex tests in 25 asymptomatic MVP patients(identified as MVP group), 25 symptomatic MVP patients(identified as MVP syndrome group) and 25 control group. RESULTS: In the five cardiovascular autonomic function tests, abnormalities of Valsalva ratio were detected in 1(4%) control group, 7(28%) MVP group, 9(36%) MVP syndrome group, heart rate response to deep breathing in 0(0%), 2(8%), 4(16%) respectively, immediate heart rate response to standing in 0(0%), 2(7.4%), 2(8%) respectively and in postural hypotension, there were no abnormal group. Abnormalities of blood pressure response to sustained handgrip were only detected in 2(8%) MVP syndrom group. According to the five categories of cardiovascular autonomic functon tests, normal in 24(96%) and early damage in 1(4%) were detected in control group. In the MVP group, normal 17(68%), early damage 6(24%) and definite damage 2(8%) were noted. In the MVP syndrome group, normal 9(36%), early damage 13(52%), definite damage 1(4%) and combined damage 2(8%) were detected. In case of heart rate response to deep breathing, we found significant differences between control and MVP syndrome group(p=0.043), and between MVP and MVP syndrome group(p=0.0043). In case of heart rate response to standing, between control and MVP syndrome group(p=0.0009), between MVP and MVP syndrome group(p=0.001), the differences were noted. In case of blood pressure response to standing, between control group and MVP group(p=0.0019), between MVP and MVP syndrome group(p=0.0075), we found significant differences. Resulting from our study, heart rate response to deep breathing and standing, blood pressure response to standing were of considerable value in assessing the autonomic dysfunction of patients with mitral valve proapse. CONCLUSION: We found autonomic dysfunction in addition to increased autonomic tone and responsiveness which have been already known previously in mitral valve prolapse. And autonomic dysfunction was more severe in symptomatic patients with mitral valve prolapse than asymptomatic ones.
Blood Pressure ; Heart Rate ; Humans ; Hypotension, Orthostatic ; Mitral Valve Prolapse* ; Mitral Valve* ; Reflex ; Respiration

BACKGROUND: Vitiligo is an acquired disorder which causes body disfiguring and may provoke emotional stress, functional impairment, and psychiatric symptoms. OBJECTIVE: (1) To assess whether the psychiatric symptoms are more frequent in vitiligo patients than control patients. (2) To investigate whether the vitiligo patients with more severe psychiatric symptoms use more negative and passive coping mechanisms than patients with less severe psychiatric symptoms. To carry out this study we evaluated psychiatric symptoms, problems in daily activities, and the relation-ship between coping mechanisms and psychiatric symptoms. METHODS: A clinical study was done on 150 vitiligo patients. Other dermatology patients were used as a control group. Both groups had visited the dermatology clinic of the Severance hospital. Questionaires regarding age, sex, severity of disease, duration of disease, SCL-90(symptom check list 90), the coping list of Weisman, and items for adaptability of daily activity were recorded. Results : Male vitiligo patients showed more psychological symptoms than female patients. Vitiligo patients had many more difficulties in daily activities than the control patients. The patients who had more severe psychiatric symptoms used more negative and passive coping mechanisms than less severe patients. Conclusion : Vitiligo provoked psychiatric symptoms and difficulties in daily activities. Psychiatrically more severe patients used negative and passive coping mechanisms. Comprehensive dermatologic and psychiatric treatment may be required in the treatment of vitiligo.
Dermatology ; Female ; Humans ; Male ; Stress, Psychological ; Vitiligo*

The purpose of this study is to develop social medicine curriculum model and to propose its management device. The study developed the curriculum model and its management plan as follows; First, the social medicine curriculum can be implemented starting from the first semester of first year through the first semester of fourth year, and is splitted up into two semesters for each year of medical school. Second, a semester consists of sixteen weeks, giving two hours course per week. Third, the sixteen weeks curriculum should be composed of sub courses which lasts at least four weeks each. Forth, the elective course of social medicine is of four blocks in total, and runs from second semester of the second year through first semester of the fourth year. This means the elective courses in the first semester are opened to third and fourth year students. And the elective courses in the second semester are opened to second and third year medical students. Fifth, the minimum number of elective courses should be more than four courses per semester. Sixth, the credits for core and elective social medicine courses are one point each for any lectures or laboratories carried out in the following way; one hour course provided for sixteen weeks or two hours course provided for eight weeks. The social medicine education stands firm as one of the core subjects in twenty-first century medical education. Thus, the effectiveness and systematic development of the program as well as running it will be the most important criterion for determining the competency of a medical school.
Curriculum* ; Education ; Education, Medical ; Humans ; Lectures ; Running ; Schools, Medical ; Social Medicine* ; Students, Medical

BACKGROUND: Primary pulmonary hypertension(PPH) that affects predominantly young and productive people, is a progressive fatal disease of unknown cause. The objectives of this study were to characterize mortality in patients with PPH and to investigate the factors associated with their mortality. METHODS: Thirteen patients with PPH were enrolled between 1988 and 1996 and followed up through July 1999. Measurements at diagnosis included hemodynamic and pulmonary function variables in addition to information on demographic data and medical history. RESULTS: 1) The mean age of the patients with PPH enrolled into the study was 36.1+/-9.3 years with female predominance. 2) The estimated median survival was 3.4+/-0.6 years. 3) Decreased cardiac index was the only significant predictor of mortality(Cox proportional hazards model). CONCLUSION: Patients with PPH have a high mortality. In this limited study with a small number of patients, mortality is largely associated with decreased cardiac index.
Diagnosis ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Mortality ; Prognosis

An unusual form of hypertrophic cardiomyopathy localized to the left ventricular apex is called apical hypertrophic cardiomyopathy. In the classic form is characterized by giant T wave inversion in electrocardiogram and an angiographic silhouette showing enddiastolic deformation of the left ventricular cavity resembling a "spade". Apical hypertrophic cardiomyopathy appears functionally similar to other forms of nonobstructive hypertrophic cardiomyopathy. The diagnosis of apical hypertrophic cardiomypathy is made chiefly from the 12 lead electrocardiogram, two-dimensional echocardiography, left ventriculogram and magnetic resonance imaging. The prognosis appears relatively favorable course. We report a case of regressed apical hypertrophic cardiomyopathy which was diagnosed by two-dimensional echocardiography and 12 lead electrocardiogram, with related literatures.
Cardiomyopathy, Hypertrophic ; Diagnosis ; Echocardiography ; Electrocardiography ; Magnetic Resonance Imaging ; Prognosis

BACKGROUND AND OBJECTIVES: The transradial approach has been suggested as an alternative entry site for coronary angiography. The complication and success rates of the vascular procedure have been associated with age. The aim of this study was to determine the safety, feasibility, and efficacy of transradial coronary angiography for patients greater than age 70 compared with younger patients. SUBJCETS AND METHODS: Clinical and angiographic data were reviewed retrospectively in 894 consecutive patients who underwent transradial coronary angiography from January 2001 through May 2003. Procedure-related results were used to compare 2 groups, patients aged < 70 years and those >70 years. RESULTS: In a consecutive series of 894 patients, 638 were < 70 years of age and 256 were >70 years of age. There was no significant difference in the rate of success in patients >70 years compared with patients < 70 (91.1% vs 93.6%). No severe complications, such as death, vascular dissection, rupture, and major cerebrovascular accidents were present in either group. Procedure-related variables, including procedure time, radiographic contrast use, and the number of catheters used per case, were similar between the two groups. CONCLUSION: Transradial access is a safe and feasible approach for coronary angiography in elderly patients, yielding results similar to those achieved with younger patients.
Aged* ; Catheters ; Coronary Angiography* ; Humans ; Retrospective Studies ; Rupture ; Stroke