Normally the AC segment of mitral valve echogram consists of a rapid slope, from A peak to C point(complete closure). The initial portion is usually less steep than its final portion ; the latter represents abrupt mitral valve closure secondary to the rapid rise in left ventricular(LV) pressure at the onset of LV systole. The point on the mitral echogram at which closure aburptly accelerates in the B point. In order to see wither or not the echocardiographically recorded mitral valve could reflect alterations in left ventricular pressure, mitral valve echograms and left ventricular pressure were obtained on 30 patients undergoing diagnostic cardiac catheterization. The results were as follow : 1) Of 23 patients with LV ejection fraction>55%(71.2%+/-7.9%), 2 had B-bump ; of 7 patients with LV ejection fraction<55%(47.0%+/-4.9%), 5 had B-bump. The difference in frequency of B-bump between the normal LV ejection fraction and the low LV ejection fraction groups was statistically significant(p<0.001). 2) Of 6 patients with LVEDP>5mmHg (17.7mmHg+/-3.6mmHg), 5 had B-bump ; of 24 patients with LVEDP<15mmHg (8.5mmHg+/-2.6mmHg), 2 had B-bump. The difference in frequency of B-bump between the normal LVEDP and the elevated LVEDP groups was statistically significant(p<0.001). 3) Of 22 patients with LV ejection fraction>55%(71.2%+/-7.9%), as well as LVDEP<15mmHg(8.5mmHg+/-2.6mmHg), 1 had B-bump ; Of 5 patients with LV ejection fraction<55%(47.0+/-4.9%), as well as LVEDP>15mmHg(17.8mmHg+/-3.6mmHg), 4 had B-bump. The difference in frequency of B-bump between in normal LV ejection fraction, as well as normal LVEDP and the low LV ejection fraction, as well as elevated LVEDP groups was statistically significant(p<0.001). Thus, the mitral B-bump correlated primarily with LV dysfunction. When properly recorded, the presence of a B-bump is a useful sign of significantl LV dysfunction.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Humans ; Mitral Valve ; Systole ; Ventricular Dysfunction, Left* ; Ventricular Pressure

There has been considerable controversy in the treatment of acute grade 3 injuries of acromioclavicular joint. Neviaser reported that the possibility of a latent degenerative arthritis occurring in the acromioclavicular joint as the result of passing Kirschner wire through the joint was more theoretical than real and any changes that may take place in the acromioclavicular joint were the result of trauma. The acromioclavicular joint and the articular disc were not disturbed at the time of operation in Neviaser technique, but we excised the articular disc that were torn for the purpose of preventing acromioclavicular joint from degenerative arthritis. We had treated 26 cases of grade 3 injuries of acromioclavicular joint with modified Neviaser technique from June 1990 to May 1994 at the Pohang St. Mary’s Hospital. The results were as follows. 1. The clinical results by Weitzman were consisted of 18 cases(69%) of excellent, 6 cases(23%) of good, 2 cases(8%) of fair and 0 case(0%) of poor. 2. Loss of reduction was 1.6mm by stress views of final reviews and didn’t affect to functional result. 3. There were no cases of redislocation of acromioclavicular joint after removal of Kirschner wires. 4. There were no cases of degenerative arthritis of acromioclavicular joint in final review. There result suggest that excision of the articular disc that were torn may be helpful in preventing acromioclavicular joint from degenerative arthritis.
Acromioclavicular Joint ; Bone Wires ; Gyeongsangbuk-do ; Joints ; Osteoarthritis

BACKGROUND: Dizziness due to brain lesions manifests mainly in infratentorial lesions, with few cases related to supratentorial lesions having been reported. This study aimed to elucidate the clinical characteristics and demographic factors of patients with dizziness caused by cerebral infarction and to determine the site of the brain where supratentorial lesions are most prevalent. METHODS: Patients with prominent dizziness who visited the emergency room of Gachon University Gil Hospital between July 2006 and July 2007 were included. Among them, 101 patients with acute cerebral infarction were categorized into supratentorial (n=51) and infratentorial (n=50) groups based on brain MRI. Demographics and clinical characteristics of dizziness in each group were compared, and common brain sites of the supratentorial group were assessed. RESULTS: The nature of the dizziness differed between the supratentorial group (vertigo, 27.4%; presyncope, 5.9%; disequilibrium, 29.4%; ocular, 11.8%; and nonspecific, 25.5%) and the infratentorial group (vertigo, 50.0%; presyncope, 6.0%; disequilibrium, 32.0%; ocular, 0%; and nonspecific, 12.0%; p=0.02). The duration of dizziness was shorter in the supratentorial than the infratentorial group (p<0.01). In the supratentorial group, common sites of the lesion were the thalamus (19.6%) and frontoparietal lobe (15.7%). The lesion usually appeared in the left hemisphere (60.8%). CONCLUSIONS: Dizziness from supratentorial lesions manifests in different ways, and its duration is shorter than that from infratentorial lesions. The central vestibular pathway may be located in the thalamus and frontoparietal lobe.
Brain ; Cerebral Infarction ; Demography ; Dizziness ; Emergencies ; Humans ; Infarction ; Syncope ; Thalamus

BACKGROUND: Newly developed alpha-, beta-receptor blocker, Amosulalol HCI(YM-09538) was evaluated for its hypotensive efficacy, safety and usefulness in patients with mild to moderate essential hypertension. METHODS: Thirty patients of essential hypertension(male 8, female 22), mean age 55 years were included for the study. Amosulalol HCI was administered 20-60mg daily for 10 weeks and initial starting dose was 10mg twice daily and dose was increased 40mg and 60mg daily in cases of insatisfactory hypotensive effect ever 2 weeks interval. Patients were evaluated every two weeks on blood pressure, pulse rate, improvement of subjective symptoms and side effects. Laboratory examinations were carried out routinely in principle two times before trial and after completion of study. RESULTS: Blood pressure began to fall significantly after tow weeks of administration and changed from initial 172.4mmHg of systolic pressure to final 149.3mmHg and from 104.7mmHg of diastolic pressure to final 92.5mmHg. The response rates were marked fall in 30%, satisfactory fall in 40%, thus overall hypotensive effect was observed in 70%. Pulse rate decreased slightiy but significantly from 4 weeks of administration. Improvement of subjective symptoms were observed in 7 cases out of 12 cases and no significant side effects were observedd except of two mild transitory cases of polyuria and indigestion. Laboratory examination also did not show any significant changes before and after medication. CONCLUSION: The daily administration fo 20-60mg of Amosulalol HCI to moderate essectial hypertension seems to be effective and safe with clinical usefulness.
Blood Pressure ; Dyspepsia ; Female ; Heart Rate ; Humans ; Hypertension* ; Nifedipine ; Perindopril ; Polyuria

Many studies have reported structural or functional brain changes in patients with alcohol-dependence (ADPs). However, there has been an insufficient number of studies that were able to identify functional changes along with structural abnormalities in ADPs. Since neuronal cell death can lead to abnormal brain function, a multimodal approach combined with structural and functional studies is necessary to understand definitive neural mechanisms. Here, we explored regional difference in cortical thickness and their impact on functional connection along with clinical relevance. Fifteen male ADPs who have been diagnosed by the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) underwent highresolution T1 and resting-state functional magnetic resonance imaging (MRI) scans together with 15 male healthy controls (HCs). The acquired MRI data were post-processed using the Computational Anatomy Toolbox (CAT 12) and CONN-fMRI functional connectivity (FC) toolbox with Statistical Parametric Mapping (SPM 12). When compared with male HCs, the male ADPs showed significantly reduced cortical thickness in the left postcentral gyrus (PoCG), an area responsible for altered resting-state FC patterns in male ADPs. Statistically higher FCs in PoCG-cerebellum (Cb) and lower FCs in PoCG-supplementary motor area (SMA) were observed in male ADPs. In particular, the FCs with PoCG-Cb positively correlated with alcohol use disorders identification test (AUDIT) scores in male ADPs. Our findings suggest that the association of brain structural abnormalities and FC changes could be a characteristic difference in male ADPs. These findings can be useful in understanding the neural mechanisms associated with anatomical, functional and clinical features of individuals with alcoholism

Myasthenia gravis is an acquired autoimmune disorder characterized clinically by the weakness of skeletal muscles and fatigability on exertion. Autoimmune diseases such as systemic lupus erythematosus, autoimmune thyroiditis, rheumatoid arthritis, Sj?gren syndrome and polymyositis may be associated with myasthenia gravis. However, there are only a few reports of transverse myelitis with myasthenia gravis. We report a case of myasthenia gravis with recurrent transverse myelitis.
Arthritis, Rheumatoid ; Autoimmune Diseases ; Lupus Erythematosus, Systemic ; Muscle, Skeletal ; Myasthenia Gravis* ; Myelitis, Transverse* ; Polymyositis ; Thyroiditis, Autoimmune

PURPOSE: To investigate the incidence and risk factors of major complications including postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy in previously vitrectomized eyes. METHODS: The authors retrospectively reviewed medical records of 52 eyes, which underwent 23-gauge transconjunctival sutureless vitrectomy of previously vitrectomized eyes by a single surgeon. Major outcomes were postoperative hypotomy (<6 mmHg), intraoperative sclera shrinkage during sclerotomy,and other postoperative complications. Multiple logistic regression analysis was performed that included 212 eyes with primary vitreoretinal surgery in order to validate secondary vitreoretinal surgery as a significant risk factor of postoperative hypotony. RESULTS: Postoperative hypotony occurred in 4 eyes (7.7%) out of 52 eyes that underwent a second vitrectomy. The odds ratio of the second vitreoretinal surgery (OR=1.15, p=0.283) was not significant by multiple logistic regression analysis that included age, sex, axial length of globe, and the number of surgeries as the independent variables. Choroidal detachment occurred in one eye but disappeared three days later. The intraocular pressure was normalized within one week in all cases. Scleral shrinkage during sclerotomy occurred in five eyes (9.6%), and there were no other major complications, such as endophthalmitis. CONCLUSIONS: A 23-gauge transconjunctival sutureless vitrecomy of previously vitrectomized eyesshowed a 7.7% incidence of postoperative hypotony and favorable prognosis.
Choroid ; Endophthalmitis ; Eye ; Incidence ; Intraocular Pressure ; Logistic Models ; Medical Records ; Odds Ratio ; Postoperative Complications ; Prognosis ; Retrospective Studies ; Risk Factors ; Sclera ; Vitrectomy ; Vitreoretinal Surgery

BACKGROUND: Neurosyphilis develops into ischemic stroke due to the occlusion of intracranial arteries, which has the histopathological change of intracranial syphilitic arteritis. There might be an association between a latent syphilis and arterial changes before the neurosyphilis develops. We evaluated the relationship between the latent syphilis and the carotid intima-media thickness (IMT) in acute ischemic stroke patients to study whether the latent syphilis affected pathological arterial changes. METHODS: Retrospectively consecutive 96 acute ischemic first ever stroke patients were selected from the Gachon stroke registration from January 2003 to May 2005. The latent syphilis group was made up of 44 patients and the non-syphilis group matched in the age and the sex and consisted of 52 patients. The stroke subtype was classified by TOAST classification. RESULTS: The mean carotid IMT of the latent syphilis group (3.06+/-3.78 mm right, 2.68+/-3.39 mm left) was thicker than that of the non-syphilis group (1.49 +/-2.37 mm right, 1.43+/-1.99 mm left)(p<0.05). The hs-CRP was more elevated in the latent syphilis group than the non-syphilis group (1.6+/-2.2 mg/dl, 1.0+/-2.3 mg/dl respectively) (p<0.05). There were no significant differences of in each of the risk factors between the two groups. CONCLUSIONS: Our results showed the patients with latent syphilis had thicker carotid IMT, and a higher level of hs-CRP than the non-syphilis patients. It could be possible that the latent syphilis attributed to the pathological changes by the inflammation in the extracranial carotid artery.
Arteries ; Arteritis ; Carotid Arteries ; Carotid Intima-Media Thickness* ; Classification ; Humans ; Inflammation ; Neurosyphilis ; Retrospective Studies ; Risk Factors ; Stroke* ; Syphilis, Latent*

Cases showing memory disturbances with isolated retrograde memory without any definitive brain lesions are classified as dissociative amnesia. Improvements in imaging techniques have allowed the organic causes of this disease to be identified in several recent cases. Several studies have diagnosed cases of memory disorders as pure retrograde amnesia (PRA). The patient reported here had no psychiatric disorder and had normal MRI results, but showed hypometabolism in PET that met the criteria for PRA.
Amnesia ; Amnesia, Retrograde ; Brain ; Humans ; Memory ; Memory Disorders

PURPOSE: To report a case of Intraoperative Floppy Iris Syndrome (IFIS) experienced during pars plana vitrectomy and phacoemulsification in a patient using tamsulosin, which is a selective alpha 1 adrenergic antagonist. CASE SUMMARY: A 77-year-old male who had used tamsulosin for the previous month for prostate cancer visited our clinic with left visual disturbance, that had developed a week earlier. The best-corrected visual acuity of the left eye was 0.02 and both pupils showed incomplete mydriasis. Pars plana vitrectomy and phacoemulsification with PCL implantation were performed on his left eye to correct a left cataract and retinal vein occlusion with vitreous hemorrhage. Phacoemulsification idenfied a billowing iris and progressive pupillary constriction. Therefore, we administered an intracameral epinephrine injection and applied an iris hook. The procedure was completed successfully without any complications. The best-corrected visual acuity of the left eye was good as at 0.9, and iris depigmentation and atrophy were checked two months postoperatively in the right eye, which had not had any previous surgical history. CONCLUSIONS: A detailed medical history taking is essential because IFIS may raise the risk of intraoperative complications, such as posterior capsule rupture, especially when the small pupil is small. Safe procedures must be planned with cessation of tamsulosin at least a week preoperatively.
Adrenergic Antagonists ; Aged ; Atrophy ; Cataract ; Constriction ; Epinephrine ; Eye ; Humans ; Intraoperative Complications ; Iris ; Male ; Medical History Taking ; Miosis ; Mydriasis ; Phacoemulsification ; Prostatic Neoplasms ; Pupil ; Retinal Vein Occlusion ; Rupture ; Sulfonamides ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage