Papillary endothelial hyperplasia(PEH), usually originates in extracranial soft tissue, is considered a reactive proliferation of endothlium and an unusual form of thrombus organization. However the occurance of PEH in the cranial cavity is very rare. The authors report a case of a PEH involving intracranial sella, parasella, cavernous sius, ethmoid and sphenoid sinus in an 11-year-old boy. The patient was presented with sudden right visual disturbance. Magnetic resonance image showed a well-enhanced mass in the right cavernous sinus extending into the ethmoid and sphenoid sinus. The cerebral angiography demonstrated a vigorous tumor staining supplied by both internal and external carotid arteries. The right fronto-temporal craniotomy and subtotal resection of the tumor were performed. The mass was comprised in a highly vascular red-black nodular tissue associated with a mixture of fresh and organizing thrombi. The histopathological examination revealed papillary structures lined by endothelium within vascular space with organized thrombus. While the patient was waiting for second operation in order to remove remaining small tumor in the ethmoid and sphenoid sinues, the lesion exhibited rapid regrowth and the size became to the preoperative size at three months after operation. At reoperation, gross total removal was accomplished by a combination of trans-cranial and trans-sphenoidal approaches. Postoperative radiotherapy was given.
Carotid Artery, External ; Cavernous Sinus* ; Cerebral Angiography ; Child ; Craniotomy ; Endothelium ; Humans ; Hyperplasia* ; Male ; Radiotherapy ; Reoperation ; Sphenoid Sinus* ; Thrombosis

No abstract available.
Cryptococcosis* ; Humans

BACKGROUND: Epidemiological studies have shown correlation between low incidence of coronary heart disease and high consumption of fish products. It has been suggested that this may be due to the high content of polyunsaturated fatty acids of the n-3 fatty acid group in fish oil. In animal studies eicosapentaenoic acid (EPA) inhibited attachment of monocytes to the arterial endothelium. METHOD: Adhesion assay was performed on the endothelial cells of the human umbilical vein with 25, 50, 100, 200 micrometer EPA-treated U937 cells. The endothelial cells were activated with lipopoysaccharide (LPS). The adhesion assay was repeated with oxidized EPA. EPA was oxidized with CuSO4 and ascorbic acid. RESULT:Viability of U937 cells were not affected by concentrations up to 200 micrometer of EPA and oxidized EPA. LPS treatment of endothelium notably increased the number of U937 cells attached to endothelial cells on the adhesion assay. However, treatment of EPA, native or oxidized, to U937 cells did not affect the number of U937 cells attached to LPS activated endothelial cells. CONCLUSION: EPA treatment, native or oxidized, of U937 cells did not affect U937 cell-endothelial cell adhesion. This suggests that inhibition of monocyte-endothelial cells attachment by EPA is not due to the effects of EPA on monocytes.
Animals ; Ascorbic Acid ; Cell Adhesion* ; Coronary Disease ; Eicosapentaenoic Acid* ; Endothelial Cells ; Endothelium ; Fatty Acids, Unsaturated ; Fish Products ; Humans ; Incidence ; Monocytes ; U937 Cells ; Umbilical Veins

OBJECTIVE: Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. MATERIAL AND METHODS: Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin(20mg/m2), etoposide(100mg/m2) and bleomycin(15mg/m2) as well as external beam radiation therapy. We compared the management problems for these tumors. RESULT: In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. CONCLUSION: Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.
Biopsy ; Bone Marrow ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination ; Endoderm* ; Endodermal Sinus Tumor* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Radiotherapy ; Survival Rate ; Testis ; Vinblastine

BACKGROUND: The hepatic and neuropsychiatric disorders caused by long term excessive alcohol abuse have been well documented. However the pathogenesis and clinical characteristics of cardiovascular disorder caused by excessive alcohol abuse has not been documented. Many patients diagnosed as idiopathic dilated cardiomyopathy(IDCM) are apt to have a history of heavy alcohol consumption and are categorized as having alcoholic ardiomyopathy(ACM). METHODS: Twenty men(agedd 32 to 63 yrs, mean age 48.6 yrs) with dilated dcardiomyopathy, with the history of excessive alcohol abuse, were analyzed with fifteen patients with IDCM as control. RESULTS: The most common alcoholic beverage consumed in ACM is Diluted soju(85.0%) followed by Takju(10.0%), beer(5.0%). Average daily alcohol consumption is 134.5+/-40.3 g, frequency of alcohol intake in a week 5.4+/-1.4 times, total life time dose of ethanol 20.0+/-7.8kg/kg of body weight and duration of alcohol intake 26.9+/-8.4 years. There were no significant differences in symptoms between the two groups. In electrocardiography, atrial fibrillation is more frequent in ACM group(40%) than IDCM group(20%). In ACM group, serum concentrations of triglyceride and total cholesterol are higher than IDCM group, but no differences in serum HDL-cholesterol, SGOT, SGPT concentrations. In echocardiography, left ventricular systolic internal dimension and right ventricular internal dimension is smaller and ejection fraction is larger in ACM group than IDCM group. CONCLUSION: We studied the clinical, laboratory, electrocardiographic and echocardiographic characteristics of alcoholic cardiomyopathy comparing with idiopathic dilated cardiomyopathy.
Alanine Transaminase ; Alcohol Drinking ; Alcoholic Beverages ; Alcoholics* ; Alcoholism ; Aspartate Aminotransferases ; Atrial Fibrillation ; Body Weight ; Cardiomyopathy, Alcoholic* ; Cardiomyopathy, Dilated ; Cholesterol ; Echocardiography* ; Electrocardiography ; Ethanol ; Humans ; Triglycerides

BACKGROUND: Toxocariasis is a common cause of eosinophilia and eosinophilic lung disease in Korea. We analyzed the characteristics of eosinophilic lung disease in toxocariasis. METHOD: One hundred and forty one patients with eosinophilia caused by a toxocara larval infection were evaluated from September 1, 2001 through March 30, 2006. The plain chest x-ray, chest CT(computed tomography), and bronchoalveolar larvage(BAL) were examined. A diagnosis of toxocariasis was made by ELISA using that secretory-excretory antigen from the T. canis larvae. RESULTS: Toxocarial eosinophilic lung diseases was diagnosed in 32 out of 141 patients. Ground glass attenuation was the main feature on the CT scans in 23 out of 141 patients (71.9%). Thirteen patients (40.6%) had a random in zonal distribution on CT. Pleural effusion was observed in 9 patients (28.1%). Twenty eight patients (87.5%) complained of respiratory symptoms. Eleven patients (34.4%) had gastrointestinal symptoms and 12 patients (37.5%) had liver infiltration. CONCLUSIONS: The most common findings of the chest CT in patients with toxocariasis was a randomly distributed ground grass attenuation. A toxocara infection should be considered in a differential diagnosis of patients who exhibit pulmonary infiltration with eosinophilia in Korea.
Diagnosis ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Fluconazole ; Glass ; Humans ; Korea ; Larva ; Liver ; Lung Diseases* ; Lung* ; Parasites ; Pleural Effusion ; Pneumonia ; Poaceae ; Thorax ; Tomography, X-Ray Computed ; Toxocara canis* ; Toxocara* ; Toxocariasis

BACKGROUND: Tei index is a Doppler-derived index of combined systolic and diastolic myocardial performance proposed to be a promising noninvasive measurement of overall cardiac function, calculated as the sum of isovolumic contraction (ICT) and isovolumic relaxation times (IRT) divided by ejection time (ET). This study aimed to investigate the effect of changes in preload on Tei index. SUBJECTS AND METHOD: The study population was 10 patients with chronic renal failure who are on regular hemodialysis (HD). They were 3 men and 7 women with a mean age of 45.3+/-12.4 years old. The complete 2-dimensional and Doppler echocardiography including recordings of mitral inflow and left ventricular outflow were performed using HP SONOS 1500 equipment before and after HD. Body weight was measured using electric scale before and after HD. Blood pressure and pulse rate were measured by an automated cuff measurement every 1 hour throughout HD. Hematocrit was monitored noninvasively and continuously using the Crit-Line instrument (In-Line Diagnostics, Riverdale, UT, USA) during HD. RESULTS: There were no significant changes in systolic and diastolic blood pressure, RR interval, left ventricular end-diastolic and end-systolic dimension, left atrial dimension, and left ventricular ejection fraction during HD. The mean body weight loss during HD was 2.1+/-0.65 kg. The percentage of reduction of body weight was 4.1+/-1.56%. Changes in total blood volume at the end of HD were compared with that of baseline -11.79+/-5.51%. The percent change in total blood volume during the HD correlated significantly with the amount of change in body weight (r=0.678, p<0.05) and percent change in body weight (r=0.835, p<0.01), respectively. ICT before HD and at the end of HD were 39+/-13.0, 42+/-24.1 msec (p=NS). IRT before HD and at the end of HD were 76+/-29.1, 95+/-28.5 msec (p<0.01) and , ET before HD and at the end of HD were 317+/-18.1, 289+/-9.0 msec (p<0.01), respectively. Tei index before HD was 0.36+/-0.10, and the index at the end of HD were 0.47+/-0.13 (p<0.001). CONCLUSION: When there is a change in preload during a short period, it seems that the effect of change in preload should be considered when using Tei index to assess ventricular function.
Blood Pressure ; Blood Volume ; Body Weight ; Echocardiography, Doppler ; Female ; Heart Rate ; Hematocrit ; Humans ; Kidney Failure, Chronic ; Male ; Relaxation ; Renal Dialysis ; Stroke Volume ; Ventricular Function

OBJECTIVES: Tetrofosmin is a new Tc-99m labeled myocardial perfusion imaging agent that shows slow clearance from the myocardium and rapid clearance from background organs. The purpose of this study was to assess the ability of exercise Tc-99m tetrofosmin single photon emission computed tomography(SPECT) to identify and localize coronary artery disease. METHODS: The study population consists of 49 patients with suspected coronary artery disease who underwent both exercise Tc-99m tetrofosmin SPECT and coronary angiography within 2 weeks. Using the one day imaging protocol, 7-10mCi of Tc-99m tetrofosmin was injected at rest and 4 hours later, 25 mCi of Tc-99m tetrofosmin was injected at peak exercise. RESULTS: The sensitivity and specificity of exercise Tc-99m tetrofosmin SPECT was 94.9% and 60% for detection of coronary artery disease with luminal narrowing more than 50%, and 96.4% and 33.3% for detection of coronary artery disease with luminal narrowing more than 70%. The sensitivity of exercise Tc-99m tetrofosmin SPECT for detection of individual stenosed vessels(>or=50% and >or=70% coronary stenosis) was 79.2%, 100% for LAD, 55.6%, 55.6% for LCx and 85.0%, 92.9% for RCA and the specificity was 88.0%, 75.0% for LAD, 100%, 87.5% for LCx, 86.2%, 77.1% for RCA respectively. CONCLUSION: Exercise Tc-99m tetrofosmin SPECT appears to be an feasible and useful noninvasive test for the diagnosis of coronary artery disease
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; Myocardial Perfusion Imaging ; Myocardium ; Phenobarbital ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND AND OBJECTIVES: We sought to characterize the lesion characteristics of mitral valve prolapse (MVP), which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans SUBJECTS AND METHODS: 497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals from Jan to Dec 2003 were prospectively enrolled in our study. RESULTS: A total of 497 patients (270 males, 54%) were enrolled and their mean age was 52+/-17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2 and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leaflet was present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in 104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and these patients were younger (37+/-14 versus 54+/-16 years, respectively, p<0.05) and had a lower prevalence of chordae rupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the 132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was the most frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial (17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%). Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension, severe MR and chordae rupture compared to the older patients (p<0.001, each). CONCLUSION: The medial part of both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristics were different according to the patients' age.
Echocardiography* ; Echocardiography, Transesophageal ; Humans ; Hypertension ; Korea* ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prevalence ; Prolapse ; Prospective Studies* ; Rupture

BACKGROUND/AIMS: The delay between the onset of myocardial infarction symptoms and primary percutaneous coronary intervention (PCI) is an important prognostic factor in patients with ST-segment elevation acute myocardial infarction (STEMI). We reviewed this delay in patients with STEMI and analyzed clinical outcomes. METHODS: The study enrolled 3,399 patients (age, 61.4 +/- 12.8 years; 25.6% women) with STEMI who underwent primary PCI within 12 hours of symptom onset between October 2005 and February 2008 from the Korea Acute Myocardial Infarction Registry. The patients were divided into two groups according to the symptom-to-balloon time: group I (< or = 3 hours, n = 955) and group II (> 3 hours, n = 2444). The in-hospital mortality rates and 1-year mortality and major adverse cardiac event (MACE) rates were compared between the two groups. RESULTS: The mean time interval from the onset of symptoms to arrival at the emergency room (ER) was 188.0 +/- 133.6 minutes (median, 152 minutes). The mean time interval from the ER to reperfusion (door-to-balloon time) was 97.8 +/- 67.9 minutes (median, 80 minutes). The mean time interval from the onset of symptoms to reperfusion (symptom-to-balloon time) was 285.8 +/- 146.2 minutes (median 250 minutes). The in-hospital mortality rate was significantly lower in group I as compared with group II (3.6% versus 5.2%, p = 0.044). The 1-year mortality rate was also significantly lower in group I (4.7% versus 7.2%, p = 0.012), while the 1-year MACE rate was not significantly different between groups (17.9% versus 20.4%, p = 0.179). CONCLUSIONS: This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI in Korea and this time delay is associated with increased 1-year mortality.
Angioplasty ; Emergencies ; Hospital Mortality ; Humans ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Reperfusion ; Time Factors