Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.
Atrial Flutter ; Atrioventricular Node ; Electric Stimulation ; Humans ; Pacemaker, Artificial ; Sick Sinus Syndrome* ; Sinoatrial Node

Usually, acute subdural hematomas (ASDHs) result from head trauma and require urgent surgical treatment. However, there have been many reports of rapid spontaneous resolution of ASDHs since 1986. Recently, we experienced a case of a massive ASDH that resolved spontaneously within 1.5 days. A 76-year-old man was admitted to a local hospital after a head injury. According to his clinical records, his initial neurologic status was good (Glasgow Coma Scale score of 14). However, his head computer tomography (CT) scan demonstrated a massive ASDH to the right, with a significant midline shift. Based on his neurological status and general condition, surgery was not considered, and the patient was closely monitored in the intensive care unit. The next day, the patient was transferred to our hospital as requested by his family, after which his neurological state stabilized, and the customary follow-up brain CT was performed. It was about 32 hours after the patient's head injury, and it revealed an unexpected finding, near-total resolution of the ASDH. Herein, we review previously reported similar cases and relevant mechanisms of rapid resolution of the ASDH. We believe that neurosurgeons should comprehensively assess the patient's condition and CT findings and provide appropriate treatment, especially when surgical intervention is unnecessary.

The management of symptomatic patients with hypertrophic Cardiomyopathy has generally included the use of beta-blockers and calcium channel blockers. Surgical treatment has been attempted for operable patients who have become refractory to medical therapy. However, associated complications, high mortality rate, and high recurrence of symptoms have shifted the treatment focus toward alternative therapy modalities. Recently, a DDD type pacemaker has been introduced as an alternative treatment option. We report a case of a patient with hypertrophic cardiomyopathy treated with dual-chamber pacing.
Calcium Channel Blockers ; Cardiomyopathy, Hypertrophic* ; Dichlorodiphenyldichloroethane ; Humans ; Mortality ; Pacemaker, Artificial ; Recurrence

Moyamoya disease is characterized by a bilateral progressive narrowing of the distal internal carotid and proximal portions of the anterior and middle cerebral arteries. The cerebral vessels of the 11 to 14 mm embryonic period are extremely similar to these moyamoya vessels. The vertebral arteries unite with a contralateral homologue to form the basilar artery during embryonic development and rarely, the failure of complete fusion results in duplication of these arteries. It is well known that moyamoya disease sometimes is accompanied by persistent primitive arteries, cerebral aneurysm, or rarely arteriovenous malformation. However, no case of the moyamoya disease with complete duplication of basilar artery has been previously reported. These two types of vascular abnormality are probably associated in certain developmental period, and moyamoya disease causes hemodynamic load in the basilar artery system as a collateral pathway and these effects are also involved in duplication of basilar artery. The relationship between these two varieties of vascular abnormality and possible pathogenesis of the moyamoya disease are discussed.
Aneurysm ; Arteries ; Arteriovenous Malformations ; Basilar Artery* ; Cerebral Arteries ; Embryonic Development ; Female ; Hemodynamics ; Middle Cerebral Artery ; Moyamoya Disease* ; Pregnancy ; Vertebral Artery

Essential thrombocythemia is one type of the related chronic myeloproliferative disorders that also include poly-cythemia vera, chronic myelogenous leukemia, and idiopathic myelofibrosis. It is a rare disorder of unknown origin characterized by thrombocytosis, excessive megakaryocytes, hemorrhage, and thrombotic complication. Several cases of ischemic stroke in essential thrombocythemia have been reported, but cerebral infarction combined with cerebral hemorrhage has been very rare and has not been reported in Korea. We report a case of cerebral infarction and chronic subdural hematoma in a pateint with essential thrombocythemia. A 59-year-old woman with essential thrombocythemia was admitted with mild left hemiparesis that developed 3 days prior. She had a history of minor trauma 15 days prior. A brain MRI showed an infarction in the right temporal lobe and a chronic subdural hematoma in the right frontoparietal area. A cerebral angiography revealed an occlusion of the M2 portion of the right middle cerebral artery.
Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Cerebral Infarction* ; Female ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Infarction ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Magnetic Resonance Imaging ; Megakaryocytes ; Middle Aged ; Middle Cerebral Artery ; Myeloproliferative Disorders ; Paresis ; Primary Myelofibrosis ; Stroke ; Temporal Lobe ; Thrombocythemia, Essential* ; Thrombocytosis

BACKGROUND: The circadian rhythm of circulating melatonin is regulated by the endogenous oscillators, the suprachi-asmatic nuclei, and entrained by the light-dark cycle of the environment, but it seems that the rhythm can be affected by variable lesions outside the retina-pineal pathway. We intended to know how acute cerebral infarction affects on the cir-cadian rhythm of plasma melatonin secretion. METHODS: Plasma melatonin level was measured from 64 patients with acute cerebral infarction. On admission, blood samples were collected by venipuncture at 2AM, 4AM, 10AM, and 2PM and melatonin level was measured by radioimmunoassay. The state of consciousness of each patient was assessed clini-cally and the infarction site and size were evaluated clinically and radiographically. RESULTS: Among 64 patients with acute cerebral infarction, dramatic blunting or obliteration of nocturnal melatonin surge in the blood was found in 29 patients. The circadian rhythm of melatonin secretion was absent in 12 of 35 alert patients, in 10 of 20 drowsy patients, and in 5 of 7 stuporous patients. Melatonin secretion into plasma was markedly decreased in all 2 comatose patients. Of 14 patients with brainstem lesions, 8 patients showed decreased melatonin levels with the absence of a nocturnal rise, although most of them were alert. CONCLUSIONS: This study suggests that brainstem and the initial mental state might contribute to the regulation of the circadian rhythm of plasma melatonin even though the lesion does not involve the retina-pineal pathway, but further extensive study is required to elucidate it. (J Korean Neurol Assoc 19(4):359~363, 2001)
Biological Clocks ; Brain Stem ; Cerebral Infarction* ; Circadian Rhythm* ; Coma ; Consciousness ; Humans ; Infarction ; Melatonin* ; Phlebotomy ; Photoperiod ; Pineal Gland ; Plasma ; Radioimmunoassay ; Stupor

The Kawasaki disease(Mucocutaneous lymph node syndrome) has been reported worldwide since the first description in 1967 in Japan. Approximately 20% of the children with untreated Kawasaki disease are believed to develop coronary artery aneurysm of which 2-3% progress to coronary artery stenosis. The early mortality of Kawasaki disease is low, resulting from coronary complications, mainly aneurysmal thrombosis with myocardial infarction. The purpose of this article is to report three cases of sudden deaths who died of cardiac sequelae of Kawasaki disease. Case 1 was a 9 year old male who died of cardiac tamponade caused by ruptured left coronary artery with features of vasculitis and aneurysmal dilatation. Case 2 was a 20 year old male who had been healthy and died suddenly and unexpectedly. At autopsy, the heart showed cardiomegaly and coronary artery aneurysm with thrombus and stenosis. Case 3 was a 10 year old male who was asymptomatic. At autopsy, the heart showed coronary artery lesions including aneurysm, fibrous thickening, and calcification, and myocardial fibrosis. According to the Classification of Kawasaki disease, case 1 was considered Stage I, and cases 2 and 3 Stage IV.
Aneurysm ; Autopsy ; Cardiac Tamponade ; Cardiomegaly ; Child ; Classification ; Constriction, Pathologic ; Coronary Stenosis ; Coronary Vessels* ; Death, Sudden* ; Dilatation ; Fibrosis ; Heart ; Humans ; Japan ; Lymph Nodes ; Male ; Mortality ; Mucocutaneous Lymph Node Syndrome* ; Myocardial Infarction ; Thrombosis ; Vasculitis ; Young Adult

An example of lymphoblastic lymphosarcoma was found in a 7-year-old male brown bear (Ursus arctos) that died after having a 7-month history of depression, anorexia and watery diarrhea. Grossly the mesenteric lymph nodes were enlarged to approximately 4 to 6 times their normal size and histologically diagnosed as lymphoblastic lymphosarcoma. The small intestinal mucosa was corrugated and had severe mural thickening due to infiltrated neoplastic cells. Hepatic metastasis was also noted. This is the first reported case of lymphosarcoma in Ursidae in Korea. As an incidental finding, endogenous lipid pneumonia was noted in the lung.
Animals ; Animals, Zoo ; Fatal Outcome ; Intestinal Mucosa/pathology ; Intestine, Small/pathology ; Korea ; Liver/pathology ; Liver Neoplasms/secondary/veterinary ; Lung/pathology ; Lymph Nodes/*pathology ; Male ; Mesentery ; Pneumonia, Lipid/pathology/veterinary ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis/pathology/*veterinary ; *Ursidae

PURPOSE: The aims of this research are to correlate prenatal renal parenchymal thickness with postnatal outcome of fetal hydronephrosis, to establish the predictability of prenatal renal parenchymal thickness for surgical treatment and to apply this parameter to the evaluation and the follow-up of prenatal hydronephrosis. Material and METHOD: Between Jun 1991 and Jun 1998 we retrospectively identified 59 cases of fetal hydronephrosis in which renal pelvic anteroposterior diameter(PAPD) was greater than 10mm. Renal parenchymal thickness(RPT), renal pelvis anteroposterior diameter and renal anteroposterior diameter(RAPD) were measured on midtransverse from prenatal sonograms. The ability of these parameters to predict who would require surgical treatment was examined. The difference of these parameters in groups were compared using Wilcoxon rank sums analysis. RESULTS: 66.7% of fetuses with a renal parenchymal thickness lesser than 8mm and 71.4% of fetuses with a renal parenchymal thickness lesser than 6mm required surgical treatment. 33.3% of fetuses with an PAPD greater than 12mm and 45% of fetuses with an PAPD greater than 15mm required surgical treatment. 60% of fetuses with an ratio of PAPD/RAPD greater than 0.4 and 70% of fetuses with an ratio of PAPD/RAPD greater than 0.5 required surgical treatment. CONCLUSION: The research shows that RPT could be used as an useful parameter in the prediction of requirement of postnatal surgical treatment of fetal hydronephrosis ,in addition to the size of PAPD and the ratio of PAPD/RAPD which have been assumed as one of the most important parameters.
Fetus ; Follow-Up Studies ; Hydronephrosis* ; Kidney Pelvis ; Retrospective Studies

Congenital absence of the epiglottis is a rare anomaly of the larynx. We present a case in a young female adult who was identified incidentally as the first case of congenital absence of the epiglottiscase found in an adult. In her history, she had suffered from frequent upper respiratory infections and muffled voice. She had a herniated lumbar nucleus pulposus, and was scheduled to undergo a laminectomy. While inducing general anesthesia on the patient, the anesthesiologists had a great deal of difficulty in intubation of the endotracheal tube by routine procedure and consulted the department of ENT. The absence of the epiglottis was observed as a result of ENT consultation when examining the patient through a fiberoptic endoscope. fiberoptic laryngoscope and neck lateral plain X-ray. Using a fiberoptic laryngoscope and a neck lateral plain X-ray, v,e confirmed a congenital absence of the epiglottis, hypertrophy of aryepiglottic fold and arytenoid region, elongated larynx, a large false vocal cord.
Adult* ; Anesthesia, General ; Endoscopes ; Epiglottis* ; Female ; Humans ; Hypertrophy ; Intubation ; Laminectomy ; Laryngoscopes ; Larynx ; Neck ; Respiratory Tract Infections ; Vocal Cords ; Voice