The coronary arteriovenous fistula (CAVF) is a rare congenital anomaly but constitutes the most common hemodynamically significant coronary artery anomaly. Transcatheter embolization is as an effective alternative to surgery even though procedure may be complicated by migration of the coil into peripheral vessels or pulmonary arteries. To our knowledge, the association of CAVF with Turner syndrome was not reported. We report a case of successful coil embolization of CAVF using a complex, helical-fibered platinum coil in patient with Turner phenotype with 46,XX.
Arteriovenous Fistula* ; Coronary Vessels ; Embolization, Therapeutic* ; Humans ; Phenotype* ; Platinum ; Pulmonary Artery ; Turner Syndrome

OBJECTIVES: The cerebrovascular diseases including stroke have become prevalent in Korea, ranking first as the cause of death in the aged. The quality of life (QOL) in stroke patients has been studied with growing interest since every aspect of life after stroke is influenced by the sequelae of this illness. This study aimed at 1) describing QOL of stroke patients and 2) identifying predictors of two month QOL after the event in stroke survivors. METHOD: WHO QOL scale was used to evaluate two month QOL after the stroke in 69 ischemic stroke patients. Data on age at the stroke event, sex, education level, brain MRI (magnetic resonance imaging) findings, symptoms of depression and anxiety, and neurologic disabilities were collected. Analyses were performed to explore the predictors of two month QOL. RESULTS: Stroke survivors with higher number and volume of frontal cortex lesions had lower two month QOL. Also, patients with more severe subcortical gray matter lesions had significantly lower two month QOL. Stroke patients with depression at the event had lower two month QOL than patients without depression. CONCLUSION: Lesions in frontal cortex and subcortical gray matter hyperintensities on MRI T2 images and depression in acute phase were of paramount importance in predicting two month QOL. Accurate and prompt neurologic and psychiatric interventions are required to improve QOL after stroke.
Anxiety ; Brain ; Cause of Death ; Depression ; Education ; Frontal Lobe ; Humans ; Korea ; Magnetic Resonance Imaging ; Quality of Life* ; Stroke* ; Survivors

The high cardiac output state and an increased incidence of atrial fibrillation are well-known cardiovascular complications of Graves' disease, whereas the valvular complications are less well recognized. With 2D color Doppler echocardiography, the cardiac and valvular function of 39 patients with Graves' disease were evaluated and our data were compared with previous Kage's study. The incidences of mitral regurgitation (MR) and tricuspid regurgitation (TR) in patients with Graves' disease were 54% and 51%, respectively. There was no correlation between the incidence of MR and ventricular dilatation. In patients with congestive heart failure (CHF), the incidences of severe TR and atrial fibrillation were significantly higher than in patients without CHF. The incidences of TR and MR in patients with Graves' disease were not different by thyroid function status (hyperthyroid vs. euthyroid). We suggest that the examination for TR and MR in patients with Graves' disease is important not only their high prevalence but also their clinical significance as a risk factor for CHF.
Atrial Fibrillation ; Cardiac Output, High ; Dilatation ; Echocardiography, Doppler, Color ; Graves Disease* ; Heart Failure ; Heart Valve Diseases ; Humans ; Incidence ; Mitral Valve Insufficiency ; Prevalence ; Risk Factors ; Thyroid Gland ; Tricuspid Valve Insufficiency

BACKGROUND/AIMS: Angiogenesis occurs in response to tissue damage, and is of vital importance for tumor growth and metastasis. Basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are potent angiogenic factors, and have been suggested to be useful diagnostic markers in certain hypervascular tumors. However, little is known of serum bFGF and VEGF in patients with hepatocellular carcinoma (HCC). We attempted to measure serum bFGF and VEGF in patients with chronic liver diseases (CLD) and HCC to assess their pathogenetic role and usability as tumor markers. METHODS: Serum bFGF and VEGF were measured in 8 patients with chronic hepatitis (CH), 15 patients with liver cirrhosis (LC), and 49 patients with HCC. bFGF was measured in 33, and VEGF was measured in 50, healthy blood donors. RESULTS: Serum bFGF was 3.8+/-1.9, 2.0+/-1.4, 4.2+/-6.0, 17.4+/-30.0 pg/mL in normal control, CH, LC, HCC, respectively. The serum bFGF level was significantly increased in patients with HCC when compared with normal control or patients with CLD. No difference, however, was observed in serum VEGF levels among the four groups. The serum levels of bFGF and VEGF were not significantly different in patients with HCC according to tumor type, size and stage. Serum bFGF showed good sensitivity (90%), specificity (87%), and positive predictive value (94%) in differentiating patients with HCC from those with CLD at the cut-off value of 4.6 pg/mL. CONCLUSIONS: bFGF might play a role in the growth of HCC and its serum level might be used as a tumor marker. On the other hand, serum VEGF does not seem to be an adequate tumor marker.
Angiogenesis Inducing Agents ; Blood Donors ; Carcinoma, Hepatocellular* ; Fibroblast Growth Factor 2* ; Hand ; Hepatitis, Chronic ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Neoplasm Metastasis ; Sensitivity and Specificity ; Biomarkers, Tumor ; Vascular Endothelial Growth Factor A*

BACKGROUND/AIMS: The prevalence of hepatitis delta virus (HDV) infection has been estimated as being approximately 5% among global HBsAg carriers. The anti-delta positive rate in Koreans had been reported as being 0.85% in 1985. While the prevalence of HBV has been decreased from nearly 10% to 5% during the past twenty years, there have been no more studies on the anti-delta prevalence in Koreans. The aim of this study was to estimate the anti-delta prevalence in Koreans and to study the clinical characteristics of anti-delta positive patients in a single center. METHODS: Serum anti-delta was measured in one hundred ninety four HBsAg-positive patients who were admitted to our hospital from February 2003 to August 2003. We checked the genotypes of the HBV in the anti-delta positive patients. The clinical features of the anti-delta positive patients were compared to those clinical features of the anti-delta negative patients from the aspect of age, gender, mode of transmission, the positivity of HBeAg and serum HBV DNA. RESULTS: Serum anti-delta was positive in seven patients among the 194 subjects, giving a 3.6% positive rate. Among these seven patients, six had hepatocellular carcinoma (HCC) and the other one had cholangiocarcinoma. All of the anti-delta positive patients had the C genotype of HBV. The anti-delta positive patients showed significantly suppressed HBV DNA replication compared to the anti-delta negative patients. CONCLUSIONS: In Koreans, anti-delta was positive mainly in HCC patients with an approximate prevalence of 4%, and this rate has not changed much for the past twenty years. HBV DNA replication was suppressed by HDV infection.
Adult ; Carcinoma, Hepatocellular/virology ; English Abstract ; Female ; Hepatitis Antibodies/analysis ; Hepatitis D/complications/*epidemiology/immunology ; Hepatitis Delta Virus/immunology ; Hepatitis delta Antigens/analysis ; Humans ; Korea/epidemiology ; Liver Neoplasms/virology ; Male ; Middle Aged ; Prevalence

BACKGROUNDS/AIMS: The fine-needle aspiration (FNA) is a useful method for diagnosis of hepatocellular carcinoma (HCC). The aims of our study are to assess diagnostic accuracy of FNA, to define proper indications of FNA for diagnosis of HCC, and to evaluate the complications of FNA. SUBJECTS AND METHODS: To assess diagnostic accuracy we compared the results of preoperative FNA with postoperative pathology in 38 resected cases with primary liver cancer. To define proper indications and complications of FNA, we prospectively followed 138 patients received FNA for their liver tumors which were suspicious of primary liver tumor. RESULTS: The sensitivity, specificity, positive and negative predictive values of FNA were 100%, 97%, 100% and 66% respectively. All patients with serum alpha-fetoprotein (AFP) level over 1000 ng/ml were having HCC on FNA result. Among 36 patients with AFP level ranged 15-1000 ng/ml and hypervascular mass on angiography, 96% were having HCC. Among 50 patients with normal AFP level and hypervascular mass on angiography, 92% were having HCC. The major complications after FNA such as hemoperitoneum, pneumothorax, and iatrogenic arterioportal shunt developed in 2%, 2%, and 7% of subjects, respectively. We did not find any case of needle-tract seeding of cancer during a mean 4.7 months of follow-up. CONCLUSIONS: Although the FNA is an accurate method for diagnosis of HCC, FNA was usually not indicated for patients with serum AFP level over 1000 ng/ml or patients with hypervascular mass on angiography when they were suspected of having primary liver cancer. Major complications were hemoperitoneum, pneumothorax and iatrogenic arterioportal shunt. Iatrogenic arterioportal shunt may influence the efficacy of subsequent transcatheter arterial embolization.
alpha-Fetoproteins ; Angiography ; Biopsy, Fine-Needle* ; Carcinoma, Hepatocellular* ; Diagnosis* ; Follow-Up Studies ; Hemoperitoneum ; Humans ; Liver ; Liver Neoplasms ; Pathology ; Pneumothorax ; Prospective Studies ; Sensitivity and Specificity

BACKGROUND: Exertional symptoms, dyspnea and impaired effort tolerance are common in patients with Graves' disease. Proposed explanations include: high-output left heart failure, ineffective oxygen utilization and respiratory muscle weakness. In addition, pulmonary hypertension has also been reported in patients with Graves' disease. A high prevalence of hypothyroidism and positive thyroid autoantibody were also observed in patients with pulmonary arterial hypertension. Therefore, the pulmonary artery pressure in patients with Graves' disease was evaluated. METHODS: Two-dimensional and Doppler echocardiographic examinations (Hewlett Packard Sonos 2500) were performed to determine the pulmonary artery (PA) pressure in 26 Graves' disease patients, both before and after treatment (23 patients with propylthiouracil and 3 with RAI), and in 10 euthyroid controls. The changes in the PA pressure after treatment were evaluated in 13 patients with Graves' disease, who became euthyroid after treatment. RESULTS: The pulmonary artery pressure was increased in the untreated Graves' disease patients compared to the normal controls (23.5+/-2.32 vs. 29.6+/-10.3 mmHg). 38.5% of the Graves' disease patients (10/26) showed pulmonary arterial hypertension (PA>30 mmHg) and the serum TBII levelwas higher in the Graves' disease patients with pulmonary arterial hypertension than in those with normal PA pressure (P<0.05). In the Graves' patients who became euthyroid after treatment, the PA pressure was significantly decreased. CONCLUSION: 38.5% of the untreated Graves' disease patients showed pulmonary arterial hypertension, and the pulmonary artery pressure was significantly decreased in those who became euthyroid after treatment. The pathogenesis and clinical importance of pulmonary arterial hypertension in Graves' disease requires further studies.
Dyspnea ; Echocardiography ; Graves Disease ; Heart Failure ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypothyroidism ; Oxygen ; Prevalence ; Propylthiouracil ; Pulmonary Artery* ; Respiratory Muscles ; Thyroid Gland

BACKGROUND: An earlier index of reperfusion after thrombolytic therapy in patients with acute myocardial infarction is desirable to determine whether additional therapy is necessary to salvage the myocardium. Cardiac troponin-T has been developed as a new myocardial specific marker for myocardial injury and has been used for early assessment of reperfusion therapy. This study was performed to investigate the utility of cardiac troponim-T for assessment of reperfusion therapy using serial serum troponin-T and the rapid assay kit. METHODS: The study was comprised of 70patients(M/F : 64/6, mean age 56+/-2 year) with acute myocardial infarction and reperfusion therapy was initiated within 6 hours after the onset of symtoms. Blood samples for CK and troponin-T were taken before thrombolysis and then 60, 90 munutes, 3, 6, 12, 24, 48, and 72 hours after thrombolysis. We compared successful reperfusion index of troponin-T [successful Reperfusion Index : troponin-T_{90 or 60min-base}> or =0.3 or 0.2ng/ml, Rapid Assay Kit(n=40) : Base(-), 90 or 60min(+)] with the real reperfusion that was assessed by coronary angiogram(TIMI grade 3 at 90 minutes after thrombolysis) or clinical reperfusion index defined as early peak of cardiac enzyme(within 12 hours for CK and within 24 hours for cardiac troponin-T). RESULTS: 1) The cardiac troponin-T and CK activity in patients with successful reperfusion showed early peak within 12 hours after thrombolysis was initiated. 2) Successful reperfusion by angiography or clinical reperfusion index were shown in 64(91%) of 70 patients with thrombolysis. 3) The sensitivity, specificity, positive and negative predictive value, and predictive accuracy for detecting reperfusion using a threshold value of 0.2ng/ml of delta troponin-T at 90 minutes after thrombolysis were 95%, 83%, 98%, 63%, and 96% respectively. 4) The sensitivity, specificity, positive, and negative predictive value, and predictive accuracy of successful reperfusion index using the rapid assay kit at 90 minutes after thrombolysis were 97%, 100%, 100%, 67%, and 97% respectively. CONCLUSIONS: The successful reperfusion index using delta troponin-T> or = 0.2ng/ml and the rapid assay kit at 90 min after thrombolysis are simple and usful for early assessment of reperfusion therapy. Thus bedside monitoring for cardiac troponin-T is now possible to improve the decision making process as to whether rescue angioplasty after thrombolysis is necessary to salvage the myocardium.
Angiography ; Angioplasty ; Decision Making ; Humans ; Myocardial Infarction* ; Myocardium ; Plasma* ; Reperfusion* ; Sensitivity and Specificity ; Thrombolytic Therapy ; Troponin T*