PURPOSE: Traumatic asphyxia is a rare clinical syndrome characterized by cervicofacial cyanosis, edema, and multiple petechiae after a severe chest crush injury, and ophthalmic involvement includes violaceous discoloration of lid, lid edema, bulbar subconjunctival hemorrhage, exophthalmos and retinal hemorrhage. The authors experienced a case of traumatic asphyxia with typical ophthalmic manifestations after a crush chest injury, and we report this case with literature review. METHODS: A-54-year old man was consulted for bilateral proptosis after a crush chest injury. Ophthal-mologice valuation and intervention were performed. RESULT: Right eye was not checked due to previous corneal opacity, but visual acuity was 0.8 and IOP was 45 mmHg in left eye. There were bilateral proptosis and severe bulbar subconjunctival hemorrhage, and orbital computed tomography showed orbit fat interposed between globe and medial orbital wall. IOP was controlled with medications and other clinical signs including proptosis showed progressive improvement.
Asphyxia* ; Corneal Opacity ; Cyanosis ; Edema ; Exophthalmos ; Hemorrhage ; Orbit ; Purpura ; Retinal Hemorrhage ; Thoracic Injuries ; Thorax ; Visual Acuity

The records of 14 patients with traumatic diaphragmatic rupture seen at Dongguk University Hospital from February 1992 through December 1995 were reviewed. Ten patients were male and four were female(M:F=2.5:1). The age distribution ranged from 17 to 73 years with the mean age of 41.7 years. The 14 patients included 12 who had blunt trauma(traffic accident 11, crushing injury 1) and 2 with penetrating diaphragmatic rupture(stab wound 2). Of those 12 blunt trauma, 7 patients(58.3%) were left sided and 5(41.7%) involved the right hemidiaphragm. The diagnosis was made preoperatively in 8 patients (57.1%) and during surgery in 6(42.9%). All right-sided injuries were repaired through a thoracotomy and left-sided defects were corrected through a laparotomy in 6, laparotomy and thoracotomy in 1. There were 2(14.3%) operative deaths that were caused by myocardial infarction and the sequelae of combined injuries.
Age Distribution ; Diagnosis ; Humans ; Laparotomy ; Male ; Myocardial Infarction ; Rupture* ; Thoracotomy ; Wounds and Injuries

BACKGROUND: Anomalous origin of a coronary artery is rare, but it can lead to angina pectoris, acute myocardial infarction, or even sudden death in the absence of atherosclerosis. Even when an anomalous vessel is identified angiographically, it may be difficult to delineate its true course on the basis of angiography alone. We attempted to determine whether transesophageal echocardiography (TEE) is of value in making the diagnosis and outlining the course of anomalous left circumflex (LCx) or right coronary arteries (RCA). METHOD: Eight adult patients with anomalous origin of LCx or RCA documented by selective coronary angiography were studied by transthoracic echocardiography (TTE) and multiplane TEE. RESULTS: Anomalous coronary ostia were visualized in all eight patients by TEE, but in only one with anomalous RCA out of eight patients by TTE. The proximal segments of anomalous coronary vessels were delineated in all eight patients by TEE and in only three with anomalous LCx out of eight patients by TTE. CONCLUSION: TEE is a valuable adjunctive diagnostic tool for the identification of anomalous coronary origin and course and is superior to TTE in adult patients.
Adult ; Angina Pectoris ; Angiography ; Atherosclerosis ; Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Humans ; Myocardial Infarction

BACKGROUND AND OBJECTIVES: Eectrocardiogram (ECG) may provide valuable informations regarding the infarct-related artery (IRA), which may be of guidance in selecting the therapeutic modality. ST segment elevation in inferior leads usually indicates occlusion of right coronary artery, less often left circumflex coronary artery or rarely occlusion of left anterior descending coronary artery may be the cause. We are to determine whether the initial ECG can differentiate the right coronary artery (RCA) or left circumflex artery (LCx) occlusion in acute inferior myocardial infarction (IMI). MATERIALS AND METHOD: We compared retrospectively the ECG recorded within 12 hours from the onset of chest pain with coronary angiographic findings in 85 patients (34% of all 250 patients) having electrocardiographic criteria for IMI. RESULTS: 1) Angiographic characteristics. Of the 85 patients, IRA was RCA in 65 (76%) (38[58%] proximal, 27[42%] distal to first right ventricular branch), and LCx in 20 (24%) (nine[45%] proximal to first obtuse marginal branch or involving a high first marginal branch, eleven[55%] distal obstruction). RCA dominance was more common in RCA occlusion group (100% vs 80%, p=0.001), and LCx dominance in LCx occlusion group (15% vs 0%, p=0.001). No significant difference was noted between two groups regarding vessels diseased, involvement of left anterior descending coronary artery and contralateral artery (RCA or LCx), location of the lesion. 2) Electrocardio-graphic characteritics. Lateral limb leads (I, aVL) :ST segment depression (> or = 1 mm) was more common in RCA occlusion group (82% vs 45%, p=0.001). Isoelectric ST segment in I was more common in LCx occlusion group (100% vs 15%, p=0.001). Left precordial leads (V(5,6)) :ST segment elevation (> or = 1 mm) was more common in LCx occlusion group (60% vs 15%, p=0.001). Isoelectric ST segment was more common in RCA occlusion group (57% vs 20%, p=0.004). ST segment depression (> or = 1 mm) was not different between two groups. Right precordial leads (V(1-4)) :ST segment changes were not different between two groups. Lead I and left precordial leads (V(5,6)) :Isoelectric ST segment in lead I and ST segment elevation (> or = 1 mm) in V(5) or V(6) was more common in LCx occlusion group (60% vs 5%, p<0.05, sensitivity 60% specificity 95% positive/negative predictive value 80%/89%, test accuracy 87%). Amplitude of R wave in V(1) :Amplitude of R wave in V was greater in LCx occlusion group (3.60+/-1.42 mm vs 2.20+/-1.42 mm, p<0.05). CONCLUSION: The initial electrocardiogram was useful in differentiating LCx occlusion from RCA occlusion in patients with IMI. Absence of ST segment depression in I and aVL, and ST segment elevation in V(5,6), isoelectric ST segment in I, tall R wave in V(1) were significantly more common in LCx occlusion.
Arteries* ; Chest Pain ; Coronary Vessels ; Depression ; Electrocardiography* ; Extremities ; Humans ; Inferior Wall Myocardial Infarction* ; Retrospective Studies ; Sensitivity and Specificity

No abstract available.
Baculoviridae* ; Glycoproteins* ; Insects*

In vitro ethylene-diamine-tetra-acetic acid (EDTA) dependent satellitism and phagocytosis of platelets by neutrophils have been considered to be rare phenomena. It is associated with pseudothrombocytopenia, abnormal histogram of platelets and pseudoleukocytosis on complete blood cell count (CBC) by automated blood cell counter, but these findings are not found in heparinized or sodium citrated blood. It has no clinical significance such as bleeding tendency or abnormal platelet function. EDTA dependent platelet satellitosis and phagocytosis must be differentiated from true thrombocytopenia. We report a case of EDTA dependent platelet phagocytosis by neutrophils in a 68 year-old male patient who was diagnosed as mycosis fungoides. His EDTA blood smear showed frequent phagocytosis of platelets by neutrophils and occasional platelet satellitism. The bood cell counts were within normal limits without pseudothrombocytopenia. Phagocytized platelets were confirmed by immunohistochemistry using GpIIb/IIIa antibody and transmission electron micrographs.
Aged ; Blood Cell Count ; Blood Platelets* ; Cell Count ; Edetic Acid* ; Hemorrhage ; Heparin ; Humans ; Immunohistochemistry ; Male ; Mycosis Fungoides* ; Neutrophils* ; Phagocytosis* ; Sodium ; Thrombocytopenia

BACKGROUND: Plaque rupture of the atherosclerotic plaque is an important pathophysiologic mechanism of acute coronary syndrorne(acute myocardial infarction or unstable angina). Plaque rupture and resulting thrombus formation could be identified by intravascular ultrasound (IVUS), even though the sensitivity was variable in previous reports. We sought to know the morphologic characteristics, incidence of plaque rupture and thrombus formation by ultrasound in patients with acute coronary syndrome. METHOD: Between April and Septernber 1997, 23 admitted patients who was diagnosed as unstable angina or acute rnyocardial infarction was included. We performed coronary angiography with IVUS examination within 2 weeks. Atherosclerotic plaque was classified into soft, fibrous, calcific, and mixed plaque, and plaque rupture was defined as rupture of fibrous cap with discontinuity and / or backflow into plaque. Thrombus was defined as a scintillating, movable mass or layering materials that could be distinguished from underlying plaque. RESULTS: Most of the plaques were soft and mixed types(14 and 6, out of 23 cases). Plaque rupture could be identified only in small portion(6 cases, 26%) of the cases. Thrombus was noted in 12 cases(52%). 4 cases showed both plaque rupture and thrombus. CONCLUSION: Soft plaque is the most frequent plaque pye in acute coronary syndrome. IVUS is a useful tool to identify the morphologic features of the plaque such as rupture and thrombus formation.
Acute Coronary Syndrome* ; Angina, Unstable ; Coronary Angiography ; Humans ; Incidence ; Infarction ; Myocardial Infarction ; Plaque, Atherosclerotic ; Rupture ; Thrombosis ; Ultrasonography*

BACKGROUND: Thrombus-containing lesions (TCL) are associated with lower initial success rates and higher restenosis rates after balloon dilation. Furthermore, it has been considered as an absolute contraindication of coronary stenting. With advances in antithrombotic regimens and implantation techniques, coronary stenting has been widened to lesions with adverse morphologic features or to patients with acute coronary syndrome. Here we report the early clinical and angiographic results of coronary stenting in TCL. METHODS: We studied 24 consecutive patients (58+/-8 years, 18 males) undergoing coronary stenting in TCL. Fifteen patients (63%) were treated for acute myocardial infarction (AMI) and 9 (37%) for unstable angina. Stenting was performed as the primary therapy in 23 patients (96%) and secondary after angioplasty failure in I patient (4%). RESULTS: 1) Twenty-five stents were deployed successfully in all 24 patients with TCL. Distal flow with TIMI grade 3 was obtained immediately in 21 patients (88%). Ventricular fibrillation occurred in 3 patients (13%) during the procedure-related death or emergency bypass surgery did not occur. Marked CK elevation (over 5000U/L) was observed in 5 patients (21%) with AMI who underwent primary stenting. Two of these 5 patients (8%) had distal flow with TIMI grade 2 consistent with distal embolization, and one (4%) had distal flow with TIMI grade 0, suggesting acute stent occlusion. All 24 patients (100%) were event-free and showed clinical improvement at the last follow-up visit (71+/-15 days). 2) Quantitative angiography demonstrated excellent angiographic results after stenting (minimal luminal diameter 0.3+/-0.3 vs. 3.4+/-0.3mm, diameter stenosis 90.1+/-10.7 vs. -13.3+/-8.1%, p<0.005 respectively). Acute gain was 3.1+/-0.3mm (p<0.005). CONCLUSIONS: With low incidents of complications, coronary stenting could be used successfully for select patients with TCL as a primary therapeutic option under aggressive antithrombotic therapy. Although early clinical results were excellent, the long-term benefits remain to be established.
Acute Coronary Syndrome ; Angina, Unstable ; Angiography ; Angioplasty ; Constriction, Pathologic ; Emergencies ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Phenobarbital ; Stents* ; Ventricular Fibrillation

Annuloaortic ectasia, cystic medial degeneration of the afflicted aortic wall leading to progressive dilatation, is often accompanied by Marfan's syndrome. Some portions of intimal flap is commonly demonstrated along the aorta in the noninvasive diagnosis of aortic dissection. We report the first case of circumscribed aortic dissection developed in a 28 year old obese non-Marfanoid patient. He was transferred after thrombolytic therapy at a community hospital because of severe chest pain and ST segment elevation. Transthoracic echocardiography showed markedly dilated aortic root, moderate amount of pericardial effusion, mild aortic regurgitation in spite of normal regional wall motion of left ventricle. Intimal flap, characteristic of aortic dissection, was not seen with computed tomography. Intimal tear was demonstrated just above aortic valve only by transesophageal echocardiography. Two parallel intimal tear and small circumscribed dissection was demonstrated by autopsy.
Adult ; Aorta ; Aortic Valve ; Aortic Valve Insufficiency ; Autopsy ; Chest Pain ; Diagnosis ; Dilatation ; Dilatation, Pathologic* ; Echocardiography ; Echocardiography, Transesophageal ; Heart Ventricles ; Hospitals, Community ; Humans ; Marfan Syndrome ; Pericardial Effusion ; Thrombolytic Therapy

Advanced or complete atrioventricular (AV) block is frequently regarded as a cause of informed syncopal attacks even though escape rhythm is maintained. Torsades de pointes (TdP) may be a significant complication of AV block associated with QT prolongation. Maintaining ventricular rate over 70 beats/min is known to be important to normalize QT interval and to reduce the possibility of bradycardia-related TdP recurrence after pacemaker implantation. We report one case of syncopal attacks associated with TdP in a 70 year old female patient with advanced AV block and prolonged QT interval. She was referred to evaluate palpitation and syncope. Advanced AV block and QT interval prolongation were seen with electrocardiography, but junctional escape rhythm was maintained. Syncopal attacks occurred during temporary pacemaker insertion. Multiple episodes of nonsustained polymorphic ventricular tachycardia and TdP related to syncopal attacks were demonstrated by 24-hour Holter monitoring. A permanent pacemaker was implanted and ventricular rate was set over 70 beats/min resulting in no recurrence of TdP and syncope.
Atrioventricular Block* ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Humans ; Recurrence ; Syncope* ; Tachycardia, Ventricular ; Torsades de Pointes* ; United Nations