We present here a brief literature review and a case study of postpartum pulmonary arterial hypertension, a rare and progressive disease with a high maternal mortality rate. The patient, a 32-year-old woman, presented with dyspnea and shivering immediately following an uncomplicated vaginal delivery. The patient had no remarkable individual or familial history. She died 4 hours after her delivery, and an autopsy revealed atherosclerosis of the main pulmonary arteries and characteristic plexiform lesions on the lung. The remaining organs showed no remarkable pathology. We reported pulmonary arterial hypertension associated with pregnancy as the cause of death.
Adult ; Atherosclerosis ; Autopsy ; Cause of Death ; Death, Sudden ; Dyspnea ; Female ; Humans ; Hypertension* ; Lung ; Maternal Mortality ; Pathology ; Postpartum Period* ; Pregnancy ; Pulmonary Artery ; Shivering

BACKGROUND: Ventricular remodeling after myocardial infarction increase mortality and morbidity. Two-dimensional echocardiography in acute myocardial infarction provides a useful diagnostic tool for evaluation of ventricular remodeling. The aims of this study were to verify whether follow-up two-dimensional echocardiography could detect ventricular enlargement after acute myocardial infarction and to find early echocardiographic predictors and clinical charateristics of ventricular enlargement. METHODS: Two-dimensional echocardiography was done prospectively at 2 week, 3 month, and 6 month after the first Q-wave acute myocardial infarction in 18 patients. The control group was 11 patients of a normal chest roentgenogram and echocardiogram who were studied for chest pain or arrhythmia. The patients were divided by the mean value of the control group left ventricular end-diastolic volume index(LVEDVI) 56.8ml/m2. The group A was more than 60ml/m2(the control group LVEDVI 56.8ml/m2) and the group B was less than 60ml/m2 of LVEDVI at 2 week post myocardial infarction. The left vantricular volume was measured by the modified disk method at the apical four chamber view. The wall motion abnormality of left ventricle was examined by the recommendation of the American Society of Echcardiography. RESULTS: The left vntricular end-diastolic volume and the left ventricular end-systolic volume were enlarged after 3 month of acute myocardial infarction in the group A compare with those of the control group. There was no ventricular enlargement during 6 month after myocardial infarction in the group B. The frequency of ventricular enlargement was increased in anterior myocardial infarction. There was no difference in left ventricular ejection fraction at 2 week post myocardial infarction between the group A(51.4+/-15.7%) and the group B(50.8+/-10.3%). The wall motion score index more than 1.5 at 2 week post myocardial infarction means the enlarged LVEDVI more than 60ml/m2 and the group of ventricular enlargement. CONCLUSION: The left ventricular enlargement could be diagnosed by the follow-up two-dimensional echocardiography in acute myocardial infarction. The echocardiographic early predictors of ventricular enlagement were the left ventricular end-diastolic volume greater than 60ml/m2 and increased wall motion score index more than 1.5 at 2 week post myocardial infarstion. The anterior myocardial infarction was the electrocardiographic predictor of ventricular dilatation. Therefore these early predictors could identify the patients of ventricular enlargement and these patients could be a candidate of follow-up echocardiography and of a specific treatment for limiting ventricular remodeling.
Arrhythmias, Cardiac ; Chest Pain ; Dilatation ; Echocardiography* ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mortality ; Myocardial Infarction* ; Prospective Studies ; Stroke Volume ; Thorax ; Ventricular Remodeling

Thymic carcinoid tumor is a rare mediastinal tumor, which was firstly described by Rosai and Higa in 1972. A carcinoid tumor of the thymus has recently been regarded as a distinct tumor from thymoma, and is probably Kultschizky cell origin. The pathologic diagnosis of thymic carcinoid is made from findings from light microscopy, immunohistochemical studies and electron microscopy. About 50% of thymic carcinoids were seen with endocrinopathies. Recurrences and extrathoracic metastasis are characteristics of thymic carcinoids. Surgical removal of the intial and tumor recurred are considered to be the most effective treatment today. However, the role of the adjuvant radiotherapy and the chemotherapy is still uncertain. Herein we report a case of thymic carcinoid tumor, which was confirmed by operation and pathologic study.
Carcinoid Tumor* ; Diagnosis ; Drug Therapy ; Mediastinal Neoplasms ; Microscopy ; Microscopy, Electron ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence ; Thymoma ; Thymus Gland ; Thymus Neoplasms

30 patients were randomly divided into three groups : halothane in oxygen(N=10) ; enflurane in oxygen(N= 10) ; Thalamonal plus nitrous oxide in oxygen(N= 10). Standardized bleeding time was measured using Ivy method before and at leaat 40 min after the induction of anesthesia. Arterial pressure was maintained at+/- 200 of control values and tem-perature was kept at 35~37 degrees C. The bleeding time was prolonged by 58% in the halothane group (P<0.001). There was essentially no change in bleeding time in the groups receiving enflurane and nitrous oxide-Thalamonal group, although there was considerable variability within each group, which did not seem to be related to differences in sex, age, type of surgery, concentration of agent used or surgical procedure. In conclusion, our resultg suggest that halothane may be contraindicated in situations where optimal hemostasis is critical.
Anesthesia ; Arterial Pressure ; Bleeding Time* ; Enflurane* ; Halothane* ; Hemorrhage* ; Hemostasis ; Humans ; Nitrous Oxide

BACKGROUND: Hypertension following coronary artery bypass graft surgery (CABG) occurs frequently. Pharmacologic therapy of postoperative hypertension has often been treated with sodium nitroprusside (SNP). Nicardipine which is a dihydropyridine calcium-channel blocker, has little or no direct negative effects on cardiac contractility. Thus, we have compared the effects on hemodynamics between nicardipine and SNP after a CABG. METHODS: After a CABG, when systolic blood pressure (SBP) was elevated above 140 mmHg, patients were randomized to receive either nicardipine (N-group, n = 26) or SNP (S-group, n = 21) at an initial rate of 2ng/kg/min until the SBP was lowered to 120 130 mmHg (target blood pressure, TBP) for 10 minutes. If the TBP was not achieved, the infusion rates of both drugs were increased by 1ng/kg/min every 10 minutes. If SBP was lowered below 100 mmHg, phenylephrine was infused. Hemodynamic measurements were obtained just before (T1) and at 10 min (T2), 60 min (T3) and 24 h (T4) after the infusin of nicardipine or SNP. Infusion time, total doses, creatine phosphokinase (CK)-MB, plasma catecholamine and the use of phenylephrine were compared between groups. RESULTS: The SBP and systemic vascular resistance were significantly decreased in both groups. The cardiac index and stroke volume index were significantly increased at T3 in both groups but they were significantly increased only in the N-group at T2. The infusion time and the total doses of both drugs were significantly less in the N-group than the S-group. There were no significant differences in CK-MB, plasma catecholamine and the use of phenylephrine between groups. CONCLUSIONS: It has been suggested that the infusion of nicardipine is as effective as the infusion of SNP for the control of postoperative hypertension and the increase of cardiac output after a CABG. However, immediately after the drug infusion, nicardipine was superior to SNP in maintaining left ventricular performance.
Blood Pressure ; Cardiac Output ; Coronary Artery Bypass* ; Coronary Vessels* ; Creatine Kinase ; Hemodynamics ; Humans ; Hypertension* ; Nicardipine* ; Nitroprusside* ; Phenylephrine ; Plasma ; Sodium* ; Stroke Volume ; Transplants ; Vascular Resistance

Peripheral scalp T-cell lymphoma is a very rare disease. We report a case of a 22-year-old man who presented an indolent large scalp mass in the right frontal scalp region. The patient’s physical examination demonstrated no palpable mass in the chest, abdomen, and extremities. The brain CT revealed a high-density large scalp mass of the subgaleal layer in the right frontal and a small scalp mass of the subgaleal layer in the left frontal. The brain MRI showed multifocal enhancing masses in the bilateral dura, the subgaleal layer of the scalp, and the skull. The patient underwent removal of the tumor found in the right frontal scalp. The histologic diagnosis was peripheral T-cell lymphoma. Bone marrow aspiration showed the involvement of T-cell lymphoma. The patient received chemotherapy with cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP protocol) for 3 cycles. The patient was discharged without neurological deficit. The patient showed no evidence of recurrence 15 months after surgery. We report a rare case of peripheral T-cell lymphoma mimicking benign scalp tumors.

Intravenous leiomyomatosis is a rare disease entity of benign smooth muscle invading into the lumen of veins. We describe a case of intravenous leiomyomatosis originating from the uterus, growing in the inferior vena cava, and extending into the right ventricle association with multiple pulmonary metastasis. A 53-year-old woman with chest discomfort and several times attacks of syncope was treated at our hospital. The tumor was successfully removed with moderate hypothermic cardiopulmonary bypass after total hysterectomy with a bilateral salphingo-oophorectomy, and multiple pulmonary metastasis under simultaneous sternotomy and laparotomy was confirmed.
Cardiopulmonary Bypass ; Female ; Heart Ventricles* ; Humans ; Hysterectomy ; Laparotomy ; Leiomyomatosis* ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis* ; Rare Diseases ; Sternotomy ; Syncope ; Thorax ; Uterus ; Veins ; Vena Cava, Inferior

Intravenous leiomyomatosis is a rare disease entity of benign smooth muscle invading into the lumen of veins. We describe a case of intravenous leiomyomatosis originating from the uterus, growing in the inferior vena cava, and extending into the right ventricle association with multiple pulmonary metastasis. A 53-year-old woman with chest discomfort and several times attacks of syncope was treated at our hospital. The tumor was successfully removed with moderate hypothermic cardiopulmonary bypass after total hysterectomy with a bilateral salphingo-oophorectomy, and multiple pulmonary metastasis under simultaneous sternotomy and laparotomy was confirmed.
Cardiopulmonary Bypass ; Female ; Heart Ventricles* ; Humans ; Hysterectomy ; Laparotomy ; Leiomyomatosis* ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis* ; Rare Diseases ; Sternotomy ; Syncope ; Thorax ; Uterus ; Veins ; Vena Cava, Inferior

No abstract available.
Myositis*

BACKGROUND AND OBJECTIVES: The observation about the movements of laryngopharyngeal or surrounding structures is very important to understand the physiology of phonation or swallowing and to diagnose the disease. Many investigating methods were used but most of them were ineffective because those were invasive or indirect methods. Ultrasonographical examination of larynx can be applied, but the shortcomings of mechanics limits the usage of ultrasonographical study of larynx. Recently, the revolution of computer and videosystem made ultrasonographical study to be applied to the larynx. In this study, authors wanted to find out the availability of the ultrasonographical study of larynx. MATERIALS AND METHODS: 3.5 and 7.5 MHz probes were applied to anterior neck and the ultrasonographical findings were observed according to the various phonation types. RESULTS: In the axial plane, the movements of bilateral vocal folds were observed. Unilateral movement of vocal cord alone was seen in the case of unilateral vocal cord paralysis. In the parasagittal plane, the movements of whole laryngopharyngeal structures were observed simultaneously. A specific tongue shape was seen on each vowel phonation. On phonation with high pitch, hyoid bone and thyroid cartilage were elevated. And thyroid cartilage was elevated and laid upon the hyoid bone moving medially. On phonation with high pitch extremely, the hyoid bone went down. On phonation loudly, echogenicity of surrounding muscles was increased. CONCLUSION: Authors think that the ultrasonographical study can be applied to the physiologic study of phonation as well as diagnostic tools or therapeutic tools.
Deglutition ; Hyoid Bone ; Larynx* ; Mechanics ; Muscles ; Neck ; Phonation ; Physiology ; Thyroid Cartilage ; Tongue ; Ultrasonography ; Vocal Cord Paralysis ; Vocal Cords