Left ventricular free wall rupture following acute myocardial infarction (AMI) is the second most common cause of death and has been reported to be responsible for 4 to 24% of all infarction deaths. The rupture occurs anywhere from a few hours to several days after AMI. The common findings of ventricular rupture are persistent chest pain bradycardia and shock. This may be often mistaken for the ruptured dissection of the ascending aorta. The different points from dissection are 1) persistent chest pain 2)persistent ST segment elevation and 3) only intramural hematoma in ascending aorta. We have sucessfully managed two patients with postinfarction myocardial rupture. Surgical management consisted of infarctectomy repairi of the ventricular rupture and coronay artery bypass grafting. We conclude that successful surgical management of ventricular free wall rupture should require prompt diagnosis and emergency operation.
Aorta ; Arteries ; Bradycardia ; Cause of Death ; Chest Pain ; Diagnosis ; Emergencies ; Heart Rupture* ; Hematoma ; Humans ; Infarction ; Myocardial Infarction ; Rupture ; Shock ; Transplants

During the last three decades childhood cancer survivorship study has extensively developed and now we have much extent of knowledge about survivor's long-term mortality and chronic illness. One of the many challenges that females survivors face includes reproductive health, which involves reproductive and sexual health changes that could later significantly reduce one's quality of life. Alkylating chemotherapy, irradiation of the CNS and/or ovaries, and pelvic and genitourinary surgery can adversely affect the reproductive organs. Increased awareness of the unique needs of female cancer survivors, timely evaluation of gonadal function, and active intervention for fertility preservation before, during, and after therapy is warranted.
Chronic Disease ; Drug Therapy ; Female ; Fertility Preservation ; Gonads ; Humans ; Hypogonadism ; Infertility ; Mortality ; Ovary ; Quality of Life ; Reproductive Health ; Survival Rate ; Survivors

A membrane glycoprotein CD4 functions as a co-receptor of a T lymphocyte. The co-receptor function has been attributed to a protein tyrosine kinase, p56lck, which is activated upon CD4 binding to MHC molecule. In this study, we present evidences that one of the pathways through which CD4 transmits its signal is cytoskeleton association of p56lck tyrosine kinase as well as CD4 itself. Cytoskeletal association of both proteins is inhibited by a tyrosine kinase inhibitor, genistein, indicating that tyrosine protein kinase activation is important for cytoskeletal association of CD4 and p56lck. Cytoskeletal association of these proteins by CD4 cross-linking is not affected by inhibitors of protein kinase C nor PI3-kinase. Taken together, these results suggest that CD4 cross-linking activates a tyrosine kinase which then induces the simultaneous association of CD4 and p56lck with cytoskeleton.
Antigens, CD4/metabolism* ; Antigens, CD4/drug effects ; Cross-Linking Reagents ; Cytoskeleton/metabolism* ; Down-Regulation (Physiology) ; Enzyme Inhibitors/pharmacology ; Flow Cytometry ; Genistein/pharmacology ; Human ; Lymphocyte Specific Protein Tyrosine Kinase p56(lck)/metabolism* ; Lymphocyte Specific Protein Tyrosine Kinase p56(lck)/antagonists & inhibitors ; Phosphorylation/drug effects ; Protein Binding ; Tetradecanoylphorbol Acetate/pharmacology ; Tumor Cells, Cultured ; Tyrosine/metabolism

Diffuse esophageal leiomyomatosis is a rare benign tumor, which can be associated with leiomyoma in female genital tracts involving the uterus, vagina, and vulva. Alport syndrome, an inherited disorder that includes the kidneys, eyes, and sensorineural hearing loss, is also rarely associated with these multiple leiomyomatosis. In our case, 18F-fluoroseoxyglucose positron emission tomography/computed tomography was used to distinguish esophageal and genital leiomyomatosis from malignant masses.
Diagnosis, Differential ; Esophageal Neoplasms/*radiography/*radionuclide imaging ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Genital Neoplasms, Female/*radiography/*radionuclide imaging ; Humans ; Leiomyomatosis/*radiography/*radionuclide imaging ; Middle Aged ; Positron-Emission Tomography/*methods ; Radiographic Image Interpretation, Computer-Assisted ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed/*methods

PURPOSE: Spirometry, because of its simplicity and reproducibility, has been used to evaluate pulmonary function in childhood asthma. We investigated whether FEF25-75% is the most sensitive parameter among other spirometric parameters in the diagnosis of pulmonary function and airway obstruction. METHODS: This study included 32 children with asthma. We recorded values of spirometry(FVC, FEV1, PEFR, and FEF25-75%) before and after symptomatic improvement and compared them. The values were recorded as a percent of the predicted normal value. RESULTS: The FEV1 value before and after symptomatic improvement was 71.7+/-15.6% and 83.8+/-12.8%, respectively; PEFR was 75.4+/-18.3% and 85.0+/-16.0%; and FEF25-75% was 60.8+/-17.9% and 81.5+/-16.3%. According to symptomatic improvement, FEF25-75% improved more than the other spirometric parameters. Of the 40 cases of spitometric measurement before symptomatic improvement, abnormal FEV1, PEFR, FEF25-75% values were observed in 25, 17 and 28 cases, respectively. There was statistically significant difference between FEF25-75% and PEFR(P=0.005), but not between FEF25-75% and FEV1(P=0.091). After symptomatic improvement, abnormal FEV1, PEFR, and FEF25-75% values were observed in 14, 12 and 9 cases, respectively. There was statistically significant difference between FEF25-75% and FEV1(P=0.044) but not between FEF25-75% and PEFR (P=0.097). The cases of normalized values with symptomatic improvement, 11 in FEV1, 7 in PEFR and 19 in FEF25-75%. CONCLUSION: FEF25-75% showed the most improvement rate before and after symptomatic improvement. FEF25-75% was helpful in the assessment of treatment effectiveness and reversible bronchial responsiveness. However, this study did not suggest that FEF25-75% is the most sensitive measurement of airway obstruction.
Airway Obstruction ; Asthma* ; Child ; Diagnosis ; Humans ; Peak Expiratory Flow Rate ; Reference Values ; Spirometry ; Treatment Outcome

The false-positive FDG uptakes on head and neck areas are common due to benign lesion, iatrogenic and physiologic changes. The Schneiderian papilloma is uncommon benign tumor arising from the mucosa of the paranasal sinuses and nasal cavity. The findings of paranasal papilloma on conventional modality such as CT and MRI are non-specific and they could be confused with inflammatory polyp or retention cyst. Despite of benign tumor, the papilloma usually shows locally aggressive growth with malignant potential, therefore the FDG can be actively accumulated in this lesion. We describe the case of 18F-FDG PET/CT finding in a 77-year-old woman who demonstrates oncocytic papilloma in maxillary sinus.
Aged ; Female ; Fluorodeoxyglucose F18 ; Head ; Humans ; Mucous Membrane ; Nasal Cavity ; Neck ; Papilloma ; Paranasal Sinuses ; Polyps ; Retention (Psychology)

Ossifying fibroma is a diagnostic designation for fibro-osseous lesion characterized by osteoid rims and osteoblasts lying in irregularly shaped bony trabeculae. We experienced 3 cases of pathologically proven ossifying fibroma. One occured in the gingivobuccal area of an 10-year-old male; another involving the maxillary sinus and alveolus of 22-year-old female and the last one in the ethmoid sinus of 31-year-old female which is unique in its presentation as a cystic mass. Total or near total excision resulted in a disease-free follow-up period of 11 to 26 months. It appeared that ossifying fibroma is demarcated from adjacent cancellous bone and when growing beyond the confines of the involved bone, is separated from the adjacent soft tissue by an expanded and attenuated layer of cortical bone.
Adult ; Child ; Deception ; Ethmoid Sinus ; Facial Bones* ; Female ; Fibroma, Ossifying* ; Follow-Up Studies ; Humans ; Male ; Maxillary Sinus ; Osteoblasts ; Young Adult

Objectives: Most developmental screening tests have been built as parent-performed questionnaires. However, they often do not guide parents on how to answer the questionnaire. This study aimed to develop easily applicable parent guidelines. Methods: We implemented the Delphi procedure with 20 panelists. The development of the initial questionnaire was based on the results of two surveys of parents and experts provided by a policy research report that investigated the item adequacy of the Korean Developmental Screening Test. Round one included 33 items comprising all possible measurements in six categories that were identified as difficult to understand or confusing. Round two merged and modified some items and included 32 items. We defined consensus as a median agreement value of one or less and convergence and stability values of 0.5 or less. The subjective usefulness of the parent guidelines was examined based on their previous test experiences. Results: Consensus was reached after the second round, reflecting the items with the highest level of accuracy in each category. Of the 167 parents who participated in the survey, 113 (67.7%) affirmed the usefulness of the guidelines, while 10 (6.0%) answered that they were not useful. Items that recommended a different scoring strategy in answering the questionnaire from their previous measurements were found to be more useful by the parents. Conclusion The parent guidelines, composed of five bullet points, drew on the consensus of the experts. Further studies are required to assess whether these guidelines improve the accuracy of screening tests in clinical settings.

The Korean Neonatal Network (KNN), which is celebrating its 10th anniversary, currently has more than 100 staff and researchers from >70 neonatal intensive care units nationwide in Korea. More than 85% to 90% of the population of very low birth weight infants in Korea are registered yearly, and more than half are followed up for up to 3 years at the KNN. A total of >19,000 cases have been accumulated through a strict data quality management process of the KNN. Based on this, >100 research projects have been proposed, >70 peer-reviewed papers have been published in leading international journals, and the cornerstone of the quality improvement project has been launched. In addition, we recently expanded the number of subjects for registration to very premature infants <32 weeks of age and continue to provide essential evidence data for establishing national health policies, such as linking with government policy projects of the Ministry of Health and Welfare for preterm infants. In such manner, the KNN is confident to be successfully and actively moving toward reaching the ultimate goal of standardizing neonatal intensive care and management of preterm infants in Korea by providing essential data for national health policy establishment along with quality improvement through evidence-based interactive data.

PURPOSE: Regional lymph node (LN) metastases are detected in 57-85% of patients with papillary thyroid carcinoma (PTC) and are associated with increased tumor recurrence. However, the management of lymphatic disease in patients with PTC has been ongoing source of debate. We have prospectively assessed the usefulness and accuracy of sentinel LN (SLN) biopsy for the detection of LN metastases in patients with PTC on preoperative imaging using single photon emission computed tomography/computed tomography (SPECT/CT) and 99mTc phytate. METHODS: We prospectively assessed 39 patients with PTC who had risk factors for recurrence or with the necessity of intraoperative LN sampling for suspicious LN metastases on preoperative imaging from August 2010 to March 2011. The patients underwent preoperative lymphoscintigraphy and SPETC/CT and intraoperative SLN biopsy (SLNB). RESULTS: 99mTc lymphoscintigraphy and SPECT/CT localized SLN in 38 patients (97.4%), with the gamma probe identifying 2.15 mean SLNs in the lateral neck of the 39 patients. Skip metastasis was found in one patient, and lateral compartment LN metastasis in 17 (43.5%). The sensitivity, specificity, and accuracy of SLNB for lateral compartment LN metastasis were 88.2%, 100%, and 94.8%, respectively. SLNB was more accurate and useful for lateral than for central compartment LN metastasis. CONCLUSION: SPECT/CT improved SLN detection and anatomical localization compared with lymphoscintigraphy. SLNB in patients with risk factors for recurrence or the necessity of intraoperative LN sampling for suspected LN metastases on preoperative imaging was accurate in detecting LN metastases and may help in deciding whether to perform lateral compartment dissection in patients with PTC.
Biopsy ; Carcinoma ; Factor IX ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Lymphoscintigraphy ; Neck ; Neoplasm Metastasis ; Nitriles ; Phytic Acid ; Prospective Studies ; Pyrethrins ; Recurrence ; Risk Factors ; Sensitivity and Specificity ; Sentinel Lymph Node Biopsy ; Thyroid Gland ; Thyroid Neoplasms ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed