We evaluated the accuracy of a noninvasive method for estimating right ventricular systolic pressures in patients with atrial septal defect and tricuspid regurgitation defected by two-dimensional and Doppler ultrasound. Of 54 patients with atrial septal defect, 24(44%) had jets of tricuspid regurgitation. By use of the maximum velocity(V) of the regurgitatant jet recorded by continuous wave Doppler ultrasound and the Bernoulli equation, we predicted right ventricular systolic pressure(RVP) calculated by the equation of RVP=4V2+10 proposed by Tei et al.The values correlated well with catheterization values(r=0.851, standerd error of estimate=4mmHg). In addition the relation between the Lt to Rt shunt amount and the severity of tricuspid regurgitation was assessed. The severity of tricuspid regurgitation graded on a four-pointscali by pulsed Doppler and two-dimensional echocardiography correlated with Qp/Qs ratio calculated by the Fick's method(p<0.05).
Catheterization ; Catheters ; Echocardiography ; Heart Septal Defects, Atrial* ; Humans ; Tricuspid Valve Insufficiency* ; Ultrasonography

No abstract available.
Angioplasty* ; Child* ; Humans ; Takayasu Arteritis*

Chronic ruptures of the patellar tendon are uncommon injuries. They are technically difficult to repair because of scar formation, poor quality of the remaining tendon, and quadriceps muscle atrophy and contracture. We report a case on the reconstruction of a chronic patellar tendon rupture. The reconstruction was performed 18 months after the injury, using an Achilles tendon allograft and reinforcing suprapatellar wire. At four weeks postoperative, the patient had attained 70degrees C flexion and 10degrees C extension lag. Nine months after the index procedure, the patient regained 130degrees C flexion and 5degrees C extension lag, and 85% quadriceps strength. The technique accomplished the preoperative goals of restoring quadriceps function and anatomic position of the patella as well as allowing early mobilization after surgery. Although this reconstructive procedure is technically demanding, the functional results obtained can be excellent. We recommend the use of this technique for chronic patellar tendon ruptures that cannot be primarily repaired.
Achilles Tendon ; Allografts* ; Atrophy ; Cicatrix ; Contracture ; Early Ambulation ; Humans ; Patella ; Patellar Ligament* ; Quadriceps Muscle ; Rupture* ; Tendons

OBJECTIVES: The aim of this study was to assess the change in oral health-related quality of life among patients with head & neck cancer who received radiotherapy. METHODS: A total of 40 patients who were diagnosed as having head and neck cancer and scheduled to have radiotherapy were enrolled in this study; however, only 25 patients were included in the final analysis. Prior to radiotherapy, a dentist performed an oral examination to check for the presence of decayed and missing teeth, plaque, and determine the gingival index. Oral health-related quality of life was assessed using the OHIP-14 questionnaire. Eight weeks after starting radiotherapy, oral health-related quality of life was re-evaluated using the same questionnaire. RESULTS: The mean age of the participants was 60.20 (±7.29) years, and 22 (88.8%) of them were men. The majority of the participants were diagnosed as having squamous cell carcinoma (68.0%). The total OHIP-14 score was significantly decreased from 56.20 (±13.50) at baseline to 45.72 (±10.98) eight weeks after radiotherapy. In addition, according to subjective oral health at baseline, the observed change in the OHIP-14 score was significantly different. CONCLUSIONS: Oral health-related quality of life was significantly lowered after radiotherapy in patients with head and neck cancer.
Carcinoma, Squamous Cell ; Dentists ; Diagnosis, Oral ; Head and Neck Neoplasms* ; Head* ; Humans ; Male ; Oral Health ; Periodontal Index ; Quality of Life* ; Radiotherapy* ; Tooth

Purpose: This study was conducted to determine the malignancy risk and diagnostic value of various types of nonshadowing echogenic foci (NEF) in the risk stratification of thyroid nodules. Methods: A total of 1,018 consecutive thyroid nodules (≥1 cm) with final diagnoses were included. The presence of NEF was determined and types of NEF were classified according to the presence of a comet tail artifact (CTA), location, and size through a prospective evaluation. The associations with malignancy, malignancy risk, and diagnostic value of various types of NEF were assessed. Results: Intrasolid punctate NEF without CTA was the only type of NEF that was an independent predictor of malignancy (P<0.001). The malignancy risk of intrasolid punctate NEF without CTA was substantially higher in solid hypoechoic nodules than in isoechoic or nonsolid nodules (71.3% vs. 9.2%, P<0.001). In solid hypoechoic nodules, slightly increased sensitivity (70.8% vs. 67.9%) for malignancy and a similar malignancy risk (71.4% vs. 71.3%) were observed for intrasolid punctate NEF (with or without CTA) and intrasolid punctate NEF without CTA, respectively. NEF with CTA at the margin of the cystic component was not associated with malignancy or benignity in nonsolid nodules (P>0.05). Conclusion Intrasolid punctate NEF without CTA was the only independent predictor of malignancy. However, solid hypoechoic nodules with intrasolid punctate NEF should be classified as high-suspicion nodules regardless of coexisting CTA. Other types of NEF had no added value for detecting malignancy compared to intrasolid punctate NEF without CTA.

BACKGROUND: The main cause of atherosclerotic peripheral vascular disease is known to be atherosclerotic processing. In patients with atherosclerotic peripheral vascular disease, other atherosclerotic diseases are frequently combined, especially coronary artery disease. There were some suggestions that the risk factors of the atherosclerotic peripheral vascular disease be different from the those of the coronary artery disease. The aim of this study was to evaluate the independent risk factors for the atheroslerotic peripheral vascular disease(PVD) without influence of coronary artery disease(CAD). METHODS: The study population was male patients with atherosclerotic peripheral vascular disease(n=66) documented by peripheral angiogram form February 1991 to Octobor 1993, and during their abmission all patients with suspected atherosclerotic peripheral vascular diaease underwent both peripheral angiogram and coronary angiogram. Careful history taking and physical examination and lipid battery sampling after at least 14 hours of fasting were also performed. RESULTS: 60% of patients with peripheral vascular disease also had coronary artery disease. There was no significant difference in total cholesterol, HDL cholesterol, LDL cholestrerol, triglyceride between patients with peripheral vascular disease and age-matched control. The prevalence of hypertension was higher in patients with peripheral vascular disease but with no statistical significance. Smoking(p<0.0001) and diabetes(p<0.05) were strongly associated with peripheral vascular disease. When patients without coronary artery disease were compared to control from the viewpoint of risk factors again, the results were the same, that is, smoking and diabetes were also associated with periperal vascular diseaes. CONCLUSION: The prevalence of associated coronary artery disease was relatively high in patients with atherosclerotic peripheral vascular disease. And smoking and diabetes seem to be important risk factors of atherosclerotic peripheral vascular disease.
Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease ; Coronary Vessels ; Diabetes Mellitus ; Fasting ; Humans ; Hypertension ; Male ; Peripheral Vascular Diseases ; Physical Examination ; Prevalence ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

Pneumomediastinum, pneumothorax and subcutaneous emphysema are uncommon in pediatric practice, but they may be rarely ocured in association with respiratory distress and excessive ressusciation in the neonatal period, and as a complication of bronchial asthma, measles in childhood. And also, there was a report of a few cases that developed to pneumomediastinum and subcutaneous emphysema caused by vomiting in patient of diabetic coma. It is rare so far in this country that above events are complicated by miliary tuberculosis, but they may lead the patient to fatal and lifethreatening conditions, even though we perform a considerable medical treatment for that. We presnted 3 cases of 6 month 20 days old female infant, and each 10 year and 11 year old boys, developed to pneumomediastinu, pneumothorax and subcutaneous emphysema, and suddenly expired during hospital treatment of miliary tuberculosis. And, we reviewed the literatures, too.
Asthma ; Child ; Diabetic Coma ; Female ; Humans ; Infant ; Measles ; Mediastinal Emphysema* ; Pneumothorax* ; Subcutaneous Emphysema* ; Tuberculosis, Miliary* ; Vomiting

BACKGROUND: Since reperfusion early after acute myocardial infarction has been demonstrated to reduce the infarct size and mortality, many drugs and interventions to reduce the reperfusion injury have been tried with limited success. Adenosine, a potent coronary vasodilator, has been reported to counteract a few mechanisms implicated with reperfusion injury, however, its effects and exact mechanisms to reduce the reperfusion injury have not been clearly elucidated. METHODS AND RESULTS: Effects of adenosine upon infarct size reduction and upon postulated mechanisms involved in the reperfusion injury such as no reflow phenomenon and neutrophil infiltration were evaluated in anesthetized open chest dog model where acute myocardial infarction was induced by 90 minute left anterior descending coronary artery occlusion followed by 240 minute reperfusion. Adenosine(3.75 mg/min) was administered intravenously for total 90 minutes from 30 minutes before reperfusion. Compared to control group(n=6), infarct area/risk area ratio was significantly lower in adenosine group(n=6)(34+12% vs. 22+/-11, p=0.04), although risk area/total left ventricular area ratio were similar in both groups. Myocardial blood flows(MBF), measured by radiolabelled microspheres, of the infarcted regions during coronary occlusion were similar in both groups, however, both subepicardial MBF(0.63+/-0.15ml/min/g vs. 0.95+/-0.31, p=0.02) and subendocardial MBF(0.45+/-0.08 ml/min/g vs. 0.69+/-0.27, p=0.02) were higher in daenosine group. Neutrophil infiltration, semiquantitatively measured under light microscope, were less severe in daenosine group,compared to control group. CONCLUSION: Intravenous adenosine administered before coronary reperfusion appears to reduce infarct size by limiting reperfusion injury through improving no reflow phenomenon and preventing neutrophil infiltration to the ischemic myocardium during reperfusion.
Adenosine* ; Animals ; Coronary Occlusion ; Coronary Vessels ; Dogs* ; Microspheres ; Mortality ; Myocardial Infarction* ; Myocardial Reperfusion ; Myocardium ; Neutrophil Infiltration ; No-Reflow Phenomenon ; Reperfusion Injury* ; Reperfusion* ; Thorax*

No abstract available.
Pulmonary Alveolar Proteinosis*

No abstract available.
Thoracotomy*