An acute myocardial infarction caused by a septic coronary embolism is a known complication of infective endocarditis and usually carries a fatal prognosis. We experienced a case of a 27-year-old man with an acute myocardial infarction caused by a coronary embolism due to bacterial endocarditis. An echocardiogram demonstrated mitral valve regurgitation with highly mobile multiple vegetations. Because of the high risk of systemic embolization and congestive heart failure, the patient underwent emergency surgery. Mitral valve replacement and an embolectomy were performed successfully without any surgical complications.
Adult ; Embolectomy* ; Embolism* ; Emergencies ; Endocarditis ; Endocarditis, Bacterial ; Heart Failure ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Myocardial Infarction* ; Prognosis

Cardiovascular disease is the most frequent cause of death in patients with acromegaly. Recently, long-term treatment with a somatostatin analogue (Sandostatin LAR) has been shown to be effective in controlling growth hormone (GH) and insulin like growth factor-1 (IGF-1) hypersecretion in most patients with acromegaly. Along with the effectiveness in the hormone profile, Sandostatin LAR has been reported to be effective for tumor mass shrinkage and clinical symptom improvement. We have encountered a female acromeglic patient with severe dilated cardiomyopathy and the patient was treated with Sandostatin LAR After treatment for 12 months, as seen by follow up echocardiography, the overall cardiac function was significantly improved. We report the case with a review of the literature.
Acromegaly* ; Cardiomyopathy, Dilated ; Cardiovascular Diseases ; Cause of Death ; Echocardiography ; Female ; Follow-Up Studies ; Growth Hormone ; Humans ; Insulin ; Octreotide* ; Somatostatin

PURPOSE: Peritoneal metastasis is a crucial factor for the prognosis in gastric cancer, but its diagnosis is difficult before laparotomy. This study analyzed the usefulness of diagnostic imaging and various tumor markers in the detection of peritoneal metastasis in gastric cancer. MATERIALS AND METHODS: The sera from 768 patients with gastric cancer were measured for CEA, CA19-9 and CA125 levels using a commercial immunoradiometric assay. All the patients underwent diagnostic imaging with computed tomography (CT) and ultrasound (US) before laparotomy. RESULTS: Preoperative levels of CEA, CA19-9 and CA125 were above the cut-off levels in 15.4%, 8.7% and 5.7% of all cases, respectively. Eighty-eight patients were diagnosed with peritoneal metastasis by laparotomy. CT and US revealed peritoneal dissemination in 15 of 88 patients (17%). Among the three tumor markers, CA19-9 and CA125 showed similar detection rates of peritoneal metastasis (37.5% and 38.6%, respectively). In particular, the serum CA125 levels showed the best sensitivity (38.6%), specificity (98.4%), and diagnostic accuracy (91.5%), and the highest odd ratio (24.46, 95% CI: 11.17~53.57) for predicting peritoneal metastasis among the markers tested. CEA did not add significant predictive information (p=0.471). CONCLUSION: Preoperative serum CA19-9 and CA125 levels may provide a predictable value in determining peritoneal metastasis in patients with gastric cancer.
Diagnosis ; Diagnostic Imaging ; Humans ; Immunoradiometric Assay ; Laparotomy ; Neoplasm Metastasis* ; Prognosis ; Sensitivity and Specificity ; Stomach Neoplasms ; Biomarkers, Tumora ; Ultrasonography

PURPOSE: To determine the usefulness of unenhanced helical CT in patients with suspected renal colic. MATERIALS AND METHODS: One hundred and fourteen patients with suspected ureteral colic, referred by physicians, underwent unenhanced helical CT. Two radiologists prospectively interpreted the results, determining the presence or absence of ureter stone and other diseases that arise outside the urinary tract. In cases of ureteral stone, we retrospectively sought secondary signs of hydronephrosis, perinephric fat stranding, thickening of renal fascia, renal enlargement, and the tissue rim sign. RESULTS: Among the 114 patients, 57 were confirmed as having ureter stones. Unenhanced helical CT depicted 57 of 58 stones in 57 patients, producing one false-negative and one false-positive result. Overall, the results showed 98% sensitivity, 95% specificity, 98% positive predictive value, 95% negative predictive value, and 97% accuracy. The frequencies of secondary signs were as follows: hydronephrosis, 95% (54/57); perinephric fat stranding, 81% (46/57); thickening of renal fascia, 77% (44/57); renal enlargement, 65% (37/57); and the tissue rim sign 72% (21/29). In 20 patients, the diagnoses were not related to stone disease and included one falsenegative diagnosis of pyonephrosis. CONCLUSION: Unenhanced helical CT provides information which is valuable in the accurate diagnosis of ureteral stone as well as other diseases that arise outside the urinary tract in patients with suspected renal colic.
Diagnosis ; Fascia ; Humans ; Hydronephrosis ; Prospective Studies ; Pyonephrosis ; Renal Colic* ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Spiral Computed* ; Ureter* ; Urinary Tract

PURPOSE: Acute lymphoblastic leukemia (ALL) accounts for approximately 75% of all cases of childhood leukemia. We investigated epidemiology, clinical and laboratory features and treatment outcome of the children with ALL in Korea during recent 5 years. METHODS: One thousand forty nine patients were enrolled between January 1994 and December 1998 from 37 major hospitals in Korea. The data regarding the clinical and laboratory features including age, WBC counts at diagnosis, immunophenotype, morphology, cytogenetics and treatment outcome of patients were analyzed retrospectively by review of patient's medical records. Kaplan-Meier survival curves were constructed. The differences between groups analyzed by log-rank test. RESULTS: There were 597 males and 452 females. The distribution between the age 2 and 5 years is most common in 46.1%. The annual incidence rate per 100,000 population varied from 1.6 to 2.2. The 5 year event free survival (EFS) rates according to good prognostic factors were as follows: 67% bet ween 1-9 year of age at diagnosis, 69% in under 10,000/mm3of initial WBC count, 74% in early pre-B cell CALLA ( ) immunophenotype, 65% in L3 morphology, 68% in no CNS invasion. Most of patients were treated by CCG treatment protocol. The 5 year EFS was 63%. Main complications were sepsis (21.8%) and hemorrhage (12.5%). The relapse rate was 15.6%. The common causes of death were sepsis, DIC, pneumonia, relapse. CONCLUSION: Our results could provide the most recent and important information about acute lymphoblastic leukemia of children in Korea.
Cause of Death ; Child ; Clinical Protocols ; Cytogenetics ; Dacarbazine ; Diagnosis ; Disease-Free Survival ; Epidemiology* ; Female ; Hemorrhage ; Humans ; Incidence ; Kaplan-Meier Estimate ; Korea* ; Leukemia ; Male ; Medical Records ; Pneumonia ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Precursor Cells, B-Lymphoid ; Recurrence ; Retrospective Studies ; Sepsis ; Treatment Outcome

BACKGROUND: Early diagnosis and proper therapy of malfunctioning prosthetic heart valves remain a challange. Transthoracic echocardiography(TTE) is the diagnostic procedure of choice for the evaluation of malfunctioning prosthetic heart valves. Howerver, TTE may be limited owing to poor acoustic windows. Some of these limitations can be overcome by transesophageal echocardiography(TTE). METHODS: The study comprised 33 consecutive patients(20 male and 13 famale patients, age range 20 to 59) in congestive heart failure after remote mitral valve replacement with bioprosthesis. The patients were examined between 1987 and 1994. All the 33 patients were studied by TTE and 19 patients among these patients furthermore by TEE. The morphology of the explanted bioprosthesis was confirmed by surgery in all cases. RESULTS: The abnormalities of the bioprosthesis were diagnosed correctly by TTE in 32 cases. The more detailed morphology of the valves could be observed by TEE(19 cases). Only in one case a small thrombus in left atrium was overlooked in TTE examination, on the otherhand it was detectedd by TEE. The severity grade of mitral regurgitation was estimatedca. I' severer by TEE in 8 cases. In all TEE examination spontaneous echocontrast was observed in left atrium. The bioprostheses from CE(Carpentier-Edwards) showed higher tendency to cuspal tearing and perforation. CONCLUSION: TTE is the diagnostic procedure of choice on patients with bioprosthetic mitral valve replacement. TTE examination confirms immediately clinical diagnosis of bioprosthetic failure. The transesophageal approach promises more detailed informations about lesions of the degenerated bioprosthetic valves and left atrium.
Acoustics ; Bioprosthesis ; Diagnosis* ; Early Diagnosis ; Echocardiography, Transesophageal* ; Estrogens, Conjugated (USP)* ; Heart Atria ; Heart Failure* ; Heart Valves ; Humans ; Male ; Mitral Valve Insufficiency ; Mitral Valve* ; Thrombosis

Blunt thorax trauma may produce a variety of cardiac lesions, which may occur alone or in combination. Nonpenetrating perforation of interventricular septum with chordae rupture of tricuspid valve is a infrequent pathologic event. A 40-years-old worker was transfered to hospital with increasing symptoms of right heart failure following a blunt compressing chest trauma with a huge overolling cement pipe(Wt.680kg) 6 weeks ago. The immediately diagnosed serial rib fracture of the left thorax cage and dislocation of the left acromoclavicular joint were treat conservatively. A conventional transthoracic color Doppler and two dimensional echocardiogram detected traumatic ventricular septal defect with bilatral shunt and tricuspid regurgitation. An additional transesophageal color echocardiopraphic demonstrated the ruptured chordae tendineae of the tricuspid septal leafet, which prolapsed deeply into the right atrium. The conventional color Doppler echocardiopraphy enhances the ability to detect the presence of a ventricular septal perforation and valve dysfunction in a patient with cardiac contusion. The transesophageal echocardiopraphy is a useful semiinvasive tool for the detailed morphological evaluation of atrioventricular valves and their substructure.
Chordae Tendineae ; Contusions ; Dislocations ; Echocardiography* ; Heart Atria ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Joints ; Rib Fractures ; Rupture* ; Thorax* ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Ventricular Septal Rupture*

The coronary arteries are also subject to congenital anomalies of both minor and major consequence. Hemodynamically significant primary anomalies of the coronary arteries are those which alter myocardial perfusion. There are four major types : coronary artery fistula, origin of the left voronary artery from the pulmonary artery, congenital coronary stenosis or atresia and origin of the left or right coronary artery from the opposite sinus of Valsalva with subsequent passage of the vessel between the aorta and right ventricular infundibulum. Minor anomlies are the variation of the origin of the coronary arteries from the aorta with normal distal circulation. We can see more coronary anomalies associated with congenital cardiac anomalies, probably representing a circulatory response to the primary intracardiac defect. We present a total of 76 cases of congenital coronary anomalies, reviewing 3946 cases of angiocardiography or selective coronary arteriography, performed during last 8 years at Sejong General Hospital.
Angiocardiography ; Angiography ; Aorta ; Arteries ; Coronary Stenosis ; Coronary Vessels* ; Fistula ; Hospitals, General ; Perfusion ; Pulmonary Artery ; Sinus of Valsalva

No abstract available.
Coronary Vessels* ; Electrocardiography* ; Spasm*

No abstract available.
Coronary Vasospasm* ; Heart Arrest* ; Verapamil*