Infective endocarditis is a life-threatening condition caused by microbial infection of the heart's endocardial surface. This condition can also be associated with bacterial infections of other organs. We experienced an unusual case of recurrent infective endocarditis associated with pyogenic spondylodiskitis. A 70-year-old man presented with persistent fever and lower back pain visited our hospital. The patient had a past history of recurrent infective endocarditis. He was diagnosed with infective endocarditis again based on clinical symptoms and echocardiographic findings. Magnetic resonance imaging was used to evaluate lower back pain, which showed acute spondylodiskitis on L3 and L4 vertebrae. The patient completely recovered following four weeks of antibiotic therapy.
Aged ; Bacterial Infections ; Discitis ; Endocarditis ; Fever ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Spine

BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH) is a well known cardiovascular prognostic predictor. Osteoporosis has been suggested to be associated with cardiovascular disease. According to studies of primary hyperparathyroidism, a pathophysiological association between calcium metabolism and LVH has been suggested but is not yet fully understood. This study was performed to investigate the association between bone mineral density (BMD) and left ventricular mass index (LVMI) in a general population. SUBJECTS AND METHODS: Data from 460 subjects among 543 subjects sampled from a general population in a rural area in Korea were analyzed. BMD, echocardiography, brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (IMT) measurement as well as the measurements of blood pressure, blood chemistry and metabolic parameters were analyzed. BMD was measured using the Sahara Clinical Bone Sonometer (Hologic Inc., Mass., USA). RESULTS: Age of the subjects was 59.4+/-12.4 years. Males were 42.2% (n=194). In a simple correlation analysis on female subjects, age and waist circumference showed negative correlation, and body mass index (BMI) showed positive correlation with BMD. However, only age showed negative correlation with BMD in male subjects. After adjusting baPWV and carotid IMT, we found that BMD was an independent determinant of LVMI in female subjects (beta=-13.703, p=0.016), but not in male subjects (beta=-1.235, p=0.841). CONCLUSION: BMD is a consistent and independent determining factor of LVMI, BMI and carotid IMT in postmenopausal women.
Africa, Northern ; Blood Pressure ; Body Mass Index ; Bone Density ; Calcium ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Hyperparathyroidism, Primary ; Hypertrophy ; Hypertrophy, Left Ventricular ; Korea ; Male ; Osteoporosis ; Pulse Wave Analysis ; Waist Circumference

BACKGROUND: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). MATERIAL AND METHOD: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. RESULT: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). CONCLUSION: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.
Ants ; Brachial Plexus Neuropathies ; Chest Tubes ; Drainage ; Female ; Ganglioneuroma ; Humans ; Mediastinum ; Neurilemmoma ; Neurofibroma ; Retrospective Studies ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy ; Vocal Cord Paralysis

The coronary artery-left ventricular microfistula is an extremely rare congenital anomaly. Little is known about their epidemiologic and clinical features. Moreover, to our knowledge, only two cases of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography have been reported in the literature. Recently we experienced a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography, who was a 63 year old woman and visited for evaluation of chest pain. Herein, along with a review of the pertinent literature regarding this disorder, we report a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography.
Chest Pain ; Echocardiography, Doppler* ; Female ; Humans ; Middle Aged

Despite the major advances in diagnostic technology and improvements in antimicrobial selection and monitoring accompanied by parallel advances in surgical techniques, the morbidity and mortality of infective endocarditis(IE) still remain high. Because of this high mortality rate, it is worthy of investigating the clinical features of IE and it's complications thoroughly. The main causes of mortality in IE are congestive heart failure and septic embolization. In 9% of active IE, acute myocardial infarction(AMI) developed. AMI caused by coronary artery obliteration by occlusion or embolization is a rare but recognized complication of aortic valve endocarditis with annular abscess. We reported a case of aortic valve endocarditis with aortic root abscess which was complicated by AMI and death.
Abscess* ; Aortic Valve ; Coronary Vessels ; Endocarditis ; Heart Failure ; Mortality ; Myocardial Infarction*

PURPOSE: To date, it has been impossible to relate the occurrence of ventricular arrhythmia to survival in hyperkalemia. QT dispersion is thought to reflect the inhomogeneity of ventricular repolarization and to be related to ventricular-arrhythmia-induced sudden cardiac death in various medical conditions. Therefore, the purpose of this study was to investigate to use QT dispersion as a prognostic marker in hyperkalemia and to suggest treatment guidelines for hyperkalemia by analyzing the correlations between the QT dispersion on the initial ECG and the treatment outcomes. METHODS: This study's population was comprised of 104 patients with serum potassium concentrations > or =5.5 mEq/L, who were divided into 2 groups; group 1 was the survival group (n=81), group 2 was the death group (n=23). We reviewed retrospectively the underlying diseases, electrolytes, treatment outcomes and the clinical and ECG findings during the initial and the recovery states. The QT interval for each lead was measured manually on an enlarged (X1.5) ECG. The QT interval was measured from the first deflection of the QRS complex to the point of the T wave offset, and the corrected QT interval was obtained by using B a z e t t's formula. The QT dispersion and the corrected QT dispersion were defined as the differences between the minimal and the maximal QT values and between the corresponding corrected QT values for each of the 12 leads, respectively. RESULTS: The treatment outcomes were not related to the initial serum potassium and the hourly serum potassium change rates. For hyperkalemia > or =7.0 mEq/L, the death group had significantly larger QT dispersion than the survival group (death group = 95.6+/-15.4 msec, survival group = 51.8+/-17.5 msec, p<0.01). However, the QT dispersions of the two groups were not different for serum potassium levels <7.0 mEq/L. For hyperkalemia > or =7.0mEq/L, QT dispersion above 65 msec had a 93.8% sensitivity, a 79.4% specificity, and a 68.2% positive predictive value for death. CONCLUSION: For hyperkalemia > or =7.0 mEq/L, QT dispersion above 65 msec should be considered to be a prognostic marker for prediction of the treatment outcome.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac ; Electrocardiography ; Electrolytes ; Humans ; Hyperkalemia* ; Potassium ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Treatment Outcome

OBJECTIVE: This study was to evaluate the prevalence rate of group B streptococcal infection in pregnant women after 35th gestational week and the relationship between group B streptococcal infection and the prognosis of pregnant women and their neonates. METHODS: From January 1, 2000 to June 30, 2001, the medical records of 204 pregnant women who had visited department of Ob and Gyn, Inha Hospital for antenatal care were reviewed. The specimen were obtained from lower vaginal wall and perineum, and were inoculated on selective media to isolate group B streptococci. The relationship between group B streptococcal infection in those pregnant women and the prognosis of them and their neonates peripartum were evaluated. RESULTS: The prevalence of group B streptococci in pregnant women was 1.96% (4/204). No group B streptococcal infection was found in their neonates (0/4). There is no significant statistical differences in prognosis between the pregnant women with group B streptococci and those without group B streptococi. CONCLUSION: This study was revealed that the prevalence rate of group B streptococci in pregnant women was very low and the screening test for group B streptococcal infection in pregnant women might be regarded as meaningless. However, group B streptococcus has been known to cause many complications in pregnant women and their neonates. Further studies are needed for the significance of group B streptococcal infection in pregnant women and their neonates.
Female ; Humans ; Infant, Newborn ; Mass Screening ; Medical Records ; Perineum ; Peripartum Period ; Pregnant Women* ; Prevalence ; Prognosis ; Streptococcal Infections* ; Streptococcus

Four cases of congenital coronary arteriovenous fistula were diagnosed using coronary angiography. Three cases had fistula-related chest pain and the remaining case showed no symptoms but displayed electrocardiographic changes suggesting myocardial ischemia. As he was elderly and had a potential for future complications, we decided to close the fistulas of all cases. Three cases were closed with transcatheter coil embolization and one with surgical ligation due to a suspicious accompanying pericardial cyst. None of the patients demonstrated periprocedural or perioperative complications and all were relieved from symptoms during the 2 year follow-up period. We concluded that transcatheter coil embolization and surgical ligation are effective methods for use in the management of coronary arteriovenous fistula.
Aged ; Arteriovenous Fistula* ; Chest Pain ; Coronary Angiography ; Coronary Disease ; Electrocardiography ; Embolization, Therapeutic ; Fistula ; Follow-Up Studies ; Humans ; Ligation ; Mediastinal Cyst ; Myocardial Ischemia

BACKGROUND AND OBJECT: We intended to assess the characteristics of ST segment deviation in lateral leads(aVL, I, V5, V6) in patients with acute inferior myocardial infarction(AIMI) and find out the relationship with culprit arteries. MATERIALS AND METHOD: The subjects were 51 patients diagnosed as AIMI by standard electrocardiogram, cardiac enzymes and typical chest pain. Subjects were devided into two groups by angiographically proven culprit arteries ; left circumflex artery(LCx) group and right coronary artery(RCA) group. We compared the frequencies of ST segment depression more than 1 mm and less than 1 mm in aVL and I, and ST segment elevation more than 0.5 mm and less than 0.5 mm in V5 and V6 in each culprit artery group. RESULTS: Among 51 patients with AIMI, 42 were RCA group and 9 were LCx group. The frequency of ST segment depression more than 1 mm in aVL was 44% in LCx group and 71% in RCA group(p=0.140). 11% of LCx group and 43% of RCA group showed more than 1 mm ST segment depression in lead I (p=0.128). 56% of LCx group showed more than 0.5 mm ST segment elevation in V5 and V6 and 81% of RCA group showed less than 0.5 mm ST segment elevation in V5 and V6 (p=0.036). CONCLUSION: Culprit arteries in patients with AIMI and ST segment deviation in V5 and V6 are significantly related with each other. ST segment elevation more than 0.5 mm in V5 and V6 was predominantly found in LCx group than RCA group. Observation for ST segment deviation in lateral precordial lead V5 and V6 would be important in predicting the culprit artery in AIMI.
Arteries* ; Chest Pain ; Depression ; Electrocardiography ; Humans ; Inferior Wall Myocardial Infarction*

Carcinomas of the lung, breast and lymphoma account for approximately 75% of malignant pleural effusions and the metastatic ovarian carcinoma is the fourth leading cause of malignant pleural effusions. The diagnosis of a malignant pleural effusion is established by demonstrating malignant cells in the pleural fluid or in the pleural biopsy. Chemical pleurodesis should be considered in cases of patients with malignant pleural effusion, who were not responded with systemic chemotherapy. We experienced a case of malignant pleural effusion treated by chemical pleurodesis, which was developed in a patient with ovarian carcinoma and we report it with the brief review or literatures.
Biopsy ; Breast ; Diagnosis ; Drug Therapy ; Humans ; Lung ; Lymphoma ; Pleural Effusion, Malignant* ; Pleurodesis*