Pericardial fat necrosis is an infrequent cause of acute chest pain and this can mimic acute myocardial infarction and acute pericarditis. We describe here a patient with the magnetic resonance imaging (MRI) findings of pericardial fat necrosis and this was correlated with the computed tomography (CT) findings. The MRI findings may be helpful for distinguishing pericardial fat necrosis from other causes of acute chest pain and from the fat-containing tumors in the cardiophrenic space of the anterior mediastinum.
Adult ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Fat Necrosis/*diagnosis ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Pericardium/*pathology

A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally significant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insufficiency symptoms due to reversal of blood flow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.
Angioplasty ; Arm ; Basilar Artery ; Blood Pressure ; Cardiovascular Diseases ; Constriction, Pathologic ; Humans ; Male ; Peripheral Vascular Diseases ; Stents ; Subclavian Artery ; Subclavian Steal Syndrome ; Upper Extremity ; Vertebral Artery ; Vertebrobasilar Insufficiency

Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE). Intestinal pseudo-obstruction (IpO) is a rare, poorly understood and recently recognized gastrointestinal manifestation of SLE. We report a 26-year-old female with SLE for 3 years. 10 months ago, IpO was diagnosed first, and it was responded well to high-dose steroid therapy. After then, oral prednisolone and azathioprine were administered, but the patient had been lost to follow up until recurrence of IpO. She was admitted with diffuse abdominal pain, distension, frequent vomiting, and intermittent dysuria due to recurrent IpO accompanied with bilateral ureterohydronephrosis. Despite of high dose steroid therapy, her symptom and imaging findings were not improved. The patient was treated with pulses of cyclophosphamide, and then the patient's symptoms and signs were gradually subsided. Three weeks following cyclophosphamide therapy, she was able to eat without vomiting and following abdominal CT showed nearly complete resolution of diffuse intestinal distension and bilateral ureterohydronephrosis. High level of awareness of IpO in SLE and appropriate medical treatment is needed to prevent unnecessary surgical treatment. And if this complication is refractory to corticosteroid, active immunosuppressive therapy, such as cyclophosphamide, should be considered.
Female ; Humans

BACKGROUND: Left ventricular hypertrophy (LVH) has been shown to be an independent risk factor for cardiovascular morbidity and mortality. The combination of hypertension and obesity are well known to act as risk factors of left ventricular hypertrophy in a number of studies, but it is unclear whether obesity itself stimulates LVH independently. Therefore, we investigated the relationship of left ventricular mass to body size in normotensive adults. METHODS: A population sample of 240 normotensive (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) adults (139 men and 101 women) was examined by echocardiography. We excluded adults with history of hypertension, thyroid diseases, diabetes mellitus and other cardiac diseases. Left ventricular mass normalized for height(2.7) was used in the analyses and left ventricular hypertrophy was defined as a value of 50 g/m(2.7) men or 47 g/m(2.7) in women. RESULTS: Left ventricular mass significantly and positively correlated with body mass index. On univariate correlation analysis after adjusting for age, the body mass index was associated with LV mass/height(2.7) (LVMI: Left Ventricular Mass Index) in males and body mass index, waist circumference, hip circumference and waist/hip circumference ratio were associated with LVMI in females. Left ventricular hypertrophy was more frequent in overweight (33.3%) and obese (39.4%) groups than in lean group (15.9%). CONCLUSION: Left ventricular mass was strongly related to obesity in normotensive adults, especially in females. Obesity may be an independent risk factor for left ventricular hypertrophy.
Adult* ; Body Mass Index ; Body Size ; Diabetes Mellitus ; Echocardiography ; Female ; Heart Diseases ; Hip ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Male ; Mortality ; Obesity* ; Overweight ; Risk Factors ; Thyroid Diseases ; Waist Circumference

BACKGROUND: Left ventricular hypertrophy (LVH) has been shown to be an independent risk factor for cardiovascular morbidity and mortality. The combination of hypertension and obesity are well known to act as risk factors of left ventricular hypertrophy in a number of studies, but it is unclear whether obesity itself stimulates LVH independently. Therefore, we investigated the relationship of left ventricular mass to body size in normotensive adults. METHODS: A population sample of 240 normotensive (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) adults (139 men and 101 women) was examined by echocardiography. We excluded adults with history of hypertension, thyroid diseases, diabetes mellitus and other cardiac diseases. Left ventricular mass normalized for height(2.7) was used in the analyses and left ventricular hypertrophy was defined as a value of 50 g/m(2.7) men or 47 g/m(2.7) in women. RESULTS: Left ventricular mass significantly and positively correlated with body mass index. On univariate correlation analysis after adjusting for age, the body mass index was associated with LV mass/height(2.7) (LVMI: Left Ventricular Mass Index) in males and body mass index, waist circumference, hip circumference and waist/hip circumference ratio were associated with LVMI in females. Left ventricular hypertrophy was more frequent in overweight (33.3%) and obese (39.4%) groups than in lean group (15.9%). CONCLUSION: Left ventricular mass was strongly related to obesity in normotensive adults, especially in females. Obesity may be an independent risk factor for left ventricular hypertrophy.
Adult* ; Body Mass Index ; Body Size ; Diabetes Mellitus ; Echocardiography ; Female ; Heart Diseases ; Hip ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Male ; Mortality ; Obesity* ; Overweight ; Risk Factors ; Thyroid Diseases ; Waist Circumference

Idiopathic hypereosinophilic syndrome is a rare systemic, leukoproliferative disorder characterized by eosinophil- mediated tissue injury causing multiple organ failure, including the heart. Cardiac involvement occurs in more than 75% of patients with hypereosinophilic syndrome. Cardiac manifestations include subendocardial fibrosis, thrombus leading to peripheral emboli, restrictive cardiomyopathy, and valvular dysfunction. It is more common in men than in women (9:1), and trends to present between the ages of 20 and 50 years. Presentation in childhood is unusual. We report for the first time a case of a 58-year-old man with idiopathic hypereosinophilic syndrome manifested by prosthetic aortic valve dysfunction that was successfully treated by steroid and hydroxyurea therapy after surgical valvular replacement.
Aortic Valve* ; Cardiomyopathy, Restrictive ; Female ; Fibrosis ; Heart ; Humans ; Hydroxyurea ; Hypereosinophilic Syndrome* ; Male ; Middle Aged ; Multiple Organ Failure ; Thrombosis

BACKGROUND: The overuse and misuse of antimicrobial agents and their resultant emergence of resistant microorganisms have made choices regarding antimicrobial therapy more difficult .Therefore,a new system that separated prescribing and dispensing medicine began on July 1,1997 to prevent overuse and misuse of medicine.We studied to evaluate changes of antibiotic sensitivities to causative microorganisms of urinary tract infection 2 years before and after the new medical system. METHODS: During each 2 years before and after the new medical system,we analyzed antibiotic sensitivities of causative microorganisms for urinary tract infection among the 447 out-patients who visited a hospital in GangNeung.The diagnosis of urinary tract infection was based on greater than 105 CFU (Colony For Unit)per ml.urine. RESULTS: The most common pathogenic microorganisms as E.coli (76.5%),followed by Klebsiella pneumoniae (5.1%),and Proteus mirabilis (3.6%)in urine culture. A first generation cephalosporin,cephalothin,against E.coli, had more significant sensitivity after the introduction of the new medical system (52.6%)than before (33.9%),especially in the 80th decade (P=0.023) and in females (P<0.001).Also,trimethoprim/sulfamethoxazole against E.coli showed signifcant improving sensitivity (P=0.025). CONCLUSION: There was little change of antibiotic sensitivity of urinary tract infection in out-patients before and after the new medical system in cephalothin and trimethoprim/sulfamethoxazole against E.coli. The change of antibiotic sensitivities will require further observation for a longer term after the introduction of the new medical system.
Anti-Infective Agents ; Cephalothin ; Diagnosis ; Female ; Humans ; Klebsiella pneumoniae ; Outpatients* ; Prescriptions* ; Proteus mirabilis ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: Antithrombin III (AT-III) produced from hepatocytes and endothelial cells is a coagulation inhibitor. The authors investigated the activity levels of AT-III in patients with liver disease and attempt to elucidate the clinical significance of activity levels of AT-III in relation to various liver disease. METHODS: This study includes 158 patients with liver disease, who visited the National Police Hospital between October 1997 and March 2002. We performed laboratory tests such as LFT, AFP and either abdominal sonography or abdominal CT. At the same time, AT-III activity levels was measured by chromogenic method using ACL 3000 (IL, Lexington, USA). AT-III activity level of 70~120% was regarded as normal. RESULTS: AT-III activity level of liver cirrhosis patients was decreased along with severity of the disease evaluated by Child-Pugh Classification. AT-III activity level of liver cirrhosis patients and hepatocellular carcinoma patients with liver cirrhosis, whose serum AFP were within normal limits, were 50.11+/-2.86% and 75.58+/-6.61%, respectively. The difference between the two groups was statistically significant (p < 0.001). CONCLUSION: Considering the results of the decrease of AT-III activity level in liver cirrhosis patients and the increase in hepatocellular carcinoma patients with liver cirrhosis, further evaluation for the possibility of hepatocellular carcinoma in liver cirrhosis patients without decrease of AT-III level or increase of AFP, may be in need.
Antithrombin III* ; Carcinoma, Hepatocellular ; Classification ; Endothelial Cells ; Hepatocytes ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Plasma* ; Police ; Tomography, X-Ray Computed

BACKGROUND: We compared the results of liver biopsy and the levels of serum type IV collagen of the hepatitis B carriers with normal liver function test (LFT) to evaluate the clinical usefulness of serum type IV collagen in predicting the progression of histopathological findings. METHODS : Thirty one chronic hepatitis B carriers with normal LFT and no significant clinical symptoms, who were Korean combat police, were classified into three groups according to their histologic results of the liver biopsies. The classification followed the standard proposed by Korean Society of Pathology. Blood samplings for serum type IVcollagen (reference : less than 5 ng/mL) were done in the morning of the same day of the liver biopsy. RESULTS: Of thirty one patients, thirteen patients showed normal histologic findings (41.9%, Group A), eleven patients revealed histologic abnormalities without fibrosis (35.5%, Group B) and seven patients were with fibrosis on liver biopsy (22.6%, Group C). Serum type IV collagen levels of Group A, B and C were 3.53 +/- .57 ng/mL, 3.56 +/- .17 ng/mL and 3.97 +/- .88 ng/mL, respectively. The average of serum type IV collagen levels of Group C was higher than of Group B and the average of Group B higher than that of Group A without any statistical significance (p > 0.05). The averages of serum type IV collagen of eighteen patients with histologic abnormalities (Group B and C) and twenty four patients without fibrosis (Group A and B) were 3.73 +/- 1.06 ng/mL and 3.55 +/- .88 ng/mL respectively. Upon comparison of these averages with the those of Group A and C, no statistical significance was established (p > 0.05). CONCLUSION : In chronic hepatitis B carriers with normal LFT findings, levels of serum type IV collagen were elevated along with histologic severities without statistical significance, therefore can not represent the changing degree of the histologic findings. Liver biopsy is considered to be one of the most accurate tool to assess the histologic status of the liver.
Biopsy* ; Classification ; Collagen Type IV* ; Collagen* ; Fibrosis ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Liver Function Tests* ; Liver* ; Needles ; Pathology ; Police

BACKGROUND: Thyroid diseases is common in adult and frequently has significant clinical consequences. But, Prevalence have not been accurately estimated before performance of sensitive TSH and high resolution ultrasound devices on thyroid gland in practice. The objective of the study was to obstain prevalance rate of thyroid dysfunction and structural abnormality by sensitive TSH, Free T4 and high resolution ultrasound. METHODS: The subjects were 10,543(5,638 male and 4,815 female) individuals who visited a health care center of a general hospital in Kangnung city during the period of Jan. 1st, 1997 through May 31st, 2000. For thyroid dysfunction, serum TSH(Thyroid Stimulation Hormone) and Free T4 concentration of those were measured by RIA or IRMA. During the period of Dec. 1st, 1997 through May 25th, 1998, 1,316 individuals were examined by radiology specialists using high resolution ultrasonography with 7.5 MHz linear array. Consequently 21 patients who showed thyroid nodule were performed ultrasound-guided fine needle aspiration. Accordingly medical records containing results of physical examination made by 3 specialists in family medicine before thyroid ultrasonography were investigated in association with other diagnostic modalities. RESULTS: The measurements of thyroid function revealed that 10,090(96.5%) were normal, 240(2.3%) low(below 0.39 mU/L) and 123(1.2%) high(above 5.1 mU/L) in TSH. In terms of prevalence rate per 1,000 population, 15.2 cases were with subclinical hyperthyroidism, and 9.0 cases with subclinical hypothyroidism, 7.7 cases with hyperthyroidism and 3.3 cases with hypothyroidism. Among 94 individuals(7.1%) with structural abnormality on thyroid gland by ultrasonography, 60(4.6%) showed solitary solid nodule, 12(0.9%) multiple solid nodules, 18(1.4%) cystic nodules and 3(0.3%) diffuse parenchymal lesions. Physical examination found only 13.3% of 91 nodules found by high-resolution ultrasonography, and nodules as large as above 1.0 cm in size were palpable only in 22.2%. 21 Of 91 thyroid nodules was received ultrasound-guided FNA and 4(19%) were found to have malignant nodules. CONCLUSION: The study results showed the relatively high rate of thyroid diseases among general population, with the prevalence rate of thyroid dysfunction 3.6%, thyroid nodule 6.9%, malignant incidentaloma among thyroid nodules 4.4%. Physical examination was relative ineffective in detection for thyroid nodules in routine health examinations.
Adult* ; Biopsy, Fine-Needle ; Delivery of Health Care ; Gangwon-do* ; Hospitals, General ; Humans ; Hyperthyroidism ; Hypothyroidism ; Male ; Medical Records ; Physical Examination ; Prevalence* ; Specialization ; Thyroid Diseases* ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography