ABSTRACT
In coronary artery bypass grafting, a diffusely diseased left anterior descending coronary artery (LAD) is an obstacle to achieving complete revascularization, consequently leading to the possibility of a poor prognosis. Long segmental reconstruction with or without endarterectomy is a revascularization method for treating diffusely diseased coronary arteries. Herein, we report a successful case of long segmental reconstruction of a diffusely diseased LAD using a left internal thoracic artery onlay patch after endarterectomy.
Subject(s)
Coronary Artery Bypass , Coronary Artery Disease , Coronary Vessels , Endarterectomy , Inlays , Mammary Arteries , PrognosisABSTRACT
BACKGROUND: Comedo extractor is in general used for the management or diagnosis of the follicular cutaneous disorders such as acne and folliculitis. During observing such extracted materials, we happened to discover the extraordinary thread-like fibrous materials. OBJECTIVE: We tried to clarify the nature of these fibrous materials. METHODS: The extracted materials from 20 patients with follicular cutanous disorders including 10 acne vulgaris and 10 pityrosporum folliculitis and 10 normal persons were investigated by pKOH, Masson trichrome for collagen fiber, Gomori's reticulum for reticulum fiber, acid orcein for elastic fiber, periodic acid-Schiff for fungal element and alcian blue for mucin. And we performed above mentioned special stainings in two biopsy specimens. RESULTS: Most of the extracted fibrous materials were reticulum fibers(95%) and some of them were elastic fibers(35%). And we observed the reticulum fibers and elastic fibers taken off from the pilosebaceous follicle on the histopathologic study. CONCLUSION: The fibrous materials extracted from follicular lesions were reticulum fibers or elastic fibers. And the observed presence of elastic fibers and reticulum fibers might result from tissue necrosis produced by leukocytes during the inflammatory phase of pilosebaceous follicles.
Subject(s)
Humans , Acne Vulgaris , Alcian Blue , Biopsy , Collagen , Diagnosis , Elastic Tissue , Folliculitis , Leukocytes , Malassezia , Mucins , Necrosis , Reticulum , SkinABSTRACT
BACKGROUND: Propylthiouracil (PIV) and methimazole (MMI) were widely used for the treatment of hyperthyroidism. Hepatic injury caused by these agents is a rare but serious complication. This study is to investigate the clinical features of hepatotoxicity from antithyroid drugs. METHODS: We reviewed 17 cases of hepatic injury during treatment with antithyroid drugs in patients with hyperthyroidism. Included were 6 cases we experienced and 11 cases reported in Korean literature from 1986 to 1999. We analyzed the clinical features of hepatic injury. RESULTS: Of 17 cases of hepatic injury, 12 were PTU cases and 5 MMI cases. The mean age of PTU cases was 40 years with 6/12 patients over 40 years old and 2/5 MMI cases were over 40 years old. The dose of PTU was 300 mg/d or more in 10/12 cases (83%) and the dose of MMI was 30 mg/d in 3/5 cases (60%). The hepatic injury occurred within 3 months in 8/12 PTU cases (67%) and within 2 months in 4/5 MMI cases (80%). The duration of hepatic injury tended to be longer in MMI cases than in PTV cases (median; 80 vs 41 days, p=0.102). In PTU cases, the duration of hepatic injury was correlated with the duration of drug use before hepatic injury (p<0.05). All of 8 biopsied cases who took PTU had predominantly hepatocellular necrosis. Two biopsied cases who took MMI had cholestatic jaundice and nonspecific abnormality, respectively. Biochemical findings of all MMI cases were compatible with cholestatic jaundice. As to the treatment of hyperthyroidism after hepatic injury, 4/12 PTU cases were treated with RAI therapy, 5 with MMI and one with surgery, and treatment was unknown in two. On the other hand 3/5 MMI cases interestingly entered into spontaneous remission after hepatic injury and 2/5 had RAI therapy. Hepatic dysfunction recurred in each one whom treatment by changing to MMI or PTU was tried on. CONCLUSION: Most of hepatic injury during treatment with antithyroid drugs developed within two to three months of drug use. The hepatic injury related to PTU was mainly cytotoxic whereas that related to MMI was cholestatic. Since there is a cross-reaction between PTU and MMI in hepatotoxicity, RAI therapy or operation shoud be considered as an alternative treatment of hyperthyroidism after hepatic injury.
Subject(s)
Adult , Humans , Antithyroid Agents , Hand , Hyperthyroidism , Jaundice, Obstructive , Methimazole , Necrosis , Propylthiouracil , Remission, SpontaneousABSTRACT
BACKGROUND: Prediction of therapeutic response to radioactive iodine (RAI) in Graves disease is poorly understood. Although thyrotropin binding inhibitor immunoglobulin (TBII) level is a strong index for relapse after antithyroid drug treatment, conflicting results are described regarding its prognostic significance in Graves disease treated with RAI. This study is to evaluate possible prognostic factors including TBII wbich affect the outcome of RAI therapy in Graves disease. METHODS: Two hundred and one patients with Graves disease who were followed for over 12 months after RAI treatment were studied retrospectively. The subjects were divided into hypothyroid, euthyroid and hyperthyroid groups, based on the thyroid function evaluated at 12 months after RAI therapy. We evaluated the association of clinical parameters including patients age, goiter size, degree of hyperthyroidism and TBII index with outcome of RAI treatment. RESULTS: In Graves disease, response rate to RAI was 70.1% (hypothyroid 22.4% and euthyroid 47.7%) until 12th month. The mean age of hypothyroid group was 40+/-11 years, significantly older than that other groups (euthyroid: 33+/-12, hyperthyroid: 35+/-13, p<0.05). Initial level of thyroid function, duration of antithyroid drug treatment prior to RAI, goiter size and dosage of RAI were not significantly different between the groups. There were 61 patients who had both TBII tests before and after RAI. Twelve had negative TBII and 49 had positive TBII before RAI admini-stration. The rate of unremitted hyperthyroidism after RAI therapy was significantly lower in patients with negative TBII than in those with positive TBII prior to RAI treatment( 0% versus 46.9%, p<0.05). CONCLUSION: Graves patients with positive TBII prior to RAI therapy were associated with lower therapeutic response to RAI than those with negatve TBII. And old age was associated with the development of early hypothyroidism after RAI therapy. These results suggest these factors be also considered in the treatment of Graves disease with RAI.
Subject(s)
Humans , Goiter , Graves Disease , Hyperthyroidism , Hypothyroidism , Immunoglobulins , Iodine , Recurrence , Retrospective Studies , Thyroid Gland , ThyrotropinABSTRACT
Rheumatic valvulitis produces at least three distinct pathologic changes, the degree varying widely among the patients: fusion of the valve leaflets at the commissures; fusion and shortening of chordae tendinae: and fibrosis of the leaflets with subsequent stiffening, contraction and calcification. The most extensive changes usually are seen in patients with recurrent attacks of rheumatic fever. We studied on outcome of the surgical treatments of rheumatic valvular diseases that have been experienced for 12 years since 1982 at Pusan National University Hospital. The diagnoses were made by rheumatic fever history, echocardiographic findings, gross operative findings and microscopic findings. Total 502 patients were performed surgery for valvular heart diseases and 440 patients of rheumatic origin have bene analysed. There were more female than male patients as 1.3:1, and the mean age was 37.8 years old. 96.3% of them affected to the mitral valve, 19.8% to aortic valve, 16.3% affected to the tricuspid valve. Most of them underwent valve replacement, and valve repair was done in 3.9% of patients. There were 36 hospital deaths (8.2%) mainly from low cardiac output syndrome, and 15 late deaths equally due to embolism and hemorrhage. Follow up was 90.1% completed (2890 patient-year). Linealized rates of late complication events are follows : thromboembolism 1.3% per patient year; anticoagulant related hemorrhage 0.8% per patient year. Overall actuarial survival including hospital mortality was 92.7+/-2.9% in 1 year, 88.0+/-4.5% in 5 year, 82.3+/-7.7% in 10 year. We conclude that the rheumatic disease is still the most frequent and the most important cause of heart valve disease. So more intensive study is needed in spite of the abrupt decreasing rate of rheumatic fever in U.S.A. and other industrial country.
Subject(s)
Female , Humans , Male , Aortic Valve , Cardiac Output, Low , Diagnosis , Echocardiography , Embolism , Fibrosis , Follow-Up Studies , Heart Valve Diseases , Heart Valves , Hemorrhage , Hospital Mortality , Mitral Valve , Rheumatic Diseases , Rheumatic Fever , Thromboembolism , Tricuspid ValveABSTRACT
BACKGROUND: Multiple trauma patients have rapidly increased due to traffic accidents, industrial disasters, incidental accidents, and violence. Multiple trauma can involve injuries to the heart, lung, and great vessels and influence the lives, necessitate prompt diagnosis and treatment. Most of the thoracic injuries can be managed with conservative method and simple surgical procedures, such as closed thoracostomy, but in certain cases open thoracotomy is necessary. MATERIALS AND METHODS: The author analyzed the surgical result of 70 cases of open thoracotomy after multiple organ injury including thoracic organ. RESULTS: The most common type of thoracic lesion was hemothorax with or without pneumothorax and diaphragmatic rupture was the second. Sixty percent of the patients were associated with bone fractures, 42.9% with abdominal injuries, and 37.1% with head injuries. The modes of operation were ligations of torn vessels for bleeding control (48.6%), repair of diaphragm (35.7%), and repair of lung laceration (25.7%) in this order of frequency and additional procedures were splenectomy (14.3%), hepatic lobectomy (8.6%) and repair of liver lacerations (5.7%). Postoperative complications were atelectasis (8.6%), wound infection (8.6%), and pneumonia (4.3%). Postoperatively six patients died (The mortality rate was 8.6%) and the causes of death were respiratory failure (2), acute renal failure (2), sepsis (1), and hypovolemic shock (1).
Subject(s)
Humans , Abdominal Injuries , Accidents, Traffic , Acute Kidney Injury , Cause of Death , Craniocerebral Trauma , Diagnosis , Diaphragm , Disasters , Fractures, Bone , Heart , Hemorrhage , Hemothorax , Lacerations , Ligation , Liver , Lung , Mortality , Multiple Trauma , Pneumonia , Pneumothorax , Postoperative Complications , Pulmonary Atelectasis , Respiratory Insufficiency , Rupture , Sepsis , Shock , Splenectomy , Thoracic Injuries , Thoracostomy , Thoracotomy , Violence , Wound InfectionABSTRACT
No abstract available.