A Case of Intrapancreatic Accessory Spleen Mistaken as a Pancreatic Mass due to Different Enhancing Pattern from Normal Spleen / 대한소화기학회지

Most cases of accessory spleen show similar features as normal spleen in imaging studies. However, some accessory spleen has unusual scan feature which can be misdiagnosed. We present a case of intrapancreatic accessory spleen that was discovered incidentally during a workup for abdominal pain in a 47-year-old woman. CT and MRI revealed a different enhancing pattern from that of the spleen. Further evaluation with endoscopic ultrasonography failed to identify the pancreatic mass. Therefore, it was surgically removed and diagnosed pathologically as an accessory spleen.

Intraabdominal tuberculosis found by abnormal finding of ampulla of Vater / 대한내과학회지

No abstract available.

Osseous genioplasty: review of 189 patients

The chin plays a decisive role in the contour of the lower face. And harmonious jaw will correspond to good facial profile and positive image. Osseous genioplasty is a widely used method to correct the 3-dimensional(sagittal, vertical, tranverse) deformity of the chin with minimal complications. During an 8 year period from 1988, the authors at the In-Je University Seoul Paik Hospital experienced 198 patients of osseous genioplasty. Results of clinical analysis are as follows : 1) Male to female ratio was 1 : 3 with female being predoniment. The average age was 24.9 years. 2) Horizontal advancement genioplasty in 169 cases was the most common procedure with 7.0mm of average advancement. There was 4 cases of horizontal retrusion with average retrusion of 4.3mm. 52 cases had vertical augmentation with average of 7.5mm increase. 9 cases had vertical reduction with average redution of 4.9mm. 3) Although malocclusion is not necessarilly contraindication to genioplasty alone, genioplasty following surgical with or without orthodontical correction of malocclusion is the way to get better result with patient satisfaction. 4) 77% of the patients had adjunctive procedures simultaneously to acheive a better contour and profile 5) Complications such as hematoma, infection, fracture, nerve damage were minimal.

VERTICAL INTERPOSITIONAL AUGMENTATION GENIOPLASTY USING THE BONE RESECTED FROM MANDIBULAR ANGLE REDUCTION

No abstract available.

The Response of Coronary Artery Diameter to Acetylcholine in Patients with or Without Minimally Diseased Coronary Artery*

BACKGROUND: Coronary artery spasm plays an important role in the pathogenesis of not only variant angina but also other forms of angina,acute myocardial infarction, and sudden death. However precise mechanisms by which coronary spasms occur remains unknown. The role of increased coronary artery tone as a part of pathogenesis of conary spasm and relation to the severity of coronary artery disease are still controversial. Thus we underwent this study to investigate the role of increased coronary artery tone as a part of pathogenesis of conary spasm and realtion to the severity of coronary artery disease. METHODS: Intracoronary acetylcholine and isosorbide dintrate were used as a spasm-provocative agent and vasodilator respectively. We analyzed 176 vessels(69 right coronary artery, 58 left anterior descending coronary artery, 49 left circumflex coronary artery) of 75 patients admitted for evaluation of chest pain syndrome. Among the 176 vessels, spasm occurred in 39 vessels of 25 patients. RESULTS: 1)Coronary artery spasm occured in 30.4%(21/69), 17.2%(10/58), 16.3%(8/49) of right coronary artery, left anterior descending coronary artery, left circumflex coronary artery respectively. 2) There is no relationship between angiographically visible minimal coronary artery disease and occurrence of spasm provoked by acetylcholine. 3) There was no significant difference of coronary risk factor predicting coronary spasm between two groups. 4) There is more significant % vasodilation by isosorbide dintrate(ISDDN) occurred din both the spastic and nonspastic arterial segment of vasospastic angina group than no spasm group(30.2%, 28.4% vs 14.2%, p<0.05). 5) Degree of % vasodilation by ISDN was more significantly larger in vasospastic angina group than no spasm group despite the presence of same amount of angiographically visible minimal coronary artery disease(38.3% vs 12.5%, p<0.05). CONCLUSION: These findings suggests that the occurrence of conronary artery spasm is not related to minimal coronary artery disease. Increased coronary artery tone observed only in vasospastic angina group may be part of pathogenesis of coronary spasm.

Influence of Balloon Size and Morphology of Coronary Stenosis on Elastic Recoil after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: The immediate result of coronary balloon angioplasty was influenced by plastic and elastic changes of the vessel wall. After successful coronary angioplasty, the minimal luminal diameter of the dilated coronary artery segment was generally smaller than the diameter of the largest balloon catheter at the maximal inflation pressure. Several mechanisms could explain this phenomenon, including vasoconstriction, subintimal or intraplaque bleeding or edema and platelet or thrombus deposition. In addition, whenever balloon inflation results in overdistension of elastic components of the arterial wall, some degree of elastic recoil may occur. METHODS: To evaluate magnitude of elastic recoil after percutaneous transluminal coronary angioplasty in relation to lesion morphology and other procedure-related variables, 141 coronary lesions were selected from patients with acute myocardial infarction, stable angina, unstable angina and post myocardial infarction angina undergoing successful coronary angioplasty. Coronary angiograms were recorded before and after angioplasty, and during dilatation of balloon. The computer measuring program was used for the assessment of balloon diameters and coronary luminal diameters. RESULTS: 1) Of all 141 coronary lesions, percent diameter stenosis before angioplasty averaged 74.2% and after angioplasty averaged 22.5%. 2) Residual diameter stenosis was directly related to the degree of elastic recoil, the greater the elastic recoil the more severe the residual lesion immediately after angioplasty. The increase in elastic recoil corresponded to a increase in the balloon/artery ratio(p<0.05). 3) The residual diameter stenosis tended to decrease in segments dilated with an oversized balloon than with an undersized balloon(p<0.05). 4) The elastic recoil increased significantly in the subgroups of coronary segments dilated with an oversized balloon, of eccentric lesion, and type C lesion(p<0.05). 5) Percent residual stenosis was more sever in eccentric stenosis dilated with undersized balloon than in concentric stenosis. 6) Elastic recoil was greater in type C coronary segment dilated with an oversized balloon than with an undersized balloon(<0.05). 7) The lesion dilated with oversize non-compliant balloon showed more elastic recoil than with oversize compliant balloon(p<0.05). CONCLUSION: Factors such as oversized balloon, eccentric lesion, type C lesion, and non-compliant balloon significantly affected increase of the elastic recoil.

Effect of Stress on Cardiovascular Autonomic Nervous Activity in Recovering Myocardial Infarction Patients and Normal Controls Measured by Power Spectral Analysis

BACKGROUND: Mental stress prebably leads to disease by the effect on autonomic nervous system, especially on cardiovascular nervous system it leads deleterious effects ranging from the apperarence or worsenig of ischemia to lethal arrhythmia or sudden death. Especially after myocardial infarction this risks were increased. PURPOSE & METHODS: In order to assess the effect of postural change and arithmetic test on the state of autonomic nervous system in patients with AMI(acute myocardial infarction) autoregressive power spectral analyses were applied to 21 healthy subjects(51.9+/-6.5 years) and 20 AMI patients(55.3+/-7.4 years) during supine, standing and arithmetic test. RESULTS: R-R interval and systolic blood pressure decreased during standing compared with during supine position but there were no remarkable changes during arithmetic test compared with during supine position. In two groups, both during standing and during arithmetic test, compared with during supine position, the remarkable increase of LF(low frequency) spectral parameters(Nu, p<0.001) and decrease of HF(high frequency) spectral parameter(Nu, p<0.001) were observed. And during arithmetic test, compared with during standing, the remarkable increase of LF spectral parameter(Nu, p<0.01) and decrease of HF spectral parameter(Nu, p<0.01) were observed. LF/HF ratio and LFCCV/HFCCV ratio, so an index of sympatho-vagal balance, significantly increased during standing and during arithmetic test compared with during supine position and the increase was more prominent during arithmetic test(p<0.05). There was no significant difference of spectral parameters beteen two groups. CONCLUSION: In conclusion, sympathetic activity increased during standing and during arithmetic test. Especially, during arithmetic test it induced only sympathetic activity to increase remarkably without significant hemodynamic changes. The state of autonomic nervous system 7-10 days after AMI was not different from that of healthy subjects. Among the spectral parameters, Nu was more useful than either PSD or CCV in assessing autonomic nervous activity.

Determinants of Successful Percutaneous Transluminal Coronary Angioplasty / 영남의대학술지

In Order to evaluate determinants of successful percutaneous transluminal coronary angioplasty (PTCA), PTCA was performed for 172 coronary arterial lesions in 120 patients(89 male, 31 female) at Yeungnam university hospital from Sep. 1992 to Aug 1993. The corinary artery luminal diameter at the site of the original stenosis was eveluated from end-diastolic frames of identical projections of the preangioplasty and immediate post angioplasty. The coronary luminal and balloon diameters were measured with using of computer measuring system. Overall success rate of 172 attempted lesions was 87.2%. Success rate of female patients was 93.5% and higher than those of male patients. According to the clinical diagnosis, success rate in stable angina was 93.7% and higher than those of post myocardial infarction angina, unstable angina and acute myocardial infarcrion. Success rate of American Heart Association type C lesion was 65.5% and lower those of type A(95.7%), type B (89.%). There was significantly difference in preangioplasty luminal stenosis, elastic recoil and length of lesion between successful PTCA group and failed PTCA group. Success rate of lesion location at a bed >45° and presence of intracoronary thrombus were lower than than those of other angiographic findings. In coclusion, primary angioplasty success was affected by specific angiographic factors, Stenosis severity, thrombus, lesion location at a bend >45°, elastic recoil, and length of lesion were the principle of determinants of coronary angioplasty success rate.

Effect of Coronary Artery Occlusion and Reperfusion on Signal Average Electrocardiography in Cats

BACKGROUND: Recently, a lower incidence of late potentials has been reported in patients with acute myocardial infarction after successful thrombolysis when compared with conventionally treated patients. In another recent study, however, no significant effect of thrombolytic therapy on any abnormal signal average electrocardiography was found at 13 days after acute myocardial infarction. The present study was designed to determine the prognostic significance of the signal average electrocardiography and to evaluate the possible value of this technique as a noninvasive tool for monitoring of coronary occlusion and reperfusion. METHODS: Signal averaging was performed by using a signal average electrocardiography with bidirectional filterings before coronary artery occlusion, at 5 minutes after coronary occlusion and on reperfusion in 20 cats. Three of them died due to malignant ventricular arrhythmia during reperfusion. In all cats, approximately 250 beats were averaged. All data were analysed at filter frequency 25 to 250Hz, 40 to 250Hz and 80 to 250Hz. The following quantitative high resolutional electrocardiographic variables were calculated by computer : 1) filtered total QRS duration, 2) duration of HFLA(high frequency low amplitude) signals under 40uV, 3) RMS voltage of terminal 40ms, 4) mean Voltage of terminal 40ms, 5) average noise voltage. RESULTS: At the filter frequency of 40 to 250Hz and 80 to 250Hz, the filtered QRS duration and duration of HFLA signals 40uV were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean voltage(terminal 40ms) were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01, p<0.01 respectively). At the filter frequency of 80 to 250Hz, the filtered QRS duration and at the filter frequency of 25-250Hz, the duration of HFLA signals at 40uV were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.05 respectively). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.01 respectively). There was no significant change of the filtered QRS duration, duration of HFLA signals 40uV,RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) after reperfusion compared with those of control at the filter frequency of 25 to 250Hz, 40 to 250Hz and 80 to 250Hz respectively. CONCLUSION: These results suggest that the signal average electrocardiography could be a valuable tool for monitoring the state of coronary artery occlusion and reperfusion.