ABSTRACT
Atrial myxoma is the most common primary cardiac tumor, and surgical removal is the treatment of choice. Atrial flutter-fibrillation is common after the surgical excision of such tumors, whereas sinus node dysfunction is a rare complication. We detected postoperative sinus node dysfunction and atrial tachycardia after the excision of a left atrial myxoma in a 63-year-old woman. The patient underwent the implantation of a permanent pacemaker two weeks after the operation. The patient underwent successful catheter ablation of macroreentrant right atrial tachycardia 16 months after the operation with no recurrence of atrial tachycardia over the next four months.
Subject(s)
Female , Humans , Middle Aged , Catheter Ablation , Heart Neoplasms , Myxoma , Recurrence , Sick Sinus Syndrome , Sinoatrial Node , TachycardiaABSTRACT
BACKGROUND/AIMS: The reflow disturbance phenomenon is associated with poor functional and clinical outcomes for patients suffering with acute myocardial infarction (AMI). In the era of primary coronary intervention (PCI), accurately identifying those lesions that are at a high risk of no-reflow is of crucial importance. Therefore, we investigated the risk factors of the reflow disturbance phenomenon in AMI patients who underwent PCI. METHODS: From February 2003 to June 2005, the clinical and angiographic characteristics of 475 patients who had undergone PCI were reviewed retrospectively. RESULTS: 65 patients (13.7%) showed the reflow disturbance phenomenon and the reperfusion times of the reflow disturbance group ranged from 1 hour to 142 hours. On univariate analysis, an older age (p<0.001), low systolic blood pressure (p=0.01), no thrombolysis followed by PCI (p<0.001), primary PCI (p<0.001), less time to PCI (p=0.001), a high peak serum CK-MB level (p=0.013), angiographically visible thrombus (p=0.016), a low pre-TIMI grade (p=0.021) and ST segment elevation on the ECG (p=0.002) were the significant risk factors of the reflow disturbance phenomenon. An older age, a low systolic BP and angiographically visible thrombus were significant risk factors on multivariate analysis. CONCLUSION: An older age, low systolic blood pressure and angiographically visible thrombus were the independent risk factors for the reflow disturbance phenonmenon in AMI patients who undergo PCI.
Subject(s)
Humans , Blood Pressure , Electrocardiography , Multivariate Analysis , Myocardial Infarction , Percutaneous Coronary Intervention , Reperfusion , Retrospective Studies , Risk Factors , Stress, Psychological , ThrombosisABSTRACT
Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm with two components of carcinoma and sarcoma. The most common site of occurrence in female genital tract is the uterine corpus. MMMT of the cervix is extremely rare. MMMT of uterine corpus is highly malignant and the prognosis is poor. Surgery is treatment of choice of uterine cerivx MMMT. The clinicopathologic characteristics of tumor and treatment are uncertain because of lack of clinical data. We experienced one case of malignant mixed mullerian tumor of uterine cervix and report our experience with a brief review of literature.
Subject(s)
Female , Humans , Cervix Uteri , Prognosis , SarcomaABSTRACT
OBJECTIVE: p16 is cyclin-dependent kinase (CDK) inhibitor which decelerates cell cycle by inactivating CDKs that phosphorylate retinoblastoma protein (pRb). In cervical carcinogenesis, abnormality of p16 gene such as methylation of p16 gene promoter was investigated as an important factor. The aims of our study are to investigate the expression of p16 gene, methylation of p16 gene promoter region, and HPV typing in uterine cervical neoplasia. METHODS: A total of 104 samples (CIN1, 30 CIN2,3 45, invasive cancer, 29) were included. Expression of p16 was analyzed by immunohistochemistry, methylation of p16 gene promoter region was analyzed with methylation specific polymerase chain reaction (MSP) and we examed the result of HPV DNA testing. RESULTS: 1. In high risk HPV and low risk or negative group, p16 gene expression was observed in CIN1 (30% vs 23%), CIN2, 3 (64% vs 58%) and in invasive cancer (80% vs 37%) respectively. In invasive cancer, p16 gene expression of high risk HPV group was statistically higher than that of low risk or negative group. 2. In high risk HPV and low risk or negative group, p16 promoter methylation was observed in CIN1 (23% vs 17%), CIN2, 3 (25% vs 47%) and in invasive cancer (19% vs 87%) respectively. In invasive cancer, p16 promoter methylation of low risk or negative HPV group was statistically higher than that of low risk or negative group. CONCLUSION: p16 gene expression would be marker for CIN and cancer. Methylation of p16 promoter region may be one of the important mechanism for uterine cervical carcinogenesis especially in negative or low risk HPV group. but further studies are needed to reinforce this statement.
Subject(s)
Carcinogenesis , Cell Cycle , DNA Methylation , Genes, p16 , Human Papillomavirus DNA Tests , Immunohistochemistry , Methylation , Phosphotransferases , Polymerase Chain Reaction , Promoter Regions, Genetic , Retinoblastoma Protein , Uterine Cervical NeoplasmsABSTRACT
OBJECTIVE: To evaluate the sensitivity and specificity of ovarian volume using 3D VOCAL and 2D ultrasound, antral follicle count, and age as predictors of menopausal status in pre- and postmenopausal women. METHODS: The subjects of this study were premenopausal (n=38) and postmenopausal (n=23) healthy women aged between 35 and 57 years of age who were interviewed about social, demographic, and medical conditions. These women underwent transvaginal ultrasound using 3D VOCAL and 2D probe to determine ovarian volume. Chi-square test was applied to evaluate the correlation between ovarian volume, antral follicle count, age and menopausal status. Receiver operating Characteristic (ROC) curves were elaborated to evaluate the sensitivity, specificity and positive and negative predictive values. RESULTS: Premenopausal women presented larger ovaries than postmenopausal women (p<0.01). Premenopausal women had a higher number of antral follicles than postmenopausal women (p<0.01). ROC curves showed that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe were more sensitive and specific markers of menopausal status than age or ovarian volume using 2D transvaginal probe. CONCLUSIONS: Ovarian volume and antral follicle count differ according to age in pre- and postmenopausal women. The data suggest that antral follicle count and ovarian volume using 3D VOCAL transvaginal probe are quite useful in predicting menopausal status.
Subject(s)
Female , Humans , Menopause , Ovary , ROC Curve , Sensitivity and Specificity , UltrasonographyABSTRACT
OBJECTIVE: To evaluate how patients in the four diagnosis groups differ in their symptoms and other characteristic levels in female stress urinary incontinence METHOD: A retrospective chart review of 240 patients with stress urinary incontinence was performed. Patients were categorized as intrinsic sphincter deficiency (ISD) or stress urinary incontinence (SUI). Within these groups, patients with hypermobility were separated from those without hypermobility. And then just patients with hypermobility were compared. Information on several types of symptoms and characteristics were captured for all patients. RESULTS: There are nothing to do with among 4 each groups and 6 symptoms (frequency, urgency, postvoid dribbling, voiding difficulty, hematuria, recurrent infection) in stress urinary incontinence. Only in diabetic status and antiincontinence surgery did the diagnosis groups differ statistically. In diabetes, patient in the ISD without hypermobility tended to have a higher prevalence of diabetes than the other 3 groups (p=0.007). Patients in the ISD with hypermobility group were more likely to have antiincontinence surgery than thosein the SUI with hypermobility group (p=0.046). No other statistical comparisons were significant at the 0.05 level, although there is some evidence that patients in the ISD with hypermobility group were more likely to have a previous hysterectomy than those in the SUI with hypermobility group (p=0.072). Patients in the ISD without hypermobility group had the largest mean and median age among the four groups, and a statistically significant difference in age was detected across all groups (p<0.001). More specifically, the ISD without hypermobility group was significantly older than the SUI with hypermobility group. CONCLUSION: There was no statistically significant among 4 each group according to each 6 symptom in stress urinary incontinence. Of the variables, diabetes, antiincontinence surgery history, hormonal use, parity and age tended to have a statistically significant difference.
Subject(s)
Female , Humans , Diagnosis , Hematuria , Hysterectomy , Parity , Prevalence , Retrospective Studies , Urinary IncontinenceABSTRACT
We present the case of a 7 year-old child who underwent angioplasty with a stent for anastomosis site stenosis between a left subclavian artery free graft and the left main coronary artery in an arterial switch operation.
Subject(s)
Child , Humans , Angioplasty , Constriction, Pathologic , Coronary Vessels , Stents , Subclavian Artery , Transplants , Transposition of Great VesselsABSTRACT
BACKGROUND AND OBJECTIVES: Cardiovascuar MR using contrast enhancement has recently been reported to be useful for diagnosing myocarditis. It is also well known that irreversible myocardial injury by epicardial coronary artery flow obstruction spreads from the endocardium to the epicardium in a wave-front pattern with a time-dependent manner. We investigated characteristics of the patterns of contrast-enhanced MR imaging according to the underlying myocardial injury mechanism. SUBJECTS AND METHODS: Of all 275 patients who underwent coronary angiogram at our hospital due to cheat pain and elevated cardiac enzymes between October, 2002 and August, 2003, 48 patients who underwent cardiac MR were enrolled in this study. We retrospectively analyzed the pattern of delayed hyperenhancement according to presence or absence of a documented infarct related artery. Endomyocardial biopsies were done in selected patients. RESULTS: Contrast MR images of all patients showed delayed hyperenhancement. The study group was divided into 2 groups according to whether the areas of hyper-enhancement were involved in the sub-endocardial portion (endocardial sparing pattern, ESP) or not. In 8 patients (Group A, 17%) who showed the endocardial sparing pattern on contrast MR, the findings of coronary angiogram were all normal. In 40 patients (Group B, 83%), who did not show the endocardial sparing pattern on contrast MR, 39 patients (97.5 %) had an infarct related artery on coronary angiogram (p=0.001). Endomyocardial biopsies were performed in 3 patients of group A. The findings of the 3 biopsies were 2 cases of definite myocarditis and 1 case of myocardial degeneration. CONCLUSION: The endocardial sparing pattern of myocardial injury demonstrated by delayed enhancement MR imaging was very useful to predict the presence of an infarct related artery in patients with myocardial necrosis that has been determined by elevated cardiac enzymes. This result can be a useful clue to determine the nature of the underlying injury mechanism such as ischemic or non-ischemic.
Subject(s)
Humans , Arteries , Biopsy , Coronary Vessels , Endocardium , Magnetic Resonance Imaging , Myocardial Infarction , Myocarditis , Necrosis , Pericardium , Retrospective StudiesABSTRACT
OBJECTIVES: This study was designed to evaluate differences in the quality of life(QOL) according to insight in patients with schizophrenia. The author speculated that insight might have an effect on individual's QOL, especially subjective QOL. METHOD: The study group consisted of patients with schizophrenia(N=55). Subjects were divided into two groups, patients with insight(N=22)and without insight(N=15), based on Scale of Unawareness of Mental Disorders(SUMD). All of the patients were administered the Quality of Life Interview (QOLI)by Lehman and compared in objective and subjective QOL between two groups. Additionally, they completed BDI and F scale on MMPI. RESULTS: The patients with insight showed a tendency of lower scores in total subjective QOLI scores and the safety issues compared to the patients without insight although not significant statistically. And they showed significantly less satisfaction with social relations. In objective QOL, there are no statistically significant differences between two groups. CONCLUSION: Such differences support the notion that schizophrenic patients with insight are less satisfied with their lives, especially in the aspect of interpersonal relations. It reflects the awareness of functional decline due to lifetime disability, disconnection from social relations, poor resources and supports, social stigma, and also depressive or anxiety symptoms. The authors propose that the treatment strategies for schizophrenia must include concern and support for domains of life with which patients feel themselves least satisfied, to increase effectiveness and efficacy of treatment and improve QOL.
Subject(s)
Humans , Anxiety , Interpersonal Relations , MMPI , Quality of Life , Schizophrenia , Social StigmaABSTRACT
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
About 40% of patients suffering from postencephalitic or idiopathic parkinsonism experience distressing and ill-defined sensations. Antipsychotic-induced acute extrapyramidal syndromes (EFSs) share phenomenological, pharmacological, and biochemical characteristics with these parkinsonisms. Thus, it is conceivable that antipsychotic-induced acute EPSs may also be associated with primary sensory symptoms. The aim of this study was to test this hypothesis, first by examining the frequency and risk factors of primary sensory symptoms and then by contrasting the clinical characteristics in patients with or without antipsychotic-induced acute EFSs and in patients who did or did not report sensory symptoms. The study group comprised 107 patients who receiving antipsychotics. The authors used DSM-IV criteria and Yale Extrapyamidal Symptom Scale for acute EFSs and modified McGill Pain Questionnaire for sensory symptoms. The results were as follows: 1) Twenty-one(19.6%) of 107 patients receiving antipsychotics reported sensory symptoms. Among these 21 patients, 12(57.1%) reported paresthesia, 6(28.6%) reported pain, 3(14.3%) reported both. 2) fifteen(34%) of the 44 patients with antipsychotic-induced EFSs reported sensory symptoms, while only 6(9.5%) of the 63 patients without EFSs reported sensory symptoms(p<0.01). The severity of sensory symptoms was significantly correlated with the EPSs rating score(p=0.001). 3) In the patients with sensory symptoms, the women significantly outnumbered the men(p<0.05). Any risk factor of sensory symptoms, however, couldn't be found in age, diagnosis, and drug. The subjective response including sensory symptoms were associated with drug response, drug compliance, quality of life and prognosis. It is suggested that further systematic investigation and interest about sensory symptoms and subjective response of the acute EPSs should be needed.
Subject(s)
Female , Humans , Antipsychotic Agents , Asian People , Compliance , Cross-Cultural Comparison , Diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Pain Measurement , Paresthesia , Parkinsonian Disorders , Prognosis , Quality of Life , Risk Factors , SensationABSTRACT
BACKGROUND: In cases of pure mitral stenosis, it is known that the impairment of left ventricular(LV) ejection performance is frequently accompanied, but long term follow up studies on the LV ejection performance after successful percutaneous mitral valvuloplasty are rare on far. METHODS: An prospective investigation was performed on 32 casas of patients, 10 being male and 22 female, who have beem maintained after successful precutaneous mitral valvuloplasty of pure mitral stenosis. The LV ejection preformances have been measured with cardiomechanography and echocardiography before and following the procedure, and the follow-up periods were 24 months in average, in the range of 12 to 35 months. RESULTS: The stroke volume, cardiac output, cardiac index, ejection fraction, mean velocity of circumferential shortening and fractional shortening(FS), which are indices of LV ejection perfomance, all increased in follow-up than before procedure. In addition, LV end-diastolic dimension and LV end-diastolic dimension index, which are indicis of LV preload, increased, and the end-systolic LV wall stress which is an index of afterload, decreased. And the ratio measured FS to expected FS, which in an index of myocardial contractility, increased in follow-up. CONCLUSION: The successful percutaneous mitral valvuloplasty of pure mitral stenosis is found to improve LV ejection performance in long term by increasing preload, decreasing afterload, and increasing myocardial contractility of left venrticle.
Subject(s)
Female , Humans , Male , Cardiac Output , Echocardiography , Follow-Up Studies , Mitral Valve Stenosis , Prospective Studies , Stroke VolumeABSTRACT
BACKGROUND: Mitral stenosis is charcterized by decrease in mitral valve area anatomically and increase in transmitral pressure gradient hemodynamically. And these changes have been used to quantify the severity of mitral stenosis clinically. To evaluate the clinical usefulness of mitral valve resistance as a hemodynamic parameter in patients with mitral stenosis, we compared the mitral valve resistance to the clinical status of the patient with mitral stenosis, the other hemodynamic parameters and static parameter. METHODS: We analyzed and reviewed the data obtained from the consecutive 27 patients with mitral stenosis(7 male, 20 female : mean age 38+/-9 years) who had been underwent percutaneous mitral valvuloplasty(PMV). RESULTS: Befor PMV, the mitral valve resistance was significantly correlated with exercise capacity on treadmill test(r=-0.37, p<0.05), mitral valve area(r=-0.72, p<0.01), transmitral mean pressure gradient(r=0.83, p<0.01),not with cardiac output, mixed venous oxygen saturation. After PMV, the mitral valve resistance was significantly correlated with mitral valve area (r=-0.72, p<0.01), transmitral mean pressure gradient(r=0.90, p<0.01).According to the results summerizing and comparing the values of before and after percutaneous mitral valvuloplasty, the mitral valve resistance had good relationship with preexisting paramerters of severity such as mitral valve area(r=-0.82, p<0.01), transmitral mean pressure gradient (r=0.92, p<0.01). CONCLUSION: This results indicate that the mitral valve resistance is a useful hemodynamic parameter in patients with mitral valve stenosis and reflects the exercise capacity during the treadmill test which was the objective parameter of practical and clinical status of the patient well than the other hemodynamic parameters in case of remarkably reduced transmitral valve blood flow due to severe mitral valve stenosis, because the degree of change in the mitral valve resistance in relagion to the degree of change in transmitral valve blood flow is relatively more constant than the other hemodynamic parameters.
Subject(s)
Female , Humans , Male , Cardiac Output , Exercise Test , Hemodynamics , Mitral Valve Stenosis , Mitral Valve , OxygenABSTRACT
Arrhythmogenic right ventricular dysplasia is a rare but important cause of ventricular tachycardia in young patioents, which is of a left bundle branch block configuration, The common abnormality on routine ECG is inverted T-waves on precordial leads and magnetic resonance image shows the fatty replacement and/or extreme thinning of the myocardium of right ventricle. Histologically, this disease is characterized by patch replacement of right ventricular myocardium by adipose and fibrous tissue. We expierienced a case of arrythmogenic right ventricular dysplasia with ventricular tachycardia which was ablated successfully by radiofrequency catheter ablation.
Subject(s)
Arrhythmogenic Right Ventricular Dysplasia , Bundle-Branch Block , Catheter Ablation , Electrocardiography , Heart Ventricles , Myocardium , Tachycardia, VentricularABSTRACT
BACKGROUND: The erythemal response and delayed tanning of the skin to UV radiations which are used as diagnostic phototest and guideline of phototherapy are different according to the races and light sources. OBJECTIVE: The MED and MMD induced by UVB radiation were measured in 130 normal young adult Koreans. METHODS: In this study, a high pressure mercury are lamp(Burdick UV-800) and a sunlight fluorescent lamp(Waldmann UV 800) were used as UVB light sources. Multiple sites of the lower baek or buttock skin were irradiated with an increasing dose by a constant, anount. The minimal doses of erythema response and delayed tanning of the skin were assessed visaually at 24 hours and 7 days after irradiation, respectively. RESULTS: MED and MMD of Burdick UV-800 are 18.0+/-9.8mJ/cm2 (mean+/-S.D.), 29.7+/-12.5mJ/cm2, respectively. MED and MMD of Waldmann UV 800 are 70.8+/-28.5mJ/cm2 and 91.2+/-33.1mJ/cm2, respecively. The most frequent MED by Burdick UV-800 is 10mJ/cm2 and those by Waldmann UV 800 are 50m J/cm2 and 60m J/cm2. CONCLUSION: In this study MED and MMD of young adult Koreans by two kinds of UVB light sources were assessed. The RESULTS: how that MED is less than MMD and the levels of MED under which the photosensitivity is suggested are 5.6mJ/cm2 by Burdick UV-800 anr 32.4mJ/cm2 by Waldmann UV 800.