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Background and Objectives@#The purpose of this study is to evaluate value of diagnostic tool for vocal cord palsy utilizing artificial intelligence without laryngoscopeMaterials and Method A dataset consisting of recordings from patients with unilateral vocal cord paralysis (n=54) as well as normal individuals (n=163). The dataset included prolonged pronunciations of the vowels /ah/, /u/, /i/, and vocal cord data from paralyzed patients. Various acoustic parameters such as Mel-frequency cepstral coefficients, jitter, shimmer, harmonics-to-noise ratio, and fundamental frequency statistics were analyzed. The classification of vocal cord paralysis encompassed paralysis status, paralysis degree, and paralysis location. The deep learning model employed the leave-one-out method, and the feature set with the highest performance was selected using the following methods. @*Results@#Vocal Cord Paralysis Classifier: The classifier accurately distinguished normal voice from vocal cord paralysis, achieving an accuracy and F1 score of 1.0. Paralysis Location Classifier: The classifier accurately differentiated between median and paramedian vocal cord paralysis, achieving an accuracy and micro F1 score of 1.0. Breathiness Degree Classifier: The classifier achieved an accuracy of 0.795 and a mean absolute error of 0.2857 in distinguishing different degrees of breathiness. @*Conclusion@#Although the small sample size raises concerns of potential overfitting, this preliminary study highlights distinctive acoustic features in cases of unilateral vocal fold paralysis compared to those of normal individuals. These findings suggest the feasibility of determining the presence, degree, and location of paralysis through the utilization of acoustic parameters. Further research is warranted to validate and expand upon these results.
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We report a case of ruptured mycotic aneurysm involving innominate artery requiring an urgent surgical treatment. A 62-yr-old woman presented with fever and dyspnea. Previously, she was diagnosed with colon cancer and received right hemicolectomy and one cycle of adjuvant chemotherapy. On echocardiogram, pericardial effusion was noted and emergency pericardiocentesis was performed. CT scan revealed aortic aneurysm involving ascending aorta and innominate artery, and thrombi surrounding those structures. Patch repair of the defect in the ascending aorta and ringed Goretex graft to bypass the innominate and ascending aorta were performed. We believe that this is the first case of ruptured mycotic aneurysm involving innominate artery.
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Femenino , Humanos , Persona de Mediana Edad , Aneurisma Infectado/cirugía , Aorta/patología , Aneurisma de la Aorta/cirugía , Tronco Braquiocefálico/patología , Neoplasias del Colon/tratamiento farmacológico , Tomografía Computarizada por Rayos X , TrasplantesRESUMEN
BACKGROUND: Several risk factors of atherosclerosis have been known. However, many patients have been experienced coronary heart disease without known risk factors of atherosclerosis, and it has been suggested that some kinds of infections may be associated with atherosclerosis as risk factors. Among many candidate infectious agents, Chlamydia pneumoniae (Cp) has been showing a positive relationship with atherosclerosis. Therefore, we investigated massive serologic study using a ELISA for detection of Cp to identify the relationship with atherosclerosis as a risk factor. METHODS: Serologic tests were done in patients who were performed coronary angiogram among patients with typical symptoms of angina and with positive results in non- invasive test (EKG, Treadmill) from May 1997 to September 1998. Among them, patients with luminal narrowing of more than 50% in at least one vessel were grouped into 'Case group (Group I)' and patients with normal coronary arteries or minimal lesion were grouped into 'Positive control group(Group II)'. We also studied healthy persons, as a 'Negative control group (Group III), who had not experienced any symptoms related with coronary heart disease and had normal EKG findings. Serologic tests for Cp-IgG and Cp-IgA were performed by ELISA. RESULTS: There was no statistical difference in seropositive rate between Group I and II, but seropositive rate of Group III was statistically lower than those of Group I or II for Cp-IgG, Cp-IgA, and both, respectively. But multivariate analysis by using logistic regression showed no statistcal differences between groups. Subgrouping by several traditional risk factors, seropositive rate for Cp-IgG and both IgG and IgA, was significantly different between Group I and III in patients without traditional risk factors of atherosclerosis, such as, females, non-smokers, normotension, non-diabetes, normal cholesterol level, and high HDL-cholesterol level. For Cp-IgA, however, the difference was observed in normotension, non-diabetes, and in normal cholesterol level. In multivariate analysis, seropositive rate for Cp-IgG and both IgG and IgA was significantly different between Group I and III in females and non-smokers, but not for the Cp-IgA. CONCLUSIONS: These results suggest that Cp infection might be an independent risk factor of atherosclerotic coronary disease, particularly in patients without traditional risk factors of atherosclerosis. Further study with coronary tissue should be continued.
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Femenino , Humanos , Aterosclerosis , Chlamydia , Chlamydophila pneumoniae , Colesterol , Enfermedad Coronaria , Vasos Coronarios , Electrocardiografía , Ensayo de Inmunoadsorción Enzimática , Inmunoglobulina A , Inmunoglobulina G , Modelos Logísticos , Análisis Multivariante , Fenobarbital , Factores de Riesgo , Estudios Seroepidemiológicos , Pruebas SerológicasRESUMEN
The purpose of this study was to visualize the spatial patterns and connection of channels created after percutaneous transmyocardial revascularization (PTMR) in normal porcine hearts, and to estimate the relative contributions of transmyocardial and coronary perfusion. Six pigs underwent PTMR creating channels using radiofrequency ablative energy. Three-dimensional computed tomography imaging of channels 1 hr after PTMR showed the direct connection of PTMR channels to the myocardial capillary network and to epicardial coronary vessels. In the heart, examined 28 day after PTMR, there was a fine, extensive, network of microvessels originating from the site of the original PTMR channel, also connecting the left ventricular cavity to myocardial capillaries. Histopathologic examination of the 1-hr specimens showed numerous regions of myocardial hemorrhage and associated inflammatory cell infiltration. In the 28-day specimens, newly developed new vascular network suggested neovascularization within the core of these channel remnants. The immunoreactivity for basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) were intense within myocardium and neovascular structure surrounding PTMR channel remnants. The vascular connections occur by direct communication with existing myocardial vasculature acutely, and angiogenesis in these channel remnant chronically.
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Animales , Angiografía Coronaria , Circulación Coronaria , Vasos Coronarios/patología , Corazón/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Aumento de la Imagen/métodos , Inmunohistoquímica , Revascularización Miocárdica/métodos , Miocardio/patología , Neovascularización Patológica/diagnóstico por imagen , Neovascularización Patológica/patología , Perfusión , Porcinos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Surgical correction of patent ductus arteriosus (PDA) is relatively safe and effective since it does not remain in the category of open-heart-surgery. Although the surgical practice for PDA is performed in almost all hospitals, they contain the problems of anxiety of patients, remained surgical wounds on patients' chests and complications of surgery and general anesthesia. Recently non-surgical methods for the obstruction of PDA have been developed and some of them including buttoned devices are used now. The success rates of these methods approach to 84%. But the problems of embolization, incomplete closure, hemolysis, stenosis of aorta and left pulmonary artery have been reported. We invented new PDA occluder , using stainless steel wire and polyurethane foam. Therefore we investigated the efficacy of occluding blood flow with the new PDA occluder in the vessels of experimental animals. METHOD: Using 304 stainless steel wire which is self-expandable stent, two star-shaped frames were made, each frame forming cone and facing the other's tip. And in the center of the frames polyurethane foam was inserted. 316L stainless steel wire was used to fix the elements described above and some portion of the wire was extracted outside of the frames, shaping hook or round loop with which the occluder could be pulled out in case of misplacement. To create the similar situation to PDA, we made shunts from artery to vein between carotid arteries and jugular veins with surgical bypass grafts or made shunts of direct artery to vein connections without grafts in 4 dogs and 1 pig. Through 8F sheath, we deployed the occluders into the shunts made of 5 grafts or made of 3 arterial ends. Also the occluders were inserted into the femoral artery of dog and iliac artery of pig. After deployment of occluders, angiograms were performed to obscure the efficacy of blocking blood flow and follow-up angiogrms were done in one and two weeks. The animals were sacrificed in one and two weeks to get the tissues including occluders inside. Gross findings were checked about thrombi formation in and around polyurethane foam. RESULTS: The 10 occluders were placed successfully except one site due to misplacement. The occluders successfully blocked the blood flows in all 10 sites within 3 - 60 minutes. Each follow-up angiogram for occluders in one and two weeks revealed good maintenance of blockade in blood flow. Observed gross findings on tissues were packed thrombi formation in the polyurethane foam and membrane formation along the occluder. CONCLUSIONS: This newly developed device revealed good efficacy for occlusion of blood flow including shunts in immediate and follow-up study. Practical method for the delivery of the device and some design modification for proper fitting into the PDA especially for small patients would be required. Longer period of follow-up with more animal experiments for other possible complications including distal embolization would be required also before clinical trial.
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Animales , Perros , Humanos , Anestesia General , Experimentación Animal , Ansiedad , Aorta , Arterias , Arterias Carótidas , Constricción Patológica , Conducto Arterioso Permeable , Arteria Femoral , Estudios de Seguimiento , Hemólisis , Arteria Ilíaca , Venas Yugulares , Membranas , Poliuretanos , Arteria Pulmonar , Acero Inoxidable , Stents , Tórax , Trasplantes , Venas , Heridas y LesionesRESUMEN
Migration of roundworms, Ascaris lumbricoies, into the biliary tract is a relatively common cause of biliary symptoms in endemic areas, but the number of reported gallbladder ascariasis was scanty even in these areas. Some diagnostic methods might provide suggestive informations, but there are no pathognomonic clinical features for biliary ascariasis, so it is discovered usually after surgical exploration, which is especially the case of gallbladder ascariasis. A young female patient with 4 months' history of right upper quadrant pain which did not respond to medical control and was aggravated recently, presented normal level of peripheral blood leukocyte count with no eosinophilia, normal liver function test, normal serum amylase level and subjectively no febrile sense. Abdominal ultrasonogram disclosed a long, thick, linear, non-motile echogenic structure, not accompanied by acoustic shadowing, within the gallbladder. The intra-and extra-hepatic bile ducts were not dilated and the pancreas was revealed as normal echogenecity and contoru. Endoscopic retrograde cholangiopancreatography was performed immediately thereafter, and it showed a thin linear filling defect in the gallbladder. Cholecystectomy was performed under the impression of gallbladder ascariasis. A mummified Ascaris lumbricoides was found in the lumen of the gallbladder. There was no stones and the histologic examination of the gallbladder revealed chronic cholecystitis.
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Femenino , Humanos , Acústica , Amilasas , Ascariasis , Ascaris , Ascaris lumbricoides , Conductos Biliares , Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Colecistitis , Eosinofilia , Vesícula Biliar , Recuento de Leucocitos , Pruebas de Función Hepática , Páncreas , Técnica Histológica de Sombreado , UltrasonografíaRESUMEN
Migration of roundworms, Ascaris lumbricoies, into the biliary tract is a relatively common cause of biliary symptoms in endemic areas, but the number of reported gallbladder ascariasis was scanty even in these areas. Some diagnostic methods might provide suggestive informations, but there are no pathognomonic clinical features for biliary ascariasis, so it is discovered usually after surgical exploration, which is especially the case of gallbladder ascariasis. A young female patient with 4 months' history of right upper quadrant pain which did not respond to medical control and was aggravated recently, presented normal level of peripheral blood leukocyte count with no eosinophilia, normal liver function test, normal serum amylase level and subjectively no febrile sense. Abdominal ultrasonogram disclosed a long, thick, linear, non-motile echogenic structure, not accompanied by acoustic shadowing, within the gallbladder. The intra-and extra-hepatic bile ducts were not dilated and the pancreas was revealed as normal echogenecity and contoru. Endoscopic retrograde cholangiopancreatography was performed immediately thereafter, and it showed a thin linear filling defect in the gallbladder. Cholecystectomy was performed under the impression of gallbladder ascariasis. A mummified Ascaris lumbricoides was found in the lumen of the gallbladder. There was no stones and the histologic examination of the gallbladder revealed chronic cholecystitis.
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Femenino , Humanos , Acústica , Amilasas , Ascariasis , Ascaris , Ascaris lumbricoides , Conductos Biliares , Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía , Colecistitis , Eosinofilia , Vesícula Biliar , Recuento de Leucocitos , Pruebas de Función Hepática , Páncreas , Técnica Histológica de Sombreado , UltrasonografíaRESUMEN
No abstract available.
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BACKGROUND: As an antihypertensive drug, Nifedipine, a calcium channel blocker was introduced recently, which also has antianginal effect. But due to the relatively short duration of action, another antihypertensive agents having longer duration of action and stronger hypertensive effect were under investigation. Nilvadipine, a new calcium channel blocker, was introduced to have more prologned duration of action and to act more specifically on vascular smooth muscle. So the efficacy and safety of oral Nilvadipine on essestial hypertension was investigated and represented by our institute. METHODS: In order to investigate the efficacy and safety of oral Nilvadipine, daily doses of 4mg twice a day were administered in 30 hypertensive patients whose states were compatible to the criteria : 1) severity of hypertension rated in Stage I and Stage II according to the classification by WHO, 2) ages ranging from 30 to 74 years regardless of sex, 3) blood pressure with 95mmHg or higher but less than 115mmHg in diastolic pressure which was the mean in a sitting position at the last two out of not less three consultations in the 2 week observation period, 4) outpatients with informed consent for 6 weeks. Blood pressure and heart rate were measured every 2 weeks. The complete with blood count with platelet, uronalysis and the electrocardiography were performed at the beginning period and the 6th weeks of therapy. And kinds of side effects were questioned by examining physicians. RESULTS: The following results were obtained : 1) Blood pressure fell significantly in 6 weeks of treatment with Nilvadipine(Mean pressure+/-S.D., 6.00mmHg vs 108.90+/-9.68mmHg p<0.05), 2) There was no significant change in EKG in 6 weeks of treatment with Nilvadipine, 3) Pulse rate was decreased in 6 weeks of treatment with Nilvadipine(80.14+/-11.90/min vs 75.39+/-6.47/min, p<0.05). 4) No significant chsange in body weight was observed(64.50+/-8.7kg vs 63.50+/-10.25kg, p<0.05). 5) There were no significant changes in blood chemistry including blood sugar, cholesterol, electrolytes, serum creatinine and alkaline phosphatase values, 6) Hematologic findings and urinalysis findings reamained unchanged, 7) Total 10 patients(33.30%) had various side effects;facial flushing 30.00%, palpitation 23.33%, headache 20.00%, nausea 10.00%, drowsiness 3.33%, heaviness 3.33% and indigestion 3.33%. But there was no serious side effect that requires to discontinue the medication of the test drug. And there was no need to reduce the dosage due to the side effect, 8) The antihypertensive effect was judged to decrease markedly in 76.70%, decrease 20.00%, unchange 3.30% and increase 0.00%, 9) The utility which was assessed with the data from the overall safety and antihypertensive effect, the drug was judged to be very useful in 60.00%, useful 33.30%, useless 6.67% and inhibited 0.00%. CONCLUSION: From the above results, Nilvadipine in doses of 4mg twice a day was effective and useful in most cases without severe side effects in essential hypertensive patients with diastolic blood pressure of 95 to 115mmHg.