This investigation was performed to evaluate Doppler mitral valve flow velocity profiles in hypertensive heart disease for the detection of the left ventricular diastolic dysfunction which preceded the systolic dysfunction. Doppler derived parameters included; the duration of the early diastolic flow velocity peak(DF duration), the downward slope of the early diastolic flow velocity peak (EF slope) and the ratio between the height of the early and the late diastolic flow velocity peak (E-E'/A-A'). Doppler flow velocity profiles were measured in 19 normotensive subjects and 28 hypertensive patients. We found decreased EF slope in hypertensive patients (3.6+/-1.4./sec) in comparison with normotensive subjects (5.2+/-2.4m/sec) (p<0.01). In hypertensive patients, E-E'/A-A' value was significantly lower (0.8+/-0.2) than that of normotensive subjects (1.6+/-0.4)(p<0.001). DF duration was similar in both groups. In conclusion, we found that Doppler mitral valve flow velocity profiles, EF slope and E-E'/A-A', were decreased in hypertensive patients, which may be due to the left ventricular diastolic dysfunction.
Echocardiography* ; Heart Diseases ; Humans ; Hypertension* ; Mitral Valve*

We expirenced multiple hepatocellular adenomatosis, which was proved by pathology, in 38 years old man who had no prior history of predisposing factors. The radiologic findings were different by the size of tumor mass and intratumoral hemorrhage. Ultrasound demonstrated inhomogeneous hyperechoic large mass in segment 5 of right lobe and hyperechoic or isoechoic multiple small nodules in right lobe. Computed tomography demonstrated low density mass without contrast enhacement. Central high density is noted in hemorrhagic portion. Magnetic resonance T1-weighted image demonstrated high signal intensity in mass and hemorrhagic portion. T2-weighted image demonstrated slightly high signal intensity in mass portion, high signal intensity in hemorrhagic portionand double-layered peripheral rim. Gradient echo image well demonstrated inhomogenesity of mass.
Causality ; Hemorrhage ; Pathology ; Ultrasonography

PURPOSE: To describe the angiographic findings of patients with recurrent hemoptysis after bronchial artery embolization (BAE) according to the point at which relapse occurred. MATERIALS AND METHODS: From 125 patients who underwent BAE due to hemoptysis between 1996 and 2000, we selected 18 of 23 who underwent additional BAE due to recurrent bleeding after initial BAE . Depending on the point at which relapse occurred, they were divided into two groups (I and II, according to whether additional BAE was performed within two weeks of initial BAE or more than two weeks after this). We retrospectively compared the two groups in terms of angiographic findings, number of embolized arteries, and character of feeding arteries at initial and additional BAE. RESULTS: Nine patients in group I (additional BAE: n=10) and nine in group II (additional BAE: n=13) were admitted for recurrent hemoptysis within two weeks of initial BAE and more than two weeks after this, respectively. In group I(n=29) and II(n=31), angiography demonstrated two direct and 27 indirect, and two direct and 29 indirect signs of hemorrhage, respectively. No statistically significant differences were observed (x2=0.005, p=0.945). Among the embolized feeder ressels in group I (n=30) there were 20 bronchial artery and 10 non bronchial systemic collaterals, while for group II(n=35), the corresponding totals were 21 and 14. Again, no statistically significant differences were encountered(x2=0.308; p=0.579). In group I, feeders were newly developed in one case(10%), previously embolized in five(50%), and missed in four(40%), while in group two the corresponding figures were none, twelve(92.3%), and one(7.7%). No significant differences were noted, though the incidence of previously embolized feeders in Group II was very high (x2=5.383, p=0.068). CONCLUSION: Among patients in whom hemoptysis after BAE recurred at different times, the angiographic findings and number of embolized arteries were not significantly different, but differences in the nature of the feeder were noted. Patients in whom hemoptysis recurred more than two weeks after BAE showed more recanalization of previously embolized feeders than those in whom there was recurrence within two weeks.
Angiography ; Arteries ; Bronchial Arteries ; Hemoptysis* ; Hemorrhage* ; Humans ; Incidence ; Recurrence ; Retrospective Studies

Extramedullary plasmacytomas (EMPs) are rare, low-grade and malignant transforming solitary tumors consisting of neoplastic plasma cell proliferation that occurs in the bones of the head and neck. Ninety percent of solitary EMPs occur in the head and neck region: these constitute, however, less than 1% of all head and neck malignancies. EMPs represent up to 4% of nonepithelial lesions of the upper respiratory tract. On initial presentations, they must be differentiated from multiple myeloma. At first, EMPs are frequently seen as masses or swellings, accompanied by nasal or pharyngeal symptoms. EMPs are of special interest to otolaryngologists, because the majority of these unusual tumors are present in soft tissues of the head and neck. We present the patient with EMPs of tonsil and adenoid and discuss the related literature on the presentation, epidemiology, workup and management of patient with this rare neoplasm.
Adenoids* ; Epidemiology ; Head ; Humans ; Multiple Myeloma ; Neck ; Palatine Tonsil* ; Plasma Cells ; Plasmacytoma* ; Respiratory System

Spontaneous esophageal perforation (Boerhaave Syndrome) is an unusual condition that frequently leads to fatal complications. It typically occurs with rigorous emesis after an unduly large meal or heavy drinking. Its diagnosis is often delayed in almost all cases due to nonspecific symptoms and signs, resulting in increased morbidity and mortality. Therefore early diagnosis and appropriate treatment are very important. Recently we experienced a case of esophagogastric junctional perforation accompanied by bilateral empyema and mediastinitis after heavy alcohol drinking in a 56-year-old male patient. He was presented with hematemesis and abdominal pain. We diagnosed him using esophagography and chest CT. Thus, we report a case with a brief review of related literatures.
Abdominal Pain ; Alcohol Drinking ; Alcoholics* ; Diagnosis ; Drinking ; Early Diagnosis ; Empyema* ; Esophageal Perforation ; Hematemesis ; Humans ; Liver Cirrhosis, Alcoholic* ; Lung* ; Male ; Meals ; Mediastinitis ; Middle Aged ; Mortality ; Tomography, X-Ray Computed ; Vomiting

PURPOSE: Among complications after the tension-free vaginal tape(TVT) procedure for female stress urinary incontinence, the voiding dysfunction is one of the most common complaints of the patients. The aim of the study was to assess the incidence of objective voiding dysfunction and evaluate the clinical, uroflometric and urodynamic risk factors predisposing to voiding dysfunction following the TVT procedure. MATERIALS AND METHODS: 437 women with stress urinary incontinence underwent the TVT procedure in our institution for recent three years. Among them, 285 patients with post-operative uroflowmetry were evaluated. Objective voiding dysfunction was defined as a peak-flow rate less than 12 ml/sec(voided volume greater than 100 ml), or inability to void at least 75% of bladder capacity, on two or more readings. Clinical and urodynamic parameters and global satisfaction were analyzed and compared between patients(objective voiding dysfunction, n=33, 11.6%) who had uroflowmetric parameters of voiding difficulties after TVT procedure and patients(well- voiding, n=252, 88.4%) who had not. RESULTS: Two hundred sixty-one patients (91.6%) answered satisfied by global satisfaction questionnaire. Subjective and objective cure rates were 93.9% and 90.9% at least 6 months follow-up. Among parameters, patient's age, peak-flow rate, and 1 hour pad test showed significant differences between voiding dysfunction group and well-voiding group(average age: 54.9 vs 50.9 years-old, p=0.024, peak urinary flow rate: 30.9 vs 24.1 ml/sec, p=0.003, 1 hour pad test: 53.8 vs 81.6 gm, p=0.035). There was no statistically significant difference in subjective and objective cure rates and satisfaction rates between the two groups. CONCLUSIONS: Women with the old age, low peak urinary flow rate, and large volume with 1 hour pad test are most likely to have voiding dysfunction after TVT procedure. Patients with these risk factors should be given more counsel regarding post-operative voiding dysfunction before the surgery.
Female ; Follow-Up Studies ; Humans ; Incidence ; Surveys and Questionnaires ; Reading ; Risk Factors* ; Suburethral Slings* ; Urinary Bladder ; Urinary Incontinence ; Urodynamics

PURPOSE: It has been stressed that age itself as well as multiple organ failure are important prognostic factors in acute renal failure (ARF) in children. This study was performed to find out the significance of age factor and underlying disease of ARF in children. METHODS: We tried to review 58 pediatric ARF cases, retrospectively, in the pediatric intensive care unit (excluding the neonatal and surgical intensive care unit cases) of the Samsung Seoul Hospital of Sung Kyun Kwan University from Sept., 1994. to Dec., 1996. RESULTS: We classified the enrolled 58 cases into 5 age groups and more than half were younger than 1 year old. As underlying causes, heart and gastrointestinal disease were predominant in less than 1 month of age group. After 1 year of age, intrinsic renal disease was the most common cause (43-50%). Among the renal disease, systemic lupus erythematosus (10-15 year group), hemolytic uremic syndrome (1-10 year group), and obstructive uropathy (less than 1 year age group) were common etiologies. The mortality was the highest (46.7%) in less than 1 year group and lowest (21.4%) in 10-15 year age group. CONCLUSION: The underlying disorders of ARF in children were different among the age group. Among intrinsic renal diseases, hemolytic uremic syndrome was the most common cause. The difference in the mortality was dependent on age and underlying disease.
Acute Kidney Injury* ; Age Factors ; Child* ; Gastrointestinal Diseases ; Heart ; Hemolytic-Uremic Syndrome ; Humans ; Critical Care ; Intensive Care Units ; Lupus Erythematosus, Systemic ; Mortality ; Multiple Organ Failure ; Retrospective Studies ; Seoul

BACKGROUND: The previous studies suggested that the rate of the people who reported having sensitivity to cold and Raynaud's disease were 12% and 5~10% of general population respectively. There are surprisingly few data on 'cold hands and feet syndrome', the conventional circulatory disorder in far-eastern Asia in spite of the assumption that it is a common disorder among Korean population. Besides, the prevalence of Raynaud's disease has not been studied for Korean complaint of the syndrome. Therefore, we conducted the survey regarding the frequency of Baynaud's disease and phenomenon among the people appealed abnormal sensory symptoms on hands and feet, and 'cold hands and feet syndrome'. METHODS: The questionnaires were asked to 1,008 out- patients who complained abnormal sensory symptoms on hands and feet. The subjects were screened among the patients who visited the clinics, mainly department of family medicine in Uijongbu St. Mary's hospital from January to July 2003. RESULTS: The most common abnormal sensory symptoms were tingling feeling and coldness, pain in the descending order. The mean age of the patients is 47 years, the average age at the onset of the symptoms is 40 years, and the mean duration they had been suffered by the symptoms is 7 years. During interview, 289 patients voluntarily appealed 'cold hands and feet syndrome' in expression of "I have cold extremities" or "I have the syndrome". Among the screened patients, 510 patients answered, "yes" to the question "Are your fingers unusually sensitive to cold?" Two hundred and nineteen patients (43%) of them showed Raynaud's phenomenon. One hundred and sixty patients were diagnosed as Raynaud's disease among 219 patients who had Raynaud's phenomenon. The rest 59 patients were diagnosed as secondary Raynaud's phenomenon. Eighty-seven patients (30%) of 289 patients who voluntarily reported 'cold hands and feet syndrome' were diagnosed as Raynaud's disease. The average age of Raynaud's disease patients is 37 years old, average first attack age is 24 years, and average suffering period is 14 years. Only 10% of cases experienced the first attacks after 40 years old. The attack rates are different by gender. The ratio is 2.3 and higher in female. Only six patients (4%) of Raynaud's disease had been diagnosed accurately. Fifty-three patients (33%) have family history and 41 of them are the first-degree relatives. The causes of secondary Raynaud's phenomenon (59 patients) are connective tissue disorders, neurologic diseases, carpal tunnel syndrome, hypothyroidism, vascular disorders, etc. The statistically significant factors that influence on Raynaud's disease are female, below 40 years old, stress, family history, hypertension, diabetes, etc. The statistical analysis in this study does not prove the association between the disease and the factors such as physical labor, manual labor using hands heavily, smoking, drinking, thyroid diseases, joint disorders, ischemic heart disease, depression. CONCLUSION: Raynaud's disease has been underlooked even though it is not uncommon and can be easily diagnosed and treated. In conclusion, the result of our study suggests that abnormal sensory symptoms on hands and feet, especially 'cold hands and feet syndrome', the conventional circulatory disorder, are the medical condition where special concern on Raynaud's disease is required.
Adult ; Asia ; Carpal Tunnel Syndrome ; Connective Tissue ; Depression ; Diagnosis* ; Drinking ; Female ; Fingers ; Foot* ; Hand* ; Humans ; Hypertension ; Hypothyroidism ; Joints ; Myocardial Ischemia ; Nervous System Diseases ; Prevalence ; Raynaud Disease* ; Sensation* ; Smoke ; Smoking ; Thyroid Diseases ; Surveys and Questionnaires

BACKGROUND: The t (8; 21) (q22; q22), which produces the fusion gene AML1/ETO, is associated with relatively good prognosis and, in particular, with a good response to cytosine arabinoside. Analysis of t (8; 21) positive leukemic blasts has shown characteristic morphological and immunological features. We performed this study to investigate the incidence of AML1/ETO rearrangement in adult acute myelogenous leukemia (AML), especially in M2 subtype, to make a comparison of clinical, morphological and immunophenotypic characteristics between AML1/ETO rearrangement positive and negative group in patients with AML and to analyze the correlation with other biological parameters. METHODS: From May 1995 to Sept. 2000, fifty-nine patients with AML, including twenty-nine AML-M2, were studied. RNAs were extracted from leukemic cells and reverse transcriptase mediated polymerase chain reaction (RT-PCR) for AML1/ETO fusion transcript was done. Chromosome study, immunophenotypic and clinical characteristics were analyzed and statistical analysis was done. RESULTS: The incidence of AML1/ETO fusion transcripts was 22.0% in AML and 44.8% in AML-M2. The morphologic finding of bone marrow in AML-M2 showed higher incidence of Auer rods, large blast with prominent golgi and abnormal granules in AML1/ETO positive patients. There was no significant difference of immunophenotype. AML patients with AML1/ETO had a tendency of higher complete remission rate (81.8% vs 56.6%, p=0.13). The overall survival (median; 82.2 weeks vs 34.4 weeks, p=0.02) and progression free survival (median; 50.9 weeks vs 20.4 weeks, p=0.02) of AML1/ETO positive group were longer than those of the negative group in AML. AML-M2 patients with AML1/ETO rearrangement had also a tendency of longer overall survival and progression free survival, although there was no significant difference between both groups. CONCLUSION: Our data suggest that AML1/ETO rearrangement is detected frequently in AML, especially M2, and is a favorable prognostic factor. Thus, molecular diagnostic approaches should be used routinely to identify patients with this genetic subtype of AML.
Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/administration & dosage ; Base Sequence ; Cohort Studies ; Confidence Intervals ; Core Binding Factor Alpha 2 Subunit ; Female ; *Gene Expression Regulation, Leukemic ; *Genetic Predisposition to Disease ; Humans ; Leukemia, Myeloid, Acute/drug therapy/*genetics/*mortality ; Male ; Middle Aged ; Molecular Sequence Data ; Oncogene Proteins, Fusion/*genetics ; Prognosis ; Prospective Studies ; Reference Values ; Reverse Transcriptase Polymerase Chain Reaction/methods ; Sensitivity and Specificity ; Statistics, Nonparametric ; Survival Analysis ; Transcription Factors/*genetics ; Translocation, Genetic ; Treatment Outcome

BACKGROUND: Essential thrombocythemia (ET) is thought to reflect transformation of a multipotent hematopoietic stem cell, but its molecular pathogenesis remains obscure. But tyrosine kinase, especially Janus kinase 2 (JAK2), has been implicated in myeloproliferative disorders other than chronic myeloid leukemia. We investigated the frequency of JAK2 mutation and its correlation with other clinicopathologic variables in Korean patients with ET and reactive thrombocytosis (RT). METHODS: JAK2 mutation analysis was performed on genomic DNA from bone marrow aspirates of 24 patients with ET and peripheral blood in 36 patients with RT using allele-specific PCR. RESULTS: JAK2 mutation was detected in 11 patients (46%) among the 24 patients with ET and was not found in 36 patients with RT. In patients with ET, older age and leukocytosis were related with JAK2 mutation without statistical significance (P=0.172 and 0.094, respectively). But this mutation was not correlated with sex, hemoglobin, platelet count, splenomegaly, increased cellularity of bone marrow, bone marrow fibrosis and vascular complications. CONCLUSIONS: The current observation strengthens the specific association between JAK2 mutation and ET. At the diagnosis of ET in Korean patients, identification of JAK2 mutation should be incorporated in the basis for new approaches.
Aged ; Alleles ; Amino Acid Substitution ; Blood Platelets/metabolism ; Female ; Humans ; Janus Kinase 2/*genetics ; Korea ; Male ; Middle Aged ; Polymerase Chain Reaction ; Thrombocytosis/blood/*diagnosis/genetics