BACKGROUND: It is well known that intracoronary thrombolysis during the early period of acute myocardial infarction leads to the limitation of myocardial necrosis, preserves left ventricular function, and improves survivals. The recanalization rate of intracoronary rrokinase infusion into infarct-related coronary artery was known as 62-94 percents in previos studies. The various factors influence the outcome of intracoronary thrombolysis, including total dose of urokinase, time from onsrt of chest pain to thrombolysis. The purpose of this study was to evaluate whether the occlusion site morphology influences recanalization rates of intracoronary thrombolysis. METHODS: We evaluated infarct-related coronary artery morphology of 56 acute mycardial infarction patients who performed intracoronary thrombolytic therapy within 6-12 hours after the onset of acute myocardial infarction. Intracoronary urokinase infusion was performed at a rate of 25000 IU/minute. The presence of calcification, collaterals, side branches and the stump site morphologies(thrombus type, pencil type, cutting type) were identified on magnified 35mm cine frames. RESULTS: Reperfusion was successed in 34 patients and failed in 22 patients. There were no statistically significant difference in the pressure of calcification, collaterals, and side branches between success and failure groups. Intracoronary thrombus was identified in 21 percent of success group, but not in failure group. The reperfusion rates according to stump site morphology were 76% in thrombus type, 58% in cutting type, and 42% in pencil type(p<0.05). CONCLUSION: Our study indicates the presence of intracoronary thrombus and the morphology of thrombus type is more effective in intracoronary thrombolysis in acute myocardial infarction. The identification of types of the coronary obstruction will be helpful for the selection of intracoronary thrombolysis in acute myocardial infarction patients. And the results suggest that the difference of stump composition show different stump morphologies.
Chest Pain ; Coronary Vessels* ; Humans ; Infarction ; Myocardial Infarction* ; Necrosis ; Reperfusion ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

Since the first report of completely amputated thumb replantation by Tamai in 1965, replantation surgery has been popularized with increasing success rate and improving functional regain. Recently, difficult replantation such as traction avulsion amputation has been challenged and good success rate and function have been reported. We have analized 34 cases of upper extremity and finger replantation in 23 patients, which were performed at the Dept. of Orthopedic surgery. Hyun Dai Hae Seong Hospital, Ulsan, Korea, from June 1982 to January 1986. The results were as follows: 1. Male patients were 22, female was 1, left upper limbs and digits injuries were more prevalent(16: 7), and average age was 25 years old. 2. The most common injury was done by cutting machine. 3. The number of amputations of fingers were almost same in all fingers and most prevalent in zone III(26 cases, Danial classification). 4. Success rate of replantation was 82.4% In cases of less than 6 hrs ischemic time, the rate was 93.4%, and more than 6 hrs ischemic time, rate was 33.3% 5. Performing arterial anastomosis prior to venous anastomosis, can find out main draining vein, and with one vein and one artery anastomosis, can get good results distal to zone IV. 6. Functional results were satisfactory, evaluating by modified. Tamai score, average 87.5. 7. 6 cases of digital replantations distal to sublimis tendon insertion have good results functionally, cosmetically and technically easy (Tamai score 98). 8. 5 cases of traction avulsion amputations needed many additional surgery to restore function, but end results were relatively satisfactory.
Amputation ; Arteries ; Clinical Study ; Female ; Fingers ; Humans ; Korea ; Male ; Orthopedics ; Replantation ; Tendons ; Thumb ; Traction ; Ulsan ; Upper Extremity ; Veins

Cervical pregnancy is a rare and dangerous form of ectopic pregnancy in which the blastocyst implants within the cervical canal below the internal os of the uterine cervix. The characteristic clinical sign is a severe asymptomatic uterine bleeding in early pregnancy or during curettage. Most cervical pregnancies result in early spontaneous abortion, complicated by severe hemorrhage from the eroded blood vessels within the cervical tissue. Because of uncontrolled profuse vaginal bleeding, total hysterectomy has been the mostly necessitated to control life-threatening bleeding. Transvaginal sonography allows early diagnosis, and conservative treatment (two-time treatment : first treatement with systemic or intraamnionic methotrexate, secondly with curettage or ligature of the uterine arteries) improves the patient's fertility. Successful treatment is defined as elimination of the cervical pregnancy with preservation of the uterus. We report two cases of cervical pregnancy managed, successfully with methotrexate, leucovorin and curettage.
Abortion, Spontaneous ; Blastocyst ; Blood Vessels ; Cervix Uteri ; Curettage ; Cytochrome P-450 CYP1A1 ; Early Diagnosis ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Leucovorin ; Ligation ; Methotrexate ; Pregnancy* ; Pregnancy, Ectopic ; Uterine Hemorrhage ; Uterus

BACKGROUND: Despite extensive investigation, the clinical features and prognostic significance of the non-Q wave myocardial infarction, when compared with Q wave myocardial infarction, remain controversial. And no definite relationship between EKG findings and infarct related arteries has been reported. METHOD: A retrospective analysis was done on 205 patient with acute myocardial infarction who were undergone coronary angiography and left ventriculography. Among them, 30 patient with non-Q wave myocardial infarction and 175 patients with Q wave myocardial infarction. RESULTS: 1) There was no significant difference between the two groups in risk factors, prevalence of preinfarct angina and preinfarct heart failure. 2) The faction of patients with non-Q wave myocardial infarction who received thromobolytic therapy was significantly less, compared to patient with Q wave myocardial infarction(p<0.0001). 3) The patients with non-Q wave myocardial infarction had a smaller infarct size estimated by peak creatine phosphokinase(p<0.01). But there was no difference in Killip's classification and left ventricular ejection fraction. 4) In patients with non-Q wave myocardial infarction, 87% of the patients had one or more abnormal EKG finding other than Q wave, and the most frequent abnormal finding was primary T wave change. 5) The location of infarct-related artery was significantly different between group(p<0.0001). The most frequently involved coronary artery in non-Q wave myocardial infarction was left circumflex coronary artery, especially in patients with normal EKG findings. 6) There was no significant difference between the two groups in the prognosis. CONCLUSION: There were significant differences between non-Q wave and Q wave myocardial infarction in the infarct size and the location of infarct related arteries. but not in the risk factors, the prevalence of previous coronary artery disease and prognsis. Further prospective and collaborative studies should be performed to define conclusion.
Arteries* ; Classification ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Creatine ; Electrocardiography* ; Heart Failure ; Humans ; Myocardial Infarction* ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors ; Stroke Volume

BACKGROUND AND OBJECTIVES: The myocardial protective effect of ischemic preconditioning is well known. However, the mechanism is remains unclear. The purpose of this study is to determine the role of adenosine, protein kinase C, KATP channel and the change of monophasic action potential duration on cardioprotective effect of ischemic preconditioning in cat. Materials AND METHODS: In this experiment, 66 cats were allocated into 7 groups:control (n=10), ischemic preconditioning (n=10), adenosine pre-treated (n=10), SPT (8-p-sulfophenyl theophylline) pre-treated (n=9), polymyxin B pre-treated (n=9), glibenclamide pre-treated (n=9) and nicorandil pre-treated (n=9) groups. Ischemic preconditioning was performed in ischemic preconditioning, SPT pre-treated, polymyxin B pre-treated and glibenclamide pre-treated groups by 3 episodes of 5 minutes ischemia and 10 minutes reperfusion. All animals were subjected to 40 minutes of ischemia and 40 minutes reperfusion. Monophasic action potential duration at 50% repolarization (MAP50) was measured in the ischemic and non-ischemic area respectively by epicardial probe throughout the experiment. The effect of ischemic preconditioning was determined by infarct size (% area at risk). RESULTS: Ischemic preconditioning, adenosine pre-treatment and nicorandil pre-treatment groups demonstrated a significant reduction in infarct size (26+/-4%, 25+/-4% and 34+/-8% infarction of the risk zone, respectively, p<0.01, p<0.01 and p<0.05 vs. control) with respect to control (41+/-8% infarction of the risk zone). However, pretreatment with SPT, polymyxin B or glibenclamide abolished the effect of ischemic preconditioning. Ischemic preconditioning group exhibited a significant reduction of MAP50 duration in the ischemic area during preconditioning;at the first preconditioning 128+/-11 msec vs. 144+/-10 msec control, at the second preconditioning 110+/-10 msec vs.147+/-10 msec control (p<0.01), at the third preconditioning 114+/-10 msec vs. 145+/-11 msec control (p<0.05). But, pretreatment with SPT, polymyxin B and glibenclamide prevented the reduction of MAP50 in the ischemic area during ischemic preconditioning. During 40 minutes ischemia, the shortening of MAP50 was more pronounced in the preconditioned group than in control group;at 5 minutes 112+/-13 msec vs. 124+/-10 msec control, at 10 minutes 89+/-12 msec vs. 133+/-11 msec control (p<0.05 ), at 20 minutes 93+/-12 msec vs. 136+/-11 msec control (p<0.05), and at 30 minutes 107+/-19 msec vs. 144+/-14 msec control (p<0.05). In adenosine pre-treated group, the MAP50 was significantly shortened than control group throughout 40 minutes occlusion period;at 5 minutes 90+/-8 msec (p<0.05), at 10 minutes 77+/-9 msec (p<0.05), at 20 minutes 92+/-8 msec (p<0.05), and at 30 minutes 103+/-8 msec (p<0.05). Nicorandil pretreatment pronounced the ischemic shortening of MAP50 in ischemic area and the effect was significant during early ischemic period;at 10 minutes 98+/-22 msec (p<0.05 vs. control). In pretreatment groups with SPT, polymyxin B or glibenclamide, the ischemic preconditioning of MAP50 measured in non-ischemic area was not significantly different compared with control group. MAP50 measured in ischemic area during reperfusion was not significantly different between groups. CONCLUSION: Based on this study, adenosine receptor-protein kinase C-KATP channel activation and monophasic action potential duration shortening during ischemia play an important role in myocardial protection during ischemic injury.
Action Potentials* ; Adenosine* ; Animals ; Cats* ; Glyburide ; Infarction ; Ischemia ; Ischemic Preconditioning* ; Nicorandil ; Phosphotransferases ; Polymyxin B ; Protein Kinase C* ; Protein Kinases* ; Receptors, Purinergic P1* ; Reperfusion

OBJECTIVES: Previous studies have reported an association between circadian preference and personality. Defense mechanism is unconscious ego process which deals with an individual's anxiety and is closely associated with one's personality. Our aim is to investigate the association between defense mechanism and circadian preference in medical students. METHODS: One hundred forty eight medical students (70 males, 78 females), aged 22 to 30, answered the Beck Depression Inventory-II, Morningness-eveningness Questionnaire, and Korean version of Defense Style Questinnaire. RESULTS: Consumption (beta=-0.262, p=0.001) and being a male (beta=0.175, p=0.031) were significant positive predictors of eveningness, while sublimation (beta=0.185, p=0.023) was a significant negative predictor of eveningness. CONCLUSION: Our study showed a relationship between specific defense mechanisms (i.e., consumption and sublimation) and eveningness in medical students, but it did not address whether the relationship is a causal one.
Anxiety ; Defense Mechanisms ; Depression ; Ego ; Humans ; Male ; Surveys and Questionnaires ; Students, Medical* ; Sublimation*

BACKGROUND: Confluent and reticulated papillomatosis(CRP), the least common of the cutaneous papillomatoses, is manifested by persistent papules that are confluent in center and reticulated at the periphery. Recently, many cases of CRP treated with minocycline have been reported. METHODS: Thirteen patients with CRP were included in this study. They were treated with various antibiotics, such as erythromycin, tetracycline, doxycycline, and minocycline. The patients have taken antibiotics twice a day for 4 weeks. They were followed-up at 4, 8, 12, and 16 weeks after treatment. We assessed about therapeutic effects, side effects, and recurrence, by phone 1 year after treatment. RESULTS: Of the total 13 patients, 9 patients had improved by more than 95% in response to various antibiotics therapy for 4 months. One patient had a mild adverse reaction and two patients symptoms recurred after 1 year follow-up. CONCLUSION: We recommended various antibiotics therapy as the first choice of treatment for CRP because those were safe, economic, and effective.
Anti-Bacterial Agents* ; Doxycycline ; Erythromycin ; Follow-Up Studies ; Humans ; Minocycline ; Papilloma* ; Recurrence ; Tetracycline

BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.
Aged ; Aging ; Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiovascular Diseases ; Cause of Death ; Chest Pain ; Coronary Disease ; Delivery of Health Care ; Diagnosis ; Hospital Mortality ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Pulmonary Edema ; Risk Factors ; Stroke ; Thrombolytic Therapy

Intrathoracic meningoceles are relatively rare entities found in patients with neurofibromatosis type I (NF1). Given that both the BRCA1 and NF-1 genes are located on the same long arm of chromosome 17, one would expect concurrence of neurofibromatosis and breast cancer. However, incidence of such co-disorders is very rare in the literature. Here, the authors report a case of a 50-year-old female patient with NF-1 and concurrent cancer of the left breast, who had a huge bilobulated intrathoracic meningocele with thoracic dystrophic scoliosis, treated surgically via a posterior-only approach for the meningocele and spinal deformity in the same setting.
Arm ; Breast Neoplasms* ; Breast* ; Chromosomes, Human, Pair 17 ; Congenital Abnormalities ; Female ; Humans ; Incidence ; Meningocele* ; Middle Aged ; Neurofibromatoses* ; Neurofibromatosis 1* ; Scoliosis

The intron has been a big biological mystery since it was first discovered in several aspects. First, all of the completely sequenced eukaryotes harbor introns in the genomic structure, whereas no prokaryotes identified so far carry introns. Second, the amount of total introns varies in different species. Third, the length and number of introns vary in different genes, even within the same species genome. Fourth, all introns are copied into RNAs by transcription and DNAs by replication processes, but intron sequences do not participate in protein-coding sequences. The existence of introns in the genome should be a burden to some cells, because cells have to consume a great deal of energy to copy and excise them exactly at the correct positions with the help of complicated spliceosomal machineries. The existence throughout the long evolutionary history is explained, only if selective advantages of carrying introns are assumed to be given to cells to overcome the negative effect of introns. In that regard, we summarize previous research about the functional roles or benefits of introns. Additionally, several other studies strongly suggesting that introns should not be junk will be introduced.
DNA ; Eukaryota ; Genome* ; Introns* ; RNA