BACKGROUND: Ventricular function is one of the important prognostic factors in patients with coronary artery disease. Among noninvasive approaches for the evaluation of ventricular performance, radionuclide ventriculo-graphy has shown to be of particular values in the patients with myocardial infarction. We have evaluated ven-tricular function with ECG-gated blood pool scan (GBPS) in patients with myocardial infarction of different locations and compared right and left ventricular functions. METHOD: Left and right ventricular function was assessed with multigated blood pool scan in 49 patients at 2-3 weeks after acute myocardial infarction (anterior infarction=23, inferior infarction=19, and lateral infarction=7). Left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), maximal emptying rate, maximal filling rate, phase angle and full width at half maximum (FWHM) of phase angles were measured during rest. RESULTS: 1) LVEF was signifi-cantly lower in the patients with anterior myocardial infarction (32.2%) than that of inferior (46.5%, p<0.001) or lateral infarction (45.5%, p<0.05), but not different between inferior and lateral infarction. 2) RVEF was significantly lower in the patients with inferior myocardial infarction (24.6%) than that of anterior (30.5%, p<0.05) or lateral infarction (36.1%, p<0.001), and RVEF of anterior infarction was significantly lower than that of lateral infarction (p<0.05). 3) Phase angle and FWHM of left ventricle and right ventricle phase histogram were not significantly different among the patients groups with different infarct sites. CONCLUSIONS: Ventricular function was differently affected by different infarct sites. Inferior infarction resulted in a greater reduction in right ventricular ejection fraction. In contrast, LVEF was greatly depressed in anterior infarction than in inferior infarction.
Coronary Artery Disease ; Heart Ventricles ; Humans ; Infarction ; Inferior Wall Myocardial Infarction ; Myocardial Infarction ; Stroke Volume ; Ventricular Function ; Ventricular Function, Left ; Ventricular Function, Right*

We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry.
Cholangiopancreatography, Endoscopic Retrograde ; Dyskinesias ; Female ; Humans ; Male ; Manometry ; Sphincter of Oddi Dysfunction* ; Sphincter of Oddi* ; Sphincterotomy, Endoscopic

PURPOSE: To investigate the feasibility of Tl-201 SPECT with intracoronary injection (IC-I) in the detection of viable myocardium, we have performed SPECT imaging after direct intracoronary injection of Tl-201 and images were compared with those of stress-reinjection (Re-I) SPECT. METHODS: Fourteen coronary artery disease patients (male 11, mean age 54 years) who had myocardial infarction or demonstrated left ventricular wall motion abnormality on echocardiography were enrolled. Three mCi of Tl-201 was injected into both coronary arteries during angiography and images were acquired between 6- and 24-hour after injection. Reinjection imaging with 1 mCi of Tl-201 was performed at 4-hour after adenosine stress imaging with 3 mCi of Tl-201. Images were interpreted according to 4-grade visual scoring system (grade 0-3). Segments with mild to moderated uptake (< or=grade 1), and upgraded more than one score with reinjection, and were defined as viable myocardium. RESULTS: Image quality was poor in two cases with IC-I. Numbers of non-viable segments were 60 (23.8%) with IC-I, and 38 (15.1%) with Re-I, respectively. Overall agreement for perfusion grade per myocardial segment in each IC-I and Re-I was 76.5%. Overall agreement for viable segment between IC-I and Re-I was 90.5%. Only one out of 38 segments interpreted as non-viable with Re-I were interpretated as viable with IC-I. And 23 out of 214 segments interpreted as viable with Re-I were interpreted as non-viable with IC-I. CONCLUSION: Intracoronary Tl-201 SPECT seemed to be not advantageous over stress-rest reinjection imaging in the assessment of myocardial viability, mainly due to low count statistics at 6-hour or 24-hour delayed time points. The feasibility of intracoronary Tl-201 SPECT is considered to be limited.
Adenosine ; Angiography ; Coronary Artery Disease ; Coronary Vessels ; Echocardiography ; Humans ; Myocardial Infarction ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To investigate the feasibility of Tl-201 SPECT with intracoronary injection (IC-I) in the detection of viable myocardium, we have performed SPECT imaging after direct intracoronary injection of Tl-201 and images were compared with those of stress-reinjection (Re-I) SPECT. METHODS: Fourteen coronary artery disease patients (male 11, mean age 54 years) who had myocardial infarction or demonstrated left ventricular wall motion abnormality on echocardiography were enrolled. Three mCi of Tl-201 was injected into both coronary arteries during angiography and images were acquired between 6- and 24-hour after injection. Reinjection imaging with 1 mCi of Tl-201 was performed at 4-hour after adenosine stress imaging with 3 mCi of Tl-201. Images were interpreted according to 4-grade visual scoring system (grade 0-3). Segments with mild to moderated uptake (< or=grade 1), and upgraded more than one score with reinjection, and were defined as viable myocardium. RESULTS: Image quality was poor in two cases with IC-I. Numbers of non-viable segments were 60 (23.8%) with IC-I, and 38 (15.1%) with Re-I, respectively. Overall agreement for perfusion grade per myocardial segment in each IC-I and Re-I was 76.5%. Overall agreement for viable segment between IC-I and Re-I was 90.5%. Only one out of 38 segments interpreted as non-viable with Re-I were interpretated as viable with IC-I. And 23 out of 214 segments interpreted as viable with Re-I were interpreted as non-viable with IC-I. CONCLUSION: Intracoronary Tl-201 SPECT seemed to be not advantageous over stress-rest reinjection imaging in the assessment of myocardial viability, mainly due to low count statistics at 6-hour or 24-hour delayed time points. The feasibility of intracoronary Tl-201 SPECT is considered to be limited.
Adenosine ; Angiography ; Coronary Artery Disease ; Coronary Vessels ; Echocardiography ; Humans ; Myocardial Infarction ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the association between smoking and osteoporotic vertebral fractures (OVFs) in postmenopausal women. SUMMARY OF LITERATURE REVIEW: Several studies have examined the relationship of smoking with hip fractures, but few studies have analyzed the relationship of smoking with spine fractures in women thus far. MATERIALS AND METHODS: This study considered 1255 postmenopausal women aged 50 years and older (enrollment from April 2008 to January 2009) from 62 study sites in a nationwide hospital. The amount of smoking was calculated in pack-years. Further, OVFs were diagnosed using a semi-quantitative method. To analyze the relationship between smoking and OVFs, we used a paired t-test, a χ2-test, and a binary logistic regression analysis. RESULTS: The past history of smoking was 7.2% in the patient group and 4.3% in the control group (p=0.025). The mean pack-years of smoking was 0.34 in the control group and 0.62 in the patient group (p=130). The mean T-score in the lumbar bone mass density (BMD) was –1.64 in the control group and –2.19 in the patient group (p=0.409). Smoking was a risk factor of vertebral fractures in postmenopausal women (odd's ratio=1.68, 95% confidence interval=1.020–2.759, p=0.042) irrespective of the lumbar BMD and the medical treatment for osteoporosis and obesity. CONCLUSIONS: Smoking is a risk factor for osteoporotic vertebral fractures in postmenopausal women independently without regard to lumbar BMD. Therefore, cessation of smoking is important for the prevention of OVFs in postmenopausal women.
Bone Density ; Female ; Hip Fractures ; Humans ; Logistic Models ; Obesity ; Osteoporosis ; Retrospective Studies ; Risk Factors ; Smoke* ; Smoking* ; Spine

BACKGROUND/AIMS: It is recommended that duodenal ulcer patients who are infected with H. pylori should be treated with eradication therapy, whether the ulcer is active or in remission. However, there has been no report on the effect of eradication treatment in patients with incidentally found S-2 stage duodenal ulcer scar. METHODS: We prospectively enrolled 80 H. pylori-positive patients with S-2 stage duodenal ulcer scar who have no past history of ulcer treatment. Treatment group received triple therapy consisted of omeprazole, amoxicillin, and clarithromycin for 2 weeks, whereas control group received no treatment. The follow-up endoscopy was performed every 1 year and when the patients have symptoms of ulcer disease. Fifty-three patients were followed up for more than 1 year. RESULTS: The eradication rate of the treatment group was 92.9%. During the follow-up period of 14.7 months, 20% (5/25) of patients in the control group (2 gastric ulcers and 3 duodenal ulcers) and 3.6% (1/28) of patients in the treatment group (1 duodenal ulcer) developed active or healing stage peptic ulcers (p=0.089). CONCLUSIONS: Our results suggest that H. pylori eradication may he effective in preventing peptic ulcers in patients with S-2 stage duodenal ulcer scar.
Amoxicillin ; Cicatrix* ; Clarithromycin ; Duodenal Ulcer* ; Endoscopy ; Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Omeprazole ; Peptic Ulcer ; Prospective Studies ; Stomach Ulcer ; Ulcer

OBJECTIVES: Two related cases of Hemolytic-Uremic Syndrome (HUS) were reported to the Korea National Institute of Health in May, 2001. Shiga toxin 2 genes were detected in both stool samples. We suspected an enterohemorrhagic Escherichia coli (EHEC) infection as the cause of the HUS, and conducted an investigation to find the source of the infection and its route of transmission. METHODS: We performed case investigations on these two related HUS cases, and obtained interviews and rectal swabs form the family members and other close contacts. Additionally, we performed rectal swabs on the cattle raised by the household of the index patient. RESULTS: We found a 20 month old index patient and a 6 year-old cousin had developed HUS, where there had been a 2 day history of contact with the index, and bacteriological examinations for these two patients revealed, indistinguishably, the same E. coli O171. The grandmother of the index patient was found to be asymptomatic, but E. coli O26 was isolated. We also found a probable case in the mother of the cousin. She reported a history of contact with the index, and developed bloody diarrhea of 3 days duration. The test results for the cattle revealed E. coli O26 in one cow, and E. coli O26 and O55 in another. E. coli O26, which was isolated in both cows and the grandmother of the index, were indistinguishably the same. CONCLUSIONS: We found that the E. coli O26 in the grandmother had originated from the cows, and that the E. coli O171 found in the index patient had been transmitted to the cousin through person-to-person contact.
Animals ; Cattle ; Diarrhea ; Enterohemorrhagic Escherichia coli* ; Family Characteristics ; Grandparents ; Hemolytic-Uremic Syndrome ; Humans ; Korea* ; Mothers ; Shiga Toxin 2 ; Zoonoses

A 50-year-old woman was referred to our hospital for evaluation of mental change and general weakness accompanied by an irregular and weak pulse. She had previously been diagnosed with Bartter's syndrome and had taken potassium-sparing diuretics. She had developed constipation that had led to abdominal pain and had taken excessive magnesium oxide over a long time. On admission, she was lethargic. Her blood pressure (BP) was 130/74 mmHg, with a heart rate varying from 30 to 78 beats/min. An electrocardiogram (ECG) revealed several abnormalities, including first degree AV block, QT prolongation, sinus pause with a junctional rhythm, and paroxysmal tachycardia alternating with sinus pause. Her serum concentration of magnesium was markedly elevated to 16.19 mg/dl. Hemodialysis and a calcium gluconate infusion was attempted to reduce magnesium levels and to counteract the cardiovascular effect of magnesium. As magnesium levels declined, her general medical condition improved and her ECG changes were normalized. Severe hypermagnesemia should be suspected as the cause of mental change, cardiovascular dysfunction, and variable ECG changes.
Abdominal Pain ; Atrioventricular Block ; Bartter Syndrome ; Blood Pressure ; Calcium Gluconate ; Constipation ; Depression ; Diuretics ; Electrocardiography ; Female ; Gluconates ; Heart Rate ; Humans ; Magnesium ; Magnesium Oxide ; Middle Aged ; Renal Dialysis ; Tachycardia, Paroxysmal

Gaegurin 4 (GGN4), an antimicrobial peptide isolated from a Korean frog, is five times more potent against Gram-positive than Gram-negative bacteria, but has little hemolytic activity. To understand the mechanism of such cell selectivity, we examined GGN4-induced K+ efflux from target cells, and membrane conductances in planar lipid bilayers. The K+ efflux from Gram-positive M. luteus (2.5microgram/ml) was faster and larger than that from Gram-negative E. coli (75microgram/ml), while that from RBC was negligible even at higher concentration (100microgram/ml). GGN4 induced larger conductances in the planar bilayers which were formed with lipids extracted from Gram-positive B. subtilis than in those from E. coli (p<0.01), however, the effects of GGN4 were not selective in the bilayers formed with lipids from E. coli and red blood cells. Addition of an acidic phospholipid, phosphatidylserine to planar bilayers increased the GGN4-induced membrane conductance (p<0.05), but addition of phosphatidylcholine or cholesterol reduced it (p<0.05). Transmission electron microscopy revealed that GGN4 induced pore-like damages in M. luteus and dis-layering damages on the outer wall of E. coli. Taken together, the present results indicate that the selectivity of GGN4 toward Gram-positive over Gram-negative bacteria is due to negative surface charges, and interaction of GGN4 with outer walls. The selectivity toward bacteria over RBC is due to the presence of phosphatidylcholine and cholesterol, and the trans-bilayer lipid asymmetry in RBC. The results suggest that design of selective antimicrobial peptides should be based on the composition and topology of membrane lipids in the target cells.
Bacteria ; Cholesterol ; Erythrocytes ; Fees and Charges ; Gram-Negative Bacteria ; Lipid Bilayers ; Membrane Lipids ; Membranes ; Microscopy, Electron, Transmission ; Peptides ; Phosphatidylcholines ; Protein Precursors

OBJECTIVE: This study examined the efficacy of the computed tomography (CT) findings in the emergency department (ED) in predicting the clinical course and severity of acute pyelonephritis (APN). METHODS: This retrospective clinical study included APN patients in the ED. All participants diagnosed with APN had undergone a radiocontrast-enhanced CT evaluation. The radiocontrast-enhanced CT findings of APN revealed the typical findings, such as hypoperfusion on the kidney, extra-renal parenchymal findings, and renal abscess formation. The patients were classified into five groups based on the CT findings. The clinical parameters analyzed were the white blood cell (WBC) count, C-reactive protein (CRP) level, quick sepsis-related organ failure-assessment (qSOFA) score, need for vasopressor, length of stay, and admission to the intensive care unit (ICU). The relationships between the clinical parameters and the five groups based on the APN CT findings were assessed. RESULTS: Among the 264 patients, there were 225 female patients and the mean age of all patients was 57.9±20.5 years: group 1 (n=31), present renal abscess with APN; group 2 (n=118), both typical and extra-renal parenchymal findings; group 3 (n=49), only typical finding; group 4 (n=32), only extra-renal parenchymal findings; and group 5 (n=34), no APN finding on CT. The length of stay increased from groups 5 to 1. The WBC count and CRP level were worsen from groups 4 to 1, except for group 5. Statistically significant trends, such as the WBC count, CRP level and length of stay correlated with each group were observed (P < 0.001, P < 0.001, and P < 0.001). Statistically significant trends in ICU admission, use of vasopressor, and qSOFA score were also observed (P=0.022, P=0.003, and P < 0.001). CONCLUSION: The specific CT findings of APN might be helpful for predicting the clinical severity and prognosis.
Abscess ; C-Reactive Protein ; Clinical Study ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Kidney ; Length of Stay ; Leukocytes ; Prognosis ; Pyelonephritis* ; Retrospective Studies ; Tomography, Spiral Computed