No abstract available.
Endocardial Cushion Defects* ; Endocardial Cushions* ; Hernia, Diaphragmatic*

Achalasia is one of the most common esophageal motility disorder which is characterized by dysphagia and noncardiac chest pain. Esophageal motility disorder has been extensively investigated in recent years as a cause of noncardiac chest pain. The exclusion of cardiac disease is usually based on the presence of normal epicardial coronary arteries. However, myocardial ischemia can occur upon physical stress in patients with normal coronary arteries and is thought to be secondary to dynamic vasoconstriction of coronary artery microcirculation. The disturbances of vasomotor control and the abnormalities of sympathetic nervous system play a role in generation of microvascular angina. Some patients with achalasia exhibit an abnormality in the autonomic nerveous system that extends beyond the gastrointestinal tract. Recently, we experienced two cases of achalasia accompanied by microvascular angina. They had persistent chest pain even after successful endoscopic treatments for achalasia and showed microvascular angina on subsequent coronary angiography and/or exercise stress test.
Chest Pain ; Coronary Angiography ; Coronary Vessels ; Deglutition Disorders ; Esophageal Achalasia* ; Esophageal Motility Disorders ; Exercise Test ; Gastrointestinal Tract ; Heart Diseases ; Humans ; Microcirculation ; Microvascular Angina* ; Myocardial Ischemia ; Sympathetic Nervous System ; Vasoconstriction

BACKGROUND: Gamma-glutamyltransferase (GGT), which is an intracellular antioxidant due to maintain intracellular concentrations of glutathione, may be a marker of oxidative stress. In the present study, oxidative stress was thought to be a cause of diabetes mellitus. So, We performed a cross sectional study about the relations between GGT and prevalence of diabetes mellitus. METHODS: In total 5049 healthy men who had visited the Yonsei Wonju Christian Hospital for health care from 1st January 2002 to 31st December 2002, we measured BMI, blood pressure, GGT, total cholesterol, ALT and fasting blood sugar levels. RESULTS: There were strong relations between serum GGT concentrations and age, BMI, total cholesterol, systolic blood pressure, diastolic blood pressure and ALT level. GGT level had positive correlations with the prevalence of diabetes mellitus and impaired glucose tolerance when divided into four classes, 0~19 IU/L, 20~39 IU/L, 40~59 IU/L and over 60 IU/L. We got the same results after adjustment with BMI, total cholesterol, blood pressure and ALT level. CONCLUSION: There was a positive correlation between GGT level and the prevalence of diabetes mellitus, and that was definite especially when BMI, total cholesterol, blood pressure and ALT levels were in normal range. We suggest that serum GGT level would be an important marker in the development of diabetes mellitus.
Blood Glucose ; Blood Pressure ; Cholesterol ; Delivery of Health Care ; Diabetes Mellitus* ; Fasting ; gamma-Glutamyltransferase* ; Gangwon-do ; Glucose ; Glutathione ; Humans ; Male ; Oxidative Stress ; Prevalence* ; Reference Values

BACKGROUND: Amorolfine is a new topical antifungal drug of the morpholine class has broad spectrum fungicidal activity. Amorolfine nail lacquer 5% is a transungual delivery system which can penetrate well through the nail plate to the infected keratin and remain there for a prolonged period. OBJECTIVE: The aim of this study is to assess the efficacy and tolerability of 5% amorolfine nail lacquer given once weekly to the patients with onychomycosis. METHODS: 29 patients with onychomycosis affecting not more than 80% of the surface of nail were treated once weekly for up to 9 months with amorolfine nail lacquer 5%. Clinical and mycological examination were performed before treatment and 3, 6, 9 months after start of treatment. Final evaluation was done 3 months after the end of treatment. RESULTS: Average affected area(%) and average score of clinical signs-thickening, splitting, discoloration-were significantly decreased 3 months after start of treatment. Mycological cure rate was continuously increased according to the treatment duration reaching 75.9% at 3 months after treatment. Overall efficacy assessed by the investgators were cure in 31.0% and improvement in 41.4%. Tolerability, mode and frequency of treatment, and formulation were evaluated as good or excellent by most of the patients.No systemic or local side effect was observed. CONCLUSION: Amorolfine nail lacquer 5% used once weekly up to 9 months was relatively effective and safe for the treatment of onychomycosis.
Fingers* ; Humans ; Lacquer* ; Onychomycosis* ; Toes*

Rapid and reliable diagnosis of measles is important to establish an appropriate therapy and to monitor the epidemic. However, classical ELISA methods using purified virus or virus-infected cells as antigens are not only difficult to determine optimal condition for diagnosis but also highly expensive to establish routine and appropriate diagnostic systems. Nucleoprotein of measles virus is one of the major antigens of measles virus that evoke initial IgM responses. It can be used as an attractive antigen for sero-diagnosis of measles during early infection. To develop simple and inexpensive diagnostic method for measles, we expressed a recombinant nucleoprotein (60-kDa) and a fragmented portion of the nucleoprotein (50-kDa) in E. coli and evaluated their appropriateness as diagnostic antigens. The proteins strongly reacted with sera from measles patients but not with normal control sera. Efficiency of recombinant nucleoprotein-ELISA (rN-ELISA) to detect IgM was compared that of whole measles virus-ELISA (MV-ELISA) on the basis of a clinical diagnosis. In rN-ELISA, sensitivity was 73.8% and agreement was above 76.4%. In MV-ELISA, sensitivity was 76.9% and agreement was 79.2%. Therefore, efficacy of rN-ELISA seemed to be similar to that of MV-ELISA. In addition, we compared with Edmonston rN-ELISA and Korean isolate rN-ELISA on the basis of commercial MV-ELISA. In Edmonston rN-ELISA, sensitivity was 94.0% and agreement was 98.4%. In the case of Korean isolate rN-ELISA, sensitivity was 96.0% and agreement was 96.9%. Thus, there was no significant difference in the efficacy between Edmonston rN-ELISA and Korean isolate rN-ELISA. Furthermore, the correlation coefficient (R2) between Edmonston rN-ELISA and Korean isolate rN-ELISA was 0.9925. These results suggest both Edmonston and Korean isolate rN-ELISA may be useful to diagnose measles.
Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Immunoglobulin M* ; Immunoglobulins* ; Measles virus* ; Measles* ; Nucleoproteins*

The infected endocarditis related permanent pacemaker occurs rare and most of them occur at generator pocket but endocarditis related permanant pacemaker lead itself occurs very rarely. The rate of infection after pacemaker implantation is reported as 0.13-7% or 0.13-19.9% and mortality rate is up to 24-33%. Focal inflammation of generator pocket is easily detected but it is difficult to diagnose endocarditis related pacemaker lead and it has poor prognosis. Especially, early diagnosis is most important because endocarditis related pacemaker is fatal. Thirteen years ago, a womon was inserted the permanent pacemaker and then only generator was removed after one month. We report a case that we had removed the pacemaker lead by open thoracostomy and cardiopulmonary circulation to treat endocarditis related pacemaker lead.
Early Diagnosis ; Endocarditis* ; Inflammation ; Mortality ; Prognosis ; Thoracostomy

Background: Many clinicians have experienced the difficulty of decision on termination of antituberculosis chemotherapy after the 6th month due to relapse of disease. There is still controversy in the effect of 2S(K)HRZ/4HRZ 6-month short course chemotherapy including pyrazinamide for 6 months in patients with pulmonary tuberculosis. And there is no long term follow-up study of 6-month short course chemotherapy for pulmonary tuberculosis in korea. So we had performed the study to find the result of 6-month antituberculosis chemotherapy for 4 years. Method: We studied prospectively the effect of 2S(K)HRZ/4HRZ in one hundred-fifty patients with pulmonary tuberculosis and followed up fifty-nine patients for more than 1 year to 4 years after the completion of 6-month short course therapy. Results: 1) Out of one hundred-fifty patients, seventy-two patients(48%) completed the prescribed 6-month chemotherapy. Sixty-eight patients(45.3%) have experienced premature discontinuation and the most common cause of premature discontinuation was drop-out against advice(thirty-six patients, 24%). Ten patients(6.7%) were treated beyond the 6 months mainly due to irregular treatment. 2) Fifty-nine patients(81.9%) among seventy-two patients with completed treatment have been followed up for more than 1 year and 32 patients(44.4%) for more than 4 years. There was three relapse patients of whom two patients have experienced relapse of pulmonary tuberculosis within 1 year after the termination of chemotherapy. 3) Among one hundred-thirty-four patients who have been assessible for more than two months of chemotherapy, including the patients who experienced within 2 months, there were eighty-two patients(61.2%) who have experienced adverse reactions and the treament regimen was changed only in thirteen patients(9.7%). The most frequent cause of adverse reactions was arthralgia and/or hyperuricemia, which had occurred in 33 patients(24.6%). Conclusion: In a university hospital in Korea, 6-month short course chemotherapy of 2S(K)HRZ/4HRZ had unnegligible relapses and premature discontinuation. Therefore, change of the regimen might be carefully considered by drug susceptibility results. Close monitoring of patients, retrial of sputum exam and radiologic evaluation during treatment might be required in the endemic area of drug resistant strains like in Korea. Further study about the effect of 6-month short course chemotherapy including pyrazinamide for 6-month might be needed.
Arthralgia ; Drug Therapy ; Follow-Up Studies* ; Humans ; Hyperuricemia ; Korea ; Prospective Studies ; Pyrazinamide ; Recurrence ; Sputum ; Tuberculosis, Pulmonary*

Primary aldosteronism due to unilateral adenoma is a rare cause of surgically curable hypertension. Bilateral adrenal mass has occasionally been reported in this syndrome, and bilateral aldosterone-producing adenoma (APA), or bilateral adrenal nodular hyperplasia have been demonstrated in some cases. However, another possibility is the coexistence of a unilateral APA with a contralateral benign or metastatic nonfunctioning mass, because adrenal tumors are frequently found at autopsy or incidentally detected during abdominal morphological evaluation in patients without adrenal dysfunction. A 39 year-old woman presented with hyperaldosteronism, suppressed renin levels, and bilateral adrenal mass on adrenal CT scanning. Selective adrenal venous sampling was unsuccessful in demonstrating concentration gradient of aldosterone. Postoperative measurement of hormone content in the tumor extract revealed unilateral aldosteron-producing adenoma with contralateral nonfunctioning black adenoma, Determination of hormone content in the tumor extract could be useful for the discrimination of functioning and nonfunctioning endocrine tumors, particularly in case of multiple tumors.
Adenoma* ; Adult ; Aldosterone ; Autopsy ; Discrimination (Psychology) ; Female ; Humans ; Hyperaldosteronism ; Hyperplasia ; Hypertension ; Renin ; Tomography, X-Ray Computed

PURPOSE: To evaluate the nation-wide results of statistics related to the neonatal period of 1996, we collected data of a total of 64 hospitals in Korea (42 university hos- pitals and 22 general hospitals). METHODS: We obtained the results of 129,175 inboms and 9,379 outborns, and analyzed the statistics of live-births, ig, distribution of live-births by gestational age and birth weight, incidence of pre-term infants and low birth weight infants (LBWI), neonatal mortality, and incidence of discharge against medical advice (DAMA). RESULTS: According to birth weight, incidence of LBWI, normal birth weight, infant and high birth weight infants was 3.6%, 86.6% and 9.8%, respectively in the case of inborn group. But incidence of LBWI was higher in outborn group as compared with the inbom group. According to gestational age, incidence of preterm, term, and post-term was 11.1%, 87.1Yo and 1.8% respectively in the inbom group. The incidence of preterm in outborn group was higher than that of inborn group, because of the influnce of transpor- tation of high risk neonates to 2nd or 3rd levels of neonatal intensive care units (NICU). Overall neonatal mortality per 1,000 live-births was 9.3 in the inborn group amd 37.6% in the outborn group. These data revealed a high neonatal mortality, because the numbers of DAMA cases was also included. The incidence of DAMA was 0.44% and 1.15% in inborn and outborn groups, respectively. The percentage of the DAMA among the numbers of neonatal mortality was 47.2-48.8M in the inborn group. CONCLUSIONS: We obtained the statistics related to live-birth, incidence of prematurity and LBWI, neonatal mortality, and incidence of DAMA in Korea. The data revealed high levels of neonatal mortality (which included the sum of neonatal death and the number of DAMA) and incidence of DAMA in Korea at present. To achieve a low-level of neonatal mortality, more efforts to decrease the incidence of DAMA are needed. Also, a greater facility for NICU and a stronger support system from a nation-wide govemment policy and system of insurance are seen to be necessary.
Birth Weight ; Gestational Age ; Humans ; Incidence* ; Infant ; Infant Mortality* ; Infant, Low Birth Weight ; Infant, Newborn ; Insurance ; Intensive Care Units, Neonatal ; Korea* ; Parturition*

BACKGROUND: Measles is a highly contagious disease caused by measles virus. Although the introduction of live attenuated measles vaccines has dramatically abrogated the endemic incidence of measles in world-wide, there are still 30 million measles cases and nearly one million deaths from measles annually. In this study, we characterized the measles outbreak in Gwangju Metropolitan City during the 2000~200 1 epidemic. METHODS: Study population included measles patients in Gwangju Metropolitan City from April, 2000 to May, 200 1. We conducted a questionnaire survey on the patients and analyzed the records based on the clinical guideline of World Health Organization (WHO). Furthermore, we isolated the measles viruses from clinical specimens of patients and analyzed the nucleotide sequences of nucleoprotein (N) gene. RESULTS: During the April 2000 to May 2001, measles epidemic, a total of 3,2 17 measles patients were reported in Gwangju Metropolitan City. The first patient of measles was reported on April, 2000. The incidence reached its peak in November, 2000 and decreased thereafter. The age distribution of the patients were various, which was ranged from 1 month after birth to 30 year adult and the peak incidence was observed at 7~13 year old. Various complications were developed in 232 patients and 2 of them died. Phylogenetic analyses of nucleotide sequences and deduced amino acid sequences of the N genes of isolated viruses revealed that all viruses isolated in Gwangju Metropolitan City were grouped into the clade H1. This suggests that a single, predominant viral genotype was responsible for the measles epidemic in Gwangju Metropolitan City. CONCLUSION: In this study, we characterized the measles outbreak in Gwangju Metropolitan City during 2000~200 1. The measles outbreak in Gwangju Metropolitan City was considered to be caused by single genotype of measles virus (clade H1). After a massive vaccination campaign among 7~16 years old children to eliminate indigenous measles from this country, it is important to continue measles vaccination and intensive surveillance clinically as well as virologically.
Adult ; Age Distribution ; Amino Acid Sequence ; Base Sequence ; Child ; Genotype ; Gwangju* ; Humans ; Incidence ; Measles virus ; Measles* ; Nucleoproteins ; Parturition ; Vaccination ; Vaccines ; World Health Organization ; Surveys and Questionnaires