We successfully closed the isolated patent ductusarteriosus(PDA) in 2 female patients using the Rashkind Double-Disc Occlusion system. nonsurgical closure of PDA usin plug was introduced by Porstmann in 1968 through transfemoral artery catheter and using umbrella by Rashkind in 1977 througth venous site. There has been continued improvement and simplification of the equipment as well as in the implantation technique. Nowaday, a multicenter study was conducted to test the safety and effectiveness of this interventioal method in States. Successful closure rate was high but some problems were reported such as embolization, abnormal deployment and residual shunt. Residual shunt was visualized by aortography in our both cases immediately after intervention but continuous murmur could not be heard in both cases. Oxygen step-up disappeared immediately after occluder implantation in both cases. Complete occlusion was expected with thrombus in near future.
Aortography ; Arteries ; Catheters ; Ductus Arteriosus, Patent* ; Female ; Humans ; Oxygen ; Thrombosis

No abstract available.
Humans ; Longitudinal Ligaments* ; Spine*

The pathogeoesis of papulonecrotic tuberculid had been thought to be the result of hernatogenous dissemination from primary tuberculous focus of other organs. But, today, the existence of papulonecrotic tuberculid as a rare cutaneous reaction to the Mycobacterium bacillus is questioned. Papulonecrotic tuberculid is, however, a real entity in underdeveloped countries where tuberculosis is more common. We report a case having papulonecrotie tuberculid associated with cervical lymph node tuberculosis confirmed by typical histopathology and by clinical response to antituberculous chemotherapy. This case supports Iden et al's view (1) that skepticism regarding the existence of papulonecrotic tuberculid is probably the result of the current decreased prevalence of untreated tuberculosis and consequently increased rarity of this entity.
Bacillus ; Drug Therapy ; Mycobacterium ; Prevalence ; Tuberculosis ; Tuberculosis, Cutaneous* ; Tuberculosis, Lymph Node

BACKGROUND: Propafenone is a new class Ic antiarrhythmic compound.This study was performed to evaluate the clinical efficacy and safety of propafenone by double-blind, placebo-controlled, randomized cross-over comparison of propafenone and disopyramide in patients with stable ventricular ectopy. METHODS: All patients were included in the study if they had an average of at least 30 PVC/hr on a 24-hour Holter recordings. During the 1st 7 days, two placebo tablets(identical in apperance to the propafenone and the disopyramide tablets) were administrated in a double-blind manner(run-in period). Then 1st treatment period lasting 1 week with one verum and the other placebo, wish-out period of 3 day,2nd treatment period lasting 1 week with cross-over drugs were followed. RESULTS: Twenty patients were enrolled. During the run-in period, VPCs were reduced to 18%, compared to the baseline data before the administration of placebo.During the treatment period,propafenone 600mg/day reduced VPCs by 43% and disopyramide 400mg/day reduced VPCs by -10% Propafenone was effective(80% or greater reduction of VPCs) in 7 of 20 patients. Disopyramide was not effective in all patients. Propafenone and disopyramide produced no significant change of paired VPCs and VT events. Propafenone had no effect on heart rate. It increased the PR interval(7.9%;p<0.01) and QRS interval(5.2%;p<0.01). The drug did not change QTc interval(-1.1%) significantly. There were no cardiovascular side effects. Propafenone produced nausea in one patient. Disopyramide produced dysuria in 2 patients. CONCLUSIONS: Propafenone was more effective in controlling VPC than disopyramide, and there was no major limiting side effects.
Cross-Over Studies* ; Disopyramide* ; Dysuria ; Heart Rate ; Humans ; Nausea ; Propafenone* ; Ventricular Premature Complexes*

BACKGROUND: Cicletanine bydrochloride is a newly developed anti-hypertensive agent. The presence of a furopyridine group characterizes its uncommon chemical structure as an antihypertensive molecule. This clinical trial was performed to confirm the efficacy and safety of cicletanine for the treatment of hypertension as a monotherapy. METHODS: In order to investigate the efficacy and safety of oral cicletanine, a now class of antihypertensive durgs, the furopyridines, on essential hypertension, a single daily dose of 50mg to 100mg cicletanine was administered in 46 hypertensive patients with diastolic blood pressure in the range of 95mmHg-115mmHg. The patients were asked to cut off other anti hypertensive agents for 10 weeks prior to this clinical trial. Blood pressure and heart rate were measured every 4 weeks. The complete blood count, blood chemistry done by SMA-12, serum electrolytes and urinalysis were performed at the 12th week of therapy. RESULTS: 1) Baseline blood pressures after 2 weeks of placebo at sitting and standing positions were 158.7+/-16.1/102.9+/-6.2 and 148.7+/-14.5/102.7+/-6.7mmHg, respectively. The overall slope which represents the tendency of blood pressure decline over the treatment period with cicletanine for all the patients in each position are as follows ; -0.726(SE : 0.150) for sitting systolic blood pressure(BP), -0.390(SE : 0.080) for sitting diastolic BP, -0.214(SE : 0.183) for standing systolic BP and -0.341(SE : 0.139) for standing diastolic BP. 2) The slope of sitting systolic BP line in cicletanine 100mg treated group was significantly stiffer than that of cicletanine 50mg treated group(-0.445 vs -1.021, p=0.0336). 3) There were no significant interval changes in heart rate over the treatment period. 4) There were no significant interval changes in blood chemistry, electrolytes, hematologic findings and urinalysis over the treatment period. 5) Several side effects were observed in six patients(epigastric discomfort in 4, easy fatigue and insomnia in one patient, respectively). CONCLUSION: Treatment with cicletanine was well-tolerated and the incidence of side effects was relatively low. Because of its unique anti-hypertensive mechanism and moderated antihypertensive effects, cicletanine may be well suited in the treatment of hypertension combined with other classes of antihypertensive agents.
Antihypertensive Agents ; Blood Cell Count ; Blood Pressure ; Chemistry ; Electrolytes ; Fatigue ; Heart Rate ; Humans ; Hypertension ; Incidence ; Sleep Initiation and Maintenance Disorders ; Urinalysis

The far lateral lumbar disc herniation occurs ten times less often than the classic posterolateral disc herniations. Its clinical presentation, the anatomy involved, and difficulty of surgical treatment are not well understood. The surgical approach and results also have not been clearly defined. Although there are limited number of reports and series in the literature, there is still no general consensus on the approach to surgical treatment. However, chymopapain, even with a history of controversy and troubling complications, has endured the test of time to show 30 years of clinical success in the treatment of herniated nucleus pulposus. Strict attention to indications, contraindications, and technique ensures safety and efficacy of treatment. Between 1984 and 1997, we treated with chymopapain injection in 69 patients with severe lumbar radiculopathy secondary to far lateral disc herniation. Average patient age was 38.5 years in the 47 male and 22 female patients involved. The L4-5 disc was the most commonly herniated level(44.9%) followed by L3-4(37.8%), L5-S1(13.0%), and L2-3(4.3%). They were assessed using standardized forms as well as the Mcnab classification and questioner. They were reviewed at an average of 5 years 8 months postoperatively. Relief of symptoms was obtained in 63 patients(91.3%) after injection. No one subsequently relapsed requiring operation. All 69 patients available for long-term follow-up had considerable and sustained relief from their symptoms. For ADL(activity of daily living), 50 patients(81.3%) answered that they had no limitation, and regarding the office or house work, 49 patients(71.0%) returned previous work without any difficulties. Based on these findings we recommend the chymopapain injection as the primary treatment for patients with severe radiculopathy secondary to far lateral herniation of a lumbar disc.
Chymopapain ; Classification ; Consensus ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Chemolysis* ; Male ; Radiculopathy

Aortic dissection is a medical emergency requiring prompt diagnosis and maybe emergency surgery especially if the ascending aorta is involved. We have performed transesophageal echocardiography(TEE) in 22 consecutive patients with suspected aortic dissection. The diagnosis was subsequently proven in 14 patients(9 males, 2 females, mean age 51+/-11years) on the basis of TEE. The results and effectiveness were compared with computed tomography (CT) and aortography. Seven patients had type I aortic dissection, three had type II and four had type III. Twelve patients had hypertension. There was aortic regurgitation in five of seven patients with type I dissection and in all three patients with type II dissection. Type I dissection was found by TEE in seven patients who had intimal flap showing parallel movement to the aortic wall. CT was positive in only three of five of these patients. Type II dissection was seen in three patients by TEE. CT demonstrated dissection in one of three of these patients. In one patient the false lumen was filled with a thrombus, which was negative at angiography. Type III dissection was found by TEE in four patients. CT was positive in two of four patients. Aortography was performed and positive in one patient. The starting point of aortic dissection could be demonstrated in all four patients by TEE. TEE was well tolerated by patients with aortic dissection and associated with no major complications. In conclusion. TEE was very useful in detecting aortic dissection and in providing a dynamic information of the intimal flap and of the presence and extent of luminal thrombus with flow dynamics.
Angiography ; Aorta ; Aortic Valve Insufficiency ; Aortography ; Diagnosis ; Echocardiography, Transesophageal* ; Emergencies ; Female ; Humans ; Hypertension ; Male ; Phenobarbital ; Thrombosis

The clinical significance of cystic fluid motion in syringomyelia is uncertain. Because of its sensitivity to fluid motion, MR imaging was used to investigate fluid dynamics in syringomyelia by various tecniques. SPAMM (Spatial Modulation of Magnetization) MRI is one of these techniques which shows the fluid motion of syrinx in syringomyelia. After taking preimaging pulse sequence, the MR images show periodic bands due to the magnetic modulation. Motion between the time of banding and image formation is directly demonstrated as a corresponding displacement of the bands. The authors evaluated 7 patients of syringomyelia due to various causes with SPAMM MRI technique and compared preoperative SPAMM MRI findings and clinical results, postoperative size of syrinx. Among 4 patients of syringomyelia with Arnold-Chiari malformation, 3 patients showed band shift representing fluid motion of syrinx on SPAMM MRI. Clinical results of these patients were good and the size of postoperative syrinx decreased. Three patients of posttraumatic or postmeningitic syringomyelia who did not show band shift on SPAMM MRI had poor clinical courses and the sizes of postoperative syrinx remained unchanged. These results indicate that SPAMM MRI may be useful in dete rmining the type of treatment and predicting clinical results in syringomyelia.
Arnold-Chiari Malformation ; Humans ; Hydrodynamics ; Magnetic Resonance Imaging* ; Prognosis* ; Syringomyelia*

No Abstract Available.
Female ; Hormone Replacement Therapy* ; Humans ; Life Style* ; Osteoporosis*

Progression of coronary artery disease after angioplasty seemed to be an important determinant of the long term efficacy of percutaneous transluminal coronary angioplasty(PTCA). In fifty seven patients who underwent coronary angiography beyond 1 month of PTCA, progression of coronary artery disease was evaluated and clinical and angiographic variables that might predict the progression after PTCA were sought. At the time of the repeat study, restenosis(>50% loss of PTCA gained diameter or >50% diameter stenosis) was found in 35 patients(61%) and progression(increasing >20% obstruction in coronary diameter or newly occurred total occlustion) was found in 20 patients(35%). Progression occurred similarly both in patients with restenosis(12 of 3, 35%) and in patients without restenosis(8 of 22, 36%). Within 6 months of PTCA, restenosis was found in 82%(23 of 28) and progression in 36%(10 of 28) and beyond 6 months, restenosis in 41%(12 of 29) and progression in 34%(10 of 29). Progression tended to occur more commonly in the artery which was dilated(10 of 60,17%) than in the artery that was not dilated(10 of 111, 9%), but this observation did not reach statistical significance. The influence of the risk factors on the progression was evaluated and progression appeared to be correlated with the initial extent of coronary artery disease and high low-density lipoprotein/high-density lipoprotein cholesterol ratio at follow-up study. Furthermore, the low-density lipoprotein/high-density lipoprotein cholesterol ratio at follow-up study was significantly higher in patients with progression in nondilated artery than that of those without progression, but there was no significant difference between patients with progression in dilated artery and patients without progression. In this study, we found that the incidence of progression was not rare within 6 months of PTCA as beyond 6 months. In addition, the incidence of progression in dilated vessels was not significantly higher than that in nondilated vessels, but high low-density lipoprotein/high-density lipoprotein cholesterol ratio was associated only with progression in non-dilated vessels, so trauma in dilated artery during PTCA might predispose the patients with low risk to the progression of coronary artery disease. Conclusively, PTCA may accelerate the progression of coronary artery disease. And the consistent relation between PTCA and progression of coronary artery disease requires further evaluation with more patients and prospective protocol.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Incidence ; Lipoproteins ; Risk Factors