BACKGROUND: The effective ventricular function during ejection and filling is likely to depend on the coordinated action of the longitudinally and circumferentially orientated myocardial fibers and the function of these longitudinal fibers has not been extensively studied. METHODS: The role of longitudinally and circumferentially orientated fibers in left ventricular wall motion was evaluated by M-mode echocardiograms of the mitral ring(whose motion reflect long axis change) and the standard minor axis(left ventricular posterior wall), simultaneous recordings of phonocardiograms and electrocardiograms on the paper (speed 100mm/sec), in 24 healty individuals, 17 patients with mitral stenosis, 11 patients with open mitral commissurotomy and 17 mitral valve replaced patients. RESULTS: In the controls long axis shortening significantly preceded minor axis shortening (phase difference between two axes : 20+/-3 msec, mean+/-SEM) during early systole, indicating left ventricle become more spherical. This phase difference was also observed in the patients with mitral stenosis and in those with open mitral commissurotomy. In patients with mitral valve replacement(MVR) whose papillary muscles had been sectioned, the onset of long axis shortening was more delayed during early systole than that of short axis(-33+/-6msec) and the end of shortening was also prolonged to early diastole more than that of normal controls (54+/-3 msec vs 90+/-8 msec, mean+/-SEM, p<0.01 by t-test). CONCLUSION: We observed the time relations between long and short axis motion in normal controls. It can be concluded that the reversed time relation in patients with MVR is one of the important factors which may effect negatively on ventricular function and long-term prognosis, thus the surgical procedures to preserve papillary annular continuity should be considered in patients with mitral valvular disease. And the controlled, prospective, clinical trials with homogenous groups of patients are needed to evaluate the potential benefits of papillary annular continuity in preserving atrio-ventricular interaction in patients undergoing mitral valvular surgery.
Axis, Cervical Vertebra* ; Diastole ; Echocardiography ; Electrocardiography ; Heart Valve Diseases* ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Papillary Muscles ; Prognosis ; Systole ; Ventricular Function

BACKGROUND: Inaccuracies associated with target-controlled infusion (TCI) delivery systems are attributable to both software and hardware issues, as well as pharmacokinetic variability. However, little is known about the inaccuracy of the syringe pump operating in TCI mode. This study aimed to evaluate the accuracy of the TCI pump based on international standards.METHODS: A test apparatus for accuracy evaluation of a syringe pump (PION TCI®, Bionet Co. Ltd.) was designed to apply the gravimetric method. Pump accuracy was evaluated in terms of deviation defined by the following equation: infusion rate deviation (%) = (Rate(mea) − Rate(est)) / Rate(est) × 100, where Rate(mea) is the infusion rate (ml/h) as measured by the gravimetric system, and Rate(est) is the infusion rate (ml/h) as estimated by the pump. An infusion rate representing TCI mode was determined from previous clinical trial data which evaluated the predictive performance of the pharmacokinetic model. The PION TCI pump used in that clinical trial was used to evaluate accuracy of the syringe pump. The distribution of infusion rates obtained from the clinical trial was calculated, and the median value of the distribution was determined as the representative value.RESULTS: The representative infusion rate representing TCI mode was 31 ml/h, at which the infusion rate deviation was 4.5 ± 1.6%.CONCLUSIONS: The inaccuracy of the syringe pump contributing to TCI system inaccuracy is insignificant.
Mesons ; Methods ; Syringes

BACKGROUND AND OBJECTIVES: Platelet-activating factor (PAF) in middle ear effusion is thought to induce hearing loss. The purpose of this study is to determine the effects of PAF placed on round window membrane (RWM) on hearing and cochlear hair cells in guinea pigs, and we also wanted to investigate the role of nitric oxide (NO) in the mechanism of PAF-induced hearing loss by comparing its immunoreactivity to iNOS between the control group and PAF application group. MATERIALS AND METHOD: Guinea pigs were divided into 2 groups: PBS, PAF. The PBS group received phosphate buffered saline (PBS) and the PAF groups received 10, 20, and 40 mug/ml of PAF soaked in gelfoam placed on the RWM. The following three tests were performed on each animal group: hearing was tested with an auditory brainstem response (ABR) test through 24 hours. At the end of 24 hours, cochlear hair cells were examined by scanning electron microscopy (SEM) and immunohistochemistry was carried out on the cochlea to test the expression of inducible nitric oxide (iNOS). RESULTS: The PAF group developed significant elevation of ABR threshold and cochlear hair cell damage in SEM compared with the PBS control group. Strong expression of iNOS on cochlea was observed in the PAF group and lighter expression was seen in PBS group. CONCLUSION: This study demonstrated that PAF placed on the RWM induced hearing loss, and cochlear hair cell damage, and strong iNOS expression in the cochlea. These findings suggest that the PAF-induced hearing loss caused by cochlear hair cell damage may have been mediated by NO. PAF-antagonists and NOS inhibitor may have future therapeutic implications in preventing sensorineural hearing loss associated with chronic otitis media.
Animals ; Cochlea ; Ear, Inner* ; Evoked Potentials, Auditory, Brain Stem ; Gelatin Sponge, Absorbable ; Guinea Pigs* ; Guinea* ; Hair ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Immunohistochemistry ; Membranes ; Microscopy, Electron, Scanning ; Nitric Oxide ; Otitis Media ; Otitis Media with Effusion ; Platelet Activating Factor

Purpose: Mechanical and functional ankle instability or combinations of both can contribute to chronic ankle instability (CAI). Therefore, the purpose of this study was to compare the difference in (1) static and (2) dynamic balance function between patients with CAI and the controls; (3) to investigate association between balance function and CAI; and (4) to examine whether balance assessments are valuable for diagnosing CAI. Methods: This study was conducted on 40 patients with CAI and 40 ankle healthy individuals. All participants evaluated the Cumberland Ankle Instability Tool questionnaire. Additionally, joint laxity and center of pressure (COP) during static postural control, anterior landing, and lateral landing were measured using an electronic pedobarography. Results: CAI patients showed a larger COP area than controls when performing static postural control (p=0.023) and lateral landing (p=0.002). As a result of the receiver operation characteristic curve analysis, COP distance, area, and speed during static postural control and COP area during lateral landing showed low accuracy, indicating that they are valuable evaluations for the diagnosis of CAI. Conclusion Patients with CAI had poor static and dynamic postural control ability. The static posture control and the lateral landing test had diagnostic significance to evaluate the objective function of CAI.

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. As the clinical manifestations are very diverse and associated with nonspecific symptoms, research seeking to identify organic causes to rule out IBS and to enable differential diagnosis is required. A 24-year-old man was referred to our hospital for specialized management of IBS. He had a 7-month history of intermittent epigastric and lower abdominal pain. On the basis of clinical examination, he was diagnosed with IBS and administered medication at a primary clinic. However, his symptoms did not improve after treatment. We performed capsule endoscopy at our hospital and identified a parasite (Ancylostoma duodenale) in the proximal jejunum. We therefore report a case of parasitic infection found by additional examination while evaluating symptoms associated with a previous diagnosis of refractory IBS.
Abdominal Pain ; Ancylostoma ; Ancylostomatoidea ; Capsule Endoscopy ; Diagnosis* ; Diagnosis, Differential ; Humans ; Irritable Bowel Syndrome* ; Jejunum ; Parasites* ; Young Adult

BACKGROUND/AIMS: Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track. METHODS: A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were devided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group. RESULTS: The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614). CONCLUSIONS: Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention.
Aged ; Aged, 80 and over ; Amylases/metabolism ; Cholestasis/diagnosis/*surgery ; Drainage ; Female ; Humans ; Jaundice, Obstructive/diagnosis/*surgery ; Male ; Middle Aged ; Pancreatitis/*etiology ; Retrospective Studies ; Risk Assessment ; Sphincterotomy, Endoscopic ; Stents/*adverse effects

Chronic thromboembolic pulmonary hypertension (CTEPH) is considered to be an aberrant outcome of acute pulmonary thromboembolism, due to inadequate thrombus dissolution. However, the mechanism of thrombi dissolution failure remains unclear. With respect to inherited thrombophilia, the co-occurrence of natural anticoagulant deficiencies with CTEPH was found to be rare. Pulmonary thromboendarterectomy (PTE) is a potentially curative surgical procedure for CTEPH, but it is associated with considerable mortality due to postoperative complications, such as reperfusion pulmonary edema and right heart failure. The postoperative course after PTE poses a unique series of ventilatory care and hemodynamic management challenges. We present the case of a 42-year-old woman with unilateral CTEPH combined with thrombophilia (Protein S deficiency). Successful PTE was followed by independent lung ventilation with unilateral nitric oxide (NO) inhalation, which resulted in functional improvement without postoperative complications.
Adult ; Endarterectomy* ; Female ; Heart Failure ; Hemodynamics ; Humans ; Hypertension, Pulmonary* ; Inhalation ; Lung ; Mortality ; Nitric Oxide ; Postoperative Complications ; Protein S Deficiency ; Pulmonary Edema ; Pulmonary Embolism ; Reperfusion ; Thrombophilia ; Thrombosis ; Ventilation

The Philadelphia (Ph) chromosome is a well- known chromosome abnormality in adults with B-lineage ALL, and is associated with a poor prognosis. This study compared the clinical manifestations and prognosis in adult Ph-positive and Ph-negative ALL patients. MATERIALS AND METHODS: We retrospectively analyzed the clinical records of adult patients newly diagnosed as B-lineage ALL, between January 1995 and February 2001. Fifty five patients were included in this study. We divided the patients into Ph-positive and Ph-negative groups. RESULTS: Eighteen of the 55 patients (32.7%) were found to have the Ph chromosome. At initial diagnosis, the Ph-positive patients had higher circulating leukocyte counts, lower platelet counts and had a greater tendency to bleed, than the Ph-negative group. The complete remission rates were 83.3% and 83.8% for the Ph-positive and the Ph-negative groups, respectively. Four of the Ph-positive, and 13 of the Ph-negative, patients underwent allogenic bone marrow transplantation. The median follow-up for the surviving patients was 39.3 months. The three-year survival rates were 10.4% and 51.8% for the Ph-positive and the Ph-negative groups, respectively. The median disease-free survival was 7.7 months for the Ph-positive group, but did not reach the median value in the Ph-negative group. Among the Ph-positive patients, age was the only factor that had an impact on the disease outcome. CONCLUSION: In adult B-lineage ALL, the Ph-positive patients had similar complete remission rates to other patients; however, the remission was of shorter duration, with a higher relapse rate in the Ph-positive patients. More effective treatments are needed to improve the survival of the Ph-positive patients.
Adult* ; Bone Marrow Transplantation ; Chromosome Aberrations ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Hydrogen-Ion Concentration ; Leukocyte Count ; Philadelphia Chromosome ; Platelet Count ; Prognosis* ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: Acute pyelonephritis (APN) is among the most common infectious diseases. Most APN occurs in young women and easily treated. Bacteremia has been associated in approximately 20-30% of those with APN. But recent documents demonstrated that blood cultures provide no useful information toward the clinical management of acute pyelonephritis. Thus we compared demographic and clinical characteristics as related to the bacteremic status, and investigated the risk factors for bacteremia. METHODS: One hundred sixty five patients, who visited myongji hospital for APN from January, 2004 to December, 2006 were included. Retrospective data were analyzed by medical record review. RESULTS: Bacteremic patients (N=51, 30.9%) were significantly older than those in nonbacteremic group (p<0.0001), had elevated serum creatinine (p=0.008), decreased platelet counts (p=0.029), lower serum protein (p=0.010), and lower serum albumin (p=0.011) than those without bacteremia. Hematuria was more severe in bacteremic patients (p<0.0001). The bacteremic cases were observed more frequently in patients with complicated APN patients than uncomplicated patients (46.7% vs. 21.4%, p=0.001). No significant difference existed between the bacteremic and non-bacteremic patients in the prevalence of resistance to quinolone of E. coli. In multivariate logistic regression analysis, serum albumin (p= 0.023), hematuria (p=0.003), and age (p=0.003) at presentation were found to be independent risk factors for bacteremia in acute pyelonephritis. CONCLUSION: Our study reveals that patients with bacteremia have different clinical characteristics compared to those without bacteremia. It is recommended to concern about the presence of bacteremia in the treatment of APN.
Bacteremia ; Communicable Diseases ; Creatinine ; Female ; Hematuria ; Humans ; Logistic Models ; Medical Records ; Platelet Count ; Prevalence ; Pyelonephritis ; Retrospective Studies ; Risk Factors ; Serum Albumin ; Urinary Tract Infections

Symptomatic muscular rings are extremely rare, and some authors have even disputed their existence. The lower esophageal muscular ring, or A ring, located about 2cm proximal to the squamocolumnar junction and are covered by squamous epithelium. These rings consist of an annular narrowing of hypertrophic muscular tissue in the esophageal body. Recently, we experienced 2 cases of symptomatic muscular ring of the esophagus and the findings. Case 1) A 52 year-old male with dysphagia, chest pain and regurgitation for several years, had esophagogram, endoscopy, esophageal motility studies and chest CT. Under the diagnosis of esophageal muscular ring, the patient had pneumatic baUoon dilatation (3.0 cm in diameter, Rigiflex), under which the patient experienced perforation of the lower esophagus and required surgery. We confirmed muscular ring of the esophagus as shown by a thickened muscularis propria layer, without other pathologic findings. Case 2) A 60 year-old male complaining of intermittent dysphagia, had esophagogram, endoscopy, esophageal motility studies and EUS. Under the diagnosis of esophageal muscular ring, he is now being treated with calcium channel blocker and nitrate, and has experienced minimal symptom improvement. We report 2 cases of symptomatic muscular ring of low esophagus with review of literature.
Calcium Channels ; Chest Pain ; Deglutition Disorders ; Diagnosis ; Dilatation ; Endoscopy ; Epithelium ; Esophagus* ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed