BACKGROUND: In Korea, cerebrovascular accident (CVA) is the most significant cause of death among older people, and the incidence of cerebral hemorrhage is much higher than that of developed countries. There have been many investigations about the risk factors for CVA in both Korea as well as developed countries. A few papers reported various risk factors for cerebral hemorrhage in developed countries:however, well-designed studies of risk factors for the various causes of CVA were rare in Korea. Therefore, the purpose of this study was to compare the risk factors for the various causes of CVA and to evaluate the risk factors compared with age- and sex-matched control groups. In addition, duplex sonographic findings of the carotid artery were evaluated in patients with cerebral infarction. METHODS: One hundred and sixty-four patients admitted to the hospital in 1996 were enrolled. The four groups were divided based on the following states: cerebral infarction (n-63), cerebral hemorrhage (n-64), cerebral infarction with atrial fibrillation (n-19), and lacunar infarction (n-18). Major risk factors were compared with age- and sex-matched control groups and among CVA groups. Duplex sonography of the carotid artery was done in 14 patients with cerebral infarction. RESULTS: In multiple logistic regression analysis, patients with cerebral infarction had higher prevalence of diabetes mellitus and lower high density lipoprotein-cholesterol level than the control group, and hypertension showed borderline significance. Patients with cerebral hemorrhage had higher prevalence of hypertension, higher high density lipoprotein-cholesterol level, and more frequent prevalence of smoking compared with the control group. Patients with cerebral infarction showed lower high density lipoprotein-cholesterol, higher low density lipoprotein-cholesterol levels, more frequent diabetes mellitus, lower prevalence of hypertension and older age than patients with cerebral hemorrhage. Patients with cerebral infarction and atrial fibrillation showed only older age than patients with cerebral infarction only. There were no differences in risk factors between patients with cerebral infarction and lacuna infarction. Atheromatous plaque was found in 71% of patients with cerebral infarction. CONCLUSION: Metabolic abnormalities played more important role in the development of cerebral infarction and hemodynamic abnormalities in cerebral infarction. Sonographic examination of the carotid artery may be useful for predicting the occurrence of cerebrovascular accident in high risk patients.
Atrial Fibrillation ; Carotid Arteries* ; Cause of Death ; Cerebral Hemorrhage ; Cerebral Infarction* ; Developed Countries ; Diabetes Mellitus ; Hemodynamics ; Humans ; Hypertension ; Incidence ; Infarction ; Korea ; Logistic Models ; Prevalence ; Risk Factors* ; Smoke ; Smoking ; Stroke ; Stroke, Lacunar ; Ultrasonography*

Actinomycoces is a gram positive, anaerobic, branching and non-acid fast bacterium which is a normal habitant of the skin, oral cavity, tonsil and gastrointestinal tract and its human infection is rare. Pelvic actinomycoses is frequently caused by Actinomycoces israel-ii. It is chronic, progressive, and more suppurative than granulomatous disease, and the symptoms are usually persistent and gradual, therefore the misdiagnosis and improper trea-tment are not uncommon. Actinomycoses is generally classified as cervicofacial, abdominal and thoracic type ac- cording to the site of the primary infection. Many actinomycotic pelvic infections in women used intrauterine device with long du- ration were reported, in contrast, others suggest that actinomycoces developed opportunistic infection irrespective of intrauterine device presence. We have experienced 4 cases of pelvic actinomycoses, one case with IUD(Lippes' loop) in a 47 year old woman, the other case with abdominal wall ctinomycoses in a 34 year old woman, the third case without IUD in a 41 year old woman, the fourth case with IUD(Cu-7) in a 37 year old woman and reported them with a review of literature.
Abdominal Wall ; Actinomycosis* ; Adult ; Diagnostic Errors ; Female ; Gastrointestinal Tract ; Humans ; Intrauterine Devices ; Middle Aged ; Mouth ; Opportunistic Infections ; Palatine Tonsil ; Pelvic Infection ; Skin

Candida albicans is a commensal yeast normally present in small numbers as normal oral flora. In a certain condition, however, the yeast may proliferate and/or become invasive resulting in oral candidiasis such as denture stomatitis, and may even cause life-threatening systemic candidiasis. The present study was undertaken to test whether polyphosphate (polyP), which has been shown to be a strong antibacterial agent against a variety of oral pathogens, has antifungal effect on C. albicans. C. albicans ATCC 90027 was grown in Sabouraud-Dextrose broth with or without polyP. Anti-C. albicans activity of polyPs with various chain lengths was determined by measuring the growth of candidal cells at 540 nm. polyPs with chain length of 3 (polyP3) or higher effectively inhibited the candidal growth when added at the very beginning of the culture, whereas orthophosphate and pyrophosphate failed to do so. At the concentration of 0.05 percent, all the polyPs tested inhibited candidal growth. The effect of polyP65 that showed stronger anti-candidal effect than others at the concentrations tested and of Calgon (hexametapolyphosphate, practical grade) was further examined. The concentration of 0.03 percent was enough for polyP65 and Calgon to suppress candidal growth throughout the 48-h incubation. PolyP65 added to the growing C. albicans at its exponential phase was as much effective in inhibiting the candidal growth as added at the very beginning of the culture. It was found that 93.8 and 96.9 percent of the yeast cells lost their viability when polyP65 was added to growing C. albicans at the concentrations of 0.03 and 0.05 percent, respectively. Intracellular nucleotide release from the candidal cells incubated with polyP65 was only slightly increased and the nucleotide release was not reversed by the addition of divalent metal ions like Mg++ and Ca++. Under the transmission electron microscope, although the majority of growing C. albicans cells appeared to be atypical in their shape in the presence of polyP65, only a small number of the cells were observed to be lysed. The overall results suggest that polyP has a strong fungicidal activity against C. albicans, in which chelation-mediated cell lysis may not play the major role, but other novel mechanisms that possibly affect the viability of the yeast may be involved. Since polyP also has a strong antibacterial effect on oral pathogens, it may well be used for the prevention and treatment of a variety of oral diseases caused by a wide spectrum of microorganisms including C. albicans.
Candida albicans ; Candidiasis ; Candidiasis, Oral ; Ions ; Phosphates ; Polyps ; Stomatitis, Denture ; Yeasts

Moyamoya disease is an unusual cerebrovascular disorder characterized by occlusive intimal dysplasia of the distal internal carotid and proximal cerebral arteries, but the etiology remains unclear. Angiographic characteristics include bilateral stenosis or occlusion of the terminal portions of the intracranial internal carotid arteries and bilateral development of fine collateral vessels at the base of the brain known as 'Moyamoya vessels'. Cardiac surgery using cardiopulmonary bypass due to coronary artery disease and others among patients with moyamoya disease is very rare, and cardiac surgery for such patients has a potential risk of intraoperative and perioperative brain ischemia. We successfully treated a patient who underwent artrial septal defect closure and coronary artery bypass graft using the cardiopulmonary bypass, so we report this case with a brief literature review.
Brain ; Brain Ischemia ; Cardiopulmonary Bypass ; Carotid Artery, Internal ; Cerebral Arteries ; Cerebrovascular Disorders ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Humans ; Moyamoya Disease* ; Thoracic Surgery* ; Transplants

A 68-year-old man with constrictive pericarditis underwent pericardiectomy. The pericardium was dissected with a Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH). The harmonic scalpel differs from electrocautery in that there is only a minimal transfer of energy and no transfer of electrical energy to the tissues. A significant decrease in intraoperative and possibly even postoperative heart rhythm disorders is to be expected, as there is no conduction of electricity. This new device has many advantages including no muscular stimulation, low heat, a smokeless field and easy hemostasis. We exprienced a patient who underwent pericardiectomy using the Harmonic scalpel, so we report this case with a brief literature.
Aged ; Electricity ; Electrocoagulation ; Heart ; Hemostasis ; Hot Temperature ; Humans ; Lobeline ; Pericardiectomy* ; Pericarditis, Constrictive* ; Pericardium

Foreign body ingestion induces various complications during the induction of and emergence from anesthesia. These complications include inconsequential mucosal scratches, abrasion, laceration, esophageal stricture, necrosis, retropharyngeal abscess formation, hemorrhage, obstruction and perforation. We experienced a case of esophageal perforation after ingestion of a dental prosthesis during emergence. A 71-year-old female patient received general anesthesia for a lumbar laminectomy. At postanesthesia care unit, she complained of a sore throat and found that her dental prosthesis was missing. The impacted dental prosthesis was found at the T7 level, which was followed due to its perforation through the esophageal wall, causing mediastinitis. She underwent an operation for the esophageal repair and was discharged with slight chest discomfort due to operation, after 10 days.
Aged ; Anesthesia ; Anesthesia, General* ; Dental Prosthesis* ; Eating ; Esophageal Perforation* ; Esophageal Stenosis ; Female ; Foreign Bodies ; Hemorrhage ; Humans ; Lacerations ; Laminectomy ; Mediastinitis ; Necrosis ; Pharyngitis ; Retropharyngeal Abscess ; Thorax

Foreign body ingestion induces various complications during the induction of and emergence from anesthesia. These complications include inconsequential mucosal scratches, abrasion, laceration, esophageal stricture, necrosis, retropharyngeal abscess formation, hemorrhage, obstruction and perforation. We experienced a case of esophageal perforation after ingestion of a dental prosthesis during emergence. A 71-year-old female patient received general anesthesia for a lumbar laminectomy. At postanesthesia care unit, she complained of a sore throat and found that her dental prosthesis was missing. The impacted dental prosthesis was found at the T7 level, which was followed due to its perforation through the esophageal wall, causing mediastinitis. She underwent an operation for the esophageal repair and was discharged with slight chest discomfort due to operation, after 10 days.
Aged ; Anesthesia ; Anesthesia, General* ; Dental Prosthesis* ; Eating ; Esophageal Perforation* ; Esophageal Stenosis ; Female ; Foreign Bodies ; Hemorrhage ; Humans ; Lacerations ; Laminectomy ; Mediastinitis ; Necrosis ; Pharyngitis ; Retropharyngeal Abscess ; Thorax

OBJECTIVE: This study compared the efficacy and tolerability of clonazepam with other benzodiazepines in patients with anxiety disorders. METHODS: Inclusion criteria were as follows: age >20 years, diagnosis of anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) criteria, taking only one type of antidepressant, and prescribed one of three oral benzodiazepines (alprazolam, clonazepam, or lorazepam). At baseline and week 6, clinical benefit was evaluated using the Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression-Anxiety Scale (CGI-anxiety), and Clinical Global Impression-Sleep Scale (CGI-sleep). RESULTS: Among 180 patients, no differences in demographic characteristics among the three benzodiazepine groups were noted. After six weeks of treatment, all benzodiazepine groups showed significant improvements in CGI-S, CGI-anxiety, and CGI-sleep scores (p<0.001). There were no differences in mean changes in CGI-S, CGI-anxiety and CGI-sleep among the three benzodiazepine groups. The incidence of side effects was significantly lower in the clonazepam group than with the other benzodiazepines. The incidences of adverse events for the clonazepam, alprazolam, and lorazepam groups were 26.7% (n=20), 48.4% (n=31), and 43.9% (n=18), respectively. CONCLUSION: The present study suggests that clonazepam is as efficacious as other benzodiazepines for the treatment of various anxiety disorders. Furthermore, the safety profile of clonazepam was superior to the other benzodiazepines in this study.
Alprazolam ; Anti-Anxiety Agents ; Antidepressive Agents* ; Anxiety Disorders* ; Anxiety* ; Benzodiazepines ; Clonazepam* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Incidence ; Lorazepam

BACKGROUND AND OBJECTIVES: The ventricular activation time (VAT) is increased in both ventricular hypertrophy and bundle branch block. It is also known that the VAT is increased in myocardial ischemia due to the development of depolarization abnormality. However, little is known about the changes in the VAT on body surface electrocardiography following coronary stenting in patients with ischemic heart disease. The purpose of this study was to evaluate the clinical significance of VAT following coronary stenting by assessing the changes in the VAT during the 6 months following coronary stenting in patients with ischemic heart disease. SUBJECTS AND METHODS: The VAT was measured in 92 patients who had underdone coronary stenting due to of significant coronary artery stenosis on coronary angiography. The electrocardiography was recorded with a high paper speed at pre-stenting, immediate after and at 1 and 6 months after coronary stenting. RESULTS: The VAT was significantly decreased during the 6 month follow-up following coronary stenting (pre-stenting ; 45.9 +/-5.9 msec, immediate after stenting ; 38.5+/-2.7 msec, after 1 month ; 38.8+/-2.8 msec and after 6 months ; 38.8+/-2.5 msec, p<0.05). The VAT dispersion was significantly decreased during the 6 month follow-up following coronary stenting in the patients with one vessel disease (p<0.05), but not with two vessels disease. CONCLUSION: Coronary stenting significantly decreased the VAT during the 6 month follow-up. We would conclude that coronary stenting relieves depolarization abnormalities caused by myocardial ischemia, and improves the intraventricular conduction velocity. However, further studies are needed to assess the usefulness of VAT in evaluating myocardial ischemia.
Bundle-Branch Block ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Stenosis ; Coronary Vessels* ; Electrocardiography ; Follow-Up Studies ; Humans ; Hypertrophy ; Myocardial Ischemia ; Stents*

BACKGROUND AND OBJECTIVES: The recovery of the normal heart rate immediately after exercise is a function of vagal reactivation. An attenuated heart rate recovery during the first minute after graded exercise is believed to be a marker of reduced parasympathetic activity and has been proven to be an independent predictor of overall mortality. However, the clinical significance of an abnormal heart rate recovery in coronary artery disease and the changes in the exercise parameters after coronary stenting have not been fully evaluated. Subjects and Methods: The study population included 53 patients with a significant coronary artery stenosis and 25 subjects with a normal coronary artery. All underwent a treadmill exercise test prior to coronary angiography. The differences in the heart rate recovery and the Duke treadmill score between two groups were investigated. After coronary stenting, changes in the exercise parameters were evaluated during the follow-up treadmill exercise test in 22 coronary artery disease patients. RESULTS: The frequencies of abnormal heart rate recovery (12% vs 38.3%, p=0.014) and a moderate to high risk Duke treadmill score (4% vs 21.3%, p=0.034) were significantly higher in the coronary artery disease group. The frequencies of these parameters were also significantly higher in the multivessel disease group than the single vessel disease group. After coronary stenting, most of the exercise parameters showed no significant changes but the Duke treadmill score improved significantly (p=0.038). CONCLUSION: The frequency of abnormal heart rate recovery was significantly higher in the coronary artery disease group. The Duke treadmill score was significantly improved and is thought to be a useful follow up parameter after coronary stenting.
Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Stenosis ; Coronary Vessels* ; Exercise Test ; Follow-Up Studies ; Heart Rate* ; Heart* ; Humans ; Mortality ; Stents*