A noninvasive method for assessing cardiac output was evaluated by comparing it with thermodilution determinations in 25 patients who admitted to Pusan national university hospital from March, 1985 to December, 1986. This method used M-mode & two dimensional echocardiography to measure the internal diameter of aortic valve anulus & pulmonary valve anulus and pulsed doppler echocardiography to obtain aortic & pulmonary blood velocity. Good correlations were observed between thermodilution and doppler echocardiographic measurements of cardiac output from aortic flow (r=0.98, p<0.05) & pulmonary flow (r=0.86, p<0.05). Linear regression analysis yielded y=0.91x0.14 for aortic flow and y=0.77x0.84 for pulmonary flow. These results indicate that accurate cardiac output can be measured by noninvasive & simple doppler echocardiography.
Aortic Valve ; Busan ; Cardiac Output* ; Echocardiography* ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed ; Humans ; Linear Models ; Pulmonary Valve ; Thermodilution

To recognize the hemodynamic change in the constrictive pericarditis, we have reviewed the Doppler echocardiography, cardiac catheterization, and pathology of 6 patients who were admitted to Pusan National University Hospital due to right-side heart failure, diagnosed as constrictive pericarditis and were undertaken pericardiectomy. Doppler echocardiographic findings showed that acceleration and deceleration of early diastolic rapid filling were increased, followed by shortening of duration but there was a tendency to decrease in velocity-time integral of early diastolic rapid filling compared to that of atrial contraction filling in the left ventricle. On the contrary, there was decrease in acceleration of rapid filling in right ventricle, but other indices were comparable to that of left ventricle. The integral of D wave increased relatively compared to that of S wave in superior vena canal flow. Also, there was decrease in peak flow velocity, acceleration and velocity-time integral of aortic and pulmonary arterial flow velocity. One patient who had increased fraction of integral of early diastolic rapid filling compared to that of atrial contraction filling in right ventricle showed that he had higher central venous pressure and D wave was dominant in superior vena caval flow. In conclusion, Doppler flow patterns showed characteristic diastolic filling inpairment and systolic dysfunction in constrictive pericarditis, so that Doppler echocardiography is believed to be a useful method of noninvasive diagnosis and follow-up of hemodynamic change in constrictive pericarditis.
Acceleration ; Busan ; Cardiac Catheterization ; Cardiac Catheters ; Central Venous Pressure ; Deceleration ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Pathology ; Pericardiectomy ; Pericarditis, Constrictive*

No abstract available.
Takayasu Arteritis*

Malignant hyperthermia is a metabolic and genetic disease which present with multiple signs of variable intensity and time course. Most of signs are nonspecific to malignant hyperthermia an4 it is not unusual for malignant hyperthermia-susceptible patients to under- go their first anesthesia uneventfully. Thus,the accurate prediction of preanesthetic susceptibility and early diagnosis of malignant hyperthermis can be lifesaving. Recently, some episodes of signs and symptoms suggestive of malignant hyperthemia after spinal an- esthesia those were suspected to be malignant hyperthermia have been reported. In our hospital, two patients suffered from signs and symptoms suggestive of malignant hyperthermia after spinal anesthesia. One patient showed severe muscle rigidity on the un- blocked upper extremities and thorax, tachycardia (120-160beat/min) and hypertension (180-160/120-100mmHg) and later he showed high fever(38-40degrees C), generalized seizure and severe acidosis. He expired the next day of operation in spite of intensive care. The other patient showed shivering, high fever(39degrees C) and elevated serum CPK level(more than 1,500IU/ L) after spinal anesthesia. Intensive treatment with cooling was immediately initiated. Then, he recovered completely 6 hours later. His mother and a brother showed increased serum CPK level(91,112IU/L, respectively), too. Although we could not performed confirmatory diagnostic test, signs and symptoms were very similar to those of malignant hyperthermia. So, we suspected that it might be malignant hyperthermia.
Acidosis ; Anesthesia ; Anesthesia, Spinal* ; Diagnostic Tests, Routine ; Early Diagnosis ; Humans ; Hypertension ; Critical Care ; Malignant Hyperthermia* ; Mothers ; Muscle Rigidity ; Seizures ; Shivering ; Siblings ; Tachycardia ; Thorax ; Upper Extremity

BACKGROUND: The high pressure zone(HPZ) at the gastroesophageal junction is an important barrier for prevention of gastroesophageal reflux. Smooth muscle layers in the lower esophageal sphincter mainly contributes to HPZ at the throacoabdominal junction. The purpose of this study was to investigate the manometric characteristics of the thoracoabdominal junction in patients after surgical removal of the lower esophageal sphincter. MATERIAL AND METHOD: Twenty two patients with prior esophagogastrectomy(10 Ivor-Lewis method and 12 left thoracotomy) and 30 normal adults(control group) were studied manometrically. RESULT: Esophageal manometry showed a HPZ and pressure inversion point distal to the anastomosis in 12 of 22 patients(2 of 10 patients with Ivor-Lewis method and 10 of 12 patients with left thoracotomy) and a HPZ in 30 of 30 normal adults. The location of HPZ from nostril was not significant different between the two groups(42.5+/-0.9cm in patients and 43.9+/-2.1cm in the control), while the length of HPZ was shorter in patients than in the control(2.13+/-0.6cm vs 2.83+/-0.59cm). By SPT and RPT, pressures of HPZ at rest were lower in patients(13.78+/-1.63mmHg, 28.58+/-6.06mmHg) than in control(20.3+/-4.95mmHg, 42.80+/-15.91mmHg). The HPZ relaxed partially in response to deglutition(84.4% in patient, 90.5% in control group) and contracted in response to increased intra- abdominal pressure induced by leg lifts(HPZ/ Intra-abdominal pressure= 1.81+/-0.23 in patient, 2.13+/-0.58 in control group). CONCLUSION: This study shows an HPZ at thoracoabdominal junction after surgical removal of the lower esophageal sphincter. It may be important to perform a crural myoplasty during esophageal reconstruction after esophagogastrectomy because crural diaphragm acts as sphincter like HPZ at the thoracoabdominal junction.
Adult ; Diaphragm* ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Gastroesophageal Reflux ; Humans ; Leg ; Manometry ; Muscle, Smooth

Human gingival fibroblasts have proven to useful as a species specific cell culture system in various system on periodontal disease and regeneration. However, their use is limited, since they are hard to obtain and lifespan is short due to replicative senescence. To overcome these disadvantages, we transfected primary human gingival fibroblasts by the E6 and E7 genes of the Human papilloma virus(HPV) 16. The full length of HPV 16 E6 and E7 was cloned from the pBR322 into BamH1 and Sal I of a pBabe vector including hygromycin B resistance. Before pBabeE6/E7 plasmid transfection, peak 8 GFP including G418 resistance was transfected into primary GF to check the transfection efficency. PBabe E6/E7 plasmid was transfected using Lipofectamine plus following manufacter's instruction into primary normal human gingival fibroblasts in 60mm dishes with FBS free DMEM. After 2 days of transfection, the cells were treated with hygromycin for 2 weeks until the transfected control cells died. The resulting hygromycin resistant colonies were pooled, and clonned, and sucessful transfection was established for immortalized gingival fibroblast cell lines. Immoralized GF cells showed stellate shape, that is similar to that of orange grains, and more rapid growth and higher proliferation than that of primary gingival fibroblasts. This cell lines overcame crisis and could be cultured over 30 subcultured, could be use for three dimentional culture, epithelial-mesenchymal interaction study.
Cell Aging ; Cell Culture Techniques ; Cell Line* ; Edible Grain ; Citrus sinensis ; Clone Cells ; Fibroblasts* ; Human papillomavirus 16 ; Humans* ; Hygromycin B ; Papilloma ; Periodontal Diseases ; Plasmids ; Regeneration ; Transfection

PURPOSE: The purpose of this study was to evaluate the results of surgical treatment of nonunion of the surgical neck of the humerus in elderly patients. MATERIALS AND METHODS: Seven patients over 60 years of age surgically treated for nonunion of the surgical neck of the humerus with follow- up over 1 year were investigated. Of the three patients with severe osteoporosis, multiple K-wires were used in 1 patient, and Ender nails were used in 2. The other 4 patients with relatively good bone quality were treated with plate and screws. Functional results were evaluated using the University of California, Los Angeles (UCLA) shoulder rating scale and statistical significance was tested using the Wilcoxon signed rank test. RESULTS: Radiological union was obtained in six patients, and 1 patient had no evidence of union at a postoperative 5 years. Active elevation improved from an average of 73 (range, 20-100) degrees to 139 (range, 110-160) degrees. The UCLA score improved from 10.9(range, 7-16) points to 27.3 (range, 10-33) points on the average. CONCLUSION: Open reduction with internal fixation and bone grafting for nonunion of the surgical neck of the humerus in elderly patients may result in significant functional improvement.
Aged* ; Bone Transplantation ; California ; Humans ; Humerus* ; Neck* ; Osteoporosis ; Shoulder

Neurilemoma(schwannoma, neurinoma, Schwann's cell tumor) is a relatively uncommon, slowly growing lesion that usually has been present for a considerable time before diagnosis and treatment are requested. The site of origin is believed to be the ectodermal Schwann cells of the nerve sheath. An interesting variant, known as the ancient neurilemoma, has been reported by Eversole and others. They suggest that the histologic feature that typify this tumor result from degenerative changes which occur as a classic neurilemoma ages. We have experienced a case of schwannoma arising on the nasal tip of a 27 years old man and discussed with brief current literatures review.
Adult ; Diagnosis ; Ectoderm ; Humans ; Neurilemmoma* ; Schwann Cells

We analyzed the practical problems and factors which affect making the correct differential diagnosis in the interpretation or test results from the nocturnal penile tumescence (NPT) test and erotic stimulation test (EST). This was done to provide better information for higher diagnostic accuracy in the clinical application of these tests. The followings are the results of NPT tests and EST identifying the factors affecting correct differential diagnosis by comparison the other differential diagnostic methods. The overall sensitivity of NPT test (Number: 114 total patients) was 82%. 21 cases (18%) could not be diagnosed correctly due to traction of the sensor (12 cases, 10%) and sleep disturbance (9 cases, 8%). The overall sensitivity of EST (Number: 174 total patients) without considering the degree of patient`s sexual drive to erotic stimulation was 77%. 40 cases (23%) could not be diagnosed correctly due to tolerance to pornographic film (17 cases, 10 %), discomfort by the body attachments (14 cases, 8%) and traction of the sensor (9 cases, 5%). However, higher sensitivity (90%) and lower rate of incorrect diagnosis (10% ) were observed in 119 patients who showed Grade II or III (moderate to good) sexual drive to erotic stimulation. The results suggest that undesirable factors in the primary screening methods, traction of sensor, sleep disturbance in NPT test, and tolerance to pornographic film, discomfort by the body attachments, traction of sensor in EST must be taken into consideration when interpretation of test results is being performed.
Diagnosis ; Diagnosis, Differential ; Diagnostic Tests, Routine* ; Erectile Dysfunction* ; Humans ; Male ; Mass Screening ; Penile Erection ; Traction

PURPOSE: To assess the spiral CT findings of inflammatory pseudotumor of the liver (IPTL), in order todistinguish this tumor from hepatocellular carcinoma, hepatic abscess or other space liver occupying lesions. MATERIALS AND METHODS: The spiral CT findings of IPTL were retrospectively evaluated in six patients. All caseswere confirmed by ultrasonography-guided gun biopsy. Four patients were men and two were women, and they were agedbetween 37 and 74 (mean, 49) years. The site, size, and number of IPTL were assessed, and their enhancementpatterns were evaluated during the arterial, portal and delayed phases of spiral CT. RESULTS: Five casesinvolveda solitary mass and in one there were multiple masses with surrounding small nodules. Four cases occurredin the right lobe and two in the left lobe. Four of five surrounding nodules were in the left lobe. During thearterial phase of spiral CT scanning, three layers were separated from four of five cases of solitary mass ; theywere composed of central and peripheral portions of low attenuation, and an intermediate portion ofisoattenuation. Delayed enhancement of the peripheral portion was prominent during the delayed phase. In the caseinvolving multiple masses three layers were not seen during the arterial phase, but during the delayed phaseenhancement was noted. CONCLUSION: The features of three layers, as seen on spiral CT, is considered to be veryspecific for distinguishing IPTL from other hepatic focal lesions.
Biopsy ; Carcinoma, Hepatocellular ; Female ; Granuloma, Plasma Cell* ; Humans ; Liver Abscess ; Liver* ; Male ; Retrospective Studies ; Tomography, Spiral Computed*