PURPOSE: In young male patients who suffered several kinds of trauma with subsequent suspicious reflex sympathetic dystrophy syndrome, we performed three-phasic bone scan in order to investigate its usefulness. MATERIALS AND METHODS: Patients with narrow range of age (21-25. mean 22.8+/-1.3, all male) were included with suspicious reflex sympathetic dystrophy syndrome of 12 feet and 5 hands. Only one was bilateral feet case and 16 were ipsilateral (Rt:13, Lt:3). The etiologic traumas were 4 fractures, 4 sprains, 3 blunt trauma, 2 cellulitis, 1 tendon tear, 1 crush injury, 1 overexercise, and 1 unknown. Radiologically 3 showed osteoporotic changes. Three-phasic bone scans were performed 21.2+/-7.3wks after trauma. RESULTS: According to symptom complex, confirmatory reflex sympathetic dystrophy syndrome 4 cases and suspicious 13 were analyzed. All confirmatory cases (100%) showed increased uptake at delay phase with periarticular accentuation. Of confirmatory 4 cases, 2 showed increased uptake in all three phases (perfusion: P, blood pool: B, and delay: D), and other 2 revealed decreased P but, both increased B and D. Of suspicious 13 cases, 9(69.2%) had increased D (4 periarticular and 5 focal), 2 decreased D, and 2 symmetric D. In 12 foot cases, so-called weight bearing patterns - increased contralateral sole at P and B - were revealed in 7(58.3%). CONCLUSION: Diffuse periarticular increased uptake at delay phase of three-phasic bone scan was a compatible finding to reflex sympathetic dystrophy syndrome in young male patients whose symptom complex strongly designated post traumatic reflex sympathetic dystrophy syndrome.
Cellulitis ; Foot ; Hand ; Humans ; Male* ; Reflex Sympathetic Dystrophy* ; Reflex* ; Sprains and Strains ; Tendons ; Weight-Bearing

A 38 year old woman presented with two week history of cough, progressive dyspnea, orthopnea and pedal edema. She had previously been in excellent health with the exception of surgery five years ago for tumor of the right thigh. The histopatihologic diagnosis was chondrosarcoma. Her clinical course was characterized by rapid aggrevation of dyspnea and eddema unresponsive to conventional managements for congestiove heart failure. Transesophageal echocardiogram showed dleft atrial mass growing from pulmonic vein. To our knowledge, cardiac metastasis from chondrosarcoma is rare and we report this is the first case of chondrosarcoma metastatic to the heart in Korea.
Adult ; Chondrosarcoma* ; Cough ; Diagnosis ; Dyspnea ; Edema ; Female ; Heart Failure ; Heart* ; Humans ; Korea ; Neoplasm Metastasis ; Thigh ; Veins

We report a case of Holt-Oram syndrome associated with tetralogy of Fallot. Right thumb was digitalized, and left thumb was hypoplastic and dislocated at metacarpopharygeal joint. Thrombocytopenia in peripheral blood and megakaryocytic hypoplasia in bone marrow was accompanied. Brief review was done with emphasis on embryologic pathogenesis.
Bone Marrow ; Joints ; Tetralogy of Fallot ; Thrombocytopenia ; Thumb

The coronary arteriovenous fistula (CAVF) is a rare congenital anomaly but constitutes the most common hemodynamically significant coronary artery anomaly. Transcatheter embolization is as an effective alternative to surgery even though procedure may be complicated by migration of the coil into peripheral vessels or pulmonary arteries. To our knowledge, the association of CAVF with Turner syndrome was not reported. We report a case of successful coil embolization of CAVF using a complex, helical-fibered platinum coil in patient with Turner phenotype with 46,XX.
Arteriovenous Fistula* ; Coronary Vessels ; Embolization, Therapeutic* ; Humans ; Phenotype* ; Platinum ; Pulmonary Artery ; Turner Syndrome

BACKGROUND: The purpose of this study is to evaluate the immediate survival, complication and follow-up results of aortic dissection and to analyze the risk factors that determine the prognosis after aortic dissection. METHODS: 29 patients(M : 12, Age : 59.0+/-11 yrs) with aortic dissection were reviewed retrospectively. Any dissection involving the ascending aorta was classified as proximal dissection and the dissection was considered to be acute if time from clinical onset of the dissection to admission was less than 2 weeks. The immediate survival rate and follow-up results of aortic dissection was compared by type, onset and mode of treatment. RESULTS: 1) The studied patient were 29(Acute onset : 24, Proximal type : 14) and 17 patients(Proximal type : 14) were surgically treated. 2) Five of 10 patients with proximal dissection and 4 of 12 patients with distal dissection, who were managed by medical treatment, died, and 1 of 4 patients with proximal dissection and none of 3 patients with distal dissection, who were managed by surgical treatment, died at hospital. There was no significant statistical difference in mortality according to type, onset and mode of treatment. 3) Nine of 14 patients with proximal dissection and 8 of 15 patients with distal dissection had one or more complications. 4) The cause of death could be established in 10 patients. The most frequent cause of death was aortic rupture including cardiac tamponade(4 of 6 patients for proximal dissection, 2 of 3 patients for distal dissection). 5) The most of death, 8 of 10 deaths occurred within 2 weeks of onset of disease. there was a good life expectancy for the discharged patient regardless of type, onset and mode of treatment. CONCLUSION: These data showed that there was equivalent outcomes in patients with aortic dissection regardless of type, onset and mode of treatment. But these data would not be applied to general population with aortic dissection because of limited number of the study.
Aorta ; Aortic Rupture ; Cause of Death ; Follow-Up Studies* ; Humans ; Life Expectancy ; Mortality ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate

BACKGROUND: Transluminal balloon coronary angioplasty is one of the most widely used therapeutic procedures in the treatment of patients with coronary artery disease. However, restenosis remains a major limitation of percutaneous coronary angioplasty despite extensive efforts to prevent recurrence. We examined the immediate and long-term results of 516 patients (617 lesions) who underwent coronary angioplasty to evaluate the initial success rate, complications, restenosis rate, and the factors affecting initial success and restenosis. METHODS: The coronary angioplasty of 516 patients(M/F : 388/128, mean age : 57 years), 671 lesions was done with conventional technique and follow-up coronary angiogram was obtained 4 to 6 months after angioplasty in 168 patients. The angiographic restenosis was defined as >50% luminal narrowing in a previously dilated lesion, and the clinical restenosis defined as the recurrence of typical angina and/or positive tests of treadmill test, or thallium scintigraphy during follow-up period. RESULTS: 1) The coronary angioplasty was successful in 459 of 516 patients(89%), 604 of 671 lesions(90%). The success rate was significantly lower in subgroups with type C lesion(52.2%, p<0.001), right coronary artery (83.7%, p<0.05) and <3.0mm of size of lesion(81.4%, p<0.001). 2) The procedural complications were as follows : intimal dissection in 143 lesions(21.3%) including acute closure in 9 lesions(1.3%), emergency bypass surgery in 6 patients(1.2%), myocardial infarction in 9 patients(1.7%), rupture of coronary artery in 2 patients, air embolism in 1 patient, and death in 1 patient(0.19%). 3) The causes of the procedural failure(n=57 patients) included guidewire passage failure in 27, balloon passage failure in 4, catheter engagement failure in 1, acute closure in 7, coronary artery rupture in 2, and suboptimal result in 16 patients. 4) Clinical follow-up was obtained in 455 patients for a mean follow-up duration of 13.2months and clinical restenosis rate was 31%(141/455). The repeat coronary angiogram was performed in 168 patients(209 lesions) for a mean follow up duration 5.4month and demonstrated 48%(100/209) angiographically restenosis rate. The clinical restenosis rate was significantly lower in subgroups with <10% of residual stenosis(18.9%, p<0.05), left circumflex coronary artery(18.5%, p<0.05). 5) The restenosis following angioplasty(n=100 lesions) was treated with repeated PTCA in 57, Stent(Palmaz-Schatz) in 6, DCA in 3, elective CABG in 9, and medication in 25. 6) During the clinical follow-up, there were nonfatal myocardial infarction in 4 patients. CONCLUSION: 1) The coronary angioplasty is an effective treatment for revascularization that has a high success rate, low incidence of complications and excellent long-term survival. 2) The restenosis rate was affected by residual stenosis which suggests that the implication of minimal residual stenosis is the most important determining factor to reduce the restenosis rate after angioplasty.
Angioplasty* ; Catheters ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Embolism, Air ; Emergencies ; Exercise Test ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Phenobarbital ; Radionuclide Imaging ; Recurrence ; Rupture ; Thallium

OBJECTIVES: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. METHODS: Among the 11 731 nurses who participated in the Korea Health and Medical Workers' Union's educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. RESULTS: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses' job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses' turnover intention. CONCLUSIONS: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses' job satisfaction. However, the nursing practice environment was not related to nurses' turnover intention.
Adult ; Female ; Humans ; *Job Satisfaction ; Logistic Models ; Male ; Middle Aged ; Nursing Staff, Hospital/*psychology ; Odds Ratio ; *Personnel Turnover ; Questionnaires

OBJECTIVES: To examine whether the nursing practice environment at the hospital-level affects the job satisfaction and turnover intention of hospital nurses. METHODS: Among the 11 731 nurses who participated in the Korea Health and Medical Workers' Union's educational program, 5654 responded to our survey. Data from 3096 nurses working in 185 general inpatient wards at 60 hospitals were analyzed using multilevel logistic regression modeling. RESULTS: Having a standardized nursing process (odds ratio [OR], 4.21; p<0.001), adequate nurse staffing (OR, 4.21; p<0.01), and good doctor-nurse relationship (OR, 4.15; p<0.01), which are hospital-level variables based on the Korean General Inpatients Unit Nursing Work Index (KGU-NWI), were significantly related to nurses' job satisfaction. However, no hospital-level variable from the KGU-NWI was significantly related to nurses' turnover intention. CONCLUSIONS: Favorable nursing practice environments are associated with job satisfaction among nurses. In particular, having a standardized nursing process, adequate nurse staffing, and good doctor-nurse relationship were found to positively influence nurses' job satisfaction. However, the nursing practice environment was not related to nurses' turnover intention.
Adult ; Female ; Humans ; *Job Satisfaction ; Logistic Models ; Male ; Middle Aged ; Nursing Staff, Hospital/*psychology ; Odds Ratio ; *Personnel Turnover ; Questionnaires

BACKGROUND: The purpose of this study was to evaluate the clinical feasibility of bedside intravenous ergonovine test with echocardiography as a noninvasive diagnostic method for coronary vasospasm. METHODS: Bedside ergonovine test was performed in 50 patients with chest pain one day after coronary angiography with spasm provocation test ; 30 patients showed positive results of provocation test while in 20 patients there was no evidence of coronary vasospasm. A bolus of ergonovine maleate(0.025 or 0.05mg) was injected at 5 min intervals up to total cumulative dosage of 0.35mg, and 12-leads ECG and 2D-echo were recorded every 3 min after each injection. Left ventricular wall motion was analyzed with a commercially available 'QUAD' system. The positive criteria of bedside ergonovine test included reversible ST segment elevation or depression, T wave changes in ECG(ECG criteria) and reversible regional wall motion abnormalities(RWMA) in Echo(Echo criteria). RESULTS: The overall sensitivity and specificity of ECG criteria were 73%(22/30) and 100% respectively ; The sensitivity of Echo criteria increased up to 90%(27/30) without the change of the specificity. Among 22 patients with reversible ECG changes only 73%(16/22) showed typical ST segment elevation while ST depression was recorded in 2 patients(9%) and minor T wave peaking or flattening without ST segment displacement in 4 patients(18%). Concomitant fixed coronary lesion does increase the sensitivity of the test compared to pure coronary vasospasm with ECG criteria(100% vs 60%, p<0.05). Mean dose of ergonovine with positive result was 173+/-95 microgram(mcg) and the amount of ergonovine for positive result was significantly larger in patients with low disease activity(Chest pain <5 times/week) than those with high disease activity(213+/-83 vs 123+/-86mcg, p<0.01). There was no procedure related mortality or fatal arrhythmias. CONCLUSIONS: Ergonovine echocardiography is a highly sensitive and specific test for coronary vasospasm and is safe in selected patients in whom the exercise test is negative and severe fixed coronary artery disease has been excluded. Presence of concomitant fixed coronary artery disease and the degree of clinical activity of coronary vasospasm may influence the results of this test.
Arrhythmias, Cardiac ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm* ; Depression ; Echocardiography* ; Electrocardiography ; Ergonovine* ; Exercise Test ; Humans ; Mortality ; Sensitivity and Specificity ; Spasm

BACKGROUND: In patients with mitral stenosis(MS) the predilection of the left atrial appendage(LAA) for thrombus formation has been known, while the characteristics and clinical implications of LAA flow have not been clearly analyzed. This prospective study with transesophageal echocardiography(TEE) was done to compare the LAA flow velocities of normal controls and patients with tight MS, to evaluate the correlation between LAA flow and hemodynamic indices and to observe the effects of successful percutaneous mitral valvuloplasty(PMV) on LAA flow. METHODS: TEE was performed in 12 normal controls and 50 patients with tight MS using a 5.0 MHz biplane transducer(Hewlett Packard SONOS 1000). Left atrial spontaneous echo contrast(SEC) was semiquantified(Grade 0-III) according to the relative extent of swirling echo movement in left atrial cavity : Grade I denotes SEC confined to LAA and swirling movement over the half of left atrial cavity was graded as III. In patients with MS. TEE was performed one day before and after PMV.Hemodynamic data(left atrial pressure, transmitral diastolic pressure gradient, cardiac output and mitral valve area) were obtained just before and after PMV. RESULTS: 1) In normal controls LAA flow recording showed two pairs of LAA ejection(positive) and filling(negative) waves. One pair of LAA ejection(appendage peak positive flow ; APF) and filling flow(appendage peak negative flow ; ANF) occurred 143+/-22msec and 289+/-33msec respectively after the onset of the ECG P wave. In early diastole another small pair of LAA ejection(ACF) and filling(ADF) occurred 550+/-21msec and 671+/-50msec respectively after the onset of ECG QRS wave. Mean absolute velocities of APF and ANF were 54+/-21 and 54+/-22cm/sec respectively, which were significantly higher than those of ACF(16+/-6cm/sec) and ADF(16+/-5cm/sec). 2) In patients with tight MS(mitral valve area of 0.9+/-0.3cm2) mean velocities of APF(20+/-12cm/sec) and ANF(23+/-16cm/sec) were significangly decreased compared with normal controls. There was no significant correlation between hemodynamic indices and absolute velocities of LAA flow. SEC was observed in 62%(31/50) and mean velocities of APF(10+/-8cm/sec) and ANF(12+/-11cm/sec) were significantly lower in patients with SEC than those values(25+/-19, 27+/-21cm/sec) in patients without SEC. There was strong negative correlation between the absolute values of APF and ANF and the grade of SEC(rAPF=-0.75, pAPF=0.00 ; rANF=-0.70, pANF=0.00). 3) After successful PMV(mitral valve area of 2.0+/-0.4cm2), APF increased from 20+/-12cm/sec to 36+/-24cm/sec and statistically significant increase of ANF was also observed(23+/-16cm/sec vs 36+/-22cm/sec, p<0.05). In patients with sinus rhythm, PMV normalized LAA flow(APF=52+/-14cm/sec, ANF=51+/-10cm/sec) while still decreased flow velocities were recorded in patients with atrial fibrillation(APF=15+/-4cm/sec, ANF=16+/-6cm/sec). CONCLUSIONS: Recording of LAA flow with TEE is an indicator of LAA function and risk of thrombus formation and cardiogenic embolism, which may not be obtained with conventional hemodynamic indices. Improvement of LAA flow and normalization of flow velocities in patients with sinus rhythm immediately after successful PMV raises a question of role of PMV in prevention of thromboembolism. Randomized sudies of the long-term effects of PMV in MS will be required before this important question can be answered.
Atrial Appendage* ; Atrial Natriuretic Factor ; Atrial Pressure ; Balloon Valvuloplasty* ; Blood Pressure ; Cardiac Output ; Diastole ; Echocardiography, Transesophageal ; Electrocardiography ; Embolism ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Prospective Studies ; Thromboembolism ; Thrombosis