No abstract available.
Down Syndrome* ; Humans ; Mothers*

ESWL has become the treatment of choice for urinary tract calculi in merit of non- invasiveness, high success rate, l w complication rate and with no need of anesthesia and admission. But we experienced that many patient complained pain during ESWL, especially during the treatment with high shock wave power. So we evaluated the quantity of fragmentation at different shock wave power but same storage which is known as compatible to the amount of energy. In our study, total of 60 cubic gypsums of average weight were fragmented in vitro at same storage, in 20, but at 3 different shock wave power setting, l00%, 76%, 46%, using EDAP LT- 01 device. The weight reductions at each shock wave power were 0.947+/-0.30gram (9.88% of total weight) at 100% shock wave power, 0.900+/-0.33 gram (9.94% of total weight) at 76% shock wave power, 0.310+/-0.14 gram (3.29% of total weight) at 46% shock wave power. The result indicate that the shock wave power is important role in fragmentation than the number of shock wave, even at same storage. So the efficacy of ESWL with low shock wave power will be decreased than with high shock wave power.
Anesthesia ; Calcium Sulfate ; Calculi ; Humans ; Shock* ; Urinary Tract ; Weight Loss

Noninvasive prediction of pulmonary arterial pressure is of paramount importance in heart disease. To estimate pulmonary arterial pressure, several echocardiographic techniques, including abnormal pulmonary valve motion, prolongation of RV preejection period/RV ejection time ratio and contrast echocardiography have been proposed. Recently Doppler echocardiography has been known to detect intracardiac blood quantitatively. For assessment of the benefit of several indices by Pulsed Doppler echocardiography for mean pulmonary arterial pressure, 22 patients(mean pulmonary pressure> or =20mmHg; 11, <20mmHg; 11) were compared with the mean pulmonary arterial pressure by cardiac catheterization. In comparison of mean pulmonary arterial pressure(MPAP); 1) Right preejection period / RV ejection time RPEP/RVET;r=0.278 2) Right preejection period / Acceleration time RPEP/AT : r=0.654 3) Acceleration time(AT) AT=-1.55(MPAP)+154.37(r=-0.763) AT=-92.99(log MPAP)+239.41(r=-0.752) AT is less than 105 msec in 9 or 11 pulmonary hypertension and one of 11 normal individual. 4) Acceleration time/ RV ejection time AT/RVET=-136.36(MPAP)+83.31(r=-0.817) AT/RVET=-0.29(log MPAP)+0.81(r=-0.803) 5) (Right preejection period+Decceleration time) / AT (RPEP+DT)/AT=9.6(MPAP)-0.16(r=0.806) (RPEP+DT)/AT=3.86(log MPAP)-2.46(r=0.789) In conclusion AT/RVET, (RPEP+DT)/AT and Acceleration time of 105 msec are valuable indices to estimate mean pulmonary arterial pressure by Pulsed Doppler echocardiogram.
Acceleration ; Arterial Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Hypertension, Pulmonary ; Pulmonary Valve

Two cases of abnormalities of the left ventricular wall(left ventricular aneurysm or diverticulum) are presented. A saccular deformity of the left ventricle may be and aneurysm or a diverticulum. In one case, the defect seems to be subcalvular aneurysm(or fibrous diverticulum) or aneurysm of the membranous ventricular septum; this lesion seems to be a natural consequence of spontaneous closure of a defect of the membranous septum. The other case, it seems that the defect is ventricular aneurysm with syndrome of myocardial infarction and normal coronary arteries, or double or accessory chambered left ventricle. The thromboembolic phenomenon was noted on a left frontoparietal lobe of brain. Both cases have the diagnosis supported by cardiac catheterization and angiography. The clinical, angiographic and pathologic characteristic of diverticulum and aneurysm of the heart are reviewed, and an attempt is made to clarify the concept of aneurysm and diverticulum of the heart.
Aneurysm* ; Angiography ; Brain ; Cardiac Catheterization ; Cardiac Catheters ; Congenital Abnormalities ; Coronary Vessels ; Diagnosis ; Diverticulum* ; Heart ; Heart Ventricles* ; Myocardial Infarction ; Ventricular Septum

BACKGROUND: The continuous use of biologic agents in the treatment of psoriasis has been reported to result in successful and sustained therapeutic effects and safety. However, some patients choose intermittent and repetitive treatment. OBJECTIVE: To determine the factors for selecting intermittent and repetitive ustekinumab treatment for the management of psoriasis. METHODS: From January 2011 to October 2016, we enrolled 30 psoriasis patients who discontinued ustekinumab treatment and were followed up for psoriasis treatment. We reviewed data regarding patients' clinical characteristics and the treatment they received, and investigated the factors for selecting intermittent treatment. RESULTS: A total of 52 ustekinumab treatment periods were administered to the 30 patients. Of the 52 treatment periods, 34.6% were covered by insurance and 82.4% were discontinued after sufficient improvement had been made or at the patient's request. Further analysis comparing the first and second ustekinumab treatments revealed that the patients who used ustekinumab in second treatment were more likely to be insured. In addition, the rate of patients reaching psoriasis area and severity index (PASI)75 and PASI90 was similar between the first and subsequent ustekinumab treatments. CONCLUSION: We found that the patients who used ustekinumab intermittently were those who were satisfied with the outcome of ustekinumab treatment but could not afford the treatment. These results suggested that economic burden can be a factor for the patients' choice of short-term intermittent treatment. The expansion of insurance coverage can increase the effectiveness of, and patients' satisfaction with, the management of psoriasis.
Biological Factors ; Cost of Illness ; Drug Administration Schedule ; Humans ; Insurance ; Insurance Coverage ; Psoriasis* ; Therapeutic Uses ; Ustekinumab*

No abstract available.
Methotrexate* ; Psoriasis*

The characterisitic finding of hypertrophic cardiomyopathy is left ventricular hypertrophy without dilated chamber. Echocardiographic studies of patients with pheochromocytoma in the past have revealed both dilated and hypertrophic cardiomyopathies, as well as obstruction of the left ventricular outflow tract. We report this case because we experienced a pheochromocytoma patient who had reversible hypertrophic cardiomyopathy which might be related with circulating catecholamine level.
Cardiomyopathy, Hypertrophic* ; Echocardiography ; Humans ; Hypertrophy, Left Ventricular ; Pheochromocytoma*

Transesophageal echocardiography(TEE) is a new acoustic window to the cardiac structures and great vessels via retrocardiac esophagus. Because of the close relation between the esophagus and the heart, higher transducer frequencies can be applied, therefore leading to improved resolution and more accurate images than transthoracic echocardiography. We describe our experience with the first 353 awake patients. The procedure was well tolerated by the patients and associated with no major complications, within examination 10 to 20 minutes. Clinical diseases which appear to be suited for TEE includes 1) evaluation of native valve diseases, particulary mitral valve, pathologic valvular abnormalities and color Doppler regurgitant flows ; 2) assesment of prosthetic heart valves to better define malfunction and important pathologic associations ; 3) congenital heart disease, particularly atrial septal defect ; 4) endocarditis and detection of vegetations and complications ; 5) detection of thrombus and tumors, size, location, morphology, stalk ; and 6) aortic pathology including atherosclerosis, aneurysm and dissection. We conclude that transesophageal echocardiography is a new imaging technique that is rapidly evolving into a major tool for general cardiac imaging in a variety pathologic conditions and is a safe and useful tool in patients. Future advances in probe technology will continue to expand its applications.
Acoustics ; Aneurysm ; Atherosclerosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis ; Equidae ; Esophagus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Valves ; Humans ; Mitral Valve ; Pathology ; Thrombosis ; Transducers

The visualization of coronary arteries by transthoracic two-dimensional echocardiography has been used for over 10 years. In many cases, the imaging quality is too poor to allow an anatomic evaluation. During the last few years, transesophageal echocardiography has been shown to provide optimal imaging quality in virtually all patients and of all cardiac structures including the coronary arteries. The purpose of this study was to test the ability of transesophageal echocardiography in the visualiation of the coronary arteries and assessment of coronary blood flow by transesophageal two-dimensional pulsed Doppler echocardiography. We Studied 285 patients, 91 men and 194 women, aged 16 to 81 year(mean 50.6 year men, mean 54.2 year women). We have been used a 5-MHz phased array transducer with incorporated color-coded Doppler. The left main coronary artery was visualized 95.1%, left circumflex artery 27.4, left anterior descending artery 21.4% and the main stem of the proximal right coronary artery 45.1%. The time-sequential left anterior descending artery flow pattern generally consisted of a small late systolic component and a large diastolic component. The peak flow velocity in the proximal left anterior descending artery during diastole was 40.8+/-8.0cm/sec(integrity 7.6+/-0.9) and during late systole was 18.5+/-5.5cm/sec(integrity 2.9+/-0.9). There were no complications during and after examination. This study suggests that transesophageal color-coded Doppler two-dimensional echocardiography appers to be a feasible noninvasive technique for imaging the proximal left coronary artery and the left anterior descending artery flow is detectable from the transesophageal approach.
Arteries ; Coronary Vessels* ; Diastole ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Echocardiography, Transesophageal ; Female ; Humans ; Male ; Systole ; Transducers

The purpose of this study was to determine the effect of reperfusion about infarct size and infarct expansion by different duration of ischemic time. Temporary coronary ligation was performed in rats for 30min, 60min, 90min and 120min, followed by reflow. Rats with permanent ligation were used for comparison. After 7 days, transverse histologic heart sections were prepared for structual analysis. The results were as follows ; 1) Reperfusion after 30 min ischemic time 1.Infarct size of reperfusion (method 1 ; 16.5+/-8.3%, method 2 ; 20.9+/-8.0%) was smaller than that of permanent ligation (method 1 ; 29.8+/-8.9%, method 2 ; 33.5+/-12.1%)(p<0.01, p<0.05). 2. Expansion index of reperfusion (46.9+/-19.6) was smaller than that of permanent ligation (88.0+/-34.9)(p<0.01). 3. The infarct thickness of reperfusion (1.59+/-0.40mm) was larger than that of permanent ligation (1.10+/-0.21mm)(p<0.01). 4.The viable left ventricular tissue area of reperfusion (28.8+/-2.90mm2) was larger than that of permanent ligation (24.2+/-3.10mm2)(p<0.01). 2) Reperfusion after 60 min ischemic time 1. There was no difference in infarct size between reperfusion and permanent ligation. 2. Expansion ratio (27.2+/-5.9%) and expansion index (51.8+/-24.6) of reperfusion were smaller than those of peremanent ligation (35.7+/-7.4%, 88.0+/-34.9)(p<0.05, P<0.05). 3. The infarct thickness of reperfusion (1.48+/-0.32mm) was larger than that of permanent ligation (1.10+/-0.21mm)(p<0.01). 3) Reperfusion after 90~120 min ischemic time reduced neither infarct size nor infarct expansion. The results of this study in the rat preparation suggest a beneficial effect of reperfusion even in late on infarct expansion independent of myocardial salvage.
Animals ; Heart ; Ligation ; Myocardial Infarction* ; Rats* ; Reperfusion*