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*

WPW syndrome is the most common variaty of preexcitaton syndrome in which whole or part of ventricular muscle is activated by the atrial impulse earlier than would be expected if the impulse reached the ventricle by way of normal conduction system alone. WPW syndrome result from existence of accessory muscle bridge(atrio ventricular connection) between atrium and ventricle. The ventricular complex observed in WPW syndrome during periods of sinus rhythm is the result of fusion, with intial phase of ventricular activation representing excitation via accessory pathway and later forces produced by excitation of residual portions of ventricle via normal His-purkinje system. The variations in QRS aberrancy in WPW syndrome depend on varying degree of preexcitation. This experimental study was undertaken to increase our knowledge on the ventricular fusion in WPW syndrome through epicardial mapping after experimental induction of ventricular preexcitaion of WPW type. In 5 normal dogs, the heart was widely exposed through transverse thoracotomy and positioned in a pericardial cradle, then electric wires were fixed on the epicardium of right atrium and ventricular bases(anterobasal and posterobasal) areas of right ventricle, anterobasal and poaterobasal areas of left ventricle for atrial and ventricular pacing. Epicardial mapping was then performed during atrial pacing alone and during atrioventricular sequential pacing at the same rate. Atrioventricular sequential pacing was done with various short AV intervals(60-110 msec) for the purpose of premature stimulation on ventricular base. In mapping we used the grid system which consisted of 29 areas to cover the right ventricle and 23 areas to cover the left ventricle. We drew 9 epicardial ishochrone maps in 5 dogs. The epicardial data during atrio-ventriclar sequential pacing were then compared with those during atrial pacing at an identical rate to study the ventricular fusion in WPW syndrome. The results were as follows; 1) The preexciting wave spread radially from the stimulated basal area to the right and left(or anterior and posterior wall) and the apex. 2) Preexciting wavefronts collided with the normal wavefronts in a wide range of ventricular activation time. 3) Preexcitation widened according to the degree of the shortening of the AV interval. 4) The duration of ventricular activation was greater in preexcited ventricles than in normally activated ventricles. The more prematurely the ventricle was stimulated, the greater the duration of ventricular activation was.
Animals ; Dogs ; Epicardial Mapping ; Heart ; Heart Atria ; Heart Ventricles ; Pericardium ; Thoracotomy ; Wolff-Parkinson-White Syndrome*

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*

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

No abstract available.
Methotrexate* ; Psoriasis*

No abstract available.
Humans ; Infant, Newborn* ; Mass Screening*