OBJECTIVE: To evaluate the influence of lung volume on dependent lung opacity seen at thin-section CT. MATERIALS AND METHODS: In thirteen healthy volunteers, thin-section CT scans were performed at three levels (upper, mid, and lower portion of the lung) and at different lung volumes (10, 30, 50, and 100% vital capacity), using spirometric gated CT. Using a three-point scale, two radiologists determined whether dependent opacity was present, and estimated its degree. Regional lung attenuation at a level 2 cm above the diaphragm was determined using semiautomatic segmentation, and the diameter of a branch of the right lower posterior basal segmental artery was measured at each different vital capacity. RESULTS: At all three anatomic levels, dependent opacity occurred significantly more often at lower vital capacities (10, 30%) than at 100% vital capacity (p = 0.001). Visually estimated dependent opacity was significantly related to regional lung attenuation (p < 0.0001), which in dependent areas progressively increased as vital capacity decreased (p < 0.0001). The presence of dependent opacity and regional lung attenuation of a dependent area correlated significantly with increased diameter of a segmental arterial branch (r = 0.493 and p = 0.0002; r = 0.486 and p = 0.0003, respectively). CONCLUSION: Visual estimation and CT measurements of dependent opacity obtained by semiautomatic segmentation are significantly influenced by lung volume and are related to vascular diameter.
Adult ; Female ; Human ; Lung/*radiography ; Lung Volume Measurements ; Male ; Spirometry ; Support, Non-U.S. Gov't ; *Tomography, X-Ray Computed ; Vital Capacity

Paralytic pontine extropia(PPE) is a exotropia in contralateral eye of lesion side, associated with one-and- a-half syndrome in acute phase of brainstem infarction and after then, often followed by non-paralytic pontine extropia(NPPE) and medial longitudinal fasciculus (MLF) syndrome in each clinical improvement. NPPE is pontine exotropia without lateral gaze palsy to ipsilateral side and is considered to be due to partial impairment of the unilateral paramedian pontine reticular formation(PPRF). We reported a case, 75 yearold man, of brainstem infarction who initially presented NPPE in acute phase, followed by ipsialteral MLF syndrome after 5th days.
Brain Stem Infarctions* ; Brain Stem* ; Brain* ; Exotropia* ; Paralysis

The genetically determined CYP2D6 activity is considered to be associated with cancer susceptibility with inter-individual variation. Genetic polymorphism of CYP2D6(B) and CYP2D6(T) was determined by the two polymerase chain reaction(PCR) and BstN1 and EcoN1 restriction fragment length polymorphisms(RFLP) for 67 lung cancer cases and 95 healthy volunteer controls. The cases were composed of 26 squamous cell carcinoma, 14 small cell carcinoma, 10 adenocarcinoma, 3 large cell undifferentiated carcinoma, and 14 not histologically diagnosed. The results were gained from the 142 subjects (57 cases and 85 controls) who observed successfully in two PCR and BstN1/EcoN1 RFLP. Only one and no mutant allele of the CYP2D6(B) and CYP2D6(T) gene was detected, that is, the frequency of mutant allele was very low; 0.7%(1/142) and 0%(0/142), respectively. Detected mutant allele of the CYP2D6(B) was heterozygous type(WM). The odds ratios for lung cancer susceptibility with CYP2D6(B) and CYP2D6(T) genotype were not calculated. These results are similar to the previous understanding that the mutant allele is very rare in Orientals compared to Caucasians, therefore, it considered that CYP2D6(B) and CYP2D6(T) genotypes have maybe no association with lung cancer susceptibility in Koreans. This is the basic data of CYP2D6(B) and CYP2D6(T) genotypes for Koreans. It would be hepful for further study to determine lung cancer susceptibility of Koreans with the data about CYP1A1, CYP2E1, GSTM1 from future study.
Adenocarcinoma ; Alleles ; Carcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Cytochrome P-450 CYP1A1 ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 CYP2E1 ; Genotype ; Healthy Volunteers ; Lung Neoplasms* ; Lung* ; Odds Ratio ; Polymerase Chain Reaction* ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length

BACKGROUND: Antibradycardia pacemaker is one of the treatment modalities for bradyarrhythmia. We present the clinical results of 440 implantations of permanent pacemaker between August 1984 and December 1997 at Department of Internal Medicine in Seoul National University Hospital. METHOD: We investigated the indication of permanent pacing, the pacing modes, the complications of permanent pacing, and the chronic pacing threshold. RESULT: The study was comprised of 440 patients (M/F : 179/261, mean age : 59+/-12 years, 58+/-14 years, respectively). Indications of the primary pacemaker implantations were sinus node dysfun-ction in 53% and atrioventricular conduction disorders in 47%. Twelve percent of total pacemaker procedures were pulse-generator replacements. Pacing modes were VVI in 59.1%, VVIR in 10.2%, DDD in 30.2%, and others in 0.5%. Complications developed in 21 cases (4.8%) during long-term follow-up. They included 8 cases of pacing failure due to increased pacing threshold, 2 cases of early power depletion, 2 cases of lead dislodgement, 6 cases of lead fracture, 3 cases of skin erosion, 3 cases of hematoma, 3 cases of infection, and 1 case of skeletal muscle stimulation. Chronic pacing thresholds at pacing width of 0.5 msec were 1.9+/-0.4 V for the epicardial ventricular leads (n=11), 1.3+/-0.5 V for the endocardial ventricular leads (n=36), and 1.1+/-0.2 V for the atrial leads (n=4) after 7 to 10 years of implantation. CONCLUSION: Sinus node dysfunction was the more common indication than atrioventricular block for the antibradycardia pacemaker implantation. Long-term follow-up of the pacemaker patients would be very useful to detect the pacing system abnormalities and to maximize the battery longevity by adjustment of pacing output according to the level of chronic pacing threshold.
Atrioventricular Block ; Bradycardia ; Dichlorodiphenyldichloroethane ; Follow-Up Studies* ; Hematoma ; Humans ; Internal Medicine ; Longevity ; Muscle, Skeletal ; Seoul ; Sick Sinus Syndrome ; Sinoatrial Node ; Skin

BACKGROUND: Antibradycardia pacemaker is one of the treatment modalities for bradyarrhythmia. We present the clinical results of 440 implantations of permanent pacemaker between August 1984 and December 1997 at Department of Internal Medicine in Seoul National University Hospital. METHOD: We investigated the indication of permanent pacing, the pacing modes, the complications of permanent pacing, and the chronic pacing threshold. RESULT: The study was comprised of 440 patients (M/F : 179/261, mean age : 59+/-12 years, 58+/-14 years, respectively). Indications of the primary pacemaker implantations were sinus node dysfun-ction in 53% and atrioventricular conduction disorders in 47%. Twelve percent of total pacemaker procedures were pulse-generator replacements. Pacing modes were VVI in 59.1%, VVIR in 10.2%, DDD in 30.2%, and others in 0.5%. Complications developed in 21 cases (4.8%) during long-term follow-up. They included 8 cases of pacing failure due to increased pacing threshold, 2 cases of early power depletion, 2 cases of lead dislodgement, 6 cases of lead fracture, 3 cases of skin erosion, 3 cases of hematoma, 3 cases of infection, and 1 case of skeletal muscle stimulation. Chronic pacing thresholds at pacing width of 0.5 msec were 1.9+/-0.4 V for the epicardial ventricular leads (n=11), 1.3+/-0.5 V for the endocardial ventricular leads (n=36), and 1.1+/-0.2 V for the atrial leads (n=4) after 7 to 10 years of implantation. CONCLUSION: Sinus node dysfunction was the more common indication than atrioventricular block for the antibradycardia pacemaker implantation. Long-term follow-up of the pacemaker patients would be very useful to detect the pacing system abnormalities and to maximize the battery longevity by adjustment of pacing output according to the level of chronic pacing threshold.
Atrioventricular Block ; Bradycardia ; Dichlorodiphenyldichloroethane ; Follow-Up Studies* ; Hematoma ; Humans ; Internal Medicine ; Longevity ; Muscle, Skeletal ; Seoul ; Sick Sinus Syndrome ; Sinoatrial Node ; Skin

We report a case of successful ventricular pacing via the coronary sinus in a 34 year-old female patient admitted because of repetitive dizziness and syncope. She had rheumatic valvular disease with mitral valve replacement 14 years earlyer. and the mitral, aortic and tricuspid valves were subsequently replaced with prosthetic mechanical valves 4 years ago. Two years after the triple valve replacement, complete AV block developed with the symptoms of dizziness and syncope. A permanent pacemaker was implanted epicardially. Six months later the epicardial lead was replaced because of increased pacing threshold. A year later the epicardial lead had to be replaced because of increased threshold and capture failure to pace. To avoid further thoracotomy, a 'Medtronic 2188' electrode was implanted in the posterior left ventricular vein via the coronary sinus. Pacing threshold was 1.2 volt/0.4 msec. Five days later, the pacing threshold increased to 3.0 volt/0.4 msec. Prednisolone had been given for 10 months. The new system has been functioning well and the pacing threshold was 1.0 volt/0.4 msec at 11 months after implantation. Ventricular pacing via the coronary sinus can be an alternative to the epicardial pacemaker system in patient whose tricuspid valve have been replaced with mechanical prosthetic valve.
Adult ; Atrioventricular Block ; Coronary Sinus* ; Dizziness ; Electrodes ; Female ; Humans ; Mitral Valve ; Prednisolone ; Syncope ; Thoracotomy ; Tricuspid Valve ; Veins

We report a case of successful ventricular pacing via the coronary sinus in a 34 year-old female patient admitted because of repetitive dizziness and syncope. She had rheumatic valvular disease with mitral valve replacement 14 years earlyer. and the mitral, aortic and tricuspid valves were subsequently replaced with prosthetic mechanical valves 4 years ago. Two years after the triple valve replacement, complete AV block developed with the symptoms of dizziness and syncope. A permanent pacemaker was implanted epicardially. Six months later the epicardial lead was replaced because of increased pacing threshold. A year later the epicardial lead had to be replaced because of increased threshold and capture failure to pace. To avoid further thoracotomy, a 'Medtronic 2188' electrode was implanted in the posterior left ventricular vein via the coronary sinus. Pacing threshold was 1.2 volt/0.4 msec. Five days later, the pacing threshold increased to 3.0 volt/0.4 msec. Prednisolone had been given for 10 months. The new system has been functioning well and the pacing threshold was 1.0 volt/0.4 msec at 11 months after implantation. Ventricular pacing via the coronary sinus can be an alternative to the epicardial pacemaker system in patient whose tricuspid valve have been replaced with mechanical prosthetic valve.
Adult ; Atrioventricular Block ; Coronary Sinus* ; Dizziness ; Electrodes ; Female ; Humans ; Mitral Valve ; Prednisolone ; Syncope ; Thoracotomy ; Tricuspid Valve ; Veins

BACKGROUND: Pressure-controlled intermittent coronary sinus occlusion(PICSO) as well as synchronized retrograde perfusion(SRP) have emerged as a new technique that can redirect blood through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. Also, coronary sinus occlusion pressure(CSOP) can be measured during application of PICSO. This experimental study was to determine the characteristics of CSOP and the effects of PICSO on the reduction of infarct size in experimentally induced acute myocardial infarction. METHOD: 22 dogs were included in this study, 9 in control group and 13 in PICSO group. Thirty minutes after experimental ligation of proximal left anterior descending artery, PICSO device was applied to PICSO group for 4 hours. Systolic and end-diastolic pressure of CSOP, LVEDP(left ventricular end-diastolic pressure), LVSP and aortic pressure with heart rate were measured every 1 hour. After 4 hours, heart was excised and 1% TTC(triphenyl tetrazolium cholride) solution was perfused distal to left anterior descending(LAD) coronary artery to measure the area of viable myocardium in LAD territory. 'The area at risk(LAD territory/LV surface area)' and 'the area of necrosis(necrosis area/LAD territory)' were calculated with cut surface of LV using planimetry. RESULTS: 1) End-diastolic pressure of CSOP and left ventricular end-diastolic pressure(LVEDP) were closely equalized and significantly correlated each other(p<0.001). 2) Aortic pressure profiles, left ventricular pressure profiles and heart rate during coronary occlusion did not differ significantly from the control group. Aortic and left ventricular systolic and mean pressures declined significantly after 1 hour of coronary occlusion. Also LVEDP increased significantly after 1 hour of coronary occlusion(p<0.01). 3) The area of myocardium at risk was similar in both groups(control 12.0+/-2.1 %, PICSO 11.5+/-1.2%). But the results of the area of necrosis within the area of risk showed that PICSO significantly reduces myocardial infarct size(control 79.1+/-4%, PICSO 25.3+/-5%). CONCLUSION: PICSO can be indicated in acute coronary syndrome to reduce the myocardial necrosis especially in LAD territory. In addition, PICSO can be used to evaluated LVEDP by measuring CSOP,especially in patients with severe aortic valvular stenosis. Further study is needed upon the effectiveness of PICSO on clinical situations and precise metabolic effects of PICSO on myocardium.
Acute Coronary Syndrome ; Animals ; Arterial Pressure ; Arteries ; Constriction, Pathologic ; Coronary Occlusion ; Coronary Sinus* ; Coronary Vessels ; Dogs ; Heart ; Heart Rate ; Humans ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Ventricular Pressure

BACKGROUND: Pressure-controlled intermittent coronary sinus occlusion(PICSO) as well as synchronized retrograde perfusion(SRP) have emerged as a new technique that can redirect blood through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion. Also, coronary sinus occlusion pressure(CSOP) can be measured during application of PICSO. This experimental study was to determine the characteristics of CSOP and the effects of PICSO on the reduction of infarct size in experimentally induced acute myocardial infarction. METHOD: 22 dogs were included in this study, 9 in control group and 13 in PICSO group. Thirty minutes after experimental ligation of proximal left anterior descending artery, PICSO device was applied to PICSO group for 4 hours. Systolic and end-diastolic pressure of CSOP, LVEDP(left ventricular end-diastolic pressure), LVSP and aortic pressure with heart rate were measured every 1 hour. After 4 hours, heart was excised and 1% TTC(triphenyl tetrazolium cholride) solution was perfused distal to left anterior descending(LAD) coronary artery to measure the area of viable myocardium in LAD territory. 'The area at risk(LAD territory/LV surface area)' and 'the area of necrosis(necrosis area/LAD territory)' were calculated with cut surface of LV using planimetry. RESULTS: 1) End-diastolic pressure of CSOP and left ventricular end-diastolic pressure(LVEDP) were closely equalized and significantly correlated each other(p<0.001). 2) Aortic pressure profiles, left ventricular pressure profiles and heart rate during coronary occlusion did not differ significantly from the control group. Aortic and left ventricular systolic and mean pressures declined significantly after 1 hour of coronary occlusion. Also LVEDP increased significantly after 1 hour of coronary occlusion(p<0.01). 3) The area of myocardium at risk was similar in both groups(control 12.0+/-2.1 %, PICSO 11.5+/-1.2%). But the results of the area of necrosis within the area of risk showed that PICSO significantly reduces myocardial infarct size(control 79.1+/-4%, PICSO 25.3+/-5%). CONCLUSION: PICSO can be indicated in acute coronary syndrome to reduce the myocardial necrosis especially in LAD territory. In addition, PICSO can be used to evaluated LVEDP by measuring CSOP,especially in patients with severe aortic valvular stenosis. Further study is needed upon the effectiveness of PICSO on clinical situations and precise metabolic effects of PICSO on myocardium.
Acute Coronary Syndrome ; Animals ; Arterial Pressure ; Arteries ; Constriction, Pathologic ; Coronary Occlusion ; Coronary Sinus* ; Coronary Vessels ; Dogs ; Heart ; Heart Rate ; Humans ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Ventricular Pressure

Propylthiouracil (PTU) is known to be a potential cause of antineutrophil cytoplasmic antibody (ANCA) positive small vessel vasculitis, resulting in glomerulonephritis and diffuse alveolar hemorrhage (DAH). Herein, we describe a 25-year-old pregnant woman who developed a perinulcear ANCA (p-ANCA) and myeloperoxidase ANCA (MPO-ANCA) positive DAH during PTU therapy. The patient improved after corticosteroid therapy and discontinuation of the PTU. Methimazole was prescribed in spite of the risk of recurrence of DAH because of the pregnancy. The patient is currently free from pulmonary problems. Our case shows that the alternative agent, methimazole, can be used to treat hyperthyroidism in a pregnant patient with PTU associated DAH.
Tomography, X-Ray Computed ; *Pulmonary Alveoli ; Propylthiouracil/*adverse effects/therapeutic use ; *Pregnancy Complications, Hematologic ; Pregnancy ; Hyperthyroidism/blood/complications/*drug therapy ; Humans ; Hemoptysis/*chemically induced/diagnosis/immunology ; Female ; Diagnosis, Differential ; Bronchoscopy ; Antithyroid Agents/*adverse effects/therapeutic use ; Antibodies, Antineutrophil Cytoplasmic/*blood ; Adult