Congenital diverticulum of the left ventricle is a very rare disease. Ventricular diverticulum is usually associated with other anomalies including intracardiac and midline thoracoabdominal defect. We describe a case with congenital left ventricular diverticulum presenting as an isolated lesion. A 37-year-old man presented with 4-year history of chest pain. Diverticulum was diagnosed by echocardiography and left ventriculogram.
Adult* ; Chest Pain ; Diverticulum* ; Echocardiography ; Heart Ventricles ; Humans ; Rare Diseases

PURPOSE: To evaluate the clinical findings and ultrasonographic findings of aortic thrombosis which developed after umblical artery catheterization in neonates. METHODS: We retrospectively evaluated clnical records and ultrasonographic findings in five cases of aortic thrombosis, which developed after umblical artery catheterization. Four were premature newborns, and one was a term neonate but small for gestational age. Three were male infants. The mean age was 29.8 days (15-71 days) and the duration of umblical artery catheterization was 16.4 days (7-31 days). The gestational age of 5 cases was between 26 and 38 weeks (mean 33 weeks) and birth weight was between 930 and 2,600 g (mean 1,950 g). All cases were diagnosed by ultrasonography only, and in 2 cases color Doppler ultrasonography was performed additionally. RESULTS: There were several associated conditions including hypothermia (n=2), perinatal asphyxia (n=2), respiratory distress syndrome (n=5), and neonatal infection (n=5). The clinical manifestations of 5 cases were hypertension (n=4), thrombocytopenia (n=4), hematuria (n=2), renal failure (n=l), and congestive heart failure (n=l). In all five cases, ultrasonography showed hyperechoic thrombus with partial occulsion of aorta. The size of thrombi varied 1.2-4x 4-25 mm. All thrombi were located around the origin site of renal artery. CONCLUSION: Aortic thrombosis, one of the complications of umblical artery catheterization can easily be diagnosed by ultrasonography, so ultrasonography would be needed as a screening study in neonate with umblical artery catheterization.
Aorta ; Arteries ; Asphyxia ; Birth Weight ; Catheterization* ; Catheters* ; Gestational Age ; Heart Failure ; Hematuria ; Humans ; Hypertension ; Hypothermia ; Infant ; Infant, Newborn* ; Male ; Mass Screening ; Prognosis* ; Renal Artery ; Renal Insufficiency ; Retrospective Studies ; Thalamus* ; Thrombocytopenia ; Thrombosis* ; Ultrasonography ; Ultrasonography, Doppler, Color ; Umbilical Arteries*

Basic life support training is a part of the curricula of medical school in Anesthesiology practice. Every effort should be made to improve proper mouth-to-mouth breathing and perform correct extemal chest compression. Skillmeter Resusci(TM) Anne (Laerdal(R), Finland) is known to be an extremely valuable aid for accurate and objective training of medical students and for evaluating their performance. Fiftytwo medical students have been trained in basic life support skills and have been evaluated with Skillmeter Resusci Anne. We adopted standards by American Heart Association. As other reports, trainees' outcome was related to psychosomatic skill rather than their knowledge or clinical experience. Repeated training improves the performance capability of artificial ventilation better than external chest compression. At least 6 times of training session seemed required for over ninety percents of the students to reach the desired level of competence in these skills. In summary, a state-of-the-art resuscitaion training manikin displayed an objective individual evaluation and also aroused the interest of the students in CPR basic life support teaching.
American Heart Association ; Anesthesiology ; Cardiopulmonary Resuscitation ; Curriculum ; Humans ; Manikins ; Mental Competency ; Respiration ; Schools, Medical ; Students, Medical* ; Thorax ; Ventilation

Ciliogenesis was investigated in the tracheal epithelium of human fetus at mid trimester of gestation (15~22 weeks), and the substructure of basal body was studied with serial, cross sections. The ciliogenic cells were long columnar cells with an electron -lucent cytoplasm, and contained rich free ribosomes and smooth endoplasmic reticulum. Apical cytoplasm of these cells contained various structures related to ciliogenesis including fibrous granules, procentrioles, centrioles and basal bodies. Basal bodies were located near apical plasma membrane and had basal foot and striated rootlets. In cross section, alar sheets appeared at transitional area between distal portion of basal body and axoneme, and basal foot at distal portion of basal body. Alar sheets arouse from each peripheral triplets of basal body and projected radially clockwise in apex to base view. Basal foot was a cone shaped structure with cross striation which base attached to two or three of the peripheral triplet sets and apex converged to basal foot cap. Three dimentional reconstruction by serial cross section of the basal body showed a structural relationship of alar sheets and basal feet with basal body. By immunohistochemistry, alpha -tubulin label was seen in both basal and surface ciliated cells, and gamma-tubulin label was seen in the apical region of surface cilated cells. These results indicate that ciliogenesis of tracheal epithelium of human fetus is performed mainly by acentriolar ciliogenesis, and suggest the ciliogenesis and ciliary movement at mid trimester of gestation are active.
Axoneme ; Basal Bodies ; Cell Membrane ; Centrioles ; Cytoplasm ; Endoplasmic Reticulum, Smooth ; Epithelium* ; Fetus* ; Foot ; Humans* ; Immunohistochemistry ; Pregnancy ; Ribosomes ; Triplets ; Tubulin

To investigate morphologic alterations in the rat uterine epithelium after chronic potassium depletion, light and electron microscopic studies were made in rats fed a potassium-free diet for 2 weeks. The uterine epithelium was simple columnar and the uterine gland was simple cuboid cells in toluidine blue staining. In experimental uterus, the epithelial cells contain many brownish granules in the supranuclear and basal cytoplasm. The cells containing dense body with pale halo appeared occasionally among the epithelial cells. By TUNEL staining, more positive cells were observed in experimental uterus than those in control group. By electron microscopy, uterine epithelial cells of control rat had short, irregular microvilli and a few apical vesicles and cytoplasm. Increased microvilli, apical vesicles and fat droplets were observed in uterine epithelial cells of the experimental rat. Apoptotic cells or cells containing apoptotic bodies were sometimes present among the epithelial cells. These results indicate that morphological alterations in the rat uterine epithelium are occurred at chronic potassium depletion, and suggest that hypokalemia may induce apoptosis of uterine epithelium.
Animals ; Apoptosis ; Cytoplasm ; Diet ; Epithelial Cells ; Epithelium* ; Hypokalemia* ; In Situ Nick-End Labeling ; Microscopy, Electron ; Microvilli ; Potassium ; Rats* ; Tolonium Chloride ; Uterus*

The loss of the uterine epithelium surrounding blastocyst is important in bringing the trophoblast into close association with the endometrial stroma during embryonal implantation in several laboratory rodents. It is usually assumed that the epithelial cells die during this process, but the cause of epithelial cell death remains speculative. This study was performed to investigate the mechanism of epithelial cell death during implantation in the endometrium of rat uterus throughout days 5-9 of pregnancy by light and electron microscopy. Cathepsin-D reactivity, detected by imunohistochemistry, was localized to all viable epithelia, some degenerating epithelial and decidual cells between days 5-9 of pregnancy. DNA fragmentation, detected by TUNEL staining, was observed in degenerating epithelial and decidual cells throughout days 6-9 of pregnancy. Cellular fragments within lumen and phagosome within trophoblasts were reacted positively to TUNEL staining. Electron microscopy revealed that the epithelium lining the antimesometrial chamber was sloughed off into the lumen on day 6 of pregnancy. Its cell organelles appeared healthy but its nucleus was condensed and irregular shaped. The detached epithelial cells lining the antimesometrial chamber on day 7 of pregnancy contained condensed and fragmented nuclei, but exhibited different morphological pattern according to the intactness or loss of cytoplamic organelles and membrane. And these cells were surrounded and phagocytosed by trophoblasts. On day 7 of pregnancy, syncytial knots were formed, and later these knots and most of detached epithelial cells were severely degenerated. Some decidual cells nearby the lumen were also degenerated at this period. These results indicate that the epithelial cell death of rat uterine endometrium during implantation is mainly due to the process of apoptosis and these dying cells are removed by trophoblasts.
Animals ; Apoptosis ; Blastocyst ; DNA Fragmentation ; Endometrium ; Epithelial Cells* ; Epithelium ; Female ; In Situ Nick-End Labeling ; Membranes ; Microscopy, Electron ; Organelles ; Phagosomes ; Pregnancy ; Rats* ; Rodentia ; Trophoblasts ; Uterus*

Methotrexate (MTX), folic acid antagonist, is effective against the cancer, but is often accompanied by damage to the small intestine due to its inhibition of cell division. The nature of cell damage induced by MTX on the surface lining and crypt cells of the small intestine was investigated in the rat receiving MTX administration. MTX was injected once in every other day intraperitoneally to rats [0.03, 0.1, and 0.3 mg per 100 g body weight in small (SD), large (LD), and over dose (OD) groups, respectively] and the animals were sacrificed with various intervals after single, three-, five-times administrations of SD, single, three-, four-times administrations of LD, and single administration of OD. In case of three times injection of LD, intravenous injection was also made. Three portions, duodenum, jejunum, and ileum of the small intestine were studied by light and electron microscopy. Histologically, there were no appreciable morphological changes in villi and crypts after single and three times administrations of SD. The cells contained dense nucleus with clear cytoplasm, however, were rarely presented among the crypt cells. The duodenal villi were relatively normal in shape, but the number of crypts were somewhat decreased in five times administrations of SD. On the other hand, the villi of jejunum and ileum were atrophied and the epithelial cells became flattened. Crypts were atrophied and decreased in number. In single administration of LD, the shape of villi were normal in all of three portions. The cellular damages were noted in crypts of all of them, and the severity was most predominant at 6 hours than at 2, 4, or 24 hours after administration. In three times administrations of LD, more serious damages were noted in intravenous injection groups than intraperitoneal injection groups. Villi and crypt of the jejunum and ileum became atrophy, and epithelial cells were vacuolated. In four times administrations of LD, loss of villi and atrophied glands contained cellular debris within their lumen were noted in all three portions. In single administration of OD, there was no remarkable changes in histological structures of duodenum, jejunun, and ileum. With TUNEL staining, positive cells were present mainly in the crypt. The positive cells appeared among the glandular cells and were consistent with dense nucleus contained cells in hematoxylin-eosin stain. In small dose group the number of apoptotic cells in duodenum and ileum was increased in proportion to the times of administration, but that in jejunum was decreased after three times of administrations because of the destruction of crypts. Most prominent apoptotic changes of crypt cells were noted at 6 hours compare with 2, 4, and 24 hours after three times administrations of SD. Positive cells appeared most numerous at 6 hours after single administration of LD and OD. Destructive changes of crypt were found in jejunum and ileum after three times intravenous injection of LD, and were found in all portions after four times administrations of LD. Electron microscopic observation generally confirmed the findings of light microscopy. The apoptotic cells appeared in the crypt and was characterized by chromatin condensation and fragmentation, cytoplasmic condensation. Notable changes were observed in epithelial and crypt cells after five- and four-times administrations of SD and LD, respectively. The epithelial cells became flat and had many fat droplets in the cytoplasm. The crypts were atrophied and the glandular cells were very flat. These changes were more severe in jejunum and ileum than in duodenum. These results indicate that the damage of small intestine by MTX is more severe in jejunum and ileum than in duodenum, and also suggest that the cell death of the crypt is mediated by apoptosis, and that of the epithelial cell is due to fatty degeneration.
Animals ; Apoptosis ; Atrophy ; Body Weight ; Cell Death* ; Cell Division ; Chromatin ; Cytoplasm ; Duodenum ; Epithelial Cells ; Folic Acid ; Hand ; Ileum ; In Situ Nick-End Labeling ; Injections, Intraperitoneal ; Injections, Intravenous ; Intestine, Small* ; Jejunum ; Methotrexate* ; Microscopy ; Microscopy, Electron ; Rats*

BACKGROUND AND OBJECTIVES: The clinical pattern of infective endocarditis is constantly changing. Diagnosis and treatment of infective endocarditis were developed by recent diagnostic strategy (Duke criteria) and introduction of transesophageal echocardiography. The aim of this study was to compare the clinical character-istics of infective endocarditis in Sejong hospital to the previous report and was to investigate risk factor of heart failure, embolism and death. MATERIAL AND METHODS: All episodes hospitalized of infective endocarditis from January of 1990 to October of 1999 in Sejong hospital were reviewed retrospectively. The total cases of infective endocarditis was 80 cases in 78 patients. RESULTS: The male to female ratio was 1:1.05 (39 male, 41 female). The mean age was 42 years. Rheumatic heart disease was the most common predisposing heart disease in 28.8%, followed by prosthetic valve endocarditis. Streptococci were the most commonly isolated micro-organisms in 18 cases (45.0%), followed by staphylococci in 11 cases. Transesophageal echocardiography has a higher sensitivity than transthoracic echocardiography for detection of vegetation, abscess and paravalvular complication in endocarditis. In patients with echocardiographic vegetation and involvement of aortic valve, there was a statistically significant increase in the risk of heart failure. The factor that was associated with a statistically significant increase in the overall risk of embolization was not exist. Ten patients died (12.5%). Risk factor for death was left ventricular dysfunction. The incidence of death was more higher in patients with abscess and non-streptococcal endocarditis. CONCLUSION: Compared to the 1980's report, we observed increased mean age of patients, the decreasing trend of rheumatic heart disease as a predisposing heart disease and the decreasing incidence of streptococci as causative microorganism. Risk factors for congestive heart failure were aortic valve endocarditis and endocarditis with vegetation. Risk factor for death was left ventricular dysfunction.
Abscess ; Aortic Valve ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Endocarditis* ; Female ; Heart Diseases ; Heart Failure ; Humans ; Incidence ; Male ; Retrospective Studies ; Rheumatic Heart Disease ; Risk Factors ; Ventricular Dysfunction, Left

BACKGROUND: Diagnosing a pulmonary embolism is difficult because its presenting symptoms are nonspecific and there are limitations with all of the objective tests. The D-dimer is known to be a marker of the lysis of intravascular cross-linked fibrin as a result of the activation of the endogenous fibrinolytic pathways, and the D-dimer assay is these an objective method for diagnosing a pulmonary embolism. This study assessed the benefits of the D-dimer test for diagnosing a pulmonary embolism using semiquantitative latex agglutination. METHODS: The latex agglutination results of 185 patients were retrospectively reviewed. The D-dimer test was performed at the time a pulmonary embolism was suspected. Ninety patients(group I) were diagnosis with PE through spiral chest CT or a chest CT angiogram, perfusion/ventilation scans, and/or pulmonary angiogram. Ninety-five patients (group II) were found not to have a pulmonary embolism through the above tests. RESULTS: The male to female ratio and mean age in groups I and II was 37:55, and 57 years old to 50:45 and 52 years old, respectively. When the cut off value for a positive D-dimer assay was set to 500 microgram, the sensitivity, positive predictive value, negative predictive value and specificity was 86.7%, 61.4%, 79.3%, and 48.4%, respectively. CONCLUSION: The semiquantitative latex agglutination method in the D-dimer test has a lower sensitivity and negative predictive value than the well known ELISA test particularly for small emboli. Therefore, this test is not a suitable screening test for excluding a pulmonary embolism.
Agglutination* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Fibrin ; Humans ; Latex* ; Male ; Mass Screening ; Middle Aged ; Pulmonary Embolism* ; Retrospective Studies ; Tomography, X-Ray Computed

PURPOSE: To investigate whether changes in plasma concentrations of transforming growth factor-beta1 (TGF-beta1), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. METHODS AND MATERIALS: Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-beta1, TNF-alpha and IL-6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. RESULTS: Thirteen patients eventually developed signs and symptoms of clinical pneumonitis while four patients did not. TGF-beta1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF-alpha and IL-6 were also elevated in the group of patients who developed pneumonitis but the pattern was not characteristic. CONCLUSIONS: Changes in plasma TGFbeta-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF-alpha and IL-6 shows no meaningful changes in association with radiation pneumonitis.
Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Humans ; Interleukin-6 ; Lung Neoplasms* ; Lung* ; Plasma* ; Pneumonia* ; Prospective Studies ; Radiation Pneumonitis ; Radiotherapy ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha