No abstract available.
Hand* ; Surgical Flaps*

No abstract available.
Breast Neoplasms* ; Breast*

Sleep disturbance and restless legs syndrome (RLS) among uremic patients is known to be high, but data on the prevalence, clinical significance, and causative factors are limited. A semiquantitative sleep and RLS questionnaire was distributed to 62 chronic hemodialysis(HD) patients. 74.5N had sleep complaints and frequent awakening was the most frequent specific sleep complaints followed by daytime sleepiness. Presence of diabetes mellitus(DM), RLS, depres- sion, high CRP level, low intact parathyroid hormone level, low subjective global assessment score, and short HD duration were associated with more sleep complaints. 58.3N had RLS and presence of DM, low serum albumin level were also associated with more severe RLS. But Kt/V, protein catabolic rate, hematocrit, plasma bicarbonate level, use of erythropoietin and sleep medication were not associated with sleep complaints and RLS. Sleep problems and RLS are comrnon in HD patients and seem to be associated with malnutrition. Presence of DM, de- pression, and RLS are likely to contribute the high prevalence of sleep disturbance.
Erythropoietin ; Hematocrit ; Humans ; Malnutrition ; Parathyroid Hormone ; Plasma ; Prevalence ; Renal Dialysis* ; Restless Legs Syndrome ; Serum Albumin ; Surveys and Questionnaires

14 supratentorial and 6 infratentorial arachnoid cysts, diagnosed and treated at Kangnam St Mary's Hospital from 1983 to 1988, are reported. The most common presenting symptoms in children were craniomegaly, delayed development, increased ICP and neurological focal signs. Neuroradiological examination included plain skull X-ray, brain CT and metrizamide CT or isotope study. Therapeutic criteria according to the clinical and radiological findings were reviewed. The results were as follows; 1) The patient below age of 2 yrs who's brain had a potent ability of growth should be operated in any cases for reducing mass effect. 2) In sylvian lesion, Type II and III according to the classification of Galassi were well treated with C-P snunt. 3) In infratentorial lesion, all patients had hydrocephalus and the patient who had communicated with subarachnoid space in metrizamide CT were well treated with V-P shunt and who not communicated with subarachnoid space was well treated with Y-shunt. 4) We had good results by fenestration above the age of 3 yrs and by C-P shunt under the age of 2 yrs in supratentorial lesion.
Arachnoid Cysts* ; Brain ; Child* ; Classification ; Humans ; Hydrocephalus ; Metrizamide ; Skull ; Subarachnoid Space

PURPOSE: Preoperative chemoradiotherapy has become an important adjunct in the management of rectal cancer. But both systemic toxicity of chemotherapy and local effect of radiation interfere wound healing of intestinal anastomosis and ultimately may lead to anastomotic leak and septic complications. The purpose of this study is to determine the optimal time interval between preoperative chemoradiotherapy and anastmotic construction, and it was evaluated by security of anastomotic construction. METHODS: One hundred and twenty male Sprague Dawley rats weighing approximately 250 g were randomly divided into 4 groups (Control group; n=40, Group 1; n=20, Group 2; n=20, Group 3; n=40). The control group (n=20) underwent anastomotic construction at 1 week after general anesthesia without preoperative chemoradiotherapy. The experimental animals (group 1, 2, 3) received preoperative chemoradiotherapy with 5 daily dose (20 mg/kg) of 5-fluorouracil and single dose of 1500 cGy radiation at the rectosigmoid junction under general anesthesia on the day after last dose of chemotherapy. And group 1~3 subsequently underwent a laparotomy to make anastomotic construction at 1 week (Group 1), 2 weeks (Group 2), and 3 weeks (Group 3; n=20) after completion of chemoradiotherapy. The security of anastomotic construction was determined by bursting pressure, tissue hydroxyproline content, gross and microscopic findings of anastomotic area at the 5th and 10th postoperative day after anastomotic construction. To evaluate systemic toxicity after che-moradiotherapy, serial body weight and alteration of CBC were measured in the control group (n=20) and Group 3 (n=20) without anastomotic construction. RESULTS: At the 5th postoperative day, Mean bursting pressures of the all treated groups were lower than that of the control group (Control group; 88 23 mmHg, Group 1; 49 22 mmHg, Group 2; 56 17 mmHg, Group 3; 78 23 mmHg). The difference was not significant in the group 3 compared with the control group. Body weight decreased in the all treated animals. The mean body weight was lowest on the day 8 after completion of chemoradiotherapy and then it gradually increased. WBC and platelet counts also decreased in the all treated animals. WBC count was lowest on the day 1 and platelet count was lowest on the day 3 after completion of chemoradiotherapy. Mean hydroxyproline contents at the anastomotic sites in the all treated groups were higher than that of the control group, especially in the group 2 and 3. Similar histologic changes were observed in both group 3 and control group. CONCLUSION: The results suggest that the optimal time interval for safe intestinal anastomosis after preoperative chemoradiotherapy is 3 weeks or later.
Anastomotic Leak ; Anesthesia, General ; Animals ; Body Weight ; Chemoradiotherapy* ; Colon* ; Drug Therapy ; Fluorouracil ; Humans ; Hydroxyproline ; Laparotomy ; Male ; Platelet Count ; Rats* ; Rats, Sprague-Dawley ; Rectal Neoplasms ; Wound Healing

BACKGROUND/AIMS: Pericardial effusion (PE), which is more than a moderate amount, is usually accompanied with various underlying illnesses. However, there have been few reports on the long-term follow-up results of these cases, and even in the studies where the etiologies were well presented. METHODS: 64 consecutive patients (mean age: 66.3 years, 23 males) with more than a moderate amount of PE, as confirmed by echocardiography, were analyzed for pericardial fluid and this was diagnosed according to ESC Executive Summary. The mean follow-up duration was 1.95+/-1.78 years and the final survival was assessed in November, 2006. RESULTS: The etiologies were composed of malignancy-related PE (MRPE: 29.7%), tuberculosis pericarditis (40.6%), idiopathic pericarditis (18.8%), hypothyroidism (7.8%), and miscellaneous (3.1%). Mortality occurred in 21 cases (32.8%), of which 15 cases were attributed to MRPE. In all patients, the mean survival duration was 372+/-247.9 days after diagnosis, and the mean survival duration was 253+/-221.5 days after pericardiocentesis. Cardiac tamponade, constrictive pericarditis and recurrent pericarditis were presented in 15 cases (23.4%), 9 cases (14.1%) and 2 cases (3.1%) respectively. The chemistry findings of PE were of no use to differentiate the etiologies. CONCLUSION: Pericardial effusion of more than a moderate amount often manifested urgent symptoms such as cardiac tamponade and intractable dyspnea, and these conditions require therapeutic pericardiocentesis more frequently than diagnostic tests. The prognosis is usually subordinate to the progression of the underlying illness, and especially in case of MRPE. The occurrence of constrictive pericarditis should be monitored carefully.
Cardiac Tamponade ; Diagnostic Tests, Routine ; Dyspnea ; Echocardiography ; Follow-Up Studies ; Humans ; Hypothyroidism ; Pericardial Effusion ; Pericardiocentesis ; Pericarditis ; Pericarditis, Constrictive ; Prognosis ; Tuberculosis

OBJECTIVE: Volume expansion has been known to be the major factor in the development of hypertenision in chronic hemodialysis(HD) patients. But some HD patients remain hypertensive even with adequate volume control, which suggests the role of undefined uremic toxin in the pathogenesis of hypertension. So we aimed to evaluate the status of blood pressure (BP) control and the effect of Kt/V (as a marker for removal of uremic toxin) on BP in chronic HD patients. METHODS: The status of BP control was obtained from records of 8 HD session in 132 patients in November 1996 and 127 patients in November 1997. Of 132 patients studied in 1996, 70 patients underwent a follow-up evaluation in 1997. All patients were dialyzed 3 times a week, 4 hours a session. Postdialytic cyclic 3',5' guanosine monophosphate (cGMP) level was measured in 48 patients as a marker of volume status. RESULTS: The prevalence of postdialytic hypertension (>140/90mmHg) was 73.5 in 1996 and 65.3% in 1997. Normotensive patients (postdialytic mean BP<114 mmHg) had higher Kt/V value than hypertensive patients in both 1996 and 1997. But there was no difference in the degree of ultrafiltration (UF) and cGMP level between two groups. Postdialytic mean BP was inversely correlated with Kt/V level but had no relationship with degree of UF and cGMP level in both 1996 and 1997. The group in which postdialytic mean BP had been decreased during 1 year study period had higher degree of elevation in Kt/V than the group in which postdialytic mean BP had been increased. The changes of postdialytic weight and degree of UF during study period were similar between two groups. The number of antihypertensives used were also inversely correlated with Kt/V but not correlated with degree of UF and cGMP level in both 1996 and 1997. CONCLUSION: Our study indicate that increasing HD adequacy is associated with improved control of postdialytic mean BP and less use of antihypertensive drugs. UF and antihypertensive drugs may not be adequate form of hypertension treatment as once thought and increasing HD adequacy can be an alternative method.
Antihypertensive Agents ; Blood Pressure* ; Dialysis* ; Follow-Up Studies ; Guanosine Monophosphate ; Humans ; Hypertension ; Prevalence ; Renal Dialysis* ; Ultrafiltration

BACKGROUND: The aim of this study was to characterize the nature and elucidate the pathogenesis of hemodialysis ascites(HA), especially with regard to the levels of Serum Ascites Albumin radient(SAAG) and the degrees of hemodialysis adequacy(Kt/Vurea). METHODS: In the study group, seven cases of HA which had developed in 6 patients from Feb. 1997 through July 1998 were included. In the control group, 24 cases which had not developed HA were included. The study design was a retrospective. Analysis of ascites on WBC, total protein and albumin, cytology, ADA(Adenosine deaminase), osmolality, SAAG and routine work-up were performed in HA group. Serum total protein and albumin, C-reactive protein(CRP), osmolality, and routine liver function test were also checked. Kt/Vurea and weekly Kt/Vurea were calculated in both group. In statistical analyses, t-test and chi-square test were used. RESULTS: Mean SAAG of HA was >1.1(1.49+/-0.40) gm/dL, and mean concentration of total protein of HA was >2.5(4.26+/-0.58) gm/dL. The mean of weekly Kt/Vurea of patients with HA(2.61+/-0.85) was significantly lower than that of patients without HA(3.48+/-0.90)(p<0.05). Positive ratio of CRP in patients with HA was higher than that of patients without HA(p<0.05). Mean concentration of serum total protein was significantly higher in patients with HA than that of patients without HA but with comparable weekly Kt/Vurea levels(p<0.05). CONCLUSION: It is regarded that the nature of HA is an exudate having high SAAG over 1.1 gm/dL. Low weekly Kt/Vurea is suggested as a cause of HA. Chronic inflammation was also regarded as an important factor causing HA.
Ascites* ; Exudates and Transudates ; Humans ; Inflammation ; Liver Function Tests ; Osmolar Concentration ; Renal Dialysis ; Retrospective Studies ; Urea*

BACKGROUND: Recently obese people have increased in Korea due to change of diet and life style. Obesity itself is an independent risk factor of cardiovascular disease. Also, obesity is associated with hyper tension, dyslipidemia, and diabetes as a componet of insulin resistance syndrome. To assess the health implications of obesity, we investigated the prevalence of obesity and the correlation between obesity and dyslipidemia. METHOD: The study was conducted in 1,733 elderly Korean(male 346, female 1,387) who lived in southwest Seoul area. Subjects were checked sex, age, height, weight, waist circumference, hip circumference blood pressure, serum total cholesterol, triglyceride, HDL cholesterol and LDL cholesterol. Overall obesity was measured by BMI(body mass index) and abdominal obesity was evaluated by WHR(waist-to-hip ratio). Subjects were divided according to their BMI(<25.0, > or = 25.0) and WHR(male< or =0.90, > or =0.90/female< or =0.85, > or =0.85). RESULT: The prevalence of obesity according to BMI was 32.1% in men and 46.4% in women. Systolic and diatolic blood pressure, total cholesterol, triglyceride, LCD cholesterol in the obese group revealed significantly higher than those in the nonobese group. In the abdominal obesity male group according to WHRl, the serum tiglyceride level was increased and the serum cholesterol level was decrea- sed but blood pressure, total cholesterol and LDL cholesterol were not different compared with the non-obese group. In the abdominal obesity female group, sys- tolic and diastolic blood pressure was significantly different in addition to triglyceride and HDL cholesterol compared with the non-obese group. CONCLUSION: Obese Korean elderly population had a characteristics like higher levels of blood pressure, serum total cholesterol, triglyceride and lower level of HDL cholesterol. which were known as cardiovascular risk factors. To evaluate the correla- tion between obesity and cardiovascular risk, prospective study for the difference of incidence of cardiovascular disease between obese and non-obese group will be continued.
Aged* ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Diet ; Dyslipidemias* ; Female ; Hip ; Humans ; Hypertension ; Incidence ; Insulin Resistance ; Korea ; Life Style ; Male ; Obesity* ; Obesity, Abdominal ; Prevalence* ; Risk Factors ; Seoul* ; Triglycerides ; Waist Circumference ; Waist-Hip Ratio

BACKGROUND AND OBJECTIVES: The QT interval (QTi) and QT dispersion (QTd), which represent the myocardial electrical heterogeneity of repolarization, were studied to recognize the differences between normal controls (n=32) and stable angina patients (n=78). SUBJECTS AND METHODS: During the treadmill exercise test, standard 12 lead Electrocardiogram (ECG) was obtained at every stage, with the QTi and QTd measured. The corrected QT interval (cQTi) and QT dispersion (cQTd) were calculated using Bazett's formula, with the Delta QT interval (DeltaQTi) measured on leads V5 and aVF. RESULTS: During exercise, the QTi had a reverse relationship with the heart rate in both groups, but was decreased by a lesser extent in the patient group. The QTd also had a tendency to decrease according to increasing heart rate in both groups and was significantly greater in the patient group. The corrected QTi increased during exercise in both groups, and reached maximum during the pre-peak stage, but was minimized during a 1 minute recovery stage in the patient group. The corrected QTd reached a maximum during the peak exercise stage in both groups, but the values between the two groups were significantly different. Both the QTi and cQTi had tendencies to increase according to the number of vessels with stenosis. The DeltaQTi tended to reflect a regional ischemia in a single vessel disease. CONCLUSION: The QTi, QTd, cQTi and cQTd were increased in the stable angina patients compared with the normal controls, and augmented during the exercise test.
Angina, Stable* ; Constriction, Pathologic ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Ischemia ; Population Characteristics