BACKGROUND: The coagulation and fibrinolytic activities increase in the setting of acute myocardial infarction (AMI) and has been shown to increase further after the administration of thrombolytic agents. The reocclusion rate was slightly higher in patients with recombinant tissue type plasminogen activator (rt-PA) than urokinase (UK). However, there are few studies on serial changes in coagulation and fibrinolytic activities during the thrombolytic therapy. METHODS: Twenty five AMI patients who visited Yongdong Severance Hospital from August 1996 to August 1997 were recruited. They were randomized two groups either double bolus UK or accelerated rt-PA. Plasma levels of fibrinogen, thrombin-antithrombin III complex (TAT), plasmin-alpha2 plasmin inhibitor complex (PIC), activities of protein C and protein S were checked before and 3, 12, 24hrs and 7days after the thrombolytic therapy. RESULTS: Plasma level of fibrinogen was decreased 3 and 12hrs after the initiation of thrombolytic therapy in both groups (p<0.05) however, the fibrinogen level in UK treated group (59.9+/-33.5 mg/dl) was decreased than rt-PA treated group (198.2+/-64.3 mg/dl) at 3hrs after thrombolytic therapy (p<0.05). Activities of protein C and protein S were increased at 3hrs after thrombolytic therapy in both groups and no difference was noticed between UK and rt-PA group. Concentrations of TAT and PIC were increased in both groups even before the thrombolytic therapy was initiated. The increment of TAT level was larger in rt-PA group (21.7+/-16.1, 8.9+/-5.4 ng/mL) compared with UK group (15.0+/-17.9, 4.6+/-1.9 ng/mL) at 3 and 12 hrs after thrombolytic therapy (p<0.05). PIC level was significantly increased at 3 and 12 hrs after the treatment in both groups and no difference was noted between UK and rt-PA group. CONCLUSION: Both coagulation and fibrinolytic activities, activated already before thrombolytic therapy, were further aug-mented after thrombolytic therapy in AMI patients. The increment of fibrinolytic activity showed no significant difference between UK and rt-PA treated group. However the coagulation activity in rt-PA treated group was increased more than UK treated group.
Antifibrinolytic Agents ; Fibrinogen ; Fibrinolytic Agents ; Humans ; Myocardial Infarction* ; Plasma ; Protein C ; Protein S ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Urokinase-Type Plasminogen Activator*

BACKGROUND: The coagulation and fibrinolytic activities increase in the setting of acute myocardial infarction (AMI) and has been shown to increase further after the administration of thrombolytic agents. The reocclusion rate was slightly higher in patients with recombinant tissue type plasminogen activator (rt-PA) than urokinase (UK). However, there are few studies on serial changes in coagulation and fibrinolytic activities during the thrombolytic therapy. METHODS: Twenty five AMI patients who visited Yongdong Severance Hospital from August 1996 to August 1997 were recruited. They were randomized two groups either double bolus UK or accelerated rt-PA. Plasma levels of fibrinogen, thrombin-antithrombin III complex (TAT), plasmin-alpha2 plasmin inhibitor complex (PIC), activities of protein C and protein S were checked before and 3, 12, 24hrs and 7days after the thrombolytic therapy. RESULTS: Plasma level of fibrinogen was decreased 3 and 12hrs after the initiation of thrombolytic therapy in both groups (p<0.05) however, the fibrinogen level in UK treated group (59.9+/-33.5 mg/dl) was decreased than rt-PA treated group (198.2+/-64.3 mg/dl) at 3hrs after thrombolytic therapy (p<0.05). Activities of protein C and protein S were increased at 3hrs after thrombolytic therapy in both groups and no difference was noticed between UK and rt-PA group. Concentrations of TAT and PIC were increased in both groups even before the thrombolytic therapy was initiated. The increment of TAT level was larger in rt-PA group (21.7+/-16.1, 8.9+/-5.4 ng/mL) compared with UK group (15.0+/-17.9, 4.6+/-1.9 ng/mL) at 3 and 12 hrs after thrombolytic therapy (p<0.05). PIC level was significantly increased at 3 and 12 hrs after the treatment in both groups and no difference was noted between UK and rt-PA group. CONCLUSION: Both coagulation and fibrinolytic activities, activated already before thrombolytic therapy, were further aug-mented after thrombolytic therapy in AMI patients. The increment of fibrinolytic activity showed no significant difference between UK and rt-PA treated group. However the coagulation activity in rt-PA treated group was increased more than UK treated group.
Antifibrinolytic Agents ; Fibrinogen ; Fibrinolytic Agents ; Humans ; Myocardial Infarction* ; Plasma ; Protein C ; Protein S ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Urokinase-Type Plasminogen Activator*

BACKGROUND: Plaque compression (and/or redistribution) and vessel expansion are important mechanisms of percutaneous coroanry balloon angioplasty. We investigated the mechanisms of balloon angioplasty according to plaque characteristics by intravascular ultrasound and assessed the time-sequencing morphometric changes of target vessel after balloon dilation without catheter change using intravascular ultrasound balloon catheter. METHOD: We studied balloon angioplasty in 10 patients (eight male, average age of 55.3 years). Quantitative coronary angiography and intravascular ultrasound images were attained at baseline and at timed intervals of 0sec, 60sec and 180sec post-balloon angioplasty. The following categories were attained : reference diameter, minimal lumen diameter, cross sectional area (CSA) of lumen (L), external elastic membrane (EEM), and plaque + media (P+M). We also assessed the plaque morphology of target lesion and classified them into two groups according to intravascular ultrasound imaging : a soft plaque group versus a group characterized by fibrous and/or mildly calcified plaque. RESULTS: The proportions of plaque compression in the total luminal gain were 80% in the soft plaque group and 70% in the other ; the absolute amount of plaque compression was 26.9% in soft plaque and 24.0% in the other group. The time sequencing changes of target lesion EEM CSA of both group were 14.4+/-2.9mm2, 14.3+/-3.8mm2 (baseline) 15.1+/-2.5mm2, 15.4+/-3.7mm2 (immediate) 15.0+/-2.8mm2, 14.5+/-3.9mm2 (180sec), those of P+M CSA (target lesion) were 10.4+/-3.3mm2, 10.7+/-2.4mm2 (baseline) 7.6+/-2.7mm2, 8.1+/-2.4mm2 (immediate) 7.9+/-2.9mm2, 8.5+/-3.4mm2 (180sec). Target lesion lumen CSA were 4.0+/-1.1mm2, 3.6+/-2.0mm2 (baseline) 7.5+/-1.1mm2, 7.3+/-3.2mm2 (immediate) 7.1+/-1.3mm2, 6.0+/-1.7mm2 (180sec) respectively. CONCLUSION: Plaque compression (and/or redistribution) is the predominant mechanism of luminal gain in both groups. The absolute amounts of P+M CSA changes and time sequencing increment of target lesion were similar in both groups. In the non-soft group, the immediate increment and time sequencing reduction of EEM CSA in target lesion were greater than those of the soft plaque group.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Catheters ; Coronary Angiography ; Humans ; Male ; Membranes ; Phenobarbital ; Ultrasonography

Hypertension is one of the common diseases nowadays. In the aspects of management, the precise prevention of its complications is more important than normalization of blood pressure level itself. Systemic considerations for medical treatment such as side effects, efficacy, compliance for medicine, long-term evaluation of complications should be the essential points of medical treatment for hypertension.
Blood Pressure ; Compliance ; Hypertension* ; Vascular Diseases*

OBJECTIVES: The purpose of this study was to identify the mediation effect of gender difference and self-esteem level between job stress and psychiatric symptom. METHODS: Male and female subjects participated in this study and filled out the Korean version of Job Stress Inventory(K-OSI), Beck's Depression Index(BDI), State-Trait Anxiety Inventory(STAI), Symptom Check List-90-Revised(SCL-90-R) and Rosenberg's Self-Esteem Scale(RSES). To explore the relationships between job stress and psychiatric symptom, a series of correlational analysis and ANOVAs were conducted to identify mediation effects self esteem level to job stress experience. RESULTS: In males, the perceived job stress level of role boundary scale was positively correlated with depressive, anxiety, psychosomatic symptoms. And role insufficiency was positively correlated with depressive and anxiety symptoms, too. In addition, the interaction effect of self-esteem was significant and the interaction effect of self-esteem was significant. It means high level of self-esteem had buffering effect of job stress on psychiatric symptoms. In females, the perceived job stress level of physical environment scale was positively correlated with depressive symptoms and role overload was positively correlated with psychosomatic symptoms. There was no significant interaction effect of self-esteem identified. CONCLUSIONS: The perceived job stresses related to role boundary and role insufficiency were important factors which result in psychiatric symptoms in males, while physical environment and role overload were important factors in females. In addition, high self esteem had buffering effects of job stresses on psychiatric symptoms, only in males not in females.
Anxiety ; Depression ; Female ; Humans ; Male ; Negotiating* ; Self Concept

OBJECTIVES: Modafinil is a waking drug prescribed to narcolepsy patients, but its usage among healthy individuals is increasing to enhance their alertness or to mitigate fatigue. This study was conducted to investigate practical use and toxic effects on neuro-immune interaction of modafinil. METHODS: This study reviewed the significance of psychoactive drugs, and discussed the benefits and risks of the application of modafinil, which seems to be ideal as an anti-psychotic or anti-fatigue agent. RESULTS: Modafinil is known to have less or no adverse effects than those found in traditional psychostimulants such as amphetamine, methylphenidate or cocaine. It can be applied as an anti-psychotic or anti-fatigue agent. However, the waking mechanism of modafinil is yet to be fully revealed. Recent studies reported that modafinil may be subject to abuse and addiction. In addition prolonged sleeplessness induces stress responses and impairs immune function. CONCLUSIONS: Modafinil can be used by anyone, who wishes to work late, stay awake, enhance their cognitive reactions, or brighten their moods. Users may already be under a great level of stress, i.e. cancer patients or soldiers in a battle field. A psychoneuroimmunological approach is thus needed to investigate the multi-functional effects of modafinil.
Amphetamine ; Benzhydryl Compounds ; Central Nervous System Stimulants ; Cocaine ; Fatigue ; Humans ; Methylphenidate ; Military Personnel ; Narcolepsy ; Psychotropic Drugs ; Risk Assessment ; Sleep Initiation and Maintenance Disorders

PURPOSE: Acute septic arthritis in infancy and childhood is uncommon. Delay of diagnosis and inappropriate treatment of septic arthritis results in permanent physical sequelae. We studied the initial treatment, clinical manifestations, involved sites, and etiologic organisms of septic arthritis. METHODS: We reviewed 74 patients who were diagnosed septic arthritis in Departments of Pediatrics and Orthopedic Surgery, Yonsei University College of Medicine from July 1986 to Sep. 1995. RESULTS: 1) Seventy-four children in the treatment group comprised of 48 males and 26 females. The age distribution is : 21 cases of neonates (28%), 19 cases of infants (26%), and 34 cases of children under 15 years. 2) The frequently involved sites were : 34 cases of hip joint (45%), 28 cases of knee joint (37%), 8 cases of shoulder joint (10%), 4 cases of elbow joint (5%), and 2 cases of ankle joint (3%). In two cases, two joints were involved simultaneously. 3) On imaging studies, 37.8% (28/74) of all cases had abnormal X-ray findings initially. Bone scan were done in 43 cases (58.1%). Half of these cases (22/43) had abnormal, increased uptake in involved joint during the third hospital day through seventh. 4) There were some predisposing factors. : respiratory tract infection (63.5%), trauma (6.8%), sepsis (8.1%), congenital hip dislocation (1/74). However, there were no specific problems in 15 cases. 5) Major complaints of patients were : limitation of motion, fever, local swelling, pain, tenderness, erythema, irritability, and heating sensation, etc. 6) Sixty-three cases had bacterial growth, either from blood or wound. Wounds cultures were positive in 23 cases. : S. aureus (13/23), Streptococcus (6/23). The combination of incision & drainage, irrigation, intravenous antibiotics and traction were therapeutic modalities. Antibiotics used were cephalosporins and vancomycin. CONCLUSIONS: Early diagnosis and treatment are essential to prevent the permanent sequelae of septic arthritis. In cases presenting with limitation of motion, fever, or pain with or without abnormal radiologic findings, septic arthritis should be ruled out.
Age Distribution ; Ankle Joint ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Causality ; Cephalosporins ; Child* ; Diagnosis ; Drainage ; Early Diagnosis ; Elbow Joint ; Erythema ; Female ; Fever ; Heating ; Hip Dislocation, Congenital ; Hip Joint ; Hot Temperature ; Humans ; Infant ; Infant, Newborn ; Joints ; Knee Joint ; Male ; Orthopedics ; Pediatrics ; Respiratory Tract Infections ; Sensation ; Sepsis ; Shoulder Joint ; Streptococcus ; Traction ; Vancomycin ; Wounds and Injuries

PURPOSE: Acute septic arthritis in infancy and childhood is uncommon. Delay of diagnosis and inappropriate treatment of septic arthritis results in permanent physical sequelae. We studied the initial treatment, clinical manifestations, involved sites, and etiologic organisms of septic arthritis. METHODS: We reviewed 74 patients who were diagnosed septic arthritis in Departments of Pediatrics and Orthopedic Surgery, Yonsei University College of Medicine from July 1986 to Sep. 1995. RESULTS: 1) Seventy-four children in the treatment group comprised of 48 males and 26 females. The age distribution is : 21 cases of neonates (28%), 19 cases of infants (26%), and 34 cases of children under 15 years. 2) The frequently involved sites were : 34 cases of hip joint (45%), 28 cases of knee joint (37%), 8 cases of shoulder joint (10%), 4 cases of elbow joint (5%), and 2 cases of ankle joint (3%). In two cases, two joints were involved simultaneously. 3) On imaging studies, 37.8% (28/74) of all cases had abnormal X-ray findings initially. Bone scan were done in 43 cases (58.1%). Half of these cases (22/43) had abnormal, increased uptake in involved joint during the third hospital day through seventh. 4) There were some predisposing factors. : respiratory tract infection (63.5%), trauma (6.8%), sepsis (8.1%), congenital hip dislocation (1/74). However, there were no specific problems in 15 cases. 5) Major complaints of patients were : limitation of motion, fever, local swelling, pain, tenderness, erythema, irritability, and heating sensation, etc. 6) Sixty-three cases had bacterial growth, either from blood or wound. Wounds cultures were positive in 23 cases. : S. aureus (13/23), Streptococcus (6/23). The combination of incision & drainage, irrigation, intravenous antibiotics and traction were therapeutic modalities. Antibiotics used were cephalosporins and vancomycin. CONCLUSIONS: Early diagnosis and treatment are essential to prevent the permanent sequelae of septic arthritis. In cases presenting with limitation of motion, fever, or pain with or without abnormal radiologic findings, septic arthritis should be ruled out.
Age Distribution ; Ankle Joint ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Causality ; Cephalosporins ; Child* ; Diagnosis ; Drainage ; Early Diagnosis ; Elbow Joint ; Erythema ; Female ; Fever ; Heating ; Hip Dislocation, Congenital ; Hip Joint ; Hot Temperature ; Humans ; Infant ; Infant, Newborn ; Joints ; Knee Joint ; Male ; Orthopedics ; Pediatrics ; Respiratory Tract Infections ; Sensation ; Sepsis ; Shoulder Joint ; Streptococcus ; Traction ; Vancomycin ; Wounds and Injuries

OBJECTIVE: To identify the technical considerations in implementing a barcode-based medication system and propose practical solutions for successful implementation of the system. In order to reduce medical errors related to medication and blood transfusion, we analyze various factors that hinder the successful implementation of the barcode-based medication system and discuss issues involved in the effective adoption of such a system. METHODS: The barcode-based medication system of this research uses one-dimensional, barcode bands on patients' wrists and two-dimensional barcodes attached to drug bags and blood bags. PDAs with barcode reading capability and wireless networking function are used, which enables Point of Care. The business process for applying the developed system and the current status of the system usage are analyzed. RESULTS: The factors causing a variety of system failures in the demonstration and pilot periods were identified and categorized as including PDA malfunction, PDA battery discharge due to users' carelessness, confusion in reading barcodes and so on. CONCLUSIONS: It is expected that the analyzed obstructive factors and the proposed technical considerations addressed in this paper can help other hospitals implement similar barcode-based medication systems successfully. Ultimately, this research will contribute to reducing medical errors and improving quality of patient care.
Adoption ; Blood Transfusion ; Commerce ; Medical Errors ; Medication Errors ; Medication Systems ; Patient Care ; Wrist

Arachnoid cysts are benign lesions that are formed between the inner and outer layers of the arachnoid, accounting for 1% of all intracranial space occupying lesions. Usually, arachnoid cysts are asymptomatic. It can be symptomatic in case of complication such as intracystic hemorrhage or acute cyst expansion. We present a case of incidentally prediagnosed arachnoid cyst which undergone intracystic hemorrhage combined with ipsilateral SDH in a young male.