The congenital pulmonary artery branch stenosis (PABS) was described by Oppenheimer (1) as early as in 1938, but it had attracted very little attention until the last decade. This disease is characterized grossly by single or multiple stenosis of the pulmonary artery and branches and has been described in the literature occasionally under the various designations including supravalvular pulmonary stenosis, coarctation of pulmonary artery, multiple peripheral stenosis of the pulmonary artery and pulmonary artery branch stenosis (3~22). It is known that this defect is no longer a very rare disease and functional problem only. The clinical significance of this disease is to differentiate from other congenital heart diseases such as patent ductus arteriosus, ventricular septal defect and pulmonic stenosis and is a cause of pulmonary hypertension. Nine cases of PABS confirmed by pressure difference in pullback tracing, selective angiography and rate of rise of pulmonary artery pressure are presented. This defect occurred as an isolated cardiovascular anomaly in 3 of the 9 patients. This condition was detected usually in childhood due to exertional dyspnea, frequent upper respiratory infections and heart murmur. Clinically the most significant diagnostic feature was the wide distribution of ejection systolic or continuous murmur, which was seldom louder than grade 4/6. It is also characteristic that the upstroke of the pulmonary artery pressure tracing is similar to the right ventricular tracing with the descending limb of the curve steeper and the dicrotic notch deeper with a low diastolic plateau. This results in a wide pulse pressure. Data are presented which suggest that comparing the rate of rise prestenotic with poststenotic pressure pulse may differentiate organic from functional pressure gradient. The purpose of this paper is to present in detail the clinical features including electrocardioram, chest X-ray, cardiac catherization, angiography, rate of rise of pulmonary artery pressure and diagnostic criteria of PABS. Only two cases of PABS were repoted in Korean literature from our laboratory.
Child ; Male ; Female ; Humans

The purpose of this study is to evaluate the relationship of the factors which could be influenced by orthognathic surgery especillay SSRO. We measured the amounts of the maximum opening, lateral movements, maximum velocity and pattern of mandibular path during the opening and closing of mandible at the following times ; preoperative, 1 month after operation, 6 months after operation respectively using MKG. And the results were compared according to the categorized subgroups. Following results were obtained : 1. The change of the amounts of mandibular lateral movement and maximum opening velocity were statistically different between male and female (p<0.05), but the others were not. 2. According to the method of operation, there was no difference in the change of the mandibular movements between the group of SSRO and SSRO plus LeFort I osteotomy (p>0.05). 3. According to the amounts of mandibular movement, the recovery of left lateral movement of the group of 6~10mm was better than the other groups (p<0.05). 4. In the frontal pattern of the opening and closing of the mandible, the complex deflected type (F5), simple deflected type (F4), complex deviated type (F3), simple deviated type (F2), straight type (F1) were obtained in order at the time of preoperative, simple deflected type, simple deviated type, complex deviated type, straight type, complex deflected type in order at the time of 1 month after surgery, and the result at the time of 6 months after surgery was the same with that of the time of preoperative. In the sagittal pattern, non-coincident type (S2) was predominant at the time of preoperative, and coincident type (S1) was predominant at the time of 1 month after surgery. After 6 months, the result was also the same with that of the preoperative in sagittal pattern. 5. There was not a statistical difference in the change of the mandibular movement between group of presence of the preoperative TMJ symptoms and non-presence group (p>0.05). 6. There was not a statistical difference in the change of the mandibular movement between repositioning device applied group and non-applied group (p>0.05). 7. Sixty three percents of the patients who had preoperative TMJ symptoms were improved after surgery and preoperative TMJ symptoms were more improved after operation in the repositioning device non-applied group statistically (p<0.05).
Female ; Humans ; Male ; Mandible ; Orthognathic Surgery* ; Osteotomy ; Temporomandibular Joint

Accidents, Traffic ; Facial Bones ; Female ; Head ; Humans ; Incidence ; Male ; Malocclusion ; Mouth ; Neck Injuries ; Occupational Groups ; Occupations ; Retrospective Studies ; Sex Ratio

Child ; Chin ; Congenital Abnormalities ; Diastema ; Female ; Gyeongsangbuk-do ; Heart ; Humans ; Hyoid Bone ; Incisor ; Jaw ; Lip ; Mandible ; Manubrium ; Mesoderm ; Neck ; Parturition ; Pregnancy ; Shock ; Surgery, Oral ; Tongue ; Transplants

Although the majority of patients with schizophrenia are not actually violent, an increased tendency toward violent behaviors is known to be associated with schizophrenia. There are several factors to consider when identifying the subgroup of patients with schizophrenia who may commit violent or aggressive acts. Comorbidity with substance abuse is the most important clinical indicator of increased aggressive behaviors and crime rates in patients with schizophrenia. Genetic studies have proposed that polymorphisms in the promoter region of the serotonin transporter gene and in the catechol-O-methyltransferase gene are related to aggression. Neuroimaging studies have suggested that fronto-limbic dysfunction may be related to aggression or violence. By identifying specific risk factors, a more efficient treatment plan to prevent violent behavior in schizophrenia will be possible. Management of comorbid substance use disorder may help prevent violent events and overall aggression. Currently, clozapine may be the only effective antipsychotic medication to repress aggressive behavior. With the current medical field moving toward tailored medicine, it is important to identify vulnerable schizophrenia populations and provide efficient treatment.
Aggression ; Antipsychotic Agents ; Catechol O-Methyltransferase ; Clozapine ; Comorbidity ; Crime ; Humans ; Neuroimaging ; Promoter Regions, Genetic ; Risk Factors ; Schizophrenia ; Serotonin Plasma Membrane Transport Proteins ; Substance-Related Disorders ; Violence

BACKGROUND: The prognosis of patients with dilated cardiomyopathy remains poor. Doppler echocardiography and cardiac iodine-123-metaiodobenzylguanidine(MIBG) myocardial scintigraphy are useful non-invasive diagnostic modalities to assess the prognosis in these patients. However, the relationship between myocardial MIBG uptake and Doppler echocardiographic. variables was not well investigated. We analyzed the cardiac MIBG imaging in 40 patients with dilated cardiomyopathy and assessed the correlation between the echocardiographic parameters and myocardial MIBG uptake. MIBG uptake(DHM), assessed as the heart/mediastinum ratio measured on anterior view image obtained 4 hours after injection, was compared with M-mode(left ventricular end-diastolic dimension, left ventricular ejection fraction) and Doppler parameters. RESULTS: 1) Early and delayed MIBG uptake of heart were significantly lower in patient group compared with normal control subjects. There were no significant differences in lung and mediastinum uptake of MIBG between the two groups. 2) Early and delayed MIBG uptake ratios of the heart to lung and heart to mediastinum were significantly lower in patient group compared with those of normal control subjects. 3) DHM was significantly lower in patients with NYHA functional class 3, 4 than those with NYHA functional class 1, 2 in patient group. There was, however, no significant difference of DHM in patient group divided by the degree of mitral regurgitation and left ventricular diastolic filling pattern. 4) There were no significant correlations between DHM and other prognostic factors(left ventricular end-diastolic dimension, left ventricular ejection fraction, peak velocity of early diastolic filling(E velocity), deceleration time of E wave, cardiac output, pulmonary capillary wedge pressure, left ventricular end-diastolic pressure and 24hr urine norepinephrine). CONCLUSION: Iodine-123-MIBG scan is a useful noninvasive imaging modality in the assessment of cardiac sympathetic neuronal integrity in patients with dilated cardiomyopathy. There were no significant correlations between cardiac MIBG uptake and other prognostic factors. The cardiac MIBG uptake probably can be utilized as an independent prognostic factor, hence it would be suggested that a large prospective clinical study is needed to consolidate these findings.
3-Iodobenzylguanidine* ; Cardiac Output ; Cardiomyopathy, Dilated* ; Deceleration ; Echocardiography* ; Echocardiography, Doppler ; Heart ; Humans ; Lung ; Mediastinum ; Mitral Valve Insufficiency ; Myocardial Perfusion Imaging* ; Neurons ; Prognosis ; Pulmonary Wedge Pressure ; Stroke Volume

PURPOSE: In some patients who receive adjuvant radiotherapy (RT) for the left breast, the stomach is located inside the RT field. This study investigates the incidence of gastric complications following adjuvant RT for breast cancer using data of the Health Insurance Review and Assessment Service in South Korea. METHODS: We identified 37,966 women who underwent surgery and received adjuvant RT for breast cancer. The cumulative incidence rate of gastric hemorrhage and gastric cancer was calculated and compared for left and right breast cancers. RESULTS: Among 37,966 patients, 19,531 (51.4%) and 18,435 (48.6%) had right and left breast cancers, respectively. After a median follow-up duration of 6.3 years, the cumulative incidence of gastric cancer and gastric hemorrhage did not differ between right and left breast cancers (p = 0.414 and p = 0.166, respectively). The multivariable analysis revealed that old age was the only factor associated with the development of gastric cancer (p < 0.001) and gastric hemorrhage (p < 0.001). The incidence of gastric cancer and hemorrhage did not differ between patients who received adjuvant RT for right and left breast cancers. CONCLUSION: Irradiation-related chronic complications of the stomach in patients with breast cancer are minimal. A study with a longer follow-up duration might be needed to assess the risk of gastric cancer.
Breast Neoplasms ; Breast ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Incidence ; Insurance, Health ; Korea ; Radiotherapy ; Radiotherapy, Adjuvant ; Stomach ; Stomach Neoplasms

In the evaluation of the source of occult bleeding, it is mandatory that the small bowel be investigated. But, the small bowel is the area where endoscopic approach is most difficult. The endoscopic evaluation of the small intestine has rapidly evolved over the last 10 years and now includes many of the diagnostic and therapeutic capabilities of standard endoscopic procedures. Various techniques have been developed, including fiberoptic sonde enteroscopy, retrograde ileoscopy, intraoperative enteroscopy, "push" enteroscopy using a pediatric colonoscope, and video enterocopy. Therefore, the small bowel enteroscope has shown great promise in the evaluation of obscure or persistent gastrointestinal bleeding. We have experienced a case of bleeding from jejunal leiomyosarcoma, which diagnosed with small bowel enteroscopy. So we report the case with a brief review of literature.
Colonoscopes ; Hemorrhage* ; Intestine, Small ; Leiomyosarcoma*

BACKGROUND AND OBJECTIVES: Primary (idiopathic) pulmonary hypertension is a rare, progressive and fatal disease. It has been defined, by the World Health Organization, as a mean pulmonary arterial pressure greater than 25 mmHg at rest, or greater than 30 mmHg during exercise, without the apparent cause of secondary pulmonary hypertension. This study was performed to better understanding the clinical presentation, natural history and prognosis of primary pulmonary hypertension. SUBJECTS AND METHODS: A total of 18 patients, who were diagnosed as primary pulmonary hypertension, at three University Hospitals, were retrospectively reviewed. All patients had undergone echocardiography and cardiac catheterization. RESULTS: With the patients there was a male: female ratio of 1:8, ranging in age between 10 and 50 years. The most common presenting symptom was dyspnea on exertion, with other symptoms comprising of fatigue in 11, chest pain in 5, syncope in 3 and hemoptysis in 2. The ECG & echocardiography reflected the presence of right-sided heart enlargement. The average right ventricular systolic pressure, from Doppler echocardiography, was 73.6+/-18.8 mmHg. The mean pulmonary artery pressure and pulmonary capillary wedge pressure were 52.9+/-18.4 and 9.2+/-3.1 mmHg, respectively. The survival times were within 30 and 21 to 60 months in 9 and the remaining patients, respectively. CONCLUSION: We conclude that primary pulmonary hypertension is common in female patients in their third to fifth decades. This study also showed a poor prognosis, as in other reports.
Arterial Pressure ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Chest Pain ; Dyspnea ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Fatigue ; Female ; Hemoptysis ; Hospitals, University ; Humans ; Hypertension, Pulmonary* ; Male ; Natural History ; Prognosis ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Retrospective Studies ; Syncope ; World Health Organization