Primary pulmonary hypertension is a rar, incurable, and progressive clinical entity. When associated with pregnancy, the prognosis of primary pulmonary hypertension is worsened with maternal mortality rates of at least 50%. The patient was a 29-year-old mother in her 2nd pregnancy, with previous uncomplicated gestation, 5 years ago. She had been well until the 28th week of present gestation when she was admitted because of increasing dyspnea on exertion. She was a housewife with no remarkable family and past histories. We have experienced a patient with primary pulmonary hypertension in pregnancy. She was treated with an oral calcium-channel blocker and low-molecular-weight heparin and was delivered vaginally with good maternal and fetal outcome. So we report a case of primary pulmonary hypertension associated with pregnancy and review literature.
Adult ; Dyspnea ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary* ; Maternal Mortality ; Mothers ; Pregnancy* ; Prognosis

Functional paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system that causes symptoms and signs of episodic catecholamine release. It has not been reported in Korea. We experienced a case of a 17 years old man with a history of diaphoresis and paroxysmal hypertension refractory to therapy since 14 years old. Urinary execretion of catecholamine and its metabolites were elevated. Computed tomography(CT) scan revealed high density mass located on the posterior mediastinum in the area of the right fifth intercostal space. At thoracotomy, a 3X3X4cm sized lesion was resected and confirmed as a paraganglioma.
Adolescent ; Humans ; Hypertension* ; Korea ; Mediastinum* ; Paraganglioma* ; Pheochromocytoma ; Thoracotomy

PURPOSE: The purpose of this study was to construct a fetal animal model of congenital diaphragmatic hernia in a lamb under domestic environments. METHODS: Left-sided diaphragmatic hernias were created in seven fetal lambs at about 85 days' gestation (experimental group). Three other fetal lambs did not receive any surgical procedure and served as control group. Four of these lambs (3 in the experimental group and 1 in the control group) were delivered after a sufficient intrauterine period. The morphological changes of lung development were compared between the two groups. RESULTS: Creation of diaphragmatic hernia resulted in marked hypoplasia in fetal lung development. In this experiment, the maternal mortality was 33.3%, and the fetal mortality was 60% which are relatively high as compared with previous reports. CONCLUSION: From this data, the authors concluded that experimental fetal diaphragmatic hernia can be established although the technique for the measurement of gestational age, anesthesia and postoperative care should be improved to overcome domestic inexperience in using the lamb as an experimental animal.
Anesthesia ; Animals ; Fetal Mortality ; Gestational Age ; Hernia, Diaphragmatic* ; Lung ; Maternal Mortality ; Models, Animal ; Postoperative Care ; Pregnancy

PURPOSE: This report presents a procedure for performing power Doppler ultrasound-guided sialography using the phenomenon of increased blood flow and illustrates its application to practical patient cases.MATERIALS AND METHODS: The salivary gland was scanned using ultrasound equipment (GE LOGIQ5 Expert® device; GE Medical Systems, Milwaukee, WI, USA) to identify pathological findings related to the patient's chief complaint. To identify the orifice of the main duct, it should be cannulated using a lacrimal dilator. After inserting the catheter into the cannulated main duct, the position of the catheter within the duct was confirmed by ultrasound. A contrast agent was injected until the patient felt fullness, and ultrasound (B-mode) was used to confirm whether the contrast agent filled the main canal and secondary and tertiary ducts. Then, power Doppler ultrasound was performed to determine whether the salivary gland had increased blood flow.RESULTS: In 2 cases in this report, a power Doppler ultrasound scan showed a significant increase in blood flow after contrast medium injection, which was not observed on a preoperative scan.CONCLUSION: Power Doppler ultrasound was found to be a simple, safe, and effective tool for real-time sialography monitoring.
Catheters ; Humans ; Salivary Glands ; Sialography ; Ultrasonography ; Vasodilation

BACKGROUND AND OBJECTIVES: Angiogenesis is important both in normal and pathologic processes, including wound healing and inflammation. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for expansion of cholesteatoma. This study was aimed to investigate mRNA and protein expression of angiogenic growth factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), transforming growth factor-alpha (TGF-alpha) and platelet derived-endothelial cell growth factor (PD-ECGF) in middle ear cholesteatoma. SUBJECTS AND METHOD: Cholesteatoma tissues and retroauricular skins were obtained from 12 patients during operation. The mRNA expression was detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), and the degree of expression was measured by comparing density ratio of beta-actin by NIH imaging analysis system. The protein expression was evaluated by immunohistochemistry, and the degrees of expression in epithelial, endothelial, inflammatory cells of cholesteatoma and retroauricular skin were judged by two pathologists and then converted on a 5-grade rating scale according to intensity of expression. RESULTS: The expression rate of mRNA in cholesteatoma and retroauricular skin was 67.7 and 33.3% in VEGF, 75.0 and 50.0% in bFGF, 53.8 and 8.3% in TGF-alpha, 67.7 and 75% in PD-ECGF. There was statistically significant difference only in TGF-alpha (p<0.05). The degrees of VEGF, bFGF, and TGF-alpha mRNA expression were about 2.6, 2.1 and 5.2 times significantly higher than retroauricular skin (p<0.05). And the degree of mRNA of PD-ECGF expression was about 1.4 times higher than retroauricular skin, although there was no statistical significance (p>0.05). The degrees of VEGF, bFGF and PD-ECGF protein expression in cholesteatoma tissue were more intense at the inflammatory (p<0.05), endothelial (p<0.05) and epithelial cell (p>0.05) than in retroauricular skin. And the degree of TGF-alpha protein expression in cholesteatoma tissue was more intense at all three cells (p<0.05) than in the retroauricular skin. CONCLUSION: These results suggest that angiogenesis processes in cholesteatoma perimatrix and the expression of angiogenic growth factors are upregulated by mRNA. Further studies for evaluating the factors that can affect the expression of mRNA and also for disclosing the roles and control mechanisms of these factors in cholesteatoma angiogenesis must be followed.
Actins ; Angiogenesis Inducing Agents ; Blood Platelets ; Cholesteatoma ; Cholesteatoma, Middle Ear* ; Ear, Middle* ; Epithelial Cells ; Fibroblast Growth Factor 2 ; Humans ; Immunohistochemistry ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Pathologic Processes ; RNA, Messenger ; Skin ; Thymidine Phosphorylase ; Transforming Growth Factor alpha ; Vascular Endothelial Growth Factor A ; Wound Healing

No abstract available.
Carcinosarcoma* ; Lung*

Postweaning multisystemic wasting syndrome (PMWS), which was first identified in western Canada in 1991 and more recently in the United States, Europe and Asia, is an emerging disease in pigs. Porcine circovirus type 2 (PCV-2) is the primary infectious viral agent causing PMWS, but the full expression of the disease may require the presence of other agents. It is reported that there is apparent synergism between PCV-2 and porcine parvovirus (PPV) in increasing the severity of the clinical signs and lesions of PMWS. From January 2006 to May 2008, a total of the 154 lymph node samples were collected from 4~12 weeks old pigs which had been submitted to the College of Veterinary Medicine, Jeju National University, Korea. These pigs were diagnosed as PMWS on the basis of clinical and pathological examination from 48 commercial herds in Jeju Island. Based on the immunohistochemistry, porcine parvovirus was detected in 69 cases (44.8%) from 154 weaned or grower pigs. PPV antigens were detected in the cytoplasm of histiocytic cells multifocally infiltrated in the cortex and paracortex of lymph nodes. The results of this study clarify that PPV is prevalent in pigs with PMWS on Jeju Island. Therefore PPV is one of the most important co-agents in the development of naturally acquired PMWS. This study may be helpful to the control of this disease and to epidemiological aspects.
Asia ; Canada ; Circovirus ; Coinfection ; Cytoplasm ; Europe ; Immunohistochemistry ; Korea ; Lymph Nodes ; Parvovirus, Porcine ; Prevalence ; Swine ; United States ; Veterinary Medicine ; Wasting Syndrome

PURPOSE: To minimize the process that acute myocardial infarction (AMI) patients have to go through when visiting the emergency room (ER), and thus to provide prompt reperfusion therapy using the six sigma protocol, a business management renovation strategy to standardize the clinical process. METHODS: Analysis was done on data obtained both before and after implementation of the six sigma protocol. Data were collected from ST segment elevation myocardial infarction (STEMI) patients who visited the ER between February 2006 and March 2009 and received reperfusion therapy. For statistical analysis used we used an unpaired t-test. RESULTS: After the six sigma protocol was put into practice, total visiting time was reduced from 124.4+/-76.1 minutes to 91.5+/-50.3 minutes, and the reduction was statistically significant (p<0.0045). Six sigma (6 sigma) means 3.4 PPM, that is, among 1 million cases no more than 3.4 cases should exceed the time limit of 90 minutes from the arrival of the patient to the needle puncture, making the task hard to achieve. sigma score was greatly elevated-from 1.48 sigma to 2.48 sigma and the sigma error rate (the proportion of cases that exceeded 90 min) improved from 62% to 45% . CONCLUSION: In this study we verified that applying the six Sigma protocol significantly reduced the time to reperfusion therapy for AMI patients. The reduction in time was due to changes in software (developed from the existing system) rather than to hardware improvements such as changes in test facilities or manpower amplification. The entire process, from a patient arriving at the ER until the patient received reperfusion therapy was viewed as one systemic flow and applying the six Sigma protocol to such flow was successful as shown by the result of this study. This shows that the six sigma protocol can be applied to a medical system if configured effectively. Further, this method can be useful not only for AMI patients, but also for many other urgent procedures such as acute cerebral infarction patients who require prompt diagnosis and hemolytic therapy, when the definition of the error rate is corrected according to the specific patients groups.
Cerebral Infarction ; Commerce ; Emergencies ; Humans ; Myocardial Infarction ; Needles ; Punctures ; Reperfusion ; Total Quality Management

PURPOSE: To minimize the process that acute myocardial infarction (AMI) patients have to go through when visiting the emergency room (ER), and thus to provide prompt reperfusion therapy using the six sigma protocol, a business management renovation strategy to standardize the clinical process. METHODS: Analysis was done on data obtained both before and after implementation of the six sigma protocol. Data were collected from ST segment elevation myocardial infarction (STEMI) patients who visited the ER between February 2006 and March 2009 and received reperfusion therapy. For statistical analysis used we used an unpaired t-test. RESULTS: After the six sigma protocol was put into practice, total visiting time was reduced from 124.4+/-76.1 minutes to 91.5+/-50.3 minutes, and the reduction was statistically significant (p<0.0045). Six sigma (6 sigma) means 3.4 PPM, that is, among 1 million cases no more than 3.4 cases should exceed the time limit of 90 minutes from the arrival of the patient to the needle puncture, making the task hard to achieve. sigma score was greatly elevated-from 1.48 sigma to 2.48 sigma and the sigma error rate (the proportion of cases that exceeded 90 min) improved from 62% to 45% . CONCLUSION: In this study we verified that applying the six Sigma protocol significantly reduced the time to reperfusion therapy for AMI patients. The reduction in time was due to changes in software (developed from the existing system) rather than to hardware improvements such as changes in test facilities or manpower amplification. The entire process, from a patient arriving at the ER until the patient received reperfusion therapy was viewed as one systemic flow and applying the six Sigma protocol to such flow was successful as shown by the result of this study. This shows that the six sigma protocol can be applied to a medical system if configured effectively. Further, this method can be useful not only for AMI patients, but also for many other urgent procedures such as acute cerebral infarction patients who require prompt diagnosis and hemolytic therapy, when the definition of the error rate is corrected according to the specific patients groups.
Cerebral Infarction ; Commerce ; Emergencies ; Humans ; Myocardial Infarction ; Needles ; Punctures ; Reperfusion ; Total Quality Management

PURPOSE: This study was performed to investigate the influence of object shape and distance from the center of the image on the volumetric accuracy of cone-beam computed tomography (CBCT) scans, according to different parameters of tube voltage and current. MATERIALS AND METHODS: Four geometric objects (cylinder, cube, pyramid, and hexagon) with predefined dimensions were fabricated. The objects consisted of Teflon-perfluoroalkoxy embedded in a hydrocolloid matrix (Dupli-Coe-Loid TM; GC America Inc., Alsip, IL, USA), encased in an acrylic resin cylinder assembly. An Alphard Vega Dental CT system (Asahi Roentgen Ind. Co., Ltd, Kyoto, Japan) was used to acquire CBCT images. OnDemand 3D (CyberMed Inc., Seoul, Korea) software was used for object segmentation and image analysis. The accuracy was expressed by the volume error (VE). The VE was calculated under 3 different exposure settings. The measured volumes of the objects were compared to the true volumes for statistical analysis. RESULTS: The mean VE ranged from −4.47% to 2.35%. There was no significant relationship between an object's shape and the VE. A significant correlation was found between the distance of the object to the center of the image and the VE. Tube voltage affected the volume measurements and the VE, but tube current did not. CONCLUSION: The evaluated CBCT device provided satisfactory volume measurements. To assess volume measurements, it might be sufficient to use serial scans with a high resolution, but a low dose. This information may provide useful guidance for assessing volume measurements.
Americas ; Colloids ; Cone-Beam Computed Tomography* ; Imaging, Three-Dimensional ; Seoul