1.The Effect of the Intravenous Esmolol on Blood Pressure and Heart Rate during Electroconvulsive Therapy.
Ok Young SHIN ; Chull Ho KANG ; Keon Sik KIM
Korean Journal of Anesthesiology 1997;33(6):1054-1060
BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.
Arterial Pressure
;
Blood Pressure*
;
Central Nervous System
;
Cross-Over Studies
;
Electroconvulsive Therapy*
;
Heart Rate*
;
Heart*
;
Hemodynamics
;
Humans
;
Hypertension
;
Mood Disorders
;
Oxygen
;
Psychotic Disorders
;
Seizures
;
Tachycardia
2.Treatment of endometrial hyperplasia with Medroxyprogesterone acetate(MPA).
Seok Mo KIM ; Kwang Sik SHIN ; Yoon Ha KIM ; Ho Sun CHOI ; Ji Soo BYUN
Korean Journal of Obstetrics and Gynecology 1999;42(8):1655-1660
OBJECTIVE: To investigate the response of hyperplastic endometrium to Medroxyprogesterone acetate according to the histologic types such as simple typical, complex typical and atypical hyperplasia. METHODS: A total of 79 patients with histologically proved endometrial hyperplasia were enrolled into this prospective study between March 1996 and May 1998. Patients without atypia were placed on a regimen of cyclic therapy with 10mg MPA orally, each day for 14days per month for 3 months. In the cases in which hyperplasia did not regress , MPA was increased to 20mg. Patients with atypical hyperplasia received continuous MPA therapy, 20mg orally each day for 3 month. All patients were followed up for a minimum of 3 months and a maximum of 1 year(mean 7 months). RESULTS: In patients with simple typical hyperplasia, 45 patients(80.4%) had regression, 11 patients(19.6%) had persistence and none had progression. In patients with complex typical hyperplasia, 10 patients(83.3%) had regression, 2 patients(16.7%) had persistence and none had progression. But, in patients with atypical hyperplasia 5 patients(45.4%) had regression, 4 patients(36.4%) had persistence and 2(18.2%) patients had well differentiated endometrial adenocarcinoma. There was no recurrence during the follow up. CONCLUSION: This data suggest that most women with typical hyperplasia respond to progestin therapy, but there is high failure rate of response to progestin therapy and risk of endometrial cancer in patients with atypical hyperplasia. If the young patient desires to preserve her fertility, then progestin therapy may be considered as primary treatment in patients with atypical hyperplasia. But older patients in whom fertility is not an issue, hysterectomy should be selected as treatment of choice for atypical lesion.
Adenocarcinoma
;
Endometrial Hyperplasia*
;
Endometrial Neoplasms
;
Endometrium
;
Female
;
Fertility
;
Follow-Up Studies
;
Humans
;
Hyperplasia
;
Hysterectomy
;
Medroxyprogesterone Acetate
;
Medroxyprogesterone*
;
Prospective Studies
;
Recurrence
3.Relation of Right Atrial Pathology to Atrial Fibrillation in Mitral Valvular Disease.
Kwang Ho KIM ; Young Sik PARK ; Gil Ja SHIN ; Woo Hyung LEE ; Woon Sup HAN
Korean Circulation Journal 1989;19(4):734-739
It is well known that there is close relation of the left atrial pathology to atrial fibrillation(AF) in patients with mitral valvular disease. To evaluate such relation is existed or not in the right atrium, the right atrial wall biopsy was performed in 31 patients with mitral valvular disease during valve surgery. The specimens obtained were interpretated by the pathologist who had no information about the patients. The specimens were graded according to severity of morphological change. In Grade I, the atrial myocardium is degenerated and has moderate fibrosis in it. Grade II shows the atrial myocardial layer of the atrium and severe degenerated with pre and postoperative heart rhythm. Four patients had Grade I change and 3 patients among them had pre and postoperative AF. Eleven patients had Grade III changes and 9 among them had pre and postoperative AF. The results show there is strong tendency that the patients with pre and postopeative AF had Grade III change in the right atrium and the relation of the right atrial pathology to AF is same as that of the left atrium.
Atrial Fibrillation*
;
Biopsy
;
Fibrosis
;
Heart
;
Heart Atria
;
Humans
;
Myocardium
;
Pathology*
4.A Comparison of Fibrillatory F Wave with Left Atrial Size and Biopsy Findings in Rheumatic Valvular Heart Disease.
Gil Ja SHIN ; Woo Hyung LEE ; Kwang Ho KIM ; Young Sik PARK ; Wun Sup HAN
Korean Circulation Journal 1988;18(2):221-229
A total of the 16 cases of rheumatic vavular heart desease were examined in order to compare fibrillatriy F wave with left atrial size and biopsy findings from October 1986 to April 1987 at the Ewha Womans University Hospital. The results were as follows : 1) Of the 16 patients, there were 5 males and 11 females. The mean age of the patients was 41.9+/-12.7 years old. 2) Among the 16 patients PTF-V1 was lesser than -0.04nn-sec, the left atrial size measured by M-mode echocardiography was 57.1+/-8.9mm. Inverse correlation between PTF-V1 and the left atrial size measured by M-mode echocardiography was observed(P<0.01). 3) No significant correlation between PTF-V1 and left atrial was found(P>0.01). 4) There was a tendency that the size of the left atrium was, the more degeneration, necrosis and fibrosis of the left atrial wall appeared through pathological findings.
Atrial Fibrillation
;
Biopsy*
;
Echocardiography
;
Female
;
Fibrosis
;
Heart
;
Heart Atria
;
Heart Valve Diseases*
;
Humans
;
Male
;
Necrosis
5.Evaluation of Hematopoietic Abnormalities and Apoptosis in Myelodysplastic Syndromes Using Long Term Bone Marrow Culture System and In Situ Nick End Labeling Method.
Jong Ho WON ; Dae Sik HONG ; Hee Sook PARK ; Jung Shin LEE
Korean Journal of Medicine 1997;53(4):469-481
OBJECTIVES: The myelodysplastic syndromes (MDS) are a group of acquired clonal hematopoietic disorders characterized by peripheral cytopenias and a hypercellular or normocellular dysplastic bone marrow. The mechanisms responsible for development of MDS are not known. We performed this study to evaluate the hematopoietic abnormalities and apoptosis in MDS. METHODS: Long-term bone marrow culture (LTBMC) was performed for colony assays, cobblestone area assay, stromal morphologic changes from 7 patients with MDS and 7 normal controls. In situ nick end labeling (ISNEL) method was performed for detection of apoptosis from LTBMC in 7 patients with MDS and 7 normal controls. ISNEL method also performed in bone marrow cell bloc samples in 36 patients with MI3S. RESULTS: Viability of nonadherent cells from LTBMC of patients with MDS was not decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Formation of the cobblestone areas from patients with MDS was slightly decreased compared with normal controls at 1st week, but significantly decreased at 2nd and 3rd weeks compared with normal controls (P<0.0001). Slightly decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Stromal layers produced in LTBMC of normal controls and 1 patient with MDS were detected at 1 week and were formed confluent stroma from 3 weeks, but another patients with MDS who did not form a confluent stroma. Patients with MDS had significantly lower colony forming unit granulocyte-macrophage (CFU-GM) compared with normal controls at 1 (P<0.01) and 2 weeks (P<0.001) of LTBMC. Two weeks of LTBMC resulted more profound inhibition of CFU-GM formation than 1 week (P<0.0001). Apoptotic cell death was absent in adherent and non adherent cells from normal controls at 1 and 2 weeks, but massive apoptotic cell death was found in adherent and non adherent cells from patients with MDS at 1 and 2 weeks and the degree of apoptosis was profound at 2 weeks compared with 1 week. Among the 36 patients, fifteen patients demonstrated varying degrees of apoptosis positive cells, 4 having low, 8 intermediates, and 3 high scores. Remaining 21 patients showed absent apoptosis or only occasional positive cells. CONCLUSION: Hematopoietic abnormalities such as a failure of differentiation are caused by the stromal defects and the biologic basis of the apparent paradox of peripheral cytopenias in the face of hypercellular (or normocellular) marrow is related by intramedullary apoptotic cell death of the stromal and hematopoietic cells.
Apoptosis*
;
Bone Marrow Cells
;
Bone Marrow*
;
Cell Death
;
Granulocyte-Macrophage Progenitor Cells
;
Humans
;
In Situ Nick-End Labeling*
;
Myelodysplastic Syndromes*
;
Stem Cells
6.A Case of Dandy-Walker Syndrome Associated with Multiple Congenital Anomalies.
Gye Weon SHIN ; Chul Ho LEE ; Bo Kyung CHO ; Chung Sik CHUN ; Sung Hun CHO
Journal of the Korean Pediatric Society 1990;33(6):848-853
No abstract available.
Dandy-Walker Syndrome*
7.Diagnostic Significance of Serum Tumor Markers in Paitents with Ovarian Tumors.
Kwang Sik SHIN ; Seok Mo KIM ; Ho Sun CHOI ; Ji Soo BYUN
Korean Journal of Obstetrics and Gynecology 2000;43(4):715-720
OBJECTIVE: This study was designed to evaluate the efficiency of tumor markers level for early diagnosis of ovarian malignancy and for differentiation between benign and malignant ovarian tumors. MATERIALS AND METHODS: We determined preoperative serum tumor markers level in patients who were going to have an operation due to ovarian tumor in OB & GY Dept. of Chonnam University Hospital from April 1993 to September 1999. RESULTS: 1) The average values of serum tumor markers in patients with malingnant ovarian tumors were statistically higher than those of benign ovarian tumors. among malignant ovarian tumors, positive rate of all serum tumor markers was highest in epithelial ovarian carcinoma group. and among ovarian tumor markers, and positive rate of CA 125 was highest in epithelial ovarian carcinoma. 2) Dermoid cyst and endometioma were correlated to CA 19-9, CA 125 levels respectively. for malignant tumors, mucinous ovarian adenocarcinoma and non-mucinous ovarian adenocarcinoma were CA 19-9, CA 125 levels respectively. 3) Among ovarian tumor markers, CA 125 was the most in sensitivity and CA 72-4 was the most in specificity and diagnostic efficiency. 4) For postmenopausal women with ovarian tumors, elevated levels of at least one of the 4 tumor markers were present in the serum in 85.7% of the women who developed cancer, 62.5% of women with borderline, 27.8% of women with benign ovarian tumors. Conclusion; It is suggested that determination of serum tumor markers in patient suspected of ovarian tumor may be helpful to clinician for early diagnosis, differentiation between malignant and benign ovarian tumors.
Adenocarcinoma
;
Dermoid Cyst
;
Early Diagnosis
;
Female
;
Humans
;
Jeollanam-do
;
Mucins
;
Sensitivity and Specificity
;
Biomarkers, Tumor*
8.The Clinical Observation in Kawasaik Disease.
Min Young PARK ; Gye Sik SHIN ; Sung Ho CHA ; Chang Il AHN
Journal of the Korean Pediatric Society 1994;37(2):167-173
One-hundred ninty five cases with Kawasaki disease who were diagnosed and treated at the Department of Pediatrics, Kyung Hee University Hospital from January 1985 to June 1993, were investigated for their clinical manifestations and laboratory findings, and cardiac complications. The results are as follows: 1) Most patients (92.8%) were under 5 years of the age. 2) Boys were more prevalent than girls, as a ratio of 2.3 : l 3) The incidence of principal symptoms and signs were fever over 5 days (89.8%), bilateral conjunctival injection (78.5%), changes of oral mucosa and lip (82.3%), skin eruption (72.8%), changes in extremities (58.5%), and cervical lymphadenopathy (47.2%). 4) The main laboratory findings observed were anemia (29.2%), leukocytosis (90.8%), thrombocytosis (89.7%), increased ESR (85.1%), positive CRP (100%), increased sGOT (33.3%), increased sGPT (34.9%), pyuria (41.5%), proteinuria (5.6%), microscopic hematuria (9.7%), and abnormalities of EKG (23.5%). 5) Abnormal findings of the heart were found in 27.2% by echocardiogram and coronary aneurysm and dilatation were present in 19.7%. 6) Among 147 cases assessed by echocardiogram, the abnormalities of coronary artery were present in 16 of 92 cases (17.4%) in the aspirin and intravenous gammaglobulin treated group, as compared with 13 of 55 cases (23.6%) in the aspirin treated group.
Alanine Transaminase
;
Anemia
;
Aspartate Aminotransferases
;
Aspirin
;
Coronary Aneurysm
;
Coronary Vessels
;
Dilatation
;
Electrocardiography
;
Extremities
;
Female
;
Fever
;
Heart
;
Hematuria
;
Humans
;
Incidence
;
Leukocytosis
;
Lip
;
Lymphatic Diseases
;
Mouth Mucosa
;
Mucocutaneous Lymph Node Syndrome
;
Pediatrics
;
Proteinuria
;
Pyuria
;
Skin
;
Thrombocytosis
9.A Measurement of Pulmonary Flow, Systemic Flow and the Ratio of Pulmonary Flow and Systemic Flow by 2D-Doppler Echocardiography in Ventricular Septal Defect: A Comparison Study with the Fick's Method by Cardiac Catheterization.
Gil Ja SHIN ; Woo Hyung LEE ; Kwang Ho KIM ; Young Sik PARK
Korean Circulation Journal 1988;18(3):403-409
In order to evaluate the effecacy of 2D-Doppler echocardiography for the measurement of pulmonary flow(Qp), systolic flow(Qs), the ratio of pulmonary flow and systemic flow and systemic flow(Qp/Qs), 19 membranous ventricular septal defect patients were examined in the period from July, 1986 to October, 1987 at Ewha Women's university hospital. The measurement of Qp, Qs, Qp/Qs by 2D-Doppler echocardiography were compared with the results by the Fick's method of cardiac catheterization.The following results were obtained. 1) The total of the 19 patients consisted of 15 males and 4 females. The mean age of the patients was 8.2 years. 2) It was found that the Fick's method and 2D-Doppler measurements of Qp (n=19, r=0.67), Qs (n=19, r=0.88), and Qp/Qs ratio(n=19, r=0.62) were highly correlated(p<0.01). 3) It is understood that the measurement of Qp, Qs, Qp/Qs ratio by 2D-Doppler echocardiography were quite useful to the noninvative diagnosis of ventricular septal defect.
Cardiac Catheterization*
;
Cardiac Catheters*
;
Diagnosis
;
Echocardiography*
;
Echocardiography, Doppler
;
Female
;
Heart Septal Defects, Ventricular*
;
Humans
;
Male
10.Wegener's Granulomatosis Presenting as Hematuria and Necrotic Papules.
Korean Journal of Nephrology 2009;28(4):345-349
Wegener's granulomatosis (WG) is an antineutrophil cytoplasm antibody (ANCA)-associated small-vessel vasculitis characterized by ear, nose, and throat (ENT) involvement, pulmonary disease, and glomerulonephritis, less commonly, the eyes, joints, skin, neurologic and cardiac tissue. Cutaneous manifestation as an initial presentation is unusual and about 15% of patients with WG will developspecific skin lesions at some time during the course of the disease. The most common skin lesion specific to WG is palpable purpura with the histopathologic correlate of leukocytoclastic vasculitis. However, a wide array of clinical and histologic features may be seen. Glomerulonephritis eventually develops in about 80% of patients, although only 20% have renal disease when they first present. Clues are proteinuria and active urine sediment containing dysmorphic red blood cells and red blood cell casts. We report a patient with Wegener's granulomatosis who presents as hematuria and necrotic papules.
Cytoplasm
;
Ear
;
Erythrocytes
;
Eye
;
Glomerulonephritis
;
Hematuria
;
Humans
;
Joints
;
Lung Diseases
;
Nose
;
Pharynx
;
Proteinuria
;
Purpura
;
Skin
;
Vasculitis
;
Vasculitis, Leukocytoclastic, Cutaneous
;
Wegener Granulomatosis