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

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

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

To identify the developmental characteristics of intermediate filaments, the expressions of various cytokeratines (CK), desmin and vimentin in fetal (14032 weeks of gestations) and adult epidermis were studied immunohistochemically. The primary antibodies used were CK7, 8, 10, 14, 18, AE8, 5D3, and MNFl16 for cytokeratins, D33 for desmin, and V9 for vimentin. At 14 weeks of gestation, the epidermis consisted of basal cells and periderm. The periderm exhibited positive staining for CK8 and AE8, and weak staining for MNF116 and D33. The basal cells showed positive staining for MNF116 and D33. The epidermis did not reacted for CK7, 10, 14, 18, 5D3, and V9 at this period. At 16-20 weeks of gestation, the epidermis was composed of basal, intermediate, and periderm layers. The periderm was positive for CK8, 18, AE8, MNF116, and D33. The intermediate cells were positive for CK10 and the basal cells CK14, MNF116, and D33. Few cells were stained positively with V9 among the basal cells. At 24-32 weeks of gestation, the epidermis exhibited no longer positive reactions for CK8, 18, AE8 and D33. The intermediate cells were positive for CK10. Immunoreactivity for MNF116 was noted in intermediate layer just above the basal layer. CKl4, MNFl16, D33, and often V9 were expressed in basal cells. The expressions of CK7 and 5D3 were not observed at any period of gestation. In adult epidermis, basal cells exhibited positive staining for CKl4, MNFl16, and D33. The intermediate cells were strongly positive for CK10, and weakly positive for CK7, 8, and MNFl16. The cells positive for V9 were often present among the basal cells. These results indicate that CK8 and 18 may serve as useful markers for periderm, CK10 for intermediate cells, CKl4 for basal cell, and suggest that the vimentin immunoreactive cells in basal cell layer are Langerhans cells.
Adult ; Antibodies ; Desmin ; Epidermis* ; Fetus* ; Humans* ; Immunohistochemistry ; Intermediate Filaments ; Keratins* ; Langerhans Cells ; Pregnancy ; Vimentin

No abstract available.
Humans ; Infant, Newborn*

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

The present study has been undertaken to investigate the values of serum lipids with hypertension and ischemic heart diseases. Serum lipids and lipoproteins were measured from 231 cases of hypertension, 23 cases of angina pectoris, 18 cases of acute myocardial infarction and 67 healthy adults together with normal value as controls. The results obtained were as follows: 1. The mean values of serum lipids in healthy adults were 111.0+/-41.3mg% for triglyceride, 171.2+/-33.5mg% for cholesterol, 175.1+/-36.3mg% for phospholipid, 479.9+/-82.6mg% for total lipid. The values of serum lipoproteins were 219.8+/-46.8mg% for beta-lipoprotein, 93.4+/-53.8mg% for pre beta-lipoprotein and 164.1+/-40.8mg% for alpha-lipoprotein. The values of cholesterol, triglyceride and beta-lipoprotein were gradually increased with aging. 2. The mean values of serum lipids in patients with hypertension were 176.3+/-94.5mg% for triglyceride, 199.7+/-36.9mg% for cholesterol, 207.8+/-38.0mg% for phospholipid, 601.9+/-139.9mg% for total lipid. The values of serum lipoproteins were 266.0+/-73.5mg% for beta-lipoprotein, 147.7+/-89.5mg% for pre-beta-lipoprotein and 187.7+/-56.7mg% for alpha-lipoprotein. The serum lipid values in patients with hypertension were significantly higher than those in healthy controls. 3. The mean values of serum lipids and lipoproteins in patients with angina pectoris were significantly higher than in healthy controls. 4. The serum lipid values in general were higher rather in patients with acute myocardial infarction than healthy controls, but the values of serum phospholipid, pre-beta-lipoprotein and alpha-lipoprotein in them were not significantly higher than those in healthy controls. 5. The values of serum HDL-cholesterol in patients with hypertension, anginal pectoris and acute myocardial infarction were lower than those in healthy controls. The values of serum HDL-cholesterol in all cases were in general higher rather in femal than male.
Adult ; Aging ; Angina Pectoris ; Cholesterol ; Humans ; Hypertension* ; Lipoproteins ; Male ; Myocardial Infarction ; Myocardial Ischemia* ; Reference Values ; Triglycerides

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

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*

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*