Tracheobronchial aspergillosis is an unusual form of invasive aspergillosis characterized by noninvasive or only superficially invasive tracheobronchitis with a propensity for dissemination. We report a two-year-old male who suddenly died of respiratory failure. Postmortem examination revealed a pseudomembrane covering the mucosa of larynx, trachea and bronchial tree of both lungs. This pseudomembrane was composed predominantly of Aspergillus hyphae. There was transmural necrotizing bronchitis with fungal invasion to the narrow zone of peribronchial tissue, and dissemination to the stomach and kidney. This form of pulmonary aspergillosis had not been reported in this country.
Aspergillosis* ; Aspergillus ; Autopsy* ; Bronchitis ; Humans ; Hyphae ; Kidney ; Larynx ; Lung ; Male ; Mucous Membrane ; Pulmonary Aspergillosis ; Respiratory Insufficiency ; Stomach ; Trachea

Transmesenteric hernias through congenital mesenteric defects are the least common of intra-abdominal hernias and rare causes of acute intestinal obstruction in infants and children. Because of its rarity and difficulty of diagnosis, the mortality and morbidity were very high, and incarceration leads to intestinal obstruction and subsequently, strangulation and gangrene of varying lengths of intestine. We present an autopsy case of transmesenteric hernia through the defect of the mesentery of ileum, showing strangulationand obstruction of the affected small bowel.
Autopsy* ; Child ; Diagnosis ; Gangrene ; Hernia* ; Humans ; Ileum ; Infant ; Intestinal Obstruction ; Intestines ; Mesentery ; Mortality

No abstract available.
Evidence-Based Practice* ; Humans

BACKGROUND: Propafenone is effective in the treatment of ventricular arrhythmias and paroxysmal supraventricular tachycardia. Propafenone has been shown to be also useful in preventing the recurrence of atrial fibrillation. But to date, date concerning the efficacy of propafenone for patients experiencing paroxysmal and chronic atrial fibrillation have not been examined in Korea. METHODS: In patients with paroxysmal atrial fibrillation propafenone was given at a dose of 450mg daily without dose titration and symptomatic recurrences were evaluated by patient interview during follow-up. In patients with chronic atrial fibrillation, who had no previously attempted cardioversion, propafenone was given at a dose of 450~675mg daily without dose titration, and after a minimum of 3 days pharmacological cardioversion was assessed. Those patients in whom sinus rhythm had been restored pharmacologically or by combined direct current cardioversion were followed with maintaining propafenone therapy also at a dose of 450~675mg daily. RESULTS: Of 7 patients with paroxysmal atrial fibrillation, 4 (57%) patients had marked symptomatic improvement and they were followed for 197 to 460 (mean 286) days Of 13 patients with chronic atrial fibrillation, 7 patients incuding 4 pharmacologically converted patients were initially controlled to sinus rhythm. In 5 (38%) patients maintenance of sinus rhythm was followed for 90 to 415 (mean 224) days. CONCLUSION: Although these observations were made in small number of patients and are so limited, the results are comparable to the previous studies which showed the potential role of propafenone in the management of atrial fibrillation.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Electric Countershock ; Follow-Up Studies ; Humans ; Korea ; Propafenone* ; Recurrence ; Tachycardia, Supraventricular

For many years, healing membranous bone fractures have been known to show a persistent lucency at the fracture interface. Radiographic follow-up has proven to be of little value as a guideline for healing of mandibular fractures. Recently, a fracture has been treated by rigid internal fixation by metallic plate and screws rather than closed reduction and wire fixation, we expected that some difference in the radiographic features of fracture healing. To investigate these questions we undertook a retrospective radiographic and clinical analysis of 33 followed patients with fractures of the body and angle of the mandible from 1993 to 1997. There were 26 male and 7 female patients ranging in age between 5 and 74 years, with an average of 29.7 years. All patients were managed by open reduction with metallic plates and screws. The length of follow-up ranged from 9 to 187 weeks. Total 81 radiographic follow-up films were obtained and divided into 3 grades according to the degree of radiolucency of fracture lines; grade 0 radiolucent fracture line and no evidence of fracture interface calcification, grade 1 decreased radiolucent area and evidence of fracture interface calcification, and grade 2 disappearance of fracture line.Until follow-up of 8 weeks, all of the radiographs showed grade 0. From 8 weeks to 16 weeks, 62.5 percent showed grade 0 and 37.5 percent showed grade 1. From 16 weeks to 48 weeks, 38.5 percent showed grade 1 and 61.5 percent showed grade 2. After follow-up of 48 weeks, all showed grade 2.In this study we have shown that the radiographic disappearance of mandibular fracture lines was usually accomplished by 48 weeks. We feel that radiographic union of the mandible is lagging well behind clinical union, but disapperance of the fracture line in rigidly fixated mandibular fracture was occurred earlier than healed by fibrous union. We propose that radiographic union of the mandible by approximately 1 year can be a guideline for the normal mandibular bone healing.
Female ; Follow-Up Studies* ; Fracture Healing ; Fractures, Bone ; Humans ; Male ; Mandible ; Mandibular Fractures* ; Retrospective Studies

Surgical operation or invasive diagnostic procedure may inflict unwanted mechanical injury on either tissue or organ. Iatrogenic injury is said that unwanted, accidental mechanical injury of the body, caused by surgical procedures. Rarely intraabdominal operation, spinal surgery or invasive diagnostic procedures can cause iatrogenic abdominal injury, which becomes the subject of a medicolegal investigation by prolonged treatment period, sequelae, and death.
Abdominal Injuries*

BACKGROUND: Blood pressures rneasured by a nurse at reception room as a part of routine physical examination are oft,en used as a indicator of medical care. Blood pressure at reception room and consultation room are, however, often different to each other and these differences are caused by various factors including difference of white coat effect by nurse and doctor. Thus, this study was performed in order to know whether blood pressure difference really exit, and its associated factors. METHODS: Two hundred ninety one patients who visited to one university hospital farnily practice were enrolled in this study. Blood pressure and pulse rate at reception room and consultation room, waiting t,ime, time interval between reception and consultation, smoking status, and intake of coffee and food were collected. Nine patients were excluded, because blood pressure either at reception room or at consulation room was not recorded. This study was performed by one nurse and two doctors. They defined the guideline for method of blood pressure measurement before the study, and used the same kind of indirect cuff sphygmomanometer. RESULTS: Two hundred eighty two patients were analyzed. The number of men was one hundred twenty five. Systolic blood pressure at consultation room was higher than that at reception room by 1.6+/-11.9mmHg (P<0.05). Sixty five cases(65%) in systolic blood pressure and 111 cases(40%) in diastolic blood pressure showed blood pressure differences more than 5mmHg. The group with systolic blood pressure difference between reception room and consultation room(SBP) in more than 5mmHg is more likely to be hypertensive than the group with SBP in less than 5mmHg(P<0.01). More female patients(66%) and hypertensive patients(59%) were belong to the group whose systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). Twenty four patients(30%) of the group whose systolic blood pressure at reception room were 5mmHg higher than at consultation room had cigarette smoking within 1 hour, and this ratio was significantly higher than the other groups whose systolic blood pressure difference was less than 5rnmHg or systolic blood pressure at consultation room were 5mmHg higher than at reception room(P<0.01). There was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site(Overall kappa, 0.747, P<0.01). CONCLUSIONS: Many patients showed blood pressure differences more than 5mmHg between reception room and consultation room. Systolic blood pressure at consultation room was higher than that at reception room, and there was relatively good concordance in classifying hypertension and normal blood pressure according to measurement site, but the adverse effect by misclassification should not be neglected. The importance as well as the limitation of blood pressure measurement at reception room should be considered in screening and treating hypertensive patient. Every time when blood pressure is taken, physicians should keep in mind to consider patients factors which may influence blood pressure level.
Blood Pressure* ; Coffee ; Female ; Heart Rate ; Humans ; Hypertension ; Male ; Mass Screening ; Outpatients* ; Physical Examination ; Smoke ; Smoking ; Sphygmomanometers

Small and large airways functions were studied in patients with hypertensive heart disease in slightly ro moderately compromised state functionally. In this study, the forced vital capacity and various flow paramaeters reflecting expiratory flow rate were determined from simultaneously recorded forced expiratory volume and maximal expiretory flow volume curves in 86 cases. The closing volume was measured by a single breath nitrogen mrthod in 57 cases and airway resistance with its related parameters by a body plethysmograph in 11 cases. These results were compared with those obtained from the same numbers of healthy controls matched for sex, age and height. In the patient group, the forced vital capadity and all the observed values of flow parameters, execpt for the ratio of the first second vital capacity to the forced vital capacity, were significantly reduced than those in the controls. When the remainder of flow parameters was volume-adjusted to the forced vital capacity, however, the mean of the peak expiratory flow rate and the maximal expiratory flow rate at the 75 percent of the vital capacity were not significantly different from that of controls. In contrast, the volume-adjusted values of maximal expiratory flow were remained significantly smaller than those in the controls. The closing volume and its ratio to the vital capacity were significantly larger in the patient group. Airway resistance and its related parameters revealed no significant differences between two groups. These findings suggest that the patients with hypertensive heart disease in a mild to moderate failure are associated with restrictive ventilatory impairment and a small airways obstruction, but with little or no large airway dysfunction.
Airway Resistance ; Closing Volume ; Forced Expiratory Volume ; Heart Diseases* ; Heart* ; Humans ; Maximal Expiratory Flow Rate ; Nitrogen ; Peak Expiratory Flow Rate ; Vital Capacity

To assess the immunological function of toluene exposed group, the proportions of T lymphocyte, B lymphocyte, CD 4 cell, CD 8 cell, the ratio of CD4 to CD8 (CD4/CD8) in peripheral blood were measured on twenty-one toluene exposed workers and twelve healthy workers who did not have previous history of toluene exposure. In addition, to evaluate the present status of toluene exposure, urinary hippuric acid concenturations were measured in exposed group. The mean concenturation of urinary hippuric acid was 2.84 g/creatinine g in exposed group. The proportions of T lymphocyte, B lymphocyte, CD8 cell and CD4/CD8 of exposed group were slightly lower than non-exposed group except the proportion of CD4 cell which was similar in both groups. But these differences were not statistically different in both groups. The proportions of T lymphocyte and CD4 cell were significantly correlated with the length of duration in exposed group (P<0.05)
Lymphocytes ; Occupations* ; Toluene*

The authors studied the ultrastructural changes of liver cell mitochondria in autolysis. The male Sprague-Dawley rats, weighting 140~160 gm were sacrificed for extract liver tissue. The slices of the liver tissue were incubated in 37 degrees C aseptic normal saline, and those were examined by following intervals; 10, 20 and 30 minutes and 1, 2, 6, 12 and 24 hours with light and electron microscope. The results obtained by light microscopy were summerized as follow. Several fine intracytoplasmic vacuoles were observed 1 hour after incubation. After 3 hours, focal destruction of cytoplasmic membrane with pyknosis of nuclei were observed. More delicate intracytoplasmic architectural changes could not be detected at light microscopic studies. The cord arrangement and cellular boundaries were relatively well preserved until 24 hours after incubation. Electronmicroscopically, mild intramitochondrial swelling with diminution of intramatrical granules were observed at 20 minutes. These were the earliest findings. Both high amplitude swelling and destruction of mitochondrial membrane were observed concurrently at 1 hour after incubation. The earlier membrane changes were observed at inner membrane with cristae and followed by degeneration of the outer membrane. The intramatrical amorphous dense deposits were observed at 30 minutes when the membranes were not destroyed. These deposits were noted in the other experimental groups which were incubated longer than 30 minutes. More electron dense deposits were observed after 1 hour at that time the membrane changes appeared. Vhe results suggest in this experiment that the earliest autolytic changes of liver cell mitochondria is loss of intramitochondrial granules and the membraneous changes led to the irreversible mitochondiral injury. The appearance of two types of intramitochondrial dense deposits would be an interesting finding needed to require further investigation for the chemical stucture and mechanism of dense deposit formation.
Male ; Humans