During the period of 4 years from May, 1981 to April, 1985, 71 cases of obstructing subinfundibular muscular bundles of the right ventricle in congential cardiovascular anomalies were diagnosed by cariac catheterization and angiography at Hanyang University. The finding of right ventricular angiogram and degree of the right ventricular outflow obstruction, clinical data, electrocardiographic data and hemodynamic data were correlated irrespectively. The summary of this article is as follows. 1) The age of patients was ranged from 1 to 22 years old with a mean age of 8 years old. There were 39 males and 32 females with M:F ratio of 1.2:1. The incidence of obstructing subinfundibular muscular bundles of the right ventricle in congenital cardiovascular anomalies was higher with increasing age. 2) The associated cardic anomalies were as follows: 40 cases (56%) of isolated ventricular septal defect(VSD), 13(18%) of tetralogy of Fallot physiology, 7(10%) of patent ductus arteriosus(PDA), 3(4%) of pulmonary stenosis, 1 aortic stenosis, 1 double outlet of right ventricle(DORV), 1 trilogy, 1 ostium secundum defect, etc. The incidence of VSD with or without other associated cardiovascular anomalies was 56 cases(79%) out of 71 cases. 3) Maximum systolic pressure gradient between proximal and distal chamber of the right ventricle were under 25 mmHg in 32 cases, between 25 and 50 mmHg in 13 and above 50 mmHg in 26. Pressure gradients of all 7 cases with PDA were under 25 mmHg. 4) Correlative assesment of angiographic manifestation(2 indicies:Diameter of right ventricular outflow tract(systolic phase)/diameter of tricuspid valvular annulus(diastolic phase)=OT/TV, Diameter of right ventricular outflow tract(systolic phase)/Length of right ventricular diaphragmatic surface(systolic phase)=OT/RV) according to pressure gradient, OT/Tv and OT/RV values were lower the increasing pressure gradient, between proximal and distal chamber of the right ventricle. These were reverse correlations but coefficients of correlation(r) were-0.49and -0.48. Therefore, the degree of right ventricular outflow obstruction could be predicted, using 2 indices of right ventricular angiogram in individual cases, but could not be calculated accurately. 5) This indicated that pressuer gradient was also affected by technical errors, variable cardic anomalies, development of sinusoid, age and the other factors. 6) We assumed that non-invasive Doppler echocardiography could be useful in making the diagnosis and follow up of the patient with obstructing subinfundibular muscle bundles in right ventricle.
Angiography ; Aortic Valve Stenosis ; Blood Pressure ; Catheterization ; Catheters ; Child ; Diagnosis ; Echocardiography, Doppler ; Electrocardiography ; Equidae ; Female ; Heart Ventricles* ; Hemodynamics ; Humans ; Incidence ; Male ; Physiology ; Pulmonary Valve Stenosis ; Tetralogy of Fallot ; Ventricular Outflow Obstruction ; Young Adult

BACKGROUND: To find out characteristics and classification of toxic agents by clinical analysis of pediatric poisoning and to determine the clinical availability of grading by using MSPC score. METHOD: Subjects were patients under 15 years exposed to toxic agents, who visited Ajou university hospital emergency center from June, 1994 to October, 1997. The study was performed retrospectively. RESULTS: The subjects were 126 cases and male to female sex ratio was 1.2:1. Mean age was 29+/-30 months old. The most common route of exposure was ingestion, following contact, inhalation and bite. The most common reason was mistake by the patient, following mistake by caregiver, suicide attempt and accident. The MSPC score distribution of symptomatic patient was as follows; 1 point: 26 cases(63.4%), 2 point: 12 cases(29.2%), 3 point: 1 case(2.4%), 4 point: 2 cases(4.8%). The classification of exposed poison was as follows; therapeutic drugs: 29 cases(23.0%), non-therapeutic drugs: 97 cases(73.0%). The most common exposed poison was household products: 23 patients(18.3%) were admitted to hospital. CONCLUSION: There was statistically significant difference in the classification of poison, MSPC score, treatment modality at hospital, first follow up period after discharge between admitted group and non-admitted group. There was statistically significant difference in the reason of exposure, route of exposure, MSPC score, admission period according to patient's age. severity grading according to MSPC score is regarded as an available method to determine the modality of management.
Caregivers ; Classification ; Eating ; Emergencies ; Female ; Follow-Up Studies ; Household Products ; Humans ; Inhalation ; Male ; Poisoning* ; Retrospective Studies ; Sex Ratio ; Suicide

BACKGROUND AND PURPOSE: The claims data of the Korean National Health Insurance (NHI) system can be useful in stroke research. The aim of this study was to validate the accuracy of hospital discharge data used for NHI claims in identifying acute stroke and use of thrombolytic therapy. METHODS: The hospital discharge data of 1,811 patients with stroke-related diagnosis codes were obtained from Jeju National University Hospital (JNUH) and Seoul Medical Center (SMC). Three algorithms were tested to identify discharges with acute stroke [ischemic stroke (IS), intracranial hemorrhage (ICH), or subarachnoid hemorrhage (SAH)]: 1) all diagnosis codes up to nine positions, 2) one primary diagnosis and one secondary diagnosis, and 3) only one primary diagnosis code. Reviews of medical records were considered the gold standards. RESULTS: Overall, the degree of agreement (kappa) was higher for algorithms 1 and 2 than for algorithm 3, and the sensitivity and specificity of the first two algorithms for IS and SAH were both >90%, with almost perfect agreement (kappa=0.83-0.84) in the JNUH data set. Regarding ICH, only algorithm 1 yielded an almost perfect agreement (kappa=0.82). In the SMC data set, almost perfect agreement was found for both ICH and SAH in all three algorithms. In contrast, the three algorithms yielded a range of agreement levels, though all substantial, for IS. Almost perfect agreement was obtained for use of thrombolytic therapy in both data sets (kappa=0.91-0.99). CONCLUSIONS: Discharge with hemorrhagic stroke and use of thrombolytic therapy were identified with high reliability in administrative discharge data. A substantial level of agreement was also obtained for IS, despite variation between the algorithms and data sets.
Data Collection ; Dataset ; Diagnosis ; Hospital Records ; Humans ; Intracranial Hemorrhages ; Medical Records ; National Health Programs* ; Sensitivity and Specificity ; Seoul ; Stroke* ; Subarachnoid Hemorrhage ; Thrombolytic Therapy*

Succinylcholine induced hyperkalemia has been reported in many neurologic disorders including subarachnoid hemorrhage. The purpose of this study was to evaluate suceinylcholine induced-hyperkalemia in twenty ruptured cerebral aneuryam patients undergoing general anesthesia for repair of the cerebral aneurysm. Serum potassium levels were measured after induction of anesthesia, but before succinylcholine, and 1, 5 and 10 min after administration of succinylcholine. Serum potassium levels were continuously increased until 10 min after euccinylcholine administration. The increments of serum potassium above 1.0mEq/L were observed in 5 of 9 patients with loss of consciousnesa A relationship between the loss of consciousness and hyperkalemic response after succinylcholine was suggested.
Anesthesia ; Anesthesia, General ; Humans ; Hyperkalemia ; Intracranial Aneurysm* ; Nervous System Diseases ; Potassium* ; Subarachnoid Hemorrhage ; Succinylcholine* ; Unconsciousness

The authors analysed statically 420 Cases of the ocular trauma among 35,460 patients who visited to the emergency department, from Jul. 1995 to Jun. 1996. Ocular trauma is one of the commonest causes of eye diseases and blindness, but its patterns and incidences are variable according to the environment. A large number of patients can be readily treated in the emergency department. Prevention is, of course, the best management, but when an ocular injury occurs, proper emergency treatment can often prevent permanent damage.
Blindness ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Eye Diseases ; Humans ; Incidence

No abstract available.
Aorta, Thoracic* ; Ductus Arteriosus, Patent*

During the period of 18 months from December 1984 to May 1986, 41 cases(25.0%) of subpulmonic ventricular septal defect(VSD) were diagnosed among 164 cases of isolated VSD in the cardiac catheterization labortory. The incidence of aortic regurgitation associated subpulmonic VSD(19.5%) was much higher than that of the other types of VSD(2.4%). None of patients less than 1 year old developed aortic regurgitation, the incidence of which has increased with the age after that. That amount of left to right shunt through the VSD was smaller in the patients with aortic cusp prolapse than those without aortic cusp prolapse, and the severity of aortic regurgitation was correlated with that of aortic cusp prolapse. 10 out of 41 patients revealed more than 20mmHg pressure gradient through right ventricle outflow tract and 9 of these patient were as sociated with aortic cusp prolapse.
Aortic Valve Insufficiency ; Cardiac Catheterization* ; Cardiac Catheters* ; Heart Ventricles ; Hemodynamics* ; Humans ; Incidence ; Prolapse

Phenylketonuria is metabolic disorder that results from a deficiency of the hepatic phenylalanine hydroxylase. But among patients with hyperphenylalaninemia, the defect resides in one of the enzymes necessary for production or recycling of tetrahydrobiopterin (BH4). The reduction of BH4 affects not only phenylalanine metabolism but also formation of the tyrosine related neurotransmitter, dopamin and tryptophan related neurotransmitter, serotonin. Administration of L-dopa and 5-hydroxytriptophan seems to be the most effective treatment and may prevent irreversible neurologic damage if started early in life in hyperphenylalaninemia due to deficiency of cofactor BH4. Therefore, all patients with PKU and hyperphenylalaninemia should be tested for BH4 deficiency as early as passible. So we measured reduced forms of biopterin in urines of 19 phenylketonuria patients by Funkushima and Nixon method and 13 of PKU patients measured dihydropterin reductase (DHPR) in white blood cells by modified Narisawa method. We could not find abnormal pterin patterns of cofactor BH4 and normal value of DHPR. All Korean 19 PKU children were classic PKU. A missense mutation has been identified in the phenylalanine hydroxylase (PAH) gene of 16 Koran PKU patients. 5 mutations (IVS4, Y204 C, R243Q, Y356 X, R413 P) have been identified. The frequency of these mutations was found to be 50% of PKU alleles. The IVS4 mutation had a high frequency in Korea and southern China, due to the result of the founder effect and genetic drift. the R413 P mutation, which may have originated in the regions surrounding the Baikal, expanded to northen China and Japan. We were not able to find Caucasian mutations in Korean ptiets. PKU mutations occured after racial divergence between Caucasian and Mongoloids. We observed that PKU patients with Y 204 C and R413 P mutations showed mild mild clinical phenotype but IVS4 mutation had severe mental retardation. the establishment of genotype will therefore aid in the prediction of clinical phenotypes in patients with this disease. So, pterin and DHPR measurement and DNA analsis will be useful for prognosis and proper treatment of PKU patients.
Alleles ; Biopterin ; Child ; China ; DNA* ; Founder Effect ; Genetic Drift ; Genotype ; Humans ; Intellectual Disability ; Japan ; Korea ; Leukocytes ; Levodopa ; Metabolism ; Mutation, Missense ; Neurotransmitter Agents ; Oxidoreductases ; Phenotype ; Phenylalanine ; Phenylalanine Hydroxylase ; Phenylketonurias ; Prognosis ; Recycling ; Reference Values ; Serotonin ; Tryptophan ; Tyrosine

OBJECTIVES: This prospective cohort study investigated the association between blood pressure (BP) as measured in different body postures and all-cause and cardiovascular (CV) mortality risk. METHODS: This population-based investigation included 8,901 Korean adults in 2001 and 2002. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured sequentially in the sitting, supine, and standing positions and classified into 4 categories: (1) normal, SBP <120 mmHg and DBP <80 mmHg; (2) high normal/prehypertension, SBP 120-129 mmHg and DBP <80 mmHg/SBP 130-139 mmHg or DBP 80-89 mmHg; (3) grade 1 hypertension (HTN), with SBP 140-159 mmHg or DBP 90-99 mmHg; and (4) grade 2 HTN, SBP ≥160 mmHg or DBP ≥100 mmHg. The date and cause of individual deaths were confirmed in the death record data compiled until 2013. Data were analyzed using Cox proportional hazard regression. RESULTS: Significant associations were found between the BP categories and all-cause mortality, but only when BPs were measured in the supine position. The multivariate hazard ratios (95% confidence intervals, [CIs]) were 1.36 (95% CI, 1.06 to 1.75) and 1.59 (95% CI, 1.06 to 2.39) for grade 1 HTN and grade 2 HTN, respectively, compared with the normal category. The associations between the BP categories and CV mortality were significant regardless of body posture among participants ≥65 years, whereas they were significant for supine BP measurements only in those <65 years. CONCLUSIONS BP measured in the supine position predicted all-cause mortality and CV mortality better than BP measured in other postures.

Pancreatic pseudocyst is a common complication of acute pancreatitis. Pseudocysts are commonly observed in the lesser sac and retroperitoneum; they are rarely seen in the liver. Herein, we report a case of intrahepatic pseudocyst, complicated by asymptomatic groove pancreatitis, that has successfully been treated with hepatic resection. A 70-year-old woman was referred to our hospital with severe upper abdominal pain. Abdominal computed tomography scan showed 11×10 cm sized cystic lesion in the left lateral section of the liver. Appearance of the pancreas was relatively normal. Endoscopic aspiration revealed a high level of amylase in the cystic fluid. After endoscopy, signs of peritonitis were observed; then, a left hemihepatectomy was performed. Pathologic examination revealed an intrahepatic pancreatic pseudocyst. The presence of intrahepatic cystic lesion in patients with suspected pancreatitis should raise the suspicion of intrahepatic pseudocyst. Intrahepatic pancreatic pseudocysts may be the only clinical manifestation even without an episode of acute pancreatitis.
Abdominal Pain ; Aged ; Amylases ; Endoscopy ; Female ; Hepatectomy ; Humans ; Liver ; Pancreas ; Pancreatic Pseudocyst* ; Pancreatitis* ; Peritoneal Cavity ; Peritonitis