No abstract available.
Animals ; Rats*

High-dose aprotinin (Hammersmith regimen) has been widely used for years to control postoperative bleeding and reduce blood consumption in cardiac surgery but had known to cause some side-effects and had disadvantage in cost-effectiveness. The prospective controlled study of 33 patients undergoing cardiopulmonary bypass was performed to evaluate the efficacy for reducing postoperative bleeding and unfavorable effects of low-dose aprotinin. The level of hemoglobin and platelet in the blood and the amount of postoperative bleeding were assessed preoperatively, and postoperatively for the study of hemostatic function. The level of BUN and serum creatinine in the blood, levels of urine creatinine, total protein, albumin, alpha-1-microglobulin and creatinine clearance were assessed before and after the operation for the study of renal function. The aprotinin group had a significant reduction in chest tube drainage; 243+/- 123 ml versus 406+/-303 ml (P=0.037) during 6 hours immediate-postoperatively, 494+/-358 ml versus 869+/-570 ml (P=0.045) during 24 hours postoperatively. The ratio of alpha-1-microglobulin/creatinine and microalbumin/creatinine in the urine were slightly increased in the aprotinin group postoperatively in comparison with the control group but there were no statistically significant difference (55+/-23 versus 24+/-10 in the alpha-1-microglobulin/creatinine, 56+/-19 versus 38+/-25 in the microalbumin/creatinine at post- operative 3rd day). There were no significant difference between two groups in other parameters of renal function, too. This study showed that low-dose aprotinin is an effective means of reducing postoperative bleeding without inducing significant renal dysfunction.
Aprotinin* ; Blood Platelets ; Cardiopulmonary Bypass* ; Chest Tubes ; Creatinine ; Drainage ; Hemorrhage* ; Humans ; Prospective Studies ; Renal Insufficiency ; Thoracic Surgery

A case of fetal supraventricular tachycardia which caused fetal hydrops was diagnosed at 29 weeks of gestation by fetal echocardiography. Transplacental fetal therapy with ma-ternal intravenous digoxin administration resulted in restoration of normal fetal sinus rhythm and disappearance of fetal hydrops on 7th day after initiation of treatment when the mat-ernal serum digoxin level was 2.11 ng/mL. The fetus showed normal sinus rhythm when evaluated by fetal echocardiography during the remainder of pregnancy with maternal oral digoxin maintenence. At birth, the infant did not show any cardiac arrhythmia and hydropic appearance.
Arrhythmias, Cardiac ; Digoxin ; Echocardiography ; Fetal Therapies* ; Fetus ; Humans ; Hydrops Fetalis* ; Infant ; Parturition ; Pregnancy ; Tachycardia, Supraventricular*

An orthotopic cardiac transplantation was successfully performed in a 40 year-old Jehovah's witness without use of any blood product. Preoperatively, the patient had been on coumadin to prevent left atrial thrombi and the INR(Internation Normalized Ratio)of prothrombin time was 2.4. During the operation, cell saver was used for shed blood and aprotinin was administered intravenously for platelet function. Total postoperative drainage was 860cc and the lowest hemoglobin was 12.2 gm/dl. Postoperative course was complicated by central nervous system infection by Listeria monocytogenes and two episodes of rejection, both of which were effectively treated. The patient is on his 5th postoperative month and doing well.
Adult ; Aprotinin ; Blood Platelets ; Central Nervous System Infections ; Drainage ; Heart Transplantation* ; Humans ; Listeria monocytogenes ; Prothrombin Time ; Warfarin

Primary malignant lymphomas of the lung are rare neoplasms representing 3.6% of all extranodal lymphomas and less than 1% of pulmonary malignancies, with its distinct clinicopathological features. A 60-year-old symptomatic man, who was a former non-smoker, had a cough and sputum. Chest roentgenogram and computed tomographic scan showed the presence of a posterior mass in the basal segment of the right lung. Transthoracic needle aspiration cytology was inadequate for the diagnosis of cancer. A subsequent right thoracotomy was carried out, which showed a primary pulmonary lymphoma of the bronchus-associated lymphoid tissue.
Cough ; Diagnosis ; Humans ; Lung ; Lung Neoplasms ; Lymphoid Tissue* ; Lymphoma* ; Middle Aged ; Needles ; Sputum ; Thoracotomy ; Thorax

A 25-year-old man with viral cardiomyopathy and chronic active hepatitis successfully underwent dynamic cardiomyoplasty for the first time in Korea on July 30, 1996. The patient had been intermittently dyspneic for 5 years and was admitted to our center twice because of heart failure. For the past 2 years, he was NYHA functional class III status with a left ventricular ejection fraction (LVEF) of around 30%. The patient was born with scoliosis and showed a short stature. The liver function showed elevated liver enzymes, and hepatitis B antigen was positive. The liver biopsy revealed chronic active hepatitis. The preoperative echocardiogram showed decreased left ventricular function with grade II mitral and grade II tricuspid regurgitation with dilated left and right atrium. Recently his symptoms worsened and we decided to perform a dynamic cardiomyoplasty. The left latissmus dorsi muscle (LDM) was mobilized and tested with lead placement on his right lateral decubitus position. The patient was positioned into supine and, after median sternotomy, the heart was wrapped with the mobilized muscle. The Russian made cardiomyostimulator (EKS-445) and leads (Myocardial PEMB for heart and PEMP-1 for LDM) were used. The total operation time was 8 hours and there were no perioperative episodes. Postoperatively the LDM had been trained for a 10 week period and currently the stimulation ratio is maintained at 1:4. The postoperative LVEF did not increase with the value of 30-35%. However, the patient feels better postoperatively with slightly increased activity.
Adult ; Biopsy ; Cardiomyopathies ; Cardiomyoplasty* ; Heart ; Heart Atria ; Heart Failure ; Hepatitis B ; Hepatitis, Chronic ; Humans ; Korea* ; Liver ; Scoliosis ; Sternotomy ; Stroke Volume ; Tricuspid Valve Insufficiency ; Ventricular Function, Left

Patients with coronary artery disease and depressed ventricular function have better long- term benefits after coronary artery bypass grafting compared with medical therapy. But operative mortality remains high. This study was designed to identify the risk factors for coronary artery bypass grafting according to ventricular function. The records of 103 patients who underwent coronary artery bypass grafting from July 1994 to June 1996 were analysed. The patients were divided into two groups based on preoperative ejection fraction: Low EF group(Ejection fraction < 40%, n=24) and Normal EF group(Ejection fraction >or= 40%, n=79). The indication of operation was significantly different between the two groups (p=0.00003). Postinfarction angina was frequent in Low EF group but unstable angina was frequent in Normal EF group. The frequency of cardiomegaly(p=0.0012), serum creatinine abnormality(p=0.0473) and preoperative use of IABP(Intra Aortic Balloon Pump, p=0.0095) were higher in Low EF group. The left internal thoracic artery was used less frequently in Low EF group(p=0.00416). The operative mortality was 8.3% in Low EF group and 5.1% in Normal EF group, but without statistical difference(p=0.5492). In Normal EF group, age (p=0.041) was identified as a significant risk factor for operative mortality. In Low EF group, age(p=0.018), preopertive use of IABP(p=0.0036), hypercholesterolemia(p=0.0007), and emergency of operation(p=0.0037) were identified as significant risk factors. Postoperative morbidity was 50% in Low EF group and 33% in Normal EF group, but without statistical significance(p=0.1007). These results suggest that in patients with coronary artery disease and depressed ventricular function, more aggresive coronary artery bypass grafting is needed to improve the symptom and long-term benefit. Risk factor
Angina, Unstable ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Creatinine ; Emergencies ; Humans ; Mammary Arteries ; Mortality ; Risk Factors* ; Ventricular Function

OBJECTIVE: To investigate the prevalence and characteristics of musculoskeletal pain (MSK) pain in Korean farmers using initial survey data of Farmers' Cohort for Agricultural Work-Related MSK pain (FARM) study. METHODS: Farmers (534 females and 479 males; mean age 57.2±7.5 years) who owned or rented a farm and belonged to an agricultural cooperative unit were recruited. Presence of pain for each body part (neck, shoulder, arm/elbow, wrist/hand/finger, low back, leg/foot), and characteristics of MSK pain (prevalence, location, duration, severity, and frequency) during the last year was assessed. Additionally, demographic data such as farming duration, history of prior injury, and workload (low, moderate, somewhat hard, or hard) were collected using structured questionnaires. RESULTS: Almost all subjects (n=925; 91.3%) complained of pain in more than one body part. The frequency order was low back (63.8%), leg/foot (43.3%), shoulder (42.9%), wrist/hand/finger (26.6%), arm/elbow (25.3%), and neck (21.8%). Low back pain was more frequent in those with over 30 years of farming experience (odds ratio [OR], 1.40; 95% confidence interval, 1.08-1.81). MSK pain was related to history of prior injury (OR, 2.18-5.24; p<0.05) in all body parts except for leg/foot, and very hard workload was associated with low back, leg/foot, neck, shoulder, and wrist/hand/finger pain (OR, 2.88-10.83; p<0.05). CONCLUSION: Most Korean farmers experience MSK pain; furthermore, there is a significant association between pain, history of prior injury, and workload, suggestive of the necessity of coping and preventive strategies to reduce injury or workload.
Agriculture ; Cohort Studies ; Female ; Human Body ; Humans ; Low Back Pain ; Male ; Musculoskeletal Pain* ; Neck ; Prevalence* ; Shoulder

OBJECTIVE: To compare the clinical effectiveness of Anastrozole in ovulation induction with that of clomiphene citrate. METHODS: Sixty anovulatory women were randomly divided into 4 groups (1 mg, 2 mg and 4 mg of Anastrozole groups and Clomiphene citrate group). The ovulation induction was tried with 3 dosages of Anastrozole or 100 mg of Clomiphene citrate for 5 days. The serum level of estradiol, testosterone, FSH and LH were serially monitored (on 3rd, 5th and 8th days of treatment). Serum estradiol level at the time of hCG injection was also measured. Ovulation rate, number of dominant follicles, endometrial thickness, and pregnancy rate were measured and compared across the study groups. RESULTS: There was no statistically significant difference in estradiol, testosterone, or LH level between women treated with Anastrozole and Clomiphene citrate. In patients treated with 4 mg of Anastrozole, serum FSH level was higher than that of the women treated with Clomiphene citrate (P<0.05). Endometrial thickness was greater in patients treated with Anastrozole than women treated with Clomiphene citrate (P<0.05). Number of dominant follicles in patients treated with Clomiphene (1.56) was slightly greater than in women treated with Anastrozole (1.0-1.1), but there was no statistically significant difference. CONCLUSION: Anastrozole had similar clinical effectiveness in ovulation induction when compared to Clomiphene citrate. At 1 mg or 2 mg of Anastrozole, ovulatory rate remained below the effectiveness of Clomiphene citrate, therefore considering the expensive cost of Anastrozole, it should not be considered as first-line medication for ovulation induction but reserved for those who have certain conditions such as thin endometrium and polycystic ovarian syndrome.
Clomiphene* ; Endometrium ; Estradiol ; Female ; Humans ; Ovulation ; Ovulation Induction ; Polycystic Ovary Syndrome ; Pregnancy Rate ; Testosterone