The scimitar syndrome is a rare malfomation that can be defined as a partial or complete right pulmonary venous return into inferior vena cava immediately above or below the siaphragm. This malfomation is often associated with hypoplasia of right lung, anomalous arterial supply of the lower part of the lung, and cardiac dextroversion. We experienced a case of scimitar syndrome in a 15 years old girl and presenting the case with a brief review of the literature.
Adolescent ; Female ; Humans ; Lung ; Scimitar Syndrome* ; Vena Cava, Inferior

Intraosseous Neurilemmomas are very rare tumor and most of them are arose in the mandibular bone. A case report is made on the intraosseous neurilemmoma in the distal shaft of tibia which belong very rarely seen in the area of bone. The case was a 23 year old male who had multicystic lesion on the distal shaft of right tibia with marginal this sclerotic change on the radiological examination. The lesion of intraosseous neurilemmoma was confirmed by the microscopic examination after surgical treatment of curettage and bone graft. Also a review of literature on the neurilemmoma was made and reported.
Curettage ; Humans ; Male ; Neurilemmoma ; Tibia ; Transplants

u-Health based on ubiquitous information and communication network is being considered as an alternative to the mainstream face-to-face healthcare services in addition to its supportive functions. Traditional healthcare system has inherent problems such as limited accessibility and inadequate fulfillment of service needs to the underserved populations. Proponents of u-Health suggest that it will provide solutions to those problems. There have been many trials and pilot projects for telemedicine since 1988 in Korea, and the system is now called "u-Health". After legislation of clause regarding telehealth in the Korean medical law in 2002, local governments have made several attempts to utilize u-Health system to the patients with chronic disease living in rural under-served area. Recently, Korean government has implemented u-Health trial projects about tehemedicine, monitoring chronic disease, and providing homecare in the three underserved rural and many-islands area. Patients' perceived level of satisfaction, preference, attitude, and usability of u-Health was significantly high. Patient's compliance to u-Health has improved over time. A strategic approach based on the innovative and proactive mindset to the u-Health is strongly needed. At the time of u-Health implementation in the medically underserved area, utilization of both u-Health center and mobile clinic is recommended to achieve operational efficiency, and ensure high quality of service. Although u-Health is effective and supportive method to the mainstream face-to-face healthcare, we should be cautious, since u-Health model needs more development and more rigorous experiments.
Chronic Disease ; Compliance ; Delivery of Health Care ; Dietary Sucrose ; Humans ; Jurisprudence ; Korea ; Medically Underserved Area ; Pilot Projects ; Telemedicine ; Vulnerable Populations

Captopril tablets of two different producers were tested for bioequivalence as well as therapeutic equivalence. The pharmacokinetics, the time course of plasma angiotensin-converting enzyme inhibition, and the changes of systolic and diastolic blood pressure after administration of drugs were studied. In a balanced, randomized two-way crossover design, two single doses of 50mg each of captopril were administered orally to twelve male volunteers. Peak blood levels of free captopril were observed about 0.85 hour after the dose, and practically free captopril could not be detected in blood within 8 hours. Peak free captopril levels of both compounds were almost identical(Capoten(R), 464.3ng/ml ; Capril(R), 504.6ng/ml). No statistically significant difference was identified between two compounds when area und the concentration time curve, peak level, time to peak were compared. Inhibition of plasma angiotensin-converting enzyme to blood free captopril concentration showed the hyperbolic concentration-response relationship with IC50 value of 7.4ng/ml. The area under the percent angiotensin-converting enzyme inhibition versus time curve were quite similar after administration of both drugs. The compounds were also found to be equivalent on the premise that no significant difference was detected when the time courses of systolic and diastolic blood pressure reduction were compared.
Biological Availability* ; Blood Pressure ; Captopril* ; Cross-Over Studies ; Humans ; Inhibitory Concentration 50 ; Male ; Pharmacokinetics ; Plasma* ; Tablets* ; Therapeutic Equivalency ; Volunteers

This study aimed to determine factors that influence blood flow through coronary bypass grafts and to analyze relationship between the graft flow and postoperative outcome. Blood flow through 146 bypass grafts(GBF) was measured with transit-time ultrasound flowmeter during coronary artery bypass grafting operations in 50 patients. Single and multiple regression analyses were done for relationships between the GBF and four variables: internal diameter of recipient coronary artery, myocardial value of bypassed branch(es), type of graft, and finding of preoperative myocardial perfusion scan. The relationship between GBF and postoperative scan finding was also analyzed. 1. The mean GBF was significantly higher in sequential grafts than in single vein grafts or in internal thoracic artery grafts(61.5 vs. 46.9 and 42.5 ml/min). 2. Myocardial value and recipient artery diameter were found to be the factors determining GBF. There was no correlation between GBF and presence of perfusion defect in the preoperative scan. 3. Myocardial value was found to be more important than recipient artery diameter in determinintg GBF. 4. Reversible perfusion defects were more frequently found in the areas supplied by grafts with low GBF. But this fact had only mild statistical significance. These results suggest that blood flow through a bypass graft is more determined by the size of its supplying myocardium than by the size of recipient artery. So, we can expect effective improvement in myocardial flow reserve after grafting of small(1~1.5mm) coronary arteries, if they supply substantial area of myocardium.
Arteries ; Coronary Artery Bypass* ; Coronary Vessels* ; Flowmeters ; Humans ; Mammary Arteries ; Myocardium ; Perfusion ; Regional Blood Flow ; Transplants ; Ultrasonography ; Veins

For the pharmacokinetic analysis of isoniazid transfer into CSF, steady-state isoniazid concentrations of plasma and CSF were measured in eleven tuberculous meningitis patients confirmed with findings of CSF and neuroimazing. Peak plasma levels (4.17-21.5 micrograms/mL) were achieved at 0.25 to 3 hours after multiple isoniazid dose (600 mg/day). Terminal half-life, total clearance (CI/F) and volume of distribution (Vd/F) were 1.42 +/- 0.41 hr, 0.47 +/- 0.22 L/kg/hr and 0.93 +/- 0.48 L/kg, respectively. Isoniazid concentrations in CSF collected intermittently were highest at 3 hr (Mean, 4.18 micrograms/mL) and were 0.54 +/- 0.21 micrograms/mL at 12 hrs after the last dose of isoniazid 10 mg/kg/day. CSF/plasma partitioning of isoniazid and equilibration rate were estimated using modified pharmacokinetic/pharmacodynamic model. Disposition rate constant from CSF to plasma and CSF/plasma partitioning ratio of isoniazid were estimated to be 0.39 h-1 and 1.17, respectively.
Administration, Oral ; Humans ; Isoniazid/*cerebrospinal fluid ; Metabolic Clearance Rate ; Models, Biological ; Tuberculosis, Meningeal/*cerebrospinal fluid

PURPOSE: Soft tissue reconstruction is essential for recovery of finger function and aesthetics in any traumatic defect. The authors applied a reverse homodigital artery island flap for soft tissue defect on distal part of digits. The aim of this study is to evaluate the efficacy of the procedure. MATERIALS AND METHODS: Seven cases of soft tissue defects of finger tip were included in this study. There were six male and one female, mean age was 43 years and mean follow-up period was 38 months. The length of flaps ranged from 2.0 to 2.5 cm and width ranged from 1.0 to 2.0 cm. Flap survival, postoperative complications were evaluated. RESULTS: All flaps survived without loss. Donor sites were repaired with primary closure in five cases and skin graft in two cases. None of the patients showed significant complications and their average finger motion was 255degrees in total active motion at the last follow-up. CONCLUSION: The authors suggest that the reverse homodigital artery island flap could be a versatile treatment option for the soft tissue defect on distal part of digits.
Arteries* ; Esthetics ; Female ; Fingers ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Skin ; Soft Tissue Injuries ; Tissue Donors ; Transplants

BACKGROUND AND OBJECTIVES: Spontaneous progression of severe congestive heart failure is structurally characterized by cellular degeneration and multiple foci of myocardial cell death. The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interaction between actin and myosin. cTnI is uniquely expressed in the adult human myocardium, and an increase in its circulating levels is highly indicative of myocardial injury. In this study, we addressed the usefulness of cTnI as a sensitive and specific molecular marker for severity in patients with congestive heart failure. MethodscTnI, creatinin kinase-MB (CK-MB), and myoglobin were assessed in 59 patients with severe congestive heart failure diagnosed by the echo-cardiography and gated equilibrium blood pool heart scan. Also we assesed cTnI, creatinin kinase-MB (CK-MB), and myoglobin in 25 persons without cardiac disease in echocardiography. RESULTS: 1) The cTnI con-centration was 89.6+/-69.3 pg/mL in patients with congestive heart failure and its level was greater than that of the control group (22.4+/-17.1, p=0.001). 2) The cTnI level differed significantly according to left ventricular ejection fraction (EF), 117.3+/-73.8 pg/mL in patients with EF\<40% (28 patients), 66.3+/-44.5 pg/mL in patients with EF> or =40% (31 patients), 22.4+/-17.1 pg/mL in the control group (25 persons) (p=0.001). CONCLUSION: cTnI was useful as a specific and sensitive serum molecular marker in patients of congestive heart failure. And its level reflected the severity of congestive heart failure.
Actins ; Adult ; Cell Death ; Echocardiography ; Equidae ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Myocardium ; Myoglobin ; Myosins ; Stroke Volume ; Troponin I* ; Troponin*

Operative clipping after previous endovascular coiling in an aneurysm is a different problem from primary clipping procedure for neurosurgeons. With the increasing use of coil embolization, neurosurgeons will more and more face the similar situation. We report surgical clipping cases of intracranial aneurysm regrown after endovascular coiling. Three patients with a history of subarachnoid hemorrhage due to ruptured aneurysm underwent endovascular treatment (EVT) with detachable coils. The aneurysms were in the posterior communicating artery, the middle cerebral artery, and distal anterior cerebral artery (DACA). Two near-total occlusions and one partial occlusion were achieved by EVT. After several months, angiographic follow-up revealed regrowth of the aneurysm requiring surgical clipping. Here, we report three cases in which surgical clipping was more difficult than a usual clipping procedure performed several months after EVT, because of adhesion and coil bulging into the aneurysmal neck. The difficulty of the treatment of the residual aneurysm after coiling is discussed, as are the surgical complications and limitations of clipping.
Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery ; Arteries ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Neck ; Subarachnoid Hemorrhage ; Surgical Instruments*

BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.
Adult ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography* ; Extremities* ; Fatigue ; Heart Septal Defects, Atrial* ; Humans