Effect of diltiazem hydrochloride on cardiac performance with particular reference to the antianginal action was studied in 17 patients with ischemic heart disease, including 12 cases of effort angina, by means of clinical and mechanocardiographic evaluations. All patients were kept on the same medications from at least 2 weeks prior to diltiazem administration until the end of the study, and were prescribed no other antianginal drugs except for liberal use of sublingual nitroglycerin. Diltiazem was given 90mg a day in three divided doses for two weeks. Clinical and mechanocardiographic evaluations, including calculations of pressure rate product(PRP), triple product(TP) and tension time index(TTI), were made before and at a weekly interval after diltiazem administration. After the medication, heart rate, blood pressure and the pre-ejection period(PEP) with its ratio to the ejection time tended to decrease, and the decreases in heart rate and the PEP at the end of two weeks were significant. The PRP, TP and TTI were also significantly decreased at the end of the second week, and the decrease in the TTI was significant even a week after the medication. An antianginal effect, which appeared within few days, was excellent to good in over 90 percent of the cases. These facts suggest that diltiazem hydrochloride has no negative inotropic action and its antianginal effecti in its early stage of the drug administration is primarily due to coronary vasodilation and, as the drug is continued, is contributed to possibly by the decrease in the myocardial oxygen consumption as well.
Angina Pectoris* ; Blood Pressure ; Diltiazem* ; Heart Rate ; Humans ; Myocardial Ischemia* ; Nitroglycerin ; Oxygen Consumption ; Vasodilation

No abstract available.
Pulmonary Artery*

No abstract available.
Body Mass Index* ; Pregnancy* ; Weight Gain*

Background: Spontaneous pneumopericardium is a very rare condition. Spontaneous pneumothorax and pneumomediastinum have been reported to be associated with an idiopathic pulmonary fibrosis (IPF). However, spontaneous pneumopericardium has not yet been reported in association with IPF. Here we report a case of spontaneous pneumomediastinum and pneumopericardium in a patient with acute exacerbation of IPF with a review of the relevant literature.
Humans ; Idiopathic Pulmonary Fibrosis* ; Mediastinal Emphysema* ; Pneumopericardium* ; Pneumothorax

Purpura nephritis, one of the commonly known complications of allergic purpura has variable symptoms ranging from mild transient hematuria to severe nephrotic syndrome leading to renal failure and death. This paper reports on the treatment and course of purpura nephritis with special reference to serum immunoglobulins and immunopathology. These cases were selected among pediatric patients with purpura nephritis admitted to the pediatric department of Severance Hospital, Yonsei University College of Medicine from Jan., 1978 to Apr., 1980. The results are as follows: 1. Among 18 patients with purpura nephritis whose serum immunoglobulin level had been checked at least once in the course of the disease, 14 cases were male and 4 female. The age distribution was from 3 years and 5 months to 15 years of age, and the peak incidence occurred at 7 years of age in 5 cases. 2. Clinical classifications were made according to clinical symptoms and laboratory results. These classifications were as follows: nephrotic syndrome 5 cases, acute nephritis 5 cases, persistent hematuria and proteinuria 3 cases, and persistent proteinuria, recurrent hematuria, recurrent hematuria and proteinuria, transient hematuria and others, 1 case each. 3. Remission occurred in 5 cases which were all male and their clinical classifications were acute nephritis 3 cases, transient hematuria 1 case and recurrent hematuria 1 case. All of these showed mild renal involvement and none had nephrotic syndrome. 4. Remission occurred in 3 cases among 7 with prednisolone therapy, whereas only 1 case showed remission among 8 cases of combined therapy with immunosuppressant. Remission occurred in 1 case without any therapy. But no therapy was specifically "effective." 5. Nine out of 18 cases(50%) developed signs of renal involvement within 15 days of onset of purpura, and almost all cases(90%) within 2 months. Nephritis preceded purpura in 2 cases by 14 days and 4 months respectively and in another case, nephritis appeared 4 years after purpura. With such variation in duration, no correlation existed between the time interval from nephritis to purpura and the course of the disease. 6. Renal biopsies revealed 14 cages of focal proliferative glomerulonephritis and 1 case of diffuse proliferative glomerulonephritis, but none showed significant crescent formation in the glomeruli. Immunofluorescent microscopic examination revealed granular deposits of Ig(G, A, M), C3/C4, fibrinogen in 8 cases, IgM was absent in 6 cases and IgG absent in 1 case. There wag no correlation with the course of the disease. Sites of deposits were mainly in the mesangium. 7. Serum levels of immunoglobulin and complement were checked in all cases. IgG was elevated in 1 case and IgA was elevated at least once in the course of the disease in 9 cases among 18(50%). IgM mas within normal limits in all. Elevation of C3 was noticed in 2 cases but levels of C4 were normal in all. 8. Among 9 casas with elevated serum IgA in the acute phase, 6 cases showed a drop in the serum IgA level to normal, mostly within 6 months; but this factor was not related to the course and prognosis of the disease since 9 other cases which showed no elevation of serum IgA were not otherwise significantly different.
Age Distribution ; Biopsy ; Classification ; Complement System Proteins ; Female ; Fibrinogen ; Glomerulonephritis ; Hematuria ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Immunoglobulins ; Incidence ; Male ; Nephritis* ; Nephrotic Syndrome ; Prednisolone ; Prognosis ; Proteinuria ; Purpura* ; Purpura, Schoenlein-Henoch ; Renal Insufficiency

Mandibular defects lead to severe deformation and functional deficiency. Vascularized osteocutaneous tissue has been widely used to reconstruct the mandible. However, it is technically challenging to shape this type of grafts in such a manner that they resemble the configuration of the mandible. A 48-year-old female patient who underwent anterolateral thigh (ALT) flap coverage after a tongue cancer excision was diagnosed with a tumor recurrence during the follow-up. A wide excision mandibulectomy and mandibular reconstruction with an ALT flap and a titanium implant were performed. The prefabricated titanium implant was fixed to the condyle. Then, an ALT flap was harvested from the ipsilateral thigh and anastomosed. After confirming that the circulation of the flap was intact, the implant was fixed to the parasymphysis. On the radiograph taken after the surgery, the prosthesis was well positioned and overall facial shape was acceptable. There was no postoperative complication during the follow-up period, 1 year and 2 months. The prefabricated implant allows the restoration of facial symmetry without harvesting autologous bone and it is a safe and effective surgical option for mandibular reconstruction.
Female ; Follow-Up Studies ; Humans ; Mandible ; Mandibular Prosthesis Implantation ; Mandibular Reconstruction* ; Middle Aged ; Postoperative Complications ; Prostheses and Implants ; Recurrence ; Thigh ; Titanium* ; Tongue Neoplasms ; Transplants

Background: Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods: CRPS patients from 37 university hospitals in South Korea were surveyed.The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results: A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.

Background: Complex regional pain syndrome (CRPS) is an intractable pain disease with various symptoms. Here, we investigated the disease status, work life, sleep problems, medical insurance, economic status, psychological problems, and quality of life (QOL) of CRPS patients. Methods: CRPS patients from 37 university hospitals in South Korea were surveyed.The survey questionnaire consisted of 24 questions on the following aspects of CRPS patients: sex, age, occupation, cause of injury, activities of daily living (ADL), pain severity, sleep disturbance, level of education, economic status, therapeutic effect, and suicidal ideation. Additionally, the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, consisting of 26 questions, was used to identify the status of QOL. Results: A total of 251 patients completed the questionnaire. According to the survey, 54.2% patients could not perform ADL on their own. Over the previous week, the mean pain score was 7.15 ± 1.78 (out of a total of 10 points); 92.1% of patients had sleep disorders and 80.5% had suicidal ideation, with most patients suffering from psychological problems. The average for each domain of WHOQOL-BREF was as follows: 21.74 ± 14.77 for physical, 25.22 ± 17.66 for psychological, 32.02 ± 22.36 for social relationship, and 30.69 ± 15.83 for environmental (out of a total of 100 points each). Occupation, ADL, sleep time, therapeutic effect, and suicidal ideation were statistically correlated with multiple domains. Conclusions Most patients had moderate to severe pain, economic problems, limitations of their ADL, sleep problems, psychological problems, and a low QOL score.

OBJECTIVE: The objective of this study was to determine whether complications and nursing interventions during hemodialysis could be reduced by using gradient ultrafiltration(GUF) and high sodium dialysate(HSD). METHODS: Thirty outpatients who had been on hemodialysis for more than 3 months were enrolled. Patients received Conventional HD(Na+ 137 mEqX4 hrs, constant UF), GUF(UF 62.5%X2 hrs, UF 37.5 %X2 hrs), HSD(Na+ 145 mEqX2 hrs, Na+ 140 mEqX2 hrs) and HSUF(GUF and HSD). Each methods were prescribed for 2 weeks. The clinical features such as thirst, interdialytic weight gain, postdialytic weight loss and MAP(mean arterial pressure) and the frequency of intradialytic complications and nursing interventions were evaluated. RESULTS: The results were as followings. Interdialytic thirst, weight gain, postdialytic weight loss and MAP(pre/post HD) were not significantly different in each method. On the other hand, there was significant difference between 4 methods in serum sodium, osmolality and Hct. There were significantly fewer episodes of hypotention, muscle cramp and headache when using GUF, HSD and HSUF than CHD. The number of nursing interventions was significantly reduced in GUF, HSD and HSUF than CHD. CONCLUSION: Hemodialysis with gradient ultrafiltration and high sodium dialysate leads fewer complications and nursing interventions, more patient's well being.
Hand ; Headache ; Humans ; Muscle Cramp ; Nursing ; Osmolar Concentration ; Outpatients ; Renal Dialysis* ; Sodium* ; Thirst ; Ultrafiltration* ; Weight Gain ; Weight Loss

BACKGROUNDS/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has malignant potential. Predicting invasive IPMN has proven difficult and controversial. We tried to identify predictive factors for invasive IPMN. METHODS: Thirty six patients underwent resection for IPMN from February 2001 to July 2011. Clinicopathological features including demographic, imaging, microscopic, and serological findings were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was used to analyze sensitivity and specificity of all possible cut-off values for the diameter of the main pancreatic duct and mass size predicting invasive IPMN. Student t-test, chi-square test, and logistic regression were used for univariate and multivariate analysis. RESULTS: The mean age was 63.5+/-8.4 years. Males were more commonly affected (58.3% vs 41.7%). Pancreaticoduodenectomy was performed in 55.6% of patients, distal pancreatectomy in 36.1%, and central pancreatic resection in 8.3%. Non-invasive IPMNs were present in 80.6% (n=29), whereas invasive IPMNs were present in 19.4% (n=7). In univariate analysis, tumor location (p=0.036), Kuroda classification (p=0.048), mural nodule (p=0.016), and main duct dilatation (> or =8 mm) (p=0.006) were statistically significant variables. ROC curve analysis showed that a value of 8 mm for the main duct dilatation and a value of 35 mm for the size of the mass lesion have 80% sensitivity and 75% specificity and 100% sensitivity and 82.6% specificity, respectively. However, in multivariate analysis, main ductal dilatation (> or =8 mm) was identified to be the only independent factor for invasive IPMN (p=0.049). CONCLUSIONS: Main duct dilatation appears to be a useful indicator for predicting invasive IPMN.
Dilatation ; Humans ; Logistic Models ; Male ; Mucins ; Multivariate Analysis ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreaticoduodenectomy ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity