BACKGROUND AND OBJECTIVES: Doppler indexes of pulmonary venous flow (PVF) have been recognized to be useful in defining left ventricular filling characteristics, but their long-term prognostic value in patients with acute myocardial infarction (AMI) is not clear. The purpose of this study was to determine the prognostic significance of Doppler indexes of PVF after AMI. SUBJECTS AND METHODS: Doppler echocardiographic examination was performed in 122 patients with AMI between 7 to 10 days after attack, and followed for 30 months. Peak systolic velocity (PVs), peak diastolic velocity (PVd), and peak reverse flow velocity associated with atrial contraction (PVa) of PVF were measured by transthoracic echocardiography. End-points were cardiac death or readmission due to congestive heart failure (re-CHF). RESULTS: There were 9 deaths (7.4%) and 13 patients with re-CHF (10.7%) during the follow-up period. Patients with events had higher PVa (p=0.039). Subgroup analysis of patients with E/A ratio > 1 showed that they had lower PVs/PVd ratio (p=0.029) and higher PVa (p=0.069). Event-free survival was significantly lower in patients with PVs/PVd ratio < 1.3 (30-month survival rate 74% vs. 100% in those with PVs/PVd ratio > or =1.3). Multivariate Cox analysis revealed that Killip class II, and EF <50% were independent predictors of cardiac events; and PVa > or =25 cm/sec as well as age > or =65 years were independent predictors of cardiac mortality in patients with E/A ratio >1. CONCLUSION: PVa and PVs/PVd ratio of PVF were helpful indexes in predicting the prognosis in patients with AMI and an E/A ratio of >1.
Death ; Disease-Free Survival ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Mortality ; Myocardial Infarction* ; Prognosis ; Pulmonary Veins ; Survival Rate

Perinatal asphyxia can cause ischemic injury to immature kidney of neonates. Proximal renal tubule is the most sensitive area, showing various manifestations ranging from mild reversible injury to irreversible tubular necrosis. Aminoglycosides can be nephrotoxic in therapeutic range in immature or damaged kidney. Thess are the very important factors to be taken into corsideration on fluid therapy and nephrotoxic drugs in neonates. The purpose of this study is to detect renal dysfunction resulting from asphyxia and gentamicin treatment. The results were as follows; 1) Urinary 2-microglobulin concentration was significantly higher in neonatal asphyxia group irrespective of meconium stain (p<0.05). The group with neonatal asphyxia only (Ia) showed a gradual decline in urinary 2-microglobulin concentration and no significant difference shown when compared with control group on 7 days old (p>0.05). The group with neonatal asphyxia and meconium stain (Ib) received gentamicin for 7 days. Their urinary 2-microglobulin concentration dropped on 4 the day and increased again on 7 th day (p<0.05). The group with meconium stain only(3) showed no significant difference in urinary 2-microglobulin concentration when compared with control group (p>0.05). 2) No differences were shown in serum creatinine, serum sodium level and urinary creatinine concentrations between each group (p>0.05). 3) No differences were shown in creatinine clearance between each group (p>0.05).Fractional excretion of urinary sodium (FENa) was significantly higher on lst day in group, I, but no differences were shown afterwards (p>0.05). 4) There is no relationship between urinary 2-microglobulin concentration and serum creatinine level, creatinine clearance of FENa. 5) No differences were shown in incidence of renal dysfunction between each group. In conclusion, acute tubular injury by perinatal asphyxia recovered soon after birth. But nephrotoxic gentamicin worsened the recovering tubular injury. In case of mild fetal hypoxia without neonatal asphyxia, proximal tubular injury was not significant.
Aminoglycosides ; Asphyxia* ; Creatinine ; Fetal Hypoxia ; Fluid Therapy ; Gentamicins* ; Humans ; Incidence ; Infant, Newborn* ; Kidney ; Kidney Tubules, Proximal ; Meconium ; Necrosis ; Parturition ; Sodium

BACKGROUND: Platelet function is directly influenced by lipoproteins, and platelets from hypercholesterolemic patients display increased reactivity which is related to initiation, progression, and development of thromboembolic complications in atherosclerosis. But the exact mechanism of this effect is unclear. METHODS: In this study, total and activated numbers of platelet glycoprotein (Gp) IIb/IIIa were evaluated in twenty patients (7 men; age, 55.4+/-8.7 years) with hypercholesterolemia (plasma total cholesterol level over 240 mg/dL and normal triglyceride level) and twenty one subjects (8 men; 51.1+/-13.7 years) with normal plasma cholesterol and triglyceride levels. Flow cytometry was used to detect the binding of fluorescein isothiocyanate (FITC)-conjugated anti-CD41 or PAC1 to platelet Gp IIb<1/4>/<1/4>IIIa in whole blood. When whole blood was incubated with PAC1, platelets were also activated with adenosine diphosphate (ADP) or thrombin. RESULTS: PAC1 was more bound to unstimulated platelets from patients with hypercholesterolemia (p<0.005), and binding of PAC1 correlated significantly with plasma total cholesteol (r=0.48, p=0.002) and LDL-cholesterol (r=0.47, p=0.002) levels. Binding of PAC1 to unstimulated platelets increased as binding of anti-CD41 increased (r=0.40, p=0.01). On multivariate linear regression analysis, plasma total cholesterol level and binding of anti-CD41 were independent variables that determined binding of PAC1. After ADP- or thrombin-stimulation, binding of PAC1 to platelets and percentage of antibody positive cells were also greater in patients with hypercholesterolemia (p<0.05). There was a significant positive correlation between mean platelet volume and binding of anti-CD41 to unstimulated platelets (r=0.46, p<0.0050), but the latter was not different between hypercholesterolemia and control groups. CONCLUSION: Unstimulated platelets from patients with hypercholesterolemia had similar total number of Gp IIb/IIIa to those from control subjects, but had more activated Gp IIb/IIIa. After ADP- or thrombin-stimulation, platelet Gp IIb/IIIa was also more activated under hypercholesterolemia.
Adenosine Diphosphate ; Atherosclerosis ; Blood Platelets* ; Cholesterol ; Flow Cytometry ; Fluorescein ; Glycoproteins* ; Humans ; Hypercholesterolemia ; Linear Models ; Lipoproteins ; Male ; Mean Platelet Volume ; Plasma ; Thrombin ; Triglycerides

BACKGROUND AND OBJECTIVES: Regular aerobic exercise plays a role in the prevention of cardiovascular diseases, but the risk of primary cardiac arrest transiently increases during vigorous exercise, particularly in sedentary men. There has been a controversy regarding the effect of exercise on platelet functional behavior, which is related to the pathogenesis of coronary ischemia. We evaluated the cytoplasmic free calcium concentration of platelets in healthy men after treadmill exercise. MATERIALS AND METHOD: Five physically active (group I: age, 24.2+/-2.3 years) and five sedentary men (group II: age, 22.4+/-1.4 years) were included in this study. Platelet calcium was measured with fluorescent dye, quin2 before and after treadmill exercise. RESULTS: Platelet calcium levels were increased from 86.8+/-11.8 nM to 128.8+/-15.0 nM in group I (p<0.05) and from 102.6+/-14.4 nM to 162.4+/-26.5 nM in group II (p<0.05) immediately after exercise. Thereafter, platelet calcium levels were decreased in group I, but continuously increased in group II. At fifteen minutes after exercise, platelet calcium concentrations were significantly higher than baseline values in group II (205.8+/-53.9 nM vs 102.6+/-14.4 nM: p<0.05), but not in group I (115.2+/-15.7 nM vs 86.8+/-11.8 nM). CONCLUSION: Cytoplasmic free calcium concentration in platelets were continuosly increased after treadmill exercise in sedentary men but not in physically active men.
Blood Platelets* ; Calcium* ; Cardiovascular Diseases ; Cytoplasm* ; Exercise ; Heart Arrest ; Humans ; Ischemia ; Male*

BACKGROUND AND OBJECTIVES: Regular aerobic exercise plays a role in the prevention of cardiovascular diseases, but the risk of primary cardiac arrest transiently increases during vigorous exercise, particularly in sedentary men. There has been a controversy regarding the effect of exercise on platelet functional behavior, which is related to the pathogenesis of coronary ischemia. We evaluated the cytoplasmic free calcium concentration of platelets in healthy men after treadmill exercise. MATERIALS AND METHOD: Five physically active (group I: age, 24.2+/-2.3 years) and five sedentary men (group II: age, 22.4+/-1.4 years) were included in this study. Platelet calcium was measured with fluorescent dye, quin2 before and after treadmill exercise. RESULTS: Platelet calcium levels were increased from 86.8+/-11.8 nM to 128.8+/-15.0 nM in group I (p<0.05) and from 102.6+/-14.4 nM to 162.4+/-26.5 nM in group II (p<0.05) immediately after exercise. Thereafter, platelet calcium levels were decreased in group I, but continuously increased in group II. At fifteen minutes after exercise, platelet calcium concentrations were significantly higher than baseline values in group II (205.8+/-53.9 nM vs 102.6+/-14.4 nM: p<0.05), but not in group I (115.2+/-15.7 nM vs 86.8+/-11.8 nM). CONCLUSION: Cytoplasmic free calcium concentration in platelets were continuosly increased after treadmill exercise in sedentary men but not in physically active men.
Blood Platelets* ; Calcium* ; Cardiovascular Diseases ; Cytoplasm* ; Exercise ; Heart Arrest ; Humans ; Ischemia ; Male*

A young metastatic lung cancer patient developed empyema due to an infection with carbapenem-resistant Acinetobacter baumannii. Hydropneumothorax was detected and managed by a tube thoracotomy. However, persistent air leakage through the chest tube was observed due to the presence of a bronchopleural fistula (BPF). As hypercapnic respiratory failure had progressed and the large air leak did not diminish by conservative management, a pumpless extracorporeal lung assist (pECLA) device was inserted. The pECLA allowed the patient to be weaned from mechanical ventilation and the BPF to heal. The present case shows the effective application of pECLA in a patient with empyema complicated with BPF and severe hypercapnic respiratory failure. pECLA enabled us to minimize airway pressure to aid in the closure of the BPF in the mechanically ventilated patient.
Acinetobacter baumannii ; Bronchial Fistula ; Carbon Dioxide* ; Carbon* ; Chest Tubes ; Empyema* ; Fistula ; Humans ; Hydropneumothorax ; Hypercapnia ; Lung ; Lung Neoplasms ; Respiration, Artificial ; Respiratory Insufficiency ; Thoracotomy

STUDY OBJECTIVE: We evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum (SPNM) . DESIGN: A retrospective case series was conducted to identify patients diagnosed with SPNM. ICD-7(J98.2) discharge codes were used for Jan. 1993 to Aug. 1996 at four institutions , and emergency department(ED) records and admission charts were reviewed. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of SPNM. RESULTS: Thirteen cases were identified. Age range was 14 to 58 years(mean 24 years). Presenting symptoms were chest pain in eight(62%), dyspnea in six(46%), both symptoms in three(23%), no complaints in three(23%). Seven(54%) patients complained only of throat discomfort. Seven(54%) had subcutaneous emphysema, and two(15.3%) had a small pneumothorax. Two(15.3%) were smokers. Three(23%) had normal esophagograms and another three had normal chest CT findings. Two cases(15.3%) were associated with inhalational drug use and three cases were due to exercise. Nine cases(69%) had a history of "Valsalva-type" maneuver. Two patients(15%) had a history of antituberculous treatment and one(7.7.%) had suffered from bronchial asthma. Mean hospital days were 7.3 days(range 3 to 14), none of all needed any intervention. Specifically, no patient developed a subsequent pneumothorax or airway compromise. Seven cases(54%) were received prophylactic antibiotics. CONCLUSION: Most simple SPNM cases are benign disease and most of them(78%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use is not a main cause of SPNM yet, but increase in use of bronchoinhalers is a suspicous cause of SPNM.
Anti-Bacterial Agents ; Asthma ; Chest Pain ; Child ; Diagnosis ; Dyspnea ; Emergencies ; Humans ; Length of Stay ; Mediastinal Emphysema* ; Natural History* ; Pharynx ; Pneumothorax ; Retrospective Studies ; Subcutaneous Emphysema ; Tomography, X-Ray Computed

No abstract available.
Adult* ; Humans ; Respiratory Distress Syndrome, Adult*

To investigate MR artifacts induced by metallic implants, scans were obtained using both the ferromagnetic Drake lip and the non ferromagnetic Yasargil clip. Scan were taken through the area of clips using geometrical phantom. The MRI was performed by spin echo technique and gradient echo technique on both 2.0T and 0.5T MR unit. The luthors evaluated the nature and differences of artifacts in each sequence and parameter. Artifacts induced by both lips were noted in the direction of frequency encoding gradient, and consisted of region of signal loss abutted in one side by survilinear region of bright signal. Geometric distortion of image was marked in the Drake clip, out was minimal in the Yasargil clip under both 2.0T and 0.5T. Artifacts were more pronounced in the gradient echo technique than those of the spin echo technique on both 2.0T and 0.5T. Although there were no differences n the nature of artifacts induced by the Drake clip among each parameter in the spin echo technique under 2.0T, artifacts were slightly more pronounced on T2 weighted image under the 0.5T field, but no differences were found in the nature of artifacts induced by the Yasargil clip in the spin echo technique under, both the 2.0T and 0.5T fields. Marked artifacts were induced through the small area of the Drake clip which were included in the scan plane, but induced artifacts were small when a small area of the Yasargil clip was included in the scan plane. It seemed likely hat artifacts were slightly more pronounced in the 2.0T than the 0.5T field in both clips, but objective evaluation of the difference was difficult, In conclusion, these results can be an essential basis for the interpretation of MR images or patents with metallic inplants.
Aneurysm* ; Artifacts* ; Lip ; Magnetic Resonance Imaging* ; Magnets

No abstract available.
Torticollis*