Exercise testing with Thallium imaging is widely used for the noninvasive evaluation of patients suspected of having coronary artery disease. However, many patients referred for stress testing connot exercise adequately for either physical or psychological reasons, and as a result may have nondiagnostic or suboptimal test results. Intravenous dipyridamole in conjunction with Thallium imaging is as effective alternative method without exercise. But, myocardial imaging using the standard scintillation camera technique(planner view) is hampered by superposition of proximal & distal cardial walls and by the segmental nature of myocardial ischemia. For this reason, Single Photon Emission Computed Tomography(SPECT) reslut in high specificity & sensitivity rates for the detection of coronar artery disease compared with conventional technique. So we performed dipyridamole Th-201 myocardial scintigraphy on 25 subjects who have suspicious angina or myocardial infarction instead of exercise Th-201 myocardial scintigraphy, and compared SPECT view with conventional plannar view. The results obtained are as follows : 1) T1-201 scintigraphic findings in 17 patients with suspicious angina were as follows ; redistribution defect was seen in 4 cases in plannar view and 13 cases in SPECT view. 2) T1-201 scintigraphic findings in 8 patients with myocardial infarction were as follows ; in planner view, perfusion defect was seen in all cases and 1 cases of them, redistribution defect was accompained, and in SPECT view, perfusion defect was seen in all cases and 6 cases of them, redistribution defect was accompained. 3) During dipyridamole infusion, the mean systolic & diatolic pressure decreased from 133+/-22.7/86+/-13.5 to 121+/-23.9/78+/-13.1mmHg and the heart rate increased from 68+/-12.4 to 84+/-12.4beats/min. 4) Adverse effects of dipyridamole were noted in 14(56%) of the subjects, but in 12 of these, the symptoms were mild in severity and subsided spontanously. To summarize, Dipyridamole-201 myocardial imaging is a useful and test for coronary artery disease, and the new tomographic technique, SPECT view, is more useful than the conventional plannar view.
Arteries ; Coronary Artery Disease ; Dipyridamole* ; Exercise Test ; Gamma Cameras ; Heart Rate ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Myocardial Perfusion Imaging ; Perfusion Imaging* ; Perfusion* ; Sensitivity and Specificity ; Thallium* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.
Critical Care ; Critical Illness ; Diagnosis ; Humans ; Incidence ; Critical Care ; Intermittent Pneumatic Compression Devices ; Male ; Pilot Projects* ; Stockings, Compression* ; Venous Thrombosis*

OBJECTIVE: To determine the effect of the addition of Vit. D3 (1,25-Dihydroxychole calciferol D3) to the conventional postmenopausal hormone replacement therapy on bone mineral density(BMD) DESIGN: A 2-year retrospective , randomized study Setting : Department of Obstetrics and Gynecology of Catholic university hospital Patients : 388 postmenopausal women were recruited and divided into 5 groups according to treatment regimen; A: conjugated estrogens only treated group(n=146), B : conjugated estrogens and progesterone treated group(n=103), C : conjugated estrogens and Vit.D3 treated group (n=36), D : conjugated estrogens, progesterone and Vit.D3 treated group (n=41), E : control group (n=60). METHODS: The bone mineral density of the lumbar spines and femoral neck were determined by dual-energy X-ray absorptiometry(DEXA) every 2 years. STATISTICS: The difference between before and after treatment was determined by paired t-test. The comparison among the groups were determined by one way ANOVA test and student's t-test. RESULTS: The addition of progesterone to estrogen showed insignificant increase in the lumbar and femoral neck BMD. The addition of Vit. D3 compared with conventional hormone replacement therapy insignificantly influened bone density in women with initially normal BMD, but definitely increase in women with initially osteopenic and osteoporotic BMD of femoral neck rather than lumar spine(p<0.05). CONCLUSIONS: The use of Vit. D3 combined with postmenopausal estrogen replacement effects the increase of BMD in low bone density than normal bone density, especially femoral neck.
Bone Density* ; Estrogen Replacement Therapy ; Estrogens ; Estrogens, Conjugated (USP) ; Female ; Femur Neck ; Gynecology ; Hormone Replacement Therapy ; Humans ; Obstetrics ; Progesterone ; Retrospective Studies ; Spine ; Vitamins*

PURPOSE: This study was done to investigate the relationship of family function, self-esteem, life satisfaction, and general characteristics to loneliness in community dwelling Korean elders and identify factors affecting loneliness. METHOD: With a cross-sectional causal-relationship design and a convenience sample, 205 elders residing in three districts of the city of Seoul, S. Korea were recruited. Participants were assessed using the Family APGAR Score, Self-Esteem Scale, Life-Satisfaction Scale, and Revised UCLA Loneliness Scale. RESULTS: The mean score for degree of loneliness (Mean=39.61, SD=10.09) was just below the mean for the scale (Possible range 20-80). Loneliness had significant negative correlations with family function (r= -.400, p<.001), self-esteem (r= -.399, p<.001), and life satisfaction (r= -.644, p<.001). Other general characteristics that had significant or nearly significant relationships with loneliness were perceived current financial and health status, whether doing any exercise or physical activities, degree of close relationship with family members, and length of living in current residence. Among variables, life satisfaction (Standardized beta = -.589, p<.001) and length of living in current residence (Standardized beta = -.136, p<.05) significantly predicted degree of loneliness. CONCLUSION: Findings of this study allow a comprehensive understanding of loneliness and related factors among community dwelling elders in Korea. However, further studies with a larger random sample from various living environments are necessary.
Apgar Score ; Humans ; Korea ; Loneliness* ; Motor Activity ; Seoul

Even though pleomorphic adenoma is the most common benign tumor of the major salivary gland, such as the parotid gland, it is relatively rare in the minor salivary gland since it accounts for only 10% of all reported pleomorphic adenoma. The minor salivary gland spreads throughout the oral cavity from nasopharynx, oropharynx, to larynx, and pleomorphic adenoma can be possibly found in every one of them. However, pleomorphic adenoma of the larynx is very rare. We experienced a case of 59 year old woman who presented 3 months history of voice change, swallowing difficulty. She had huge pleomorphic adenoma originated from arytenoid area of larynx. We resected the mass by suprahyoid approach and obtained good postoperative results. We reporte this case with a review of literature.
Adenoma, Pleomorphic ; Deglutition ; Female ; Humans ; Larynx ; Mouth ; Nasopharynx ; Oropharynx ; Parotid Gland ; Salivary Glands ; Salivary Glands, Minor ; Voice

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the relationship between the expression of Bcl-2, Bax, p27 and lymph node metastasis (LNM) in papillary thyroid cancer (PTC). SUBJECTS AND METHOD: The thyroid tissue samples were obtained randomly from the department of pathology at Kangbuk Samsung Hospital. The specimens were from 72 patients, comprising 25 patients with thyroid nodular hyperplasia (TNH), 23 PTC without LNM, and 24 PTC with LNM between January 2006 and May 2008. Immunohistochemical staining for Bcl-2, Bax, and p27 was performed, and quantified blindly by three pathologists who had no clinical information of the patients. Immunohistochemical expression was scored as high (>25% of cells stained) or low (0-25%). RESULTS: Expression of Bcl-2 was scored as high for 1 (4%) TNH, 3 (13%) PTC without LNM and 4 (17%) PTC with LNM cases. Expression of Bax was scored as high for 0 (0%) TNH, 9 (39%) PTC without LNH and 16 (67%) PTC with LNM cases. Expression of p27 was scored as high for 13 (52%) TNH, 12 (52%) PTC without LNM and 13 (54%) PTC with LNM cases. Expression of Bax in the PTC with LNM group was scored higher than TNH (p<.01) and PTC without LNM (p<.05). There was no statistically difference in the immunoreactivity for Bcl-2 and p27 among the three groups. However, some positive expressions of p27 were noted at the cytoplasm of the PTC. CONCLUSION: Our results suggest that immunohistochemical analysis of Bax may be helpful in the diagnosis of PTC and in the evaluation of lymph node metastatic potential in PTC.
Carcinoma, Papillary ; Cytoplasm ; Factor IX ; Humans ; Hyperplasia ; Lymph Nodes ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND/AIMS: BK virus (BKV) has been associated with late-onset hemorrhagic cystitis (HC) in recipients of hematopoietic stem cell transplantation (HSCT). Cidofovir has been used at higher doses (3 to 5 mg/kg/wk) with probenecid prophylaxis; however, cidofovir may result in nephrotoxicity or cytopenia at high doses. METHODS: Allogeneic HSCT recipients with BKV-associated HC are treated with 1 mg/kg intravenous cidofovir weekly at our institution. A microbiological response was defined as at least a one log reduction in urinary BKV viral load, and a clinical response was defined as improvement in symptoms and stability or reduction in cystitis grade. RESULTS: Eight patients received a median of 4 weekly (range, 2 to 11) doses of cidofovir. HC occurred a median 69 days (range, 16 to 311) after allogeneic HSCT. A clinical response was detected in 7/8 patients (86%), and 4/5 (80%) had a measurable microbiological response. One patient died of uncontrolled graft-versus-host disease; therefore, we could not measure the clinical response to HC treatment. One microbiological non-responder had a stable BKV viral load with clinical improvement. Only three patients showed transient grade 2 serum creatinine toxicities, which resolved after completion of concomitant calcineurin inhibitor treatment. CONCLUSIONS: Weekly intravenous low-dose cidofovir without probenecid appears to be a safe and effective treatment option for patients with BKV-associated HC.
Administration, Intravenous ; Adult ; Antiviral Agents/*administration & dosage/adverse effects ; BK Virus/*drug effects/immunology ; Cystitis/diagnosis/*drug therapy/immunology/virology ; Cytosine/administration & dosage/adverse effects/*analogs & derivatives ; Drug Administration Schedule ; Female ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Immunocompromised Host ; Male ; Organophosphonates/*administration & dosage/adverse effects ; Polyomavirus Infections/diagnosis/*drug therapy/immunology/virology ; Retrospective Studies ; Time Factors ; Transplantation, Homologous ; Treatment Outcome ; Tumor Virus Infections/diagnosis/*drug therapy/immunology/virology ; Viral Load

Polyomavirus BK viral allograft nephritis is a great challenge in posttransplant management and graft survival because of difficulty in diagnosing and treatment. Initial treatment usually involves reducing immunosuppressive medications. However if concomitant acute rejection exist, it is more challenging in managing these patients, because acute rejection requires increase in immunosuppression. We present a case of a 35-year-old man who developed BK viral allograft nephritis and concomitant acute rejection 3 months after transplantation. BK viral allograft nephritis was missed in diagnosis and only pulse steroids for anti-rejection therapy was done. Initially, renal function was improved, but 4 months later, he presented with deterioration in renal function. Second renal biopsy showed BK allograft nephritis without rejection. BK viral DNA in plasma by PCR and urinary decoy cell were also positive. Reduction in immunosuppression by discontinuing mycophenolate mofetil stabilized the deterioration in renal function, however it failed to clear viremia.
Adult ; Allografts* ; Biopsy ; BK Virus* ; Diagnosis ; DNA, Viral ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation ; Nephritis ; Nephritis, Interstitial* ; Plasma ; Polymerase Chain Reaction ; Polyomavirus ; Steroids ; Viremia

OBJECTIVE: Although hemodialysis using heparin bound Hemophan (HBH-HD) has been reported to be a possible modality in patients at risk of bleeding, the efficiency and safety of HBH-HD is not certain. Therefore, we prospectively compared the safety and efficiency of HBH-HD with those of saline flushing HD (SF-HD) and HD using low dose heparin (LDH-HD) in 13 HD patients at risk of bleeding in a cross-over design. METHODS: The safety and efficiency were evaluated by measuring activated partial prothrombin time (aPTT) before and during HD, hemostasis time after needle removal, total blood compartment volume (TBCV) loss of dialyzer, urea clearance (K) and Kt/V. RESULTS: There was no difference in compression time needed to achieve hemostasis at puncture site after needle removal between HBH-HD, SF-HD and LDH-HD. During HBH-HD, there was a slight increase in aPTT at 15 min (50.6+/-4.5 sec), compared to predialysis levels (40.9+/-4.7 sec). In this cross- over study, aPTT during dialysis session was markedly higher in LDH-HD than those in HBH-HD or SF-HD (p<0.05). The loss of TBCV of the dialyzer was greater in SF-HD than HBH-HD or LDH-HD (17.4+/-1.9% vs. 12.4+/-1.4% vs. 10.1+/-1.8%). However, there was no difference in K (212.0+/-30.7 vs. 217.2+/-36.9 vs. 221.6+/- 29.5 mL/min) and Kt/V (1.22+/-0.12 vs. 1.24+/-0.16 vs. 1.26+/-0.18). CONCLUSION: We concluded that the safety and efficiency of HBH-HD are not different compared to SF-HD or LDH-HD and HBH-HD could an alternative hemodialysis method in patients at risk of bleeding.
Anticoagulants ; Cross-Over Studies ; Dialysis ; Flushing* ; Hemorrhage* ; Hemostasis ; Heparin* ; Humans ; Needles ; Prospective Studies ; Prothrombin Time ; Punctures ; Renal Dialysis* ; Urea

OBJECTIVE: Although cyclophosphamide (CYC) is effective for the treatment of diffuse proliferative lupus nephritis (DPLN) and severe membranous nephropathy (MN), it has serious adverse effects. Therefore, we evaluated our clinical observations with mycophenolate mofetil (MMF) for empirical treatment of DPLN and severe MN. METHODS: Seventeen patients with biopsy proven severe MN (n=8) and DPLN (n=9) received MMF for > or = 6 months as primary treatment (n=9) or subsequent maintenance therapy after CYC treatment (n=8). Treatment outcome was evaluated by random urine protein/creatinine ratio (UP/Cr) and serum creatinine (sCr) at the start and at 12 months and compared by the Wilcoxon signed-rank test. RESULTS: Overall, the mean (+/-SD) UP/Cr decreased in both MN (6.48+/-3.03 vs. 1.31+/-1.22, p= 0.016) and DPLN (3.77+/-2.34 Vs 0.83+/-0.53, p=0.043) patients. No significant change in serum Cr was detected in both MN and DPLN patients. Adverse events included nausea/abdominal discomfort (n=1) and menstrual irregularity (n=1). CONCLUSION: Short term empirical treatment with MMF in the majority of patients with severe MN and DPLN was well tolerated and effective in decrease of proteinuria and stabilization of renal function. Controlled clinical trials are necessary to define the role of MMF in the treatment of severe MN and DPLN.
Biopsy ; Creatinine ; Cyclophosphamide ; Glomerulonephritis, Membranous* ; Humans ; Lupus Nephritis* ; Proteinuria ; Treatment Outcome