BACKGROUND: Evaluating the segmental wall motion of left ventricle is important in patients with myocardial infarction for choosing therapeutic modality and predicting prognosis. Radionuclide Multigated Angiography(MUGA) is a reliable noninvasive method for the evaluation of left ventricular performance. Methods : MUGA scan(LV ejection fraction, phase image histogram, regional wall motion) was performed and analyzed in 45 patients with myocardial infarction(31 : acute MI, 14: old MI) and 13 normal controls. RESULTS: 1) The LVEF of acute and old MI group was significantly reduced and the SDph of acute and old MI group was significantly increased as compared with that of control group(p<0.05). 2) In acute MI group, the LVEF of group without, IV Urokinase was more reduced than that of group with IV Urokinase and the SDph of group without IV Urokinase was more increased than that of group with IV Urokinase(p<0.05). As a result of wall motion scoring, the linear correlation exists between SDPh and sum of wall motion scoring(r=0.62, p<0.01). 3) In MI group, the LVEF of anterior wall MI was more reduced than that of inferior wall MI and the SDPh of anterior wall MI was more increased than that of inferior wall MI(p<0.05). 4) In acute anterior wall MI, the reverse correlation exists between LVEF and SDPh and the linear correlation exists between sum of wall motion scoring and SDPh(r=-0.73, 0.72, p<0.01). But there are no statistical significances of correlation between them in acute inferior MI(r=-0.44, 0.42, p>0.05), in old anterior MI(r=-0.65, 0.47, p>0.05) and in old inferior MI(r=-0.47, 0.46, P>0.05). CONCLUSION: These results suggest that Phase angle(SDPh) is thought to be valuable index to evaluate left ventricular function with application of other indeces in Myocardial infarction. Left ventricular function measured by SDph in acute or anterior MI is lower than old or inferior MI.
Heart Ventricles ; Humans ; Myocardial Infarction* ; Prognosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

Metastatic cancers to the thyroid gland are rare, with the most common primary site being the kidney. The next most common sites are the breast, lung, melanoma, colon and larynx. In the case of thyroid metastasis of renal cell carcinoma, the thyroid metastasis may be the initial manifestation and the incidence of this type seems disproportionate to the frequency of the primary renal cell carcinoma. 3Ve have recently experienced two cases of thyroid metastasis of renal cell carcinoma and report them with a brief review of the related literature.
Breast ; Carcinoma, Renal Cell* ; Colon ; Incidence ; Kidney ; Larynx ; Lung ; Melanoma ; Neoplasm Metastasis ; Thyroid Gland* ; Thyroid Neoplasms

Sorafenib is an oral multikinase inhibitor that has shown a survival benefit in patients with advanced hepatocellular carcinoma, and is considered to be generally safe. We treated a patient with interstitial lung disease that was associated with sorafenib therapy for the treatment of advanced hepatocellular carcinoma. A 74-year-old man with hepatitis-C-virus-related hepatocellular carcinoma was treated with sorafenib. After 8 days of sorafenib administration, he received radiation therapy for an intrahepatic tumor located in segment eight. On the 24th day of sorafenib treatment, the patient developed acute interstitial pneumonitis that rapidly improved after the discontinuation of sorafenib and treatment with high-dose steroids. This case alerts physicians to the possibility of sorafenib-induced interstitial lung disease.
Aged ; Carcinoma, Hepatocellular ; Humans ; Lung Diseases, Interstitial ; Niacinamide ; Phenylurea Compounds ; Steroids

BACKGROUND/AIMS: The aim of this study was to elucidate the antiviral efficacy and the predictors of entecavir treatment in nucleoside-naive chronic hepatitis B patients. METHODS: A total of 160 patients treated with entecavir (0.5 mg daily) for at least 24 weeks were consecutively enrolled. The virologic response (HBV DNA<2,000 copies/mL), biochemical response (ALT< or = upper limit of normal), and virologic breakthrough (>1 log10 copies/mL increase in HBV DNA level above nadir on two consecutive occasions) were retrospectively analyzed. RESULTS: The mean follow-up duration was 58.8 weeks, and 85 patients (53.1%) showed HBeAg positivity. The median pretreatment levels of serum ALT and HBV DNA were 99 IU/L and 7.6 log10 copies/mL, respectively. The cumulative rates at 12, 24, 48, and 72 weeks were 37.5%, 68.1%, 87.4%, and 95.8%, respectively, for the virologic response; 40.0%, 66.2%, 84.5%, and 92.7% for the biochemical response; 10.6%, 18.8%, 27.0%, and 34.5% for HBeAg loss; and 3.5%, 7.1%, 9.0%, and 13.2% for HBeAg seroconversion. There was no case of virologic breakthrough. An absence of HBeAg and a low serum HBV DNA level (<8 log10 copies/mL) at baseline were significant predictors of the virologic response in a multivariate analysis (P<0.01). CONCLUSIONS: Entecavir therapy showed excellent efficacy in nucleoside-naive chronic hepatitis B patients. The predictors of a virologic response were an absence of HBeAg and a low baseline HBV DNA level.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Female ; Genotype ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B e Antigens/analysis ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Time Factors

OBJECTIVES: Aims of this study were 1) to estimate prevalence rates of suicidal ideation and suicide attempt, 2) to find out whether the gender difference and age difference(13-15 years vs 16-18 years) for suicide behaviors exist, 3) to analyse correlates of suicide attempts among junior and high school adolescents aged 13-18 years old. METHODS: A self-administered questionnaire was used in a cluster random sample of 2,203 school adolescents(male 1,105, female 1,098). Data were obtained on a wide range of constructs including suicidal ideation and attempts during past 2 weeks, depressive symptoms, symptoms of DSM-IV alcohol dependence, family structure, socioeconomic status, smoking, satisfaction with school achievements, and subjective health status. Chi-square test were done for analysing gender difference and age difference of suicide behaviors. Statistical analyses including uni-variate and multi-variate logistic regression analysis were done for each sex, respectively. RESULTS: 1) The prevalence of suicide ideation during past 2 week was 30.7% in the total sample. The prevalence rates of male and female ideators were 26.9% and 34.9% respectively. The prevalence of suicide attempt during past 2 week was 5.3% in the total sample. The prevalence of suicide attempt in males was 3.4% and 7.3% in females. 2) Gender difference was significant. That is, female respondents showed higher rate of suicidal ideation and suicide attempt. In our study age difference was found only at the rate of suicide attempt. That is, older adolescents(16-18 years) showed only statistically significant higher rate of suicide attempt than younger adolescents(13-15 years). 3) Multi-variate logistic regression analysis revealed that the correlates for suicide attempt were female, moderate to severe depressive symptoms, alcohol dependence in the total sample. In males the correlate for suicide attempt was alcohol dependence. In females, were moderate to severe depressive symptoms, and alcohol dependence. CONCLUSION: Depressive symptoms, alcohol dependence, presence of suicidal ideation were strong predictors for suicide attempts. This suggest that early detection of treatment of depression and alcohol dependence is important and psychiatric approach and follow-up be needed for the prevention of suicide.
Adolescent* ; Alcoholism ; Surveys and Questionnaires ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Logistic Models ; Male ; Prevalence* ; Risk Factors* ; Smoke ; Smoking ; Social Class ; Suicidal Ideation ; Suicide*

BACKGROUND AND OBJECTIVES: P-wave dispersion (PWD) is a well-known electrophysiologic parameter of atria which are prone to fibrillation. Although paroxysmal atrial fibrillation (PAF) following an acute myocardial infarction (AMI) is not uncommon, the relationship between PWD and PAF following AMI has not been determined. SUBJECTS AND METHODS: We reviewed the electrocardiograms, recorded on admission and every day during hospitalization, of 144 patients with primary anterior AMIs and measured the P-wave duration. The left atrial diameter and left ventricular ejection fraction (LVEF) were evaluated by echocardiography. RESULTS: PAF occurred in 20 patients. The maximum P-wave duration and PWD were found to be significantly higher in patients with PAF than those without PAF (120.1+/-8.6 vs. 109.2+/-12.2 ms, p<0.001; and 68.5+/-11.9 vs. 48.7+/-9.6 ms, p<0.001, respectively). The minimum P-wave duration was significantly lower in patients with PAF than in patients without PAF (51.6+/-13.3 vs. 60.4+/-11.7 ms, respectively, p=0.003). There was no significant difference in the left atrial diameter between patients with PAF and patients without PAF (37.3+/-4.4 vs. 36.8+/-5.1 mm, respectively p=0.652); however, the LVEF was significantly different in the patients who developed PAF compared to those who did not develop PAF (38.5+/-11.4 vs. 45.1+/-8.7%, respectively, p=0.003). CONCLUSION: The maximum P-wave duration and PWD were significant predictive factors of PAF in patients with anterior wall ST elevation AMI based on univariate analysis. On the basis of multivariate analysis, age was an independent predictive parameter for PAF as well.
Atrial Fibrillation ; Echocardiography ; Electrocardiography ; Hospitalization ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Stroke Volume

A 37-year-old male presented with fever and jaundice was diagnosed as hepatitis A complicated with progressive cholestasis and severe autoimmune hemolytic anemia. He was treated with high-dose prednisolone (1.5 mg/kg), and eventually recovered. His initial serum contained genotype IA hepatitis A virus (HAV), which was subsequently replaced by genotype IIIA HAV. Moreover, at the time of development of hemolytic anemia, he became positive for immunoglobulin M (IgM) anti-hepatitis E virus (HEV). We detected HAV antigens in the liver biopsy specimen, while we detected neither HEV antigen in the liver nor HEV RNA in his serum. This is the first report of hepatitis A coinfected with two different genotypes manifesting with autoimmune hemolytic anemia, prolonged cholestasis, and false-positive IgM anti-HEV.
Adult ; Anemia, Hemolytic, Autoimmune/*diagnosis/drug therapy/etiology ; Anti-Inflammatory Agents/therapeutic use ; Cholestasis/*diagnosis/drug therapy/pathology ; Coinfection/*diagnosis ; Genotype ; Hepatitis A/complications/*diagnosis/genetics ; Hepatitis E/complications/*diagnosis/genetics ; Humans ; Immunoglobulin M/blood ; Liver/pathology/virology ; Male ; Prednisolone/therapeutic use ; RNA, Viral/blood

BACKGROUND/AIMS: Effective bowel preparation is essential for accurate diagnosis of colon disease. We investigated efficacy and safety of 2 L polyethylene glycol (PEG) solution with 90 mL sodium phosphate (NaP) solution compared with 4 L PEG method. METHODS: Between August 2009 and April 2010, 526 patients were enrolled who visited Seoul National University Bundang Hospital for colonoscopy. We allocated 249 patients to PEG 4 L group and 277 patients to PEG 2 L with NaP 90 mL group. Detailed questionnaires were performed to investigate compliance, satisfaction and preference of each method. Bowel preparation quality and segmental quality were evaluated. Success was defined as cecal intubation time less than 20 minutes without any help of supervisors. RESULTS: Both groups revealed almost the same baseline characteristics except the experience of operation. PEG 4 L group's compliance was lower than PEG 2 L with NaP 90 mL group. Success rate and cecal intubation time was not different between two groups. Overall bowel preparation quality of PEG 2 L with NaP 90 mL group was better than PEG 4 L group. Segmental bowel preparation quality of PEG 2 L with NaP 90 mL group was also better than PEG 4 L group in all segments, especially right side colon. Occurrence of hyperphosphatemia was higher in PEG 2 L with NaP 90 mL group than PEG 4 L group. However, significant adverse event was not reported. CONCLUSIONS: PEG 2 L with NaP 90 mL method seems to be more effective bowel preparation than PEG 4 L method.
Administration, Oral ; Adult ; Aged ; Colonic Diseases/diagnosis ; Colonoscopy/*methods ; Humans ; Male ; Middle Aged ; Patient Compliance ; Phosphates/*administration & dosage ; Polyethylene Glycols/*administration & dosage ; Questionnaires ; Solutions ; Therapeutic Irrigation