PURPOSE: To evaluate the clinical features and radiographical landmarks of patients who has a thoracolumbar fracture combined with posterior ligament complex injury retrospectively. MATERIALS AND METHODS: The preoperative plain radiographys, axial CT, MRI and medical records of 27 patients were reviewed who were confirmed the posterior ligament complex injury in operation from January, 2002. to December, 2004. RESULTS: The patients were from 15 years to 75 years of age (mean 39.1 years), 20 males and 7 females. The mechanisms of injury were 17 falls from a height, 7 traffic accidents and 3 direct blow injuries. There were 17 cases (63%) in thoracolumbar transitional zone, such as 11 cases in T11-T12, 6 cases T12-L1. There were 9 cases of compression fracture and 18 cases of burst fracture according to the shape of fractured vertebra. In the plain radiograph, the degree of kyphotic angle was between 6~49 degrees (mean 22 degrees), anterior vertebral height loss was 7~70% (mean 39%), and posterior vertebral height loss was 0~8% (mean 3%). 21 cases (78%) were the anterior vertebral height loss below 50%, 23 cases (85%) were the degree of kyphotic angle below 30 degrees. Neurological deficits were not registered. 23 cases (85%) were positive in MRI and 24 cases (89%) were positive in direct focal tenderness in the view of posterior ligament complex injury. Conclusions: The posterior ligament complex injury is common finding of the thoracolumbar fracture. The high resolution MRI findings and direct focal tenderness are very importance in identifying the posterior ligament complex injury that is important prognostic factor particularly in mild anterior vertebral height loss and mild kyphotic angle in the plain radiograph.
Accidents, Traffic ; Female ; Fractures, Compression ; Humans ; Ligaments* ; Magnetic Resonance Imaging ; Male ; Medical Records ; Retrospective Studies ; Spine

To investigate the significance of precordial ST-segment depression in acute inferior myocardial infarction, electrocardiographic findings in 51 consecutive patients with acute inferior myocardial infarction were analysed with clinical findings and coronary artery angiography. Thirty patients(Group A) had no or <1.0mm ST depression, and twenty one patients(Group B) had > or =1.0mm ST depression in two or more precordial(VI-6) leads were included in this study. Patients in Group B thd greater summed ST-segment elevation in leads II, III, AVF(6.3+/-6.1 vs 2.4+/-2.3mm, p<0.05), higher plasma peak CK levels(1776.8+/-1503.3 vs 5666.6+/-587.7 IU/L, p<0.05), higher plasmal peak CK-MB levels(141.2+/-1553.3 vs 34.1+/-35.7 IU/L, p<0.05), more prevalence of proximal left anterior descending coronary artery disease (46.6% vs 16.6%, p<0.05) than patients in Group A. There was no significant difference between Group A and Group B in the LV ejection fraction, delta area decreasing rate, infarction related asynergy, complications during hospitalization and cardiac events during follow up period. In conclusion, patients with acute inferior myocardial infarction who have associated with precordial ST depression had more extensive myocardial damage probably due to concomitant left anterior descending coronary artery disease.
Angiography ; Coronary Artery Disease ; Coronary Vessels ; Depression* ; Electrocardiography ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Inferior Wall Myocardial Infarction* ; Plasma ; Prevalence

PURPOSE: Detrusor hyperactivity with impaired contractility(DHIC) can be found in many elderly patients with benign prostatic hyperplasia(BPH). It is hard to expect the efficacy of transurethral resection of prostate(TURP) on such patients. Therefore, we retrospectively estimated the effect of TURP on BPH patients with DHIC. MATERIALS AND METHODS: Eighteen male patients with BPH and DHIC were underwent TURP. Through urodynamic studies, DHIC was identified. Findings of bladder outlet obstruction were evaluated with TRUS and/or diagnostic cystoscopy in all patients. They were requested to go through uroflowmetry and international prostate symptom score(IPSS), before and after TURP. The subjective satisfaction scale was measured after TURP. RESULTS: Total IPSS(from 20.6 to 12.5), obstructive symptom score(from 11.5 to 6.0), and maximal flow rate (from 6.0 ml/sec to 14.6 ml/sec) of the patients were improved significantly(p<0.05) after TURP. Storage symptom score(from 9.0 to 6.3) got better, but the improvement was not statistically significant(p>0.05). Only 2(12%) of the patients were unsatisfied with the outcomes of TURP. CONCLUSION: We suggest that TURP can be used as a good therapeutic option for selected patients with BPH accompanied with DHIC.
Aged ; Cystoscopy ; Humans ; Male ; Prostate ; Prostatic Hyperplasia* ; Retrospective Studies ; Transurethral Resection of Prostate* ; Urinary Bladder Neck Obstruction ; Urodynamics

BACKGROUND: Previous studies of animal and human experiments have shown excellent correlation between true or angiographic stenosis severity and stenosis severity calculated from intracoronary Doppler flow measurements and continuity equation method. However, there remains practical problems to be solved on its clinical application. To minimize these problems, the concept of modified continuity equation method, calculating the percent area stenosis by comparing the maximal in-stenosis flow velocity to the distal reference flow velocity, was introduced and compared with dipyridamole stress thallium-201 SPECT. METHODS: In this prospective study, 102 patients (mean age 57+/-10 years, 69 men, 33 women) with coronary artery stenoses ranging from 23-89% in percent diameter stenosis, who received coronary angiography, dipyridamole stress thallium-201 SPECT, and successful intracoronary flow velocity measurements were included. Modified continuity equation method and distal coronary flow velocity reserve were compared to the result of dipyridamole stress thallium-201 SPECT and quantitative coronary angiography. RESULTS: Measurements of adequate intralesional and stenosis distal flow velocities were successful in 102 out of 106 stenoses (96%). Minimal luminal area and percent area stenosis calculated from modified continuity equation method showed significant correlations with those of quantitative coronary angiography. Modified continuity equation method significantly underestimated the severity of stenosis than quantitative coronary angiography did. The test accuracy in relation to the result of dipyridamole stress thallium-201 SPECT were 91% in modified continuity equation method, 80% in quantitative coronary angiography and 63% in distal coronary flow velocity reserve. CONCLUSION: Application of intracoronary Doppler guide wire and modified continuity equation method appears to provide useful on-site implications for the anatomic and functional assessment of coronary artery stenosis. The modified continuity equation method would be one of the promising concepts for clinical decision making during coronary interventions.
Animals ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis* ; Coronary Vessels* ; Decision Making ; Dipyridamole* ; Humans ; Male ; Phenobarbital ; Prospective Studies ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND AND OBJECTIVES: It has been shown that the coronary flow reserve (CFR) of an infarct related artery can predict left ventricular functional recovery following acute myocardial infarction (AMI). However, the prognostic value of CFR on the long-term clinical outcome of patients with an AMI has not been studied. SUBJECTS AND METHODS: Using a Doppler guide wire, we measured the CFR in 130 patients with an AMI following successful intervention (6+/-3 days after onset of the AMI). Two-year follow-up was conducted with regard to end points, including : cardiac death, non-fatal AMI, and severe congestive heart failure (CHF; > or = NYHA III). RESULTS: During the follow-ups, cardiac events occurred in 17 patients (5 deaths, 3 non-fatal AMIs and 9 severe CHFs). After analysis of the receiver operating characteristic curves, the best cut-off value for CFR in predicting cardiac events was 1.4 (sensitivity 76.5%, specificity 73.5%, accuracy 82.0%). With cardiac events as an end point, a 2-year Kaplan-Meier event survival analysis revealed that the patients with a CFR < or = 1.4 had a worse prognosis than those with a CFR >1.4 (Event free survival rates were 69.8% vs. 95.4%, respectively, p<0.001). Using Cox proportional hazard analyses, as an independent predictor, age, heart rate, CFR and left ventricular end systolic volume index, were also found to be significantly associated with cardiac events (hazard ratios 1.1224, 1.0404, 0.1887, and 1.0588, respectively). CONCLUSION: The coronary flow reserve, of infarct related arteries, measured during the early recovery phase can be used as an independent predictor for the prognosis of patients with an acute myocardial infarction following successful intervention.
Arteries ; Coronary Circulation ; Death ; Follow-Up Studies ; Heart Failure ; Heart Rate ; Humans ; Myocardial Infarction* ; Prognosis ; ROC Curve ; Sensitivity and Specificity ; Stroke Volume ; Survival Rate

PURPOSE: This study was design and performed for evaluations of resent clinical pattern of bronchiolitis caused by RSV infection with children under 2 year of age for 5 years, who were admitted to pediatric ward. METHODS: The inclusion criteria of the patients were children under 24 month-of-age, clinical manifestations of lower respiratory tract infection, and RSV antigen that was detected by a direct immunofluorescence test from the nasal secretions. The additional laboratory and simple chest X-ray findings were reviewed from the medical records of children who were admitted Wonkwang university hospital from Jan. 1999 to Dec. 2003. RESULTS: In the 5 year study duration, 127 patients were enrolled and outbreak of RSV bronchiolitis took place in 2001. The 80 cases(63 percent) of RSV infection were concentrated in later autumn and winter. Number of the cases show coughing were 120(94.5 percent), but rale was audible in 78 cases(61.4 percent). Dyspnea, wheezing, and intercostal retraction were noticed in 27(21.3 percent), 21(16.5 percent), and 4(3 percent) cases respectively. The most common chest X-ray finding was hyperinflation of the lung that was noticed in 110 cases(86.6 percent). Care with mechanical ventilator for more than 2 days required in 5 cases. CONCLUSION: Lower respiratory tract infection by RSV was common in late autumn and winter season but year-round infection was noticed. The severity of RSV respiratory tract infectiontakes in some degree a grave course. So we suggest that population-based surveillance of acute respiratory infection due to RSV is necessary for assessment of prevalence and epidemiology of this disease.
Bronchiolitis ; Child* ; Cough ; Dyspnea ; Epidemiology ; Fluorescent Antibody Technique, Direct ; Humans ; Lung ; Medical Records ; Prevalence ; Respiratory Sounds ; Respiratory Syncytial Viruses* ; Respiratory System* ; Respiratory Tract Infections* ; Seasons ; Thorax ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Previous studies have indicated that idiopathic dilated cardiomyopathy (IDCM) is associated with a high incidence of lethal ventricular arrhythmia and sudden cardiac death (due to arrhythmic events). The objective of this study was to evaluate predictive factors of arrhythmic events in IDCM. SUBJECTS AND METHODS: A total of 174 patients with IDCM were evaluated for the measurement of multiple parameters such as PR interval, QRS duration, rate corrected QT dispersion, bundle branch block, atrial fibrillation, left ventricular end diastolic dimension, ejection fraction, left atrial size, and left ventricular hypertrophy. The patients were divided into 2 groups:group A with and group B without arrhythmic events. RESULTS: Over an observation period of 38+/-19 months, arrhythmic events developed in 39 of the 174 patients (4 VT, 1 VF and 34 sudden cardiac death, 22.4%). In multivariate analysis, only QTDc was found to be an independent predictor of arrhythmic events (RR:1.03, 95% CI:1.01 - 1.04, p<0.01). The positive and negative predictive values of arrhythmic events in patients with QTDc>108 ms were 43.8% (7/16) and 85.6% (83/97) respectively. The positive predictive value of arrhythmic events in patients with QTDc>108 ms and EF<28% was 66.6% (8/12). CONCLUSION: The extent of repolarization dispersion and LV systolic function was determined to have value as a useful screening test for the prediction of arrhythmic events in IDCM.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Bundle-Branch Block ; Cardiomyopathy, Dilated* ; Death, Sudden, Cardiac ; Humans ; Hypertrophy, Left Ventricular ; Incidence ; Mass Screening ; Multivariate Analysis ; Tachycardia, Ventricular ; Ventricular Fibrillation

BACKGROUND AND OBJECTIVES: Acute aortic syndrome (AAS) is a heterogeneous group of disorders that often present with severe chest or back pain. It includes acute aortic dissection (AD), intramural hematoma (IMH), dissecting aneurysm, and penetrating aortic ulcer (PAU). The clinical picture of AAS and its prognosis have not been studied in a large number of Korean patients. Therefore, we organized a multi-center registry to identify the clinical characteristics and treatment patterns, as well as long-term outcomes in Korean patients with AAS. SUBJECTS AND METHODS: Five-hundred twenty-eight patients, who had been diagnosed with AAS, were enrolled into this registry from 10 centers. On a retrospective basis, we collected demographic, laboratory, imaging data, as well as follow-up clinical outcomes by reviewing medical records from individual centers. All the data were collected in core lab and analyzed in detail. RESULTS: The mean patient age was 60.1+/-14.5 years; the male-to-female ratio was M : F=297 : 231. The prevalent risk factors for AAS included hypertension (361, 68.4%) and diabetes (52, 11.1%). The components of AAS that are included in this study are acute AD (446, 84.5%), IMH (57, 10.7%), and PAU (11, 2.1%). By type of AAS, patients diagnosed with Stanford A were 45.6% of enrolled patients, whereas those with Stanford B were 54.4% of enrolled patients. Among nearly half of the patients were treated with medicine (55.7%) alone, whereas 40.0% underwent surgery and 4.3% underwent endovascular treatment. Overall, the in-hospital event rate was 21.2% and the in-hospital death rate was 8.1%. The mean follow-up duration was 42.8 months and there showed 22.9% of total event and 10.1% of death during this period. CONCLUSION: By organizing a multi-center registry of AAS, we could identify the characteristics of AAS in real-world Korean patients. Further, prospective study is warranted with a larger number of patients.
Aneurysm, Dissecting ; Aortic Diseases ; Back Pain ; Follow-Up Studies ; Hematoma ; Humans ; Hypertension ; Medical Records ; Population Characteristics ; Prognosis ; Pyridines ; Retrospective Studies ; Risk Factors ; Thiazoles ; Thorax ; Ulcer

BACKGROUND AND OBJECTIVES: The TIMI myocardial perfusion (TMP) grade is known as one of the methods to assess the viability of the myocardium in ischemic heart disease. This study was designed to assess the value of TMP grade itself and to evaluate the correlation with coronary flow reserve (CFR) in the prediction of left ventricular remodeling and functional change after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). SUBJECTS AND METHODS: We measured CFR and TMP grade after successful elective PCI (diameter stenosis <0%, and TIMI flow 3) in 83 patients (mean age 55+/-1 years, 18 females) with AMI within 7 days of symptom onset. Left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), ejection fraction (LVEF), and left ventricular regional wall motion score index (LVRWMSI) were assessed by echocardiography just before and at 9 months after angioplasty (mean 9+/-5 months). RESULTS: Although they had achieved (TIMI 0.021) TIMI 3 flow after successful intervention, 27 of 83 patients (32.5%) had impaired myocardial perfusion. After PCI, angiographic TMP grade was well correlated with CFR measured using Doppler wire (TMP 0/1;1.4+/-0.3, TMP 2;1.9+/-0.6, TMP 3;2.2+/-0.4, rs=0.618, p=0.000). Post-PCI TMP grade was significantly related to the change of LVEDVI (r=0.452, p=0.000), LVESVI (r=0.435, p=0.000), LVEF (r=0.281, p=0.010) and LVRWMSI (r=0.328, p=0.036). CONCLUSION: The TMP grade, a simple angiographic method, might be useful as a predictor of LV volume and functional change in AMI. In the cardiac catheterization laboratory, it could simply replace CFR for the assessment of myocardial viability in patients who receive an elective PCI within 7 days of AMI onset.
Angioplasty ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic ; Coronary Circulation ; Echocardiography ; Humans ; Myocardial Infarction* ; Myocardial Ischemia ; Myocardium ; Percutaneous Coronary Intervention ; Perfusion* ; Stents ; Stroke Volume ; Thymidine Monophosphate ; Ventricular Remodeling

It is known that tachyarrhythmias in patients with congenital heart defects have a potentially high impact on quality of life, morbidity and mortality. Conventional treatment with antiarrhythmic drugs may have untoward results including recurrence of tachyarrhythmia and its adverse effects. Therefore, radiofrequency catheter ablation is increasingly used for the treatment of supraventricular tachycardias in patients with congenital heart diseases, although abnormal anatomy and atypical conduction systems have the potential to complicate catheter ablation procedures. This report describes our experience with the successful radiofrequency catheter ablation of atrio-ventricular nodal reentrant tachycardia (AVNRT) in a patient with dextrocardia with situs solitus (isolated dextrocardia).
Anti-Arrhythmia Agents ; Catheter Ablation* ; Dextrocardia* ; Heart Defects, Congenital ; Heart Diseases ; Heart Septal Defects, Atrial* ; Humans ; Mortality ; Quality of Life ; Recurrence ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular