BACKGROUND: There has been reports which suggest that the morphologic feature of ventricular premature complex(VPC) might reflect the cardiac state. METHODS: To test this, we studied retrospectively the association between the morphologic feature of VPC(shape and duration) and cardiac state(structural and functional) by analysing the records of ECG(179 cases) obtained from reviewing echocardiogram performed in our hospital from 1988 to early 1991. Group 1(n=84) had VPC-QRS complexes with either smooth and uniterruped contour or narrow(<0.04 sec) notching and group 2(n=95) demonstrated VPC with broad(> or =0.04 sec) notching or shelves. Without taking into account of either the presence of the type of the underlying cardiac disease and other constitutional disease state, we classified the type of VPC on ECG according to the above criteria and analysed its simple association with cardiac size and functional state on echocardiogram. RESULTS: In group 1, 68 of 84 cases with a VPC had no notching. In group 2, the VPC-QRS duration was greater than group 1(0.154+/-0.022 vs 0.141+/-0.011 sec(mean+/-S.D.), p=0.0001).Left ventricular end-diastolic diameter(LVED) and ejection fraction(EF) showed a significant difference between the two groups(5.12+/-0.64 vs 5.72+/-0.95cm, p=0.0003 and 65.89+/-10.84 vs 60.82+/-15.5%, p=0.012 respectively). In group 2, 50 of 95 cases(53%) showed ejection fraction less than 64%. By defining left ventricular structural dilatation and functional impairment on echocardiogram as LEVD greater than 5.5cm and EF less than 64% respectively, the sensitivity and specificity of VPC morphology was 60% and 74% respectively. CONCLUSIONS: We conclude that a broadly(> or =0.04 sec) notched VPC of long duration(> or =0.15 sec) is a simple and reliable 12-lead ECG marker for an abnormal structural and functional state of the heart(dilatation and hypokinetic left ventricle), irrespective to underlying cardiac disease, while a VPC with smooth contour or narrow(<0.04 sec) notching with short duration(<0.15 sec) reflects a normal sized heart with normal systolic function.
Dilatation ; Electrocardiography ; Heart ; Heart Diseases ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: Ambulatory blood pressure monitoring is widely available in clinical practice. To evaluate the pattern of normal 24 hour variation of blood pressure and the problems in analysis of data which was obtained with use of automatic blood pressure recorder, 24 hour ambulatory blood pressure was measured. METHODS: Ambulatory blood pressure was recorded for 24 hours with automatic blood pressure monitor in 22 normotensive young adolescents. RESULTS: 1) Average 24-hour BP was 109mmHg in systolic(115+/-30 for male, 102+/-30 for female), 66mmHg in diastolic(69+/-18 for male, 63+/-19 for female) and pulse rate was 72 beats per minute(70+/-23 for male, 75+/-26 for female). 2) Data obtained from ambulatory blood pressure monitor should be analyzed after deletion of unacceptable data with use of conventional criteria. Blood pressure increase which is not accompanied by increase in pulse rate increase can be used as another criteria to rule out unacceptable blood pressure data. 3) Blood pressure was low from mid-night to 6 A.M. and began to rise slowly till mid-day and then maintained steadily through the remainder of the day. And 24 hour variation of blood pressure was more adequately assessed after application of Fourier analysis. CONCLUSIONS: These results suggest that certain deletion criteria was inevitable during analysis of the data which were obtained from ambulatory blood pressure recorder and Fourier analysis can be used as valuable smoothing technique to assess the 24-hour blood pressure profiles.
Adolescent* ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Blood Pressure Monitors ; Fourier Analysis ; Heart Rate ; Humans ; Male

PURPOSE: Appropriate antibiotic therapy is important in childhood urinary tract infection and the selection of anibiotics is based on antimicrobial sensitivity of Escherichia coli. Extended- Spectrum beta-Lactamase(ESBL) is an enzyme produced by gram-negative bacilli that has the ability to hydrolyse penicillins, broad-spectrum cephalosporin and monobactam. There have been many reports of outbreaks of hospital infection by ESBL-producing organism. However, community-acquired infection with ESBL-producing organism are rare. This study was performed to retrospectively identify the incidence, characteristics and risk factors of ESBL(+) E. coli in community-acquired childhood UTI. METHODS: In 288 children admitted in Ewha Womans University Hospital with E. coli UTI from Mar 2001 to February 2003, ESBL was isolated. ESBL was confirmed by the utilization of an automatized machine(Vitek GNS 433 card) using liquid medium dilution method according to National Committee for Clinical Laboratory Standard. The clinical characteristics, risk factors, antimicrobial resistance and treatment effectiveness were compared with ESBL(-) E. coli UTI. RESULTS: Of 288 E. coli isolates, 31(10.8%) produced ESBL and 93.5%(29/31) occurred in infants younger than 6 month of age(P<0.01). No significant differences were noted in prior antibiotic use, prior admission history and underlying urogenital anomaly. Antimicrobial resistance was significantly higher in ESBL(+) E. coli compared with control patients (P< 0.05). Although ceftriaxone showed 100% resistance in ESBL(+) E. coli, bacteriologic sterilization rate after ceftriaxone therapy was higher(96.8%). However, the recurrence rate of febrile UTI within 6 months was higher(25.8%) than control patients(6.6%). CONCLUSION: Epidemiologic study is required to find out any new risk factors of community-acquired ESBL(+) E. coli UTI and changes in selection of empirical antibiotics shouldbe considered
Anti-Bacterial Agents ; Ceftriaxone ; Child ; Community-Acquired Infections ; Cross Infection ; Disease Outbreaks ; Epidemiologic Studies ; Escherichia coli* ; Escherichia* ; Female ; Humans ; Incidence* ; Infant ; Penicillins ; Recurrence ; Retrospective Studies ; Risk Factors* ; Sterilization ; Treatment Outcome ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: To ensure safety of blood transfusion, accuracy in performance of blood grouping tests (BGT) is essential. External proficiency testing (PT) for BGT has not been conducted in Korea. The first PT for BGT in domestic blood centers was conducted in order to evaluate the domestic status of accuracy of BGT in blood centers and to aid in improving the quality of blood centers. METHODS: Whole blood survey specimens consisting of three panels for ABO grouping and two panels for Rh typing were sent to 81 blood centers. Evaluation criteria for BGT were as follows: 'Good' for answers with 100% referee consensus, 'Acceptable' for correct answers other than those of the referee, and 'Unacceptable' for answers other than those of 'Good+acceptable' as correct answers. RESULTS: Rates of correct answers on three panels for ABO grouping were all 100%; however, that of cell typing for the panel with BW was 61.7%, and 31 blood centers incorrectly reported normal 'B' type as an answer. The rate of correct answers for the Rh negative panel was 100%; however, that for the weak D panel was 84%, and 13 blood centers incorrectly reported Rh negative type as an answer. CONCLUSION: Findings from this study demonstrated that some hospital blood centers were not able to correctly detect blood groups with weak antigens. Therefore, to improve the quality of blood centers, intensive education for blood center staff and continued PT for BGT should be required.
Blood Group Antigens ; Blood Grouping and Crossmatching ; Blood Transfusion ; Consensus ; Dietary Sucrose ; Korea

BACKGROUND AND OBJECTIVES: Although CO2 laser turbinate surgery is known to be an effective method in reducing the nasal symptoms of perennial allergic rhinitis, the long term effects have not yet been evaluated. Therefore, the purpose of this study was to assess the subjective and objective long term results of CO2 laser surgery. MATERIALS AND METHODS: The charts and questionnaires of 49 patients who received laser surgery at our department from January 1994 to December 1999 were reviewed. Preoperative and postoperative nasal volume of 20 randomly selected patients were measured by acoustic rhinometry. Nasal mucosa of 10 patients before and after laser surgery yearly for 6 years were examined under light and electron microscopy. RESULTS: Watery nasal discharge, nasal obstruction and sneezing had improved significantly after laser surgery. Postoperative nasal volumes also increased significantly. Histological findings 6 years after laser surgery revealed focal squamous epithelium and regenerating ciliated columnar epithelium. Decreased goblet cells, fibrous proliferation and scarce vessels and glands were also observed. CONCLUSIONS: CO2 laser surgery proves to be an effective method in reducing the symptoms of perennial allergic rhinitis for short and long periods.
Epithelium ; Goblet Cells ; Humans ; Laser Therapy ; Lasers, Gas* ; Microscopy, Electron ; Nasal Mucosa ; Nasal Obstruction ; Rhinitis* ; Rhinometry, Acoustic ; Sneezing ; Turbinates* ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Although CO2 laser turbinate surgery is known to be an effective method in reducing the nasal symptoms of perennial allergic rhinitis, the long term effects have not yet been evaluated. Therefore, the purpose of this study was to assess the subjective and objective long term results of CO2 laser surgery. MATERIALS AND METHODS: The charts and questionnaires of 49 patients who received laser surgery at our department from January 1994 to December 1999 were reviewed. Preoperative and postoperative nasal volume of 20 randomly selected patients were measured by acoustic rhinometry. Nasal mucosa of 10 patients before and after laser surgery yearly for 6 years were examined under light and electron microscopy. RESULTS: Watery nasal discharge, nasal obstruction and sneezing had improved significantly after laser surgery. Postoperative nasal volumes also increased significantly. Histological findings 6 years after laser surgery revealed focal squamous epithelium and regenerating ciliated columnar epithelium. Decreased goblet cells, fibrous proliferation and scarce vessels and glands were also observed. CONCLUSIONS: CO2 laser surgery proves to be an effective method in reducing the symptoms of perennial allergic rhinitis for short and long periods.
Epithelium ; Goblet Cells ; Humans ; Laser Therapy ; Lasers, Gas* ; Microscopy, Electron ; Nasal Mucosa ; Nasal Obstruction ; Rhinitis* ; Rhinometry, Acoustic ; Sneezing ; Turbinates* ; Surveys and Questionnaires

OBJECTIVE: The favored method of preserving fertility in young female cancer survivors is cryopreservation and autotransplantation of ovarian tissue. Reducing hypoxia until angiogenesis takes place is essential for the survival of transplanted ovarian tissue. The aim of this study was to investigate the role of angiopoietin-1 (Angpt-1), angiopoietin-2 (Angpt-2), and vascular endothelial growth factor (VEGF) in ovarian tissue grafts that were cryopreserved using two methods. METHODS: Ovarian tissues harvested from ICR mice were divided into three groups: group I (control), no cryopreservation; group II, vitrification in EFS (ethylene-glycol, ficoll, and sucrose solution)-40; and group III, slow freezing in dimethyl sulfoxide. We extracted mRNA for VEGF, Angpt-1, and Angpt-2 from ovarian tissue 1 week following cryopreservation and again 2 weeks after autotransplantation. We used reverse transcriptase-polymerase chain reaction to quantify the levels of VEGF, Angpt-1, and Angpt-2 in the tissue. RESULTS: Angpt-1 and Angpt-2 expression decreased after cryopreservation in groups II and III. After autotransplantation, Angpt-1 and Angpt-2 expression in ovarian tissue showed different trends. Angpt-1 expression in groups II and III was lower than in group I, but Angpt-2 in groups II and III showed no significant difference from group I. The vitrified ovarian tissues had higher expression of VEGF and Angpt-2 than the slowfrozen ovarian tissues, but the difference was not statistically significant. CONCLUSION: Our results indicate that Angpt-2 may play an important role in ovarian tissue transplantation after cryopreservation although further studies are needed to understand its exact function.
Angiopoietin-1* ; Angiopoietin-2 ; Animals ; Anoxia ; Autografts ; Cryopreservation* ; Dimethyl Sulfoxide ; Female ; Fertility ; Fertility Preservation ; Ficoll ; Freezing ; Humans ; Methods* ; Mice ; Mice, Inbred ICR ; Ovary ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Messenger ; Sucrose ; Survivors ; Tissue Transplantation ; Transplantation, Autologous ; Transplants* ; Vascular Endothelial Growth Factor A* ; Vascular Endothelial Growth Factors ; Vitrification

BACKGROUND: One quarter to one third of patients with NSCLC present with primary tumors that although confined to the thorax are too extensive for surgical resection. Until resently standard treatment for these patients had been thoracic radiation, which produces tumor regression in most patients but few cures and dismal 5-year survival rate. The fact that death for most patients with stage III tumors is caused by distant metastases has promped a reevaluation of combined modality treatment approaches that include systemic chemotherapy. Therefore, we report the results observed in a study to evaluate the effect of multimodality treatment in locally advanced non-small cell lung cancer from 1/91 to 8/93 in CNUH. METHOD: We grouped the patients according to the treatment modalities and evaluated response rate, median survival and the effect of prognostic variables. Among 67 patients evaluated, twenty seven patients classified with group A, received cisplatin and etoposide containing combination chemotherapy alone, eighteen patients, classified with group B, received chemotherapy and radiotherapy, fifteen patients, group C, received neoadjuvant or adjuvant chemotherapy and surgery with/without radiation therapy, seven patients, group D, received only supportive care. RESULT: The major response rate for group A and B was 37% and 61% respectively. There was no statistically significant difference in response rate between A and B groups(p=0.97). The analysis of prognostic factors showed that differences of age, sex, pathology, blood type, smoking year, stage and ECOG performance did not related to improvement in survival. Median survival time was 8.6 months for group A, 13.4 months for group B, 19.2 months for group C, and 5.4 months for group D, respectively and there was statistically significant difference(p=0.003), suggesting that multimodality therapy was associated with signigicant improvement in survival. Subset survival analysis showed a significant therapeutic effect for earlier stage and good performance state(p=0.007, 0.009, respectively). A possible survival advantages were observed for major response groups. CONCLUSION: It was suggested that multimodality therapy for the management of patients who had stage III disease, has yielded good median survival and long survival for seleted patients. But, it is necessory to validate above result with further investigation in large scale and in prospective randomized trials.
Carcinoma, Non-Small-Cell Lung* ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination ; Etoposide ; Humans ; Neoplasm Metastasis ; Pathology ; Prospective Studies ; Radiotherapy ; Smoke ; Smoking ; Survival Rate ; Thorax

BACKGROUND: The majority of patients with locally advanced, unresectable, non-small cell lung cancer(NSCLC) were treated with conventional thoracic radiation therapy Throcic radiation therapy produces tumor regression in most patients but few cures and dismal 5-year survival rate. Several randomized studies have demonstrated that systemic chemotherapy controls micrometastasis and improve survival ratNes for patients who have locally advanced NSCI.C. Hut the optimal frequency of chemotherapy and sequence for chemotherapy and radiotherapy are yet to be determined. In this study, we analyzed response rate, median survival time, side effects and prognostic variables according to the frequency of chemotheray in locally advanced NSCLC patients. METHODS: We separated locally advanced, unresectable, NSCLC patients into two groups according to given number of chemotherapy cycles. Among 28 patients evaluated, eleven patients were classified to group A, receiving above 3 cycled chemotherapy and seventeen patients, classified to group B, receiving 3 cycled chemotherapy. In both groups, thoracic irradiation of 5940 cGy was given to all patients after chemotherapy. RESULTS: 1) Median survival time was 12.9 months for group A, 12.8 months for group B but there was no statistically significant difference(P>0.05), 2) Overall response rates were not significantly different between two groups(P>0.05). 3) Frequency rate of local failure and distant metastasis were not significantly different between two groups (P>0.05). 4) The grade and frequency of toxicities during treatment were not significantly different between two groups (P>0.05). 5) Clinical stage was the only major prognostic factor for overall survival (P<0.05). CONCLUSION: Median survival time, response rate, toxicities and frequency of local failure and distant metastasis were not significantly different between two groups. So, when we treat locally advanced, unresectable, NSCLC patients in sequential combined treatement, we should consider planned therapy(limiting chemotherapy cycles given), because planned therapy reduces many troubles of patients, that is, economic loss and time consuming, psychiatric anxiety etc, during treatment period. The optimal frequency of chemotherapy is remained to be validated in large scale study in the future in the setting of combined treatment.
Anxiety ; Drug Therapy ; Humans ; Lung ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Radiotherapy ; Reaction Time ; Small Cell Lung Carcinoma* ; Survival Rate

PURPOSE: We evaluated the efficacy of breast magnetic resonance imaging (MRI) for detecting additional malignancies in breast cancer patients newly diagnosed by breast ultrasonography and mammography. METHODS: We retrospectively reviewed the records of 1,038 breast cancer patients who underwent preoperative mammography, bilateral breast ultrasonography, and subsequent breast MRI between August 2007 and December 2010 at single institution in Korea. MRI-detected additional lesions were defined as those lesions detected by breast MRI that were previously undetected by mammography and ultrasonography and which would otherwise have not been identified. RESULTS: Among the 1,038 cases, 228 additional lesions (22.0%) and 30 additional malignancies (2.9%) were detected by breast MRI. Of these 228 lesions, 109 were suspected to be malignant (Breast Imaging-Reporting and Data System category 4 or 5) on breast MRI and second-look ultrasonography and 30 were pathologically confirmed to be malignant (13.2%). Of these 30 lesions, 21 were ipsilateral to the main lesion and nine were contralateral. Fourteen lesions were in situ carcinomas and 16 were invasive carcinomas. The positive predictive value of breast MRI was 27.5% (30/109). No clinicopathological factors were significantly associated with additional malignant foci. CONCLUSION: Breast MRI was useful in detecting additional malignancy in a small number of patients who underwent ultrasonography and mammography.
Breast ; Breast Neoplasms* ; Humans ; Information Systems ; Korea ; Limit of Detection ; Magnetic Resonance Imaging* ; Mammography* ; Retrospective Studies ; Ultrasonography* ; Ultrasonography, Mammary