Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Only a few patients reach adulthood without surgical correction. Unrepaired TOF patients with mild to moderate right ventricular outflow tract (RVOT) obstruction may be clinically silent until adulthood. TOF with hypoxic spells present as periods of profound cyanosis that occur because of almost total RVOT obstruction. So, hypoxic spell typically occurs in a crying infant but is rare in an adult. In this report, we presented a case of a 75-year-old patient with uncorrected TOF presenting with hypoxic spell, consequent pulmonary hypertension and chronic heart failure. This is the oldest case of natural survivor with uncorrected TOF in Korea and the oldest patient presenting hypoxic spell worldwide.
Adult ; Aged* ; Anoxia ; Crying ; Cyanosis ; Heart Defects, Congenital ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Infant ; Korea ; Survivors* ; Tetralogy of Fallot*

This study is aimed at developing a nutritional task of a community as public health activities of Su-Dong Myun, Demonstration Project area of Ewha Womans University. The content of this study is the points of nutritional diagnosis for the residents nutritional evaluation, the analysis of the related factors and the educational material with Nutrition Education-Index. Two hundreds housewives were examined during the period of Jan. 30 in 1989. 1. In terms of the housewives' age, those aged 30 to 39 were 32.5% which was the highest and educational level, graduation of primary school was 31.5% which was the highest. The housewives who had no job were 60.6% and those who participated in community activities were 56.5%. 2. In terms of the points of nutritional diagnosis, 50 to 74 points were 51.5% which was the highest and total average was 65.1 +/- 15.0. 3. As for the points of nutritional knowledge, the average was 54.9 points, attitude was 77.4 points and eating practice was 70.8 points. 4. The number of clinical symptoms of nutritional deficiency was 16.1 ones per person. 5. As for the relation which nutritional knowledge, attitude, eating practice exert on one another, nutritional knowledge had negative correlation with eating practice(-0.04) and attitude has some correlation with eating practice(0.17). 6. The variable having to do with the points of nutritional diagnosis showed the highest correlation coefficient(0.55) as the points of nutritional knowledge. 7. As for the variable having to do with the number of the symptoms of nutrition deficiency, the higher points of knowledge(-0.05) is, the higher the total average points of nutritional diagnosis(-0.09) is, negative correlation was appeared. 8. The result in which the variant having to do with the number of clinical symptoms of nutritional deficiency was analyzed by multiple regression analysis showed that the lack of time for preparing meals in non agricultural households made the greatest contribution (9% explained) and the households having vegetable garden made the second greatest contribution (3% explained).
Diagnosis ; Eating* ; Family Characteristics ; Female ; Humans ; Malnutrition ; Meals ; Public Health ; Rural Population* ; Vegetables

BACKGROUND: Low flow anesthesia provides many advantages, including reduced cost, conservation of body heat and airway humidity. This study was performed to compare low flow anesthesia with high flow anesthesia and to investigate whether the advantages of low flow anesthesia during positive pressure ventilation can be combined with the laryngeal mask airway in paralyzed pediatric patients. METHODS: Thirty-one pediatric patients of ASA physical status 1 or 2 were studied and divided into two groups according to the fresh gas flow (FGF) in the breathing system; low flow group (FGF approximation 1 L/min, n = 17) or high flow group (FGF approximation 4 L/min, n = 14). Each respiratory parameter was measured when a steady state was reached at 20 min after induction. RESULTS: There were no significant differences of respiratory data between the two groups except that the inspired oxygen concentration was lower in the low flow group than in the high flow group. Hemodynamic changes with the laryngeal mask airway insertion were not statistically significant. CONCLUSIONS: A laryngeal mask airway is an effective airway device for low flow anesthesia as well as for high flow anesthesia in paralyzed pediatric patients.
Anesthesia* ; Hemodynamics ; Hot Temperature ; Humans ; Humidity ; Laryngeal Masks* ; Oxygen ; Pediatrics* ; Positive-Pressure Respiration* ; Respiration

BACKGROUND: The resistance rate of Escherichia coli (E.coli) against ciprofloxacin is reported as high as 30% in Korea. The purpose of this study was to evaluate the clinical outcome of two empirical antibiotics, ciprofloxacin and cefotaxime, in patients with acute pyelonephritis (APN). MATERIAL AND METHODS: We retrospectively reviewed medical records of APN patients who were prescribed with ciprofloxacin or cefotaxime as empirical antibiotics from November 2004 and June 2006. The Successful treatment (ST) was defined as the condition that a patient maintained body temperature below 37.7degrees C for more than 48 hours after treatment. RESULTS: A total of 64 patients were enrolled (31 in the ciprofloxacin and 33 in the cefotaxime group). Average age was 58.9 (+/-15.8) years and 58 (90.6%) patients were women. Comparing WBC count and CRP level before treatment with those after 48 hours of treatment, significant improvements were found only in the cefotaxime group. After 48 hours, the cefotaxime group had more patients with ST, but the difference was not significant [19 (58%) vs. 12 (39%), P=0.131]. After 72 and 120 hours, the cefotaxime group showed significantly higher ST rate than the ciprofloxacine group [72 hours; 30 (91%) vs. 19 (61%), P=0.016 and 120 hours; 32 (97%) vs. 23 (74%), P=0.009]. Even after adjusting demographic factors, the cefotaxime group showed higher ST rate. CONCLUSION: Cefotaxime can be considered as a better option for empirical treatment for APN in aspects of improvement of acute phase reactants and clinical cure, especially in endemic area of highly resistant E. coli.
Acute-Phase Proteins ; Anti-Bacterial Agents ; Body Temperature ; Cefotaxime ; Ciprofloxacin* ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Escherichia coli ; Female ; Humans ; Korea ; Medical Records ; Pyelonephritis* ; Retrospective Studies ; Treatment Outcome

BACKGROUND: The resistance rate of Escherichia coli (E.coli) against ciprofloxacin is reported as high as 30% in Korea. The purpose of this study was to evaluate the clinical outcome of two empirical antibiotics, ciprofloxacin and cefotaxime, in patients with acute pyelonephritis (APN). MATERIAL AND METHODS: We retrospectively reviewed medical records of APN patients who were prescribed with ciprofloxacin or cefotaxime as empirical antibiotics from November 2004 and June 2006. The Successful treatment (ST) was defined as the condition that a patient maintained body temperature below 37.7degrees C for more than 48 hours after treatment. RESULTS: A total of 64 patients were enrolled (31 in the ciprofloxacin and 33 in the cefotaxime group). Average age was 58.9 (+/-15.8) years and 58 (90.6%) patients were women. Comparing WBC count and CRP level before treatment with those after 48 hours of treatment, significant improvements were found only in the cefotaxime group. After 48 hours, the cefotaxime group had more patients with ST, but the difference was not significant [19 (58%) vs. 12 (39%), P=0.131]. After 72 and 120 hours, the cefotaxime group showed significantly higher ST rate than the ciprofloxacine group [72 hours; 30 (91%) vs. 19 (61%), P=0.016 and 120 hours; 32 (97%) vs. 23 (74%), P=0.009]. Even after adjusting demographic factors, the cefotaxime group showed higher ST rate. CONCLUSION: Cefotaxime can be considered as a better option for empirical treatment for APN in aspects of improvement of acute phase reactants and clinical cure, especially in endemic area of highly resistant E. coli.
Acute-Phase Proteins ; Anti-Bacterial Agents ; Body Temperature ; Cefotaxime ; Ciprofloxacin* ; Demography ; Emergencies* ; Emergency Service, Hospital* ; Escherichia coli ; Female ; Humans ; Korea ; Medical Records ; Pyelonephritis* ; Retrospective Studies ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease with high mortality if left untreated. But, confirmative diagnosis is difficult because many diagnostic modalities are nonspecific. Pulmonary angiography, which is considered as the gold standard diagnostic tool, is invasive, costly, time-consuming, and not always available in small centers. Echocardiography is a non-invasive and available in the emergency room without significant time delay. We investigated the role of echocardiography as a screening test in patients with suspected PE. MATERIALS AND METHODS: (A) Retrospective study: We analyzed the recorded videotapes of transthoracic echocardiography in fifty patients with confirmed PE from Jan 1995 to Aug 1999. From the frequent echocardiographic findings of those patients, positive criteria were defined as followed ( 2 among 1-5 or only 6). (1) RV or pulmonary artery dilatation (RVEDA/LVEDA 0.6) (2) RV hypokinesis (3) paradoxical septal wall motion (4) pulmonary hypertension (5) TR (moderate degree or more) (6) Visible thrombus. Although the degree of TR was less than moderate, if the degree of pulmonary hypertension was more than moderate, we considered as PE. (B) Prospective study: From Nov 1999 to June 2000, patients with suspected pulmonary embolism underwent a transthoracic echocardiography and perfusion-ventilation lung scan or chest CT. We assessed echocardiographic findings, sensitivity and specificity of the previously defined echocardiographic positive criteria for PE. RESULTS: (A) Retrospective study: The sensitivity of echocardiography for PE was 74%. (B) Prospective study: The number of enrolled patients was thirty-four. In twenty patients the diagnosis was PE. The sensitivity of echocardiography was 75% but the specificity was 14%. CONCLUSION: Echocardiography may be used as a good screening test in patients who are clinically suspicious of pulmonary embolism.
Angiography ; Diagnosis ; Dilatation ; Echocardiography* ; Emergency Service, Hospital ; Humans ; Hypertension, Pulmonary ; Lung ; Mass Screening* ; Mortality ; Prospective Studies ; Pulmonary Artery ; Pulmonary Embolism* ; Retrospective Studies ; Sensitivity and Specificity ; Thrombosis ; Tomography, X-Ray Computed ; Videotape Recording

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease with high mortality if left untreated. But, confirmative diagnosis is difficult because many diagnostic modalities are nonspecific. Pulmonary angiography, which is considered as the gold standard diagnostic tool, is invasive, costly, time-consuming, and not always available in small centers. Echocardiography is a non-invasive and available in the emergency room without significant time delay. We investigated the role of echocardiography as a screening test in patients with suspected PE. MATERIALS AND METHODS: (A) Retrospective study: We analyzed the recorded videotapes of transthoracic echocardiography in fifty patients with confirmed PE from Jan 1995 to Aug 1999. From the frequent echocardiographic findings of those patients, positive criteria were defined as followed ( 2 among 1-5 or only 6). (1) RV or pulmonary artery dilatation (RVEDA/LVEDA 0.6) (2) RV hypokinesis (3) paradoxical septal wall motion (4) pulmonary hypertension (5) TR (moderate degree or more) (6) Visible thrombus. Although the degree of TR was less than moderate, if the degree of pulmonary hypertension was more than moderate, we considered as PE. (B) Prospective study: From Nov 1999 to June 2000, patients with suspected pulmonary embolism underwent a transthoracic echocardiography and perfusion-ventilation lung scan or chest CT. We assessed echocardiographic findings, sensitivity and specificity of the previously defined echocardiographic positive criteria for PE. RESULTS: (A) Retrospective study: The sensitivity of echocardiography for PE was 74%. (B) Prospective study: The number of enrolled patients was thirty-four. In twenty patients the diagnosis was PE. The sensitivity of echocardiography was 75% but the specificity was 14%. CONCLUSION: Echocardiography may be used as a good screening test in patients who are clinically suspicious of pulmonary embolism.
Angiography ; Diagnosis ; Dilatation ; Echocardiography* ; Emergency Service, Hospital ; Humans ; Hypertension, Pulmonary ; Lung ; Mass Screening* ; Mortality ; Prospective Studies ; Pulmonary Artery ; Pulmonary Embolism* ; Retrospective Studies ; Sensitivity and Specificity ; Thrombosis ; Tomography, X-Ray Computed ; Videotape Recording

PURPOSE: Oxcarbazepine (OXC) is chemically related to carbamazepine (CBZ). OZC exerts less liver enzyme induction than CBZ and is completely metabolized by reduction to the active metabolite, 10, 11-dihydro-10-hydroxy-5H-dibenzo (b,f) azepine-5-carboxamide (MHD). It was known that OXC had no significant pharmacokinetic interactions with other antiepileptic drugs. But it is not thoroughly studied yet because of short duration of clinical application. We investigated whether the plasma concentration of OXC metabolite (MHD) is changed by valproic acid compared with OXC monotherapy and studied the correlation of the dose of OXC with the plasma concentration of its active metabolite (MHD). METHODS: The patient with OXC monotherapy (19 cases) and patients with OXC and valproic acid(16 cases) were incluses. We analyzed the level of its metabolites MHD by HPLC RESULTS: The plasma concerntration of MHD in OXC monotherapy is 15.5+/-3.2 microgram/ml and that of the MHD in polytherapy with valproic acid is 16.4+/-3.4 microgram/ml at the same dose of OXC. The plasma concentration of MHD is ranged from 7.4 microgram/ml at 600 mg/day of OXC to 27.0 microgram/ml at 1800 mg/day of OXC and highly correlated with OXC dose per body weight (r=0.72-84). CONCLUSION: There is no significant change or difference of MHD plasma concentraion between OXC monotherapy and polytherapy with valproic acid at the same dose of OXC. THe plasma concentration of MHD is highly correlated with OXC dose per body weight.
Anticonvulsants ; Body Weight ; Carbamazepine ; Chromatography, High Pressure Liquid ; Enzyme Induction ; Humans ; Liver ; Plasma* ; Valproic Acid

Tumor necrosis factor receptor-related 2 (TR2, HVEM or TNFRSF-14) plays an important role in immune responses, however, the mechanisms regulating its expression are unclear. To understand the control of TR2 gene expression, we studied the upstream region of the gene. Gel supershift assays revealed inducible binding of nuclear factor of activated T cells (NFAT) to a putative NFAT site within the TR2 promoter. Furthermore, cotransfection of a dominant negative NFAT construct, or siRNA for NFAT, resulted in increased expression of a TR2 reporter gene. Our findings demonstrate that NFAT negatively regulates TR2 expression in activated T cells.
Animals ; Base Sequence ; CD4-Positive T-Lymphocytes/metabolism ; Cells, Cultured ; Down-Regulation ; Mice ; Mice, Inbred C57BL ; Molecular Sequence Data ; NFATC Transcription Factors/*physiology ; Receptors, Tumor Necrosis Factor, Member 14/*biosynthesis ; T-Lymphocytes/*metabolism

Eosinophilic lung diseases are heterogeneous disorders characterized by varying degrees of pulmonary parenchyma or blood eosinophilia. Causes of eosinophilic lung diseases range from drug ingestion to parasitic or fungal infection as well as idiopathic. The exact pathogenesis of eosinophilic lung disease remains unknown. Urushiol chicken can frequently cause allergic reactions. Contact dermatitis (both local and systemic) represents the most-common side effect of urushiol chicken ingestion. However, there has been no previous report of lung involvement following urushiol chicken ingestion until now. A 66-year-old male was admitted to our hospital with exertional dyspnea. Serial chest X-ray revealed multiple migrating infiltrations in both lung fields, with eosinophilic infiltration revealed by lung biopsy. The patient had ingested urushiol chicken on two occasions within the 2 weeks immediately prior to disease onset. His symptoms and migrating lung lesions were resolved following administration of oral corticosteroids.
Adrenal Cortex Hormones ; Aged ; Allergens ; Biopsy ; Chickens* ; Dermatitis, Contact ; Dyspnea ; Eating* ; Eosinophilia ; Eosinophils ; Humans ; Hypersensitivity ; Lung ; Lung Diseases ; Male ; Pulmonary Eosinophilia ; Thorax