To analyze the effects of the characteristics of the systolic anterior motion(SAM) of the mitral valve on the left ventricular outflow pressure gradient and to determine the relation between the anatomical characteristics of the left ventricle and the left ventricular outflow pressure gradient, mitral valve and left ventricular M mode echocardiogram and continuous wave Doppler echocardiogram of the left ventricular outflow tract were recorded in 7 patients with hypertrophic obstructive cardiomyopathy(HOCM), aged 19 to 66 years(mean 37 years). Mitral-septal distance at the closest apposition(S-SAM;1.1+/-2mm), duration of mitral-septal apposition(89+/-20 msec), time interval from the peak of the R-wave to initial apposition of the mitral valve against the interventricular septum(R-SAM interval ; 222+/-32 msec) and left ventricular posterior wall thickness(LVPWT; 1.1+/-0.5mm) were observed on mitral valve and left ventricular M-mode echocardiograms and peak flow velocity in the left ventricular outflow(V-LVOT; 3.5+/-1.5 m/sec) was measured from the Doppler echocardiograms of the left ventricular outflow tract. V-LVOT was correlated significantly with degree of mitral-septal apposition(r=-0.70, p<0.05), duration of mitral-septal apposition(r=0.74, P<0.05), R-SAM interval(r=-0.80, p<0.05) and LVPWT(r=0.78, p<0.05). These results suggest that the closer apposition of mitral valve against interventricular septum, the more prolonged mitral-septal apposition, the earlier onset of SAM of the mitral valve and the thicker the left ventricular posterior wall, the more increase the LV outflow pressure gradient in HOCM.
Cardiomyopathy, Hypertrophic* ; Heart Ventricles ; Humans ; Mitral Valve*

BACKGROUND: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with communityacquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of .dying of severe community-acquired pneumonia. METHODS: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. RESULTS: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnea, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+)cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Save patients death(70%) occured after admission within the first five days, and a mean duration of hospitalization was 11.2 days. CONCLUSION: As the results show most death occured within the first days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.
Adult ; Anoxia ; Anti-Bacterial Agents ; Azotemia ; Cyanosis ; Enterobacter ; Female ; Hope ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypotension ; Critical Care ; Korea ; Leukocytosis ; Leukopenia ; Male ; Medical Records ; Mortality ; Patients' Rooms ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Insufficiency ; Retrospective Studies ; Sputum ; Tachypnea ; Vancomycin

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography

BACKGROUND: This study investigated the effects of total knee arthroplasty (TKA) on bone mineral density (BMD) of the proximal femur in patients who underwent the procedure. METHODS: Forty-eight patients scheduled to undergo unilateral TKA because of primary knee osteoarthritis were included in this study, which was conducted at a medical center between October 2006 and October 2009. In these 48 patients, 96 hips were evaluated. Measurement of BMD was performed preoperatively and one month, three months, six months, and one year after unilateral TKA. Repeated measured analysis of variance and paired t-tests for comparison of two repeated samples were used to compare differences between time points (preoperation, one, three, six, and 12 months) and between the operative and nonoperative sides. RESULTS: Preoperatively, BMD of the femoral neck, trochanter, and total hip on the operative side were lower than on the nonoperative side; however, there was no statistical difference. BMD of both femoral neck areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both trochanter areas was significantly lower than preoperative BMD at one month and three months after TKA. BMD of both total hips was significantly lower than preoperative BMD at three months after TKA. However, no statistical differences of changes in BMD were observed between the operative and nonoperative sides at each measurement time. CONCLUSIONS: According to our results, TKA was found to affect both proximal femurs during the acute period. However, TKA did not affect a change in BMD of the proximal femur during one year postoperative.
Aged ; Arthroplasty, Replacement, Knee/*adverse effects ; Bone Density/*physiology ; Female ; Femur Neck/*physiopathology ; Follow-Up Studies ; Humans ; Male ; Middle Aged

We report two patients of generalized nonconvulsive status epilepticus (GNSE) accompanied by end-stage renal disease. Both patients were presented with impaired responsiveness and behavioral abnormalities. Continuous generalized epileptiform discharges were noted on EEG. GNSEs of our patients were responsive to benzodiazepines clinically and electroencephalographically. And they were controlled by short-term antiepileptic treatment and improvement of uremic condition. (J Korean Neurol Assoc 19(5):533~536, 2001)
Benzodiazepines ; Electroencephalography ; Humans ; Kidney Failure, Chronic* ; Status Epilepticus* ; Uremia

Pyogenic granuloma is a overzealous proliferation of a vascular type connective tissue as a result of some minor trauma and is a well circumscribed elevated, pedunculated or sessile benign inflammatory lesion of skin and mucous membrane. The clinical features of pyogenic granuloma are indicative but not specific and nearly all cases of pyogenic granulomas are superficial in nature, and there is little if any mention in the literature of these lesions producing alveolar bone even jaw bone loss. This case is somewhat unique in that the lesion was an obvious histologic pyogenic granuloma; however, it appeared to invade the mandibular bone which resulted in the loss of the adjacent teeth. A 12-year-old boy came to Seoul National University Dental Hospital with chief complaints of left facial swelling. The features obtained were as follows ; Plain radiograms showed a large well-circumscribed radiolucent lesion on left mandibular ramus area, which made severe expansion of lingual cortex and displacement of lower left 3rd molar tooth germ. Computed tomograms showed large soft tissue mass involving left masticator space with destruction of left mandibular ramus. Histologically, sections revealed loose edematous stroma with intense infiltration of inflammatory cells and proliferation of vascular channels. Also, there were focal areas of extensive capillary proliferation, bone destruction and peripheral new bone formation.
Capillaries ; Child ; Connective Tissue ; Granuloma, Pyogenic* ; Humans ; Jaw ; Male ; Mandible ; Molar ; Mucous Membrane ; Osteogenesis ; Seoul ; Skin ; Tooth ; Tooth Germ

PURPOSE: This study was aimed to evaluate the cell cycle arrest and apoptosis induction after irradiation and epidermal growth factor(EGF) treatment in three human epithelial tumor cell lines(A431, Siha, KB). MATERIALS AND METHODS: Single irradiation of 2, 5 and 10 Gy was done on three cell lines with 5.38 Gy/min dose rate using Cs-137 irradiator at room temperature. Also, EGF of 10 ng/ml was added immediately after 10 Gy irradiation. Cell growth was evaluated by counting the living cell number using a hemocytometer at 1 day, 2 days, 3 days, 4 days and 5 days after irradiation. Cell cycle arrest and apoptosis induction were assayed with the flow cytometry at 8 hours, 12 hours, 1 day, 2 days, 3 days, 4 days and 5 days after irradiation. RESULTS: Growth of irradiated three cell lines were inhibited in proportion to radiation dose. EGF treatment after irradiation showed various results according to cell lines. On all cell lines, G2 arrest was detected after 8 hours and maximized after 12 hours or 1 day. Amount of G2 arrest was positively dose dependent. But, EGF showed no significant change on G2 arrest. G2 arrest was recovered with time at 2 Gy and 5 Gy irradiation. But, at 10 Gy irradiation, G2 arrest was continued. Apoptosis was detected at 10 Gy irradiation. On EGF treated group after irradiation, A431 and Siha cell lines showed slightly increased apoptosis but there was no statistically significant difference. KB cell line showed no marked change of apoptosis induction. CONCLUSION: Irradiation effects cell cycle arrest and apoptosis induction in three human epithelial tumor cell lines but epidermal growth factor doesn't effect change of cell cycle arrest and apoptosis induction.
Apoptosis* ; Cell Count ; Cell Cycle Checkpoints ; Cell Cycle* ; Cell Line ; Cell Line, Tumor* ; Epidermal Growth Factor* ; Flow Cytometry ; Humans* ; KB Cells

Background: Long-term care insurance for the elderly has been stably established along with the quantitative expansion of long-term care facilities. Indeed, the need for a paradigm about human rights-based service approach is being raised throughout society from a service perspective. Therefore, this study aimed to analyze the association between elderly human rights awareness and quality of service by considering human rights education as a moderate variable. Methods: This study conducted surveys with 138 caregivers working in long-term care facilities located in Seoul and Gangwon.General characteristics, awareness of human rights, and the level of service quality were examined using descriptive statistics, frequency analysis, and correlation analysis. And multi-variable linear regression with a hierarchical framework was employed. These analyses were performed using IBM SPSS ver. 25.0. Results: Of the 138 caregivers, 97.1% were female, 87.7% were more than 50 years old, and most of their education level was high-school graduates. Their length of employment ranged from more than 5 years to less than 10 years. The level of awareness regarding elderly human rights of the elderly was below normal (mean=2.21), but the quality of service was high (mean=4.21), and the need for human rights education was also high (mean=4.28). Among the general characteristics, the length of employment was significantly associated with awareness of elderly human rights. Moreover, political rights awareness, included as sub-domains of human rights, was positively associated with quality of service. However, the moderating variable, human rights education, was not significantly associated with the quality of service. Conclusion In this study, human rights education, as a moderating variable, did not have a statistically significant effect on caregivers’ human rights awareness in relation to service quality. This finding is inconsistent with previous research results. These results can be explained by the fact that the frequency of education in long-term care facilities was a significant factor in the practice of protecting the human rights of the elderly. Therefore ongoing encouragement for the frequency of current human rights education and improvements in the educational approach appear to be necessary. In addition, these findings reveal the need for strength of education policies and effective in-depth research about human rights and quality of service to respect the human rights of the elderly.

Recently the incidence of Group B streptococcus (Streptococcus agalactiae) infection has been increased in nonpregnant adults, especially including the elderly and those with underlying diseases. One year ago, a 72-year-old diabetic woman underwent both total knee replacement and then received intermittently acupuncture due to both knee pain. Five days ago, she developed painful swelling on right knee joint. The synovial fluid showed leukocytosis (WBC 8,200/mm3), she was diagnosed as prosthetic joint infection, and treated with cefazolin. Her condition was rapidly aggravated despite of antibiotics therapy, open debridement and drainage was performed. But she expired due to sepsis. Both blood and synovial fluid culture yielded S. agalactiae. We reported a case of prosthetic knee joint infection caused by S. agalactiae.
Acupuncture ; Adult ; Aged ; Anti-Bacterial Agents ; Arthroplasty, Replacement, Knee ; Cefazolin ; Debridement ; Drainage ; Female ; Humans ; Incidence ; Joints ; Knee ; Knee Joint ; Leukocytosis ; Sepsis ; Streptococcus ; Streptococcus agalactiae ; Synovial Fluid

Rituximab has been shown to be effective in rheumatoid arthritis (RA) and is recommended for patients exhibiting an inadequate response to tumor necrosis factor (TNF) inhibitors. To date, there have been no reports of tuberculosis in RA patients treated with rituximab. We report the use of rituximab in a TNF inhibitor-refractory RA patient who had developed tuberculosis. A 52-year-old man with RA had been treated with adalimumab for 3 months, but failed to respond well to the treatment. He reported fever, coughing, sputum, and weight loss. He was diagnosed with pulmonary tuberculosis and started anti-tuberculosis medication. His arthritis was not controlled for despite increasing the dose of prednisolone. He was treated with rituximab without serious adverse effects. Sixteen weeks later, he demonstrated improvement with both arthritis and tuberculosis.
Antibodies, Monoclonal, Humanized ; Antibodies, Monoclonal, Murine-Derived ; Arthritis ; Arthritis, Rheumatoid ; Cough ; Fever ; Humans ; Middle Aged ; Prednisolone ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary ; Tumor Necrosis Factor-alpha ; Weight Loss ; Adalimumab ; Rituximab