No abstract available.
Mortality* ; Tuberculosis*

BACKGROUND: Cardiopulmonary exercise test is a useful test for the evaluation of the cardiovascular and respiratory systems. Obese subjects have an increased resting metabolic rate (VO2) compared to non-obese subjects and the increase is more marked during dynamic exercise, which results in the limitation of maximal exercise in obese subjects. In this study, the influence of the obesity and fat distribution on the maximal exercise capacity were evaluated. METHODS: Maximal exercise capacity was represented by maximam maximum oxygen uptake and VO2 max in the cardiopulmonary test. Obesity, total fat content and abdominal obesity(waist to hip ratio, WHR) were measured by bioelectrical impedence method. Total of 42 volunteers(male 22, female 20) were evaluated. RESULTS: 1) Weight to height ratio(mean±SD) was 110%±14.9% in men and 100±11.1% in women. 2) Fat ratio(mean±SD) was 23.3±5.2% in men and 27.55±3.9% in woman. 3) Waist to hip ratio(mean±SD) was 0.85±0.04 in men and 0.8±0.03 in woman. 4) In men, VO2max/min/Kg was negatively correlate with obesity, fat ratio, and abdominal fat distribution. 5) In woman, VO2max/Kg was negatively correlated with obesity and fat ratio, but did not show significant relationship with abdominal fat distribution. CONCLUSION: Obesity was a limiting factor for maximal exercise in both men and women. Abdominal obesity was a limiting factor for maximal exercise in men but its implication to women needs further evaluation.
Abdominal Fat ; Exercise Test* ; Female ; Hip ; Humans ; Male ; Obesity ; Obesity, Abdominal ; Oxygen ; Respiratory System

PURPOSE: To compare the precise roles of high-resolution computed tomography (HRCT) and fiberoptic bronchoscopy (FOB) in the evaluation of patients presenting with hemoptysis and to determine the optimal timing for HRCT. MATERIALS AND METHODS: The results of HRCT and FOB were compared in 23 patients (15 men, 8 women) presenting with hemoptysis. Etiologies included bronchietasis (n=4), parenchymal pulmonary tuberculosis (n=4), lung cancer (n=4), endobronchial tuberculosis (n=2), and broncholithiasis (n=2). Hemoptysis was proved to be due to miscellaneous causes in an additional three cases and to be cryptogenic in four. The diagnostic results of FOB performed before and after HRCT were compared as were those of HRCT performed within and after the first 48 hours of active bleeding. RESULTS: FOB and HRCT offered a correct diagnosis in 39% and 65% of cases, respectively (p=0.005). HRCT demonstrated three cases of bronchiectasis and three of parenchymal pulmonary tuberculosis which were beyond the range of a bronchoscope. In two of five cases in which HRCT findings were nonspecific, chondromatous hamartoma and lung cancer were confirmed by FOB. In cases where HRCT was performed prior to FOB, the latter demonstrated the location and diagnosis in 82% and 47% of cases, respectively (p=0.303) ; when HRCT was performed after FOB, HRCT was correct in 67% and 17% of cases, respectively (p=0.178). In none of three cases (0%) in which HRCT was performed during the first 48 hours of active bleeding did the procedure allow a specific diagnosis. In 15 of 20 (75%) cases in which HRCT was performed after the first 48 hours, however, the diagnosis provided by CT was correct. CONCLUSION: The results of this study suggest that in patients presenting with hemoptysis, both HRCT and FOB should be used for evaluation, since they are diagnostically complementary. FOB is more useful for the diagnosis of endobronchial lesion, and HRCT for bronchiectasis and parenchymal pulmonary tuberculosis. If, in cases of hemoptysis, initial diagnosis is attempted within the first 48 hours of active bleeding, FOB should be the initial step, and HRCT images should not be obtained until active bleeding has been shown on plain chest radiograph to have abated. If this initial approach takes place after the first 48 hours of active bleeding, FOB and HRCT are equally suitable.
Bronchiectasis ; Bronchoscopes ; Bronchoscopy* ; Diagnosis ; Hamartoma ; Hemoptysis* ; Hemorrhage ; Humans ; Lung Neoplasms ; Male ; Radiography, Thoracic ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Many clinical measures have been used to assess fall risk in elderly adults. The first objective of this study was to assess the clinical availability of maximal step length (MSL) as a measurement predicting falling probability in future. The second objective of this study was to try to find out how to use MSL more easily in a clinical setting. METHODS: The study population consisted of 50 community-dwelling people (> or =60 yrs). Demographic data were reviewed by self-recorded questionnaire and MSL, US and TUG had been done when the subjects visited a clinic in March and April 2004. They revisited the clinic after one year and information of fall incidence was obtained and their visual acuity was examined. To examine the association between many performance tests (MSL Unipedal stance, Timed up and go) and their real falling after tests, we analysed data by Mann-Whitney rank Test, pearson correlation and multiple regression. RESULTS: The average MSL predicted future falling (P-value 0.025), but Unipedal stance, Timed up and go did not. The predicting ability of MSL was preserved using many MSL measures (average MSL corrected by leg length and height, one direction measure among six directions of MSL, and average of left and right three directions of MSL). CONCLUSION: This study showed that MSL had the ability to predict elderly adults' falling in future. And this study showed that MSL can be used more easily in a clinical setting.
Adult ; Aged ; Humans ; Incidence ; Leg ; Visual Acuity ; Surveys and Questionnaires

BACKGROUNG: Continuous air leakage through chest tube after lung surgery may increase pt's hospital stay and lead to many complications including empyema etc. Chemical pleurodesis has frequently been used for prevention of air leakage. Therefore, we performed chemical pleurodesis using diluted fibrin glue in patients with continuous air leakage and observed the effects and efficiency of treatment. MATERIAL AND METHOD: From September, 2001 to August, 2005, 16 patients whose continuous air leakage lasted more than 7 days underwent chemical pleurodesis with diluted fibrin glue. The effects of treatment, complications and recurrences were reviewed. Dissolved fibrinogen 1.0 g and aprotinin 500,000 KIU were mixed in a 50 cc syringe (Mixed solution A). And dissolved thrombin 5,000 IU and Calcium chloride 600 mg were mixed in a 50 cc syringe (Mixed solution B). Cefazolin 1.0 g was mixed in a 50 cc syringe (Mixed solution C). Rubber tube was inserted between the chest tube and the collecting bottle. An inserted rubber tube was positioned 60cm above the patient and forming a loop appearance was done. Mixed solutions A, B and C were injected into the highest rubber tube. RESULTS Continuous air leakages disappeared in all 16 patients at next day. Chest tubes were removed after 3 days in all patients. Complications were chest pain in 12 patients (75%), leukocytosis in 14 patients (88%), fever and chill in 14 patients (88%). All complicaitons were transient and disappeared without specific treatment. CONCLUSION: Our findings demonstrated that diluted fibrin glue chemical pleurodesis was effective in patients with continuous air leakage lasting more than 7 days. Diluted fibrin glue chemical pleurodesis had good results with acceptable complications. Long term follow-up is necessary to evaluate the accurate effects of treatment and recurrence in a large number of patients.
Aprotinin ; Calcium Chloride ; Cefazolin ; Chest Pain ; Chest Tubes ; Empyema ; Fever ; Fibrin Tissue Adhesive* ; Fibrin* ; Fibrinogen ; Humans ; Length of Stay ; Leukocytosis ; Lung* ; Pleurodesis ; Recurrence ; Rubber ; Syringes ; Thrombin ; Tissue Adhesives

BACKGROUND AND OBJECTIVES: Because the exercise treadmill test (ETT) based on ST-segment analysis is limited due to low sensitivity and specificity, there has been an interest in the additional analysis of high-frequency components of QRS (HFQRS) for the detection of coronary artery disease (CAD). We sought to evaluate the feasibility and clinical usefulness of HFQRS analysis during exercise stress echocardiography (ESE). SUBJECTS AND METHODS: We evaluated 175 patients (age 57+/-9,118 men) who performed ESE and either coronary computed tomographic angiography or coronary angiography. ETT was performed using the HyperQ stress system for both conventional ST-segment analysis and HFQRS intensity analysis. RESULTS: Thirty-two patients (31%) had significant CAD. The sensitivity and specificity of HFQRS analysis were 68.8% and 74.8%, respectively. The combined model, including HFQRS analysis and ESE, provided the best diagnostic accuracy, with the area under the receiver-operating characteristics curve (AUC) of 0.948 {95% confidence interval (CI)=0.913-0.984} compared with ST-segment analysis (AUC 0.679, 95% CI=0.592-0.766). CONCLUSION: HFQRS analysis during ESE is feasible and may provide additional diagnostic information for the detection of significant CAD.
Angiography ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography, Stress* ; Electrocardiography* ; Exercise Test* ; Humans ; Myocardial Ischemia* ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Undifferentiated(embryonal) sarcoma of the liver developing predominantly in the late childhood is extremely rare in malignant hepatic tumors. It has been described by a variety of terms such as malignant mesenchymoma, embryonal sarcoma, fibromyxosarcoma, embryonal rhabdomyosarcoma or primary sarcoma of the liver. The tumor usually presents a huge mass containing solid and sometimes cystic components, and is cmposed of large stellate and spindle cells in an abundant myxoid matrix. The treatment of choice is surgical resection with or without adjuvant chemotherapy and/or radiotherapy, but the prognosis of this disease has been reported extremly poor. We experienced a case of undifferentiated(embryonal) sarcoma of the liver recently which was confirmed by pathological examinations in a 18-year-old boy. He visited our hospital for examination of the progressive growing RUQ abdominal mass detected incidentally. On physical examination, a firm, non-tender, hard, fixed, huge, abdominal mass was palpated in the right upper quadrant of abdomen. Abdominal ultrasonography, computerized tomography and magnetic resonance imaging showed a 10x15cm sized mass confined to the left lobe of the liver, and it was hypovascular mass on angiography. We performed left lobectomy including the tumor and it was confirmed as undifferentiated (embryonal) sarcoma of the liver by pathologic examination. We herein report this case including histologic, electronmicroscopic and flow cytometric results with the review of literatures.
Abdomen ; Adolescent ; Angiography ; Chemotherapy, Adjuvant ; Humans ; Liver* ; Magnetic Resonance Imaging ; Male ; Mesenchymoma ; Physical Examination ; Prognosis ; Radiotherapy ; Rhabdomyosarcoma, Embryonal ; Sarcoma* ; Ultrasonography

Authors analysed and present the results of CT in evaluating preoperative staging, of non-Small cell lungconcer, especially focusing mediastinal lymph node metastasis and direct invasion to the mediastinum or chestwall. All 28 cases were thoroughly assessed by open thoracotomy and mediastinoscopy in Seoul Natinal UniversityHospital during recent 3 years. The results are as follows: 1. 26 cases were male and 2 cases were female withpeak age incidence of 6th decade. 2. Histopathological type were 20 cases of squamous cell carcinoma, 6 cases ofadenocarcinoma, 1 case of undifferentiated large cell carcinoma and 1 case of adenosquamous cell carcioma. 3.Overall prevalence rate of mediastinal lymph node metastasis was 37%. Prospective metastatic lymph node evaluationusing 15mm size criterior revealed sensitivity 56%, specificity 92%, accuracy 76%. Retrospective analysis using10mm size criterior revealed sensitivity 90%, specificity 53%, accuracy 67%, while the results of 15mm sizecirterior were sensitivity 60%, specificity 88%, accuracy 78%. 4. Plotted ROC curve with 109 mediastinal lymphnodes suggested optimum size criterior of metastasis being between 10mm and 15mm in diameter. 5. Prevalence rateof direct mediastinal or chest wall invasion was 31%. Results of CT interpretation concerning direct mediastinalor chest wall invasion revealed sensitivity 63%, specificity 100%, accuracy 88%. Authors believe from the basis ofthese results that CT palys unique and reliable role in preoperative staging of non-small cell carcinoma of lungand emphasize CT should be a routine preoperative staging work up.
Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Female ; Humans ; Incidence ; Lymph Nodes ; Male ; Mediastinoscopy ; Mediastinum ; Neoplasm Metastasis ; Prevalence ; Prospective Studies ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Seoul ; Thoracic Wall ; Thoracotomy

It is uncommon for Fabry's disease (FD) patient to present with an isolated ischemic stroke without other typical symptoms or signs of FD. A 48-year-old woman presented with recurrent limb weakness and her brain magnetic resonance imaging revealed multiple ischemic brain lesions. Ten years ago, the patient had been diagnosed with heterozygote FD by the genetic test, but she had not shown any typical symptoms or sign of FD so far. Isolated organ involvement could occur in heterozygote FD.
Brain ; Brain Ischemia ; Extremities ; Fabry Disease ; Female ; Heterozygote ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Stroke

BACKGROUND: In hypertrophic cardiomyopathy(HCM), which is known as genetic disease, severity and location of left ventricular hypertrophy(LVH) is variable. So we investigated additional modify role of angintensin-I converting enzyme(ACE) gene, which is known to be implicated in cardiac hypertrophy. ACE genotypes and degree of hypertrophy were determined in each subject. METHOD: 172 patients(37 HCM, 26 normotenisve LVH, 19 hypertenisve LVH, 79 normal control) were included in this study. Left ventricular mass index(LVMI) was calculated from electrocardiogram by Rautaharju equation, and LVH was defined as LVMI is above 131g/m2 in male or above 110g/m2 in female. In HCM group, extent of left ventricular hypertrophy was also assessed by Wigle's method. DNA was extracted from peripheral blood and ACE I/D polymorphism was confirmed by PCR method. RESULTS: Frequency of D/D genotype is significantly higher in normotensive LVH group(0.231) and in HCM group(0.243) than normal control group(0.076)(Fisher's exact test, p<0.05). There was no significant difference in genotype frequency between other groups. The mean LVMI(g/m2) and Wigle's LVH score was significantly higher in DD than II and ID(259.8+/-156.4g/m2 vs 176.6+/-56.2g/m2, p<0.05, t-test, 7.82+/-2.4 vs 5.35+/-1.9, p<0.05, Mann-Whitney test). LVMI and LVH score also exhibited increasing tendency toward II, ID DD genotypes. CONCLUSION: D allele of ACE gene contribute to the development of cardiac hypertrophy in HCM as well as normotensive LVH.
Alleles ; Cardiomegaly ; DNA ; Electrocardiography ; Female ; Genotype ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Male ; Polymerase Chain Reaction