BACKGROUND: Intravascular ultrasound (IVUS) is one of the golden standards for the assessment of optimal angioplasty. Pressure-derived myocardial fractional flow reserve (FFRmyo) is a lesion-specific functional index of epicardial conduit and may be particularly useful for the assessment of optimal coronary angioplasty. The purpose of this study was to assess IVUS parameters and FFRmyo after successful angioplasty on coronary angiogram and compare them between balloon and stent group. METHODS: The study population consisted of 28 patients who underwent revascularization (14 cases of balloon angioplasty only, 14 cases of angioplasty with stent) from Jan. 1999 to Aug. 2000 at Inha University Hospital. After successful angioplasty on coronary angiogram, we measured minimal luminal diameter (MLD), minimal luminal area (MLA), lesion area stenosis (l-AST) and reference area stenosis (r-AST) with IVUS imaging. And we calculated FFRmyo from the ratio of mean coronary pressure distal to the stenosis (Pd) to the aortic mean pressure (Pa) during maximum coronary hyperemia (Pd/Pa). RESULTS: There was significant difference of MLD (2.2+/-0.4 vs 2.6+/-0.3), MLA (4.4+/-1.1 vs 6.4+/-1.7), r-AST (43.7+/-9.2 vs 29.8+/-9.4) and FFRmyo (0.89+/-0.07 vs 0.93+/-0.03) between balloon and stent group. All IVUS parameters (MLD, MLA, r-AST) are well correlated with FFRmyo after angioplasty (r=0.52, p<0.05, r=0.48, p<0.05 and r=-0.72, p<0.05 respectively). By multiple regression analysis, r-AST showed the best correlation with FFRmyo among IVUS parameters. CONCLUSION: Coronary angioplasty with stent showed more favorable MLD, MLA, r-AST and FFRmyo than balloon angioplasty. FFRmyo may be seemed to be alternative to IVUS for estimating the result of coronary angioplasty.
Angioplasty* ; Angioplasty, Balloon ; Constriction, Pathologic ; Fractional Flow Reserve, Myocardial ; Humans ; Hyperemia ; Phenobarbital ; Stents ; Ultrasonography*

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the important features. The main reason for underdiagnosis is thought to be a low frequency in complaining of symptoms due to the reduction of intellectual recognition and physical activity. Among the various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreased complaints for wheezing are also noted in elderly asthmatics. The objective of this study is to determine if less complaints of wheezing in elderly asthmatic is due to a decrease in the development of wheezing. METHODS: 61 young (20-39 years old), 68 middle-aged (40-59 years old) and 65 elderly (older than 60 years old) stable asthmatic subjects were studied (each group shall be called, hereafter, Young Group, Middle-aged Group and Old Group, respectively). During the methacholine induced airway narrowing, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted in 194 asthmatics. RESULTS: One hundred and sixty-nine patients (87%) developed wheezing during the methacholine induced airway obstruction. The frequency of wheezing during the methacholine challenge was found to be comparable among the groups. The methacholine concentration, % fall in FEV1, and FEV1 levels of the initial detection of wheezing were not different among the groups. Among the patients who developed wheezing, 47 patients (77%), 42 patients (61.8 %) and 26 patients (40%) complained of wheezing in Young, Middle and Old Group, respectively. CONCLUSION: In conclusion, the decreased perception of wheezing is a main factor for the low frequency of complaints of wheezing in elderly asthmatics.
Adult ; Age Factors ; Aged ; Analysis of Variance ; Asthma/*complications/diagnosis ; Chi-Square Distribution ; Comparative Study ; Female ; Human ; Male ; Middle Age ; Perception ; Respiratory Sounds/*etiology

Henoch-Sch nlein purpura is a systemic small-vessel IgA dominant vasculitis involoving the capillaries, arterioles, or venules. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement, all of which can occur in any order and at any time over several days to weeks. The central nervous system and lungs may be involved. The gastrointestinal tract is involved in more than 50 percent of patients, manifested most commonly by abdominal pain and gastrointestinal bleeding. And rarely may occur intussusception, bowel nerosis, perforation and intramural hematoma of the duodenum. We report a case of intramural hematoma of the duodenum with Henoch-Sch nlein purpura in 48 year old female patient which was demostrated by upper gastrointestinal endoscopy, abdominal CT scan, hypotonic duodenography and histologic finding of duodenal biopsy. She was treated with supportive care and improved rapidly without any serious gastrointestinal complications.
Abdominal Pain ; Arterioles ; Arthralgia ; Biopsy ; Capillaries ; Central Nervous System ; Duodenum ; Endoscopy, Gastrointestinal ; Exanthema ; Female ; Gastrointestinal Tract ; Hematoma* ; Hemorrhage ; Humans ; Immunoglobulin A ; Intussusception ; Lung ; Middle Aged ; Purpura* ; Tomography, X-Ray Computed ; Vasculitis ; Venules

Endobronchial tuberculosis is defined as a specific inflammation of the trachea or major bronchi caused by the tubercle bacillus. It is recognized as one of the most common and serious complication of pulmonary tuberculosis. A diagnosis of endobronchial tuberculosis is difficult due to the diversity of radiological patterns. But, it is still relatively common disease in korea. Endobronchial tuberculosis as a cause of the acute respiratory distress syndrome (ARDS) is quite rare. The mortality rate of ARDS is still high in korea. The detection and early elimination of the causes for ARDS at the initial stage can result in a more favorable prognosis. So, patients with ARDS, especially due to endobronchial tuberculosis or other form of tuberculosis, should be treated with antituberculous drugs as soon as possible. We experienced a young female with complaints of sudden onset dyspnea, mild fever. In this case the clinical features, laboratory data and radiologic findings allowed an initial presentation of ARDS. The ARDS was defined by the American-Europian Consensus Conference 19921-3). The cause of ARDS was revealed endobronchial tuberculosis. We started antituberculosis medication and steroid injection quickly, which resulted in good prognosis. We emphasize the prognosis depends mainly on the early recognition and treatment of endobronchial tuberculosis.
Bacillus ; Bronchi ; Consensus ; Diagnosis ; Dyspnea ; Female ; Fever ; Humans ; Inflammation ; Korea ; Mortality ; Prognosis ; Respiratory Distress Syndrome, Adult* ; Trachea ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: In elderly asthmatics, underdiagnosis is one of the most important feature. The main reason of underdiagnosis is thought to be decreases in complaining of symptoms by reduction of intellectual faculties or physical activity. Among various symptoms, wheezing is the principal clue in diagnosing bronchial asthma, and decreases in wheezing complaints are also noted in elderly asthmatics. The objective of this study is to determine whether decreases in wheezing complaints in elderly asthmatic is due to decrease in the development of wheezing or decrease in the perception of wheezing. METHODS: Sixty one young(20-39 years old), 68 middle aged(40-59 years old), and 65 elderly(older than 60 years) stable asthmatic subjects were studied. During methacholine challenge test, lung auscultation and questionnaire survey about presence and perception of wheezing were conducted. RESULTS: One hundred sixty nine patients (87%) developed wheezing during the methacholine challenge test. Development of wheezing during methacholine challenge test was not different between groups. The methacholine concentration, % fall in FEV1, and FEV1% at first detection of wheezing were not different between groups. Among the patients who developed wheezing, 47 patients (90%), 42 patients (74%), and 26 patients (46%) felt wheezing in young, middle, and old age groups, respectively. CONCLUSION: In conclusion, the perception of wheezing are more decreased in elderly asthmatics compared to those in younger patients.
Aged* ; Asthma ; Auscultation ; Humans ; Lung ; Methacholine Chloride ; Motor Activity ; Respiratory Sounds* ; Surveys and Questionnaires

Dengue fever/dengue shock syndrome is an acute febrile illness caused by a Flaviviridae virus. Dengue virus infection can cause a wide spectrum of illness, and disease is characterized by sudden onset of high fever, chill, severe headache, skin rash, general malaise and thrombocytopenia with hemoconcentration. Dengue fever is endemic in most tropical areas of world, including the Caribbean, Central and South America, Africa, and Southeast Asia. Tourists to these areas are liable to infection. We experienced a Korean female who returned to Korea from Myanmar in severely ill state. She was confirmed serologically to be inblieted with Dengue shock syndrome. In spite of intensive medical care, she died of Dengue shock syndrome. We emphasize that favorable prognosis depends mainly on the early recognition and treatment of shock.
Africa ; Asia, Southeastern ; Caribbean Region ; Dengue Virus ; Dengue* ; Exanthema ; Female ; Fever ; Flaviviridae ; Headache ; Humans ; Korea ; Myanmar* ; Prognosis ; Severe Dengue* ; Shock ; South America ; Thrombocytopenia

Dengue fever/dengue shock syndrome is an acute febrile illness caused by a Flaviviridae virus. Dengue virus infection can cause a wide spectrum of illness, and disease is characterized by sudden onset of high fever, chill, severe headache, skin rash, general malaise and thrombocytopenia with hemoconcentration. Dengue fever is endemic in most tropical areas of world, including the Caribbean, Central and South America, Africa, and Southeast Asia. Tourists to these areas are liable to infection. We experienced a Korean female who returned to Korea from Myanmar in severely ill state. She was confirmed serologically to be inblieted with Dengue shock syndrome. In spite of intensive medical care, she died of Dengue shock syndrome. We emphasize that favorable prognosis depends mainly on the early recognition and treatment of shock.
Africa ; Asia, Southeastern ; Caribbean Region ; Dengue Virus ; Dengue* ; Exanthema ; Female ; Fever ; Flaviviridae ; Headache ; Humans ; Korea ; Myanmar* ; Prognosis ; Severe Dengue* ; Shock ; South America ; Thrombocytopenia

Mitochondrial myopathies are diseases caused by defects in metabolic pathway of mitochondria. Mitochondrial myopathy is known as one of the causes of recurrent myoglobinuria, while clinically, rarely causes acute renal failure requiring medical treatments. We report a case of rhabdomyolysis and acute renal failure associated with mitochondrial myopathy. A 58-year-old male was presented with dyspnea and hypotensive shock. The patient had a history of recurrent dark colored urine and cramping leg pain after prolonged fasting. Laboratory findings showed hyperkalemia, azotemia, metabolic acidosis, and elevated AST, ALT, and creatinine kinase. He had no history of trauma or medication. Muscle biopsy showed "ragged red fibers" in modified Gomori staining. On electron microscope, increased number of mitochondria and abnormal mitochondria were seen. He received hemodialysis and his renal function recovered after 1 month.
Acidosis ; Acute Kidney Injury* ; Azotemia ; Biopsy ; Creatinine ; Dyspnea ; Fasting ; Humans ; Hyperkalemia ; Leg ; Male ; Metabolic Networks and Pathways ; Middle Aged ; Mitochondria ; Mitochondrial Myopathies* ; Muscle Cramp ; Myoglobinuria ; Phosphotransferases ; Renal Dialysis ; Rhabdomyolysis* ; Shock

BACKGROUND: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease of unknown etiology. The disease is relatively common in western countries, but so far, only about 20 cases have been reported in Korea. Thus, the purpose of our prospective study was to evaluate the clinical characteristics of PBC in Korea. METHODS: Between October 1994 and February 1999, 16 patients diagnosed as PBC at our department were enrolled in this study. We analyzed these patients for the distribution of age and sex, initial symptoms and signs, associated disorders, laboratory, endoscopic, and radiologic and histologic findings. RESULTS: Of the 16 patients, the ratio of male to female was 1:7 and the average age was 57.5 years. Pruritus (37.5%) was the most frequent presenting symptom followed by xerostomia and xerophthalmia (12.5%), jaundice (6.3%), chronic fatigue (6.3%), melena (6.3%). Associated disorders were Sj gren's syndrome (25%), arthropathy (12.5%), Raynaud's phenomenon (6.3%) and diabetes (6.3%). Abnormalities of liver function were found frequently. Antimitochondrial antibody (100%), antinuclear antibody (31.25%) and rheumatoid factor (31.25%) were found. Long-term administration of UDCA improved both clinical and biochemical signs in most patients, however, 2 patients experienced exacerbation during UDCA therapy. CONCLUSIONS: We experienced 16 cases of PBC within a short period. It is expected that we can find these patients more frequently if we suspect this disease in patients with pruritus and unexplained obstructive pattern of liver function abnormality.
Antibodies, Antinuclear ; Fatigue ; Female ; Hemolytic-Uremic Syndrome ; Humans ; Jaundice ; Korea ; Liver ; Liver Cirrhosis, Biliary* ; Liver Diseases ; Male ; Melena ; Pancreatitis ; Prospective Studies ; Pruritus ; Rheumatoid Factor ; Xerophthalmia ; Xerostomia