BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.
Aged ; Aging ; Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiovascular Diseases ; Cause of Death ; Chest Pain ; Coronary Disease ; Delivery of Health Care ; Diagnosis ; Hospital Mortality ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Pulmonary Edema ; Risk Factors ; Stroke ; Thrombolytic Therapy

Heterotopic pregnancy occurs when an intrauterine pregnancy co-exists with an ectopic pregnancy. It is a potentially fatal condition, rarely occuring in natural conception cycle. But its incidence is increased since the rise in PID, pelvic surgery, IUD, and advent of assisted reproductive technology involving use of superovulatory drugs and/or in vitro-fertilization. We present a case of intrauterine twin pregnancy and right tubal pregnancy following treatment with in vitro-fertilization. The right tubal pregnancy was diagnosed after rupturing at 6th gestational weeks, and resected via laparoscopy. And healthy twin babies were delivered without complication at 38th gestational week. So we report this case with a brief review of the literatures.
Female ; Fertilization ; Humans ; Incidence ; Laparoscopy ; Pregnancy ; Pregnancy, Ectopic ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Pregnancy, Twin ; Reproductive Techniques, Assisted

Recently, laser treatment of benign prostatic hyperplasia (BPH) is considered as a promising alternative to traditional transurethral resection of the prostate (TURP). To evaluate the effectiveness and safety of laser therapy on BPH, we compared the results of transurethral balloon laser thermotherapy (TUBALT, n=13) and Hybrid laser prostatectomy (HLP, n=21) with those of TURP (n=25) in 58 patients with mild and moderate BPH. Following data were evaluated at postoperative 1, 3 and 6 months : AUA symptom score (SS), maximal flow rate (Qmax), subjective symptom improvement (SI), postoperative complications. All 3 groups show significant improvement after treatment in the Qmax values. Among 3 groups, the Qmax value was lower in TUBALT group (12.9+/-3.3 ml/sec) than those in HLP group (15.5+/-5.2 ml/sec) and TURP group (18.7+/-5.3 ml/sec) on postoperative 6 months. The Qmax values were not significantly different between HLP and TURP groups. In the SS values, all 3 groups show significant improvement after treatment and, TUBALT (9.9+/-9.7) and HLP (10.3+/-9.4) group were comparable to TURP group (5.2+/-4.2) on postoperative 6 months. In global assessment of SI, both HLP (87.5%) and TUBALT (75%) group were also comparable to TURP (90%) group on postoperative 3 months. but TUBALT group showed delayed symptom improvement compared to TURP group. Postoperative complications were minimal both in HLP and TUBALT groups, compared to TURP group. These results suggest that both HLP and TUBALT are effective in mild and moderate BPH, Further more, HLP treatment could be considered a promising alternative to TURP.
Humans ; Hyperthermia, Induced* ; Laser Therapy ; Postoperative Complications ; Prostate ; Prostatectomy* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate

BACKGROUND: Disparities of Minor H antigens can induce graft rejection after MHC-matched transplantation. H60 has been characterized as a dominant antigen expressed on hematopoietic cells and considered to be an ideal model antigen for study on graft-versus-leukemia effect. METHODS: Splenocytes from C57BL/6 mice immunized with H60 congenic splenocytes were used for establishment of H60-specific CTL clones. Then the clones were characterized for proliferation capacity and cytotoxicity after stimulation with H60. Clone #14, #15, and #23 were tested for the TCR binding avidity to H60-peptide/H-2Kb and analyzed for TCR sequences. RESULTS: H60-specific CTL clones showed different levels of proliferation capacity and cytotoxic activity to H60-stimulation. Clones #14, #15, and #23 showed high proliferation activity, high cytotoxicity, and low activities on both aspects, respectively, and have TCRs with different binding avidities to H60-peptide/H-2Kb with t 1/2 values of 4.87, 6.92, and 13.03 minutes, respectively. The TCR usages were Valpha12D-3-01+Jalpha11-01 and Vbeta12-1-01+Dbeta1-01+J2-7-01 for clone #14, Valpha13D-1-02+Jalpha34-02 and Vbeta13-1-02+Dbeta2-01+Jbeta2-7-01 for clone #15, and Valpha16D+Jalpha45-01 and Vbeta12-1-01+Dbeta1-01+Jbeta2-5-01 for clone #23. CONCLUSION: The results will be useful for modeling GVL and generation TCR transgenic mouse.
Animals ; Clone Cells ; Graft Rejection ; Histocompatibility ; Histocompatibility Antigens ; Mice ; Mice, Transgenic ; Transplants

Metabolomics has been used as a powerful tool for the analysis and quality assessment of the natural product (NP)-derived medicines. It is increasingly being used in the quality control and standardization of NP-derived medicines because they are composed of hundreds of natural compounds. The most common techniques that are used in metabolomics consist of NMR, GC-MS, and LC-MS in combination with multivariate statistical analyses including principal components analysis (PCA) and partial least squares-discriminant analysis (PLS-DA). Currently, the quality control of the NP-derived medicines is usually conducted using HPLC and is specified by one or two indicators. To create a superior quality control framework and avoid adulterated drugs, it is necessary to be able to determine and establish standards based on multiple ingredients using metabolic profiling and fingerprinting. Therefore, the application of various analytical tools in the quality control of NP-derived medicines forms the major part of this review. Veregen® (Medigene AG, Planegg/Martinsried, Germany), which is the first botanical prescription drug approved by US Food and Drug Administration, is reviewed as an example that will hopefully provide future directions and perspectives on metabolomics technologies available for the quality control of NP-derived medicines.
Chromatography, High Pressure Liquid ; Dermatoglyphics ; Metabolomics* ; Prescriptions ; Quality Control* ; United States Food and Drug Administration

PURPOSE: Mycoplasma pneumoniae is one of the most common causes of pneumonia in children and adolescents. Though cold agglutinin test and specific antibody test are used in the diagnosis of mycoplasma pneumonia, there are some limitations in early diagnosis. In this study, we evaluated the availability and usefulness of polymerase chain reaction (PCR) in the diagnosis of M. pneumoniae pneumonia and compared it with serologic test. METHODS: One hundred twenty four children who were clinically diagnosed with pneumonia and admitted to Kyunghee Hospital from January 1998 to March 2001 were enrolled. Mycoplasma specific antibody test using commercial kit (Serodia-MYCO II, Fusirebio Inc., Tokyo, Japan) and PCR using mycoplasma DNA obtained from throat swabs were done. The sensitivity and specificity of PCR were evaluated. RESULTS: M. pneumoniae pneumonia was diagnosed when the mycoplasma specific antibody titer was over 1: 160 or when the titer increased more than fourfold during follow-up period. The specificity, sensitivity, false-positive rate and false-negative rates of PCR were 93.0%, 58.3%, 33.3%. and 9.7%, respectively. CONCLUSION: PCR has shown high specificity. But, the positive result in PCR don't correlate with the disease activity and PCR does not have high sensitivity. So PCR must be used alongside with serologic test in the diagnosis of pneumonia. But, it seems possible to improve sensitivity by delicate handling of samples and by improving PCR technology, and PCR will possibly be used in the diagnosis of early infections of M. pneumoniae pneumonia and in the evaluation of treatments in the future.
Adolescent ; Child* ; Diagnosis ; DNA ; Early Diagnosis ; Follow-Up Studies ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Serologic Tests

Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor's suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient's inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.
Adult ; Aneurysm, False ; Cadaver ; Deception ; Donor Selection ; Emergencies ; Hepatic Artery ; Humans ; Intracranial Hemorrhages ; Laparotomy ; Ligation ; Liver Diseases ; Liver Transplantation* ; Liver* ; Pliability ; Rupture ; Situs Inversus* ; Tissue Donors ; Transplants ; Vena Cava, Inferior ; Viscera

BACKGROUND: Percutaneous mitral balloon valvuloplasty (PMV) has been proposed as an alternative to surgery for selected patients with symptomatic mitral stenosis. The presence of mild mitral regurgitation (MR) in mitral KERN=5535>stenosis is usually not considered as a contraindication for the procedure. But, the results of PMV in the subgroup KERN=>of patients with concomitant mild MR are unknown. Accordingly, this study evaluates the clinical outcome of a consecutive series of patients with mitral stenosis and mild MR undergoing PMV. METHODS: Between August 1992 and December 1996 we attempted to dilate the mitral valves of 43 consecutive patients with symptomatic mitral stenosis. Mean age of the group was 45.9+/-10.6 years and 37 patients were women. They were divided into two groups according to the presence or absence of mild MR before the procedure. Clinical feature, inital result, complication were compared. RESULTS: 1) Age, gender, symptomatic status, and atrial fibrillation were similar in both groups. 2) Patients with MR had more thickened valve (2.50+/-0.33 vs 1.84+/-0.55, p=0.048) and subvalvular tissue (2.55+/-0.73 vs 1.88+/-0.73, p=0.015), higher echocardiographic score (8.44+/-1.01 vs 7.08+/-1.65, p=0.004). 3) Mitral valve area gain on the first day after PMV was smaller in patients with MR(p=0.008). 4) The success rate of PMV, the incidence of severe MR after PMV, and the restenosis rate on 6 month were similar in both groups. CONCLUSION: Although the PMV in patients with mild MR obtained smaller increments in mitral valve area compared to those without MR, they showed similar immediate and short-term results after PMV.
Atrial Fibrillation ; Balloon Valvuloplasty* ; Echocardiography ; Female ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency* ; Mitral Valve Stenosis*

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.
Anesthesia, Spinal ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Length of Stay ; Pain, Postoperative ; Prolapse ; Surveys and Questionnaires ; Urinary Retention ; Wounds and Injuries

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.
Anesthesia, Spinal ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Interviews as Topic ; Length of Stay ; Pain, Postoperative ; Prolapse ; Surveys and Questionnaires ; Urinary Retention ; Wounds and Injuries