Although the confirmative diagnosis of typhoid fever is by culture of the causative organism, usually from blood, a serological test is still necessary to provide a more rapid method of diagnosis. The indirect fluorescent antibody test, using a Salmonella typhi Vi antigen and a FITC-conjugated rabbit anti-human polyvalent immunoglobulin, was evaluated for the diagnosis of typhoid fever. Serum specimens were collected from patients with febrile diseases on admission. Of the 32 patients with titers of 1:64 or more, 22 were confirmed to have typhoid fever by blood culture and 7 had fever of undetermined origin that was considered to be typhoid fever clinically. Three patients were diagnosed to have salmonellosis other than typhoid fever. Of the 121 patients with titers of 1:32 or less, 105 patients had non-typhoidal febrile disease, 15 patients had fever of undetermined origin, and one patient was confirmed to have typhoid fever by blood culture. When a Vi antibody titer of 1:64 or more was taken as serological evidence for the diagnosis of typhoid fever, the sensitivity and specificity were 95.7% and 97.2%, respectively. The incidence of positive test results following fever onset was 70.0% within 1 week of fever onset, 88.9% from 1 to 2 weeks, and 100% after 2 weeks. In conclusion, the Vi-indirect fluorescent antibody test(Vi-IFAT) can be employed as a useful serologic test in the diagnosis of typhoid fever.
Antigens, Bacterial/*analysis ; Fluorescent Antibody Technique/*standards ; Human ; Salmonella typhi/immunology ; Sensitivity and Specificity ; Typhoid Fever/*diagnosis

Percuaneous mitral valvuloplasty(PMV) is an alternative to surgical mitral commissurotomy for patients with mitral stenosis. To assess the immediate and follow-up results of PMV and to identify factors in fluencing the outcome and coplications of PMV, we analyzed the clinical, echocardiographic and hemodynamic data of 108 patients who underwent PMV. 1) Good hemodynamic results were obtained in 86 patients(79.6%). The factors predicting immediate outcome of PMV were mitral valve mobility, total echoscore, and EBDA/BSA. 2) Predictors of the increase in mitral valve area by PMV were age, sex, rhythm, and NYHA functional class before PMV. The independant predictors were rhythm(p=0.008) and functional class(p=0.002). 3) The degree of mitral regurgitation increased in 26 patients(24%), did not changed in 79 patients(73%) and decreased in 3 patients(3%). The increase of MR could not predicted from any features of the clinical, echocardiographic or hemodynamic daa. The severity of MR decreased by one grade in 15% of patients and did not change in 66% of patients during follow-up. 4) Left-to-right shunt was detected in 19 patients(18%). The predictors were valve mobility, pulmonary artery pressure and pulmonary vascular resistance. 5) Follow-up catheterization(mean 14 months) identified restenosis in six of 16 patients. The predictors of restenosis were sex, total echosecore, and left atrial volume. 6) The hemodynamic data at follow-up were good compared with prePMV data(p<0.01), but follow-up miral valve area decreased than that of postPMV(p<0.05). Immediate decrease in pulmonary vascular resistance followed by progressive improvement during follow-up. 7) Immediate complications of PMV were peripheral arterial embolism in one patient(1%), pericardial effusion in two(2%), transient arrhythmia in four(4%), left-to-right shunt in nineteen(18%) and increase in the grade of MR in twenty-six(24%). This study suggests, that PMV produces excellent immediate and follow-up results and is a safe and effective procedure in the nonsurgical treatment of mitral stenosis.
Arrhythmias, Cardiac ; Echocardiography ; Embolism ; Follow-Up Studies* ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Pericardial Effusion ; Pulmonary Artery ; Vascular Resistance

Percuaneous mitral valvuloplasty(PMV) is an alternative to surgical mitral commissurotomy for patients with mitral stenosis. To assess the immediate and follow-up results of PMV and to identify factors in fluencing the outcome and coplications of PMV, we analyzed the clinical, echocardiographic and hemodynamic data of 108 patients who underwent PMV. 1) Good hemodynamic results were obtained in 86 patients(79.6%). The factors predicting immediate outcome of PMV were mitral valve mobility, total echoscore, and EBDA/BSA. 2) Predictors of the increase in mitral valve area by PMV were age, sex, rhythm, and NYHA functional class before PMV. The independant predictors were rhythm(p=0.008) and functional class(p=0.002). 3) The degree of mitral regurgitation increased in 26 patients(24%), did not changed in 79 patients(73%) and decreased in 3 patients(3%). The increase of MR could not predicted from any features of the clinical, echocardiographic or hemodynamic daa. The severity of MR decreased by one grade in 15% of patients and did not change in 66% of patients during follow-up. 4) Left-to-right shunt was detected in 19 patients(18%). The predictors were valve mobility, pulmonary artery pressure and pulmonary vascular resistance. 5) Follow-up catheterization(mean 14 months) identified restenosis in six of 16 patients. The predictors of restenosis were sex, total echosecore, and left atrial volume. 6) The hemodynamic data at follow-up were good compared with prePMV data(p<0.01), but follow-up miral valve area decreased than that of postPMV(p<0.05). Immediate decrease in pulmonary vascular resistance followed by progressive improvement during follow-up. 7) Immediate complications of PMV were peripheral arterial embolism in one patient(1%), pericardial effusion in two(2%), transient arrhythmia in four(4%), left-to-right shunt in nineteen(18%) and increase in the grade of MR in twenty-six(24%). This study suggests, that PMV produces excellent immediate and follow-up results and is a safe and effective procedure in the nonsurgical treatment of mitral stenosis.
Arrhythmias, Cardiac ; Echocardiography ; Embolism ; Follow-Up Studies* ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Pericardial Effusion ; Pulmonary Artery ; Vascular Resistance

A retrospecive clinical observation was done on 325 cases of hypertension admitted to Department of internal Medicine of Seoul Red Cross Hospital from January, 1979 to December, 1982. The following results have been obtained. 1) The observed patients were 157 males and 168 females, and the prevalence rate of malignant hypertension among 325 hypertensions was 16 cases (4.9 percent). Among 16 cases of malignant hypertension 9 cases were male and 7 cases were female. Most frequently in 50, 60 and 40 years of age in this order each sex. 2) The average admitted dates are 7 days. 27 cases (8.3percent) were readmitted above 2 times after one discharged. 3) The most freqeuntly observed duration of Known hypertension 37.9 percent was 6-10 years and the next frequently observed duration 37.4 percent was 3-5 years. 4) The highest percentage of malignant hypertension had systolic blood pressure between 190-209mmHg and diastolic blood pressure between 150-169mmHg. 5) The highest percentage of seasonal number was spring (31.1 percent) and the next autumn, summer, winter in this order and the prevalence rates of hypertention are increased average 1.9% of each year. 6) The 78.5 percent of the patients were found that their blood pressure were abnormaly high when they were examined with related symptoms on admission, and they major symptorms were headache and dizziness. 7) The physical examination on admission, tachycardia (56percent), tachypnea (15.1percent), semicoma to coma (12.9 percent) in this order. 8) The status of treatment in hypertension on admission was as follows; imtermittent treatment 54.5 percent, no treatment 31 percent and continuous treatment 14.5 percent in this order. 9) In the chest X-ray on admission, the most frequent finding was cardiomegaly, and normal finding was the next frequency. The pulmonary Tbc was noted in 12.6 percent. 10) According to the degree of fundoscopic abnormality by K-W classification stage III was 68.8 percent and stage IV was 31.2 percent. 11) Electrocardiogram abnormalities were 44.9 percent, and 87.5 percent of malignant hypertension revealed electrocardiographic abnormalities and left ventricle hypertrophy was observed in 70.5 percent. 12) Hypercholesterolemia 78 percent, Hypernatremia 69.8 percent, Hypokalemia 22.8 percent, serum chloride 34.5 percent (<95m Eg/l), BUN 53.8 percent (>20mg/dl) and creatinine 45.8 percent (>3mg/dl) on admission. 13) Proteinuria was observed in 87.5 percent of malignant hypertension. 14) Marked improved for clinically was 24 percent and mortality rate was 5.2 percent, most common cause of death are cardiovascular accident (64.7percent) and renal failure (23.5percent).
Blood Pressure ; Cardiomegaly ; Cause of Death ; Classification ; Coma ; Creatinine ; Dizziness ; Electrocardiography ; Female ; Headache ; Heart Ventricles ; Humans ; Hypercholesterolemia ; Hypernatremia ; Hypertension ; Hypertension, Malignant ; Hypertrophy ; Hypokalemia ; Internal Medicine ; Male ; Mortality ; Physical Examination ; Prevalence ; Proteinuria ; Red Cross ; Renal Insufficiency ; Seasons ; Seoul ; Tachycardia ; Tachypnea ; Thorax

PURPOSE: To compare the usefulness of double-dose contrast-enhanced CT (DDCE-CT) and conventional contrast-enhanced CT (CCE-CT) in the detection of metastatic brain lesions. MATERIALS AND METHODS: Sixteen patients with brain metastases were evaluated with both CCE-CT and thinslice DDCE-CT. For CCE-CT, an initial injection of 100 ml contrast medium was given, and DDCE-CT with both 10-mm and 5-mm thickness was performed after the addition of an extra 100 ml of contrast medium. The numbers of metastatic lesions detected by CCE-CT and by DDCE-CT were compared, as were the findings of contrast-enhanced MRI (CE-MRI) and thin-slice DDCE-CT in seven patients who underwent both these procedures. RESULTS: Fourteen metastatic brain lesions were detected by CCE-CT, 22 by 10-mm-thickness DDCE-CT, and 36 by 5-mm thickness DDCE-CT. Thus, almost 2.6 times more lesions were detected by thin-slice DDCE-CT than by CCE-CT. Metastatic lesions were detected by 10-mm-thickness DDCE-CT in 16 patients and by CCECT in seven; in five, edema only was detected, while in four there were no detectable metastases. CCE-CT detected four lesions of less than 5 mm in diameter, while 10-mm-thickness DDCE-CT and 5-mm-thickness DDCE-CT detected seven and 18 lesions, respectively. Eleven lesions were detected by thin-slice DDCE-CT and 17 by CE-MRI in the seven patients who underwent both CE-MRI and DDCE-CT. The lesions detected only by CE-MRI were less than 5 mm in diameter and were discovered in the cerebellum or inferior temporal lobe. CONCLUSION: Thin-slice DDCE-CT was superior to CCE-CT in detecting metastatic brain lesions.
Brain* ; Cerebellum ; Edema ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Temporal Lobe ; Tomography, X-Ray Computed*

Twenty-five patients underwent flexible fiberoptic bronchoscopic examination under fluoroscopic guidance. All patients had an endoscopically invisible pulmonary lesion suggestive of malignancy. A diagnostic specimen was obtained in 23 of the 25 patients (92%). A pathological finding of lung cancer was obtained in 14 patient (56%) through the transbronchial lung biopsy (12 cases) and by washing cytology (2 cases). Remaining 11 patients who were undiagnosed for pulmonary malignancy were followed by clinically had roentgenographically over 6 months. We evaluated the sensitivity and specificity of the TBLB procedures including brushing cytology and noted an 82.4% in sensitivity and 100% in specificity.
Adult ; Aged ; Biopsy/methods ; Bronchoscopy ; Female ; Fiber Optics ; Human ; Lung/pathology* ; Lung Neoplasms/pathology* ; Male ; Middle Age

The symptoms of hypertrophic cardiomyopaty frequently result from impaired left ventricular relaxation, abnormal left ventricular filling, and decreased compliance of left ventricle in spite of normal systolic function. Several studies have suggested that the assessment of transmitral flow velocity waveform with pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy provide a noninvasive and clinically useful expression of left ventricular diastolic performance. In this study, pulsed Doppler echocardiography was used to measure diastolic indices from transmitral flow velocity waveform and thereby to assess left ventricular diastolic function in 20 patients with hypertrophic cardiomyopathy (14 septal hypertrophy, 3 apical hypertrophy, and 3 concentric hypertrophy). The diastolic indices to measure are isovolumic relaxation time(IVRT), deceleration time(DT), pressure half time(PHT), deceleration of early diastolic flow(DEF), EF slope, peak flow velocity in early diastole(PFVE), peak flow velocity during atrial systole(PFVA), and PFVE/PFVA ratio. The diastolic indices obtained from patients were compared with those in 20 age-matched control subjects without heart disease. The relationship between left ventricular wall thickness index(Th Index) and diastolic indices were evaluated. In addition, the effect of calcium channel-blocking agent on left ventricular diastolic function were evaluated. The results were as follows ; 1) There were no significant differences in RR interval, BP, end-systolic left ventricular dimension, and end-diastolic left ventricular dimension, but significant differences in interventricular septal thickness, posterior wall thickness, and left atrial dimension between hypertrophic group and control group. 2) The systolic index(ejection fraction) showed no significant difference between hypertrophic group and control group. 3) All diastolic indices except PFVA showed significant differences between hypertrophic group and control group. 4) Th Index did not showed a significant correlation with the diastolic indices except PFVE/PFVA. 5) There were no significant changes in RR interval, BP end-systolic left ventricular dimension, end-diastolic left ventricular dimension, left atrial dimension, and ejection fraction between medication and drug withdrawal. IVRT significantly increased after drug withdrawal. But other diastolic indices showed no significant changes after drug withdrawal. According to above results the assessment of left ventricular diastolic function by pulsed Doppler echocardiography was a clinically useful method in detecting diastolic dysfunction in patients with hypertrophic cardiomyopathy. Calcium channel-blocking agent may have beneficial effect in improving left ventricular diastolic function in patients with hypertrophic cardiomyopathy.
Calcium* ; Cardiomyopathy, Hypertrophic* ; Compliance ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Heart Ventricles ; Humans ; Hypertrophy ; Relaxation

Interrupted aortic arch may be defined as a discontinuity of the aortic arch. This uncommon anomaly was first described by Steidele in 1778 and was later classified into 3 types by Celoria and Patton. We experienced the case of a 25-year-old male with an interrupted aortic arch(Type B) which was well supplied by collateral circulations. Ligation of collateral supplies and a Y-graft replacement from ascending aorta to descending thoracic aorta and left subclavian artery was done. Postoperative aortogram revealed no collateral circulations and good continuity of the aorta without narrowing of the anatomic site. During the period of 2-month follow up, the patient was able to lead a relatively active life.
Adult ; Aorta ; Aorta, Thoracic ; Collateral Circulation ; Equipment and Supplies ; Follow-Up Studies ; Humans ; Ligation ; Male ; Subclavian Artery

BACKGROUND: Rotational atherectomy has been shown to be safe and efficient for the treatment of ISR, but the recurrence rate is still high. Intracoronary-irradiation after rotational atherectomy may be a reasonable approach to prevent recurrent ISR. SUBJECTS & METHODS: Fifty consecutive patients with diffuse ISR (length > 10 mm) in native coronary arteries underwent rotational atherectomy and adjunctive balloon angioplasty followed by beta irradiation using a 188Re-MAG3-filled balloon catheter. The radiation dose was 15 Gy at 1.0 mm deep into vessel wall. RESULTS: Mean length of the lesion and irradiated segment was 25.6 +/- 12.7 mm and 37.6 +/- 11.2 mm, respectively. The radiation was delivered successfully to all patients, with a mean irradiation time of 201.8 61.7 seconds. No adverse event including myocardial infarction, death, or stent thrombosis occurred during the follow-up period (mean 10.3 +/- 3.7 months) and non-target vessel revascularization was needed in one patient. Six-month binary angiographic restenosis rate was 10.4 % and loss index was 0.17 +/- 0.31. CONCLUSIONS: beta irradiation using 188Re-MAG3-filled balloon following rotational atherectomy is safe and feasible for patients with diffuse ISR, and it may improve the clinical and angiographic outcomes. Further prospective randomized trials are warranted to evaluate the synergistic effect of debulking and irradiation in patients with diffuse ISR.
Angioplasty, Balloon ; Atherectomy, Coronary* ; Catheters ; Coronary Vessels ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Recurrence ; Stents ; Thrombosis

Objective: This study examined whether the changes in reimbursement coverage of brain magnetic resonance image (MRI) affected practice for patients who visited the emergency department with dizziness as the chief complaint. Methods: Among the 5,423 patients who visited the emergency department for dizziness in 2017, 2019, and 2021, 4,497 patients were included in the study retrospectively and investigated by brain diffusion-weighted MRI and the presence of cerebral infarction on brain diffusion-weighted MRI. This study examined whether there was a significant difference before and after the change. Results: In 2017, 2019, and 2021, 1,489, 1,570, and 1,438 patients with dizziness visited the emergency department, respectively. The number of patients who underwent a brain MRI scan gradually increased from 237 (15.9%) in 2017 to 628 (40.0%) in 2019 and 948 (65.9%) in 2021 (P<0.001). The number of positive findings on brain MRI scan increased gradually from 30 patients (2.0%) in 2017 to 47 patients (3.0%) in 2019 and 53 patients (3.7%) in 2021 (P=0.025). The ratio of positive findings of brain MRI scans to the number of patients who underwent brain MRI scans decreased gradually to 12.7% in 2017, 7.5% in 2019, and 5.6% in 2021 (P=0.001). Conclusion The changes in the reimbursement coverage of brain MRI affect the number of brain MRI scans and the detection of cerebral infarction.