BACKGROUND: Paroxysmal supraventricular tachycardia(PSVT) is frequently associated with ST segment depression or T-wave inversion. However, the mechanism of ST-T changes in the context of various mechanisms of PSVT is not clear. The purpose of this study was to evaluate the prevalence of ST depression or T-wave inversion during PSVT and determine whether these changes are related to the mechanism of PSVT or the rate of the tachycardia. METHODS: Twelve-lead electrocardiograms were recorded during sinus rhythm and during PSVT in 163 patients who underwent an electrophysiologic study for ablation. Tachycardia cycle length, presence of ST depression or T-wave inversion during PSVT and the mechanism of tachycardia were evaluated. Significant ST depression was defined as at least 1mm horizontal or downsloping depression, measured 80ms after the J point and T-wave inversion as inversion of T-wave which was positive in the same lead during sinus rhythm. RESULTS: 1) The mechanism of PSVT analysed for ST segment depression was atrioventricular nodal reentry tachycardia in 60 cases and atrioventricular reentry tachycardia in 111 cases. The mean tachycardia cycle length was 373.8+/-68.0 msec. 2) ST depression and T-wave inversion was observed during PSVT in 56%(96/171) and 45%(77/171) of cases, respectively. 3) Tachycardia cycle length, degree of ST depression and number of leads with ST depression are not different according to the mechanism of PSVT. 4) ST depression and tachycardia cycle length had significant correlation, especially in atrioventricular reentry tachycardia. 5) Leads with T-wave inversion during tachycardia was observed more frequently in atrioventricular reentry tachycardia than atrioventricular nodal reentry tachycardia(p<0.05), but no difference between manifest and concealed bypass tract. CONCLUSIONS: ST segment depression is rate-related phenomenon and not different according to the mechanism of PSVT. Leads with T-wave inversion during tachycardia was observed more frequently in atrioventricular reentry tachycardia.
Depression* ; Electrocardiography ; Humans ; Prevalence ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular

Paget bone disease(PBD) is usually focal, but can be wide spread disorder of the skeletal remodeling characterized by greatly increased osteoclast size and activity. It has extremely variable prevalence worldwide, being common in England and northern European countries and areas populated by their descendants, but strikingly uncommon in Asia, the middle east, Africa and Scandinavia. It's occurrence also shows familial clustering, some postulates autosomal dominant inheritance. Many studies have shown that paramyxoviruses may play a critical role in the etiology of this disorder. However, the precise etiology of PBD remains unknown.We describe a kindred with PBD in 3 successive generations. The propositus, a 55-year-old man, has panostotic PBD and giant cell reparative granuloma of pagets disease involving his head, mandible, abdomen and ileum, rare tumorous complication of Paget's disease. Bowed limbs were first noticed at age 25 years, and progressed for 20 years. Giant cell reparative granuloma began manifesting at age 45 years, and responded dramatically to high-dose dexamethasone therapy. His pretreatment biochemical finding were remarkable for elevated serum ALP, 765(normal 66-220 u/L) and osteocalcin, 154(normal 6.3-30.7 mg/ml), but normal serum calcium, phosphorous, 250HD and PTH. A nondecalcified iliac crest specimen demonstrated classic histopathologic 25OHD and PTH. A nondecalcified iliac crest specimen demonstrated classic histopathologic changes of PBD on light microscopy. His decreased father had a similar degree of bony deformities beginning at age 20 years, but had not been examined. His two asymptomatic daughters, 20 and 24-year-old, were both found to be affected with widespread PBD by bone scan, radiographic study, and their serum ALP levels, 939 and 435U/L, respectively. This is the first report of familial occurance of PBD and a case of giant cell reparative granuloma of Paget's disease in Korea, where PBD is very rare.
Abdomen ; Africa ; Asia ; Bone Diseases ; Calcium ; Congenital Abnormalities ; Dexamethasone ; England ; Extremities ; Family Characteristics ; Fathers ; Giant Cells ; Granuloma ; Head ; Humans ; Ileum ; Korea ; Mandible ; Microscopy ; Middle Aged ; Middle East ; Nuclear Family ; Osteocalcin ; Osteoclasts ; Pedigree ; Prevalence ; Scandinavian and Nordic Countries ; Wills ; Young Adult

BACKGROUND: Pericardiocentesis is not routinely recommended in most patients with pericardial effusion (PE), except for patients with cardiac tamponade. However, the long-term follow-up results in patients with clinically not significant PE are few. METHODS: Sixty-five consecutive patients (mean age:57 yrs, 26 males) out of 87 patients with PE, who were clinically not serious, were studied prospectively once in every two month for mean 6 months (2-12 months) without any specific treatment. The amount of PE was measured at the enddiastole period of parasternal long axis view and apical four chamber view. RESULTS: The incidence of insignificant PE in our echocardiographic laboratory is 3.4% (n=87 from 2461). The maximal accumulation site of PE was posterior (n=51, 79%). The next is anterior (n=11, 17%) and right ventricular side (3, 5%). The amount of PE is less (0.37+/-0.17cm vs 0.64+/-0.54cm, p=0.018) in localized PE (n=24, 37%) than that of diffuse form (n=41, 63%), which spreads to more than 2 chambers. The presumptive etiologies of PE were unknown (n=41), heart failure (n=5), myocardial infarction (n=6), viral (n=3), and others (n=10). The amount of PE was decreased from 0.54+/-0.46 cm to 0.30+/-0.26 cm, 0.23+/-0.24 cm, and 0.21+/-0.23 cm 2, 4, and 6 months after intial evaluation, respectively, without any complication. CONCLUSION: The patients with PE, not combining >KERN= Axis, Cervical Vertebra ; Cardiac Tamponade ; Echocardiography ; Follow-Up Studies* ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Pericardial Effusion* ; Pericardiocentesis ; Prospective Studies

Drug Information Centers are responsible for providing updated, relevant drug information on the efficacy, safety and quality of drugs as well as disease status to health-care practitioners and finally to patients. This study was designed to revise the drug information service based on the evaluation to meet the social requirement that is created by the recent "Drug Prescription and Dispensing Law" A retrospective analysis was conducted from April 1997 untill September 2000. To evaluate the trend of service, the evaluated period was divided in 7 6-months intervals. The feedback system was used to measure the satisfaction score as an outcome. Out of 618 total enquiries, 192 (31.0%) was received in the last 6-month period. The method of receiving and providing drug information by Drug Information Research Institute (DIRI) gradually changed from telephone calls to e-mailing system (2.2% vs. 67.2% in question, 2.2% vs. 70.3% in answer). Drug information questions concerning the pharmacology (18.8%), adverse drug reaction (10.5%), availability (10.3%) and drug interaction (5.2%) were asked most frequently. The median time to respond the inquired questions was 24 hours (range: 1 hr-8 days). The reference used most frequently to answer was the tertiary literature (42.0%) followed by the second literature (27%) and primary literature (7%). The evaluable 29 feedbacks showed that DI services provided by DIRI were satisfactory in accuracy and time. On the basis of the analysis and evaluation of this project, DIRI have developed the more specified Q and A Sheet Form, systemic database and on-line Q and A corner accessible through the homepage.
Academies and Institutes ; Drug Information Services* ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions ; Electronic Mail ; Humans ; Information Centers* ; Pharmacology ; Prescriptions ; Retrospective Studies ; Telephone

BACKGROUND AND OBJECTIVES: Right-sided infective endocarditis (RtIE) occurs in about 5-10% of total infective endocarditis cases. In western countries, many cases of RtIE are related to drug addiction. However, there been only scant reports of right-sided infective endocarditis in Korea. The aim of the study was to identify the clinical characteristics of RtIE, such as frequency, predisposing risk factors, causative organisms and in-hospital mortality in Korea. SUBJECTS AND METHODS: All episodes diagnosed as infective endocarditis, between 1989 and 2003, at the Asan Medical Center were retrospectively reviewed using Duke's criteria. A total of 308 patients were diagnosed as infective endocarditis. RESULTS: RtIE was found in 34 patients (11.0%), with a mean age of 44.1+/-15.0 years. Fifteen patients had congenital heart diseases. However, several in-hospital invasive procedures and skin injuries were the most common predisposing risk factors in patients with uncorrected congenital heart disease (group A), whereas unknown causes were most common in patients without uncorrected congenital heart disease (group B). The most common causative organisms in groups A and B were Streptococcus viridans (6/15, 40%) and Staphylococcus aureus (13/19, 68.4%), respectively. In group A, the location of vegetations was variable according to the turbulent flow, but was exclusively at the tricuspid valve in group B. There were 6.7% (1/15) and 26.3% (5/19) inhospital mortalities in groups A and B, respectively (p=0.196). CONCLUSION: No drug addict with RtIE was seen. The most important predisposing risk factor in patients with RtIE was the presence of uncorrected congenital heart disease. The predisposing risk factors, causative organisms and the locations of vegetation in patients with RtIE differed according to the patient's uncorrected congenital heart disease.
Chungcheongnam-do ; Endocarditis* ; Endocarditis, Bacterial ; Heart Defects, Congenital ; Heart Diseases ; Hospital Mortality ; Humans ; Korea* ; Retrospective Studies ; Risk Factors ; Skin ; Staphylococcus aureus ; Substance-Related Disorders ; Tricuspid Valve ; Viridans Streptococci

Various cell types in higher multicellular organisms are genetically homogenous, but are functionally and morphologically heterogeneous due to the differential expression of genes during development, which appears to be controlled by epigenetic mechanisms. However, the exact molecular mechanisms that govern the tissue-specific gene expression are poorly understood. Here, we show that dynamic changes in histone modifications and DNA methylation in the upstream coding region of a gene containing the transcription initiation site determine the tissue-specific gene expression pattern. The tissue-specific expression of the transgene correlated with DNA demethylation at specific CpG sites as well as significant changes in histone modifications from a low ratio of methylated H3- lysine 4 or acetylated H3-lysine 9, 14 to acetylated H4 to higher ratios. Based on the programmed status of transgene silenced in cloned mammalian ear-derived fibroblasts, the transgene could be reprogrammed by change of histone modification and DNA methylation by inhibiting both histone deacetylase and DNA methylation, resulting in high expression of the transgene. These findings indicate that dynamic change of histone modification and DNA methylation is potentially important in the establishment and maintenance of tissue-specific gene expression.
Transgenes/*genetics ; Swine ; Organ Specificity/genetics ; Methylation ; Lysine/*metabolism ; Histones/*metabolism ; Histone Deacetylases/metabolism ; Gene Silencing ; *Gene Expression ; Fibroblasts ; Ear ; *DNA Methylation ; Cells, Cultured ; Animals, Genetically Modified ; Animals ; Acetylation

Objective: To evaluate the reliability of CT measurements of muscle quantity and quality using variable CT parameters. Materials and Methods: A phantom, simulating the L2–4 vertebral levels, was used for this study. CT images were repeatedly acquired with modulation of tube voltage, tube current, slice thickness, and the image reconstruction algorithm. Reference standard muscle compartments were obtained from the reference maps of the phantom. Cross-sectional area based on the Hounsfield unit (HU) thresholds of muscle and its components, and the mean density of the reference standard muscle compartment, were used to measure the muscle quantity and quality using different CT protocols. Signal-to-noise ratios (SNRs) were calculated in the images acquired with different settings. Results: The skeletal muscle area (threshold, -29 to 150 HU) was constant, regardless of the protocol, occupying at least 91.7% of the reference standard muscle compartment. Conversely, normal attenuation muscle area (30–150 HU) was not constant in the different protocols, varying between 59.7% and 81.7% of the reference standard muscle compartment. The mean density was lower than the target density stated by the manufacturer (45 HU) in all cases (range, 39.0–44.9 HU). The SNR decreased with low tube voltage, low tube current, and in sections with thin slices, whereas it increased when the iterative reconstruction algorithm was used. Conclusion Measurement of muscle quantity using HU threshold was reliable, regardless of the CT protocol used. Conversely, the measurement of muscle quality using the mean density and narrow HU thresholds were inconsistent and inaccurate across different CT protocols. Therefore, further studies are warranted in future to determine the optimal CT protocols for reliable measurements of muscle quality.

Objective: To evaluate the reliability of CT measurements of muscle quantity and quality using variable CT parameters. Materials and Methods: A phantom, simulating the L2–4 vertebral levels, was used for this study. CT images were repeatedly acquired with modulation of tube voltage, tube current, slice thickness, and the image reconstruction algorithm. Reference standard muscle compartments were obtained from the reference maps of the phantom. Cross-sectional area based on the Hounsfield unit (HU) thresholds of muscle and its components, and the mean density of the reference standard muscle compartment, were used to measure the muscle quantity and quality using different CT protocols. Signal-to-noise ratios (SNRs) were calculated in the images acquired with different settings. Results: The skeletal muscle area (threshold, -29 to 150 HU) was constant, regardless of the protocol, occupying at least 91.7% of the reference standard muscle compartment. Conversely, normal attenuation muscle area (30–150 HU) was not constant in the different protocols, varying between 59.7% and 81.7% of the reference standard muscle compartment. The mean density was lower than the target density stated by the manufacturer (45 HU) in all cases (range, 39.0–44.9 HU). The SNR decreased with low tube voltage, low tube current, and in sections with thin slices, whereas it increased when the iterative reconstruction algorithm was used. Conclusion Measurement of muscle quantity using HU threshold was reliable, regardless of the CT protocol used. Conversely, the measurement of muscle quality using the mean density and narrow HU thresholds were inconsistent and inaccurate across different CT protocols. Therefore, further studies are warranted in future to determine the optimal CT protocols for reliable measurements of muscle quality.

BACKGROUND: Various eccrine tumors are rather common diseases in clinicians. However, data on the clinicopathologic features of eccrine tumors in Korea are limited. OBJECTIVE: The purpose of this study was to investigate the clinicopathologic characteristics of eccrine tumors in Korea. METHODS: Two hundred and sixty five cases of eccrine tumors, seen from 2002 to 2004 in Korea, were retrospectively analyzed clinically and histopathologically. RESULTS: The most common eccrine tumors identified within Koreans were syringoma (61%), followed by eccrine poroma (13%), eccrine hidrocystoma (9%), and nodular hidradenoma (6%). Moreover, eccrine tumors were usually found to occur in middle-aged woman as multiple asymptomatic skin-colored papules. The most common site of occurrence was the face (45%), followed by the neck (9%), scalp (5%), foot (5%), abdomen (4%), and vulvar (3%). CONCLUSION: The results of this study will be useful and fundamental data on eccrine tumors for clinicians and pathologists.
Abdomen ; Acrospiroma ; Female ; Foot ; Hidrocystoma ; Humans ; Korea ; Neck ; Poroma ; Retrospective Studies ; Scalp ; Syringoma

BACKGROUND AND OBJECTIVES: Chronobiological rhythms have been shown to influence the occurrence of a variety of cardiovascular disorders, including acute myocardial infarction (AMI). The present study investigated whether the onset of acute aortic syndrome (AAS) has unique chronobiological rhythms in Korean populations. SUBJECTS AND METHODS: The clinical data of 371 consecutive AAS patients, admitted between 1993 and 2003, were retrospectively analyzed; 310 AMI patients, who underwent primary percutaneous angioplasty in the hyperacute phase between 1998 and 2001, were also selected. RESULTS: In the AAS group, the final diagnoses were aortic dissection (AD) and aortic intramural hematoma (AIH) in 212 and 159 patients, respectively Similar to AMI, AAS showed a significantly higher occurrence from 6 AM to noon compared with other time periods (p=0.0013). AAS showed a second peak occurrence from 6 PM to midnight, which was not observed in the AMI group. A subgroup analysis revealed that younger patients (age < 60 years) and those with a past medical history of hypertension had the highest occurrence from 6 PM to midnight, which was quite different compared to the AAS patients. No significant variation was found for the day of the week in either group. Although no significant seasonal variation was observed in the frequency of AMI, the frequency of AAS was significantly higher during winter (p<0.001). The circadian and seasonal variations in the frequency of AIH were similar to those of AD. CONCLUSION: AAS shows unique circadian and seasonal variations in Korean populations. Our findings may have implications for the prevention of AAS by tailoring treatment strategies to ensure maximal benefits during the vulnerable periods.
Angioplasty ; Circadian Rhythm ; Diagnosis ; Hematoma ; Humans ; Hypertension ; Myocardial Infarction* ; Retrospective Studies ; Seasons