Post-traumatic tricuspid insufficiency is a rare condition and may be clinically silent and imprecise. The diagnosis may be difficult when it progreses slowly and other acute lesions exist concomittantly. Two-dimenstional Doppler echocardiography appears to be an essential procedure in diagnosting the rupture of chordae tendineae or papillary muscle following traumatic injury. We report a case of tricuspid insufficiency of which symptom developed 8 years later following a blunt chest trauma. The patient was operated by tricuspid vlave repair with chordal replacement and ring annuloplasty successfully. We would like to emphasize that patients sustaining major thoracic trauma should be carefully examine for possible blunt chest trauma including cardiac valve rupture or tear.
Chordae Tendineae ; Diagnosis ; Echocardiography, Doppler ; Heart Valves ; Humans ; Papillary Muscles ; Rupture ; Thorax*

Congenital diverticulum of the left ventricle is a very rare disease. Ventricular diverticulum is usually associated with other anomalies including intracardiac and midline thoracoabdominal defect. We describe a case with congenital left ventricular diverticulum presenting as an isolated lesion. A 37-year-old man presented with 4-year history of chest pain. Diverticulum was diagnosed by echocardiography and left ventriculogram.
Adult* ; Chest Pain ; Diverticulum* ; Echocardiography ; Heart Ventricles ; Humans ; Rare Diseases

BACKGROUND: Propofol has a high incidence of pain with intravenous injection, and different methods have been used to minimize the incidence and severity of this pain. In this study, we have compared the effect of lidocaine pretreatment with that of metoclopramide pretreatment on propofol injection pain. METHODS: Ninety healthy female patients scheduled for general anesthesia were randomly divided into three groups; saline group (n = 30), lidocaine group (n = 30) and metoclopramide groups (n = 30). Each patient received 2 ml of pretreatment solution (normal saline, 1% lidocaine, 0.5% metoclopramide) via 18 G angiocatheter inserted in the antecabital fossa after applying an arm tourniquet inflated to 50 mmHg. The tourniquet was released 1 minute later, followed by intravenous injection of 2.5 mg/kg of propofol. The assesement of pain was made at the induction of anesthesia and in the recovery room and the severity of pain was classified as none, mild, moderate, severe by one observer. RESULTS: The severity and incidence of pain diminished significantly in the lidocaine group and the metoclopramide group compared with the saline group at the induction of anesthesia (P < 0.05) and there was no significant difference between the lidocaine group and metoclopramide group. We had similar results in the recovery room and one patient from the saline group and the metoclopramide group had no recall regarding injection pain. CONCLUSIONS: Intravenous metoclopramide pretreatment is as effective as intravenous lidocaine pretreatment in alleviating the propofol injection pain.
Anesthesia ; Anesthesia, General ; Anesthetics ; Arm ; Equidae ; Female ; Humans ; Incidence ; Injections, Intravenous ; Lidocaine* ; Metoclopramide* ; Propofol* ; Recovery Room ; Tourniquets

BACKGROUND: Propofol increases the risk of bradycardia compared with other anesthetics. This paper reports the heart rate response to intravenous atropine during propofol and enflurane anesthesia. METHODS: Sixty patients undergoing a transabdominal hysterectomy under general anesthesia were randomly assigned to two groups: the propofol group and the enflurane group. All the patients received midazolam 2 mg intramuscularly and were then anesthetized with propofol or enflurane. The blood pressure and heart rate were taken at 1 min intervals for 10 min after a bolus injection of atropine 5microgram/kg. RESULTS: In the enflurane group, the systolic blood pressure and heart rate were increased significantly at 1, 2 and 3 min after the atropine injection (P<0.05). When the two groups were compared, the heart rate in the enflurane group was significantly higher at 1, 2 and 3 min after atropine injection than in the propofol group (P<0.05). CONCLUSIONS: The heart rate response to intravenous atropine during propofol anesthesia is attenuated compared with enflurane anesthesia.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Atropine* ; Blood Pressure ; Bradycardia ; Enflurane* ; Heart Rate* ; Heart* ; Humans ; Hysterectomy ; Midazolam ; Propofol*

PURPOSE: We investigated the operative outcome after bypass surgery in patients selected using viability criteria on F-18 FDG PET. MATERALS AND METHODS: Rest-24hr delay redistribution imaging of Tl-201 SPECT and F-18 FDG PET were performed in 11 patients. Seven of these 11 patients (6 men, 1 woman) were evaluated to have viable myocardium by F-18 FDG PET. Changes in symptoms and left ventricular ejection fraction (LVEF) after operation were evaluated. RESULTS: In seven of 11 patients, a significant amount of viable myocardium was found on F-18 FDG PET and Tl-201 SPECT. Severity of both chest pain and dyspnea improved markedly in all patients. Mean LVEF improved from 22% to 32%. CONCLUSION: F-18 FDG PET could be used to select the patients who will benefit from coronary artery bypass surgery.
Cardiomyopathies* ; Chest Pain ; Coronary Artery Bypass ; Dyspnea ; Humans ; Male ; Myocardium ; Positron-Emission Tomography ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon

BACKGROUND AND OBJECTIVES: The clinical pattern of infective endocarditis is constantly changing. Diagnosis and treatment of infective endocarditis were developed by recent diagnostic strategy (Duke criteria) and introduction of transesophageal echocardiography. The aim of this study was to compare the clinical character-istics of infective endocarditis in Sejong hospital to the previous report and was to investigate risk factor of heart failure, embolism and death. MATERIAL AND METHODS: All episodes hospitalized of infective endocarditis from January of 1990 to October of 1999 in Sejong hospital were reviewed retrospectively. The total cases of infective endocarditis was 80 cases in 78 patients. RESULTS: The male to female ratio was 1:1.05 (39 male, 41 female). The mean age was 42 years. Rheumatic heart disease was the most common predisposing heart disease in 28.8%, followed by prosthetic valve endocarditis. Streptococci were the most commonly isolated micro-organisms in 18 cases (45.0%), followed by staphylococci in 11 cases. Transesophageal echocardiography has a higher sensitivity than transthoracic echocardiography for detection of vegetation, abscess and paravalvular complication in endocarditis. In patients with echocardiographic vegetation and involvement of aortic valve, there was a statistically significant increase in the risk of heart failure. The factor that was associated with a statistically significant increase in the overall risk of embolization was not exist. Ten patients died (12.5%). Risk factor for death was left ventricular dysfunction. The incidence of death was more higher in patients with abscess and non-streptococcal endocarditis. CONCLUSION: Compared to the 1980's report, we observed increased mean age of patients, the decreasing trend of rheumatic heart disease as a predisposing heart disease and the decreasing incidence of streptococci as causative microorganism. Risk factors for congestive heart failure were aortic valve endocarditis and endocarditis with vegetation. Risk factor for death was left ventricular dysfunction.
Abscess ; Aortic Valve ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Endocarditis* ; Female ; Heart Diseases ; Heart Failure ; Humans ; Incidence ; Male ; Retrospective Studies ; Rheumatic Heart Disease ; Risk Factors ; Ventricular Dysfunction, Left

PURPOSE: E-cadherin and CD44H have been shown to play a role in the progression and the metastasis of tumors. This study evaluated the clinical correlations between expression of E-cadherin and CD44H and various clinicopathologic factors and the value of expressions of E-cadherin and CD44H as prognostic factors in Borrmann type IV gastric cancer. MATERIALS AND METHODS: In 122 patients with Borrmann type IV gastric cancer, we performed the immunohistochemical stainings for E-cadherin and CD44H. We analyzed the correlation between the expressions of E-cadherin and CD44H and lymphatic invasion, venous invasion, perineural invasion, histologic type, lymph node metastasis, depth of invasion, stage, and peritoneal dissemination, and survival. RESULTS: There were no correlations between reduced expression of E-cadherin and CD44H and lymphatic invasion, venous invasion, perineural invasion, histologic type, lymph node metastasis, depth of invasion, and stage. However, there was a significant correlation between lymph node metastasis and the lymphatic invasion (P=0.022). There was also a significant correlation between the peritoneal dissemination and CD44H expression (P=0.005). The 5-year survival rate was correlated with CD44H expression (P=0.026), peritoneal dissemination (P<0.01), depth of invasion (P<0.01), lymph node metastasis (P<0.01), stage of tumor (P<0.01), and lymphatic invasion (P<0.01). There was no correlation between expression of E-cadherin and survival rate. CONCLUSION: The expression of CD44H and peritoneal dissemination was correlated. The expression of CD44H was an independent prognostic factor in Borrmann type IV gastric cancer. Further prospective studies with a large number of cases are required.
Cadherins* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms* ; Survival Rate

PURPOSE: To examine an estimate factor and grasp the relation of difference for Type A Behavior Pattern(TABP), Perceived Stress Questionnaire, Depression and HIT-6 in the Chronic headache client. METHOD: Data collected by self-reported questionnaires from 38 client in S city who were selected by criteria of IHS, from the 19th of October to 10th of December, 2004. RESULT: 1) Differences between biographical data by TABP was significant by SaSang constitutions, by Stress was significantly influenced by age, and by Depression were significantly influenced health status and SaSang constitutions. 2) Correlations Coefficients among Study Variables were Stress and Depression(r=.494, p=.002) and Depression and HIT-6(r=.432, p=.010).3) In regression analysis, HIT-6 were significantly influenced by Depression and Type A Behavior Pattern(TABP). These variables explained 38% and 34% respectively. CONCLUSION: The result suggest that chronic headache management with psychological aspect, as well as physical aspect should be a focus to enhance the quality of life.
Constitution and Bylaws ; Depression* ; Hand Strength ; Headache Disorders* ; Humans ; Quality of Life ; Surveys and Questionnaires

BACKGROUND: A laparoscopic hysterectomy is gaining popularity on account of its many benefits. The trendelenburg position and pneumoperitoneum necessary for a laparoscopy causes intraoperative hemodynamic fluctuations. The aim of this study was to evaluate the intraoperative hemodynamic and postoperative analgesic effects of preemptive epidural analgesia in a laparoscopic hysterectomy. METHODS: Fifty ASA 1 and 2 patients were randomized to two groups. Nothing was applied to the control group before inducing general anesthesia. In the epidural group, an epidural catheter was inserted through the L2-3 space and 1% lidocaine 10 ml was injected. The blood pressures, heart rates, cardiac outputs, stroke volumes and cardiac indexes were measured using NICO(TM) (Non-Invasive Cardiac Output using partial carbon dioxide rebreathing technique, fast mode, Novametrix Medical Systems Inc, USA) at time before induction (T1), post-intubation (T2), post-insufflation and in the trendelenburg position (T3), post-intubation 10 (T4), 20 (T5), 30 (T6) and 60 minutes (T7), post-exsufflation (T8) and post-neutral position (T9). The pain scores were assessed by the patients using a 100 mm visual analogue scale at 1, 3, 6, 12 and 24 hours postoperatively. RESULTS: There were important differences in the blood pressures, cardiac outputs, stroke volumes and cardiac indexes between the two groups. No significant changes in the heart rate were observed during surgery in either groups. The postoperative pain scores were significantly lower in the epidural group compared with the control group. CONCLUSIONS: Preemptive epidural analgesia produces a more stable hemodynamic state during a laparoscopic hysterectomy and reduces the level of postoperative pain.
Analgesia ; Analgesia, Epidural* ; Anesthesia, General ; Carbon Dioxide ; Cardiac Output ; Catheters ; Head-Down Tilt ; Heart Rate ; Hemodynamics* ; Humans ; Hysterectomy* ; Laparoscopy ; Lidocaine ; Pain, Postoperative ; Pneumoperitoneum ; Stroke Volume

PURPOSE: To compare the differential findings of tuberculous otitis media(TOM) with those of chronic suppurative otitis media with or without cholesteatoma, as seen on high resolution temporal bone CT. MATERIALS AND METHODS: We retrospectively reviewed 14 cases of TOM, 30 cases of chronic suppurative otitis media(CSOM), and 30cases of chronic otitis media with cholesteatoma(Chole). All had been pathologically confirmed. We evaluated thepreservation of mastoid cells without sclerotic change, the location and extension of soft tissue to the externalauditary canal, the erosion of ossicles, the tegmen tympani, scutum, bony labyr inth, facial nerve canal andsigmoid sinus, and the presence of intracranial co mplications. RESULTS: Soft tissue in the mastoid antrum wasseen in all cases of TOM(100%), 29 cases of CSOM(96.7%), and 26 cases of Chole(86.7%). In contrast, the softtissue in the entire middle ear cavity was noted in 13 cases of TOM(92.8%), 7 cases of CSOM(23.3%), and 12 casesof Chole(40%). Soft tissue extended to the superior aspect of the external auditory canal in 4 cases of TOM(28.6%) and 5 cases of Chole (16.7%). Mastoid air cells were seen in 9 cases of TOM (64.3%), 4 cases of CSOM(13.3%), and 3 cases of Chole(10%). Ossicular erosion was noted in 6 cases of TOM (42.9%), 12 cases of CSOM (40%),and 26 cases of Chole(86.7%), while in one case of TOM (7.1%), 5 cases of CSOM (16.7%), and 15 cases of Chole(50%)there was erosion of the scutum. In one case of TOM, follow-up CT study after 9 months of antituberculousmedication without surgery revealed complete clearing of previously noted soft tissue in the middle ear cavity. CONCLUSION: Specific CT findings of TOM were not seen, but if there were findings of soft tissue in the entiremiddle ear cavity, soft tissue extension to the external auditory canal, preservation of mastoid air cells withoutsclerotic change, and intact scutum, TOM may be differentiated from other chronic otitis media.
Cholesteatoma ; Ear ; Ear Canal ; Ear, Middle ; Facial Nerve ; Follow-Up Studies ; Mastoid ; Otitis Media* ; Otitis Media, Suppurative ; Otitis* ; Retrospective Studies ; Temporal Bone* ; Tuberculosis