BACKGROUND AND OBJECTIVES: In acute myocardial ischemia, the conduction velocity of action potential is decreased by several electrophysiological and physical factors. The ventricular activation time(VAT) is a time duration of electrical impulse propagating from endocardium to epicardium. The goal of this study is to determine whether the reduction in conduction velocity in acute myocardial ischemia can lead a change in VAT. MATERIALS AND METHOD: Thirty patient, 18 males and 12 females, who had received percutaneous balloon coronary angioplasty(PTCA) were enrolled. The mean age was 59 years old. A twelve lead surface electrocardiogram(ECG) were obtained before, during, 1 minute, 5 minutes, and 10 minutes after the PTCA as digitized data by using Cardiolab EP 4.1 program. The magnitude of the QRS wave was amplified 3 to 4 folds and the speed was increased to 200mm/sec in order to get the VAT easily and accurately. The data was the mean of three consecutive VATs. The number of vessel treated with PTCA included left anterior descending artery(12), left circumflex artery(9), and right coronary artery(9). Among twelve chronic stable angina, sixteen unstable angina, and two acute myocardial infarction patients, twenty six had single and four had two vessel diseases. RESULTS: The significant increase in VAT during PTCA compared to that before PTCA was observed in eight of 12 leads. In addition, the significant decrease in VAT of 1, 5, and 10 minutes after PTCA compared to that during PTCA were noted. Furthermore, 10 minutes after PTCA, VAT decreased significantly compared to that before PTCA. The leads did not show a significant change of VAT depending on target vessels. The ECG of 16 patients showed changes of the ST segment during PTCA. The changes of VAT were not related to the ST segment change. CONCLUSION: The conduction delay from endocardium to epicardium in acute myocardial ischemia was presented as a prolongation of VAT in surface ECG. In addition, the conduction delay was recovered within 5 minutes after relief of ischemia. Therefore, the changes of VAT can possibly be used as one of the noninvasive parameters of myocardial ischemia.
Action Potentials ; Angina, Stable ; Angina, Unstable ; Electrocardiography ; Endocardium ; Female ; Humans ; Ischemia ; Male ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia* ; Pericardium ; Thoracic Surgery, Video-Assisted

Gastric tuberculosis is a rare disease and the diagnoeis of gastric tuberculosis is based on either positive histological or bacteriological study. We experienced a case of gastric tuberculosis with pleural effuaion in 59 year-old woman, diagnosed by the histological study of the endoscopic biopsy specimen. Follow up endoscopic finding revealed marked improvement of gastric lesion after anti-tubercadoua medication. We reported the case with review of literature.
Biopsy ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Rare Diseases ; Tuberculosis*

Although the effect of ultraviolet (UV) irradiation on immune response was reported to supress cellular immune response, the exact mechanism was not elucidated. As recent development in cytokine research progress, it is well-known that immune response is regulated by cytokines and especially cellular immune response is induced by interferon (IFN)-r and interleukin (IL)-12 which is mainly produced from lymphocytes and macrophages respectively. Therefore our purpose was to elucidate the UV effect on cellular immune response and its mechanism. We have investigated the changes of host resistance by injection of Listeria monocytogenes which is an intracellular parasite after UVB irradiation in C57BL/6 mice which is known to have relatively strong cellular immune response. In addition we also have investigated the changes in the production of IFN-r from lymphocytes and the production of tumor necrosis factor (TNF)-a and IL-12 from macrophages in mice by UVB irradiation. The increase of mouse spleen index and susceptibility of iisteria monocytogenes infection was correlated with the decreased production of IFN-r, TNF-a and IL-12, which was known to induce the suppression of cellular imrnune response.
Animals ; Cytokines* ; Immunity, Cellular ; Interferons ; Interleukin-12 ; Interleukins ; Listeria monocytogenes* ; Listeria* ; Lymphocytes ; Macrophages ; Mice ; Parasites ; Spleen ; Tumor Necrosis Factor-alpha

BACKGROUND: Exercise testing is an importnat diagnostic and prognostic procedure in the assessment of patients with ischemic heart disease. But standard ST-segment depression criteria was not high enough to estimate coronary srtery disease. Recently, the heart rate adjustment of ST segment depression, ST segment/heart rate slope and index, have been proposed as a more accurate criteria for diagnosing significant coronary artery disease. The objective of this study was to compare the discriminating power of proposed ST segment/heart rate slope and index with that of a standard method of assessing exercise-induced ST segment depression for estimating coronary artery disease. METHODS: Sixty nine patients with ischemic heart disease were studied with exercise treadmill testing and coronary angiography. Computer-measured ST-segment amplitudes were obtained and analysis of the heart rate-adjusted ST segment depression(ST/HR slope and big up tri, Delta ST/HR index) was done. The sensitivity, specificity, and extent of coronary artery disease on each criteria were compared. RESULTS: 1) The sensitivity of big up tri, Delta ST/HR index partition of 1.6uV/beats/min was slightly higher(83%) and the specificity of ST/HR slope partition of 2.4uV/beats/min was higher(87%) than the standard exercise electrocardiographic criteria. 2) Early onset of ischemic ST-segment depression, profound ST-segment depression(> or =2mm), and downsloping ST-segment were associated with more extensive coronary artery disease. 3) On ST/HR slope, no CAD was 1.7+/-0.26uV/beats/min, one vessel disease was 2.6+/-0.34 uV/beats/min, two vessel disease was 2.7+/-1.36uV/beats/min, one vessel disease was 2.8+/-0.35uV/beats/min, and on big up tri, Delta ST/HR index, no CAD was 1.8+/-0.38uV/beats/min, one vessel disease was 2.8+/-1.36uV/beats/min, two vessel disease 3.4+/-1.44uV/beats/min, and three vessel disease was 3.7+/-2.95uV/beats/min. The increment of ST/HR slope and big up tri, Delta ST/HR index were associated with the coronary artery disease and its severity, but the correlations were not high enough. CONCLUSION: The heart rate adjustment of ST segment depression was not high enough for improved detection of coronary artery disease, compared with standard ST-segment depression criteria. But these indexes can be improved the clinical usefulness of the treadmill exercise test for coronary aretry disease.
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Depression* ; Electrocardiography ; Exercise Test ; Heart Rate* ; Heart* ; Humans ; Myocardial Ischemia* ; Sensitivity and Specificity

BACKGROUND: Both PCNA and Ki-67 have been used as marker for cellular proliferation. The drawback of Ki-67 antibody in immunohistochemistry was that it can be labelled only on fresh tissue, however, MIB1 is a newly developed Ki-67 antiboc which can be labelled on formalin-fixed tissue. OBJECTIVE: The purpase of the present study is to compir the stainability of the Ki-67 antibody with that of the ICNA antibody on formalin-fixed, para fin embedded tissues. METHODS: Using MIE1, the newly developed Ki-67 antibody and PC10(PCNA antibody), speci mens of squamous cell carcinoma(SCC), Bowens disease(BL), actinic keratosis(AK) and basal cell epithelioma(BCE) were stained by one hour immunocytial, mistry using a Microprobe immuno/DNA stainer. RESULTS: The labelling indices (LI) of MIB1 were 82.6%, 37.4%, 38.3% & 81.1% respectively in SCC, BD, AK & BC, while the LI of PC10 were 77.69%, 26.6% & 64.4%. The labelled cells of both antibodies differed in distribution patterns on turmor tissues. CONCLUSION: MIBI cain be used to be an alternative m.rl r for proliferating cells. MIBI PC10, when used together, will be mutually compensatory the study of proliferating cell kinetics.
Actins ; Antibodies ; Cell Proliferation ; Humans ; Immunohistochemistry ; Kinetics ; Male ; Proliferating Cell Nuclear Antigen* ; Skin*

PURPOSE: Gamma-globulin is effective in preventing coronary aneurysm, the primary complication of Kawasaki disease(KD). However, in order to predict high-risk cases which absolutely require gamma-globulin, because of its high expenses, Harada score(HS) was introduced in Japan in 1990. We attempted to compare HS scoring with the health insurance criteria currently used in Korea. METHODS: Retrospective studies were performed on 123 cases who did not receive gamma-globulin among 283 KD patients who had been treated in this hospital from 1990 to 1997. Chi-square analyses were used. RESULTS: Of the 123 subjects, 91(74%) had HS scores higher than 4, and 32(26%) had HS less than 4, whereas 56(45.5%) belonged to the high-risk group and 67(54.5%) to the low-risk group according to the insurance criteria, with both methods differing significantly(P<0.001). Of 18 cases with the coronary complications only 2 cases had an HS<4, whereas 4 patients belonged to the low-risk group. Even though both methods did not differ significantly in discriminating risky cases, twice as many patients may have been denied adequate treatment if the insurance criteria had been applied. Of various factors, the age and albumin level were found relevant to the coronary complication. CONCLUSION: No statistically significant difference was found between HS and the insurance criteria in predicting the incidence of coronary complications in 123 KD patients. But a less lenient criteria used in the current health insurance policy may result in more cases with coronary complications.
Coronary Aneurysm* ; gamma-Globulins ; Humans ; Incidence ; Insurance ; Insurance, Health ; Japan ; Korea ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies

PURPOSE: To find the more effective treatment methods that improving thesurvival of patients with glioblastoma multiforme(GBM), we analyze the prognostic factors and the outcome of therapy in patients with GBM. METHODS AND MATERIALS: One hundred twenty-one patients with a diagnosis of GBM treated at Severance Hospital between 1973 and 1993 were analyzed for survival with respect to patients characteristics, that is, duration of symptom, age, and Karnofsky performance status, as well as treatment related variables such as extent of surgery and radiotherapy. RESULTS: The median survival time(MST) and 2-year overall survival rate (OSR) of the patients with GBM were 13 months and 20.8%, respectively. Duration of symptom, age, Karnofsky performance status(KPS), radiotherapy, and extent of surgical resection were associated with improved survival in a univariate analysis. Patients whose duration of symptom was longer than 3 months, had the 2-year OSR of 47.2%(p=0.0082), who were younger than age 50, 32.9%(p=0.0003). In patients with a KPS of 80 or higher, the 2 year OSR was 36.9%(p=0.0422). Patients undergoing radiotherapy had the 2-year OSR of 22.9%(p=0.030), and surgical resection of 23.3%(p<0.000). A cox regression model confirmed a significant correlation of duration of symptom, age, radiotherapy,and extent of surgical resection with survival, excluding KPS(p=0.8823). The 2-year OSR were 22.3% and 19.4%, combined with chemotherapy or without, respectively(p=0.06028). The duration of symptom of 3 months or shorter. 50 years of age or older, and undergoing stereotactic biopsy only were considered as risk factors. then patients without any risk factors had the MST of 29 months and 2-year OSR of 53.9% compared to 4 months and 0% for patients who had all 3 risk factors. Most of all treatment failure occurred in the primary tumor site(86.4%) CONCLUSION: The duration of symptom, age, radiotherapy, and extent of surgical resection were a prognostically significant independent variables. To get a better survival, it seems to be reasonable that the study design which improves the local control rates is warranted.
Biopsy ; Diagnosis ; Drug Therapy ; Glioblastoma* ; Humans ; Karnofsky Performance Status ; Radiotherapy ; Risk Factors ; Survival Rate ; Treatment Failure

Systemic lupus erythematosus (SLE) has been described very rarely in association with underlying malignancy. We experienced a 68-year-old male with systemic erythematosus lupus associated with squamous cell lung cancer. He had radiation therapy as a primary treatment modality. Ten months after the radiation therapy, he suffered from intermittent fever, myalgia, multiple arthralgia, dry cough, and dyspnea. He had leukocytosis and lymphopenia. Anti-nuclear antibody was positive. He had bilateral pleural effusion, pericardial effusion, and proteinuria (2405 mg/day). He had peripheral neuropathy with lower extremity weakness. There was no evidence of recurrence of lung cancer. He was treated with naproxen (1 gm/day) with symptomatic improvement. We describe a clinical course of paraneoplastic SLE in patient with lung cancer, and review the literatures.
Aged ; Arthralgia ; Cough ; Dyspnea ; Fever ; Humans ; Leukocytosis ; Lower Extremity ; Lung Neoplasms* ; Lung* ; Lupus Erythematosus, Systemic ; Lymphopenia ; Male ; Myalgia ; Naproxen ; Paraneoplastic Syndromes* ; Pericardial Effusion ; Peripheral Nervous System Diseases ; Pleural Effusion ; Proteinuria ; Recurrence

PURPOSE: To introduce and assess the results of punctoplasty using a radiofrequency surgical unit for punctal stenosis. METHODS: Patients who complained of epiphora, had an intact lacrimal pathway below puncti, and underwent punctoplasty with the Ellman Surgitron F.F.P.F were evaluated in the present study. RESULTS: A total of 19 patients (31 eyes) were included in the study. The average age was 55 years (+/-15.7 years). At the last follow-up visit, 27 eyes (87%) had patent puncti, 1 eye became stenotic again, and 3 eyes were completely obstructed. Twenty-two eyes (71%) showed almost complete disappearance of dye on the fluorescein dye-disappearance test (FDDT). Twenty-five eyes (81%) had symptomatic improvement. No significant complication was reported postoperatively. CONCLUSIONS: Punctoplasty with a radiofrequency surgical unit is a simple and effective method for punctal stenosis.
Constriction, Pathologic ; Eye ; Fluorescein ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases

Laser in situ keratomileusis(LASIK) composed of corneal flap and excimer laser photorefractive keratectomy(PRK) has been used for correction of high myopia. Among many kinds of excimer laser, VISX STAR has advantages like correction of cylindrical astigmatism and prevention of central island. We evaluate the effects and clinical course of LASIK using SCMD microkeratome and VISX STAR on 105 myopic eyes under -7.00D from Dec. 1996 to July 1997. The range of refractory error was from -7.00D to -15.00D and age was from 21yrs to 44yrs(mean age was 28.6yrs). The attempted correction of refractory error was determined depending on cycloplegic refraction. We evaluated the change of uncorrected visual acuity, best corrected visual acuity, spherical equivalent, astigmatism, corneal topography before operation, one day, one week, two months, and six months after operation. Uncorrected visual acuity was improved from 0.05 to 0.77, whereas best corrected visual acuity was decreased slightly from 0.92 to 0.85. Spherical equivalent was changed from -10.07 to -0.38D. However, change of cylindrical error was from -1.22D to -1.06D. This difference was not statisyically significant(p>0.05). 105 high myopic eyes were divided into two groups, in which one group was from -7.00D to -10.00D and the other group was from -10.00D to 15.00D. These two groups were compared in the point of effect of LASIK on visual improvement and correction of refractory error, retrospectively. However, there was no statistically significant differences of clinical results between two groups. With these results, it was found that LASIK using VISX STAR would be an excellent procedure for visual improvement and correction of refractory error in high myopia. However, the methods and technology would be required to control underlying astigmatism in VISX STAR system.
Astigmatism ; Corneal Topography ; Keratomileusis, Laser In Situ* ; Lasers, Excimer ; Myopia* ; Retrospective Studies ; Visual Acuity