Aortic dissection is caused by longitudinal dissection of weakened aortic media by blood stream and associated with hypertension, Marfan's syndrome, congenital vascular anomaly such as bicuspid aortic valve or coarctation of aorta and pregnancy. Aortic dissection has a very high mortality of over 90% without treatment. In Korea, it is easily anticipated that the frequency of aortic dissection maybe increased probably due to the westernization of life style and increasing tendency of hypertension and lift expectancy. But there are lack of detailed reports about aortic dissection in Korea till now. The author reviewed 28 cases of aortic dissection for 15years and compared them with other countries in aspects of etiological diseases, clinical presentations, complications, laboratory data, diagnostic modalities, treatments and hospital courses. The results were as folowings: 1) The most frequent age group was seventh decade and there was slightly higher incidence in female. 2) According to the DeBakey classification, type I was found in 25%, type II in 43%, and type III in 32%. 3) Hypertension was the most frequent cause, comprising 71% (20 cases) and Marfan's syndrome was found in 3 cases and cardiovsascular syphilis, chest trauma and unknown in each 2 cases respectively. 4) The frequent symptoms were pain in 79%, dyspnea in 46%, headache in 32%, and nausea & vomiting in 21%. Diastolic murmur was heard in 21%. 5) Aortic rupture was complicated in 32%, vascular obstruction in 32%, shock in 25%, aortic regurgitation in 21% and congestive heart failure in 18%. 6) According to the age of dissection, acute dissection was found in 61% and chronic dissection in 39%. Aortic rupture, heart failure and vascular obstruction were more common in acute dissection. The patients who died in hospital were exclusively in acute dissction. In marfan's syndrome aortic dissection occurred suddenly during hospitalization. 7) Chest x-ray film showed cardiomegaly in 46%, dilatation of aortic arch in 39% and diffuse mediastinal widening in 31%. 8) Laboratory data showed leukocytosis in 36%, anemia in 25%, increased total bilirubin in 18%, increased SGOT or SGPT in 32%, increased BUN or creatinine in 18%, hematuria in 39% and proteinuria in 46%. 9) ECG showed left ventricular hypertrophy in 42%, old myocardial infarction or myocardial ischemia in 25%, ventricular arrhythmia in 18%, atrial arrhythmia in 11% and heart block in 11%. 10) The first recognition of aortic dissection was made by aortography in 32%, echocardiography in 32%, C.T. in 29% and abdominal sonography in 7%. 11) The hospital death rate was 21% and the causes of death were aortic rupture in 4 cases and congestive heart failure and D.I.C. in each one. The higher mortality was observed in acute dissection, combined hypertension, intially hypotensive patient, old age, congestive heart faiulre, aortic rupture and myocardial ischemia or infarction. The authors have found that, comparing with those of other countries, aortic dissection was more common in female, proximal type were more frquent, dyspnea and aortic rupture were more common and aortic regurgitation was less common. And renal and hepatic dysfunction were more common.
Alanine Transaminase ; Anemia ; Aorta, Thoracic ; Aortic Coarctation ; Aortic Rupture ; Aortic Valve ; Aortic Valve Insufficiency ; Aortography ; Arrhythmias, Cardiac ; Aspartate Aminotransferases ; Bicuspid ; Bilirubin ; Cardiomegaly ; Cause of Death ; Classification ; Creatinine ; Dilatation ; Dyspnea ; Echocardiography ; Electrocardiography ; Estrogens, Conjugated (USP) ; Female ; Headache ; Heart ; Heart Block ; Heart Failure ; Heart Murmurs ; Hematuria ; Hospitalization ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Incidence ; Infarction ; Korea* ; Leukocytosis ; Life Style ; Marfan Syndrome ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Nausea ; Pregnancy ; Proteinuria ; Rivers ; Shock ; Syphilis ; Thorax ; Vomiting ; X-Ray Film

The laser is a new surgical modality that utilizes high intensity beams radiant energy to vaporize of coagulate tissue. Radiant energy is generated by stimulated emission of photons resulting in a unidirectional monochromatic beam that is temporary coherent small diameter beams of great power density are achievable by this means. The author reviewed 24 months experience with a CO2 laser involving neurosurgical operations to 45 neurosurgical lesion, i, e. brain tumor 25, intracerebral hemorrhage 15, cerebral paragonimiasis 1, cysticercosis 1, brain abscess 1, and arteriovenous malformation of brain 1 and spine 1 were removed with the use of Shaplan CO2 laser since 1981. We have conclude that there had been a significant reduction in blood loss and neurological morbidity though it was readily conceded that the number of operations were relatively small. The particular advantages of the combination of CO2 laser and microscope were felt to be precision reduction of mechanical trauma good hemostasis and low cost. Especially the blood loss and replacement during operation have been reduced.
Arteriovenous Malformations ; Brain ; Brain Abscess ; Brain Neoplasms ; Cerebral Hemorrhage ; Cysticercosis ; Hemostasis ; Lasers, Gas* ; Paragonimiasis ; Photons ; Spine

In 1960, Tskimoto first mentioned the spinal cord lesions caused by compression of posterior longitudinal ligament(OPLL), thereafter, hundreds of cases have been reported. There are, however, some controversial opinions concerning the mechanisms of the formation and development of OPLL and questions why a special ligaments, posterior longitudinal ligaments can be calcified, enlarged and compress the cord. And also, there have been many reports describing various surgical method that could manage OPLL, but the OPLL still has many problems in surgical treatment. Recently, the neurosurgical team at the St. Pauls Hospital, encountered and operated on 7 cases of OPLL at cervical area. After all dignostic tests and examinations were done, the morphological classification, combined other lesions and pathological status were verified and analyzed during treatment. The different surgical methods were taken case by case. The authors would like to share with you our experiences of the surgical methods, indications of operation the results and the progrosis of treatment in OPLL.
Classification ; Ligaments ; Longitudinal Ligaments ; Ossification of Posterior Longitudinal Ligament* ; Spinal Cord

Universal adhesives that simplify bonding procedures and be used in multi-etch mode have been developed. In this study, the effects of agitation and solvent evaporation time of a universal adhesive on microtensile bond strength (µTBS) were evaluated by varying the times of these two procedures. Eighteen human molars were used to fabricate specimens, and the teeth were randomly divided into six experimental groups. Each group had different agitation time (5 s, 10 s, 20 s) and evaporation time (10 s, 20 s). The specimens were cut into a rod-shape with a cross-sectional area of 1 mm2 , and their µTBS was measured. The data were analyzed using an ANOVA and Tukey’s post hoc test. After this, the debonded surface was observed using scanning electron microscopy (SEM). In the groups with a solvent evaporation time of 20 s, µTBS was statistically higher, even with a short agitation time (p<0.05). Furthermore, for the groups with the shorter evaporation time, bonding strength decreased statistically as the agitation time shortened (p<0.05). The results of this experiment suggest that if the solvent was adequately evaporated, sufficient bonding strength could be obtained even when the adhesive was agitated for a short time. This is supported by the results of SEM image analysis, which revealed a uniform adhesive layer with well-infiltrated tags in the groups with the prolonged evaporation time. It may be crucial to secure an adequate evaporation time in order to obtain optimal bonding strength.

Universal adhesives that simplify bonding procedures and be used in multi-etch mode have been developed. In this study, the effects of agitation and solvent evaporation time of a universal adhesive on microtensile bond strength (µTBS) were evaluated by varying the times of these two procedures. Eighteen human molars were used to fabricate specimens, and the teeth were randomly divided into six experimental groups. Each group had different agitation time (5 s, 10 s, 20 s) and evaporation time (10 s, 20 s). The specimens were cut into a rod-shape with a cross-sectional area of 1 mm2 , and their µTBS was measured. The data were analyzed using an ANOVA and Tukey’s post hoc test. After this, the debonded surface was observed using scanning electron microscopy (SEM). In the groups with a solvent evaporation time of 20 s, µTBS was statistically higher, even with a short agitation time (p<0.05). Furthermore, for the groups with the shorter evaporation time, bonding strength decreased statistically as the agitation time shortened (p<0.05). The results of this experiment suggest that if the solvent was adequately evaporated, sufficient bonding strength could be obtained even when the adhesive was agitated for a short time. This is supported by the results of SEM image analysis, which revealed a uniform adhesive layer with well-infiltrated tags in the groups with the prolonged evaporation time. It may be crucial to secure an adequate evaporation time in order to obtain optimal bonding strength.

BACKGROUND: Depressive symptoms are common in the medically ill patients although depressive disorders are considerably underdiagnosed and undertreated. Therefore, we examined the characteristics of depressive tendency in medical inpatients. METHODS: The patient group-144 subj.cts(90 males, 54 females) were selected from medical inpatients of Kae Jung hospital. 158 subjects(106 male, 52 females) with no prior history of diseases were selected for the control group. The Beck Depression Inventory(BDI) and Hamilton Rating Scale for Depression(HRSD) was used for both groups from June to December 1997. RESULTS: The patient group had a significant higher BDI and HRSD score than controls(p<0.01). In the patients, 31.3% had scores on the BDI greater than the cutting score of 21, and 26.4% had scores on the HRSD greater than the cutting score of 22. In the patients, demographic and medical variables were evaluated with respect to depression. those in their 60's, with education level of elementary school and below. the divorced, bereaved and separated, and having duration of illness more than one year were statistically more depressed, but depression was not associated with sex, religion and medical diagnosis. CONCLUSIONS: This study indicates that depressive tendency may be a common phenomena in medically ill patients. Therefore, we should suspect depression in the management of these patients.
Depression ; Depressive Disorder ; Diagnosis ; Divorce ; Education ; Humans ; Inpatients* ; Male

BACKGROUND: Glomerular endothelial cells should participate in the process of glomerular disease by expressions of HLA antigens and adhesion molecules. However, few have been known about the regulation of the expression of these molecules in human glomerular endothelial cells(HGEC). The aim of this study was to evaluate the expressions of VCAM-1, ICAM-1 and HLA-DR to see if there are any cytokine-dependent or time-dependent differences. METHODS: HGEC were isolated and cultured from the normal portion of the kidneys removed due to renal cell carcinoma, which was confirmed by factor VIII and fluorescent-labeled acetylated LDL. The effects of cytokine on the cell surface expression of VCAM-1, ICAM-1 and HLA-DR were measured by ELISA. RESULTS: ICAM-1 was increased by IL-1 beta, TNF-alpha and IFN-gamma. VCAM-1 was increased by IL-1 beta and TNF-alpha, not by IFN-gamma. IFN-gamma only increased expression of HLA-DR. Basal expression of ICAM-1 was higher than VCAM-1 and HLA-DR. The time course of expression was different according to adhesion molecule. CONCLUSIONS: These data showed that the expression of adhesion molecules and HLA-DR in HGEC were regulated differentially by inflammatory and immune-regulatory cytokines.
Carcinoma, Renal Cell ; Cytokines ; Endothelial Cells* ; Enzyme-Linked Immunosorbent Assay ; Factor VIII ; HLA Antigens ; HLA-DR Antigens* ; Humans* ; Intercellular Adhesion Molecule-1 ; Interleukin-1beta ; Kidney ; Tumor Necrosis Factor-alpha ; Vascular Cell Adhesion Molecule-1

In order to develop an experimental DNA vaccine for the prevention and treatment of hepatitis B virus infection, hepatitis B virus surface antigen (HBsAg) DNA was subcloned into an E. coli-eukaryotic cell shuttle vector and was expressed in the Baculovirus expression system. Intramuscular, intradermal, and intraperitoneal injections of 30 microg of the plasmid DNA expressing HBsAg induced humoral and cellular immune responses in ICR mice. The first IgG antibodies were detected after ten days and specific IgG antibody titers peaked after two months of a single intramuscular DNA injection. Anti-HBs antibody titers gradually increased and peaked at four months following intradermal DNA injection, and in case of intraperitoneal injection they peaked at seven months. Generation of HBs-specific helper T lymphocytes was also investigated through the production of interleukin-2 by T helper cells. Boosting effects of HBs DNA were investigated without much results. In general, DNA-mediated HBs immunization induced humoral and cellular immune responses in mice that appears to simulate immune responses in human during the course of HBV vaccination.
Animal ; Cloning, Molecular ; DNA, Viral/immunology* ; Hepatitis B/prevention & control* ; Hepatitis B Antibodies/immunology ; Hepatitis B Surface Antigens/genetics* ; Hepatitis B Vaccines/immunology* ; Human ; Interleukin-2/biosynthesis ; Male ; Mice ; Mice, Inbred ICR ; Plasmids/immunology* ; Spleen/immunology ; Spleen/cytology ; Vaccination ; Vaccines, DNA/immunology*

It has been well known that dilated cardiomyopathy (D-CMP) has characterized by systolic dysfunction of left ventricle (LV). But there are few studies about LV diastolic and right ventricular (RV) dysfunction in D-CMP. The purpose of this study is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The purpose of this tudy is to assess the LV and RV systolic function as well as diastolic function in D-CMP. The gated blood pool scan (GBPS) was undertaken in 14 patients with D-CMP and 14 normal controls. The results are as follows : 1) Compared to normal controls, the global and regional ejection fraction of LV were significantly reduced (P<0.001) in D-CMP. But, there was no significant difference in LV ejection time between the two groups. 2) Peak filling rate and peak filling time were significantly reduced (P<0.001, P<0.05) in D-CMP 3) Global ejection fraction of RV was also significantly reduced in D-CMP compared to normal controls (P<0.001) But there was no significant difference in ejection rate of right ventricle between the two groups. 4) There was close correlation (R=0.802) between ejection fraction and filling rate of LV : filling rate was also reduced as ejection fraction decreased. And LV filling rate was also reduced with reduction of ejection rate. It is concluded that D-CMP shows diastolic impairment as well as systolic pumping failure and this systolic dysfunction is accounted for the diastolic impairment in D-CMP. And D-CMP shows also right ventricular dysfunction in almost all cases, as well as left ventricular dysfunction.
Cardiomyopathy, Dilated* ; Heart Ventricles ; Humans ; Ventricular Dysfunction, Left ; Ventricular Dysfunction, Right

Atlanto axial(A-A) dislocation which may be either congenital or due to traumatic inflammatory causes or tumor etc are managed accordingly depending upon their causes. Generally conservative treatment or operative posterior fusion have been employed. A case of traumatic A-A transligamental dislocation has been encountered at St. paul's Hospital by our neurosurgical team. A transoral anterior fusion had been done and the result was successful and very encouraging. It is therefore with great pleasure that we share with you this experience, that management of A-A dislocation could wholly be by surgical technique.
Dislocations* ; Pleasure