BACKGROUND: Circardian variation in the onset of cardiovascular events includig sudden cardiac death, myocardial infarction and ventricular arrhythmias has been discribed. The frequency of ventricular premature complexes has also been reported to demonstrate a pattern consisting of a daytime peak and nightime nadir. We tried to see if the same circardian pattern is found in dilated cardiomyopathy patients. We have also studed how various modifying factors such as left ventricular ejection fration and ACE inhibitor use may affect the circardian pattern. METHOD: 24-hour ambulatory electrocaridiographic monitorings were performed in 50 dilated cardiomyopathy patients and 20 control subjects. Patients were prospectively divided in 2 groups based on LVEF and ACE inhibitor use. RESULTS: In dilated cardiomyopathy patients, the expected morning increase in VPC frequency is absent and show a peak in evening. This pattern is not correlated with heart rate. Evening peak is more prominent in low LVEF group and ACE inhibitor non-user group. CONCLUSION: In dilated cardiomyopathy patients, VPC frequency show a peak in the evening.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated* ; Death, Sudden, Cardiac ; Heart Rate ; Humans ; Myocardial Infarction ; Prospective Studies ; Ventricular Premature Complexes*

It has been emphasized that the treatment of choice for the trochantric fracture of the femur is open reduction and rigid internal fixation to reduce complications by early ambulation. The incidence of trochanteric fracture of the femur in the young age group has been considerably increased in recent years because of increased traffic and industrial accidents. The author treated 38 cases of trochanteric fracture of the femur in the year 1974 through 1979, at the Department of Orthopaedic Surgery, School of Medicine, Soon Chun Hyang College. The results were as follows: 1. In sex distribution, 24 out of 38 were males and 14 were females. 16 cases out of 24 male patients were in the age group 20-40 and 9 cases out of 14 female were over 60 years of age. Over all mortality was 7.9%. 2. The numbers of patients of type I and III were 11 cases in each type out of 38 trochanteric fracture. 3. 26 cases out of 38 cases were treated by open reduction and internal fixation and the others were by traction and cast. 4. The applied metal devices were 3 types: Smith-Peterson nail and Thornton or McLaughlin plate, compression hip screw, and multiple pinning. 5. Mean duration of bony union is shorter in the group of open reduction and internal fixation (13 weeks) than the group of traction and cast (15 weeks). The cause of difference is that the 6 out of 9 cases of type IV and V were included in conservative group. 6. The incidece of the complications such as coxa vara, slipping screw, long nail and traction palsy occurred higher in the group fixed with Smith-Peterson nail and plate than the group fixed with compression hip screw.
Accidents, Occupational ; Coxa Vara ; Early Ambulation ; Female ; Femur ; Hip ; Humans ; Incidence ; Male ; Mortality ; Paralysis ; Sex Distribution ; Traction

BACKGROUND: The potent bronchodilatory effects of ketamine on airway smooth muscle tone are important in the management of patients with asthma, but its mode of action is unclear. In the present study we evaluated that effects on isolated guinea pig tracheal smooth muscle. METHODS: Changes of isometric contraction of strip were measured. (1) Serial stimulation with acetylcholine(ACh) in Krebs solution or with A23187, nifedipine, ketamine were evaluated. After that, ACh stimulation was induced in Ca2+ free solution. (2) In Ca2+ free solution, ACh contraction was obtained(L1) and emptied by repetitive ACh stimulation. Internal stores were refilled by Ca2+ with ACh stimulation. During the incubation period, A23187, nifedipine, ketamine, cyclopiazonic acid + ketamine was added and tested for their ability to inhibit refilling. Refilling was evaluated by ACh produced contraction (L2) with ratio (L2/L1). (3) Effects of ketamine on the contraction induced by caffeine were also checked. RESULTS: Ketamine inhibited amplitude dose-dependently by successive application of ACh in modified Krebs solution and Ca2+ free solution. Ca2+ influx through voltage gated channels were inhibited with nifedipine but not with A23187. ACh sensitive internal store were different when A23187, nifedipine and ketamine were applied in Ca2+ free solution. Refilling of internal store were potentiated by A23187, but decreased by nifedipine and ketamine. Caffeine produced contractions in the presence of ketamine were not significantly different from control. CONCLUSION: We concluded that the inhibitory effects of ketamine in guinea pig trachea were by acting through voltage and receptor gated channels in dose-depedent manner and these effects may be interferences of intracellular second messengers system.
Animals ; Asthma ; Caffeine ; Calcimycin ; Guinea Pigs* ; Guinea* ; Humans ; Isometric Contraction ; Ketamine* ; Muscle, Smooth ; Nifedipine ; Second Messenger Systems ; Trachea*

Chyle is the digestive product absorbed from intestinal lymphatics which the component have high concentration of triglyceride and protein. The various pathological circumstances which give rise to intrathoracic effusion of chyle are well documented and so the etiology is clearly defined in most instances. However, the occurrence of chylothorax in early infancy, in the absence of other demonstrable diseases and without apparent birth trauma, suggests the existence of congenital malformation of the thoracic ducts. We lately experienced a 20 day old new born who was proved to have congenital chylothorax by clinical history and laboratory findings. So we report the clinical findings and laboratory findings with the review of the literatures on congenital chylothorax.
Chyle ; Chylothorax* ; Parturition ; Thoracic Duct ; Triglycerides

Diagnosis of a thymic carcinoid was made on transthoracic fine needle aspiration in a 36-year old woman who had an anterior mediastinal mass on chest X-ray and CT scan. The aspiration smears showed numerous anastomosing ribbons and cords of small round tumor cells. The tumor cells had slightly eccentric nuclei and some granular cytoplasm. The small and uniform nuclei of the tumor cells had finely granular chromatin and thin nuclear membrane. The cytologic diagnosis of a carcinoid was confirmed on histopathologic, immunohistochemical, and electromicroscopic examination of surgical specimen.
Adult ; Alleles* ; Biopsy, Fine-Needle ; Carcinoid Tumor ; Carotid Body ; Child* ; Chromatin ; Cytoplasm ; Diagnosis ; Female ; Humans ; Immunoglobulin A* ; Nuclear Envelope ; Paraganglioma ; Thorax ; Tomography, X-Ray Computed

PURPOSE: Currently, pancreatic exocrine carcinomas present with low resectability rates and poor survival, even after curative surgery. In this article, the clinicopathological characteristics, and treatment outcomes, of patients are analyzed and discussed. METHODS: Between 1983 and 2000, 106 exocrine pancreatic carcinoma patients were operated on at our institute. The medical records of 95 patients diagnosed with a ductal adenocarcinoma were reviewed, and the postoperative follow up results analyzed. RESULTS: The locations of the tumors were the head, body and diffusely spread in 76 (80.0%), 17 (17.9%) and 2 (2.1%) patients, respectively. Of the 95 patients, 29 underwent surgical resection (resectability rate; 30.6%), 33 palliative bypass procedures and the other 33 an exploration only. The 1-, 3-, and 5-year survival rates in the resection group were 66.7%, 19.8% and 9.9%, respectively. In the non- resection group the 1-year survival rate was 3.3%, with a mean survival period of 5.5 months. The overall 1-, 3- and 5-year survival rates were 23.0%, 6.6%, and 3.3%, respectively. From a multivariate analysis, the location of tumor (P= 0.0067), TNM stage (P=0.0010) and resectability of tumor (P<0.0001) were all significant prognostic factors. CONCLUSION: Pancreatic carcinomas have very low resectability, with a bad prognosis, and long term survival can only be obtained by their early detection and curative resection.
Adenocarcinoma ; Follow-Up Studies ; Head ; Humans ; Medical Records ; Multivariate Analysis ; Prognosis* ; Survival Rate

BACKGROUND: According to the results of Diabetes Control and Complication Trial, the best strategy to prevent and/or delay diabetic complications is to maintain the normal blood glucose levels. This led to emphasize the necessity of intensive management of diabetes. The purpose of the study was to determine blood glucose/insulin index and carbohydrate (CHO)-to-insulin ratios after normalization of blood glucose levels, and to select the factors to influence the blood glucose/insulin index and CHO-to-insulin ratios in Korean type 2 diabetic patients with continuous subcutaneous insulin infusion (CSII) treatment using insulin pump and CHO counting as a meal management. METHODS: Fifty-five type 2 diabetic patients who started CSII therapy checked their blood glucose levels before and after three meals, and recorded the amounts of insulin injected in fasting and each meal and the amounts of carbohydrates consumed in each meal. Actual blood glucose/insulin index and CHO-to-insulin ratio were determined using the records, and also they were calculated using Functional Insulin Treatment Training Methods (FITTM) proposed by Howorka. Calculated values were compared to actual values. The meaningful factors to influence the actual values were selected by backward stepwise regression analysis. RESULTS: The average age of the subjects was 49.9+/-12.5 years, and the duration of diabetes was 8.7+/-4.5 years. Their body mass index was 22.5+/-3.6 kg/m2. Daily insulin requirements to normalize the blood glucose levels reached to maximum levels at l0 day CSII treatment, and they were reduced and stabilized after 20 days of the treatment. The quotient K, representing insulin sensitivity, was also decreased after CSII treatment. The basal insulin index was 0.21 IU/kg at 10 days and 0.16 IU/kg at 20 days in our study, and these values were lower than the value from FITTM, 0.35 IU/kg The blood/glucose index was -2.5 mmol/L at 10 day CSII treatment, and it was decreased to -4.4 mmol/L at 20 day treatment to the stable levels. CHO-to-insulin ratio provided by FITTM was 2.59 IU/CHO exchange unit and the ratio was 3.12 IU/CHO exchange unit at 10 days, which was decreased to 1.84 IU/CHO exchange unit at 20 days in our study. CHO-to-insulin ratios at breakfast from carbohydrate counting were higher than those of lunch and dinner, and the ratios were 1.5 to 2.5 IU/CHO exchange unit. According to the stepwise regression analysis, the blood glucose/insulin index was affected by gender, age, body mass index (BMI), fasting blood glucose levels and fasting c-peptide levels, and CHO-to-insulin ratios were influenced by gender, age, BMI, post-prandial blood glucose levels and post-prandial c-peptide levels. CONCLUSIONS: CSII treatment can make blood glucose levels maintain in normal ranges in Korean type 2 diabetic patients, and can improve insulin sensitivity. Basal insulin requirements were lower and prandial insulin requirements were higher than those calculated from FITTM. This difference between Korean and the Western can be related to difference of insulin secretion from pancreas and nutrient intake.
Blood Glucose ; Body Mass Index ; Breakfast ; C-Peptide ; Carbohydrates ; Diabetes Complications ; Fasting ; Humans ; Insulin Resistance ; Insulin* ; Lunch ; Meals ; Pancreas ; Reference Values

BACKGROUND: A recent case-control study from Finland reported a strong relationship between high antibody titers to Chlamydia pneumoniae , strain TWAR, and both chronic heart disease and acute myocardial infarction. Other studies also suggested an association between C. pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not been yet regarded as an established theory. The objective of this study was to investigate the relationship between C. pneumoniae immnoglobulin G antibody titers and angiographically diagnosed coronary artery disease. METHOD: Coronary angiography was performed. Controls (n=89) were coronary angiographically normal cases and coronary artery disease (n=115) was diagnosed if coronary artery luminal diameter is obstructed more than 50% in more than one coronary artery. Micro-IF assay was used to measure C. pneumoniae TWAR antibodies. The sera were titrated in two-fold dilutions starting from 1 in 8, and a titre of 1 in 8 or more was judjed positive. RESULTS: The estimated risk of coronary artery disease, adjusted for age and gender, was greater among subjects with high (> or =1:128) antibody titers than with low (< or =1:8) antibody titers (relative risk, 7.9:95% confidence interval, 1.3-47.9). CONCLUSION: These results support an association between infection with >ENGLISH=Ptimes-i< C. pneumoniae and coronary artery disease only in high (> or =1:128) antibody titers.
Antibodies ; Bacteria ; Case-Control Studies ; Chlamydia* ; Chlamydophila pneumoniae* ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Finland ; Heart Diseases ; Myocardial Infarction ; Phenobarbital ; Pneumonia

BACKGROUND: A recent case-control study from Finland reported a strong relationship between high antibody titers to Chlamydia pneumoniae , strain TWAR, and both chronic heart disease and acute myocardial infarction. Other studies also suggested an association between C. pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not been yet regarded as an established theory. The objective of this study was to investigate the relationship between C. pneumoniae immnoglobulin G antibody titers and angiographically diagnosed coronary artery disease. METHOD: Coronary angiography was performed. Controls (n=89) were coronary angiographically normal cases and coronary artery disease (n=115) was diagnosed if coronary artery luminal diameter is obstructed more than 50% in more than one coronary artery. Micro-IF assay was used to measure C. pneumoniae TWAR antibodies. The sera were titrated in two-fold dilutions starting from 1 in 8, and a titre of 1 in 8 or more was judjed positive. RESULTS: The estimated risk of coronary artery disease, adjusted for age and gender, was greater among subjects with high (> or =1:128) antibody titers than with low (< or =1:8) antibody titers (relative risk, 7.9:95% confidence interval, 1.3-47.9). CONCLUSION: These results support an association between infection with >ENGLISH=Ptimes-i< C. pneumoniae and coronary artery disease only in high (> or =1:128) antibody titers.
Antibodies ; Bacteria ; Case-Control Studies ; Chlamydia* ; Chlamydophila pneumoniae* ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Finland ; Heart Diseases ; Myocardial Infarction ; Phenobarbital ; Pneumonia

In patients undergoing hemodialysis, spontaneous bleedings have been reported in locations such as mediastinum, subdural space, retroperitoneum, pericardial and pleural cavities. A 61 year-old woman had been treated three times a week with maintenance hemodialysis via tunnelled cuffed central venous catheter for 4 months. She had a sudden onset of severe pain on right chest wall 24 hours after maintenance hemodialysis. We found that her right upper chest wall was swollen. Urgent computed tomography revealed a soft tissue mass with high density in right chest wall. The lesion was enhanced by contrast but was not clearly marginated in arterial phase. We did emergent hemodialysis, and did transfusion of packed red blood cells and fresh frozen plasma and compressed locally on her right chest wall. Hematoma was spontaneously resolved only after supportive care. Therapeutic approaches to uremic patients with bleeding disorders include angiography, hemodialysis, peritoneal dialysis, transfusion of packed red cells and fresh frozen plasma, infusion of erythropoietin, desmopressin, conjugated estrogen, etc. In this case, spontaneous bleeding without trauma history can occur in patients with endstage renal disease who underwent hemodialysis using catheter. Therefore, immediate treatment should be followed when evidence of bleeding is found.
Angiography ; Catheters ; Central Venous Catheters ; Deamino Arginine Vasopressin ; Erythrocytes ; Erythropoietin ; Estrogens ; Female ; Hematoma ; Hemorrhage* ; Humans ; Kidney Failure, Chronic ; Mediastinum ; Middle Aged ; Peritoneal Dialysis ; Plasma ; Pleural Cavity ; Renal Dialysis* ; Subclavian Artery* ; Subdural Space ; Thoracic Wall