No abstract available.

17 cases of acute myocardial infarction with no or insignificant narrowing of major coronary arteries on angiogram and without any-other types of heart disease were found in a series of 133 consecutively studied patients with acute myocardial infarction(12,7%). There were no differences in risk factors between groups. Although the infarction site were similar in both groups, the patients with normal coronary arteries had fewer complications during hospitalization(p<0.05) and lesser ST segment change during the exercise test before discharge(p<0.05). In the hemodynamic fingings, cardiac index, left ventricualr and diastolic pressure and resional wall motion were similar in both groups of the patients, but ejection fraction was higher(p<0.05) in the patients with the normal coronary arteries. In conclusion, it could be predicted that the acute myocardial infarction with the normal coronary arteries would have the better prognosis. And a transient coronary occlusion, as the most likely pathogenic mechanism of the acute mtocardial infarction with normal coronary arteries, might be studied in the aspect of the thrombosis following lysis, the coronary artery spasm and the platelet aggregation.
Angiography* ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels ; Exercise Test ; Heart Diseases ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction* ; Platelet Aggregation ; Prognosis ; Risk Factors ; Spasm ; Thrombosis

A 6-yr-old male weighing 20 kg with the diagnosis of a large vallecular cyst in the oropharynx was scheduled for surgical excision. After a slight loss of consciousness following an IV injection of ketamine 10 mg while maintaining spontaneous respiration, 4% lidocaine was sprayed into the right nostril. An uncuffed 4 mm OD wire-reinforced endotracheal tube was advanced through the right nostril and positioned in the nasopharynx. An ultrathin 60 cm Olympus LF-P fiberoptic bronchoscope (OD: 2.2 mm) was threaded and the vocal cords and surrounding structures were identified as intact. The endotracheal tube and fiberscope were withdrawn. Ketamine 10 mg was injected intravenously again. Following direct insertion of an Olympus fiberoptic bronchoscope (OD: 3.8 mm) through the right nostril without tube placement and visualization of the vocal cords, topical anesthesia of the larynx was achieved by spraying 1 ml 2% lidocaine through the biopsy channel. Thirty seconds later, it was passed into the trachea and 1 ml 2% lidocaine was sprayed intratracheally. The bronchoscope was withdrawn. The 4 mm uncuffed wire-reinforced tube was passed again through the right nostril and an ultrathin fiberoptic bronchoscope (OD: 2.2 mm) was threaded over the tube, and passed smoothly without resistance. There was neither laryngeal spasm nor cough. Anesthesia was maintained with enflurane 2.0 vol%, N2O (1.5 L/min) and O2 (1.5 L/min). The mass was successfully excised and extubated without compromise. The patient was uneventfully discharged the next day.
Anesthesia ; Biopsy ; Bronchoscopes ; Cough ; Diagnosis ; Enflurane ; Humans ; Ketamine ; Laryngismus ; Larynx ; Lidocaine ; Male ; Nasopharynx ; Oropharynx ; Respiration ; Trachea ; Unconsciousness ; Vocal Cords

In various autopsy series, overdiagnosis as well as underdiagnosis of pulmonary embolism has been reported. During the past decade, mortality rate has not declined despite advances in diagnostic methods. To evaluate the hypothesis that changes of hemodynamic parameters responded by mean pulmonary arterial pressure differences are of paramount importance to guide prognosis, experimental model of anesthetized dogs was used. Six dogs were anesthetized with 15 milligrams per kilogram of pentobarbital sodium, given intravenously and paralyzed with 2 milligrams of pancuronium bromide. 0.3 to 0.8 gram per kilogram of autologous blood clot was infused into the right atrium through a left external jugular vein. The dogs after embolization were divided into group A(mean pulmonary arterial pressure 33mmHg) and group B(mean pulmonary arterial pressure 43 mmHg). Each group of three dogs was monitored for a total of 4.5 hours. A 7F Swan-Ganz catheter was positioned and used to measure with fluid-filled transducer pulmonary capillary wedge pressure, mean pulmonary arterial pressure and mean right atrial pressure. Cardiac ouput was measured in triplicate by thermodilution and divided by weight to obtain the cardiac index. Blood gases, pH and saturation of arterial blood were measured. White blood cell and platerlets were counted in arterial blood. The results are as follows : 1) Changes in mean arterial pressure showed no significant differences between group A and group B following embolization. 2) Changes in mean pulmonary arterial pressure showed significant differences between group A and group B(p<0.05). 3) Changes in cardiac index showed significant differences between group A and group B after 45 minutes following embolization(p<0.05). 4) Changes in total pulmonary resistance showed significant differences between group A and group B after 45 minutes following embolization(p<0.05). 5) PaO2 showed significant differences between group A and group B after one hour following embolization(p<0.05), but arterial pH showed no significant difference. 6) Changes in mean pulmonary capillary wedge pressure, mean right atrial pressure and heart rates showed no significant differences between group A and group B following embolization. In conclusion, changes in mean pulmonary arterial pressure, cardiac index, total pulmonary resistance and PaO2 showed significant differences between group A and group B following embolization.
Animals ; Arterial Pressure ; Atrial Pressure ; Autopsy ; Catheters ; Dogs* ; Gases ; Heart Atria ; Heart Rate ; Hemodynamics ; Hydrogen-Ion Concentration ; Jugular Veins ; Leukocytes ; Models, Theoretical ; Mortality ; Pancuronium ; Pentobarbital ; Prognosis ; Pulmonary Artery* ; Pulmonary Embolism* ; Pulmonary Wedge Pressure ; Thermodilution ; Transducers

DCRV is a rare cause of right ventricular outflow obstruction by anomalous muscle bundle at the level of sinus portion. The symptoms due to DCRV itself were mild inspite of significant pressure gradient over 90mmHg between proximal and distal chamber, and became severe by associated complication of bacterial endocarditis or aortic regurgitation in ventricular septal defect. In 12 cases(40%), right ventricular hypertrophy configuration in electrocardiogram was characteristic. Although R wave in V1 was tall, S wave in V6 and R wave in aVR were indistinctive. Those were very useful findings for diagnosis of DCRV which was thought to be possible only invasively. With operation prior to overt right ventricular faliure, the prognosis was good with only minor complication.
Adolescent* ; Adult* ; Aortic Valve Insufficiency ; Diagnosis ; Electrocardiography ; Endocarditis, Bacterial ; Heart Septal Defects, Ventricular ; Humans ; Hypertrophy, Right Ventricular ; Prognosis ; Ventricular Outflow Obstruction

PURPOSE: Recognition of impending death is crucial not only for efficient communication with the caregiver of the patient, but also determination of the time to refer to a separate room. Current studies simply list the events 'that have already occurred' around 48 hours before the death. This study is to analyze the predictability of each event by comparing the time length from 'change' to death. METHODS: Subjects included 160 patients who passed away in a palliative care unit in Incheon. The analysis was limited to 80 patients who had medical records for the last week of their lives. We determined 9 symptoms and 8 signs, and established the standard of 'significant change' of each event before death. RESULTS: The most common symptom was increased sleeping (53.8%) and the most common sign was decreased blood pressure (BP) (87.5%). The mean time to death within 48 hours was 46.8% in the case of resting dyspnea, 13.6% in the ease of low oxygen saturation, and 36.9% in the case of decreased BP. The symptom(s) which had the highest positive predictive value (PV) for death within 48 hours was shown to be resting dyspnea (83%), whereas the combination of resting dyspnea and confusion/delirium (65%) had the highest negative PV. As for the most common signs before death within 48 hours, the positive PVs were more than 95%, and the negative PV was the highest when decreased BP and low oxygen saturation were combined. The difference in survival patterns between symptoms and signs was significant. CONCLUSION: The most reliable symptoms to predict the impending death are resting dyspnea and confusion/delirium, and decline of oxygen saturation and BP are the reliable signs to predict the event.
Blood Pressure ; Caregivers ; Dyspnea ; Humans ; Medical Records ; Oxygen ; Palliative Care ; Prognosis ; Terminally Ill

From march, 1983 to May, 1987, we experienced 17 patients of Marfan syndrome. The clinical profile and course of 17 patients of Marfan syndrome were reviewed. 1) Their ages ranged from 13 to 50 years with a mean age of 30 years and 16 patients were male and 1 patient was female. 2) musculoskeletal features were present in 14(88%) of the 16 examined. Ocular features were found in 5(42%) of 12 examined. Familial features were present in 7(47%) of 15 examined. 3) Among cardiovascular manifestations dissecting aneurysm was present in 10(59%) patients, aortic annuloectasia in 15(94%), MR in 4(24%) and MVP in 1(6%). 4) Modified Bentall operation was performed to 8 patients. Two of them died. The other 8 patients took a conservative medical therapy. Four of them died.
Aneurysm, Dissecting ; Female ; Humans ; Male ; Marfan Syndrome*

This study was undertaken to evaluate the present status of intestinal helminthic infections in Koreans, from April 1967 through May 1969. The nationwidely collected stool specimens and scotch-tape anal swabs from primary schoolchildren, middle school students, draftees to army recruitment camp, soldiers and inhabitants of various parts of Korea were examined. The methods employed were Kato's cellophane thick smear technique and formalin-ether sedimentation technique in 40,581 for the prevalence rate of various intestinal helminths, scotch-tape anal swab technique in 8,585 for the prevalence rate of Enterobius vermicularis and by Stoll's dilution egg counting technique in 1,174 for the evaluation of the worm burden of some helminths. The results are as follows. Result of stool examination: The positive rate of intesinal helminthes of any kind was 90.5% among 40,581. In rural people, it was 92.3% in average in contrast to 85.0% in Seoul inhabitants. The infection rate of A. lumbricoides in 40,581 was 58.2%. It was higher in rural people 62.9% than in Seoul inhabitants and highest in 5-9 year-old group by age. The infection of Trichocephalus trichiurus showed the highest prevalence rate in Koreans and it was 74.5%. No remarkable difference was observed between Seoul inhabitants(72.2%) and rural people(75.2%). The tendency of higher prevalence rate with the older age group was observed. The infection rates of hookworm and Trichostrongylus orientalis in 40,581 examinations by cellophane thick smear were 5.1% and 5.8% respectively. But in 4,949 examinations for which refined cellophane thick smear technique and formalin-ether sedimentation technique were employed, the infection rates were turned out 17.6% in hookworm and 15.9% in T. orientalis. Although rural people showed higher infection rate of hookworm(18.8%) than Seoul inhabitants(13.8%), the reverse was true in T. orientalis infection rate(14.5% : 20.3%). Both kinds of infections were tend to be higher with the increase of age. The infection rates of Clonorchis sinensis and Metagonimus yokogawai were 4.7% and 0.4% respectively. In both kinds of infections male showed higher infection rates than female and the tendencies of higher infection rate in the older age group were observed. The provinces which showed the higher infection rate of C. sinensis were South and North Kyongsang Do and North Cholla Do, all of which are provinces of southern part of Korea. Some endemic foci of M. yokogawai were noticed in South Kyongsang Do and South Cholla Do. The infection rate of Taenia spp. by applying only the stool examination was 0.7% throughout the survey. No sex difference in infection rate of Taenia spp. was noticed, but in older age group it was increased. Cheju Do, the island of extreme southern part of Korea seemed the most endemic area and South and North Cholla Do were next in ranking of Taenia infection rate. The ova of Hymenolepis nana were observed in 0.2% and all of them were under the age of 20 except only one caes. The infection rate seemed higher in female (0.3%: 0.1%). No geographical difference was noticed except 1.1% of schoolchilderen and students of Cheju Do. Result of Scotch-tape anal swab technique for E. vermicularis infection. The infection rate of E. vermicularis in 8,585 urban and rural schoolchildren and rural inhabitants was 46.6%. Female (57.9%) had definitely higher infection rate than male (41.4%). The infection rate was significantly higher in rural people than Seoul schoolchildren. The exteme example was 79.7% in schoolchildren of South Cholla Do. Result of worm burden examination by Stoll's dilution egg-counting technique: Among 1,174 examinations, countable(E.P.G.> 100) cases of A. lumbricoides were 745(63.5%) and the mean E.P.G. was 9,723. The mean E.P.G. in Seoul inhabitants was 5,835 in contrast to 10,820 in rural people. The age group of 5-9 showed the heaviest mean E.P.G., 11,337. 70.6% of 745 cases were less than 10,000 in E.P.G. which means light infection. Countable cases by Stoll's technique for T. trichiurus ova were 63.5% and mean E.P.G. was 649. No difference between Seoul and rural inhabitants was observed. Grade I and II in which E.P.G. is less than 5,000 involve 99.3% of positive cases. 91 cases (7.9%) in 1,174 were positive for hookworm ova by Stoll's technique and mean E.P.G. was 501. All cases were in Grade I and II which were less than 5,000 in E.P.G. Trichostrongylus orientalis was positive only in 25 cases (2.1%) by Stoll's technique and mean E.P.G. was 340. No cases were found to have more than 5,000 in T. orientalis E.P.G. The mean E.P.G. of Clonorchis sinensis among the referred cases of clonorchiasis to Department of Parasitology, Seoul National University, was 9,416. On the other hand mean E.P.G. of C. sinensis was 21,376 among cases in the hyperendemic area of Kimhae, South Kyongsang Do, and 3,073 in cases from other various localities. Among referred clonorchiasis cases to our Department, 21.6% were turned out to have the E.P.G. more than 10,000. The cases who have the E.P.G. more than 10,000 in hyperendemic area, Kimhae were 40.7% and in other various localities were 9.1%
parasitology-helminth-nematoda-trematoda-cestoda ; epidemiology ; Ascaris lumbricoides ; Trichocephalus trichiurus ; Trichostrongylus orientalis ; Clonorchis sinensis ; Metagonimus yokogawai ; Taenia sp. ; Hymenolepis nana ; Enterobius vermicularis

To localize bypass pathways, left and right ventricular regions were analyzed at rest by phase image analysis in 6 patients with Wolff-Parkinoson-White syndrome and 5 patients with concealed bypass pathway. These were compared with image findings in 12 normal subjects. In normal subjects, the earliest emptying occured in ventricular septal, apical and left basal segments. Mean difference between the earlist left and right ventricular phase angle was 2.3+/-5.6degrees in patients with normal conduction, -14.0+/-15.1degrees in patients with left bypass pathways, 15.0+/-0degrees in patients with right bypass pathways and -6.6+/-12.3degrees in patients with concealed bypass pathways. In patients with bypass pathways, there was complete agreement between phase and electrophysiologic maps, but incomplete agreement(4 of 6) between surface ECGs and electrophysiologic map in a patient with left posterior and left bypass pathways. The phase image represents a new, noninvasive method of evaluating ventricular pre-excitation. The method may provide useful information complementary to that of electrocardiographic and electriphysiologic analysis.
Electrocardiography ; Humans ; Wolff-Parkinson-White Syndrome*

Nail toxicity following systemic chemotherapy is common. Onychopathy during the period of neutropenia following chemotherapy may cause subungual abscesses and serious infection. Despite taxoid-related toxicity being increasingly reported since 2000, there are still phase II systemic chemotherapy studies using taxoid that have never mentioned nail changes. Recently, new criteria for the evaluation of nail toxicity have been suggested. The present report is the first of its kind, in Korea, to describe a case of docetaxel-associated onychopathy, which improved following a reduction in the docetaxel dose.
Antimetabolites, Antineoplastic/administration & dosage ; Antineoplastic Agents, Phytogenic/administration & dosage/adverse effects ; Antineoplastic Combined Chemotherapy Protocols/*adverse effects ; Deoxycytidine/administration & dosage/analogs & derivatives ; Dose-Response Relationship, Drug ; Female ; Fluorouracil/analogs & derivatives ; Humans ; Lymphatic Diseases/drug therapy ; Middle Aged ; Nail Diseases/*chemically induced ; Stomach Neoplasms/drug therapy ; Taxoids/*administration & dosage/*adverse effects