No abstract available.
Humans* ; Ligaments*

Amniotic fluid embolism (AFE) is a rare peripartum complication with a mortality rate of 61 to 86%. The main clinical manifestations include shock, acute pulmonary edema, neurologic signs, and coagulopathies. Most diagnosis of AFE is made on the postmortem examination of the maternal pulmonary vasculature, but antemortem confirmation of amniotic fluid material by aspiration of pulmonary blood is rare. We report the first case in Korea who survived from amniotic fluid embolism confirmed by the identification of amniotic fluid debris in pulmonary artery blood. Serial echocardiographic changes of left ventricle systolic dysfunction are also described with a brief review of literatures.
Amniotic Fluid* ; Autopsy ; Diagnosis ; Echocardiography ; Embolism, Amniotic Fluid* ; Female ; Heart Ventricles* ; Korea ; Mortality ; Neurologic Manifestations ; Peripartum Period ; Pregnancy ; Pulmonary Artery ; Pulmonary Edema ; Shock

Traumatic hip joint dislocations account for 2–5% of total joint dislocations. Bilateral asymmetric hip joint dislocation with anteriorly and posteriorly dislocation is an even more rare case because it was according to G. Loupasis reported in 11 cases only since 1879. We want to report 2 cases of bilateral asymmetric hip joint dislocation with unilateral acatabulum fracture which happened in our hospital. Bilateral asymmetric dislocation of hip joint accompanied by unilateral fracture of acetabulum is a very rare case so statistical verification cannot be done. However, close examinations are required at early treatment and follow-up because the patterns of dislocation and fracture of hip joint are variable and an orthopedic emergent condition and several complications may occur at both hip joints.

No abstract available.
Carcinoma, Transitional Cell* ; Tuberculosis, Renal* ; Ureter*

BACKGROUND: Insulin resistance syndrome has been proposed as a major promotor of atherosclerotic disease and earlier studies have implied the hyperinsulinemia itself may enhance coronary vasomotor tone. In patients with vasospastic angina, previous studies have been inconclusive whether to basal coronary artery tone is elevated at the spasm related and nonspasm related artery. This study was performed to investigate whether basal coronary artery tone is elevated ans insulin resistance syndrome correlates to vasospastic angina. If insulin resistance syndrome correlates to vasospastic angina, we also investigated whether insulin resistance syndrome correlates to basal coronary artery tone. METHODS: The study comprised 27 patients with vasospastic angina(M/F ; 19/8, mean age ; 52+/-2 year) and 21 control subjects with atypical chest pain(M/F ; 9/8, mean age ; 47+/-3 year). We assessed basal coronary artery tone by obtaining the percent increase in coronary artery diameter induced by nitroglycerin and also examined glucose and insulin response to an oral glucose load of 75g. RESULTS: 1) There were no significant differences in body surface area, abdominal hip ratio, body mass index, incidence of hypertension, lipid profile, von-Willebrand factor, fibrinogen, and microalbumin except smorking incidence [vasospastic angia ; 16(50%) vs control ; 5(24%), p<0.05)] between vasospastic angina group and control. 2) Basal coronary artery tone was greater at the nonspastic site of the spasm-related artery(28.1+/-2.2% vs 13.1+/-0.9%, p<0.0001) and non-spasm related artery(23.7+/-1.6% vs 13.1+/-0.9, p<0.0001) in the patients with vasospstic angina than in control subjects. In the patients with vasospastic angina, high activity group had a greater basal coronary artery tone than low activity group at the nonspastic site of the spasm-related artery(31.7+/-2.6 vs 20.4+/-2.7%, p<0.001) and non-spasm related artery(26.8+/-2.0 vs 19.4+/-5.8%, p<0.001). 3) Plasma glucose and serum insulin response to an oral glucose load were similar between vasospastic angina group and control subjects, and glucose area, insulin area, and insulinogenic index(delta sigma Glucose / delta sigma Insulin)(330+/-12 vs 328+/-20 mg/dl *hour, 107+/-14 vs 96+/-17uU/ml*hour, and 2.18+/-0.33 vs 2.63+/-0.46, respectively, p=NS) also did not between both groups. 4) Two group did not differ siginificantly in the prportion of glucose intolerance but glucose area and insulin area were significantly high in vasospastic angina patients with glucose intolerance than in control subjects with normal glucose tolerance(366+/-22 vs 257+/-17mg /dl*hour, 127+/-19 vs 52+/-15uU*hour, respectively, p<0.05), but basal coronary artery tone did not differ significantly between vasospastic angina patients with glucose intolerance and control subjects with normal glucose tolerance. CONCLUSION: 1) These results revealed that basal coronary artery tone is elevated at the nonspastic site of the spasm related artery and non-spastic vessel, and the disease activity associated with elevated basal coronary artery tone in vasospastic angina. 2) But these results did not reveal the correlation of hyperinsulinemia with vasospastic angina, and so we did not determine the role of hyperinsulinemia as a pathogenesis of coronary spasm and the relation between hyperinsulinemia and basal coronary artery tone.
Arteries ; Blood Glucose ; Body Mass Index ; Body Surface Area ; Coronary Vessels* ; Fibrinogen ; Glucose ; Glucose Intolerance ; Hip ; Humans ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Nitroglycerin ; Spasm ; Thorax

Transitional cell carcinoma(TCC) of the bladder is confined to mucosa or submucosa on initial presentation. However, high grade superficial tumors tend to recur and progress to muscle invasive or metastatic diseases. Regardless of radical cystectomy in invasive bladder cancer, a poor prognosis was noted due to local recurrence and distant metastasis in recent studies. In this study, the clinical and pathological factors affecting survival of patients with muscle invasive bladder cancer were analyzed. METHODS: A total of 105 patients with histopathologically verified muscle invasive bladder cancer who were admitted to Asan Medical Center between August 1989 and August 1998 were reviewed retrospectively. The clinical manifestations, laboratory findings, and histopathological findings at initial diagnosis were evaluated. Overall survival, disease free survival, and disease specific survival according to many prognostic factors were also analyzed. RESULTS: The factors affecting overall survival of muscle invasive bladder cancer were age, sex, TNM stage, performance status, tumor size, invasion of deep bladder muscle, tumor grade, lymphovascular invasion, and complete resection of tumors. In patients with completely resected bladder cancer by radical cystectomy, tumor size, deep bladder muscle invasion, stage, and lymph node involvement were significant prognostic factors. In patients who had either incomplete resection of bladder cancer or in whom no operation was performed, the survival rate was lower in cases with lymph node involvement or hemoglobin level of less than 10 g/dl. CONCLUSION: After radical cystectomy, the recurrence rate appeared to be higher in solid tumors with deep bladder muscle invasion and lymphovascular invasion on cystoscopic findings. Overall survival was higher in patients with lower tumor stage, no lymph node involvement, and completely resected bladder cancer. Age and sex had no significant correlation with overall survival. No apparent survival advantage was noted in those patients who received post-operative chemotherapy. However, prospective randomized controlled studies are necessary to evaluate the benefit of adjuvant chemotherapy in muscle invasive bladder cancer.
Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cystectomy ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

OBJECTIVES: The rates, correlates, and factor structure of depressive symptoms in a Korean rural sample were examined using Korean version of the Center for Epidemiologic Studies Depression Scale(CES-D). METHODS: Door to door visiting survey was conducted by trained interviewers. A random cluster sample of 1,315 respondents, aged 30 and over completed the CES-D scale along with additional sociodemographic questionnaires. RESULTS: In this sample, mean CES-D score of male and female were 7.8 and 9.5, respectively, which were lower than those reported previously. Symptoms of depression were most common among the less educated, non-married and female according to ANCOVA. Age was not a significant risk factor for depressive symptoms. Different factor structures emerged from this sample as compared to other studies using this approach. Somatic symptoms and affective symptoms were combined as one factor and emotional hardship emerged as a separate factor. CONCLUSIONS: Symptom scores and risk factors were similar to the results reported in other countries but unique factor structures were found in this study. Further research is needed about the Korean depressive symptomatology and related areas.
Affective Symptoms ; Surveys and Questionnaires ; Depression* ; Epidemiologic Studies ; Epidemiology ; Female ; Humans ; Male ; Risk Factors*

BACKGROUND AND OBJECTIVES: Homocysteine is a metabolite of methionine metabolism with atherogenic and thrombotic properties. Increased blood homocysteine has been recognized as a risk factor for atherosclerotic coronary artery disease, but it is not much to be clarified in this country. MATERIALS AND METHOD: In a case-control study, we examine the relationship between the risk of atherosclerotic coronary artery disease and serum total homocysteine, folate, vitamin B12, vitamin B6, and other conventional risk factors. Thirty nine patients with significant stenosis of epicardial coronary artery and 20 healthy age-sex matched control subjects were included. Fasting venous blood was obtained and serum total homocysteine (tHCY) concentration was measured by high performance liquid chromatography and fluorescent detection method. RESULTS: Compared with control group, case group had higher tHCY concentrations (14.9+/-6.9 vs 10.8+/-4.2 mol/L, p<0.05) and lower folic acid concentration (6.7+/-3.6 vs 11.0+/-5.7 ng/mL,p<0.05). There were higher tHCY concentrations of patients with 2 vessel and 3 vessel disease than that of patients with 1 vessel disease (17.2+/-6.7 and 18.4+/-9.8 micro mol/L vs 12.4+/-3.9 micro mol/L,p<0.05). Vitamin B12 and vitamin B6 concentrations showed no significant difference between case group and control group. Compared with control group, there were more smokers (51.5% vs 25.0%, p<0.05), and patients with hypertension (39.4% vs 0%, p<0.001) and diabetes (30.3% vs 0%, p<0.001) in case group. Increased tHCY (tHCY over 14.7 mol/L) was an independent risk factor for atherosclerotic coronary artery disease (OR; 6.75, 95% CI; 1.15 - 40.99, p<0.05) together with smoking (OR; 5.4, 95% CI; 1.22 - 23.95, p<0.05). CONCLUSION: These data support the hypothesis that elevated serum tHCY concentration is a risk factor for Korean patients with atherosclerotic coronary artery disease, and low folate concentration may be responsible for elevated tHCY concentration.
Case-Control Studies ; Chromatography, Liquid ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Fasting ; Folic Acid ; Homocysteine* ; Humans ; Hypertension ; Metabolism ; Methionine ; Risk Factors* ; Smoke ; Smoking ; Vitamin B 12 ; Vitamin B 6

The Eisenmenger syndrome is characterized by severe irreversible pulmonary hypertension and right-to-left shunting of blood through the pulmonary-systemic communication. The resultant right-to-left shunt leads to clinical cyanosis and secondary manifestations of chronic hypoxemia. Clinical features include dyspnea on exertion, fatigue, palpitation, hemoptysis, syncope, chest pain and predisposition to brain abscess and cerebrovascular accident. Brain abscess is a serious complication of cyanotic congenital heart disease and major cause of death. We report a patient with Eisenmenger syndrome in whom the presence of right-to-left shunt and paradoxical embolism appears to be critical for the development of brain abscess.
Anoxia ; Brain Abscess* ; Brain* ; Cause of Death ; Chest Pain ; Cyanosis ; Dyspnea ; Eisenmenger Complex* ; Embolism, Paradoxical ; Fatigue ; Heart Defects, Congenital ; Hemoptysis ; Humans ; Hypertension, Pulmonary ; Stroke ; Syncope

There are many various complications associated with coronary artery stenting, in cluding thrombotic and hemorrhagic complications, in-stent restenosis, side branch occlusion, stent embolization. The retention of equipment components is the uncommon, unexpected and often problematic situations that can arise requiring ingenuity, skill, and creativity. We reports on a patient in whom an sleeve marker ring of a stent balloon catheter retained within the lumen of the coronary artery following coronary stenting. The sleeve marker ring was extracted by dilatation and withdrawal of balloon catheter which readvanced over a guidewire positioned in the center of ring.
Catheters ; Coronary Vessels* ; Creativity ; Dilatation ; Humans ; Stents*