Systolic time interval measurements were made sequentially during second, third trimesters and postpartum period. Recordings were made in the supine position after bed rest for at least five minutes in order to obtain a steady state. In second trimester, pre-ejection period index (PEPI) was significantly shortened and left ventricular ejection period index(LVETI) remained normal while PEP/LVET decreased. Four possible mechanisms may be involved to account for the alterations in hemodynamic changes during this period(late stage of second trimester) : (1) increased metabolic demands of pregnancy: (2) hemodynamic effects of hypervolemia: (3) circulatory adjustments secondary to an arteriovenous shunt-like effect of the placental circulation: (4) cardiovascular effect of steroid hormone. The third trimester was characterized-by a markedly shortened LVETI, a prolonged PEPI and PEP/LVET. This findings are consistent with impaired left ventricular performance and are probably due to decreased left ventricular preload resulting from diminished venous return secondary to inferior vena caval obstruction by the large gravid uterus. In the postpartum period, the PEPI and PEP/LVET remained elevated and the LVETI shortened in the supine position. It is concluded that alterations in systolic time intervals occur normally during the course of uncomplicated pregnancy and persist into the postpartum period.
Bed Rest ; Female ; Hemodynamics ; Humans ; Placental Circulation ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Supine Position ; Systole* ; Uterus

A 29-year-old man was referred to the emergency department with a complaint of abdominal pain and dizziness. He had experienced two previous syncopal episodes. His family history revealed that his mother and his two uncles had received permanent pacemaker implantation. His initial heart rate was 49 beats per minute. The electrocardiography (ECG) showed atrial flutter and right bundle branch block (RBBB) with left anterior fascicular block (LAFB). On admission, 24-hour Holter showed ventricular pause up to 16 seconds during syncope. Radio frequency catheter ablation (RFCA) of atrial flutter was performed. The ECG revealed bifascicular block (RBBB and LAFB) and first-degree atrioventricular block. He received a permanent pacemaker implantation. His brother's and his sister's ECGs also showed trifascicular block and the pedigree showed autosomal dominant inheritance. This patient was diagnosed with a progressive familial heart block (PFHB) type I. This would be the first report of a PFHB type I case documented in Korea.
Abdominal Pain ; Adult ; Atrial Flutter ; Atrioventricular Block ; Bundle-Branch Block ; Catheter Ablation ; Dizziness ; Electrocardiography ; Emergencies ; Heart ; Heart Block ; Heart Rate ; Humans ; Korea ; Mothers ; Pedigree ; Syncope ; Wills

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive fibrosis and destruction of intra- and extrahepatic bile ducts resulting in hepatic failure and death. Only the liver transplantation is the possible treatment for patients to survive. There has been a few reports that steroid is an effective treatment in autoimmune variant sclerosing cholangitis, which is thought to be a familial diseases with different etiology, and steroid responsive biliary strictures be named as immunoglobulin G4 (IgG4)-associated cholangitis (IAC). There is no reliable data regarding effective steroid treatment in autoimmue variant sclerosing cholangitis in Korea. We report a case of 32-year-old male with sclerosing cholangitis, who was diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) and liver biopsy, showing favorable response to prednisolone therapy.
Adult ; Anti-Inflammatory Agents/*therapeutic use ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Cholangitis, Sclerosing/*diagnosis/pathology ; Humans ; Male ; Prednisolone/*therapeutic use ; Treatment Outcome

BACKGROUND/AIMS: Although transcatheter arterial chemoembolization (TACE) is a major treatment modality for unresectable hepatocellular carcinoma (HCC), acute hepatic failure after TACE is not rare. However, reports dealing with this important complication are not good enough and results are often variable. The purpose of this study was to evaluate the incidence and associated risk factors of acute hepatic failure after TACE. METHODS: From January 2001 to November 2004, six hundred and thirtytwo TACE sessions were performed in 377 patients (294 men and 83 women). Adriamycin mixed lipiodol solution and gelfoam were used for TACE. Various clinical and radiological factors before and after the procedure were reviewed retrospectively. Univariate and multivariate analyses were performed to evaluate the risk factors associated with the development of acute hepatic failure after TACE. RESULTS: Acute hepatic failure occurred in 76 (12.0%) of the 632 TACE sessions within 14 days. Univariate analysis revealed that Child-Pugh class, 1st TACE, total bilirubin level, number of involved segments, total size of tumor, presence of right portal vein thrombosis (PVT) or main PVT, involvement of segment 1, 5, 6, 7, modified UICC stage, and doses of chemotherapeutic agent were significantly different between the patients with or without hepatic failure after TACE. Among them, elevated total bilirubin (p=0.001, E (beta)=1.449), presence of right (p=0.035, E (beta)=2.109) or main (p=0.011, E (beta)=4.067) PVT were independently associated factors in multivariate analysis. CONCLUSIONS: The incidence of acute hepatic failure after TACE was 12.0%. Elevated bilirubin level and portal vein thrombosis could be considered as the predictive factors for acute hepatic failure after TACE in HCC patients.
Adult ; Aged ; Aged, 80 and over ; Antibiotics, Antineoplastic/adverse effects/therapeutic use ; Carcinoma, Hepatocellular/complications/pathology/*therapy ; Chemoembolization, Therapeutic/*adverse effects/methods ; Doxorubicin/adverse effects/therapeutic use ; Female ; Humans ; Incidence ; Iodized Oil/adverse effects/therapeutic use ; Liver Failure, Acute/epidemiology/*etiology ; Liver Function Tests ; Liver Neoplasms/complications/pathology/*therapy ; Male ; Middle Aged ; Multivariate Analysis ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Severity of Illness Index

PURPOSE: The aim of study was to provide suggestions for prioritizing research in effort to reduce cancer burden in Korea based on a comprehensive analysis of cancer burden and Delphi consensus among cancer experts. MATERIALS AND METHODS: Twenty research plans covering 10 topics were selected based on an assessment of the literature, and e-mail surveys were analyzed using a two-round modified Delphi method. Thirty-four out of 79 experts were selected from four organizations to participate in round one, and 21 experts among them had completed round two. Each item had two questions; one regarding the agreement of the topic as a priority item to reduce cancer burden, and the other about the importance of the item on a nine-point scale. A consensus was defined to be an average lower coefficient of variation with less than 30% in importance. RESULTS: Seven plans that satisfied the three criteria were selected as priority research plans for reducing cancer burden. These plans are "research into advanced clinical guidelines for thyroid cancer given the current issue with over-diagnosis," "research into smoking management plans through price and non-price cigarette policy initiatives," "research into ways to measure the quality of cancer care," "research on policy development to expand hospice care," "research into the spread and management of Helicobacter pylori," "research on palliative care in a clinical setting," and "research into alternative mammography methods to increase the accuracy of breast cancer screenings." CONCLUSION: The seven plans identified in this study should be prioritized to reduce the burden of cancer in Korea. We suggest that policy makers and administrators study and invest significant effort in these plans.
Administrative Personnel ; Breast Neoplasms ; Consensus ; Delphi Technique ; Early Detection of Cancer ; Electronic Mail ; Health Policy* ; Helicobacter ; Helicobacter pylori ; Hospices ; Humans ; Korea ; Mammography ; Palliative Care ; Policy Making ; Smoke ; Smoking ; Thyroid Neoplasms ; Tobacco Products

PURPOSE: To evaluate the relationship between depressive symptoms and health care costs in outpatients with chronic medical illnesses in Korea, we screened for depressive symptoms in 1,118 patients with a chronic medical illness and compared the severity of somatic symptoms and health care costs. PATIENTS AND METHODS: Data were compared between outpatients with depressive symptoms and those without depressive symptoms. Depression and somatic symptoms were measured by Zung's Self-rating Depression Scale (SDS) and Patient Health Questionnaire (PHQ)-15, respectively. We also investigated additional data related to patients' health care costs (number of visited clinical departments, number of visits made per patients, and health care costs). A total of 468 patients (41.9%) met the criteria for depressive disorder. RESULTS: A high rate of severe depressive symptoms was found in elderly, female and less-educated patients. A positive association between the severity of somatic symptoms and depressive symptoms was also identified. The effects of depressive symptoms in patients with chronic illnesses on three measures of health services were assessed by controlling for the effects of demographic variables and the severity of somatic symptoms. We found that the effects of depressive symptoms on the number of visited departments and number of visits made per patients were mediated by the severity of somatic symptoms. However, for health care costs, depressive symptoms had a significant main effect. Furthermore, the effect of gender on health care costs is moderated by the degree of a patient's depressive symptoms. CONCLUSION: In summary, there is clearly a need for increased recognition and treatment of depressive symptoms in outpatients with chronic medical illnesses.
Adult ; Aged ; Aged, 80 and over ; Chronic Disease/*economics ; Depression/*complications/diagnosis/*economics ; Female ; *Health Care Costs ; Humans ; Male ; Middle Aged ; *Outpatients ; Regression Analysis ; Sex Factors