Two dimensional alignment of valves in the cardiac skeleton is studied using 49 fetal hearts. They are standardized with fixed length between the centers of mitral and tricuspid valves. The relations among the parameters and of wall thichness ratio are studied, especially by the change of gestational age, mitral aortic distance and pulmonary-aortic distance, the angles between the two lines and mitral-tricuspid line. Anterior shift of great vessels was seen in heart with gestational age less than 20 weeks. Long mitral-aortic distance showed anterior shift of the great arteries and left ventricle was relatively thicker than right ventricle. Narrow aortomitral-tricuspid angle denoted posterior shift of great vessels and thich right ventricle. Short pulmonary-aortic distance denoted antero-posterior alignment and posterior shift of the vessels and thick left ventricle. Left-right alignment of vessels was not associated with right-ward shift but only with pulmonic displacement to the left. By these observation abnormal alignment of valves in cardiac skeleton would be a basic defect in bulboventricular malformation and we could find basic difference of cardiac skeleton, between normal variation and abnormal heart.
Humans

Background: This study was designed to determine whether presynaptic receptor blockade could be differentiated from postsynaptic receptor blockade by examining the effect of increasing frequencies of indirect stimulation on partial twitch depression in vitro rat phrenic nerve hemidiaphragm preparations. Methods: After isolating rat phrenic nerve hemidiaphragm preparation, T200/T1 ratio (twitch height of the 200th stimuli divided by that of the 1st stimuli) at frequencies of 0.2, 0.5, 1.0, and 2.0 Hz using a drug concentration which provided approximately 20% twitch depression at 0.1 Hz was calculated. To compare T200/T1 ratios with TOF ratios, 2.0 Hz TOF response was measured immediately after 200th stimuli at either frequency of stimulation. Results: Hexamethonium caused a marked decrease in T200/T1 ratio at 0.5~2.0 Hz of stimulation, whereas alpha-bungarotoxin caused no change in T200/T1 ratios at up to 2.0 Hz of stimulation. The T200/T1 ratios produced by d-tubocurarine, vecuronium, mivacurium, and rocuronium located intermediate between alpha-bungarotoxin and hexamethonium, however significant differences among four drugs were found at 2.0 Hz. The propensity for decrease in T200/T1 ratios at 2.0 Hz might differ from this study: hexamethonium >d-tubocurarine >rocuronium >mivacurium = vecuronium >alpha-bungarotoxin. T200/T1 ratios at 2.0 Hz were not different from TOF ratios. Conclusions: When the observed effects in this study were provided with result of alpha-bungarotoxin acting predominantly at postsynaptic receptors and hexamethonium acting predominantly at presynaptic receptors, the effects of nondepolarizing muscle relaxants at each binding site could be differentiated by examining the T200/T1 ratios at 2.0 Hz.
Animals ; Binding Sites ; Bungarotoxins ; Depression* ; Hexamethonium ; Phrenic Nerve* ; Rats* ; Receptors, Presynaptic ; Tubocurarine ; Vecuronium Bromide

PURPOSE: Allelic loss on chromosome 18q is a hallmark of presence of a tummor represser gene. Recently, DPC4 (deleted in pancreatic carcinoma, locus 4), a candidate tumor suppressor gene, has been localized at 18q21. Inactivation of DPC4 gene was reported in pancreatic carcinomas, coloretal carcinomas, and prostatic carcinomas. The aim of the present study was to determine if it might be altered in stomach cancer. MATERIALS AND METHODS: We tested for DPC4 gene mutations and allelic status at 18q21 using a modified 'cold SSCP' method in 48 primary gastric carcinoma and correlated the findings with various clinicopathologic characteristics of the patients. RESULTS: The frequency of mutations in primary gastric cancer was 27.1% (13/48). Mutations of exon 1, 8, 10 were found in 2 (4.1%), 4 (8.2%) and 7 cases (14.6%), respectively. DNA sequencing of 13 cases with DPC4 mutations identified six cases (46.1%) with substitution, four cases with deletion (30.7%), and two cases (23.1%) with insertion. No significant difference was observed in the frequency of DPC4 mutations in terms of other various clinicopathologic characteristics. CONCLUSION: These findings suggest that DPC4 mutations may play a significant role in the establishment and progression of the primary gastric cancer.
Exons ; Genes, Tumor Suppressor ; Humans* ; Loss of Heterozygosity ; Polymorphism, Single-Stranded Conformational ; Sequence Analysis, DNA ; Stomach Neoplasms* ; Stomach*

Background: Esmolol is rapid hydrolyzed by plasma esterase but may inhibit plasma cholinesterase activity based on its structure. This study was designed to evaluate the interactions between esmolol and succinylcholine or mivacurium which are metabolized by plasma cholinesterase and to determine the inhibitory effect of esmolol on human plasma cholinesterase. Methods: Neuromuscular effects of succinylcholine (1.0 mg/kg) and mivacurium (0.15 mg/kg) with or without esmolol (0.5 mg/kg or 1.0 mg/kg) were compared in 57 adult patients (ASA class I) during O2-N2O-isoflurane anesthesia. Neuromuscular block was monitored by recording the compound electromyogram of the hypothenar muscle resulting from supramaximal train of four stimuli applied to the ulnar nerve. Also plasma cholinesterase activity was measured before and 5, 10 minutes after injection of esmolol. Results: Time from injection to onset of over 95% block, clinical duration from injection to 25% recovery of control twitch, and recovery index defined as from 25% to 75% twitch recovery of succinylcholine or mivacurium were not altered by pretreatment of esmolol. Plasma cholinesterase activity was not decreased after injection of esmolol 0.5 mg/kg, but decreased by 5% after injection of 1.0 mg/kg (p<0.05). Conclusions: It is unlikely that neuromuscular blocking effects of succinylcholine and mivacurium are prolonged by administration of clinical doses of esmolol (0.5~1.0 mg/kg) due to inhibition of plasma cholinesterase activity in human.
Adult ; Anesthesia ; Cholinesterases ; Humans ; Neuromuscular Agents ; Neuromuscular Blockade ; Plasma ; Succinylcholine* ; Ulnar Nerve

OBJECTIVE: As an electronic health record system is implementing in Korean health care sectors, concerns about key functionalities of electronic health record systems are increasing. The purpose of this study was to identify core functions and set the priority in electronic health record systems under the Korean contexts in order to assure and improve the quality of the systems. METHODS: A survey was conducted using questionnaire developed by the study team based on literature review. The subjects were medical record administrators working at medical record department in general hospitals. RESULTS: The response rate was 59.8%(55/92). The functions which more than ninety percent of subjects responded as necessary right now and/or in near future related to 'drug alert', 'clinical guideline', 'chronic disease management', 'automated real-time surveillance', 'coded data', 'result reporting', 'de-identifying data', 'disease registry', and 'provider-provider communication and connectivity'. CONCLUSION: The results showed the high prioritized functions were decision support and health information/data management.
Electronic Health Records* ; Health Care Sector ; Hospitals, General* ; Humans ; Medical Record Administrators ; Medical Records ; Needs Assessment* ; Surveys and Questionnaires

Spondylometaphyseal dysplasia (SMD) is an extremely rare, which affects the spine and metaphy-ses of the tubular bones on terms of enchondrogenesis. Children who had Kozlowski dwarfism, type of SMD are not recognized until they reach school age since they have normal clinical feature, weight and size in early childhood. Authors experienced a typical case of Kozlowski type of SMD in a 10 years old male who had i) generalized platyspondyly with anterior tapering of vertebrae ii) generalized metaphyseal dysplasia iii) minimal changes in the carpal and tarsal bones. This case is to be reported with review of references.
Child ; Dwarfism ; Humans ; Male ; Spine ; Tarsal Bones

To clarify the exact role of endomyocardial biopsy in the diagnosis and monitoring of adriamycin-induced cardiotoxicity and to observe the actual relationship between pathologic changes and cardiac dysfunction, a cross-sectional clinical study was conducted. Echocardiography was used to evaluate cardiac dysfunction in 18 patients who had received chemotherapy including adriamycin(mean dose : 410mg/m2 of B.S.A.) without clinical evidence of congestive heart failure, and in 19 normal controls. Six patients receiving adriamycin underwent 7 transfemoral endomyocardial biopsy procedures, and the specimens were evaluated by light and electron microscopy for evidence of drug-related cardiotoxicity. Indexes of cardiac systolic function obtained by M-mode echocardiography(left ventricular dimension, excursion of interventricular septum and left ventricular posterior wall, shortening fraction and ejection fracton) did not show any statistically significant difference between patients who received adriamycin and normal controls. In transmitral flow-velocity curves recorded by Doppler echocardiography with a 2.25MHz probe, the patients showed less E peak velocity and decreased E/A ratio compared with normal controls, which suggests left ventricular diastolic dysfunction in the patients who received adriamycin. All the specimens of the endomyocardial biopsy showed significant pathologic changes of adriamycin indnced cardiotoxicity which was characterized by myofibrillar loss and vacuolization of the cytoplasm. In 2 specimens, pathologic grade was II, while 5 specimens showed pathologic changes of grade III and further chemotherapy with adriamycine was not done in thse 5 cases. From these results it is suggested that pathologic changes precede the clinical onset of congestive cardiomyopathy in the patients receiving adriamycin and left ventricular diastolic dysfunction occurrs before ejection fraction falls to subnormal levels. We conclude that sequential endomyocardial biopsy is absolutely indicated for exact diagnosis and monitoring of adrinamycin-induced cardiotoxicity to prevent the development of irreversible and often fatal cardiomyopathy.
Biopsy ; Cardiomyopathies ; Cardiomyopathy, Dilated ; Cytoplasm ; Diagnosis ; Doxorubicin* ; Drug Therapy ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Humans ; Microscopy, Electron

Pericardial defect is a rare congenital cardiac disorder. Most patients were asymptomatic but some patients with partial pericardial defect occasionally complain acute symptoms such as angina, syncope, rarely sudden cardiac death. So, differential diagnosis with other ischemic or structural heart disease is crucial in the management of such patients. But there is no consistently successful diagnostic method. In the past, artificial diagnostic pneumothorax was used to document the absence of pericardium. However, it is not easily accepted due to excess morbidity and failure rate. Recently, echocardiography and more often, computed tomography, magnetic resonance imaging are used to confirm the diagnosis. We experienced a 52 years old male patient with atypical chest pain, who was diagnosed as complete left pericardial defect with computed tomography.
Chest Pain ; Death, Sudden, Cardiac ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Heart Diseases ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pericardium ; Pneumothorax ; Syncope

OBJECTIVE: The purpose of this study was to determine the important factors affecting survival and pregnancy rate in frozen-thawed embryo transfer cycles. METHODS: we performed reprospective analysis in 738 cycles of frozen-thawed embryo transfers, in relation to the insemination methods, the freezing stage of embryo, patient's age, infertility factors and the origin of injected sperm in ICSI cycles. After conventional IVF or ICSI, the supernumerary PN stage zygotes or multicellular embryos were cryopreserved by slow freezing protocol with 1,2-propandiol (PROH) as a cryoprotectant. RESULTS: The survival rates of thawed embryos were 69.3% (1585/2287) in conventional IVF group and 71.7&% (1645/2295) in ICSI group. After frozen-thawed embryo transfers, 27.0% (92/341) and 32.0% (109/341) of pregnancy rates were achieved in conventional IVF and ICSI group, respectively. There were no significant difference in the survival and pregnancy rates according to the insemination methods, the freezing stage and patient's age. However, the pregnancy rate (36.2%) of male factor infertility (22.9%). In ICSI group, the origin of injected sperm did not affect the outcome of frozen-thawed embryo transfer cycles. CONCLUSION: The present study demonstrates that acceptable clinical outcomes can be achieved after the transfer of frozen-thawed embryos regardless of the stage of embryos for freezing, the patient's age and the origin of injected sperm.
Embryo Transfer* ; Embryonic Structures* ; Freezing ; Humans ; Infertility ; Insemination ; Male ; Pregnancy Rate* ; Pregnancy* ; Sperm Injections, Intracytoplasmic ; Spermatozoa ; Survival Rate ; Zygote

In gastric cancer, the significance of lymphatic invasion as a prognostic factor is controversial. This study was performed to investigate the significance of lymphatic invasion as a prognostic factor in early results of gastric cancer after gastrectomy. We had been prospectively analyzed 362 consecutive patients resected from June 1994 to June 1996 in the Department of Surgery, Ajou University Hospital. Grading of the lymphatic invasion was determined by pathologists according to the JRSGC classification. The difference in the survival rate between the ly0 group and the ly1 group was statistically insignificant, so we only used ly2 and ly3 as the risk group. The prognostic values of lymphatic invasion as a single parameter for survival and early recurrence were determined by using univariate and multivariate analyses. Lymphatic invasion was observed in 90 (24.9%) of the 362 gastric cancer cases, and ly2 or ly3 were 66 (18.3%)cases. The incidence of ly> or =2 steadily increased with advancing TNM stage : stageI, 9/124 (7.3%); stageII, 5/50 (10.0%); stageIII, 24/111 (21.6%); stageIV, 28/78 (35.9%). The incidence of ly> or =2 was significantly correlated with other prognostic factors such as lymph node metastasis, the depth of the primary tumor, and the stage (p<0.05). The cummulative 2-year-survival rate determined by the Kaplan-Meirer method was 56.4% in patients with ly> or =2 and 90.9% in patients with ly<2. The log-rank test showed significant differences between the ly<2 group and the ly> or =2 group (p<0.05). Multivariate analysis of the survival function showed that the depth of the primary tumor had the highest prognostic value followed by lymphatic invasion (ly> or =2) as an independent prognostic factor (p=0.0008, Exp(B)=3.55). The cummulative recurrence free rate determined by the Kaplan-Meirer method was 78.7% in the ly> or =2 group and 90.54% in the ly<2 group. There was statistically significant difference (p<0.05). Univariate analysis for recurrence after radical resection showed that lymphatic invasion had a prognostic impact in the ly> or =2 group (p=0.0055). Therefore lymphatic invasion with ly2 or ly3 grade is an independent prognostic factor that is associated with poor prognosis for early results after gastrectomy. In grading of lymphatic invasion by gastric cancer, simple differentiation of whether lymphatic invasion is present or not was insignificant in the results of our study. In the future, the grade of lymphatic invasion in gastric cancer should be carefully classified by pathologists.
Classification ; Fibrinogen ; Gastrectomy ; Humans ; Incidence ; Lymph Nodes ; Lymphatic Vessels* ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Prospective Studies ; Recurrence ; Stomach Neoplasms* ; Survival Rate