BACKGROUND: Perfusion scintigraphy with dipyridamole have been reported to be useful for diagnosis of coronary artery disease and the assessment of the presence and extent of myocardium at ischemic risk, especially in patients who can not undergo dynamic exercise testing. Dipyridamole, pharmacologic coronary vasodilator, also induces fall in blood pressure and rise in heart rate. The purpose of this study was to answer the question if dipyridamole induced peripheral hemodynamic responses were related to chest pain, ST changes on EKG, scintigraphic defect or extent of coronary stenosis. METHODS: Dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 43 subjects who were suspected to have coronary artery disease. The peripheral hemodynamic response was graded as absent(group 0) if there was a < or =10mm fall in systolic blood pressure (SBP) and/or < or =10 beats/min rise in geart rate(HR) ; moderate(group 1) if there was >10 but < or =20mm fall in SBP and/or >10 but < or =20 beats/min rise in HR ; and marked (group 2) if there was >20mm fall in SBP and/or >20 beats/min rise in HR. RESULTS: The overall diagnostic sensitivity and specificity for coronary artery disease of dipyridamole perfusion scintigraphy were 68%, 83% while per vessel sensitivity and specificity for coronary artery disease were 66%, 97%. The numbers of induced chest pain and ischemic ST changes among hemodynamic subgroups, were 40%, 40% in group 0, 33%, 27% in group 1 and 50%, 40% in group 2 without significant difference in each hemodynamic subgroups. Either the numbers of diseased coronary arteries or the numbers of patients demonstrationg reversible scintigraphic defects were not statically different among each subgroups. CONCLUSION: Although the peripheral hemodynamic response dose not always correlate with its central coronary effect but dipyridamlole 99mTc-MIBI myocardial perfusion scintigraphy is an useful test for diagnosis of coronary artery disease.
Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis ; Dipyridamole* ; Electrocardiography ; Exercise Test ; Heart Rate ; Hemodynamics* ; Humans ; Myocardial Perfusion Imaging ; Myocardium ; Perfusion Imaging ; Sensitivity and Specificity

Sarcoidosis is a systemic granulomatous disorder of unknown etiology characterized by granuloma formation. Due to the limited incidence of sarcoidosis in pediatric patients, little is known about the clinical course of this disease. A combination of clinical, radiologic, and pathologic examination is necessary to exclude other differential diagnoses (i.e., infection and granulomatous inflammatory disorder) and establish a diagnosis of sarcoidosis. Here, we report a case of histologically confirmed sarcoidosis initially misdiagnosed as hepatosplenic abscesses in an 11-year-old male. Treatment with corticosteroids improved his symptoms and resolved his skin and hepatosplenic lesions. A three-year follow-up was uneventful. This study emphasizes the importance of considering sarcoidosis in children presenting with findings of multi-organ involvement in the presence of histologic evidence of granuloma.

BACKGROUND: This prospective study was performed to evaluate factors influencing weight changes pregnancy period and pospartum period. METHODS: A total of 195 women followed by prenatal care of the department of OBGY at Ajou University hospital, Suwon, Korea, between march, 1998 and march, 2000. Parity, activity, alcohol, smoking, age of menarche, and age of first and last pregnancy were recorded for prenatal information. Anthropometric measurements was checked at regular visits until 6 weeks after delivery and by telephone call at 6 months and 1 year postpartum. RESULTS: Mean age was 30.1 years old and mean body mass index was 21.1 kg/m2. Mean total weight gain during pregnancy was 13.6+/-4.63 kg and wide range was at third trimester. It shows that weight reduced gradually until 6 months postpartum but increased after that time. 1 year postpartum weight gain had high correlation(R=0.999, 0.01) with 6 months postpartum weight gain. Total pregnancy weight gain, weight retention on 6 week postpartum were not significantly correlated with 1 year postpartum weight gain. OR for becoming overweight on 1 year postpartum(> OR =5.2 kg) with excessive rate of gain on 6 months postpartum(> OR =2.9 kg) was 5.41(95% CI 2.20 13.31) adjusted by multiple logistic regression analysis(age, activity level, parity). OR for becoming overweight on 1 year postpartum with excessive rate of Total pregnancy weight gain(> OR =13.6 kg) was 4.48(95% CI 1.84 10.89) by multiple logistic regression analysis. CONCLUSION: 1 year postpartum weight gain had the correlation with only 6 months postpartum weight gain.
Body Mass Index ; Female ; Gyeonggi-do ; Humans ; Korea ; Logistic Models ; Menarche ; Overweight ; Parity ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Prenatal Care ; Prospective Studies* ; Smoke ; Smoking ; Telephone ; Weight Gain

Retroperitoneal fibrosis is a rare disease characterized by the formation of dense plaque of fibrous tissue covering the retroperitoneal structures. This disease is commonly presented as ureteral obstruction, but the involvement of duodenum is rare. We report a case of retroperitoneal fibrosis which was complicated with duodenal stenosis and was successfully treated with corticosteroids. A 58-yr-old man, who had history of aorto-iliac bypass graft due to arteriosclerosis obliterans with infrarenal aortic occlusion was admitted to the hospital with abdominal pain and a mass. Abdominal CT scan revealed the periaortic soft tissue mass encircling grafted aorta and stenosis of duodenal third portion. Retroperitoneal fibrosis with duodenal stenosis was diagnosed and prednisolone therapy was initiated. Follow-up CT scan showed that the patient responded to prednisolone therapy with eased pain, shrinking periaortic mass, and reduced duodenal stenosis.
Anti-Inflammatory Agents, Steroidal/therapeutic use ; Case Report ; Duodenal Obstruction/*complications/drug therapy/physiopathology/radiography ; Glucocorticoids, Synthetic/therapeutic use ; Human ; Male ; Middle Age ; Prednisolone/therapeutic use ; Retroperitoneal Fibrosis/*complications/drug therapy/physiopathology/radiography ; Tomography, X-Ray Computed/methods ; Treatment Outcome

A link between sensorineural hearing loss and autoimmune disease is postulated.The pathogenesis of sudden sensorineural hearing loss (SNHL)in patients with systemic lupus erythematosus (SLE)is not clear.However,several reports have suggested vasculitis secondary to SLE as underlying mechanism or association of antiphospholipid antibody (aPL).Although there were some cases of sensorineural hearing loss associated with systemic lupus erythematosus or lupuslike syndrome treated with plasmapheresis or immunosuppressive agents,there has been no case of SNHL in patients with SLE reported in Korea.We describe an 18-year-old female with systemic lupus erythematosus who presented with sudden sensorineural hearing loss.She was treated with high-dose corticosteroids with favorable clinical outcome.
Adolescent ; Adrenal Cortex Hormones ; Antibodies, Antiphospholipid ; Autoimmune Diseases ; Female ; Hearing ; Hearing Loss, Sensorineural* ; Humans ; Lupus Erythematosus, Systemic* ; Plasmapheresis ; Vasculitis

BACKGROUND: Acute respiratory distress syndrome (ARDS) is characterized by severe inflammatory pulmonary edema of unknown pathogenesis. To investigate the pathogenesis of ARDS associated with neutrophilic oxidative stress, the role of phospholipase A2 (PLA2) was evaluated by the inhibition of calcium channel. METHODS: In Sprague-Dawley rats, acute lung injury (ALI) was induced by the instillation of E.coli endotoxin (ETX) into the trachea. At the same time, diltiazem was given 60 min prior to tracheal instillation of ETX. Parameters of ALI such as lung and neutrophil PLA2, lung myeloperoxidase (MPO), BAL neutrophils, protein, surfactant were measured. Production of free radicals from neutrophils was measured also. Morphological studies with light microscope and electron microscope were carried out and electron microscopic cytochemistry for detection of free radicals was performed also. RESULTS: Diltiazem had decreased the ALI parameters effectively in ETX given rats and decreased the production of free radicals from neutrophils and lung tissues. Morphological studies denoted the protective effects of diltiazem. CONCLUSION: Diltiazem, a calcium channel blocker, was effective in amelioration of ALI by the suppression of neutrophilic oxidative stress mediated by PLA2 activation.
Acute Lung Injury* ; Animals ; Calcium Channels ; Diltiazem* ; Free Radicals ; Histocytochemistry ; Lung ; Neutrophils* ; Oxidative Stress* ; Peroxidase ; Phospholipases A2 ; Pulmonary Edema ; Rats ; Rats, Sprague-Dawley ; Respiratory Distress Syndrome, Adult ; Trachea

OBJECTIVES: In South Korea, there is limited information on nicotine dependence (ND) and its correlation with psychiatric disorders. Based on the National Epidemiologic Survey of Psychiatric Disorders in South Korea in 2006, we examined the relationship between the severity of tobacco smoking and mental disorders, paying specific attention to suicidal ideas, plans, and attempts. METHODS: A total of 6,510 adults underwent face-to-face interviews. The Korean version of the Composite International Diagnostic Interview (K-CIDI) was used to evaluate lifetime prevalence and correlates of mental disorders. According to the the severity of tobacco smoking, participants were grouped into never-smokers, ever-smokers, and ND. The frequencies of mental disorders and suicidal tendencies were analyzed among ND/ever-smokers. Multivariate logistic regression analysis was used to predict the odds ratios and significance levels among groups. RESULTS: Associations of ND with alcohol use disorder, mood disorder, anxiety disorder, pathological gambling, and suicidal tendencies were significant, even after controlling for demographic characteristics. Associations of most psychiatric disorders with smoking were stronger in females than in males. CONCLUSION: ND is highly associated with alcohol use disorder, mood and anxiety disorders, pathological gambling, and suicidal tendencies. Interventions are needed in order to prevent the development of ND from regular smoking.
Adult ; Anxiety Disorders ; Female ; Gambling ; Humans ; Logistic Models ; Mental Disorders ; Mood Disorders ; Odds Ratio ; Prevalence ; Republic of Korea ; Smoke ; Smoking ; Suicide ; Tobacco ; Tobacco Use Disorder

A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long- standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/ or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.
Adult ; Antibodies, Monoclonal/pharmacology ; Antigens, CD20/biosynthesis ; Biopsy ; Female ; Graft Rejection ; Graft Survival ; Histocompatibility Testing/methods ; Humans ; Immunoglobulins/chemistry ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Plasmapheresis ; Transplantation Conditioning

Background/Aims: With the global increase in patients with solid malignancies, it is helpful to understand the outcomes of intensive care unit (ICU) admission for these patients. This study evaluated the risk factors for ICU mortality and the shortand long-term outcomes in patients with solid malignancies who had unplanned ICU admission. Methods: This retrospective cohort study included patients with solid malignancies treated at the medical ICU of a single tertiary center in South Korea between 2016 and 2022. Results: Among the 955 patients, the ICU mortality rate was 23.5%. Lung cancer was the most common cancer type (34.2%) and was significantly associated with increased ICU mortality (odd ratio [OR] 1.58, p = 0.030). Higher Sequential Organ Failure Assessment scores at ICU admission (OR 1.11, p < 0.001), the need for mechanical ventilation (OR 6.74, p < 0.001), or renal replacement therapy during the ICU stay (OR 2.49, p < 0.001) were significantly associated with higher ICU mortality. The 1-year survival rate after ICU admission was 29.3%, with a median survival of 37 days for patients requiring mechanical deviaventilation, and 23 days for patients requiring renal replacement therapy. Conclusions This study showed that critically ill patients with solid malignancies had poor 1-year survival despite relatively low ICU mortality. These findings highlight the need for careful consideration of ICU admission in patients with solid malignancy, and decision-making should be based on an understanding of the expected short- and long-term prognosis of ICU admission after an informed discussion among patients, families, and physicians.

Background/Aims: With the global increase in patients with solid malignancies, it is helpful to understand the outcomes of intensive care unit (ICU) admission for these patients. This study evaluated the risk factors for ICU mortality and the shortand long-term outcomes in patients with solid malignancies who had unplanned ICU admission. Methods: This retrospective cohort study included patients with solid malignancies treated at the medical ICU of a single tertiary center in South Korea between 2016 and 2022. Results: Among the 955 patients, the ICU mortality rate was 23.5%. Lung cancer was the most common cancer type (34.2%) and was significantly associated with increased ICU mortality (odd ratio [OR] 1.58, p = 0.030). Higher Sequential Organ Failure Assessment scores at ICU admission (OR 1.11, p < 0.001), the need for mechanical ventilation (OR 6.74, p < 0.001), or renal replacement therapy during the ICU stay (OR 2.49, p < 0.001) were significantly associated with higher ICU mortality. The 1-year survival rate after ICU admission was 29.3%, with a median survival of 37 days for patients requiring mechanical deviaventilation, and 23 days for patients requiring renal replacement therapy. Conclusions This study showed that critically ill patients with solid malignancies had poor 1-year survival despite relatively low ICU mortality. These findings highlight the need for careful consideration of ICU admission in patients with solid malignancy, and decision-making should be based on an understanding of the expected short- and long-term prognosis of ICU admission after an informed discussion among patients, families, and physicians.