BACKGROUND: In infective endocarditis, the recent introduction of transesophageal echocardiography(TEE) improved diagnostic sensitivity and detection of complications. Although the detection rate of vegetations is above 90% by TEE, the prognostic significance of these lesions remains unclear. The purpose of this study was to investigate prognostic factors for systemic embolism and death in infective emdocarditis by the analysis of transesophageal echocardiographic findings. METHODS: Transthoracic echocardiography(TTE0 and TEE were performed in 56 patients with active left-sided infective endocarditis during admission. If a vegetation was present, the size, mobility and consistency of vegetation were analyzed and paravalvular complications were assessed by TEE. Systemic emboli and in-hospital death dude to infective endocarditis were correlated to clinical and echocardiographic findings. RESULTS: 1) Echocardiographic evaluation revealed vegetations(53 patients), abscess(13 patients) and left ventricular dysfunction(13 patients). Systemic embolic events occured in twenty patients(36%) and death occured in thirteen patients(23%). 2) The size, mobility or consistency of vegetation was all foung not to be significant predictor of systemic embolism. But the incidence of embolism is significantly higher in patients who revealed increased vegetation size on follow-up echocardiogram. 3) The incidence of death was significantly higher in patients with left ventricular dysfunction or abscess on echocardiography. Although the mobility or consistency of vegetation was not related to mortality, the mortality was higher significantly in patients with larger vegetations. CONCLUSION: Our data suggest that left ventricular dysfunction, abscess and large vegetation are risk factors for higher mortality and increased vegetation size on follow-up echocardiography is risk factor for systemic embolism. Because TEE is more useful than TTE in evaluating of vegetation and paravalvular complications, TEE should be performed early in all patients with active left-sided infective endocarditis.
Abscess ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Endocarditis* ; Follow-Up Studies ; Humans ; Incidence ; Mortality ; Prognosis ; Risk Factors ; Ventricular Dysfunction, Left

Transcervical chorionic villus sampling (CVS) was performed in 174 patients between 7 & 12 menstrual weeks of pregnancy opting for prenatal diagnosis. Advanced maternal age was the most common indication for CVS (39.7%). The sampling success rate was 95.4% (166/174), representing 88.9% at 7 to 8 weeks, 98.9% at 9 to 10 weeks & 92.7% at 11 to 12 weeks gestation. In 139 of 174 patients (80%), successful sampling was accomplished in one or two catheter passages only. Four spontaneous fetal losses (2.3%) occurred. The cytogenetic analysis routinely used was the direct overnight & long-term culture methods which revealed 4 abnormalities (2.4%). To date, 90 of the women have been delivered & all infants are doing well and the remaining 65 pregnancies are continuing uneventually. Maternal serum alphafetoprotein (MSAFP) concentration was determined in 72 patients immediately before & after CVS. A significant increase of 20% or more, comparable to pre CVS levels, was noted immediately after sampling in 56 of 72 patients (77.8%). The increase in MSAFP concentration correlated with the amount of villi sampled (r = 0.498, p less than 0.001) & with the number of sampling attempts (p less than 0.05). Estimated CVS related fetomaternal hemorrhage (FMH) ranged from 0.005 to 0.1552 ml and in 5 of 72 patients (6.90%) 0.06 ml or more of FMH was noted. Two of the 5 patients had FMH of 0.1 ml or more.
Chorionic Villi Sampling/*adverse effects ; *Chromosome Aberrations ; Female ; Fetomaternal Transfusion/etiology ; Human ; Pilot Projects ; Pregnancy/*blood ; Rh Isoimmunization/etiology ; Support, Non-U.S. Gov't ; alpha-Fetoproteins/*analysis

BACKGROUND: Intracranial germ cell tumors are higher in the East Asia such as Korea and Japan than any other Western countries. By analyzing common clinical features of intracranial germ cell tumors in children, we will prevent from misdiagnosing and delaying in the establishment of diagnosis. Furthermore, we can choose appropriate therapeutic plans to improve patient's prognosis.METHODS: We retrospectively reviewed the medical records of 68 patients to investigate and analyze clinical characteristics of intracranial germ cell tumors in children.RESULTS: The average age of 68 patients was 14.8 years old, and the male to female ratio in all patients was 3:1. The most common symptom presented by 30 patients was headache regarded as a nonspecific symptom in brain tumors. Sixty four patients were diagnosed by histologic method called biopsy and most of them were come out into germinoma. Thirty five patients were included in low-risk group and 30 patients were in high-risk group. Intracranial germ cell tumors in this study were most commonly located in the pineal gland.CONCLUSION: There are a variety of types in intracranial germ cell tumors, and they have been accurately diagnosed by radiologic, histologic methods and elevated tumor markers. We concluded that it is necessary for early diagnosis to evaluate exhaustively in patients suspected of brain tumors.
Biopsy ; Brain Neoplasms ; Child ; Early Diagnosis ; Far East ; Female ; Germ Cells ; Germinoma ; Headache ; Humans ; Japan ; Korea ; Male ; Medical Records ; Neoplasms, Germ Cell and Embryonal ; Retrospective Studies ; Biomarkers, Tumor

BACKGROUND: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. MATERIALS AND METHOD: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. RESULT: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was 165.3+/-43.1 minutes and mean ACC time was 110.4+/-48.2 minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. CONCLUSION: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long- term follow-up will be required to analyze the benefits of robot-assisted operation.
Aortic Valve ; Arm ; Catheterization ; Endoscopes ; Hemorrhage ; Hospital Mortality ; Humans ; Length of Stay ; Mammary Arteries ; Mitral Valve ; Reoperation ; Robotics ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery* ; Voice

Central anticholinergic syndrome is defined as an absolute or relative reduction in cholinergic activity in the central nervous system and has a wide variety of manifestations. It is associated with almost any drug given during anesthesia, except neuromuscular relaxants, and treated with the cholinesterase inhibitor physostigmine. The diagnosis of central anticholinergic syndrome is often made when symptoms resolve promptly after the administration of physostigmine. We present a case of a central anticholinergic syndrome diagnosed by treatment with physostigmine, in a patient who received closure of patent foramen ovale associated with stroke.
Anesthesia ; Anticholinergic Syndrome* ; Central Nervous System ; Cholinesterases ; Diagnosis ; Foramen Ovale, Patent ; Humans ; Physostigmine ; Stroke

Long-term results of orthotopic heart transplantation vary among different institutions. The purpose of the present study was to assess the factors, which might affect long-term survival and complications. Between November 1992 and July 2003, 112 heart transplantations (M/F=89: 23) were performed. The standard technique was used in the first 57 patients and the bicaval technique in the latter 55 patients. Indications for transplantation in decreasing order of frequency were dilated cardiomyopathy (75%), ischemic cardiomyopathy (7%), and others (18%). The mean follow up duration was 51.8 +/- 31.3 months with 98 patients remaining alive. Preoperatively, all patients were either in NYHA functional class III or IV. Postoperatively, all patients showed improvement to functional class II or I, except 3 patients that remained in NYHA class III. The mean number of rejection cases within the first year was 0.6 +/- 0.8, with humoral rejection noted in 3 cases. The graft vascular disease (GVD) -free survival at 3 and 5 years was 96% and 83%, respectively. The 7-year survival after heart transplantation was 84%. There were 16 deaths, of which infection (n=4) was the most common followed by rejection (n=3), and malignancy (n=2). The present long-term results, were relatively superior to those seen in western countries. The relatively low GVD-free survival rate is thought to have contributed. The complications encountered after transplantation were mostly immunosuppressive drug related, suggesting further potentials for improvement in long-term survival.
Adult ; Female ; Follow-Up Studies ; Graft Rejection/epidemiology ; *Heart Transplantation/mortality ; Humans ; Incidence ; Kidney/blood supply ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Vascular Diseases/epidemiology

Tumors of the minor papilla are very rare and these tumors have generally been known as neuroendocrine tumors such as carcinoid tumor and somatostatinoma. As these are mostly submucosal tumors, their diagnosis is difficult by just performing endoscopic forceps biopsy, but diagnosis is possible by surgery or endoscopic resection. EUS and ERCP is an essential tool for the diagnosis of these tumors, and abdominal CT or MRI is also useful because there is the possibility of malignant tumors such as carcinoid tumor. For our present two cases, screening endoscopy revealed the polypoid lesion of the minor papilla. EUS disclosed that the submucosal tumor was limited to the submucosal layer and no abnormality was found from the abdominal CT and ERCP. Herein, we performed endoscopic resection for making the diagnosis and treatment. Histologically, these 2 tumors were diagnosed as ectopic pancreas and gangliocytic paraganglioma, respectively.
Biopsy ; Carcinoid Tumor ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Endoscopy ; Magnetic Resonance Imaging ; Mass Screening ; Neuroendocrine Tumors ; Pancreas ; Paraganglioma ; Somatostatinoma ; Surgical Instruments ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: To compare the pattern of myocardial fibrosis in various valvular heart diseases (VHD), the morphometric data of the myocardial tissue and serum biochemical markers of myocardial fibrosis were analyzed in patients with aortic stenosis (AS), aortic regurgitation (AR) and mitral regurgitation (MR). SUBJECTS AND METHODS: Blood samples were obtained from 21 patients with AS, 23 with AR and 29 with MR. The serum levels of aminoterminal propeptide, of type I/III procollagen (PINP/PIIINP), and fibronectin were measured to estimate the synthesis of the extracelluar matrix. The carboxy-terminal telopeptide collagen type I (CITP), matrix metalloproteinase-1 (MMP-1, collagenase) and the tissue inhibitor, metalloproteinase-1 (TIMP-1), were also measured to estimate the collagen degradation and metabolism activities. The left ventricular mass (LVM) was calculated by echocardiography. Of the patients, myocardial tissue was obtained during surgery in 11 with AS, 8 with AR and 13 with MR;the collagen volume fraction (CVF) was calculated using picrosirius red staining. RESULTS: The LVM was significantly larger in the AS and AR groups compared to the MR group (p<0.001), and the CVF also showed significant differences (13+/-3% in AS, 10+/-3% in AR, and 6+/-3% in MR, p<0.001). The fibronectin level was significantly elevated in the AS and AR groups than the MR group (p<0.001), whereas the CITP and MMP-1 levels were significantly higher in the MR group (p<0.05). The PINP/PIIINP showed no significant difference between the groups (p>0.05), and the biochemical markers were no different between the AS and AR groups (p>0.05). Fibronectin was the only parameter showing a positive correlation with both the CVF (r=0.388, p=0.01) and the left ventricular mass (r=0.278, p=0.02). CONCLUSION: Different mechanisms for the matrix synthesis and degradation were present for the maintenance of myocardial fibrosis and hypertrophy according to the type of VHD, and fibronectin, a major non-collagenous extracelluar matrix, was proved to be an important factor associated with cardiac hypertrophy and myocardial fibrosis.
Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Biomarkers ; Cardiomegaly ; Collagen ; Collagen Type I ; Echocardiography ; Fibronectins ; Fibrosis* ; Heart Valve Diseases* ; Humans ; Hypertrophy ; Matrix Metalloproteinase 1 ; Metabolism ; Mitral Valve Insufficiency ; Procollagen

This study was performed to analyse the tendency of the self-care studies, to investigate the variables related to self-care, which could be applied for the data establishing the theory of self-care. to accomplish the objectives of this study, the researchers analyzed 83 studies, available that contained the area of self-care, which was published in local and foreign areas between 1981 and Feb. 1997. The findings of this study are as follows: 1) Studies published in Korea were about twice more than foreign studies. According to the statistics, the number of studies in this study tended to increase year by year. Between 1991 and 1995 were most. Analysis on the subject of this studies showed, that they were most dealt with chronic diseases an adults. 2) The theoretical definition of self-care were most referred to Orem's self-care. For the main concept of studies, self care performance was the most. 3) The correlational study was most often used design and experimental study is tended to increase. The questionnaires were the most often used data collection method. There was lots of different variable measuring technique to evaluate main concepts. 4) In the results of analysis on the propositions related to the self-care performance, a client's education, social support, self-efficacy, and level of knowledge as a causal variable were found. Also, the physiological index improved and quality of life were fond to be significant effective variables.
Adult ; Chronic Disease ; Surveys and Questionnaires ; Education ; Humans ; Korea ; Quality of Life ; Self Care*