BACKGROUND: We performed electrical cardioversion for the patients with chormic nonvalvular atrial fibrillation under the transesophageal echocardiographic guidance after anticoagulation to evaluate the safety of this procedure and the effects of electrical cardioversion on the atrial function. METHODS: After anticoagulation therapy with coumadine for three weeks, we tried chemical cardioversion with amiodarone first. Failed cases were included in this study. Pre-cardioversion transesophageal echocardiographic parameters were measured after exclusion of thrombi. After sedation with intravenous midazolam, direct-current cardioversion was done with the transesophageal echocardiographic probe in situ. Immediately after sinus conversion, we measured echocardiographic parameters again. Spontaneous echo contrast(SEC), left atrial appendage flow velocity, pulmonary vein flow velocity and time-velocity-integral(TVI), transmitral flow velocity, TVI and deceleration time were measured. All patients were anticoagulated for at least 4 weeks after cardiovesion. RESULTS: The total number of patients was forty one(24 males, 17 females) with the mean age of 58 years(range : 39-70). Mean duration of atrial fibrillation was 65 months(range : 1-360). Hypertension(12), dilated cardiomyopathy(10), cerebrovascular accidents(6), ischemic heart disease(2) and chronic lung disease(1) were associated. There were no complications. SEC increased or newly appeared in 18(43.9%) patients after sinus conversion. The left atrial appendage emptying velocity decreased(32.8+/-17.4 vs. 22.1+/-11.4cm/sec, p=0.020) and systolic TVI of both upper pulmonic vein increased significantly after sinus conversion. In two cases, early systolic forward flow(S1) of pulmonic vein appeared after sinus conversion. Transmitral E velocity decreased(86.9+/-28.8 vs. 76.3+/-30.6cm/sec, p=0.006) and the deceleration time increased(164+/-49 vs. 206+/-53msec, p=0.000) after sinus conversion. Transmitral A velocity was still low(34.9+/-19.5cm/sec) and E/A ratio was high(2.6+/-1.4) immediately after sinus conversion. CONCLUSION: After appropriate anticoagulation therapy and exclusion of left atrium and left atrial appindage thrombi with TEE we could perform electrical cardioversion safety without complications. The changes in transesophageal echocardiographic parameters after sinus conversion revealed the appearance of atrial mechanical activity in concordance with electrical activity. But these findings suggested atrial stunning or electromechanical dissociation which necessitates extended anticoagulation therapy until the full recovery of atrial mechanical function.
Amiodarone ; Atrial Appendage ; Atrial Fibrillation* ; Atrial Function ; Deceleration ; Echocardiography* ; Echocardiography, Transesophageal ; Electric Countershock* ; Heart ; Heart Atria ; Humans ; Lung ; Male ; Midazolam ; Pulmonary Veins ; Veins ; Warfarin

Osteochondrodysplasia is a heterogeneous group of disorders appearing short limbed dwarfism. Because many of these entities are lethal and hereditary, an accurate diagnosis is mandatory. The purpose of this study is to define the clinicopathologic features and radiologic findings of osteochondrodysplasia. We reviewed 29 autopsy cases of congenital short limbed dwarfism, consisting of thanatophoric dysplasia (TD) (12 cases), osteogenesis imperfecta (OI) (12 cases), asphyxiating thoracic dysplasia (ATD) (3 cases), short-rib-polydactyly syndrome (SRPS) (1 case) and hypochondrogenesis (1 case). The gestational age ranged from 16 to 41 weeks. Of 6 fetuses that were born alive, 3 were ATD, 2 were TD and 1 was hypochondrogenesis. TD was frequently complicated by hydramnios. Of 8 cases studied chromosomally, only 1 showed chromosomal abnormality -46XY, inv 9. Intrauterine growth retardation was frequently associated with OI. Pulmonary hypoplasia was present in 23 cases (79%), including all cases of ATD, SRPS and hypochondrogenesis, 11 in TD and 7 in OI. Other associated anomalies were present in 17 cases (59%).
Autopsy* ; Chromosome Aberrations ; Diagnosis ; Dwarfism ; Extremities ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Osteochondrodysplasias* ; Osteogenesis Imperfecta ; Polyhydramnios ; Thanatophoric Dysplasia

No abstract available.
Common Variable Immunodeficiency* ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Immune System Diseases

No abstract available.
Arthroplasty, Replacement, Hip* ; Ceramics* ; Hip*

Pancreatic neuroendocrine tumor (PNET) refer to tumors originating from the islet of Langerhans and shows various prognosis based on the presence or absence of symptoms due to hormone secretion, the Ki-67 cell proliferation index, and the histologic grade, and according to the degree of disease progression defined by the tumor-node-metastasis (TNM) stage classification. The purpose of medical treatment for PNET is to control symptoms or inhibit tumor growth. Somatostatin analogues can be administered for the purpose of controlling symptoms caused by the secretion of specific hormones, and are accepted as effective drugs for inhibiting the progression of G1/G2 tumors based on World Health Organization (WHO) classification with a Ki-67 cell proliferation index less than 20%. Among the molecularly targeted agents, everolimus and sunitinib can be considered in patients with WHO G1/G2 PNET showing progression after somatostatin analog therapy. Cytotoxic chemotherapy is generally administered to patients with large tumor volume and rapidly progressing metastatic NET, and etoposide/cisplatin combination therapy has been considered as a standard treatment. For the patient group of Grade 3 PNET (well differentiated) newly classified by the WHO 2017 classification, guidelines for standard treatment have not yet been established. As it has been reported, studies are needed to evaluate the treatment response rate of somatostatin analogues or molecularly targeted therapies for the patient with Grade 3 PNET. It is important to consider a multidisciplinary approach with all possible treatment options including medical treatment, radical resection of primary or metastatic lesions, liver-directed therapies, and peptide receptor radionuclide therapy for the patients with PNET.

Pancreatic cancer is still one of the most aggressive malignancy, showing 10% of 5-year survival. Among the several reasons of the grave prognosis, the poor response to chemotherapeutic agents and the absence of effective tool for early detection are the most important. Regarding treatments, surgical resection is still positioned as the only one for expecting the cure of pancreatic cancer. However, the rate of recurrence after surgery is still high as more than 50%. And the portion of patients who are diagnosed at the resectable stage is still less than 15% of all cases. So, chemotherapy and radiotherapy are the main players for combating with pancreatic cancer. After the introduction of outcomes of FOLFIRINOX, and gemcitabineabpaclitaxel for metastatic pancreatic cancer, two-digit overall survival can be expected. And, neoadjuvant treatments including concurrent chemoradiation therapy for borderline resectable pancreatic cancer and/or resectable pancreatic cancer are reported as superior to upfront surgery. More recently, several target agents including polyadenosine diphosphate-ribose polymerase inhibitors and immunologic drugs are under evaluation for pancreatic cancer. So, herein, current status of chemotherapy and radiation therapy for pancreatic cancer will be addressed.

In order to evaluate the radio-protective advantage of an enhanced dynamic wedge (EDW) over a physical wedge (PW), we measured peripheral doses scattered from both types of wedges using a 2D array of ion-chambers. A 2D array of ion-chambers was used for this purpose. In order to confirm the accuracy of the device, we first compared measured profiles of open fields with the profiles calculated by our commissioned treatment planning system. Then, we measured peripheral doses for the wedge angles of 15 degrees, 30 degrees, 45 degrees, and 60 degrees at source to surface distances (SSD) of 80 cm and 90 cm. The measured points were located at 0.5 cm depth from 1 cm to 5 cm outside of the field edge. In addition, the measurements were repeated by using thermoluminescence dosimeters (TLD). The peripheral doses of EDW were (1.4% to 11.9%) lower than those of PW (2.5% to 12.4%). At 15 MV energy, the average peripheral doses of both wedges were 2.9% higher than those at 6MV energy. At a small SSD (80 cm vs. 90 cm), peripheral dose differences were more recognizable. The average peripheral doses to the heel direction were 0.9% lower than those to the toe direction. The results from the TLD measurements confirmed these findings with similar tendency. Dynamic wedges can reduce unnecessary scattered doses to normal tissues outside of the field edge in many clinical situations. Such an advantage is more profound in the treatment of steeper wedge angles, and shorter SSD.
Heel ; Silver Sulfadiazine ; Toes

PURPOSE: This study was conducted to evaluate the clinical efficacy of pharmacologic treatment of amatoxin poisoning patients. METHODS: Literature was accessed through PubMed, EMBASE, Cochrane library, KoreaMed, KISS and KMBASE. Studies relevant to human use of pharmacologic therapy including silymarin, penicillin and N-acetylcysteine (NAC) for amanita poisoning were included. Case reports, letters, editorials and papers with insufficient information were excluded. Comparison of clinical outcomes (especially mortality and liver transplantation rate) in each study was analyzed. RESULTS: The final analysis included 13 retrospective studies. None of these studies showed direct comparisons of individual agents. Among 12 studies comparing silymarin vs penicillin, eight showed clinical superiority of silymarin. Among eight studies comparing silymarin with NAC, six showed clinical superiority of silymarin. Among seven studies of NAC vs penicillin, five showed clinical superiority of NAC. CONCLUSION: This systematic review suggested that clinical superiority of various pharmacological agents used to treat amatoxin poisoning is debatable. Nevertheless, the available evidence suggests it is reasonable to consider combinations of multiple agents for patients with amanita poisoning. Further studies are required to establish a treatment regimen for amanita poisoning.
Acetylcysteine* ; Amanita ; Humans ; Liver Transplantation ; Mortality ; Penicillins* ; Poisoning* ; Retrospective Studies ; Silymarin* ; Treatment Outcome

OBJECTIVES: In previous studies, significant correlations between depression or somatization and the mode of anger expression were reported. However few studies were done in psychiatric patients, while some evidences were found that anger expression as well as anger suppression were related to development of somatization. This study aimed to investigate the relationship of the state-trait anger and the mode of anger expression to depression and somatization in psychiatiric patients. METHODS: The depression and somatization questionnaire of SCL-90-R and Korean Adaptation of the State-Trait Anger Expression Inventory were administered to 53 psychiatric patients and 59 normals. The relationship of anger to depression and somatization was analyzed by correlation and regression analyses. RESULTS: In comparison with the normal control group, the psychiatric patient group showed significant differences on trait anger temperament but no significant differences on other anger variables. In regression analysis, the anger-in score was related to depression and somatization. However, the degree of explanatory power was higher in depression than in somatization. In the case of analyzing the state-trait anger, anger-in was significant predictor variable for depression in psychiatric patient group. CONCLUSION: These results suggested that anger-in is the important factor in the onset of depression and somatization. Rather than the relationship of anger-in and somatization, the relationship of anger-in and depression is higher; therefore the caution is necessary in the interpretation of previous studies. The relationship of anger-in to depression and somatization may have important implications for psychotherapy.
Anger* ; Depression* ; Humans ; Psychotherapy ; Surveys and Questionnaires ; Temperament

OBJECTIVES: For the relapse prevention in alcohol dependence, a lot of studies suggested that combined administration of two or more drugs which have different mechanism of action is more effective than each drug alone. In order to investigate the effectiveness of combined administration of naltrexone and acamprosate in comparison with naltrexone alone, this study was carried out by comparing the amount of alcohol intake in C57BL/6 mice co-administered with naltrexone and acamprosate with that in C57BL/6 mice with naltrexone alone. METHODS: In 42 C57BL/6 mice in the state of alcohol dependence, naltrexone 0.025mg/kg or 1.0mg/kg alone or with acamprosate 50mg/kg or 200mg/kg were administrated for ten days. The amounts of alcohol consumption for 2 hour, water consumption for 22 hours, and food intake for 24 hours were measured. RESULTS: 1) A significant reduction of alcohol intake for 2 hours was observed when the mice were treated with naltrexone 0.025mg/kg or 1.0mg/kg and acamprosate 50mg/kg or 200mg/kg simultaneously compared with naltrexone 0.025mg/kg or 1.0mg/kg alone. This effect was significant on the eighth and tenth days of drug administration. 2) Naltrexone administration of 1.0mg/kg was significantly more effective than that of 0.025 mg/kg in reducing alcohol intake from the second day of drug administration up to the tenth day. 3) No significant difference was revealed between the effect of naltrexone alone and that of naltrexone with acamprosate on 22 hour water consumption and 24 hour food intake. CONCLUSION: From these results, it is suggested that the effect of combined treatment with naltrexone and acamprosate is superior to that of naltrexone alone in prevention of relapse in alcohol dependence.
Alcohol Drinking ; Alcoholism ; Animals ; Drinking ; Eating ; Mice* ; Naltrexone* ; Recurrence