BACKGROUND AND OBJECTIVES: Intracardiac electrocardiographic finding using as a guide for selective catheter ablation in patients with AV nodal reentrant tachycardia (AVNRT) is not specific. Therefore, we evaluated the efficacy and safety of the anatomical approach for catheter ablation in patients with AVNRT. MATERIALS AND METHOD: Among the patients diagnosed as AVNRT by electrophysiologic study, total 66 patients (M:F=26:40) were included in this study. In the right anterior oblique radiographic view, the septal annulus of tricuspid valve, extending from the most posterior region of the annulus adjacent to coronary sinus ostium (posterior) to His bundle recording site (anterior), was divided into posterior (P), mid (M), and anterior (A) sites. Radiofrequency (RF) energies were applied from the posterior part to the anterior part sequentially along the septal annulus of tricuspid valve until successful ablation. RESULTS: Successful anatomical sites were located in posterior (11 patients), mid (48 patients), and anterior (7 patients) sites. The most patients (62 patients) were treated with slow pathway ablation except 4 patients in whom fast pathway was ablated. Probable slow potentials were observed in 8 patients (12%, 3 in posterior sites and 5 in mid sites). Transient complete AV block followed by first degree AV block and delayed complete AV block was occured in one case whose ablation site was A1. And another 3 patients had postablation first degree AV block. CONCLUSION: In patients with AVNRT, the ablated pathway were different according to successful anatomical site. And RF catheter ablation of atrioventricular nodal reentrant circuit guided by anatomical landmark is safe and efficacious.
Atrioventricular Block ; Bundle of His ; Catheter Ablation* ; Catheters* ; Coronary Sinus ; Electrocardiography ; Humans ; Tachycardia, Atrioventricular Nodal Reentry* ; Tricuspid Valve

Although the goal of fracture treatment is alive bony union with anatomical reduction, prosthetic replacement is indicated for some complicated femoral neck fracture. However it is not defined until now which one is selected between hemiarthroplasty and total hip replacement for the delayed or complicated femoral neck fracture. In order to get the criteria which one is better for this patient when indicated, we reviewed the result of 39 endoprosthetic and 16 total hip replacement patients at Seoul National University Hospital between June of 1975 to June of 1980. Both methods of endoprosthesis and total hip replacement showed satisfactory results of 72% and 90% respectively. Considering two points of the pain-relief and walking ability, total hip replacement is believed to be far better than endoprosthesis, especially for those patients who are over 50 years of age and have had more active living conditions before fracture.
Arthroplasty, Replacement, Hip ; Femoral Neck Fractures ; Femur Neck ; Femur ; Hemiarthroplasty ; Humans ; Joints ; Seoul ; Social Conditions ; Walking

3 cases of giant cell tumor in the distal femur or upper tibia were treated by curettage and acrylic cement packing between October 1978 and May 1981. All were females. The postoperative courses were satisfactory with no recurrence or malignant change for periods of 16 months to 30 months. In one case, acrylic cement reinforced with tantalum wire was used because it is superior to acrylic cement alone in mechanical properties. The adventages of this method are: 1. The cautery effect of setting cement. 2. Avoidence of the need for large quantities of cancellous bone 3. The possibility of incorporating a prosthesis if the lesion is extensive. 4. Rapid mobilization. 5. Ease of early diagnosis of recurrence.
Cautery ; Cementation ; Curettage ; Early Diagnosis ; Female ; Femur ; Giant Cell Tumors ; Giant Cells ; Humans ; Methods ; Prostheses and Implants ; Recurrence ; Tantalum ; Tibia

Multiple involvement of arterial fibromuscular dysplasia is unusal and such a case is quite limited in the literature. We present a case of multiple arterial fibromuscular dysplasia with aneurysm formation in a 38-year-old non-hypertensive man. Angiographic study showed multiple aneurysmal dilatations of the right renal, superior mesenteric, celiac axis, and left colic arteries. The resected right kidney demonstrated an aneurysm of the main renal artery and extensive infarction in the midportion of the renal parenchyma. The segmentally resected superior mesenteric artery disclosed a similar nature of aneurysm occluded by recent thrombi. Microscopically, all the resected arterial walls showed both intimal and medial fibroplasia together with periadventitial fibrosis resulting in marked narrowing of the lumen and subsequent thrombus formation.

OBJECTIVE: To evaluate the inhibition effects of hyper-reflexic detrusor activity by sacral afferent nerve stimulation in spinal cord injury (SCI) patients. METHOD: The subjects were thirteen patients with SCI who had symptoms of urinary incontinence, because of hyper-reflexic bladder contractions. According to the level and severity of injury, the patients were divided into groups of tetraplegia/paraplegia and complete/incomplete. We applied dorsal penile nerve (DPN) stimulation using portable stimulator during the continuous bladder filling. Stimulation parameters were biphasic rectangular pulses of 25 Hz frequency, 250 microseconds pulse width. Stimulation intensity was twice the threshold of pudendo-anal reflex. The one minute stimulation was repeated to every reflex contraction during the cystometry. Immediate suppressive effect of DPN was analyzed. RESULTS: Of 13 patients who had a reflex bladder, hyper-reflexic detrusor contractions were suppressed effectively in 12 by DPN stimulation. The suppressive effect in groups of level and severity was not statistically significant. CONCLUSION: DPN stimulation for inhibition of hyper-reflexic bladder contraction is an adjunctive method of incontinence management in SCI patients of different level and severity.
Humans ; Pudendal Nerve ; Reflex ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Incontinence

The T cell antigen receptor (TcR) in combination with costimulatory signals triggered by accessory molecules present on the surface of the antigen-presenting cells (APC) regulates the activation and growth of T lymphocytes. Calyculin A and Okadaic acid is known to be an inhibitor of serine/threonine phosphatase and RK-682 specifically blocks functions of tyrosine phosphatase. To investigate roles of these inhibitors in TcR-mediated signaling cascade, chimeric molecule CD8-5 which contains the extracellular and transmembrane domains of the human CD8a molecule and the cytoplasmic tail of TcR 5 chain were stably expressed in Jurkat cell line. CD8-5 chimeric protein induced tyrosine phosphorylation of various cytoplasmic substrates and IL-2 gene expression in a NFAT dependent manner by stimulation with anti-CD8 mAb OKT8 as seen in TcR stimulation. When CD8-5 transfectants were preincubated with Okadaic acid, Calyculin or RK682, they differentially affected tyrosine phosphorylation of signaling mediators including CD8-5 molecule. When Jurkat Tag cell line was used where SV40 T antigen is stably expressed and the expression of p-galactosidase is driven by the multiple NFAT binding sites plus minimal IL-2 promoter, these phosphatase inhibitors -RK682, Calyculin A, Okadaic acid- effectively inhibited IL-2 gene expression at the concentration of 1.2832 x 10 ' M, 3.9924 x 10 M, 7.2707 x 10 M respectively. These results suggested that Okadaic acid, Calyculin or RK682 modulate TcR-proximal as well as TcR-distal signaling events during T cell activation.
Antigen-Presenting Cells ; Antigens, Viral, Tumor ; Binding Sites ; Cell Line ; Cytoplasm ; Gene Expression ; Humans ; Interleukin-2 ; Jurkat Cells ; Okadaic Acid* ; Phosphorylation ; Receptors, Antigen, T-Cell ; T-Lymphocytes ; Tyrosine

In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations.
Anatomic Variation ; Head* ; Pathology ; Rotator Cuff ; Shoulder ; Tendons

OBJECTIVES: We were to analyze the effect of managing metabolic syndrome using a u-health service in a health center. METHODS: We collected biometric data from 316 subjects living in a county (gun) in South Korea before and after the introduction of uhealth services in 2010. Analysis was done by contingency table using SPSS and latent growth model using AMOS. RESULTS: We found that regional u-health services affected instance of metabolic syndrome. Further, biometrics and health behavior improved. After six months of u-health services, the number of subjects with three or more factors for metabolic syndrome decreased by 62.5%; 63.3% of regular drinkers stopped drinking; 83.3% of subjects who rarely exercised began to exercise twice a week or more; and 60.9% of smokers stopped smoking. CONCLUSIONS: U-health services can change health behavior and biometrics to manage metabolic syndrome in rural areas. The usefulness of u-health services is discussed.
Disease Management ; Health Behavior ; Republic of Korea

BACKGROUND: This study was performed to evaluate our experience on laparoscopic appendectomy. METHODS: Retrospective analysis was performed on 2,856 patients who had been operated by laparoscopic appendectomy under diagnosis of acute appendicitis at the Sung-Ae Hospital and Kwang-Myoung Sung-Ae Hospital from October 1991 to July 1998. RESULTS: Among 2,856 patients who had undergone laparoscopic appendectomy,2,379 patients (83.3%) were operated due to simple acute appendicitis, 275 patients (9.6%) due to perforated appendicitis. Operation time was 44.6 minutes for simple acute appendicitis and 60.3 minutes for perforated appendicitis. In perforated appendicitis, intra-peritoneal irrigation and drain insertion was performed. The length of hospital stay in patient with simple acute appendicitis was 3.7 days (5.82 days in conventional appendectomy) and patients with perfotrated appendicitis was 6.1 days (9.91 days in conventional appen-dectomy). Complications such as wound infection, intra-abdomen abscess, trocar site bleeding, subcutaneous emphysema developed in 43 (1.5%) patients (79/1,947, 4.5% in conventional appendectomy). In 202 (7.1%) patients, appendix was normal, but another diseases were detected, including acute pelvic inflammation, ovarian cyst, mesenteric lymphadenitis, enteritis, diverticulitis in order. CONCLUSION: Overall complication rate was lower in laparoscopic appendectomy compared with conventional appendectomy and the length of hospitalization of laparoscopic appendectomy was shorter. When the acute appendicitis is suspected, especially in the reproductive women, the laparoscopic approach would be better diagnostic and therapeutic value than conventional method. Therefore laparoscopic appendectomy would be replaced with conventional appendectomy.
Abscess ; Appendectomy* ; Appendicitis ; Appendix ; Diagnosis ; Diverticulitis ; Enteritis ; Female ; Hemorrhage ; Hospitalization ; Humans ; Inflammation ; Length of Stay ; Mesenteric Lymphadenitis ; Ovarian Cysts ; Retrospective Studies ; Subcutaneous Emphysema ; Surgical Instruments ; Wound Infection

Pleomorphic xanthoastrocytoma is histologically characterized by marked cellular pleomorphism of lipid-laden neoplastic astrocytes and bizarre giant cells showing mitotic figures and high cellularity. Inspite of its ominous-looking microscopic features, howerver, the prognosis is usually favorable. This tumor develops mainly in the supratentorial area of young people and frequently involves the leptomeninges. We experienced a case of pleomorphic xanthoastrocytoma in 18 year-old-male. In addition to the cellular pleomophism, the prominent reticulin fibers surround the individual tumor cells or the tumor cells nests. Immunohistochemical staining and electron microscopy revealed glial fibrillary acidic protein(GFAP) expression and pericytoplasmic basal lamina in the tumor cells.