The purpose of this study was to investigate the effects of combined exercise on visceral fat, cardiac function, adipocytokine, and NT-pro BNP concentration according to angiotensin-converting enzyme(ACE) genotype in obese middle aged men. Fifty three obese men (II type: 18, ID type: 20, DD type: 15), ratio of visceral and subcutaneous were over 0.4, were enrolled in the study. The combined exercise program included stretching, resistance training, aerobic exercise, and yoga. The exercise was conducted for 60 minutes, 4 times a week for 12 week period. ACE genotype was determined using a polymerase chain reaction (PCR), and the genetic subtype was classified in three patterns e.g. II, ID, DD. As a results, body weight, BMI, and WHR significantly decreased after 12 weeks of combined exercise in ID type and DD type. Body fat(%), visceral fat and V/S significantly decreased after 12 weeks in DD type. HDL-C and LDL-C significantly improved in II, ID and DD type. Cardiac structure decreased in all genotype and cardiac function increased in DD type. IL-6 and NT-pro BNP, the risk factors of cardiovascular disease, were significantly decreased in DD type, after 12 weeks. Therefore, exercises have shown to be most effective in type DD which is also considered as the risk of cardiovascular diseases. Among all the ACE genotype, DD type requires the most exercise.

We have recently experienced a rare case of abdominal aortic injury caused by shearing force falling from 8 meter height in upright position. The patient was 43 year old and sustained Ll, L2, L5, compression fractures and both distal tibia and fibula comminuted fractures involving ankle joints. 2 years and 2 months later, marked stenosis of the distal abdominal aorta was found together with clinical manifestations of ischemia of both legs. Aorto-femoral bypass on both sides has completely relieved the symptoms.
Accidental Falls ; Ankle Joint ; Aorta, Abdominal ; Constriction, Pathologic ; Fibula ; Fractures, Comminuted ; Fractures, Compression ; Humans ; Ischemia ; Leg ; Tibia

Monitoring fetal movement serves as an indirect rneasure of fetal well-being, especially for central nervous system integrity and function. Methods to monitor fetal movement vary from the simple approach of having the mother chart perceived movement to highly specialized methods. However there were no reliable objective monitoring methods in Korea. For development of objective method for evaluating fetal movement, during pregnancy, one-hundred and two pregnant patients were entered to this study. All patients were divided into following 3 groups and each type of monitoring methods were applied. Group 1(N=20): Type I using portable FHR Doppler unit(IFD-100 model, Intermed, Korea). Group 2(N=20): Type II using FHR Microphone(Prenatal Listening Kit, Model FS002, Unisar Inc., US). Group 3(N=62): Type III using conventional ultrasound transducer(Corometric 115 Model, US). In this study, accurate counting of the fetal movementutus were best performed using Type III, because of monitoring fetal movements has its greatest efficiency when using conventional ultrasound transducer of fetal monitor. It was also attractive to doctors and nurses as a convenient methods because it needed only single transducer when compared to Type I and II. Although monitoring fetal body movement permits a general assessment of well-being, no perfect technique is still reliable. Futher techniques would be developed using the results of this study for improvement of several factors such as accuracy and objectiveness
Central Nervous System ; Fetal Monitoring ; Fetal Movement* ; Humans ; Korea ; Mothers ; Pregnancy* ; Transducers ; Ultrasonography

BACKGROUND: Efficacy of percutaneous transluminal angioplasty(PTA) in the treatment of Peripheral arterial disease has been established. Complications such ans PTA-induced dissections or residual stenosis with occasional mural thrombi have been reported, which compromise the results. New procedures can be used in combination with PTA to improve the immediate and long term results, such ans prolonged balloon inflation, atherectomy, or implantation of endovascular prosthesis. In addition, the occurrence of other lesions, such as spontaneous or post-catheterization dissection or post-PTA restenosis, has prompted the insertion of a vascular stent. But there was few reports on stenting for peripheral arterial disease in Korea. METHODS: To evaluate the safety, efficacy and stability of stent in peripheral arterial disease, twenty-six consecutive symptomatic patients with 37 peripheral lesions were treated with 39 balloon expandable(33 Strecker and 6 Palmaz)stents with or without prior balloon angioplasty in the period of March 1991 and February 1994. RESULTS: The major cause of disease was arteriosclerosis(22 out of 26). The implantation sites for our study include 22 in common iliac artery, 11 in external iliac artery 2 in aorta, subclavian artery, superficial femoral artery each other. Indication for stent deployment were primarily suboptimal results(19 lesions), insufficient PTA such as dissections(4), restenosis after previous PTA(2), and primary stenting was performed without preceding therapeutic PTA(10). Stent deployment was technically successful in 24 of the 26 patients(92%) and clinical success rate was in 25 of the 26 patients treated(96%). Hemodynamic change revealed markedly improvement before and after stenting(peak pressure difference from 66.329.0mmHg to 9.1+/-7.1mmHg; Mean pressure difference from 33.0+/-22.5mmHg to 4.7+/-4.3mmHg). There were two procedural complications which included one stent migration and one artery perforation. During the 7 months of follow-up(1-18 momths), two restenosis occurred. One patient died due to cerebral hemorrhage during thrombolysis with urokinase. CONCLUSION: The stent deployment is relatively safe and very effective primary therapeutic modality and may abolish the limitation of PTA such as suboptimal result, dissection with sudden occlusion and restenosis in peripheral vascular disease and highly recommended in selected cases.
Angioplasty, Balloon ; Aorta ; Arteries ; Atherectomy ; Cerebral Hemorrhage ; Constriction, Pathologic ; Femoral Artery ; Hemodynamics ; Humans ; Iliac Artery ; Inflation, Economic ; Korea ; Peripheral Arterial Disease* ; Peripheral Vascular Diseases ; Prostheses and Implants ; Stents* ; Subclavian Artery ; Urokinase-Type Plasminogen Activator

BACKGROUND: Platelet aggregation and thrombus formation within the coronary artery are major factors in acute coronary syndrome. The platelet glycoproteinIIb/IIIa receptor is a pivotal mediator of platelet aggregation. Recently there have been reports that the genetic polymorphism of GPIIIa is an inherited risk factor for coronary artery thrombosis. This study investigated the relation between the Pl(A) polymorphism and coronary artery disease in Korean patients. METHODS: One hundred patients with acute myocardial infarction and unstable angina were enrolled. Coronary angiogram was performed in eighty-one cases. Genomic DNA from peripheral blood was amplified by polymerase chain reaction. Allele-specific restriction digestion was used to determine the Pl(A) genotype. RESULTS AND CONCLUSIONS: The prevalence of Pl(A2) genotype was zero percent in our study group. All patients had the Pl(A1/A1) genotype. These results suggest that Pl(A) genetic polymorphism of GPIIIa is not an inherited risk factor for coronary artery diseases in Koreans.
Acute Coronary Syndrome ; Angina, Unstable ; Blood Platelets* ; Coronary Artery Disease* ; Coronary Vessels* ; Digestion ; DNA ; Genotype ; Humans ; Integrin beta3* ; Myocardial Infarction ; Platelet Aggregation ; Polymerase Chain Reaction ; Polymorphism, Genetic* ; Prevalence ; Risk Factors* ; Thrombosis

BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity

BACKGROUND: Evaluating the segmental wall motion of left ventricle is important in patients with myocardial infarction for choosing therapeutic modality and predicting prognosis. Radionuclide Multigated Angiography(MUGA) is a reliable noninvasive method for the evaluation of left ventricular performance. Methods : MUGA scan(LV ejection fraction, phase image histogram, regional wall motion) was performed and analyzed in 45 patients with myocardial infarction(31 : acute MI, 14: old MI) and 13 normal controls. RESULTS: 1) The LVEF of acute and old MI group was significantly reduced and the SDph of acute and old MI group was significantly increased as compared with that of control group(p<0.05). 2) In acute MI group, the LVEF of group without, IV Urokinase was more reduced than that of group with IV Urokinase and the SDph of group without IV Urokinase was more increased than that of group with IV Urokinase(p<0.05). As a result of wall motion scoring, the linear correlation exists between SDPh and sum of wall motion scoring(r=0.62, p<0.01). 3) In MI group, the LVEF of anterior wall MI was more reduced than that of inferior wall MI and the SDPh of anterior wall MI was more increased than that of inferior wall MI(p<0.05). 4) In acute anterior wall MI, the reverse correlation exists between LVEF and SDPh and the linear correlation exists between sum of wall motion scoring and SDPh(r=-0.73, 0.72, p<0.01). But there are no statistical significances of correlation between them in acute inferior MI(r=-0.44, 0.42, p>0.05), in old anterior MI(r=-0.65, 0.47, p>0.05) and in old inferior MI(r=-0.47, 0.46, P>0.05). CONCLUSION: These results suggest that Phase angle(SDPh) is thought to be valuable index to evaluate left ventricular function with application of other indeces in Myocardial infarction. Left ventricular function measured by SDph in acute or anterior MI is lower than old or inferior MI.
Heart Ventricles ; Humans ; Myocardial Infarction* ; Prognosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

No abstract available.
Colitis, Ulcerative* ; Sweet Syndrome* ; Ulcer*

The measurement of gastric emptying time is useful in differentiation of the hypochondriacal neurosis from the functional gastrointestinal disturbance, and also useful in searching the hidden gastro-intestinal disease in patients who are believed as the functional gastrointestinal disturbance. We confirmed in this study that the more delayed gastric emptying time was measured in functional gastrointestinal disturbance compared to normal group, and more shortened gastric emptying time was found after treatment with dopamine antagonist (cleboril) in this group.
Dopamine ; Gastric Emptying* ; Gastrointestinal Diseases* ; Humans ; Hypochondriasis

Since 1991 the orthotopic ileocolic neobladder after radical cystoprostatectomy for bladder cancer has been performed at our hospital. We report our 5 year experience of ileocolic neobladder with focus on complications, urodynamic data and continence status. Between May 1991 and April 1996, a total of 49 men underwent bladder replacement with an orthotopic ileocolic neobladder following radical cystectomy for management of invasive bladder cancer. Mean age of the patient .was 53.2 years (range 34-68) Mean follow up was 42 months (range 4-63). There was one perioperative death due to sepsis who had been suffered from diabetes mellitus. Early complications were developed in 8 patients (16.7%); neobladder leak in 1 (2.1%), wound infection in 2 (4.2%), wound dehiscence in 2 (4.2%), prolonged ileus in 1 (2.1%), and pneumonia in 1 (2.1%). Neobladder-related late complications requiring rehospitalization were noted in 7 patients (14.6%); cecourethral anastomosis site stricture in 1 (2.1%) which was treated endoscopically, ureteral strictures at the reimplantation site in 5 (7 renal unites, 10.4%) which were successfully treated with balloon dilation in 4 patients and with open revision in 1 patient, and neobladder perforation in 1 (2.1%) which was managed conservatively without sequelae. Urethral recurrence was noted in 1 patient and has been managed with M-VAC chemotherapy. There was no. vesicoureteral reflux in any patient. Urodynamic study of the neobladder at 6 months showed a low pressure (mean 24.2 cm H2O), large capacity (mean 553 ml) and an adequate maximal urethral closure pressure (mean 51.3 cmH2O). The peak flow rate in all patients was good (mean 11.3m/sec). All patients were dry during daytime but mild stress urinary incontinence was noted in 5 patients (10.4%) and nighttime continence was good in 91.7% at 6 months. Our results indicate that orthotopic ileocolic neobladder provides good functional results and would be one of the ideal urinary diversion for bladder substitution after radical cystoprostatectomy and will continue to be our procedure of choice in selected male bladder cancer patients.
Constriction, Pathologic ; Cystectomy ; Diabetes Mellitus ; Drug Therapy ; Follow-Up Studies ; Humans ; Ileus ; Male* ; Pneumonia ; Recurrence ; Replantation ; Sepsis ; Ureter ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Diversion ; Urinary Incontinence ; Urodynamics ; Vesico-Ureteral Reflux ; Wound Infection ; Wounds and Injuries