BACKGROUND: Spontaneous echo contrast(SEC) is known to predict the increased incidence of thromboembolism in a variety of heart diseases. Transesophageal echocardiography can be useful for the detection of SEC due to proximity of the probe to the left atrium. We performed this study (1) to evaluate the incidence of SEC in mitral stenosis and its relation to the past history of thromboembolism and (2) to characterize the echocardiographic and hemodynamic indices in patients with SEC compared with those without SEC. METHODS: Transesophageal and thransthoracic echocardiographies were done in 89 patients with mitral stenosis. Biplane probe was used in transesophageal echocardiography. In 47patients cardiac catheterization and angiography were performed. RESULTS: (1) SEC was found in 56 out of 89 patients(63%), and left atrial thrombus was found in 32 patients. (2) Left atrial dimension was larger in patients with SEC than in patients without SEC(57.3%+/-8.4mm vs 49.3+/-6.8mm, p<0.05) and mitrial valve area was smaller in patients with SEC than in patients without SEC(0.85+/-0.27cm2 vs 0.97+/-0.24cm2) (3) Association of SEC to thrombi or previous history of arterial embolism showed a high sensitivity and negative predictive value. CONCLUSION: SEC was an useful finding to predict the increased risk of thromboembolism in patients with mitral stenosis. Patients with SEC had severe mitral stenosis than patients without SEC.
Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Heart Atria ; Heart Diseases ; Hemodynamics ; Humans ; Incidence ; Mitral Valve Stenosis ; Thromboembolism ; Thrombosis

BACKGROUND: We evaluated 1) the sequential changes of angiotensin-converting enzyme (ACE) mRNA expression in lung (main site for circulating ACE synthesis) and left ventricle, and 2) whether such expression is modified by ACE inhibitor or angiotensin II receptor blocker treatment after acute myocardial infarction (MI) in rats. METHODS: Placebo, captopril (2 g/liter drinking water) or TCV-116 (10 mg/kg/day gavage) was administered 3 days before left coronary occlusion and continued for 6 weeks. At 1, 3 and 6 weeks after operation, hemodynamic measurement was performed and pulmonary and myocardial ACE mRNA expression was analyzed by quantitative RT-PCR using rcRNA as an internal standard. RESULTS: Mean BP and LVEDP increased in untreated rats compared with captopril- and TCV-116-treated rats (post-MI 6week, p<0.05). Pulmonary ACE mRNA increased in acute phase (post-MI 1 week, max. 1.4 fold, p<0.05 vs. pre-MI) and returned to pre-MI value thereafter. In contrast, cardiac ACE mRNA expression showed slightly decreasing tendency in acute phase, and was increased up to 1.6 fold in chronic phase after MI (post-MI 3 and 6weeks, p<0.05 vs. pre-MI). No changes in pulmonary ACE gene expression were found with RAS blockade. However, in acute phase after MI, cardiac ACE mRNA increased with both captopril and TCV-116 treatment (post-MI 24hour and 1week, max. 2 fold, p<0.05 vs. untreated group). CONCLUSION: 1) In contrast to the pulmonary ACE mRNA that is activated in acute phase, the cardiac ACE mRNA is activated in chronic phase after MI. 2) RAS blockade does not affect the change of pulmonary ACE expression, but modulate the change of cardiac ACE expression after MI.
Animals ; Captopril ; Coronary Occlusion ; Drinking ; Gene Expression* ; Heart Ventricles ; Hemodynamics ; Lung* ; Myocardial Infarction* ; Myocardium* ; Peptidyl-Dipeptidase A ; Rats ; Receptors, Angiotensin ; RNA, Messenger

A functional upper airway obstruction due to a vocal cord dysfunction(VCD) is characterized by a paradoxical adduction of the vocal cords throughout the respiratory cycle with no obvious organic cause for the obstruction. It commonly occurs paroxysmally and imitates acute asthmatic attacks, often in patients with coexisting asthma. They present with episodes of dyspnea associated with inspiratory wheezing that persists despite conventional asthma treatment and a flattening of the inspiratory limb of the flow-volume curve; an adduction of the vocal cord during inspiration. Failure to recognize concurrent vocal cord dysfunction and asthma has led not only to the excessive use of bronchodilators and corticosteroids, but also to intubation and tracheostomy. Here, we report a case of coexistent obstructive pulmonary disease and functional upper airway obstruction due to a vocal cord dysfunction where a bronchoscopy showed a paradoxical vocal cord motion and typical features of a variable extrathoracic obstruction and a lower airway obstruction on the Flow-volume loop during a symptomatic period.
Adrenal Cortex Hormones ; Airway Obstruction* ; Asthma ; Bronchodilator Agents ; Bronchoscopy ; Dyspnea ; Extremities ; Humans ; Intubation ; Lung Diseases, Obstructive* ; Respiratory Sounds ; Tracheostomy ; Vocal Cord Dysfunction* ; Vocal Cords*

Authors analyzed the findings of findings of chest radiographs and high-resolution CT(HRCT) of chronic mercury vapor poisoning in 12 patients who were diagnosed by previous working history for mercury-thermometer and high level of mercury in blood and urine. The purpose of this paper is to introduce the HRCT findings of chronic mercury vapor poisoning. Duration of mercury exposure was ranged from 10 to 41 months(mean, 21.8 months). Estimated value of serum mercury was ranged from 3.6 to 8.7µg/dl(mean, 5.3 µg/dl: normal value is less than 0.5µg/dl). Estimated value of mercury in urine was ranged from 104 to 482µg/1(mean, 291.4µg/1: normal value is less than 20µg/1). Chest radiographs showed positive findings such as ground-glass opacities and peribronchial cuffings in only 2 out of 12 patients, but HRCT showed positive findings such as ground-glass opacities in 8 patients, peribronchial cuffings in 7 patients, centrilobular abnormalities in 5 patients, interface sign in 4 patients, interlobular septal thickening with intralobular lines in 2 patients and lobular consolidation in one patient. In conclusion, chest HRCT is superior to chest radiograph to show the pulmonary manifestation of chronic mercury vapor poisoning. In patients with chronic mercury vapor poisoning, HRCT findings of centrilobular distributed ground-glass opacities and peribronchial cuffinges are characteristic.
Humans ; Lung* ; Poisoning* ; Radiography, Thoracic ; Reference Values ; Thorax

Massive pulmonary embolism is a major cause of morbidity and death in hospital. Most episodes of acute pulmonary embolism occurred from multiple emboli. When pulmonary embolism is suspected, the definitive diagnosis is pulmonary arteriography, but high degree of certainty can also be achieved with ventilation-perfusion scanning. The therapeutic modalities available for patients with acute pulmonary embolism are prophylatic and definitive therapy. Prophylatic therapy including anticoagulant with heparin is used to prevent further emboli episodes that might be fatal. Definitive therapy for pulmonary embolism including thrombolytic agents and pulmonary embolectomy attempts to dissolve and remove the resolution of the pathophysiologic sequelae of pulmonary embolism. We experienced a case of acute massive pulmonary embolism which occupied the pulmonary arteries bilaterally. Patient with orthopedic surgery one month before developedd dyspnea and chest tightness. Eventhough continuing enough amount of anticoagulant therapy, rapid hemodynamic deterioration and severe hypoxia occurred progressively. Urgent pulmonary embolectomy was succeeded and he has been followed up at out patient department.
Angiography ; Anoxia ; Diagnosis ; Dyspnea ; Embolectomy ; Fibrinolytic Agents ; Hemodynamics ; Heparin ; Humans ; Orthopedics ; Pulmonary Artery* ; Pulmonary Embolism* ; Thorax

A case of left parietal pleomorphic xanthoastrocytoma that occurred in a 58-year-old woman is reported clinicopathologically. Histopathologic diagnosis of pleomorphic xanthoastrocytoma was made because of the unique pleomorphic histologic features, positive glial fibrillary acidic protein in immunohistochemical staining. The flow cytometric analysis reveals DNA aneuploidy and relatively high S-phase fraction. The pleomorphic xanthoastrocytoma is considered as a special subgroup of glioma on the basis of superficial cortical location, GFAP expression, marked cellular atypia, xanthomatous cells, and relatively favorable prognosis.
Female ; Humans

Parricide, the crime of murdering a parent, accounts for about 5% of all homicides. Filicide is the crime of murdering one's own child. This study aimed to review demographic features and criminal characteristics of individuals who committed parricide and filicide in Republic of Korea (ROK). This study is based on data from the Korea Police Crime Analysis System, from 2006~2013. We assessed the diverse characteristics of both victims and perpetrators. Over the selected period, 381 parents were killed by their children and 230 children were killed by parents in the ROK. Parricides caused by schizophrenic murders accounted for 39.6% of all cases. Moreover, approximately 44.4% of the perpetrators attempted suicide following the maternal filicide. In our findings, psychiatric illness was a very important predictor in parricide, and these further suggest that young mothers with severe mental illness require careful monitoring by mental health support service.
Child ; Crime ; Criminals ; Homicide ; Humans ; Korea ; Mental Health ; Mothers ; Parents ; Police ; Republic of Korea ; Schizophrenia ; Suicide, Attempted

BACKGROUND: To standardize the histocompatibility testing among different laboratories, we have developed and performed a proficiency survey (external quality control) program in HLA typing with participation of nationwide HLA laboratories in Korea. METHODS: During a two-year period, four trials of proficiency survey were performed with 35-39 participating laboratories. Test number and items included in each survey were 3 HLA class Iantigen typings, 2 class II DNA typings, and 6 HLA crossmatch tests (3 cells x 2 sera). RESULTS: HLA class I serological typing was performed on a total of 12 whole blood specimens representing 7 HLA-A and 17 HLA-B antigens. More than 90% of the laboratories correctly identified 7 HLA-A (A2, A3, A11, A24, A26, A30, A33) and 13 HLA-B antigens (B7, B8, B13, B14, B27, B35, B48, B51, B52, B54, B58, B60, B61). Lower consensus (<90%) was obtained for B62, B67, B75, and B15 (B*1511). Considerable difference in antigen detection rate was observed between different commercial trays used. HLA class II DNA typing was performed on a total of 8 DNA specimens representing 13 HLA-DRB1 and 11 DQB1 alleles. For HLA-DRB1 typing (16-26 laboratories), correct assignment rate was very high (98%) for generic level, but lower (80%) for allele level. For DQB1 typing (5-8 laboratories), 100% consensus was obtained for allelic level. With respect to HLA crossmatching, detection rate of incompatibility was very low in the 1st trial. HLA crossmatch workshop on the standardization of typing methods was performed after the 1st trial, and thereafter the number of laboratories using sensitive methods were increased and the detection rate of incompatible crossmatch was much improved (1st 29-46%, 2nd 78-97%). CONCLUSIONS: Through these HLA typing proficiency surveys, standardization of test methods and improvement of typing results were obtained. A continuous survey program would play an important role for improving success rate of organ transplantations in Korea.
Alleles ; Consensus ; DNA ; DNA Fingerprinting ; Education ; Histocompatibility Testing* ; HLA-A Antigens ; HLA-B Antigens ; HLA-DRB1 Chains ; Korea* ; Organ Transplantation ; Transplants

Holoprosencephaly is a rare malformation complex or development defect including different degrees of incomplete cleavages of the embryonic prosencephalon and varying degrees of the midface defects, resulting from the defect of prechordal mesoderm, migrating forward into the area anterior to the notochord during the third week of fetal development. Early antenatal diagnosis of holoprosencephaly is important to find out its severity, to predict its prognosis, and to determine proper management according to its prognosis and severity. The possibility of early antenatal diagnosis of holoprosencephaly by ultrasound has been suggested, but occasionally missed and rarely confirmed. We present one case of lobar holoprosencephaly, diagnosed postnatally and one case of alobar holoprosencephaly, diagnosed antenatally in our hospitals.
Fetal Development ; Holoprosencephaly* ; Mesoderm ; Notochord ; Prenatal Diagnosis ; Prognosis ; Prosencephalon ; Ultrasonography

Holoprosencephaly is a rare CNS developmental defect with midline cleavage of embryonal forebrain during the fourth week of fetal development characterized with s single ventricle. Holoprosencephaly is divided into three types by the degree of the brain cleavage : alobar, semilobar, and lobar. Depending on the degree of defected regions, there exist variable clinical symptoms and signs such as stillbirth, hypotonia, apnea, convulsion, delayed development and visual disturbance. It was frequently associated with the deformity of the brain as well as the midline facial structures. Advances in neuroimaging over the past decades have led us to a better understanding of the pathogenesis and the variability of holoprosencephaly. As a result, a lot of cases of holoprosencephaly with various clinical and pathologic findings have been reported. We experienced a case of isolated interhemisphere fusion of frontal lobes with intact septum pellucidum in a child with febrile status epilepticus. Is it a variant of holoprosencephaly?
Apnea ; Brain ; Child ; Congenital Abnormalities ; Fetal Development ; Frontal Lobe* ; Holoprosencephaly* ; Humans ; Muscle Hypotonia ; Neuroimaging ; Prosencephalon ; Seizures ; Septum Pellucidum* ; Status Epilepticus ; Stillbirth