BACKGROUND: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with communityacquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of .dying of severe community-acquired pneumonia. METHODS: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. RESULTS: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnea, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+)cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Save patients death(70%) occured after admission within the first five days, and a mean duration of hospitalization was 11.2 days. CONCLUSION: As the results show most death occured within the first days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.
Adult ; Anoxia ; Anti-Bacterial Agents ; Azotemia ; Cyanosis ; Enterobacter ; Female ; Hope ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypotension ; Critical Care ; Korea ; Leukocytosis ; Leukopenia ; Male ; Medical Records ; Mortality ; Patients' Rooms ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Insufficiency ; Retrospective Studies ; Sputum ; Tachypnea ; Vancomycin

CYP1A2, CYP2D6 and N-acetyltransferase activities were estimated in 100 patients with bladder cancer and 84 control subjects from measurements of theophylline, metoprolol and isoniazid and their metabolites in urine, respectively. The frequency of occurrence of slow acetylators of isoniazid and poor metabolizers of metoprolol were 16.7% and 1.2% in the control group and 16.3% and 2.0% in the cancer patient group. These differences were not significant. The recovery ratio of 1-methyluric acid(1-MU) from theophylline was significantly higher in patients with bladder cancer than in control subjects(0.340 +/- 0.016 versus 0.260 +/- 0.020, p< 0.05). The 1-MU recovery ratio was a significant, independent risk factor among the metabolic capacities tested as shown by logistic regression analysis, controlling for N-acetylation of isoniazid, hydroxylation of metoprolol, age, sex, and smoking. We concluded that the capacity for 3-demethylation of theophylline, as a reflection of CYP1A2 activity, is significantly associated with increased risk of nonoccupational urinary bladder cancer.
Acetylation ; Adult ; Aged ; Amines/metabolism ; Bladder Neoplasms/enzymology/*epidemiology ; Carcinoma, Transitional Cell/enzymology/*epidemiology ; Case-Control Studies ; Cytochrome P-450 CYP1A2 ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System/metabolism/*urine ; Disease Susceptibility ; Enzyme Induction ; Female ; Human ; Isoniazid/*pharmacokinetics ; Korea/epidemiology ; Logistic Models ; Male ; Methylation ; Metoprolol/*pharmacokinetics ; Middle Age ; Mixed Function Oxygenases/metabolism ; Mixed Function Oxygenases/metabolism ; Oxidoreductases/*urine ; Smoking ; Support, Non-U.S. Gov't ; Theophylline/*pharmacokinetics ; Uric Acid/analogs & derivatives/urine

Quadricuspid aortic valve is a rare congenital abnormality but it is well recognized as the cause of significant aortic regurgitation. We describe 5 patients who underwent surgery for severe aortic regurgitation associated with quadricuspid valve. In all patients, this abnormality had been incidentally detected during surgery. Two of the patients had infective endocarditis. In accordance with the Hurwitz and Roberts classification, two valves were type d, two were type a, and one was type c.
Aortic Valve Insufficiency ; Aortic Valve* ; Classification ; Congenital Abnormalities ; Endocarditis ; Humans

BACKGROUND AND PURPOSE: Although thrombolytic strategies with streptokinase(STK) and tissue-type plasminogen activator(t-PA) in the treatment of acute myocardial infarction(AMI) have been studied in large-scale clinical trials in the western countries, such large-scale studies with urokinase(UK) are scanty. Even though UK is most commonly used thrombolytic agent for the treatment of AMI in Korea, there is no consensus on the dosage and the way of administration of UK in patients with AMI. Accordingly, a prospective clinical study was performed to evaluate the effects of thrombolytic strategies of intravenous double bolus method and standard double-infusion method with different dosage of UK in the treatment of AMI. SUBJECTS AND METHODS: Ninety there patients with AMI(male 75, female 18, age 57.5+/-10.8 years) were studied. The patients were divided into 3 groups according to dosage of UK and method of administration. Group I : 19 patients who received 1.5 million U of UK IV bolus, followed by 1.5 million U IV infusion for an hour(High Dose Group). Group II : 34 patients received 20,000U/kg body weight of UK IV bolus, followed by 20,000U/kg IV infusion for an hour(Double Dose Group). Group III : 40 patients received 1.5 million U of UK IV bolus and followed by 20,000U/kg IV bolus in 30 minutes with total dose of no more than 3 million U(Double Bolus Group). Coronary angiography(CAG) and left ventriculography(LVG) were performed 90 minutes after the administration of UK and post-AMI 7-10 days to investigate the patency of infarct-related artery(IRA) and LV function. Patency of IRA was graded according to the extent of flow of IRA. TIMI grade 0-1 was regarded as occluded, and grade 2-3 flow as patent. LV ejection fraction(EF) by echocardiography was measured on day 1, day 7-10 and 1 month after AMI. Indirect clinical parameters of thrombolysis were evaluated and were compared with CAG findings. RESULTS: 1) The 90 minutes IRA patency in Group III(Double bolus ; 79.0%) was higher than that in Group 1, but showed no statistically significant difference(High dose ; 61.5%, p=0.790). The 90 minutes IRA patency in Group III showed borderline significance with Group II(Double dose ; 57.1%, p=0.057). TIMI flow III in Group III(60.6%) was significantly higher than that in Group II(53.6%, p=0.0468) but showed no statistically significant difference with Group I(61.5%, p=0.158). 2) The EF by LVG were 49.1% in Group I, 41.7% in Group II and 49.2% in Group III. The difference in EF between Group I and Group III vs Group II was significant(p=0.008 in Group I, p=0.014 in Group III vs Group II). 3) Fatal bleeding complications(1 intracranial hemorrhage and 1 gastric ulcer bleeding) developed in Group II (Double dose). 4) Pain to door time, pain to needle time and door to needle time tended to be shorter in open(TIMI flow II-III) IRA group than in closed IRA group. 5) Initial EF were similar between open IRA group and closed IRA group(46.1% and 42.1% ; p=NS). The EF of open IRA group measured by LVG on initail coronary angiography(41.8% in closed IRA vs 48.0%, in open IRA, p=0.03) and by 2D-Echo on 7-10 day(41.7% in closed IRA vs 51.0% in open IRA, p=0.004) were better than those of closed IRA group. 6) Indirect clinical indices of reperfusion such as mean CPK peak, time to CPK peak significantly lower in open IRA group than in closed IRA group. 7) Fatal bleeding complications(1 intacranial hemorrhage and 1 gastric ulcer bleeding) developed in closed IRA group. CONCLUSION: The findings we observed in this trial showed that earlier initiation and more rapid infusion of UK were associated with more increased 90min patency of infarct-related artery and more improved LV function without any obviously increased bleeding complications or other serious life-threatening complications than conventional UK therapy. Specifically, double bolus IV injection of UK(1.5 million U bolus followed by 20,000 U/Kg bolus in 30min)was more effective method of thrombolysis than conventional method for achieving optimal reperfusion in AMI patients. Also, IRA patency at 90 minutes after the initiation of thrombolysis was important in preserving global LV function in early recovery phase of AMI. Further trials may be needed to determine more effective thrombolysis with UK in AMI.
Arteries ; Body Weight ; Consensus ; Echocardiography ; Female ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Korea ; Myocardial Infarction* ; Needles ; Plasminogen ; Prospective Studies ; Reperfusion ; Stomach Ulcer ; Urokinase-Type Plasminogen Activator*

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).
Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Multivariate Analysis ; Prospective Studies ; Stents ; Ureter* ; Ureteral Obstruction

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).
Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Hydronephrosis ; Multivariate Analysis ; Prospective Studies ; Stents ; Ureter* ; Ureteral Obstruction

Relationships between recovery of vestibuloocular reflex and expression of c-fos immunoreactive cells in the medial vestibular nuclei following unilateral labyrinthectomy(ULX) were investigated in rats. Frequency of spontaneous nystagmus, velocity of eye movement induced by sinusoidal rotation of the whole body at frequencies of 0.1, 0.2, 0.5Hz, and the number of c-fos immunoreactive cells in the medial vestibular nuclei were measured for 72 hours after ULX. Frequency of spontaneous nystagmus was 3.9+/-0.5 beats/sec(M+/-SD) immediately after ULX and disappeared completely within 48 hours. On sinusoidal rotation, eye movement induced by rotation toward the lesioned side recovered normal pattern within 24 hours at 0.1Hz rotation, and 12 hours at 0.2, 0.5Hz. Directional preponderance which represents the symmetry of bilateral vestibular functions decreased to less than 20% at 72 hours, but did not recover normal limit. The number of c-fos immunoreactive cells in the bilateral medial vestibular nuclei was severe asymmetry till 24 hours of ULX. However, the symmetry was recovered after 48 hours. These results indicate that the recovery of vestibuloocular reflex correlates with the expression of c-Fos immunoreactive cells of the medial vestibular nuclei in the early stage of vestibular compensation following ULX. Therefore, the vestibular nuclei may play a key role in vestibular compensation.
Animals ; Compensation and Redress ; Eye Movements ; Rats* ; Reflex, Vestibulo-Ocular* ; Vestibular Nuclei*

BACKGROUND: Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. MATERIAL AND METHOD: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7+/-6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve. Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III~IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7+/-5.4 (7 to 24) months. RESULT: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4+/-3.5 mm preoperatively to 33.2+/-3.4 mm postoperatively (p<0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. CONCLUSION: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies.
Aneurysm ; Aorta* ; Aortic Valve Stenosis ; Aortic Valve* ; Bicuspid ; Dilatation* ; Echocardiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Recurrence ; Sutures*

Primary achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. Traditional treatment methods are balloon dilatation and myotomy, but these methods have critical complications and even fatal including esophageal perforation, gastroesophageal reflux, and continuing dysphagia. Botulinum toxin, which has been used for dystonias of skeletal muscles, is presented as a new alternative treatment method for achalasia, aimed to lowering of LES pressure by Pasricha et al. They also reported that endoscopic botulinum toxin injection into LES was effective, safe, and simple method without any significant complication. We report 7 cases of primary achalasia treated with endoscopic botulinum toxin injection, who showed clinical improvement without any complication. We compared results of pre-treatment with those of post-treatment using botulinum toxin in the aspects of clinical, radiological, manometrical recording in these cases. Symptomatic improvement was shown in 4 cases(57.1%), symptom score was decreased from 7.43+/-0.53 to 4.43+/-2.51(p=0.03), The luminal diameter at esophagogastric junction increased from a mean of 3.21+/-0,99 mm to 5.14+/-0.90 mm (p=0.015), and luminal diameter at esophageal body decreased from a mean of 40.29+/-19.37 mm to 32.71+/-15.45 mm (p=0.015). In follow up manometric recording, peristaltic waves at the body were recovered in 2 cases(28.6%), gastroesophageal pressure gradient(AP) was non-significantly decreased from 6.30+/-4.0 mmHg to 3.12+/-4.47 mmHg (p=0.45). One patient complained of transient chest pain within one hour after the botulinum toxin injection, but she did not need any medication. We concluded that botulinum injection was a simple, safe, and effective therapeutic method for primary achalasia, even though further evaluatian should be performed in the much more cases and the results of long term follow-up, and cost-effectiveness of this method.
Botulinum Toxins* ; Chest Pain ; Deglutition ; Deglutition Disorders ; Dilatation ; Dystonia ; Esophageal Achalasia* ; Esophageal Perforation ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Follow-Up Studies ; Gastroesophageal Reflux ; Humans ; Muscle, Skeletal ; Phenobarbital