Six cases of bileaflet mechanical mitral valve thrombosis were serially assessed by Doppler echocardiography and cinefluoroscopy during thrombolytic therapy with urokinase. Two patients had dual mechanical valve replacement in the aortic and mitral positions simultaneously. Bileaflet thrombosis was diagnosed by 2-dimensional echocardiography in three cases, Doppler echocardiography and cinefluoroscopy in six cases. Thrombolytic therapy using urokinase was successful in five patients (3 cases : UK 1,000,000 unit x 3 hours for 2 days, 2 cases ; UK 1,000,000 unit/24 hours for 5 and 7 days respecitively, 1 case ; UK 1,000,000 unit/hr x 3 hours for 1 day). The other one patients had massive cerebral thromboembolism and subsequently died. These study demonstrated the usefulness of Doppler echocardiography and cinefluoroscopy in diagnosis and serial assessment of thrombolytic therapy in the patients with mechanical mitral valve thrombosis.
Diagnosis* ; Echocardiography ; Echocardiography, Doppler ; Humans ; Mitral Valve* ; Thromboembolism ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator*

This study investigated the influence of different durations of aerobic exercise on fuel utilization, lactate levels and antioxidative status in trained rats. Forty rats underwent physical training (T, n = 20) or non- training (NT, n = 20) for 6 weeks. For physical training, animals exercised on a treadmill for 30 min 5 days per week. At the end of week 6, the animals in each group were subdivided into BE, DE-0.5, DE-1 and DE-2, which were sacrificed at the end of week 6 without having performed exercise or after exercise on a treadmill for 0.5h, 1h and 2h, respectively, immediately before being sacrificed. The plasma glucose level in DE-2 of the NT group was significantly lower than in the other groups. Muscle and liver glycogen levels were significantly lower in DE-1 and DE-2, but there were no significant differences between DE-1 and DE-2 in the T group. Liver protein in DE-2 of the NT group was significantly lower. Muscle TG levels were decreased in DE-0.5 of the T group, while those of the NT group were decreased in DE-1. FFA levels were increased in DE-0.5 of the T group and in DE-1 of the NT group. Lactate levels were increased in DE-0.5 of the NT group, while they were increased in DE-1 of the T group. Catalase activity of the T group was lower in BE but higher in DE-0.5, DE-1 and DE-2. SOD activities were higher in trained rats, while the GSH/GSSG ratios were higher in BE, DE-0.5 and DE-1 in the T group, and there was no difference in that of DE-2. There were no differences in MDA levels in BE and DE-0.5, but they were significantly lower in DE-1 and DE-2 of the T group. Overall, the results of this study, suggest that training may improve exercise performance by facilitating the mobilization and oxidation of fat and conserving limited carbohydrate storage, and that it may delay the onset of fatigue and enhance the antioxidative defense system, but cannot support two hours of vigorous exercise.
Animals ; Blood Glucose ; Catalase ; Exercise* ; Fatigue ; Lactic Acid* ; Liver ; Liver Glycogen ; Muscles ; Rats*

OBJECTIVE: To determine the prognostic factors for local recurrence of nodular hepatocellular carcinoma after segmental transarterial chemoembolization. MATERIALS AND METHODS: Seventy-four nodular hepatocellular carcinoma tumors < or = 5 cm were retrospectively analyzed for local recurrence after segmental transarterial chemoembolization using follow-up CT images (median follow-up of 17 months, 4-77 months in range). The tumors were divided into four groups (IA, IB, IIA, and IIB) according to whether the one-month follow-up CT imaging, after segmental transarterial chemoembolization, showed homogeneous (Group I) or inhomogeneous (Group II) iodized oil accumulation, or whether the tumors were located within the liver segment (Group A) or in a segmental border zone (Group B). Comparison of tumor characteristics between Group IA and the other three groups was performed using the chi-square test. Local recurrence rates were compared among the groups using the Kaplan-Meier estimation and log rank test. RESULTS: Local tumor recurrence occurred in 19 hepatocellular carcinoma tumors (25.7%). There were: 28, 18, 17, and 11 tumors in Group IA, IB, IIA, and IIB, respectively. One of 28 (3.6%) tumors in Group IA, and 18 of 46 (39.1%) tumors in the other three groups showed local recurrence. Comparisons between Group IA and the other three groups showed that the tumor characteristics were similar. One-, two-, and three-year estimated local recurrence rates in Group IA were 0%, 11.1%, and 11.1%, respectively. The difference between Group IA and the other three groups was statistically significant (p = 0.000). CONCLUSION: An acceptably low rate of local recurrence was observed for small or intermediate nodular tumors located within the liver segment with homogeneous iodized oil accumulation.
Adult ; Aged ; Carcinoma, Hepatocellular/*pathology/radiography/*therapy ; Chemoembolization, Therapeutic/*methods ; Chi-Square Distribution ; Female ; Humans ; Iodized Oil/administration & dosage ; Liver Neoplasms/*pathology/radiography/*therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local/radiography ; Prognosis ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed

We performed radionuclide ventriculography before and within 1 week after percutaneous mirtal valvuloplasty(PMV) to evaluate left ventricular(LV) function in 20 patients(3 males and 17 females, mean age of 38±10 years) who were pure mitral stenosis before PMV and less than grade 1 mitral regurgitation developed after PMV. 9 out of 20 patients had atrial fibrillation and 3 patients developed a small left-to-right shunt(Qp/Qs<1.5)after PMV using double-balloon technique resulted in a increase in mitral valve area(0.9±0.3 to 2.1±0.8mm
Atrial Fibrillation ; Cardiac Output ; Female ; Humans ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Radionuclide Ventriculography ; Stroke Volume

BACKGROUND: Weight loss through low-calorie diets (LCDs) decreases visceral fat (VF). However, the effects on muscle mass, changes of dietary quality, and insulin sensitivity are unknown for Korean obese type 2 diabetic subjects. Therefore, this study examined such effects of LCDs. METHODS: A total of 30 obese type 2 diabetic subjects (body mass index, 27.0 +/- 2.2 kg/m2) were randomly assigned to an LCD or control group. Subjects on LCDs took 500~1,000 kcal fewer energy than their usual dietary intake (1,000~1,500 kcal/day) over the course of 12 weeks. The abdominal VF and femoral muscle mass were evaluated by computed tomography, and insulin sensitivity was assessed using an insulin tolerance test (Kitt; rate constant for plasma glucose disappearance, %/min). Dietary nutrient intake consumed by subjects was assessed by 3-day food records. RESULTS: The percent VF reduction was -23.4 +/- 17.2% in the LCD group and -9.8 +/- 11.8% in the control group after 12 weeks (P < 0.001, P = 0.002). However, significant decrease in femoral mass or proportional change of marcronutrient intake and mean adequacy ratio were not found in the LCD group, as compared to the control group. Insulin sensitivity improved in the LCD group, as compared to the control group (P = 0.040). CONCLUSION: LCD effectively improved insulin sensitivity and reduced abdominal VF without reduction of femoral muscle and dietary quality in obese type 2 diabetic subjects.
Caloric Restriction ; Diabetes Mellitus, Type 2 ; Glucose ; Insulin ; Insulin Resistance ; Intra-Abdominal Fat ; Muscles ; Plasma ; Weight Loss

Aortic dissection is a medical emergency requiring prompt diagnosis and maybe emergency surgery especially if the ascending aorta is involved. We have performed transesophageal echocardiography(TEE) in 22 consecutive patients with suspected aortic dissection. The diagnosis was subsequently proven in 14 patients(9 males, 2 females, mean age 51+/-11years) on the basis of TEE. The results and effectiveness were compared with computed tomography (CT) and aortography. Seven patients had type I aortic dissection, three had type II and four had type III. Twelve patients had hypertension. There was aortic regurgitation in five of seven patients with type I dissection and in all three patients with type II dissection. Type I dissection was found by TEE in seven patients who had intimal flap showing parallel movement to the aortic wall. CT was positive in only three of five of these patients. Type II dissection was seen in three patients by TEE. CT demonstrated dissection in one of three of these patients. In one patient the false lumen was filled with a thrombus, which was negative at angiography. Type III dissection was found by TEE in four patients. CT was positive in two of four patients. Aortography was performed and positive in one patient. The starting point of aortic dissection could be demonstrated in all four patients by TEE. TEE was well tolerated by patients with aortic dissection and associated with no major complications. In conclusion. TEE was very useful in detecting aortic dissection and in providing a dynamic information of the intimal flap and of the presence and extent of luminal thrombus with flow dynamics.
Angiography ; Aorta ; Aortic Valve Insufficiency ; Aortography ; Diagnosis ; Echocardiography, Transesophageal* ; Emergencies ; Female ; Humans ; Hypertension ; Male ; Phenobarbital ; Thrombosis

OBJECTIVE: We wanted to evaluate whether tumors located in a segmental border zone are predisposed to local recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma. MATERIALS AND METHODS: Seventy-three hepatocellular carcinoma nodules were retrospectively analyzed for local tumor recurrence after performing segmental transarterial chemoembolization by using follow-up CT studies (median follow-up period: 20 months, range: 4-77 months). The tumors were divided into two groups according to whether the lesions were located at the segmental border zone (Group I) or not (Group II). Comparison of the tumor characteristics and chemoembolization methods between the two groups was performed using the chi-square test. The local recurrence rates were compared by Kaplan-Meyer method and analyzed with the log rank test. RESULTS: Local tumor recurrence occurred for 25 hepatocellular carcinoma nodules (42.9%). The follow-up periods, tumor characteristics and chemoembolization methods between Groups l and ll were comparable. The local recurrence rate was 64.0% (16/25) in Group I and 18.8% (9/48) in Group II. The difference was statistically significant on the univariate and multivariate analyses (p = 0.000 for both). CONCLUSION: Tumor location in a segmental border zone was a significant risk factor for local tumor recurrence after performing segmental transarterial chemoembolization for hepatocellular carcinoma.
Risk Factors ; Retrospective Studies ; Proportional Hazards Models ; Neoplasm Recurrence, Local ; Middle Aged ; Male ; Liver Neoplasms/*pathology/*therapy ; Iodized Oil/administration & dosage ; Humans ; Female ; Doxorubicin/administration & dosage ; Chi-Square Distribution ; *Chemoembolization, Therapeutic ; Carcinoma, Hepatocellular/*pathology/*therapy ; Aged ; Adult

No abstract available.
Lung Neoplasms* ; Lung*

PURPOSE: A retrospective clinical study of 213 patients who underwent curative resection due to hepatocellular carcinoma was performed in order to compare the mortality and survival rates of elderly patients with those of younger patients following the resection. MATERIALS AND METHODS: All subjects underwent curative resection at Shinchon & Yongdong Severance Hospital between January 1985 to December 1994. The subjects were classified into three age groups: Group I (n=26) under 40, Group II (n=142) between 41 and 60, and Group III (n=45) over 60. Variables considered include sex, family history, accompanied diseases, Hbs Ag, -PF, Child classification, operative method, resection margin, number of mass, size of mass and gross-appearance were evaluated by X2-test (p=0.05). The one, three and five year survival rates were analysed in each group by the Kaplan- Meyer method and survival curves were compared by the log-rank test. A probability of <0.05 was accepted as significant. RESULTS: The results showed that elderly patients have no significant differences from the younger patients in any of the variables considered including postoperative morbidity, survival rate and disease-free survival rate, except for the family history and positive Hbs Ag in which the elderly patients showed significantly lower values. CONCLUSION: These results suggest that hepatocellular carcinoma in the aged can be treated in identical manner as in younger patients.
Aged ; Carcinoma, Hepatocellular* ; Child ; Classification ; Disease-Free Survival ; Humans ; Mortality ; Retrospective Studies ; Survival Rate

Patient death with a functioning graft(DFG) has been a predominant cause of graft loss. According to conventional graft survival(C-GS) analysis, DFG is considered as a graft failure. However, such survival analysis may obscure immunologic graft loss and distort the overall graft results as well as risk factors affecting the graft survivals. In functional graft survival(F-GS) analysis, the DFG is considered as censored data(in which the graft survived until patient death) which is more closely related with the immunologic graft loss. We designed our study to identify the differences and significance of F-GS compared to C-GS. From April 1984 to October 1995, 1242 living donor kidney transplantations under cyclosporine were performed at Yonsei University Medical Center. At least a 1-year follow-up was possible in all the patients. The graft survival rate was calculated by both C-GS and F-GS analyses. The recipient's and the donor's ages, the donor-recipient relationship, the degree of HLA matching, the degree of ABO blood type matching, the episodes of acute rejection within 1 year, and the presence of diabetes mellitus were monitored as risk factors affecting the graft survival in the two analysis methods. Univariate and multivariate analyses for risk factors were done by the Kaplain-Meier method and the Cox proportional harzard model. The C-GS rate were 96.3% at 1 year, 81.8% at 5 years, and 58.4% at 10 years compared to 98.5%, 88.1%, and 67.9%, respectively in the F-GS analysis. Elderly recipients(> or =50), elderly donors(> or =50), presence of acute rejection within 1 year post-transplant, ABO blood type minor mismatching, and diabetic recipients were risk factors affecting long-term graft survival in the C-GS analysis. However, elderly recipients and diabetic recipients were no longer considered as risk factors in the F-GS analysis. In fact, elderly recipients or diabetic recipients showed equal or even better graft survivals in the F-GS analysis compared with younger or non-diabetic recipients. The differences between the C-GS and the F-GS analyses in such subgroups suggests that the primary cause of graft loss in these groups was non-immunologic. Death with functioning graft(DFG) needs to be considered in analyzing kidney-transplant outcomes. Hence, we propose that all transplant graft survival data be presented in two ways, by conventional and functional graft analyses.
Academic Medical Centers ; Aged ; Cyclosporine ; Diabetes Mellitus ; Follow-Up Studies ; Graft Survival* ; Humans ; Kidney Transplantation ; Living Donors ; Multivariate Analysis ; Risk Factors ; Transplants*