The spontaneous contrast echo (SCE) is a phenomenon that the contrast effect appears spontaneously on 2D-echocardiography without intravenous contrast material. This appears when hemostasis is in the cardiac cavity and the tendency for thrombosis formation may be increased. The SCE can be observed in the patient with severe mitral stenosis, postprosthetic valvular replacement or left ventricular enlargement. We report 4 cases of SCE on two-dimensional echocardiogram in the patient with severe mitral & aortic valvular disease.
Echocardiography* ; Hemostasis ; Humans ; Mitral Valve Stenosis ; Thrombosis

BACKGROUND: It is expected that the number of families who provide caregiving for hospice patients will be increased in this society. Family caregiver will have fi nancial, psychological, social burden and stress related to this responsibility. Hospice patients, facing death, need not only biomedical therapy, but also systematic and continuous treatments such as mental or psycho-social intervention. The purpose of this study was to investigate the family caregiver's depression level and the associated factors. METHODS: The survey was conducted with 62 family caregivers of the hospice patients who had been hospitalized at the Gwangju Veterans Hospital from December 2005 to May 2006. The questionnaire consisted of the general characteristics of the subjects, Beck's depression inventory (BDI) evaluating the depression level and family APGAR score evaluating the family function. RESULTS: The mean age of the subjects was 58.2 years. The relationship with patients as 'spouse' accounted for 42 individuals (67.7%). The mean (+/- SD) BDI score was 25.3 (+/- 10.1) points and 58 percent of the subjects were suggested to have depression tendency (> or = 21 point). There was no relationship between the caregiver's depression level and their gender, religion, household income and Family APGAR score. However, the depression level was signifi cant related to the total caregiving duration (P = 0.001), visiting frequency of visitors (P = 0.004) and caregiving hours per day (P = 0.005). CONCLUSION: More than half of the family caregivers were suggested to have depression tendency. The depression level was infl uenced by the burden of caregiving and the visiting frequency of visitors. There is a need to activate social resources to share the burden of caregiving and to develop continuous and comprehensive care for hospice patients and their families.
Apgar Score ; Caregivers ; Depression ; Family Characteristics ; Hospices ; Hospitals, Veterans ; Humans

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.
Adult ; Arteries ; Cardiopulmonary Bypass ; Catheterization ; Causality ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Emergencies ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Hemodynamics ; Humans ; Lower Extremity ; Male ; Oxygenators, Membrane ; Spasm* ; Stents ; Transplants*

BACKGROUND: In hypovolemic shock, multiple organ failure is caused by translocation of endotoxins and microorganisms from the ischemic gut mucosa. Therefore, much attention has been paid to the gut mucosa oxygenation in shock resuscitation. The current guidelines on cardiopulmonary resuscitation restrain the use of sodium bicarbonate due to paradoxical intracellular acidosis. Because THAM, CO2-consuming agent, does not produce CO2 and induce intracellular acidosis, THAM has been known as a effective buffering agent. This study was purposed to investigate the effect of THAM and sodium bicarbonate on the gut mucosa oxygenation in cats which were in hemorrhagic shock and resuscitation. METHODS: 18 anesthetized cats were subjected to hemorrhage to decrease the mean arterial blood pressure to 35-45 mmHg and this blood pressure was maintained for 120 minutes. After 90minutes, we infused 1.945% hypertonic saline, 2.8% sodium bicarbonate and 0.3M THAM as same volume and osmolality. Mean arterial pressure(MAP), mesenteric arterial-venous pH differences[pH(a-v)], mesenteric venous oxygen tension(PvO2), mesenteric arterial-venous carbon dioxide tension differences[P(v-a)CO2], mesenteric arterial-venous lactate differences[Lactate(v-a)] were measured 1, 5, 15, 30 minutes after drug infusion and 30, 60 minutes after reperfusion. RESULTS: There were no statistical significances in MAP, pH(a-v), PvO2, Lactate(v-a) among the three groups. There were significant differences in P(v-a)CO2 and ETCO2 between sodium bicarbonate group and THAM group. CONCLUSIONS: This study suggest that THAM and sodium bicarbonate do not have significant effects on the tissue oxygenation and hemodynamic improvement in hypovolemic shock. We suppose that THAM does not produce carbon dioxide but may correct intracellular acidosis.
Acidosis ; Animals ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide ; Cardiopulmonary Resuscitation ; Cats* ; Endotoxins ; Hemodynamics ; Hemorrhage ; Hydrogen-Ion Concentration ; Lactic Acid ; Mucous Membrane* ; Multiple Organ Failure ; Osmolar Concentration ; Oxygen* ; Reperfusion ; Resuscitation ; Shock ; Shock, Hemorrhagic* ; Sodium Bicarbonate* ; Sodium* ; Tromethamine*

BACKGROUND: Kidney transplantation from cadaveric donor is increasing in KOREA. Knowledge of donor factors that can influence early graft function should be an important guideline in determining the suitability of a donor kidney for transplantation. METHOD: From June 1989 to August 1995, sixty patients with end-stage renal disease underwent kidney transplantation from thirty-two cadaver donors in Asan Medical Center. In this study, we reviewed the clinical characteristics of the cadaver donors including vital sign, urine output, serum creatinine, amounts of vasopressor needed, as well as the cause of brain death and evaluated the effect of these parameters on the early post-transplantation graft function (up to 6 months). RESULTS: The data are given as median (range). The donors had been admitted for 40 hours (12-177) before nephrectomy. During admission, the lowest systolic blood pressure was 85mmHg (60-130). Platelet count was 112 X 10(3)/L (11-270 X 10(3)). Hour urine output was 447ml/h (212-937). These parameters did not have significant effects on the early post-transplantation graft function of our patients. Fifteen of thirty two donors had peak serum creatinine higher than 1.4mg/dl (mean 1.9mg/dl, range 1.5-3.6mg/dl) with serum creatinine 1.5mg/dl (1.5-2.0) at the time of nephrectomy. The declining tendency and lowest level of serum creatinine after renal transplantation in patients who received kidneys from donor with peak serum creatinine higher than 1.4mg/dl was not different from those in patients who received kidney with normal function. CONCLUSION: The transient hypotension or acute reversible mild to moderate deterioration of renal function in cadaver donor does not seem to have significant effect on the early post-transplantation graft function if underlying organic renal disease could be ruled out by careful history taking and clinical evaluation.
Blood Pressure ; Brain Death ; Cadaver* ; Chungcheongnam-do ; Creatinine ; Humans ; Hypotension ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Korea ; Nephrectomy ; Platelet Count ; Tissue Donors* ; Transplants* ; Vital Signs

This study was undertaken to investigate an involvement of nitroxergic innervation in gastric smooth muscle of rat. Isometric tension study, the measurement of single cell length, NADPH diaphorase stain of smooth muscle layers and neuronal nitric oxide synthase (nNOS) western blotting were performed. Sodium nitroprusside (SNP), a nitric oxide donor, relaxed the muscle strips precontracted by acetylcholine (ACh) in a concentration-dependent manner. Pretreatment of L-arginine decreased the contraction induced by electric field stimulation (EFS). Pretreatment of NG-nitro-L-arginine methyl ester (L-NAME), a NOS inhibitor, increased the EFS-induced contractions. LY 83583, a guanylate cyclase (GC) inhibitor, reversed the inhibitory actions of L-arginine on the muscle contractions. The effects of L-Arginine, L-NAME and LY 83583 on ACh-induced contractions were not significant. L-arginine reduced the EFS-induced contraction in circular muscle, whereas L-NAME enhanced the EFS-induced contraction in longitudinal strips. By EFS, the phasic contractions appeared approximately 20~25 seconds later. L-NAME significantly shortened the delay time to about 2~3 seconds. In single cell study, ACh contracted gastric smooth muscle cells, SNP relaxed the cells, and the latter also inhibited the ACh-induced contraction. LY 83583 enhanced the ACh-induced contraction and antagonized SNP-induced relaxation. NADPH diaphorase activity was assessed by a histochemistry, nitroblue tetrazolium (NTB) staining. Positive staining was observed in both circular and longitudinal muscle layers. L-arginine increased the staining, while L-NAME decreased the staining. Western blotting for nNOS proved the presence of nNOS in rat gastric smooth muscle. EFS and additional Ca2+ increased nNOS protein expression. These results suggest that in rat stomach, both circular and longitudinal muscle layers are innervated with nitroxergic nerves which relax the gastric smooth muscle via NO-cGMP pathway.
Acetylcholine ; Animals ; Arginine ; Blotting, Western ; Guanylate Cyclase ; Humans ; Muscle Contraction ; Muscle, Smooth* ; Myocytes, Smooth Muscle ; NADPH Dehydrogenase ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase Type I ; Nitroblue Tetrazolium ; Nitroprusside ; Rats* ; Relaxation ; Stomach ; Tissue Donors

Dental infection which has been harmful to human for a long time occurs when the balance of three factors; host, environment and source of infection are broken and occurs especially when the balance of the resistance of the host and the toxin of bacteria are collapsed. Though dental-origin infection causes severe pain, it is commonly localized in gingiva, pulp and the surface of alveolar bone and as the decrease of its prevalence due to the development of antibiotics and the ease of treatment by a simple aids, there are no case that proper caution are made for the infection. Expecially in case of patient with infectious Hansen's disease(leprosy), as they have many other medical diseases, dental disease are mostly passed by. As oromaxillary infection can end up to death, though it is hard to treat a severly progressed myofascial space infection, general understanding about the reason, the pattern of spreading, treatment, prevention of it should be needed to make actual management in the situation of an doubtless developing of infection in patient treatment and situation of suspicious development of early myofascial space infection. Since last 5 years, 36% of the patients were hospitalized due to their dental infection and consistent advertising and treatment resulted in a gradual decrease of it.
Anti-Bacterial Agents ; Bacteria ; Gingiva ; Humans ; Prevalence ; Stomatognathic Diseases

Primary non-Hodgkin's lymphoma of the liver, an organ normally devoid of a native lymphoid tissue, is very rare. We report a case of primary hepatic T-cell lymphoma in a 18-year-old girl, with review of literature. The pateint admitted with fever for 5 months. The ultrasonography revealed a 10 x 7 cm sized mass in the left lobe of the liver. On abdominal CT, the mass was poorly enhancing and low attenuated. On MRI, the signal intensity of the mass was low in T1 weighted image, heterogeneously high in T2 weighted image, and peripherally enhanced in contrast enhancing T1 weighted image. The biopsy specimen obtained by laparatomy showed anaplastic tumor. The malignant cells were positive for T-cell lineage (CD3, CD44, CD45RO). There was no evidence of the lymphoma in other regions. The patient was treated with CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) chemotherapy without objective response. The patient died of sudden cardiogenic shock.
Adolescent ; Biopsy ; Doxorubicin ; Drug Therapy ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Liver* ; Lymphoid Tissue ; Lymphoma ; Lymphoma, Non-Hodgkin ; Lymphoma, T-Cell* ; Magnetic Resonance Imaging ; Shock, Cardiogenic ; T-Lymphocytes ; Tomography, X-Ray Computed ; Ultrasonography ; Vincristine