A 63 year old male suffered from a acute huge inferolateral and posterior myocardial infarction with vertricular septal perforation(1x1.5cm). Cardiogenic shock and ventricular tachycardia occured on the 3rd day in hospital. After cardiopulmonary resuscitation the deteriorated condition of the patient was improved by intraaortic balloon counterpulsation(IABP). The invasive diagnostic procedure(LV angiography and coronary angiogram) was carried out under the employment of IABP and artificial ventrilation. The patients has recovered from the operation(coronary artery bypass graft and VSD patch op) and myocardial infarction. Because of recurrent aspiration pneumonia the patient was nourished per gastrostomy. He died 3 month later due to upper gastrointestinal bleeding.
Angiography ; Arteries ; Cardiopulmonary Resuscitation ; Counterpulsation* ; Employment ; Gastrostomy ; Hemorrhage ; Humans ; Inferior Wall Myocardial Infarction* ; Male ; Middle Aged ; Myocardial Infarction ; Pneumonia, Aspiration ; Shock, Cardiogenic* ; Tachycardia, Ventricular ; Transplants ; Ventricular Septal Rupture*

OBJECTIVEAcne vulgaris is a chronic dermatologic problem with multiple factors involved in its pathogenesis. Alternative solutions to acne treatment were instigated by antibiotic resistance despite of its extensive use. Purified bee venom (PBV) has been proposed as a promising candidate for that purpose. The present study was designed to confirm the antibacterial effect of PBV and access the efficacy of cosmetics containing PBV in subjects with acne vulgaris.

METHODSThe skin bacterium Propionibacterium acnes was incubated with PBV at various concentrations and bacterial growth was evaluated using the colony forming unit (CFU) assay. The mechanism of PBV employed in killing P. acnes was examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). In addition, a total of 12 subjects were randomized in a double-blind, controlled trial to receive either cosmetics containing PBV or cosmetics without PBV for two weeks. Evaluations included lesion counts and skin microorganism.

RESULTSPBV exhibited antimicrobial activity in a concentration-dependent manner, reducing the number of P. acnes CFU by approximately 6 logs at a concentration of 0.5 mg. When PBV concentration was higher than 1.0 mg, no P. acnes colonies were spotted on an agar. TEM and SEM of untreated P. acnes illustrated the normal pleomorphic structure, whereas the PBV-treated bacterium lost the integrity of surface architecture. Significant difference (P=0.027) in the grading levels based on numbers of lesion counts for inflammatory and noninflammatory was observed in favour of the PBV group compared with the control group. In terms of average decrement of skin microorganism, subjects receiving cosmetics containing PBV experienced a significant 57.5% decrease of adenosine triphosphate levels, whereas participants receiving cosmetics without PBV experienced a nonsignificant decrease of 4.7%.

CONCLUSIONThese results show that the in vitro actions of antimicrobial activity of PBV were translated in vivo. Cosmetics containing PBV provided a certain degree of efficacy in terms of lesion counts and skin microorganism concentration compared with cosmetics without PBV in subjects with acne vulgaris. PBV may be a good candidate compound for developing therapeutic drug for the treatment of acne vulgaris.

Acne Vulgaris ; drug therapy ; microbiology ; Adolescent ; Adult ; Anti-Infective Agents ; therapeutic use ; Bee Venoms ; therapeutic use ; Child ; Cosmetics ; Double-Blind Method ; Humans ; Propionibacterium acnes ; drug effects

Nonsteroidal antiinflammatory drugs(NSAIDs) are known as clinically effective agents for treatment of inflammatory diseases. Inhibition of cyclooxygenase has been thought to be a major facet of the pharmacological mechanism of NSAIDs. However, it is difficult to ascribe the antiinflammatory effects of NSAIDs solely to the inhibition of prostaglandin synthesis. Human neutrophil elastase (HNElastase; HNE, EC 3.4.21.37) has been known as a causative factor in inflammatory diseases. To investigate the specific relationship between HNElastase inhibition and specificity of molecular structure of several NSAIDs, HNElastase was purified by Ultrogel AcA54 gel filtration, CM-Sephadex ion exchange, and HPLC (with TSK 250 column) chromatography. HNElastase was inhibited by aspirin and salicylate in a competitive manner and by naproxen, ketoprofen, phenylbutazone, and oxyphenbutazone in a partial competative manner, but not by ibuprofen and tolmetin. HNElastase-phenylbutazone-complex showed strong Raman shifts at 200, 440, 1124, 1194, 1384, 1506, and 1768 cm(-1). The Raman bands 1194, 1384, and 1768 cm(-1) may represent evidences of the conformational change at -N=N-phi radical, pyrazol ring, and -C=O radical of the elastase-drug complex, respectively. Phenylbutazone might be bound to HNElastase by ionic and hydrophobic interaction, and masked the active site. Inhibition of HNElastase could be another mechanism of action of NSAIDs besides cyclooxygenase inhibition in the treatment of inflammatory diseases. Different inhibition characteristics of HNE-lastase by NSAIDs such as aspirin, phenylbutazone-like drugs and ineffective drugs could be important points for drawing the criteria for appropriate drugs in clinical application.
Anti-Inflammatory Agents, Non-Steroidal/pharmacology* ; Chromatography, Affinity ; Computer Simulation ; Enzyme Inhibitors/pharmacology ; Human ; Isoenzymes/isolation & purification ; Isoenzymes/antagonists & inhibitors ; Ketoprofen/pharmacology ; Leukocyte Elastase/isolation & purification ; Leukocyte Elastase/antagonists & inhibitors* ; Models, Molecular ; Naproxen/pharmacology ; Phenylbutazone/analogs & derivatives ; Salicylates/pharmacology ; Spectrum Analysis, Raman

PURPOSE: The purpose of this study was to investigate the anger expression types in nurses and to analyze the differences between the anger expression types and interpersonal problems. METHODS: The data were collected from 149 nurses working in general hospitals with 300 beds or more in Seoul or Gyeonggi province, Korea. For anger expression type, the anger expression scale from the Korean State-Trait Anger Expression Inventory was used. For interpersonal problems, the short form of the Korean Inventory of Interpersonal Problems Circumplex Scales was used. Data were analyzed using descriptive statistics, cluster analysis, multivariate analysis of variance, and Duncan's multiple comparisons test. RESULTS: Three anger expression types in nurses were found: low-anger expression, anger-in, and angerin/ control type. From the results of multivariate analysis of variance, there were significant differences between anger expression types and interpersonal problems (Wilks lambda F = 3.52, p < .001). Additionally, anger-in/control type was found to have the most difficulty with interpersonal problems by Duncan's post hoc test (p < .050). CONCLUSIONS: Based on this research, the development of an anger expression intervention program for nurses is recommended to establish the means of expressing the suppressed emotions, which would help the nurses experience less interpersonal problems.
Adult ; *Anger ; *Expressed Emotion ; Female ; Hospitals, General ; Humans ; *Interpersonal Relations ; Male ; Middle Aged ; Nurses/*psychology ; Nursing Staff, Hospital/*psychology ; Republic of Korea ; Surveys and Questionnaires ; Young Adult

significant advances have been made in understanding the biological underpinnings of post-traumatic stress disorder(PTSD), particularly in the field of genetics and neuroimaging. Association studies in candidate genes related with hypothalamic-pituitary-adrenal axis, monoamines including serotonin, dopamine and noradrenaline, and proteins including FK506-binding protein 5 and brain-derived neurotrophic factor have provided important insights with regard to the vulnerability factors in PTSD. Genome-wide association studies and epigenetic studies may provide further information for the role of genes in the pathophysiology of PTSD. Hippocampus, medial prefrontal cortex, anterior cingulated cortex and amygdala have been considered as key structures that underlie PTSD pathophysiology. Future research that combines genetic and neuroimaging information may provide an opportunity for a more comprehensive understanding of PTSD.
Amygdala ; Axis, Cervical Vertebra ; Brain-Derived Neurotrophic Factor ; Dopamine ; Epigenomics ; Genome-Wide Association Study ; Hippocampus ; Neuroimaging ; Norepinephrine ; Prefrontal Cortex ; Proteins ; Serotonin ; Stress Disorders, Post-Traumatic ; Tacrolimus Binding Proteins

Mitral valvular heart diseases are known to be one of the easily detectable and the hemodynamic chane to the severity and duration of diseases can directly be described by echocardiography. The objective of this study was to determine the echocardiographic characteristics in 3 groups of mitral valvular diseases, that is mitral stenosis(112 cases), mitral stenoinsufficiency (66 cases). and mitral insufficiency(20 cases). 1) In mitral valve study, closing velocity of anterior leaflet reduced in mitral stenosis than other two groups and DE amplitude was greater in mitral insufficiency but there were no significant differences in 3 groups of mitral valvular diseases. DE and AC slope were slightly more rapid in mitral stenosis group and left ventricular outflow tract was much increased in mitral insufficiency group. 2) In aorta and left atrium study, aortic cusps separation was much increased in mitral insufficiency and left atrium was slightly more dilated in mitral stenoinsufficiency than other two groups. But left atrial dimension in mitral insufficiency was more diminished than that in mitral, stenosis, which is probably due to the short durationn of diseases and small range of materials in mitral insufficiency group. 3) In left ventricle study, thickness of interventricular septem, LSa, Ena, left ventricular dimension, LVPW, LV volume. and stroke volume were more increased in mitral insufficiency than mitral stenosis, because of the left ventricular volume overloading. Vcf and PEP/LVET were higher in mitral insufficiency than other two groups. Ejection fraction and fractional shortening were more diminished in mitral stenoinsufficiency but no significant difference was found. 4) In right ventricle study, there were no remarkable changes in right ventricular dimension and right ventricular internal dimension index in all 3 groups of mitral valvular diseases. 5) Calcification of mitral leaflets was observed in 85.7% of mitral stenosis, 90.9% of mitral stenoinsufficiency and 10% of mitral insufficiency, but heavy calcification was more remarkable in mitral stenosis group(25%). 6) Atrial fibrillation was observed in 47% of total mitral valvular diseases, mitral stenosis being 43.8%, mitral stenoinsufficiency 60.6% and mitral insufficiency 20%. In cases of atrial fibrillation, left atrial dimension was significantly enlarged compared with the group without atrial fibrillation.
Aorta ; Atrial Fibrillation ; Constriction, Pathologic ; Echocardiography* ; Heart Atria ; Heart Valve Diseases* ; Heart Ventricles ; Hemodynamics ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Stroke Volume

PURPOSE: We performed this study to investigate the outcome of surfactant replacement therapy (SRT) in above nearterm neonates who were required mechanical ventilatory care due to meconium aspiration pneumonia (MAP), respiratory distress syndrome (RDS) or other severe pneumonia (PN). METHODS: 48 patients, gestational period 36 weeks, who were admitted in NICU of Dongsan Medical Center, Keimyung University between July 1999 and June 2004 were enrolled. They were divided into three groups, MAP group (15 cases), RDS group (27 cases) and PN group (6 cases). All patients were received SRT and evaluated several clinical data (gestational age, oxygen index, duration of ventilator care) and outcome (complications and mortality rate) between pre-SRT and post-SRT. The mean dose of surfactant (modified bovine surfactant, Newfacten, Yuhan Co., Seoul, Korea) was 120 mg/kg. RESULTS: Among each groups, mean pre-SRT OI was higher in MAP group (213.2) than other groups, mean duration (days) of ventilatory care and oxygen therapy were similar distributions. Compared with pre-SRT values, significant improvements (P<0.05) in mean values for FiO2 and oxygenation index were documented at 12 hours after SRT. Early complications (persistent pulmonary hypertension of newborm, pneumothorax) and survival rate were lower in MAP group. Within RDS group, earlier SRT (given before 12 hours of life) revealed significantly lower early complication rate than later SRT (given after 12 hours of life) (13.3% vs 58.3%, P<0.05) CONCLUSION: Our study suggested that SRT seems to be an effective therapy in above nearterm neonates with severe pulmonary disease, and earlier SRT tends to reduce complications in RDS group than later therapy.
Humans ; Hypertension, Pulmonary ; Infant, Newborn* ; Lung Diseases* ; Meconium Aspiration Syndrome ; Mortality ; Oxygen ; Pneumonia ; Seoul ; Survival Rate ; Ventilators, Mechanical

OBJECTIVES: To evaluate an association between depression and altered immunity, we examined peripheral T lymphocyte or natural killer (NK) cell measures plasma ACTH and cortisol using the flow cytometry in acute and unmedicated patients with major depressive disorder (MDD). METHODS: Forty-two patients with MDD from the outpatient clinic and forty normal controls from the hospital staff were recruited. We applied Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) for depressed subjects. Peripheral T lymphocyte or NK cell measures (CD3, CD4, CD8, or CD56) and plasma hormones (ACTH and cortisol) were obtained from all subjects. RESULTS: There were no statistical differences in CD3, CD4, CD8, or CD56 between the two subjects. The number of CD56 cells negatively correlated with HAM-D scores (r=-0.42, p<0.01), but did not correlate with HAM-A scores in patients with MDD. The number of CD56 cells showed strong negative correlation with CD4/CD8 (r=-0.47, p<0.01) in the control group, but not in the depressed group. Patients with MDD had higher cortisol level than controls within the normal range. CONCLUSION: The trait of immunological imbalance and HPA axis abnormality were shown in patients with MDD. Especially, the severity of depression, but not the anxiety, could be reflected as decreased number of CD56 (NK T) cells in acute and unmedicated state.
Adrenocorticotropic Hormone ; Ambulatory Care Facilities ; Anxiety ; Axis, Cervical Vertebra ; Depression ; Depressive Disorder, Major* ; Flow Cytometry ; Humans ; Hydrocortisone ; Killer Cells, Natural ; Lymphocytes ; Natural Killer T-Cells* ; Plasma ; Reference Values

OBJECTIVE: There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis. MATERIALS AND METHODS: A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established. RESULTS: CEA or CAS is indicated when the patient has a symptomatic stenosis > or = 50%, or when the patient has an asymptomatic stenosis > or = 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected. CONCLUSION: We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.
Carotid Arteries ; Carotid Stenosis* ; Constriction, Pathologic ; Endarterectomy, Carotid ; Humans ; Stents

The National Teacher Training Center for Health Personnel (NTTC) / Korea, administrated jointly by Seoul National University College of Medicine, is a resource to conduct programs on fundamental and applied problems in Korean medical education, to assist faculty of health professions to gain increased knowledge of the methods of teaching, educational evaluation and curriculum planning. Of varieties of educational services given for health profession faculty since its establishment in 1975, faculty development program has been one of the major activities to provide educational experiences to the faculty members to improve their teaching effectiveness by conducting workshops, seminars and conferences. A total of 30 short-term educational workshop programs, designed for newly appointed medical school faculty members were implemented during a period from 1981 to 1989, and their postworkshop questionnaires were analysed together with summary reports from convertors in view of evaluating immediate effectiveness. The number of participants was 655 from 27 out of 31 medical schools. They attended a 3-day promotional workshop under the same workshop objectives and format with a class size of no more than 30/workshop. The selection procedure was mostly relied on the recommendation through the dean's office. The workshop format was generally well accepted among the participants as a necessary mechanism for reclarification of the faculty roles in teaching-learning process, especially in professional educational programs. Teaching strategies including small group discussions and various group dynamics techniques were the integral parts of the workshop format aiming for the active participation throughout the educational activities in development of lecturing and test-item construction skills. Impeding and enhancing factors identified during the workshop were listed and recommendations to NTTC, medical schools and related organizations were made with regard to further improvement in faculty development programs.
Congresses as Topic ; Curriculum ; Education* ; Education, Medical ; Health Occupations ; Health Personnel ; Humans ; Korea ; Research Report ; Schools, Medical* ; Seoul ; Surveys and Questionnaires