Ventricular premature beats(VPB) are the most common cardiac arrhythmia and frequently found in apparently normal healthy persons as well as in various heart diseases. Postectopic potentiation of ventricular contraction has widely reported by electrocardiography. In this study, the authors performed comparative assessment of the left ventricular function at the preextrasystolic, extrasystolic and postextrasystolic beats by M-mode echocardiography and electrocardiography. The results obtained were as followings; 1) Among 22 patients of isolated, unifocal ventricular premature beats with fully compensatory pause, male were 6 and female 16, mean age being 47.2 years. 2) Hypertensive heart disease was the most common underlying disease of ventricular premature beats(5 patients) and the others were valvular heart diaeases(3), ischemic heart diseases(3), cardiomyopathy(2), intracerebral hemorrhagy(1), atrial septal defect of secundumtype(1), cor pulmonale(1), pericarditis(1), 1degree A-V block(1) and enteric fever(1). In 3 patients the causes were not clarified. 3) R wave amplitude was higher in the postextrasystolic beat(2.02+/-0.79cm) than preestrasystolic beat(1.86+/-0.66cm) 4) PEP/LVET ratio showed more decrease(18%) in postextrasystolic beat than that of preextrasystole. 5) Diastolic filling time of mitral valve was more reduced in the extrasystole than preextrasystole, but that of postextrasystole exceeded the preextrastystole. 6) Aortic cusps separation was more decreased in the extrasystole than preextrasystole and slightly more increased in the postextrasystole than preextrasystole. 7) LVID, LSa, ENa, DeltaEN/Deltat, LVEDV, SV and LV mass showed more decrease in extrasystole compared with those in pre-and postextrasystole, which was higher than preextrasystole. But LVESV was slightly lower in extrasystole than preextrasystole. 8) In extrasystolic beat, LVEDV, LVESV, stroke volume, and ejection fraction of ventri cular premature beat were 15.77%, 0.18%, 24.05% and 12.21% lower, respectively, than those of preextrasystole. And in the postextrasystole, LVEDV, LVESV, stroke volume and ejection fraction were 23.35%, 2.42%, 28.51% and 10.4% higher, respectively, than these of preextrasystole.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature* ; Echocardiography* ; Electrocardiography ; Female ; Heart ; Heart Diseases ; Heart Septal Defects, Atrial ; Humans ; Male ; Mitral Valve ; Stroke Volume ; Ventricular Function, Left*

Doxorubicin(Adriamycin(R)) is effective in the treatment of various solid tumors and hematologic malignancies. Because of dose-related cardiotoxicity, however, early inappropriate discontinuation of doxorubicin therapy may minimize its therapeutic efficacy in many patients. Consequently, clinically sensitive tests are needed to select patients in whom treatment must be stopped early. Various techniques have been used for early detection of subclinical doxorubicin-induced cardiotoxicity, including electrocardiography, systolic time intervals, echocardiography, radionuclide angiography and endomyocardial biopsies. Most studies of doxorubicin cardiotoxicity have dealt with systolic function of the left ventricle and effects on diastolic function have not been reported. In order to determine whether impaired diastolic function may be an early sign of doxorubicin cardiotoxicity, a retrospective study was performed in 12 patients who had undergone serial radioangiography and were found to have left ventricular ejection fractions(LVEF)> or =55% prior to doxorubicin treatment and during follow-up. Average rapid filling velocity(RFV) and slow filling velocity(SFV) were both significantly reduced after doxorubicin treatment. RFV fell from 5.17+/-1.52 units/second to 4.18+/-0.96(P<0.01) and SFV fell from 2.20+/-1.32 units/second to 1.42+/-0.62(P<0.05). There were no significant changes in filling volume ratio, total diastolic time and diastolic time ratio. Since a change in left ventricular diastolic function can occur before ejection fraction falls to subnormal levels, diastolic function as well as systolic function should be examined in the early detection of doxorubicin cardiotoxicity.
Biopsy ; Doxorubicin* ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart Ventricles ; Hematologic Neoplasms ; Humans ; Radionuclide Angiography ; Retrospective Studies ; Systole

A Clinical observation was made on 10 cases of childhood urolithiasis under 15 year-old who were admitted to the department of urology, Hanyang University Hospital during the period from May, 1972 to Dec, 1983. The results were as follows: 1. of 3482 cases hospitalized, 10 cases were urolithiasis in childhood giving ratio of 0.29%. 2. The favorable age was absent, but showed even distribution. 3. Congenital anomalies 2, metabolic cause 1, idiopathic cause 7 were recognized as etiologic causes. 4. Incidence of lower urinary stone was high, 70%. 5. The most frequent symptoms and signs were voiding difficulty, 4 cases. Hematuria, flank pain and bladder irritative symptoms were also noted. 6.The urine cultures were showed Klebsiella pneumonia in 1 case, Enterobacter aerogens in 1 case, Enterococci in 1 case and combined infection of E. coli and Enterococci in 1 case. 7. Stone analysis was showed calcium oxalate in 3 cases, combined stone of calcium oxalate and ammonium phosphate in 1 case and fibrinoid calculi in 1 case. 8. Recurred rate cannot be estimated because of the patient was not revisited to out-patient-department at all after discharge.
Adolescent ; Ammonium Compounds ; Calcium Oxalate ; Calculi ; Enterobacter ; Flank Pain ; Hematuria ; Humans ; Incidence ; Klebsiella ; Pneumonia ; Urinary Bladder ; Urinary Calculi ; Urolithiasis* ; Urology

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

Primary angiitis of the CNS(PACNS), also known as isolated angiitis of the CNS, is an idiopathic vasculitis confined to the CNS and it primarily occurrs to middle aged adults. Neurologic manifestations include headache, focal seizure, and progressive, behavioral or multifocal neurologic impairments. A 20-month-old boy was presented with recurrent right-sided hemiplegia and loss of consciousness. Brain MRI revealed focal T2 hyperintensely enhanced lesions involving left lentiform nucleus and caudate nucleus with no mass effects. Cerebral angiogram disclosed multifocal stenosis in both middle cerebral arteries and left posterior cerebral artery. The child was treated with prednisone alone since he was diagnosed as IACNS. He was asymptomatic with a normal neurologic examination and continued on prednisone therapy. Therefore, it is concluded that children who have frequent or severe headache or focal neurologic deficits should be carefully evaluated and those meeting criteria of IACNS should be treated aggressively.
Adult ; Brain ; Caudate Nucleus ; Central Nervous System* ; Child* ; Constriction, Pathologic ; Corpus Striatum ; Headache ; Hemiplegia ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Middle Cerebral Artery ; Neurologic Examination ; Neurologic Manifestations ; Posterior Cerebral Artery ; Prednisone ; Seizures ; Unconsciousness ; Vasculitis*

Aspergillosis is defined to include any infection caused by a species of Aspergillus. Aspergillosis is a granulomatous, necrotizing. and cavitary disease of lung, often with hematogenous spread to other organs such as brain. kidney, heart, spleen. intestine, skin, and bone. Aspergillosis is becoming increasingly vulnerable to patients with malignant disease and to patients receiving immunosuppressive therapy and antibiotics for a wide range of illness. We present a case of this disease involved the right kidney without lung.
Anti-Bacterial Agents ; Aspergillosis* ; Aspergillus ; Brain ; Heart ; Humans ; Intestines ; Kidney ; Lung ; Skin ; Spleen

Advances for the treatment of childhood cancer in several decades have remarkably improved long-term survival. Anticancer therapy is capable of causing a variety of delayed toxicities including secondary malignant neoplasm. Therefore close follow-up for secondary malignant neoplasm is important for surviving patients from cancer. Renal cell carcinoma is a rare tumor in childhood and has been reported previously to occur after treatment of a few solid tumors, including neuroblastoma. This report represents the first documented case of renal cell carcinoma arising as a secondary malignant neoplasm in a pediatric patient who previously was treated for germ cell tumor.
Carcinoma, Renal Cell* ; Child* ; Follow-Up Studies ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Neuroblastoma

OBJECTIVE: Chest pain is one of the most common complaints in the emergency department (ED). Cardiac computed tomography angiography (CCTA) is a frequently used tool for the early triage of patients with low- to intermediate-risk acute chest pain. We present a study protocol for a multicenter prospective randomized controlled clinical trial testing the hypothesis that a low-dose CCTA protocol using prospective electrocardiogram (ECG)-triggering and limited-scan range can provide sufficient diagnostic safety for early triage of patients with acute chest pain. METHODS: The trial will include 681 younger adult (aged 20 to 55) patients visiting EDs of three academic hospitals for acute chest pain or equivalent symptoms who require further evaluation to rule out acute coronary syndrome. Participants will be randomly allocated to either low-dose or conventional CCTA protocol at a 2:1 ratio. The low-dose group will undergo CCTA with prospective ECG-triggering and restricted scan range from sub-carina to heart base. The conventional protocol group will undergo CCTA with retrospective ECG-gating covering the entire chest. Patient disposition is determined based on computed tomography findings and clinical progression and all patients are followed for a month. The primary objective is to prove that the chance of experiencing any hard event within 30 days after a negative low-dose CCTA is less than 1%. The secondary objectives are comparisons of the amount of radiation exposure, ED length of stay and overall cost. RESULTS AND CONCLUSION: Our low-dose protocol is readily applicable to current multi-detector computed tomography devices. If this study proves its safety and efficacy, dose-reduction without purchasing of expensive newer devices would be possible.
Acute Coronary Syndrome ; Adult ; Angiography* ; Chest Pain ; Coronary Angiography ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital ; Heart ; Humans ; Length of Stay ; Prospective Studies ; Radiation Exposure ; Retrospective Studies ; Thorax ; Triage

Autologous stem cell transplantation (ASCT) for the treatment of high-risk neuroblastoma (NBL) is an accepted method for restoring bone marrow depression after high dose chemotherapy. We retrospectively analyzed eighty eight cases of NBL that underwent ASCT following marrow ablative therapy at 12 transplant centers of the Korean Society of Pediatric Hematology-Oncology between January 1996 and September 2000. Seventy nine children were of stage IV NBL and 9 were of stage III with N-myc amplification. Various cytoreductive regimens were used. However, the main regimen was 'CEM' consisting of carboplatin, etoposide and melphalan, and this was used in 66 patients. Total body irradiation was also added in 36 patients for myeloablation. To reduce tumor cell contamination, stem cell infusions after CD34+ cell selection were performed in 16 patients. Post-transplantation therapies included the second transplantation in 18 patients, interleukin2 therapy in 45, 13-cis retinoic acid in 40, 131-meta-iodobenzylguanidine in 4, conventional chemotherapy in 11, and local radiotherapy in 8. Twenty two patients died, sixty six patients are surviving 1 to 46 months after ASCT (median followup duration, 14.5 months). Although the follow-up period was short and the number of patients small, we believe that ASCT might improve the survival rate in high-risk NBL.
Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy ; Female ; Human ; Korea ; Male ; Myeloablative Agonists/therapeutic use ; Neuroblastoma/mortality ; Neuroblastoma/pathology ; Neuroblastoma/therapy* ; Retrospective Studies ; Stem Cell Transplantation* ; Survival Rate ; Transplantation Conditioning ; Transplantation, Autologous ; Treatment Outcome

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is one of the most important armamentarium against various hematologic malignancies or some solid tumors. We investigated the number of patients who might need transplants and compared with that of actual transplants to conceptualize current status and circumstances of HSCTs in Korean children. METHODS: Questionnaires were sent to Korean Society of Hematopoietic Stem Cell Transplantation (KSHSCT) members who were taking care of children with malignancies or hematologic diseases. Almost all of the newly diagnosed patients between Jan, 1st and Dec, 31st, 2003 were enrolled in the study. RESULTS: Seven hundred forty eight children (male to female ratio = 1.4:1) were enrolled. The median age was 6.1 years old (8 days~28.8 years old). Malignant diseases consisted of 695 cases (92.9%), and among them almost half were hematologic malignancies. The participating members speculated that HSCTs should be indicated in 285 children (38.1%) which included 209 allogeneic, and 76 autologous transplants. In reality, however, allogeneic HSCTs were performed only in 140 children (67.0%) with the median interval of 5.9 month, and autologous transplants in 44 children (57.9%) with 8.3 month. In autologous setting, all the patients received peripheral blood stem cells (PBSCs), whereas bone marrow (61%), cord blood (34%), and PBSC (5%) were used in allogeneic HSCTs. Donor types were as follows: unrelated donor (37%), cord blood (34%), sibling donor (25%), and family (4%). The reasons for not performing HSCTs were unfavorable disease status or death, no availability of suitable donor, economical situation, and refusal by parental preferences. Under the strict insurance regulations, many transplants were not covered by insurance. More autologous transplants were performed without insurance coverage than allogeneic HSCTs (P=0.013). Those cases were advanced cases and HLA mismatch transplants for allogeneic setting, and relatively rare diseases still awaiting favorable results of transplants for autologous setting. CONCLUSION: HSCTs are essential part of treatment strategies for children with various diseases. Unfortunately, however, a third of patients who were in need of transplants did not receive HSCTs due to various reasons. It is necessary to expand unrelated donor pool or cord blood banks for the cases lacking HLA-identical sibling donors. Also medical insurances should cover HSCTs for rare diseases as well as for less favorable but novel situations where there are no suitable alternatives.
Autografts ; Bone Marrow ; Child* ; Disulfiram ; Female ; Fetal Blood ; Hematologic Diseases ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Insurance ; Insurance Coverage ; Parents ; Rare Diseases ; Siblings ; Social Control, Formal ; Stem Cells ; Tissue Donors ; Unrelated Donors ; Surveys and Questionnaires