No abstract available.
Peutz-Jeghers Syndrome*

No abstract available.
Child* ; Glomerulonephritis* ; Humans

No abstract available.
Meconium* ; Peritonitis*

No abstract available.
Hepatolenticular Degeneration*

Ascending aortic aneurysm of the thorax is a condition characterized by an increase in the diameter of the ascending aorta between the aortic valve and the brachiocephalic artery. Most patients with ascending aortic aneurysm are asymptomatic and do not require treatment; the rates of dissection, rupture, and mortality are also low. In this report, we describe the autopsy findings in a case of sudden death due to acute myocardial infarction secondary to the previously asymptomatic, unruptured, and undissected aortic aneurysm of the thoracic ascending aorta extending to the sinus of Valsalva. The findings in this case emphasize the importance of preventive management of asymptomatic ascending aortic aneurysms, and possible mechanisms of sudden cardiac death in patients with uncomplicated ascending aortic aneurysm is also discussed.

BACKGROUND: Despite remarkable progress of understanding the pathophysiology and therapy of bronchial asthma, asthma morbidity and mortality are on the rise. Also hospitalization and attending rates of emergency department for asthma have been increasing gradually. We analyzed clinical characteristics and prognosis of patients who visited emergency room due to asthma attack in order to define clinical characteristics of these group of patients. METHOD: We reviewed 105 adult asthmatic patients who attended emergency department of Korea University Hospital between August 1995 and July 1996, retrospectively. RESULTS: 103 patients(56 female, 47 males, mean age : 48.6 years) attended-68 self referral, 18 practitioner referral and 17 OPD transfer- and 86 patients(83.5%) were admitted. Attending emergncy department was clearly more frequent in December(13.6%) and May(12.6%). Time lag between onset of asthmatic attack and arrival at the hospital was 14.2 15.5 hour and initial peak expiratory flow rate was 166.7 68.3L/min.(43.3% predicted) The commonest cause for visiting emergency room was aggravation of asthma due to upper respiratory tract infection in mild asthmatics. About half of them had history of previous ER visits. Their prognosis was not bad, but after discharge, about half of patients escaped from OPD follow-up. CONCLUSION: As a group they merit detailed attention and follow up arrangement. Clinician need to monitor and review the treatment plans, the medications, the patient's management technique, and the level of asthma control. For this group, plans for longer term treatment, including asthma education program and adjustment of overall treatment plan should be made.
Adult ; Asthma ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Korea ; Male ; Mortality ; Peak Expiratory Flow Rate ; Prognosis ; Referral and Consultation ; Respiratory Tract Infections ; Retrospective Studies ; United Nations

BACKGROUND: The prevalence of Gastro-esophageal reflux(GER) in patients with asthma is estimated to be 50~60% and treatment of GER has been shown to improve asthma symptoms in Western. But GER has been known to be less common in Eastern and GER prevalence rates in asthmatics are not available in Korea. METHOD: We compared the prevalence rate of GER in 42 patients with asthma to that in 20 healthy normal controls and examed the efficacy of new prokinetic drug, cisapride(40mg/day, 8weeks) in patients with GER and asthma. For acid GER to be considered pathological, 24 hour esophageal pH monitoring should reveal values exceeding upper limit of 95 percentile for at least one of 6 parameter of DeMesseter's table. RESULT: The results showed GER was more common in patients with asthma(11/42, 26.2%) than normal controls(3/20, 15%) and asthmatics group showed a significant longer supine time pH<4(%) and total time pH<4(%), and more reflux episodes as compared with normal control group. After 4 asthmatics with GER were treated with cisapride, their asthma symtom scores, FEV1 and composite scores of pH monitoring were improved. CONCLUSION: GER is more common in asthmatics than in normal controls in Korea and prepulsid reduces asthma symptoms in patients with GER and asthma.
Asthma ; Cisapride ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Korea ; Prevalence

Background: Although most of the patients with tuberculous pleural effusions completely reabsorbed their effusions and became asymptomatic within 2 to 4 months, later surgical procedures such as decortication is needed in some patients because of dyspnea caused by pleural loculations and thickening despite anti-tuberculous chemotherapy. It is obligatory to secure adequate drainage to prevent the development of complications. But, the best methods for treating loculated tuberculous pleural effusions remain debatable. Recent several reports revealed that intrapleural instillation of fibrinolytic agents is an effective adjunct in the management of complicated empyema and may reduce the need of surgery. Purpose: The effects of catheterization with intrapleural urokinase instillation were prospectively evaluated in the patients with septated tuberculous pleural effusion, and compared with other therapeutic effects of different modalities of therapy such as repeated thoracentesis and small-bored catheterization. Methods: Forty-eight patients diagnosed with tuberculous pleurisy were randomly separated into three groups ; control group(n=13), catheter group(n=12), urokinase group(n=22). In urokinase group, dose of 100,000U urokinase was instilled into the pleural cavity via a percutaneous drainage catheter for complete drainage or total dose of 700,000U of urokinase. After two hours clamping, the catheter was opened and intermittently irrigated. The early and late effectiveness of therapies was assessed by radiographically and by measuring the volume of fluid drained from the catheter. Results: There was statistically significantly better result in the urokinase group in respect of frequency of catheterization, frequency of catheter obstruction and the duration of catheterization in early effectiveness(p<0.05). There were no difference in radiologic improvement of folllow-up in later phase chest X-ray between urokinase group and catheter group in later phase(p>0.05). But there were more failure rates in control group especially honeycomb septa in pleural effusion sonographically than former two groups. And there were no complications of urokinase such as fever or hemorrhage. Conclusion: In the treatment of septated tuberculous pleurisy, there were better results in urokinase than those of catheterization alone in early effectiveness. And there was no difference in radiographic improvement between urokinase group and catheter group. Intrapleural instillation of urokinase is an effective and safe mode of treatment for septated tuberculous pleural effusions and alleviates the need for thoracotomy.
Catheter Obstruction ; Catheterization ; Catheters ; Constriction ; Drainage ; Drug Therapy ; Dyspnea ; Empyema ; Fever ; Fibrinolytic Agents ; Hemorrhage ; Humans ; Pleural Cavity ; Pleural Effusion* ; Prospective Studies ; Thoracotomy ; Thorax ; Tuberculosis, Pleural ; Urokinase-Type Plasminogen Activator

Background: Although most of the patients with tuberculous pleural effusions completely reabsorbed their effusions and became asymptomatic within 2 to 4 months, later surgical procedures such as decortication is needed in some patients because of dyspnea caused by pleural loculations and thickening despite anti-tuberculous chemotherapy. It is obligatory to secure adequate drainage to prevent the development of complications. But, the best methods for treating loculated tuberculous pleural effusions remain debatable. Recent several reports revealed that intrapleural instillation of fibrinolytic agents is an effective adjunct in the management of complicated empyema and may reduce the need of surgery. Purpose: The effects of catheterization with intrapleural urokinase instillation were prospectively evaluated in the patients with septated tuberculous pleural effusion, and compared with other therapeutic effects of different modalities of therapy such as repeated thoracentesis and small-bored catheterization. Methods: Forty-eight patients diagnosed with tuberculous pleurisy were randomly separated into three groups ; control group(n=13), catheter group(n=12), urokinase group(n=22). In urokinase group, dose of 100,000U urokinase was instilled into the pleural cavity via a percutaneous drainage catheter for complete drainage or total dose of 700,000U of urokinase. After two hours clamping, the catheter was opened and intermittently irrigated. The early and late effectiveness of therapies was assessed by radiographically and by measuring the volume of fluid drained from the catheter. Results: There was statistically significantly better result in the urokinase group in respect of frequency of catheterization, frequency of catheter obstruction and the duration of catheterization in early effectiveness(p<0.05). There were no difference in radiologic improvement of folllow-up in later phase chest X-ray between urokinase group and catheter group in later phase(p>0.05). But there were more failure rates in control group especially honeycomb septa in pleural effusion sonographically than former two groups. And there were no complications of urokinase such as fever or hemorrhage. Conclusion: In the treatment of septated tuberculous pleurisy, there were better results in urokinase than those of catheterization alone in early effectiveness. And there was no difference in radiographic improvement between urokinase group and catheter group. Intrapleural instillation of urokinase is an effective and safe mode of treatment for septated tuberculous pleural effusions and alleviates the need for thoracotomy.
Catheter Obstruction ; Catheterization ; Catheters ; Constriction ; Drainage ; Drug Therapy ; Dyspnea ; Empyema ; Fever ; Fibrinolytic Agents ; Hemorrhage ; Humans ; Pleural Cavity ; Pleural Effusion* ; Prospective Studies ; Thoracotomy ; Thorax ; Tuberculosis, Pleural ; Urokinase-Type Plasminogen Activator

PURPOSE: We evaluated the indications of operation and radiologic findings in 12 operated DeBakey type III aortic dissections. MATERIAL AND METHODS: We retrospectively reviewed radiologic findings of 12 operated DeBakey type III aortic dissections, using CT, MRI, or aortography, and correlations were made with clinical course of the patients. RESULTS: Three cases were uncomplicated dissections. There were aneurysm rupture in 4 cases, impending rupture in 4 cases, occlusion of common lilac artery in 2 cases, occlusion of renal artery in 1 case, and compression of bronchus and esophagus by dilated aorta in 1 case. Associated clinical sign and symptoms were chest and back pain in 12 cases, claudication in 3 cases, dyspnea and dysphagia in 1 case, hoarseness in 1 case, and hemoptysis in 1 case. Post-operative complications were death from aneurysm rupture in 1 case, paraplegia in 2 cases, acute renal failure in 3 cases, and hemopericardium in 1 case. CONCLUSION: Although medical therapy is preferred in management of DeBakey type Ill aortic dissection, surgical treatment should be considered in patients with radiological findings of aortic rupture, impending rupture, occlusion of aortic major branches.
Acute Kidney Injury ; Aneurysm ; Aorta ; Aortic Aneurysm* ; Aortic Rupture ; Aortography ; Arteries ; Back Pain ; Bronchi ; Deglutition Disorders ; Dyspnea ; Esophagus ; Hemoptysis ; Hoarseness ; Humans ; Magnetic Resonance Imaging ; Paraplegia ; Pericardial Effusion ; Renal Artery ; Retrospective Studies ; Rupture ; Thorax