Anthracycline drugs are chemotherapeutic agents highly effective against a wide range of neoplasms. However, its administration may be complicated by cardiotoxic reactions. There is a continuum of increasing risk with increasing total dose of drug rather than an absolute cutoff point for total dose drug of that should not be exceeded under any circumstances. At the present time it appears that a potentially important clinical application of Doppler echocardiography would be the noninvasive evaluation of global ventricular function. To assess the value of serial Doppler echocardiography in detecting early signs of anthracycline cardiotoxicity in children, we studied 50 patients (35 male and 15 female children, age range 1.6 to 20 years) admitted to the Department of Pediatrics in the Kyungpook National University Hospital for treatment of neoplasia between July 20, 1988 and April 20, 1991 prospectively. Eight three Doppler echocardiograms were performed prior to and at intervals after receiving varying doses of anthracycline and aortic velocity, acceleration time (AT), ejection time (ET), ratio at AT to ET (AT/ET), acceleration and velocity time integral, and mitral velocity of E and A waves and velocity time integral were measured. Pretreatment parameters were not differ from those of normal age matched control children. The aortic AT/ET showed significant increase with increase in anthracycline dosage, being a mean (+/-SD) of 0.30+/-0.07 in the pretreatment group, 0.33 (+/-0.09) after 100 mg/M2 (p<0.001) but the mitral E/A peak velocity ratio showed significant decrease, being a mean (+/-SD) of 1.47 (+/-0.26) in the pretreatment group and 1.36 (+/-0.09) after 400mg/M2(p<0.05). We could not reliably ascertain the relationship between Doppler echocardiographic changes and development of anthracycline cardiomyopathy but these preliminary data show that Doppler echocardiography may detect incremental changes in left ventricular function in anthracycline cardiomyopathy. It is hoped that further study at higher dose levels in large populations for a sufficient follow up time will identify those patients with a risk of developing cardiomyopathy and then manage them appropriately.
Acceleration ; Cardiomyopathies ; Child* ; Echocardiography* ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Gyeongsangbuk-do ; Hope ; Humans ; Male ; Pediatrics ; Prospective Studies ; Ventricular Dysfunction, Left* ; Ventricular Function ; Ventricular Function, Left

RATIONALE: Studies on ictal SPECT as a method of presurgical evaluation in neocortical epilepsy have been rare and inadequate. We evaluated the accuracy in the localization of epileptic foci with ictal SPECT in neocortical epilepsy and tried to find out the determining factors of its accuracy. METHODS: We performed ictal SPECT 66 times with 99m-Tc-HMPAO in 56 patients, who received video-EEG monitoring and had electroclinical features of neocortical epilepsy. Invasive monitoring was performed in 28 patients & epileptic surgery was done in 31. Their results were also used to help determine the location of epileptic foci. In 54 of 66 scans data about injection time and temporal relationship of HMPAO injection to the onset and secondary generalization of seizures were available. RESULTS: Frontal lobe epilepsy(FLE) was most common(35%) followed by lateral temporal lobe epilepsy(28%), occipital lobe epilepsy(11%), parietal lobe epilepsy(9%), and etc. Ictal SPECT demonstrated unilateral hyperperfusion in 53 of 66 scans (80.3 %) which were concordant with electroclinical lateralization in 48 of 53 (90.6 %). Localized hyperperfusion was evident in 42 of 66 scans (63.6 %) which were concordant with electroclinical localization in 33 of 42(78.6 %). Correctly localized hyperperfusion or correctly-lateralized but diffuse hyperperfusion were detected in 37 of 54 scans in which data about injection time were available. The mean injection time was 32.1 seconds. In 16 scans ictal SPECT showed no hyperperfusion or falsely localized/lateralized hyperperfusion. Their mean injection time was 41.6 seconds. The difference of injection time between two groups was not significant(p-value=0.07), but there was a tendency that the mean injection time of the former group was earlier than that of the latter group. We had chances to perform ictal SPECT repeatedly in 8 patients under the similar conditions. The fact that earlier injection improved the accuracy of ictal SPECT in 6 patients supports the importance of early injection. In 48 studies with ictal injection, only 11 scans gave no or incorrect information of the localization or lateralization of epileptic foci. But, in 6 studies with postictal injection, 5 scans was not helpful. The difference between two groups was statistically significant(p<0.05). The presence of focal lesion, the location of epileptic foci, or secondary generalization did not influence the accuracy of ictal SPECT. CONCLUSIONS: Our data suggest that ictal SPECT in neocortical epilepsy is useful in localization of epileptic foci. Whether injected ictally or postictally and the injection time from seizure onset seems to influence the accuracy of ictal SPECT in neocortical epilepsy.
Epilepsy ; Frontal Lobe ; Generalization (Psychology) ; Humans ; Occipital Lobe ; Parietal Lobe ; Seizures ; Technetium Tc 99m Exametazime ; Temporal Lobe ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: To evaluate the efficacy of vigabatrin and valproic acid add-on therapy in the treatment of uncontrolled partial-onset seizures through randomized active controlled parallel-group trial. METHODS: Criteria for entry included a requirement for three or more partial seizures per month despite the blood level of carbamazepine was within therapeutic range. During the 56-day baseline period, patients had at least 6 partial onset seizures. Vigabatrin or valproic acid were administered as the second drug in a randomized fashion. RESULTS: Forty one patients completed the trial(21 for vigabatrin, 20 for valproic acid). There is no statistically significant difference in age, age at onset, baseline seizure frequency, dose of carbamazepine, and serum level of carbamazepine between two groups. Two patients of vigabatrin-treated group and three patients of valproic acid treated group were dropped out because of side effects. The mean vigabatrin and valproic acid does were 2809 and 1490 mg, respectively. The percentage of patients achieving at least a 50% reduction in seizure frequency at the end of 8-week of add-on trial was 62% among vigabatrin-treated patients and was 50% for patients who received valproic acid(not statistically different). There was no significant difference in seizure reduction, percent seizure reduction, and truncated percent seizure reduction between two groups. The side effects were mild and transient neurotoxic symptoms in the patients who completed the trial(5 patients for vigabatrin, 10 patients for valproic acid). CONCLUSIONS: This trial indicates that vigabatrin and valproic acid are safe and effective in the treatment of intractable partial-onset seizures. The efficacy of vigabatrin as a new add-on antiepileptic drug is comparable to the previous valproic acid carbamazepine combination in the sense of seizure reduction and maybe even superior to that in the consideration of side effects
Carbamazepine* ; Humans ; Seizures* ; Valproic Acid* ; Vigabatrin*

To evaluate characteristic CT findings of orbital pseudotumor and to define differentialpoints from other pathology, the authors retrospectively reviewed CT of 19 patients who were prooen to have orbital pseudotumor by clinical course and, in some cases, biopsy. A variety of CT findings including extraocular muscle thickening(11 cases), streaky infiltration of retroorbital fat(11 cases), mass formation(10 cases), optic nerve thickening (6 cases), conjunctival thickening (5 cases), scleral thickening(4cases), enlarged lacrimal gland(4 cases) and destruction of orbital bone (2 cases) were observed. Thickening of the anterior portion and irregular margin were characteristic findings of extraocular muscle and optic nerve lesions. Mass formation predominantly occurs in the anterior portion of the orbit. In most cases more than two orbital structures are involved by lesion.
Biopsy ; Humans ; Optic Nerve ; Orbit* ; Orbital Pseudotumor* ; Pathology ; Retrospective Studies

BACKGROUND: The proper management of the patients with hypotention remains a difficult clinical problem. This study was designed to evaluate the efficacy and safety of gepefrin in the treament of symptomatic hypotensive patients in outpatient clinic of university hospital. METHODS: Thirty milligrams of Gepefrin was given twice daily for 4 weeks in 30 patients with hypotension(6 males, 24 females ; 23-60 years of age). Blood pressure, heart rate, subjective symptoms and side effects were checked before medication and at the end of 1st, 2nd, 3rd, 4th week of medication. RESULTS: 1) Grpefrin increased sitting systolic blood pressure significantly(p<0.05) by the end of 1st week and thereafter. 2) Hypotensive symptoms were improved in 76% of hypotensive patients and overall rate of usefulness was 70%. 3) Heart rate did not change significantly. 4) One patient complained of loose bowel movement and another one, of anorexia among 30 study patients and all laboratory parameters were within normal limits before and after drug treatment, thus the rate of safety was 93%. CONCLUSION: Results from this study suggests that gepefrin 60mg daily increases the blood pressure mildly and improves the symptoms moderately in symptomatic hypotensive patients.
Ambulatory Care Facilities ; Anorexia ; Blood Pressure ; Female ; Heart Rate ; Humans ; Hypotension* ; Male ; Quality of Life

The ankle is a complex, weight bearing joint and its injury result in a severe functional disturbance of complex anatomical characteristics. It is very important to understand the mechanism of trauma in order to make definite diagnosis and proper treatment. The authors analysed 52 cases(52 patients) of the ankle fractures which were admitted and treated in Orthopaedic department, Korea University Hospital from Sept. 1980 to Dec. 1986. The results obtained were as follows : l. Of the 52 cases, male was 32 cases(61.5%), female was 20 cases(38.5%) and average age of the patients was 32.9 years. 2. The causes of the injury were slipping down, traffie accident, falling down and sports injuries, in orders. 3. Open fractures were 8 cases(15.4%) and closed fractures were 44 cases(84.6%). The most common type of the ankle fracture was supination-extenal rotation type(18 cases, 34.1%) and next was pronation-external rotation type(15 cases, 30%), according to the classification of Lauge-Hansen. 4. 38 cases(73.1%) were treated by open reduction and 14 cases(26.9%) by closed reduction, and average duration of immobilization was 7.7 weeks in open reduction and 10.4 weeks in closed reduction. 5. The associated fractures other than ankle was 15 cases(28.8%). 6. The better results were obtained from open reduction and the worst results obtained from pronation-dorsiflexion type, according to the criteria of Meyer. 7. The complication was 7 cases(13.5%), traumatic arthritis 4 cases, malunion 2 cases and nonunion 1 case. 8. Accurate reduction and rigid internal fixation of the fractured lateral malleolus, distal fibular and distal tibiofibular diastasis was important in treatment of the ankle fracture.
Accidental Falls ; Ankle Fractures ; Ankle ; Arthritis ; Athletic Injuries ; Classification ; Diagnosis ; Female ; Fractures, Closed ; Fractures, Open ; Humans ; Immobilization ; Joints ; Korea ; Male ; Weight-Bearing

No abstract available.
Upper Extremity Deep Vein Thrombosis

We have clinically evaluated 40 cases of high myopia(47 catarctous eyes) with an axial length of over 26 mm which were treated with ECCE and posterior chamber intraocular lens implantation from January 1987 to June 1990 at the 51. Mary's Hospital in the Department of Ophthalmology of Catholic University Medical College. The results were as follows: 1. Most common axial length was from 26.00 mm to 26.50 mm in 24 eyes(51.5%)and most common anterior chamber depth was from 2.51 mm to 3.00 mm in 22 eyes(48.6%). 2. The most common associated diseaes was vitreous opacity(19 eyes: 40.4%). 3. Posterior chamber lens power ranged from +10.00D to +14.00D, and the most frequently implanted posterior chamber lens power was +10.50D. 4. Postoperative corrected visual acuity was the same as preoperative corrected visual acuity in 46 eyes(97.9%) and improved up to 0.5 or more in 31 eyes(66.0%).
Anterior Chamber ; Lens Implantation, Intraocular ; Myopia* ; Ophthalmology ; Visual Acuity

BACKGROUND: Semiology of epileptic seizure is very important for diagnosis and treatment. However, little is known about the reliability of the observers' description. This study aims to determine the description reliability of seizures in the aspects of classification and lateralization. METHODS: We recorded 72 patients with habitual seizures during video-EEG monitorings. We, then, compared the ictal behaviors described by frequency observers and those recorded on the videotape to compare the accuracy of the observers' descriptions. Finally, we reviewed which aspects of the informants affected the reliability of the data. RESULTS: The classification of seizures based only on the observer-description was somewhat discordant from the videotape (correct classification: 82%) especially in dividing simple partial from complex partial seizures. Description of many ictal behaviors in presumed complex partial seizure such as oroalimentary automatism, motionless staring, tonic/clonic posture and version was accurate except for the hand automatism. A specified direction by the observer has a very high true positive rate. The accuracy of the description was related to the educational status of the observer. CONCLUSIONS: Semiology description by well-educated observers is may be reliable, but every physician should keep its limitation in mind and judge accordingly.
Automatism ; Classification ; Diagnosis ; Educational Status ; Epilepsy ; Hand ; Humans ; Medical History Taking ; Posture ; Reproducibility of Results ; Seizures ; Videotape Recording

OBJECTIVE & BACKGROUND: There have been reports on the lateralizing value of temporal lobe interictal epileptiform discharge(IED), yet it is a matter of debate till now. We studied our patients focusing on the degree of lateralization by which accurate lateralization was possible and also on the significance of bisynchronous IED(BIED) in the lateralization of temporal lobe epilepsy. METHOD: Fifty two patients were included in the study who were diagnosed as having medial temporal lobe epilepsy through video-EEG monitoring and brain MRI. Twenty four hour sleep-deprived interictal scalp EEG was checked for all of them. After that, we counted the number of independent IED(IIED) and BIED originating from anterior temporal areas. Then we tried to find a reasonable degree of IED above which correct lateralization of epileptogenic area was possible by using brain MRI as a standard. We also tried to find a significance of BIED in the lateralization of temporal lobe epilepsy by comparing the result excluding patients with BIED to that includig patients with BIED. RESULT: Lateralization of IED was over 80% accurate if the cutoff point was set at 70% and patients with BIED were included, but nearly 100% accurate of the cutoff point was set at 80% and patients with BIED were excluded. CONCLUSION: Influence of BIED on the accuracy of lateralization by IED is significant, and if the lateralization of IED is over 80% in patients with no BIED, the chance of true lateralization is very high.
Brain ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Scalp ; Temporal Lobe*