Recently, [I-123]IPT SPECT has been used for early diagnosis of Parkinson's patients(PP) by imaging dopamine transporters. The dynamic time activity curves in basal ganglia(BG) and occipital cortex(OCC) without blood samples were obtained for 2 hours. These data were then used to measure dopamine transporters by operationally defined ratio methods of (BG-OCC)/OCC at 2 hrs, binding potential Rv=k3/k4 using graphic method or RA= (ABBG-ABOCC)/ABOCC for 2 hrs, where ABBG represents accumulated binding activity in basal ganglia(integral 0 120minBG(t)dt) and ABOCC represents accumulated binding activity in occipital cortex(integral 0 120minBG(t)dt). The purpose of this study was to examine the IPT pharmacokinetics and investigate the usefulness of simplified methods of (BG-OCC)/OCC, RA, and RA which are often assumed that these values reflect the true values of k3/k4. The rate constants K1, k2, k3 and k4 to be used for simulations were derived using [I-123]IPT SPECT and aterialized blood data with a standard three compartmental model. The sensitivities and time activity curves in BG and OCC were computed by changing K1 and k3(only BG) for every 5min over 2 hours. The values (BG-OCC)/OCC, RA, and Rv were then computed from the time activity curves and the linear regression analysis was used to measure the accuracies of these methods. The rate constants K1, k2, k3, k4 at BG and OCC were 1.26+/-5.41%, 0.044+/-19.58%, 0.031+/-24.36%, 0.008+/-22.78% and 1.36+/-4.76%, 0.170+/-6.89%, 0.007+/-23.89%, 0.007+/-45.09%, respectively. The Sensitivities for ((delta S/S)/(delta k3/k3)) and ((delta S/delta S)/(delta K1/K1)) at 30min and 120min were measured as (0.19, 0.50) and (0.61, 0.23), respectively. The correlation coefficients and slopes of ((BG-OCC)/OCC, RA, and Rv) with k3/k4 were (0.98, 1.00, 0.99) and (1.76, 0.47, 1.25), respectively. These simulation results indicate that a late [1-123]IPT SPECT image may represent the distribution of the dopamine transporters. Good correlations were shown between (BG-OCC)/OCC, RA or Rv and true k3/k4,, although the slopes between them were not unity. Pharmacokinetic computer simulations may be very useful technique in studying dopamine transpoter systems.
Computer Simulation* ; Dopamine* ; Early Diagnosis ; Linear Models ; Pharmacokinetics ; Tomography, Emission-Computed, Single-Photon

PURPOSE: Neonatal hyperbilirubinemia has benign courses in most cases, but the possibility of toxicity of hyperbilirubinemia required courses examination of every newborn infant to identify the severity of hyperbilirubinemia progress. This study aims to see how the body surface area of newborns influences the decline rate of serum bilirubin level in conventional phototherapy. METHODS: Based on the charts of the Pediatrics Department, Dae-Dong Hospital from January 2003 to December 2006, we analyzed 168 neonates diagnosed as neonatal hyperbilirubinemia (serum bilirubin > or =15 mg/dL) in retrospective way. We excluded newborn infants under 37 weeks of gestation and under 2,500 g birth weight and classified neonates into four groups by the calculation results of body surface area:males above 75 percentile (group A), males below 25 (group B), females above 75 (group C), and females below 25 (group D). RESULTS: Out of 168 samples, the number of group A, B, C, D was 30, 20, 20, 15 respectively. In conventional phototherapy, the mean decline rates of serum bilirubin of group B and D recording 2.09 mg/dL/day and 1.77 mg/dL/day, were significantly faster than those of group A and C recording 1.63 mg/dL/day and 1.41 mg/dL/day (P<0.01). No significant differences were found in different duration of phototherapy between groups below 25 percentile and those above 75 in both genders. CONCLUSION: In conclusion, body surface area influences of infants the decline rate of serum bilirubin level in conventional phototherapy.
Bilirubin* ; Birth Weight ; Body Surface Area* ; Female ; Humans ; Hyperbilirubinemia ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn ; Male ; Pediatrics ; Phototherapy* ; Pregnancy ; Retrospective Studies

The AMBU bag is a useful equipment at the cardiopulmonary resuscitation (CPR) or the respiratory therapy. The AMBU bag eonsists simply of a self-reflating bag, a patient valve and a inlet valve. The patient valve is a non-rebreathing valve and the self-inflating bag is a recoiled rubber bag. The inlet valve on the posterior site of self-inflstion bag is closed during the bag is squeezed, and opened during the bag is released. During reflation of bag, fresh room air through the one-way valve and fresh oxygen through the orifice for oxygen supply will mix. Therefore the inspiratory oxygen concentration is decided by a speed of re- flation of the self-reflating bag. We measured inspiratory oxygen concentration during AMBU bag ventilation under different inspiration : expiration (I:E) ratio, frequency of venti- lation, ventilatory volume and flow rate of oxygen. The results were that factors increase a inspirstory oxygen concentration are 1) decrease of I:E ratio, 2) decrease of frequency of ventilation, 3) decrease of ventilatory volume, 4) inerease of flow rate. We found that haste of physician makes frequent squeezing of AMBU bag and the haste results a decrease of inspiratory oxygen concentration.
Bays ; Cardiopulmonary Resuscitation ; Humans ; Oxygen* ; Respiratory Therapy ; Rubber ; Ventilation*

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.
Angioplasty ; Angioplasty, Balloon ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Ischemic Attack, Transient ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Stents* ; Stroke ; Takayasu Arteritis ; Thrombosis ; Transplants

PURPOSE: Cyclosporin A (CsA) is widely used as a prophylactic and therapeutic agent against a graft- versus-host disease following bone marrow transplantation. Herein, a case of cyclosporin-induced optic neuropathy, after bone marrow transplantation, is reported, which to our knowledge has never previously been reported. METHODS: A 43-year-old man, with acute myelogenous leukemia, who was treated with bone marrow transplantation one month previously, also with immunosuppressive medication, presented with decreased visual acuity and nystagmus in both eyes. He had been administerd CsA for about one month, from one day before the bone marrow transplantation. A fundus examination, visual field, electroretinography, and brain MRI were performed. RESULTS: At the first ocular examination, his visual acuity was markedly decreased in both eyes. On fundus examination, an edematous optic nerve head, with superficial peripapillary hemorrhage, was noticed in both eyes. A large central scotoma was seen in both eyes on a visual field examination. The amplitude of the b-wave in the scotopic ERG was slightly decreased in both eyes. However, there were no abnormal findings in the other examinations. Cyclosporin-induced optic neuropathy was suspected as the cause of the decreased visual acuity, so the CsA was discontinued and replaced by FK506(tacrolimus). On the second day after the discontinuation of the CsA, the optic disc edema improved, and the visual acuity of both eyes recovered almost too normal. CONCLUSIONS: It is important to monitor the neuro-ophthalmologic and neurologic signs of bone marrow transplant closely in patients taking cyclosporin.
Adult ; Bone Marrow ; Bone Marrow Transplantation ; Brain ; Cyclosporine* ; Edema ; Electroretinography ; Hemorrhage ; Humans ; Leukemia, Myeloid, Acute ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Optic Disk ; Optic Nerve Diseases* ; Scotoma ; Visual Acuity ; Visual Fields

Essential osteolysis is very rare, slowly progressive disease. Its etiology and pathophysiology is still unknown. Only one case has been reported in Korea. We experienced one case of essential osteolysis associated with renal insufficiency involving bilateral carpal, metacarpal, tarsal, metatarsal bones, elbow, ankle. We report a case of 24-year-old female who had manifestations of essential osteolysis with renal insufficiency with brief review of literatures.
Ankle ; Elbow ; Female ; Humans ; Korea ; Metatarsal Bones ; Osteolysis, Essential* ; Renal Insufficiency ; Young Adult

Bilateral hypoglossal nerve palsy is a rare clinical presentation. We report a case of central skull base osteomyelitis (SBO) presenting with complete tongue paralysis in a 53-year-old man who was not diabetic or immunocompromised. Magnetic resonance imaging demonstrated characteristic features including abnormal contrast enhancement in the clivus (T1-weighted images). Blood tests revealed elevated acute-phase reactants and leukocytosis, which prompted prolonged antibiotic treatment. He responded well to the antibiotics, which together with typical clinical and imaging findings led to the diagnosis of bacterial SBO.
Acute-Phase Proteins ; Anti-Bacterial Agents ; Cranial Fossa, Posterior ; Hematologic Tests ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Leukocytosis ; Magnetic Resonance Imaging ; Middle Aged ; Osteomyelitis ; Paralysis ; Skull ; Skull Base ; Tongue

PURPOSE: The aim of this study was to evaluate the clinical efficiency of cardiac troponin T(cTnT) in detecting myocardial damage in neonatal asphyxia and to compare the diagnostic value of cTnT with creatine kinase MB(CK-MB). METHODS: Sixty-three neonates were enrolled in this study, consisting of 27 asphyxiated infants(asphyxiated group; 1-min or 5-min Apgar score< or=6) and 36 healthy infants(control group). The two groups were divided to 4 subgroups as follows; group I(17 preform asphyxiated neonates), group II (10 full-term asphyxiated neonates), group III(16 preterm healthy neonates), group IV(20 full-term healthy neonates). Serum cTnT was measured within 24 hours, at 24-47 hours, and 48-72 hours after birth, respectively. Serum CK-MB was measured within 24 hours after birth. RESULTS: 1) cTnT within 24 hours in asphyxiated group was significantly higher than in the control group(P<0.05). 2) cTnT in group II was not significantly higher than in group I (P>0.05), whereas CK-MB in group II it was higher than in group I (P<0.001). Between group III and IV, cTnT and CK-MB showed significant differences(P<0.05). 3) cTnT did not change with gestational age or birthweight. CK-MB was correlated to birthweight and gestational age. 4) Twelve asphyxiated infants had at least one abnormal cTnT(>0.2 microgram/L). Ten of them(83%) had a tricuspid insufficiency of moderate or severe degree. CONCLUSION: cTnT is a more heart-specific serodiagnostic marker than other markers in asphyxiated neonates with suspected myocardial damage.
Asphyxia* ; Creatine Kinase ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Parturition ; Troponin T* ; Troponin*

PURPOSE: To evaluate the usefulness of pulmonary function test for the prediction of successful weaning and extubation from the ventilator in very low birth weight(VLBW) infants with chronic lung disease. METHODS: This study included 15 VLBW infants(<1,500 g) with chronic lung disease who were admitted to Neonatal Intensive Care Unit of Samsung Medical Center from July, 1995 to June, 1996. They had extubation failure more than one time. This study was performed by reviewing of patients records retrospectively. The extubation criteria were based on clinical status, ABGA profiles and ventilatory parameters. At the time of last extubation failure and final success, we analyzed the distribution of age and weight of infants, ventilator profiles, ABGA profiles, dynamic and static pulmonary function test profiles measured by Bicore CP-100R from the infant with ventilator assistance daily in line monitoring. The paired T-test and linear logistic regression analysis were used to compare the variables between the evets of extubation failure and success. RESULTS: At the time of successful extubation, expiratory airway resistance was significantly lower and minute volume was significantly higher in dynamic pulmonary function test and respiratory system resistance was significantly lower in static pulmonary function test(P<0.05). In ventilator parameter, Fi02 and respiratory rate were lower at successful extubation(P<0.05). No statistically significant differences in ABGA profiles were seen between unsuccessful and successful extubation. CONCLUSION: The pulmonary function test is a useful predictor for successful weaning and extubation in VLBW infants with chronic lung disease. Among various parameters of pulmonary function test, expiratory airway resistance, minute ventilation and respiratory system resistance are suggested as successful weaning parameters.
Airway Resistance ; Bronchopulmonary Dysplasia ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Logistic Models ; Lung Diseases* ; Lung* ; Parturition ; Respiratory Function Tests* ; Respiratory Rate ; Respiratory System ; Retrospective Studies ; Ventilation ; Ventilators, Mechanical ; Weaning*

BACKGROUND: Diastolic function can be assessed by Doppler-derived left ventricular(LV) filling patterns. E/A ratio<1 and prolongation of isovolumic relaxation time(IVRT) are diagnostic of impaired relaxation of left ventricle during diastole. In early stage of acute myocardial infarction, myocardial stiffness can normalize the E/A ratio and mask the Doppler indexes of abnormal relaxation in patients with acute myocardial infarction. METHODS: LV filling patterns were studied with Doppler echocardiography in 10 healthy subjects and 27 patients with recent acute myocardial infarction. Cardiac catherterization was performed in the 11+/-2 days after onset of acute myocardial infarction and left ventricular end-diastolic pressure(LVEDP) and myocardial stiffiness index(MSI) were studied. RESULTS: In patients with acute myocardial infarction, IVRT was significantly prolonged ; E/A ratio and deceleration time were decreased but not significantly different from those of normal subjects. In the patient's group of E/A>1,IVRT and atrial filling fraction(AFF) were significantly shortened, and LVEDP was significantly increased, compared to those of the patient's group of E/A<1. But ejection fraction was similar in both groups. In the patients with acute myocardial infarction, E/A ratio and LVEDP showed good correlation(r=0.64, p<0.05). MSI was increased in the patient's group of E/A>1 and also was well correlated with LVEDP(r=0.8, p<0.05). CONCLUSIONS: Thus we conclude that normal of increased E/A ratio in recent acute myocardial infarction may reflect increased LVEDP due to increased myocardial stiffness.
Deceleration ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Heart Ventricles ; Humans ; Masks ; Myocardial Infarction* ; Relaxation