BACKGROUND: Although myocardial contrast 2D echocardiography is a good method to diagnose and evaluate myocardial ischemia and reperfusion, it has required intracoronary or intra aortic root injection of contrast agent and furthemore, the degree of myocardial contrast produced is small. Second harmonic imaging which is based on the non linear emission of harmonics by resonant microbubble in the ultrasound field improves the ultrasound contrast single to noise ratio. METHODS: We measure the videointensity of interventricular septum(IVS) and lateral wall(LW) of second harmonic imaging myocardial contrast 2D echocardiography before and after LV injection of Levovist(300mg/ml, 0.4ml/Kg) in both pre and post left anterior descending coronary artery(LAD) ligation in 7 open chest pigs. RESULTS: 1) The mean(+/-SD) pre LAD ligation videointensity is significantly greater with after contrast than before contrast(IVS : 111.1+/-33.9 vs 31.1+/-7.6 ; p=0.00046, LW : 120.5+/-21.5 vs 42.2+/-10.0 ; p=0.00006). The post LAD ligation videointensity is also significantly greater with after contrast than before contrast(IVS : 62.8+/-24.6 vs 35.6+/-15.1 ; p=0.00379, LW : 129.9+/-10.9 vs 48.7+/-21.1 ; p=0.00006). 2) The videointensity of IVS is significantly greater with after contrast than before contrast in both pre and post LAD ligation(62.8+/-24.6 vs 111.1+/-33.9 ; p=0.0031). The post LAD ligation videointensity of LW after contrast is not different from that of pre LAD ligation(129.9+/-10.9 vs 120.5+/-21.5 ; p=0.1037). 3) The post LAD ligation videointensity increase of IVS is lower than pre LAD ligantion videointensity increase(27.2+/-18.3 vs 79.9+/-35.0 ; p=0.0006). But the videointensity increase of LW is not different between pre and post LAD ligation(78.2+/-23.4 vs 81.2+/-24.5 ; p=0.3778). CONCLUSION: These findings indicate that the myocardial blood flow and its decrease due to LAD ligation can be evaluated accurately by second harmonic imaging myocardial contrast 2D echocardiography.
Coronary Vessels* ; Echocardiography* ; Ligation* ; Microbubbles ; Myocardial Ischemia ; Noise ; Reperfusion ; Swine ; Thorax ; Ultrasonography

PURPOSE: We performed a retrospective study to determine the comparative characteristics of vesicoureteral reflux (VUR) between the infants less than 1 year and children more than 1 year old and whether early treatment in infantile VUR may be of benefit to preserve the renal function and to prevent the new renal scar. MATERIALS AND METHODS: All of 62 cases (infant group 19 and children group 43) with primary VUR were managed as the ureteral reimplantation from January 1991 to December 1996. RESULTS: The average age of patients was 7.1 months in infant group and 6.0 years in children group. The sex ratio of male to female showed no difference between infant and children group (1.7:1 Vs 1.5:1). The average follow up periods were 20.5 and 23.7 months in infant and children groups, respectively. The high grade reflux and renal scarring in infant group were significantly more frequent than those in children group (P<0.05), but the prevalence of urinary tract infection in children group was significantly higher than that in infant group (P<0.05). There was no significant difference in the rates of bilaterality and in the sex ratio between infant and children group. The success rate of operation was 100 percent in both groups. CONCLUSION: We suggest that the early surgical treatment in infants with bilateral and higher grade VUR may be of benefit to the preservation of renal function and the decrease of renal parenchymal change.
Child* ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Infant* ; Male ; Prevalence ; Replantation ; Retrospective Studies ; Sex Ratio ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

We report a patient with pachydermoperiostosis accompanied by hypertrophic gastritis. A 26-year-old man showed deep folds and furrows of the face and scalp, and terminal spade-like expansion of fingers and toes. Physical examination revealed no abnormalities except a grotesque appearance. Results of routine laboratory tests were unremarkable. Mild periosteal reactoins of both femurs and humeri were noted on long bone series, and hypertrophic gastritis on fibroscopic examination drew our attention. The relationship between pachydermoperiostosis and hypertrophic gastritis is uncertain. However it is probable that hypertrophic gastritis may be the endodermal counterpart of the ectodermal manifestations of pachydermoperiostosis.
Adult ; Ectoderm ; Endoderm ; Femur ; Fingers ; Gastritis, Hypertrophic* ; Humans ; Osteoarthropathy, Primary Hypertrophic* ; Physical Examination ; Scalp ; Toes

No abstract available.

Bone is a heterogenous and anisotrophic material exhibiting elastic, viscoelastis and plasticproperties. A considerable amount of information is now available regarding biomechanical properties and mechanisms of fractures of mature long bones, but less is known about the properties of the growing bones. In order to assess the biomechanical properties under tension, rabbits growing bones were loaded with Instron Modal 1,000 until fracture occurred. Two hundred tibiae of 100 New Zealand white immature rabbits were divided into 6 experimental groups according to maturity and size. Group I-R(40 right tibiae of 1-month old rabbits), Group I-L (40 left tibiae of 1-month old rabbits), Group II-R(20 right tibiae of 3-month old rabbits), Group II-L (20 left tibiae of 3-month old rabbits), Group III-R(40 rigth tibiae of 5-month old rabbits), and Group III-L(40 left tibiae of 5-month old rabbits). The following results were obtained. 1. Fracture type was transverse.or nearly transverse in 170 out of the total 200 tibiae(85%).
Absorption ; Elastic Modulus ; New Zealand ; Rabbits ; Tensile Strength ; Tibia

PURPOSE: Forearm lengths in cases of unilateral congenital radioulnar synostosis, were analysed radiographically to evaluate the amount of length discrepancy according to different types. MATERIALS AND METHODS: We measured the ulnar length ratio (length of affected forearm/length of unaffected forearm) in 15 cases of uni-lateral congenital radioulnar synostosis. We observed two distinct radiographic patterns. Type I (Lamda type) appeared to be of gamma character grossly, and showed severe radial bowing and a severely hypoplastic radial head. Type II (Chi type) seemed x like in character, showed mild radial bowing and a mildly hypoplastic, or normal radial head. RESULTS: Nine cases were type I and 6 were type II. The ulnar length ratio was 0.89 in type I and 0.98 in type II. Significant differences were formed in the ulnar length ratios between normal subject and type I, and between type I and type II (p<0.05). The equation determined by simple linear regression analysis in a patient of type I, who had been followed for 10 years, was'ulnar length ratio=0.959-0.013 X age (year)'. CONCLUSION: Unilateral congenital radioulnar synostosis can be classified into two types according to radiological morphology. This classification can be helpful in the prediction of forearm length discrepancy, and in the determination of surgical treatment type.
Classification ; Forearm* ; Head ; Humans ; Linear Models ; Synostosis*

BACKGROUND: The bispectral index (BIS) has been used as an indicator of a sedative state and has been considered to be related to anesthetic agents and noxious stimulus. In this study, we measured the BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia after premedication with or without midazolam or morphine and evaluated the bispectral index as an indicator of an objective evaluation of midazolam premedication and relation to the cardiovascular response to the anesthetic induction. METHODS: Seventy five patients scheduled to undergo elective surgery under general anesthesia were divided into 3 groups. Each group received midazolam and glycopyrrolate (midazolam group, n = 25), or morphine and glycopyrrolate (morphine group, n = 25), or glycopyrrolate only (control group, n = 25) as premedication (midazolam 0.08 mg/kg IM, morphine 0.05 mg/kg IM, glycopyrrorate 0.2 mg IM). Then, anesthetic induction (propofol 2 mg/kg, succynylcholine 1 mg/kg) was done. The bispectral index, blood pressure, and heart rate were measured at before induction, after propofol injection, and intubation. RESULTS: The Bispectral index was significantly lower in the midazolam group and the morphine group compared with the control group before anesthetic induction. Blood pressure was not significantly different among the three groups. Heart rate was significantly lower in the midazolam group compared with the control group before anesthetic induction. CONCLSIONS: Midazolam or morphine premedicated patients appear to maintain a stable heart rate and have a low BIS at before induction. The Bispectral index could be objectively used in midazolam-premedicated patients when evaluating the degree of sedation and predicting hemodynamic changes, and probably in morphine-premedicated patients also.
Anesthesia ; Anesthesia, General ; Anesthetics ; Blood Pressure ; Glycopyrrolate ; Heart Rate ; Hemodynamics ; Humans ; Intubation ; Midazolam* ; Morphine* ; Premedication* ; Propofol

BACKGROUND: After experimental cryogenic cerebral injury, severe focal brain contusion develops due to blood-brain barrier breakdown and vasogenic cerebral edema formation. This study has been conducted to find out the effects of hypertonic saline against cryogenic brain edema in rats. METHODS: Thirty rats of either sex weighing 250 to 300 g underwent a 60 seconds of cryogenic brain injury. All rats were randomly divided into one of three groups; control group (n = 10), 7.5% saline group (n = 10), and 10% mannitol group (n = 10). The water contents were measured 60 minutes after cryogenic injury by using the dry-weight method. RESULTS: The water contents in the 7.5% saline and 10% mannitol groups were significantly decreased compared with the control group. The levels of edema in the 7.5% saline and 10% mannitol groups were also significantly decreased compared with the control group. Although it appeared as if that 10% mannitol might decrease edema formation more than 7.5% saline, there were no statistical differences between the 7.5% saline and 10% mannitol groups. CONCLUSIONS: Hypertonic saline (7.5%) may be as effective agent to reduce edema formation after brain trauma to the same degree as mannitol.
Animals ; Blood-Brain Barrier ; Brain Edema ; Brain Injuries* ; Brain* ; Edema* ; Mannitol* ; Rats*

The association of gastric tubular adenoma and adenocarcinoma is already well known. Then, are those two pathologic lesions merely incidentally coexisting or does the one evolve to the other? That is a longstanding controversy. Nowadays, as is the case with the colonic tubular adenoma, the hypothesis that gastric tubular adenoma may be a precancerous lesion is generally accepted. However the direct evidences are rare. We report a clear case proving the potential of direct malignant transformation of gastric tubular adenorna through the 9-year close endoscopic follow-up. The developed cancer is well differentiated, surrounded with background tubular adenoma and limited to the submucosal layer.
Adenocarcinoma ; Adenoma* ; Colon ; Follow-Up Studies*

The authors analyzed 24 cases of the pineal region tumors which were treated at the Department of Neurosurgery, Yonsei University during the last eight years. Tumors of the pineal region constitutes 2.5% of all brain tumors in authors' series. Most(79.1%) of the patients were younger than 20. Of these 24 cases, 19 were male and 5 were female. Presenting symptoms were headache, vomitting and clouding of sonsciousness due to obstructive hydrocephalus, followed by eye signs, such as Parinaud's syndrome, abducens palsy, and papilledema. Other signs are ataxia and hemiplegia. Plain skull films showed abnormal calcifications and findings of increased intracranial pressure. Location and size of the tumors were most accurately visualized by the brain CT scan. Pathological types of the pineal tumors could be differentiated by the brain CT scan from the patterns of contrast enhancement and tumor density. Among the 24 patients received VP shunt surgery for hydrocephalus. Eighteen patients had the radiation therapy either after the surgery or radiation alone. Germinoma was the most frequent type of pineal region tumors in this series, accounting for half of the patients who had the surgery. There was no immediate postoperative mortality, but one patient with pineoblastoma died from multiple spinal seeding nine months after the surgery. In conclusion, it is most important to identify the pathological type of the tumors in pineal region, because the prognosis of the patient as well as the mode of treatment varies according to the pathological diagnosis. Stereotaxic biopsy of the pineal region tumors is the most accurate diagnostic methods in authors' series among such other methods as brain CT scan, CSF cytology and/or tumor marker study.
Ataxia ; Biopsy ; Brain ; Brain Neoplasms ; Diagnosis ; Female ; Germinoma ; Headache ; Hemiplegia ; Humans ; Hydrocephalus ; Intracranial Pressure ; Male ; Mortality ; Neurosurgery ; Ocular Motility Disorders ; Papilledema ; Paralysis ; Pinealoma ; Prognosis ; Skull ; Tomography, X-Ray Computed