No abstract available.
Chungcheongnam-do* ; Humans ; Infant* ; Sex Ratio*

No abstract available.
Female ; Labor, Induced* ; Pregnancy*

BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity

BACKGROUND: Intracoronary stent with various designs have been developed to treat dissections or acute closure after angioplasty. The efficacy of flexible coil stent as a bail-out device has been reported. However, the restenosis after stenting still remained as a main limitation like other devices. This study reports on the angiographic follow-up after successful intracoronary stenting with flexible coil stent. METHOD: From April 1993 through July 1994, coronary stenting was tried in 21 patients by a single operator for various indications(acute or threatened closure, suboptimal result after balloon angioplasty). The nineteen(95%) out of 20 patients in whom stent was successfully deployed underwent follow-up coronary angiography 7.6+/-3.0 months after coronary stenting. RESULT: Mean age was 54.7+/-11.3(33-73) years and 16 parients were men. Clinical diagnosis of patients were as follows : stable angina 7, unstable angina 6, old myocardial infarction with stable angina 6 and acute myocardial infarction in 1 patient, respectively. Stents were implanted at left anterior descending artery in 9, left circumflex artery in 5 and right coronary artery in 8. Ten out of 21 stents(47.6%) were found to be renarrowed more than 50% at follow-up coronary angiography. There was no significant difference in clinical and angiographic variables between restenosis group and no-restenosis group. Coronary artery bypass graft surgery was performed in 1 patient for the treatment of restenosis after stenting. Repeat PTCA was performed in 3 patients and remaining 5 patients were followed medically. CONCLUSION: Flexible coil(Gianturco-Roubin) coronary stent is a useful adjunct percutaneous intervention to prevent or minimize complicatioms associated with dissections. Despite favorable initial angiographic and clinical results, 47.6% of stents were found to be renarrowed significantly at follow-up coronary angiography. New techniques or more optimal characters of stents would be desired.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Diagnosis ; Follow-Up Studies* ; Humans ; Male ; Myocardial Infarction ; Stents* ; Transplants

BACKGROUND: Intracoronary stent with various designs have been developed to treat dissections or acute closure after angioplasty. The efficacy of flexible coil stent as a bail-out device has been reported. However, the restenosis after stenting still remained as a main limitation like other devices. This study reports on the angiographic follow-up after successful intracoronary stenting with flexible coil stent. METHOD: From April 1993 through July 1994, coronary stenting was tried in 21 patients by a single operator for various indications(acute or threatened closure, suboptimal result after balloon angioplasty). The nineteen(95%) out of 20 patients in whom stent was successfully deployed underwent follow-up coronary angiography 7.6+/-3.0 months after coronary stenting. RESULT: Mean age was 54.7+/-11.3(33-73) years and 16 parients were men. Clinical diagnosis of patients were as follows : stable angina 7, unstable angina 6, old myocardial infarction with stable angina 6 and acute myocardial infarction in 1 patient, respectively. Stents were implanted at left anterior descending artery in 9, left circumflex artery in 5 and right coronary artery in 8. Ten out of 21 stents(47.6%) were found to be renarrowed more than 50% at follow-up coronary angiography. There was no significant difference in clinical and angiographic variables between restenosis group and no-restenosis group. Coronary artery bypass graft surgery was performed in 1 patient for the treatment of restenosis after stenting. Repeat PTCA was performed in 3 patients and remaining 5 patients were followed medically. CONCLUSION: Flexible coil(Gianturco-Roubin) coronary stent is a useful adjunct percutaneous intervention to prevent or minimize complicatioms associated with dissections. Despite favorable initial angiographic and clinical results, 47.6% of stents were found to be renarrowed significantly at follow-up coronary angiography. New techniques or more optimal characters of stents would be desired.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Diagnosis ; Follow-Up Studies* ; Humans ; Male ; Myocardial Infarction ; Stents* ; Transplants

In complication of infective endocaditis splenomegaly and splenic infarction are not uncommon but splenic rupture is very rare. We report a case of splenic rupture complicated by infective endocarditis in 1 71-yr-old man who had been suffered from rheumatic heart disease (aortic regurgitation and stenosis and mitral regurgitation). The patient was admitted to mild fever and generalized weakness for 20 days. Diagnosis of infective endocarditis due to Staphylococcus epidermidis was made by clinical manifestaions and blood culture study.On 34th day of admissionthe patient suddenly displayed the symptoms and signs of massive intraperitoneal hemorrhage. Splenic rupture was revealed by paracentesis and radiologic studies. Rupture of spleen is an uncommon and usually fatal complication of infective endocarditis. Therefore early diagnosis and prompt treatment must be performed.
Constriction, Pathologic ; Diagnosis ; Early Diagnosis ; Endocarditis* ; Fever ; Hemorrhage ; Humans ; Paracentesis ; Rheumatic Heart Disease ; Rupture ; Spleen ; Splenic Infarction ; Splenic Rupture* ; Splenomegaly ; Staphylococcus epidermidis

Although it has been suggested that the calcium antagonist verapamil has beneficial effects on ischemic myocardium, its effect during coronary reperfusion has not been studied in detail. The purpose of this study was to investigate the inhibitory effect of verapamil on myocardial damage quantitatively using 111 In-anticardiac myosin antibody (ACM Ab) and qualitatively using electronmicroscopic method. Anesthetized open-chest dogs were subjected to 1 hour of occlusion of the left anterior descending coronary artery (LAD) followed by 90 minutes of reperfusion. Regional myocardial blood flow was determined by injecting 85Sr-microsphere prior to LAD reperfusion, and regional myocardial damage was measured by injecting 111In-ACm Ab at 30 minutes after LAD reperfusion. Six dogs were randomly selected as saline control and verapamil-treated (0.6 mg/kg. hr) groups each. Saline or verapamil was infused at 40 minutes after LAD occlusion and continued through the experiment. 1) Verapamil produced significant (P<0.05 by Wilcoxon rank sum test) decrease in heart rate, mean arterial blood pressure and double product. There was no significant change in pulmonary hemodynamics or cardiac output. 2) Stroke volume was reduced significantly (P<0.05 by Wilcoxon rank sum test) after 30 minutes of LAD reperfusion in the control group, but it was preserved in the verapamil-treated group. 3) There was an inverse exponential relationship between 111In-ACm Ab localization and regional blood flow in both control (r=-0.86) and verapamil treated (r=-0.71) groups. Significant difference between the two groups was found in exponential curve (p[t]<0.05). 4) A lesser uptake of 111in-ACM Ab was observed in the verapamil treated group compared with that in the control group in the region where the regional blood flow was lower than 30+/- of normal. 5) In the control group, the myocardium showed swelling, contraction bands, and electron dense granules in the mitochondria which were proven to be calcium aggregates. In the verapamiltreated grooup, the myocardium showed fewer electro dense granules and mild degree of contraction bands. This study supports the concept that verapamil reduces the myocardial damage following coronary reperfusion in myocardial infarction and may reduce contraction band necrosis.
Animals ; Arterial Pressure ; Calcium* ; Cardiac Output ; Coronary Vessels ; Dogs ; Heart Rate ; Hemodynamics ; Mitochondria ; Myocardial Infarction* ; Myocardial Reperfusion* ; Myocardium* ; Myosins ; Necrosis ; Regional Blood Flow ; Reperfusion ; Stroke Volume ; Verapamil

PURPOSE: Brain metastasis from colorectal cancer is a rare clinical condition. We have experienced five cases of brain metastases in a relatively short period of time during extensive chemotherapy for advanced colorectal cancer. To examine whether this phenomenon is a simple coincidence or there is a correlation with prolongation of life span in patients with stage IV colorectal cancer, we analysed five patients with brain metastases. METHODS: The case histories of 47 patients with unresectable systemic metastases who had undergone sequential chemotherapy (FOLFOX and FOLFIRI) in Ajou University Hospital from August 2002 to December 2004 were reviewed and analyzed for clinical characteristics. The sites of unresectable metastases were the liver (n=28), the lung (n=28), and the paraaortic nodes (N=6). Diagnostic criteria of unresectable metastasis were multiple or bilobar lesions in hepatic metastasis and multilobar involvement in pulmonary metastasis. RESULTS: There was no complete remission. Partial remission was noted in 31.9% of the patients and stable disease in 8.5%. Sequential chemotherapy showed no effect in 59.6% of the patients. Brain metastases occurred in five patients (10.6%). Accompanying metastases were found in the lung (n=4), the liver (n=3), the paralortic lymph nodes (n=2), and bone (n=1). Four patient (21.0%) were noted in the response group. The mean interval from primary cancer surgery to the diagnosis of brain metastasis was 27.5 (20~44) months. From the start of chemotherapy, brain metastasis was diagnosed at an average of 10.5 (8~16) months. Metastasectomies were performed in three patients, and stereotaxic radiosurgery was performed in two patients. One patient died with the disease, and four patients have been alive with the disease for more than six months. CONCLUSIONS: It is still unclear whether the increasing incidence of brain metastasis is related with prolongation of life expectancy in patients with stage IV colorectal cancer. However, about half of the stage IV colorectal cancer patients were found to obtain meaningful survival benefits by sequential chemotherapy, and 20% of chemo- responders showed brain metastases. Therefore, we conclude that the increasing incidence of brain metastasis seems to correlate with prolongation of life expectancy in stage IV colorectal cancer.
Brain* ; Colorectal Neoplasms* ; Diagnosis ; Drug Therapy* ; Humans ; Incidence ; Life Support Care ; Liver ; Lung ; Lymph Nodes ; Metastasectomy ; Neoplasm Metastasis* ; Radiosurgery

BACKGROUND: Cicletanine bydrochloride is a newly developed anti-hypertensive agent. The presence of a furopyridine group characterizes its uncommon chemical structure as an antihypertensive molecule. This clinical trial was performed to confirm the efficacy and safety of cicletanine for the treatment of hypertension as a monotherapy. METHODS: In order to investigate the efficacy and safety of oral cicletanine, a now class of antihypertensive durgs, the furopyridines, on essential hypertension, a single daily dose of 50mg to 100mg cicletanine was administered in 46 hypertensive patients with diastolic blood pressure in the range of 95mmHg-115mmHg. The patients were asked to cut off other anti hypertensive agents for 10 weeks prior to this clinical trial. Blood pressure and heart rate were measured every 4 weeks. The complete blood count, blood chemistry done by SMA-12, serum electrolytes and urinalysis were performed at the 12th week of therapy. RESULTS: 1) Baseline blood pressures after 2 weeks of placebo at sitting and standing positions were 158.7+/-16.1/102.9+/-6.2 and 148.7+/-14.5/102.7+/-6.7mmHg, respectively. The overall slope which represents the tendency of blood pressure decline over the treatment period with cicletanine for all the patients in each position are as follows ; -0.726(SE : 0.150) for sitting systolic blood pressure(BP), -0.390(SE : 0.080) for sitting diastolic BP, -0.214(SE : 0.183) for standing systolic BP and -0.341(SE : 0.139) for standing diastolic BP. 2) The slope of sitting systolic BP line in cicletanine 100mg treated group was significantly stiffer than that of cicletanine 50mg treated group(-0.445 vs -1.021, p=0.0336). 3) There were no significant interval changes in heart rate over the treatment period. 4) There were no significant interval changes in blood chemistry, electrolytes, hematologic findings and urinalysis over the treatment period. 5) Several side effects were observed in six patients(epigastric discomfort in 4, easy fatigue and insomnia in one patient, respectively). CONCLUSION: Treatment with cicletanine was well-tolerated and the incidence of side effects was relatively low. Because of its unique anti-hypertensive mechanism and moderated antihypertensive effects, cicletanine may be well suited in the treatment of hypertension combined with other classes of antihypertensive agents.
Antihypertensive Agents ; Blood Cell Count ; Blood Pressure ; Chemistry ; Electrolytes ; Fatigue ; Heart Rate ; Humans ; Hypertension ; Incidence ; Sleep Initiation and Maintenance Disorders ; Urinalysis

With the advent of duplex ultrasound imaging as a diagnostic tool of venous disease, radionuclide venography (RNV) is losing its popularity as a primary diagnostic method of venous disease. PURPOSE: We attempted to reassess the diagnostic role of RNV for the lower extremity venous disease as a primary and an adjuvant diagnostic method. METHODS: Radionuclide venography (Technetium- 99m-RBC venography) and duplex scan (DS) were compared in 80 limbs of 80 patients having clinically suspcious deep venous disease of lower extremities. The criteria for positive RNV included 1) nonfilling of deep vein, 2) abnormal venous collaterals, 3) slow ascending of isotope, and 4) residual hot spot. Abnormal RNV findings were compared with DS findings in 3 groups of patients based on DS findings. RESULTS: DS results can be divided as deep vein thrombosis (DVT) (n=46), chronic venous insufficiency (CVI) (n=18), and nonspecific (n=16). The concordance rates between RNV and DS were 79% in DVT group and 50% in CVI group. In 6 patients (7.5%) with negative or equivocal DS with positive RNV results, we could find clinically relevant findings of CVI on those limbs. CONCLUSION: RNV seemed to have an acceptable role in the diagnosis of leg venous thrombosis as an adjuvant diagnostic method with DS, especially for the patients showing equivocal DS results.
Diagnosis ; Extremities ; Humans ; Leg* ; Lower Extremity ; Phlebography* ; Ultrasonography ; Veins ; Venous Insufficiency ; Venous Thrombosis