The tricuspid valve is not a simple but a complex structure, tricuspid valve complex. This complex is composed of tricuspid orifice, annulus, valve leaflet, chordae tendineae and papillary muscles. There are flew articles about these structures. The authors studied tricuspid valve complex in 53 cases of normal korean adults, such as circumference of tricuspid annulus, the maximum diameter of the tricuspid orifice, height and breadth of the cusps, including commissures, the ratio of rough to clear zone, the number of scallops of posterior cusp, the number, length and pattern of arrangement of the several types of chordae, the number and morphological characteristics of papillary muscles.
Adult* ; Chordae Tendineae ; Heart* ; Humans ; Papillary Muscles ; Pectinidae ; Tricuspid Valve*

No abstract available.
Gastric Emptying*

PURPOSE:BK virus associated nephropathy (BKVAN) affects 1-10% of kidney transplant (KT) patients and it produces a progressive destruction of allograft. Reducing immunosuppression is the only way to save the graft, while it needs tight monitoring of the graft rejection and graft survival is poorer in advanced case. Leflunomide has immunosuppressive effect and also antiviral activity. Addition of leflunomide may improve BK virus clearance and graft survival. METHODS:6 KT patients with biopsy proven BKVAN (Histological pattern B) were treated with leflunomide and reduced immunosuppression. All patients were monitored with serial determination of viral load in blood and graft function. RESULTS:BKVAN was diagnosed at 14 months (7-28) post transplant, at that time median serum creatinine concentration was 2.8 mg/dL (1.8-3.6). 12.5 months (6-16) later of leflunomide treatment, median serum creatinine was 2.3 mg/dL and no graft loss was found. CONCLUSION:Leflunomide therapy with reduced immunosuppression may be effective in the treatment for BKVAN.
Biopsy ; BK Virus ; Creatinine ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Isoxazoles ; Kidney ; Kidney Transplantation ; Transplantation, Homologous ; Transplants ; Viral Load ; Viruses

BACKGROUND/AIMS: Diabetic nephropathy is a growing cause of end-stage renal failure, and renal transplantation is considered the best option for survival in patients who experience such renal failure. Patients with diabetes are older and frequently have comorbidity, and only a minority of these patients is considered for renal transplantation. The survival rate of patients having diabetes treated with transplantation has improved, although the long-term prognosis has not been determined. This study examined the clinical outcome of renal transplantation in patients having diabetes compared to that in nondiabetic patients. METHODS: We compared diabetic (n=70) and nondiabetic (n=355) groups of patients for whom medical records were available for more than 3 months at our hospital from March 1998 to August 2008. RESULTS: The recipients were significantly older in the diabetic group (50.6+/- 10.5 vs. 39.8+/- 10.8 years), while donor age was significantly younger in that group (33.2+/- 9.0 vs. 37.5+/- 1.3 years). Cardiovascular events occurring after transplantation were more frequent in the diabetic group (11/70 vs. 10/355). Kaplan-Meier curves for cumulative survival of the renal allograft and patient survival revealed no difference between the two groups. The allograft survival rate in the diabetic group was 100% at 5 years and 79% at 10 years posttransplantation. In the nondiabetic group, the renal allograft survival rate was 98% at 5 years and 75% at 10 years. The patient survival rates did not differ significantly: 100% vs. 99% at 5 years and 91% vs. 91% at 10 years for the diabetic and nondiabetic groups, respectively. CONCLUSIONS: In our study, the long-term survival of renal transplantation in patients with diabetes equaled that of nondiabetic patients. Graft survival was also comparable between the two groups. Therefore, kidney transplantation may be another therapeutic option for end-stage diabetic nephropathy.
Comorbidity ; Diabetic Nephropathies ; Graft Survival ; Humans ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Medical Records ; Prognosis ; Renal Insufficiency ; Survival Rate ; Tissue Donors ; Transplantation, Homologous ; Transplants

OBJECTIVE: Lumbar lordotic curve on L4 to S1 level is important in maintaining spinal sagittal alignment. Although there has been no definite report in lordotic value, loss of lumbar lordotic curve may lead to pathologic change especially in degenerative lumbar disease. This study examines the changes of lumbar lordotic curve after posterior lumbar interbody fusion with wedge shape cage. METHODS: We studied 45patients who had undergone posterior lumbar interbody fusion with wedge shape cage and screw fixation due to degenerative lumbar disease. Preoperative and postoperative lateral radiographs were taken and one independent observer measured the change of lordotic curve and height of intervertebral space where cages were placed. Segmental lordotic curve angle was measured by Cobb method. Height of intervertebral space was measured by averaging the sum of anterior, posterior, and midpoint interbody distance. Clinical outcome was assessed on Prolo scale at 1month of postoperative period. RESULTS: Nineteen paired wedge shape cages were placed on L4-5 level and 6 paired same cages were inserted on L5-S1 level. Among them, 18patients showed increased segmental lordotic curve angle. Mean increased segmental lordotic curve angle after placing the wedge shape cages was 1.96? Mean increased disc height was 3.21mm. No cases showed retropulsion of cage. The clinical success rate on Prolo's scale was 92.0%. CONCLUSION: Posterior lumbar interbody fusion with wedge shape cage provides increased lordotic curve, increased height of intervertebral space, and satisfactory clinical outcome in a short-term period.
Postoperative Period

Pseudomonas aeruginosa pneumonia is characteristically found as a hospital-acquired infection in patients with underlying medical disorders. Few cases of community acquired P. aeruginosa pneumonia have been reported in individuals without underlying diseases. We report a case of P. aeruginosa pneumonia in a healthy 33-year-old man. He visited our hospital because of fever, non-productive cough, and pleuritic chest pain. On physical examination, the breathing sounds were decreased on the right lower lung field. The chest radiograph showed lobar consolidations with a cavity on the right upper lung field. Blood cultures and a pleural fluid culture yielded P. aeruginosa. Despite aggressive management including antibiotics and mechanical ventilation, he died 26 hours after the onset of symptoms. P. aeruginosa should be included in the differential diagnosis of severe community-acquired pneumonia.
Adult* ; Anti-Bacterial Agents ; Chest Pain ; Cough ; Diagnosis, Differential ; Fever ; Humans ; Lung ; Physical Examination ; Pneumonia* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Sounds ; Sepsis

Hernodialysis(HD) patients are continuously exposed to hyperkalemia, the degree of which depends on the amount of dialysate potassium(K) removal and intra- compartmental K shifts besides poor dietary K compli- ance. Chronically hyperkalemic outpatients(n=20) on chronic hernodialysis by routine monthly serum potassium(SK) concentration measurements(SK> or =5.1mEq/L, more than 4 times in 6 months) was looked for the derangements of short-term interval K handling by observing the pattern of change in plasma K(PK) thru HD. In all 20 patients, as expected, the predialysis PK(PKo, 5.3 +/- 0.16mEq/L) were significantly correlated with the end-dialysis PK(PKe, 3.8+/-0.09mEq/l.)(r=0.65, p<0.01) and the magnitude of the fall in PK(PKo-PKe, 1.6+/-0.55mEq/L)(r=0.85, p<0.0001). Also, PKo were ne- gatively correlated with anion gap(r=-0.50, p<0.05) and plasma Na level(r=-0.69, p<0.01). PK at 2 hours after HD(PKr, 4.6+/-0.13mEq/L) revealed a marked post- dialytic K rebound. PKr correlated with PKe, whereas no significant correlation between the magnitude of the rise in PKe(PKr-PKe) and PKe was found. Of 20 hyperkalemic patients, PK of 9 patients(group I), sur- prisingly, showed normokalemia(4.7+/-0.09mF) and that of 11(group II) showed true hyperkalernia(5.8>0.19 mEq/L). Between 2 groups, significant differences were found in plasma Na level(140 +/- 0.8 vs. 1360.7mEq/L, p<0.01) and the percentage of(PKr-PKe) divided by PKe(141.8 vs. 272.5Yo, p<0.01), but no difference in anion gap, pH, albumin, creatinine, and(PKo-PKe) divided by PKO, respectively. Based on this data, we conclude that hyperkalemic hemodialysis patients should be confirmed by plasma K determination to exclude factitious hyperkalemia, and they may have the derangements of internal K balance due to transcompartmental K shifts following HD, which would be partly related to that of Na balance.
Acid-Base Equilibrium ; Creatinine ; Humans ; Hydrogen-Ion Concentration ; Hyperkalemia ; Plasma ; Potassium* ; Renal Dialysis*

OBJECTIVE: The AMSLU(TM) cage is a newly developed instrument, that utilizes concept of the key-stone graft in posterior lumbar interbody fusion. The authors try to prove the short-term efficacy of AMSLU(TM) cage in surgical treatment of degenerative cervical disc disease. METHODS: We investigate clinical and radiological features of 24 patients who underwent anterior cervical fusion with AMSLU(TM) cage during the period between January 2001 and February 2002. Clinical and radiological results were assessed by using Odom's criteria and regular follow-up of radiographs, respectively. RESULTS: All patients included in this study had been followed by at least 6 months. Except 3 patients, all patients underwent single-level operation, and among remaining 21 patients, C5-6 was the most commonly involved level (17 cases). Symptomatic improvement was found in 22 cases (91%). Evidence of bone fusion was invariably found by the end of the postoperative 6 months in every case and increase of disc height was also shown in all patients. Neither operation-related nor instrument-related complications was seen. CONCLUSION: Anterior cervical fusion with AMSLU(TM) cage has several advantages over the preexisting instruments, such as easy maneurability, avoidance of donor site complications, and anatomical contour which renders it to endure lateral shearing force and its relatively large contact area.
Follow-Up Studies ; Humans ; Tissue Donors ; Transplants

Isolated fetal ascites may be different from general category of nonimmune hydrops in both prenatal course and prognosis. We experienced one case of isolated fetal ascites of unknown origin treated by in utero ultrasound-directed paracentesis and so present it with brief review of literature.
Ascites* ; Edema ; Paracentesis* ; Prognosis

No abstract available.
Ischemic Attack, Transient*