No abstract available.
Breast Neoplasms* ; Breast* ; Estrogens*

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*

BACKGROUND AND OBJECTIVES: The relationship of cold pressor, hyperventilation and exercise test responses to circadian patterns and types of angina in vasospastic angina have still not been known. The aim of this study was to identify subgoups of patients who have similar clinical features and provocation test response. MATERIALS AND METHODS: Twenty-one consecutive patients with pure vasospastic angina were studied. Six exercise tests were performed in the early morning, late morning, and late afternoon in consecutive days, and 2 hyperventilation tests and 2 cold pressor tests in the early morning. Circadian distribution and types of angina(at rest, on physical activity or both) were evaluated by clinical history, clinical records and ambulatory ECG recordings during admission and follow-up periods(mean 19+/-9 months). RESULTS: Three patterns of circadian distribution of anginal attacks were identified during all observation periods together(morning and night: MN n=, morning and afternoon or evening: M+/E n=, morning, night and afternoon and/or evening: MN+/E n=1). Exercise test was positive in 36%(40/111) without circadian variation, hyperventilation test in 66%(23/35) and cold pressor test in 6%(2/33). Neither hyperventilation test nor cold pressor test was related to circadian patterns, types or activity of angina, or numbers of spastic artery. But positive exercise test increased significantly in patients with angina on physical activity(43% vs 21%, p<0.05), high activity(57% vs 18%, p<0.01), multivessel spasm(50% vs 27%, p<0.05 ) and circadian patterns of M+/E and MN+/E(29%, 55% vs 4%, p<0.05, p<0.01). All patients with MN had rest angina and single vessel spasm. All 6 patients with M+/E had angina both at rest and on physical activity and 5 single vessel spasm. Eight of 11 patients with MN+/E had angina both at rest and on physical activity and 8 multivessel spasm. CONCLUSION: These findings suggest that hyperventilation test is highly sensitive in vasospastic angina without any relationship to clinical features, but exercise test response is related well to circadian patterns of angina attacks which are associated with characteristic clinical features.
Arteries ; Electrocardiography ; Exercise Test ; Follow-Up Studies ; Humans ; Hyperventilation ; Motor Activity ; Muscle Spasticity ; Spasm

No abstract available.
Slipped Capital Femoral Epiphyses*

PURPOSE: We investigated the effect of anticholinergic drug treatment before midurethral sling surgery in patients with mixed urinary incontinence(MUI). MATERIALS AND METHODS: Between January 2004 and December 2006, 112 female patients with MUI were evaluated. Forty-seven patients were not medicated with anticholinergic drugs(Group A) and 65 patients were medicated with anticholinergic drugs(Group B) for 2 weeks or more(2-8 weeks, mean 2.34+/-1.02) before the midurethral sling operation. After the midurethral sling operation, the patients were followed up for 4 weeks or more(4-48 weeks, Group A is 7.83+/-8.70, Group B is 6.77+/-7.58). Cure of the incontinence after the procedure was defined as the absence of subjective symptoms such as frequency, urgency, urge incontinence and the absence of objective leakage on stress testing. All other cases were considered failures. RESULTS: There were no significant differences between the group that was not medicated preoperatively (Group A) and the group that was preoperatively medicated(Group B)(cure rate of Group A was 87.2% and Group B was 89.2%, p=0.745) in the cure rate for pure stress urinary incontinence. However, comparison of the postoperative results for the MUI showed significant differences (cure rate of Group A was 63.8% and Group B was 81.6%, p=0.035). The cure rate was significantly higher in the preoperatively medicated patients than in the patients who were not preoperatively medicated with regard to the MUI. CONCLUSIONS: Our findings suggest that treatment with anticholinergic medications before a midurethral sling operation improves the cure rate in patients with MUI.
Exercise Test ; Female ; Humans ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Urge

Between July 1982 and July 1985, we treated thirty-one fractures of the tibial shaft by intramedullar ary Ender's nailing at the Department of orthopedic Surgery of Pusan Paik Hospital. Reductions of the fractures were achieved by closed method in 25 cases and open method in 6 cases. The results were as follows. 1. The average age was 34. 5 years and the most common cause of injury was traffic accident(67.7%) 2. Nineteen cases (61%) were closed fracture and 12 cases (39%) open. Seventeen cases (55%) were simple fracture and 14 cases (45%) comminuted. The most common level of the fracture was middle third of the tibial shaft. 3. Twenty cases (64.5%) had associated injuries and average interval from injury to operation was 11. 8 days. 4. The average healing time was 16.7 weeks and the time prolonged in comminuted fractures than in simple fractures. 5. Complications were one case of valgus deformity (11°), one case of delayed union with pseudoane urysm of anterior tibial artery on fracture site and one case of infected nonunion in Grade III open comminuted fracture. 6. Ender nails are relative ease of nailing, allow early weight bearing and decrease complication. Ender nailing is considered to be a good method in treating tibial shaft fracture especially for management of multiple injured patient and when other procedures have failed.
Busan ; Congenital Abnormalities ; Fractures, Closed ; Fractures, Comminuted ; Humans ; Methods ; Orthopedics ; Tibia ; Tibial Arteries ; Weight-Bearing

The relationship between infective endocarditis and mycotic aneurysm formation appers clear : In about two to ten percent of patients with infective endocarditis harbor septic intracranial aneurysms. But the pathogenesis, natural course and management of these lesions remains controversial. Aggressive medical treatment of the underlying infected cardiac valve or surgical replacement therapy have significantly reduced the morbidity and mortality rates associated with infective endocarditis. Clinical predictors of mycotic aneurysm, especially neurologic prodromes prior to rupture have been ill-defined since most series contain few patients or include patients with infective aneurysms who have no infective endoarditis. Similarly there has been no consensus regarding the indications and timing of cerebral angiography in patients with infective endocarditis. We have experienced a case of cerebral mycotic aneurysm complicated with subarachnoid hemorrhage due to infective endocarditis in a 29 year-old female patient, who admitted to our hospital because of the pain and paralysis of sudden onset in right forearm, which was diagnosed by echocardiography, brain computed tomography and 4-vessel cerebral angiography. The patient died of sudden rupture of mycotic aneurysm in the 7th hospital day despite intensive medical treatment. We report one case of cerebral mycotic aneurysm with a brief of literature.
Adult ; Aneurysm ; Aneurysm, Infected* ; Brain ; Cerebral Angiography ; Consensus ; Echocardiography ; Endocarditis* ; Female ; Forearm ; Heart Valves ; Humans ; Intracranial Aneurysm ; Mortality ; Paralysis ; Rupture ; Subarachnoid Hemorrhage*

The prognostic factors for extrahepatic biliary atresia (EHBA) after Kasai portoenterostomy include the patient's age at portoenterostomy (age), size of bile duct in theporta hepatis (size), clearance of jaundice after operation (clearance) and the surgeon's experience. The aim of this study is to examine the most significant prognostic factor of EHBA after Kasai portoenterostomy. This retrospective study was done in 51 cases of EHBA that received Kasai portoenterostomy by one pediatric surgeon. For the statistical analysis, Kaplan-Meier method, Logrank test and Cox regression test were used. A p value of less than 0.05 was considered to be significant. Fifteen patients were regarded as dead in this study, including nine cases of liver transplantation. There was no significant difference of survival to age. The age is also not a significant risk factor for survival in this study (Cox Regression test; p = 0.63). There was no significant difference in survival in relation to the size of bile duct. However, bile duct size was a significant risk factor for survival (Cox Regression test; p = 0.002). There was a significant difference in relation to survival and clearance (Kaplan-Meier method; p = 0.02). The clearing was also a significant risk factor for survival (Cox Regression test; p = 0.001). The clearance of jaundice is the most significant prognostic factor of EHBA after Kasai portoenterostomy.
Bile Ducts ; Biliary Atresia* ; Humans ; Jaundice ; Kaplan-Meier Estimate ; Liver Transplantation ; Prognosis ; Retrospective Studies ; Risk Factors

A 33 year old woman with tuberous sclerosis and pulmonary lymphangiomyomatosis was undertaken bilateral sequential lung transplantation. Due to the progressive dyspnea and recurrent pneumothorax, she could not handle her normal daily life without oxygen supplements. The natural history of a patient with tuberous sclerosis and symptomatic lung involvement says the mean expected survival is 4 years. Such guidelines as severe obstructive lung disease, unavailable medical therapy, substantial limitation in activities of daily living, and limited life expectancy made her be a recipient of lung transplantation expecting both prolongation of life and the better quality of life. In this transplantation case, we have experienced such delicate problems as gross ventilation-perfusion mismatch, reperfusion pulmonary edema, much decreased renal function, etc.
Activities of Daily Living ; Adult ; Dyspnea ; Female ; Humans ; Life Expectancy ; Life Support Care ; Lung Diseases, Obstructive ; Lung Transplantation* ; Lung* ; Lymphangioleiomyomatosis ; Natural History ; Oxygen ; Pneumothorax ; Pulmonary Edema ; Quality of Life ; Reperfusion ; Tuberous Sclerosis

The purpose of this study was to evaluate the humeral tunnel characters and clinical relevance according to entry point of the humeral tunnel in the baseball players. It was hypothesized that the medial collateral ligament (MCL) reconstruction with nonanatomical starting location of the humeral tunnel (inferior edge of the medial epicondyle: group NA) provided less favorable radiological and clinical outcomes compared to that with anatomical starting location (original footprint of the MCL: group A). The retrospective case review yielded 19 consecutive athletes who underwent isolated MCL reconstruction using the docking technique. Three dimensional-computed tomography scan was performed at 3 months, and the iso-surfacing by marching cubes algorithm were applied to evaluate the length and angle of humeral tunnel. Three outcome measures were used in this study: the visual analog scale for pain, range of motion and the Conway scale. The angle of the humeral tunnel was measured 12.2° (range, 7.9°–25.2°) in the group NA and 15.5° (range, 9.8°–30.4°) in the group A (p<0.05). The mean length of humeral tunnel is measured 16.3 mm (range, 11.7–20.1 mm) in the group NA and 15.2 mm (range, 10.3–19.1 mm) in the group A (p<0.05). MCL reconstruction brought substantial improvement in pain and function. However, between-group comparison revealed no statistical differences in all outcome measurements. The MCL reconstruction using the docking technique provided favorable clinical outcomes in baseball players. Although the humeral tunnel angle and length were different depending on the humeral entry points, clinical differences between the two entry points were not found.
Athletes ; Baseball* ; Collateral Ligaments* ; Humans ; Outcome Assessment (Health Care) ; Range of Motion, Articular ; Retrospective Studies ; Visual Analog Scale