No abstract available.
Animals ; Dogs*

BACKGROUND: The authors performed this study to investigate the hemodynamic effect of nicardipine using an esophageal Doppler monitor (EDM) during gynecologic laparoscopic surgery. METHODS: Forty patients scheduled to undergo gynecologic laparoscopic surgery, were divided into two groups; the control group (Group C) and the nicardipine group (Group N). Pneumoperitoneum was initiated using CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured using EDM, i.e., before skin incision (T1), 5, 10 and 15 min after the initiation of pneumoperitoneum (T2, T3 and T4), and 5 min after deflation (T5). RESULTS: Mean arterial pressure (MAP) was significantly lower in Group N patients than in Group C patients at 5 and 10 min after the initiation of pneumoperitoneum (T2 and T3) (P < 0.05). No significant heart rate (HR) differences were observed between the two study groups. Cardiac output (CO), peak velocity (PV) and corrected flow time (FTC) were significantly higher in Group N at 10 min after the initiation of pneumoperitoneum (T3) (all P < 0.05). CONCLUSIONS: The nicardipine continuous infusion at 0.5?2.0microg/ kg/min is effective at attenuating hemodynamic changes after pneumoperitoneum during gynecologic laparoscopic surgery.
Arterial Pressure ; Cardiac Output ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy ; Nicardipine ; Organothiophosphorus Compounds ; Pneumoperitoneum ; Skin

BACKGROUND: Although medical students' clinical competence should be assessed systematically and objectively, written exams or faculty's subjective methods were used in the past. We assessed the clinical competence of the family medicine clerkship students using the OSCE and evaluated the reliability and the validity of the OSCE. The purpose of this study was to find the logistic problems and the feasibility of the OSCE to an entire clerkship evaluation. METHODS: Twenty six volunteers took part in the OSCE. Ten, 5-minute long stations, were divided into 4 areas: 3 for history taking, 3 for physical exam, 3 for technical skill, and 1 for interview skill areas. RESULTS: Eleven students were examined on first session and 15 students on second session 4 weeks later. The mean OSCE score was 65.5 5.63. The reliability of the total stations was 0.615. The total OSCE score was not different by the sessions, but there was a significant difference in the two stations where the examiners had been changed. There were statistically significant correlations between the total OSCE score and the two previous written exams (r=0.56, 0.54, P<0.01). There was no significant logistic problem and the examinees showed positive responses to the OSCE. CONCLUSION: The OSCE was a useful tool for assessing the clinical competence of family medicine clerkship students. The reliability of the OSCE was moderate and in order to extend the OSCE to an entire clerkship evaluation, we need further study to acquire a higher reliability and validity.
Clinical Competence* ; Humans ; Reproducibility of Results ; Volunteers

BACKGROUND: Patients diagnosed as an advanced cancer and families need accurate information about the length of survival in order to plan for and to make the best use of the time that remains. The health care of that patient can then be redirected toward palliation and mobilizing resources to ensure a comfortable life. The purposes of this study were to evaluate the prognostic value of performance status plus some physical symptoms and some biological indices and there fore to assist in planning appropriate palliative care. METHODS: This study was performed on 161 patients, who had been diagnosed as advanced cancer in Korea University Guro Hospital from July 1999 to July 2000. : We requested Karnofsky performance status scale, mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea and dry mouth We assessed the biological indices by leukocyte count, plasma albumin, proteinuria. RESULTS: We could confirm 82 patients' death(54.37) of 151 patients. Univariate analysis showed that Karnofsky performance status scale, mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea, dry mouth, leukocyte count, albumin and proteinuria demonstrated a statistically significant predictive prognosis. Multivariate analysis using Cox's proportional hazard model showed that age, performance status, albumin, proteinuria were independent predictors of survival and severity of pain had the borderline value. CONCLUSION: Age, performance status, albumin and proteinuria were the independent prognostic factors for patients with advanced cancer.
Anorexia ; Delivery of Health Care ; Dyspnea ; Humans ; Jaundice ; Karnofsky Performance Status ; Korea ; Leukocyte Count ; Mouth ; Multivariate Analysis ; Palliative Care ; Prognosis ; Proportional Hazards Models ; Proteinuria ; Serum Albumin

Phytochemical constituents were isolated from the fruits of Acanthopanax chiisanensis by repeated column chromatography. Their structures were identified as beta-sitosterol (1), daucosterol (2), sesamin (3), chiisanogenin (4), and 22alpha-hydroxy chiisanogenin (5) by spectroscopic analysis (MS, 1H-, and 13C-NMR). Compounds 1 - 5 were isolated for the first time from the fruits of A. chiisanensis.
Eleutherococcus* ; Araliaceae ; Chromatography ; Fruit* ; Terpenes*

OBJECTIVE: To know when we can identify fetal Y chromosome SRY gene by using fetal DNA in maternal plasma. METHODS: DNA from maternal plasma of 62 pregnant women (48: inpatients, 14: outpatients) underwent a sensitive Y-PCR assay to identify SRY gene of Y chromosome. RESULTS: Of the patients, fetus-derived Y sequences were detected in 37 (88.1%) of the 42 maternal plasma samples from women bearing male fetuses. One of the 20 women bearing female fetuses had positive result from plasma DNA. Seventh gestational week was the earliest gestation of gender identification. CONCLUSION: We could identify fetal gender using fetal DNA in maternal plasma (sensitivity 88.1%). The earlist to detect was 7th gestational week.
DNA* ; Female ; Fetus ; Genes, sry ; Humans ; Inpatients ; Male* ; Plasma* ; Pregnancy ; Pregnant Women ; Y Chromosome

Myotonic dystrophy is an autosomal-dominant inherited neuromuscular disorder that's characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, the heart, lung and intestine. Its most common complication is postoperative respiratory failure. We encountered a patient who developed sudden unexpected peripartum cardiomyopathy (PPCM) and respiratory failure due to presumed myotonic dystrophy after cesarean section. We report here on our clinical experience with this malady and we include a brief review of the medical literature on myotonic dystrophy.
Cardiomyopathies ; Cataract ; Cesarean Section ; Female ; Heart ; Humans ; Intestines ; Lung ; Muscle Weakness ; Muscles ; Muscular Dystrophies ; Myotonia ; Myotonic Dystrophy ; Peripartum Period ; Pregnancy ; Respiratory Insufficiency

BACKGROUND: It is often difficult to make a diagnosis of cardiac ischemia in patients attending emergency department (ED) with symptoms of acute coronary syndromes (ACS) because existing cardiac markers are not sensitive for reversible myocardial ischemia. Ischemia modified albumin (IMA) has recently been shown to be an early and sensitive marker of myocardial ischemia. We investigated the usefulness of ischemia modified albumin (IMA) as an early triage marker for ACS and tried to establish a newly standardized albumin-adjusted IMA index which has been expected to be more sensitive and accurate than conventional IMA value. METHODS: We enrolled 209 consecutive patients (men 95, women 114) who presented to the ED with symptoms suggestive of ACS from June to July, 2005. All patients were classified to ACS group (n=42) and others (n=167) based on diagnosis of cardiologists. The ideal cutoff value of IMA was calculated by the receiver operating characteristic (ROC) curve analysis and diagnostic utilities of combination tests (myoglobin, CK-MB, troponin T and EKG) were compared with those of IMA. The albumin-adjusted IMA index was calculated and applicated from the results of correlation assay between serum albumin concentration and IMA value. RESULTS: Mean IMA level (U/mL) of ACS group was significantly higher than that of non-ACS group (P<0.05) and sensitivity and specificity was 92.9% and 35.9% at a cutoff value of 85.1 U/mL, respectably. In combination with conventional cardiac markers, the sensitivity increased to 96.3%. IMA value had a negative lnear relationship with serum albumin concentration (YIMA= -23.1Xalbumin+200, R=0.99) and albumin-adjusted IMA index was calculated as [IMA index = serum albumin conc. (g/dL) x 23 + IMA (U/mL) -100]. The sensitivity and specificity was 97.6% and 34.1% at a cutoff value of 83.3 IMA index, respectively. CONCLUSIONS: IMA is a useful sensitive marker for the identification of ACS in patients with normal cardiac markers and EKG finding and follow-up combination testing may be required to rule out other diseases. The calculated albumin-adjusted IMA index is recommended to make a diagnosis of ACS more sensitively.
Acute Coronary Syndrome* ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Ischemia* ; Mass Screening* ; Myocardial Ischemia ; ROC Curve ; Sensitivity and Specificity ; Serum Albumin ; Triage ; Troponin T

The retrograde approach through a collateral artery is now thought to improve the success rate of percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), and different kinds of strategies for this technique have been developed. However, the basic principles of PCI for CTO, such as firm back-up support with a guiding catheter and fine control of the guide wire, should be adhered to more strictly to succeed with this complex procedure. We present a case in which a CTO of the proximal left anterior descending artery was successfully opened by the retrograde approach through a collateral from the left circumflex artery, during which two guiding catheters were simultaneously used in the same coronary artery for the purpose of strong back up support for the retrograde device and fine control for the antegrade device.
Angioplasty, Balloon, Coronary ; Arteries ; Catheters ; Coronary Occlusion ; Coronary Vessels ; Percutaneous Coronary Intervention

The primary success rate of intraluminal angioplasty for long superficial femoral artery (SFA) occlusions is low due to the long occlusion length and the hard component of the occlusion. To overcome this problem, subintimal angioplasty has been previously proposed and this technique is now considered as an effective method for the treatment of SFA occlusions. Subsequently, various devices and strategies have been developed to increase the success rate of subintimal angioplasty for SFA occlusions. Here, we present a case in which a long chronic total occlusion of SFA was successfully recanalized by the retrograde subintimal angioplasty through the popliteal artery after the failed antegrade subintimal approach.
Angioplasty ; Femoral Artery ; Popliteal Artery