BACKGROUND: Assessment of segmental wall motion is one of the most challenging tasks in echocardiography. The diagnosis of ischemic heart disease by echocardiography depends on the accurate detection of segmental wall motion abnormalities. However, echocardiographic regional wall motion analysis is impaired by incomplete endocardial definition due to obesity, chronic obstructive lung disease, etc. The purpose of this study was to examine the value of tissue harmonic imaging for endocardial border definition. METHODS: We recorded echocardiograms in 30 consecutive patients, in which more than one segment of left ventricule were poorly visualized, by ATL HDI 3000 and analyzed left ventricular segmental wall motion and then recorded echocardiograms again by tissue harmonic imaging (THI) technique. Endocardial border definition for each segment was graded from grade A to C (grade A in which endocardium is clearly visualized, grade B in which endocardium is poorly visualized and grade C in which endocardium is not seen). Densitometric analysis was perfromed in 10 randomly selected patients. Mean density and dynamic range in histogram were obtained at septum, posterior wall and left ventricle cavity on parasternal long axis view with both techniques. RESULTS: Among total 480 segments, 237 segments (49.4%) were categorized as grade A, 152 segments (31.7%) were categorized as grade B and 91 segments (18.9%) were categorized as grade C in fundamental modes. However, 380 segments (79.2%) were categorized as grade A, 75 segments (15.6%) were categorized as grade B and 25 segments (5.2%) were categorized as grade C in tissue harmonic modes. Visualization of 37.7% (181 segments/480 segments) of all segments was improved in tissue harmonic imaging, with 5.2% (25 segments/480 segments) improved from "not seen" to "clearly visualized". Of these improved 181 segments in THI, 105 segments (58%) were the lateral and anterior walls on apical views. In densitometric analysis of septum, wall density and delta density (wall densityLV cavity density) were significantly higher in THI than fundamental modes (p<0.05). But, W/C ratio (wall density/LV cavity density) was not different between two imaging modalities. In densitometric analysis of posterior wall, all parameters were not significantly different between two imaging modalities. Also, W/C ratio of dynamic range (posterior wall dynamic range/LV cavity dynamic range) was not significantly different between two imaging modalities. CONCLUSION: Tissue harmonic imaging has significant value in endocardial border definition in the patients with poor echocardiographic windows and appears promising with the added advantage of no requirement for intravenous access.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography ; Endocardium ; Heart Ventricles ; Humans ; Myocardial Ischemia ; Obesity ; Pulmonary Disease, Chronic Obstructive

BACKGROUND AND OBJECTIVES: Acute coronary syndrome occurs most commonly in the setting of atherosclerotic coronary artery disease, but there is little information concerning the mechanism responsible for the transition from stable to unstable coronary atherosclerotic plaque. Hypothetically, several microorganism(Chlamydia pneumonia, Cytomegalovirus and Helicobacter pylori) and their inflammatory reaction have been suggested as a causative motive in progression of acute coronary syndrome. Although it is unclear whether the serum level of CRP as a inflammatory parameter is concerned with previous inflammatory change or myocardial necrosis, CRP apper to be predictive of higher risk for cardiac event in the patients with acute coronary syndrome. Our objective was to evaluate whether the inflammatory parameters(CRP, ESR and WBC count) is useful in predicting the short-term cardiac risk within 30 days. MATERIALS AND METHOD: One hundred and ten patients with acute coronary syndrome were enrolled from April 1998 through August 1998. Blood samples were collected at 1st hour, 24th hour, 48th hour and 7th day and tested for CRP, ESR, WBC count and CK-MB level. Values of 323 normal were used as control. All patients were followed up for 30 days and assessed for the presence of cardiac complications. RESULTS: Peak CRP value of the patients with acute myocardial infarction(3.4+/-3.85 mg/dL, n=2) was higher than that of the patients with unstable angina(0.7+/-0.93 mg/dL, n=8, p<0.05) and controls(0.3+/-0.48 mg/dL, n=23, p<0.05). Peak CRP value of patients with cardiac complication was higher than that of patients without complication(7.7+/-4.77 mg/dL, n=5 vs 1.3+/-1.74 mg/dL, n=5 ; p<0.05). In multivariate analysis, peak CRP value was the only predictive parameter for development of cardiac complications in the patients with acute coronary syndrome(Odds ratio 4.893, 95% confidence interval 1.212-19.756, p value=.026). In the high-CRP group(>2 mg/dL, n=0), the cardiac complication rate was higher than the low-CRP group(< or =2 mg/dL, n=0) (43.3% vs 2.5%, p<0.05). Peak CRP value was correlated with age(r=.191, p=.045), pulse rate(r=.186, p=.008), left ventricular ejection fraction(r=0.384, p<0.001), peak ESR(r=.383, p<0.001) and peak WBC count(r=.307, p=.001), but not with peak CK-MB level. CONCLUSION: Elevated CRP level in patients with acute coronary syndrome seems to be a valuable prognostic factor for the development of cardiac complications within 1 month after admission.
Acute Coronary Syndrome* ; Coronary Artery Disease ; Cytomegalovirus ; Helicobacter ; Humans ; Multivariate Analysis ; Necrosis ; Plaque, Atherosclerotic ; Pneumonia

Although idiopathic hypereosinophilic syndrome(IHES) commonly involves the lung, it is rarely associated with acute respiratory distress syndrome (ARDS). Here we describe a case of IHES presented in conjunction with ARDS. A 37-year-old male visited the emergency department at Samsung Medical Center, Seoul, Korea, with a chief complaint of dyspnea. Blood tests showed profound peripheral eosinophilia and thrombocytopenia. Patchy areas of consolidation with ground-glass opacity were noticed in both lower lung zones on chest radiography. Rapid progression of dyspnea and hypoxia despite supplement of oxygen necessitated the use of mechanical ventilation. Eosinophilic airway inflammation was subsequently confirmed by bronchoalveolar lavage, leading to a diagnosis of IHES. High-dose corticosteroids were administered, resulting in a dramatic clinical response.
Adrenal Cortex Hormones ; Adult ; Anoxia ; Bronchoalveolar Lavage ; Diagnosis ; Dyspnea ; Emergency Service, Hospital ; Eosinophilia ; Eosinophils ; Hematologic Tests ; Humans ; Hypereosinophilic Syndrome* ; Inflammation ; Korea ; Lung ; Male ; Oxygen ; Pulmonary Embolism ; Radiography ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Seoul ; Thorax ; Thrombocytopenia

BACKGROUND: Toxocariasis is a common cause of eosinophilia and eosinophilic lung disease in Korea. We analyzed the characteristics of eosinophilic lung disease in toxocariasis. METHOD: One hundred and forty one patients with eosinophilia caused by a toxocara larval infection were evaluated from September 1, 2001 through March 30, 2006. The plain chest x-ray, chest CT(computed tomography), and bronchoalveolar larvage(BAL) were examined. A diagnosis of toxocariasis was made by ELISA using that secretory-excretory antigen from the T. canis larvae. RESULTS: Toxocarial eosinophilic lung diseases was diagnosed in 32 out of 141 patients. Ground glass attenuation was the main feature on the CT scans in 23 out of 141 patients (71.9%). Thirteen patients (40.6%) had a random in zonal distribution on CT. Pleural effusion was observed in 9 patients (28.1%). Twenty eight patients (87.5%) complained of respiratory symptoms. Eleven patients (34.4%) had gastrointestinal symptoms and 12 patients (37.5%) had liver infiltration. CONCLUSIONS: The most common findings of the chest CT in patients with toxocariasis was a randomly distributed ground grass attenuation. A toxocara infection should be considered in a differential diagnosis of patients who exhibit pulmonary infiltration with eosinophilia in Korea.
Diagnosis ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Fluconazole ; Glass ; Humans ; Korea ; Larva ; Liver ; Lung Diseases* ; Lung* ; Parasites ; Pleural Effusion ; Pneumonia ; Poaceae ; Thorax ; Tomography, X-Ray Computed ; Toxocara canis* ; Toxocara* ; Toxocariasis

OBJECTIVE: Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. MATERIAL AND METHODS: Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin(20mg/m2), etoposide(100mg/m2) and bleomycin(15mg/m2) as well as external beam radiation therapy. We compared the management problems for these tumors. RESULT: In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding. CONCLUSION: Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.
Biopsy ; Bone Marrow ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination ; Endoderm* ; Endodermal Sinus Tumor* ; Female ; Humans ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Radiotherapy ; Survival Rate ; Testis ; Vinblastine

BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitations of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric antibiotic regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. METHODS: Medical records of adults (> 15 years of age) hospitalized for CAP or pulmonary tuberculosis between March 1995 and February 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer to "atypical" pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum with compatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinical response to anti-tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of respiratory pathogens from all body sites, and their clinical significance were evaluated. RESULTS: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria, 246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171 (71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44 (18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococcal streptococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable : E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae, and A. baumannii and K. pneumoniae), S. aureus (2 definite and 2 probable), and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8 isolates). The rates of admission to the intensive care unit and of using assisted ventilation were 18% and 9.3% respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but all seven isolates from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolates of K. pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. CONCLUSION: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test to "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which will be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.
Adult ; Anti-Bacterial Agents ; Anti-Infective Agents ; Cefotaxime ; Chungcheongnam-do ; Coinfection ; Diagnosis ; Fever ; Gentamicins ; Haemophilus ; Hospitals, University* ; Humans ; Hypothermia ; Incidence ; Influenza, Human ; Intensive Care Units ; Korea ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Mortality ; Mucormycosis ; Mycobacterium ; Mycobacterium tuberculosis ; Mycoplasma ; Penicillins ; Pneumonia* ; Prospective Studies ; Seoul ; Serologic Tests ; Sputum ; Streptococcus pneumoniae ; Tachypnea ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary ; Ventilation

BACKGROUND AND OBJECTIVES: Congestive heart failure is one of the most frequent problems in cardiovascular patients. The objectives of this study were to evaluate the demographic and clinical characteristics and prognostic factors of patients hospitalized with congestive heart failure in Korea. SUBJECTS AND METHODS: Nine university hospitals were involved, and gathered prospective clinical data on patients with heart failure. One thousand eight hundred and sixty four patients, admitted between Jan.1 1998 and Aug. 31 2003, were enrolled, and data from 1,759 patients were analyzed. RESULTS: The cumulative survival rates at 6 month, and 1 and 2 years were 90.8, 80.1 and 76.4%, respectively. Ischemic heart disease was the most frequent underlying disease (32.3%). Diabetes mellitus (OR: 1.682, 95%CI: 1.234-2.389, p=0.005), a previous history of myocardial infarction (OR: 2.521, 95%CI: 1.742-4.258, p<0.0001) and cerebrovascular accidents (OR: 2.020, 95%CI: 1.166-3.101, p=0.001) were the worst prognostic factors. CONCLUSION: Ischemic heart disease was the major cause of heart failure. The two year survival rate of patients with congestive heart failure was 76.4%. The factors relating to a poor prognosis were diabetes, a previous history of myocardial infarction and cerebrovascular accidents.
Diabetes Mellitus ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hospitals, University ; Humans ; Korea* ; Myocardial Infarction ; Myocardial Ischemia ; Prognosis ; Prospective Studies ; Stroke ; Survival Rate

A 41-year-old male pharmaceutical worker developed dyspnea and wheezing 10 years after beginning the work. He had handled powder of cephalosporin precursor, 7-aminocephalosporanic acid (7-ACA). He had suffered from dyspnea, chest tightness and wheezing in the workplace for the last three years. Recently, these symptoms were aggravated. His pulmonary function test showed severe obstructive pattern and PC(20) was 0.06 mg/ml on MBPT(methacholine bronchial provocation test). Skin prick test and intradermal test showed positive reactions to ceftriaxone, cefazolin, etc. During the skin test, he suffered from an asthmatic attack and anaphylactic shock. Bronchial provocation test with cefotiam elicited a dual asthmatic reaction. We presumed that IgE-mediated mechanism may be mainly involved in the pathogenesis of cephalosporin induced occupational asthma, in addition to other immunologic or non-immunologic mechanisms. Further studies will be necessary to investigate the pathogenesis of this disease.
Adult ; Anaphylaxis ; Asthma, Occupational* ; Bronchial Provocation Tests ; Cefazolin ; Cefotiam ; Ceftriaxone ; Dyspnea ; Humans ; Intradermal Tests ; Male ; Respiratory Function Tests ; Respiratory Sounds ; Skin ; Skin Tests ; Thorax

With the increasing proportion of elderly and diabetic dialysis patients, permanent dual lumen catheters are becoming popular. One of the most frequent causes for the failure of hemodialysis in CRF patients with the tunneled cuffed catheter is the catheter dysfunction. It is thought to be due to encasement of the catheter by fibrin sleeve or fibrin sheath, kinking or malposition of the catheter. Catheter dysfunction due to fibrin sheath formation could sometimes be managed by reversal of arterial and venous lines, urokinase lock or infusion, and catheter exchange. Recently percutaneous fibrin sheath stripping (PFSS) became another modality of salvaging failing tunneled cuffed catheter before attempting catheter exchange. There was no report of applying PFSS to salvage the permanent dual lumen catheter in Korea. Authors recently experienced a case of successful application of PFSS to extend the life of catheter in a CRF patients as a last resort after failure of repeated urokinase trials. It is thought that PFSS is a simple and effective procedure which extends the longevity of permanent dual lumen catheter.
Aged ; Catheters* ; Dialysis ; Fibrin* ; Health Resorts ; Humans ; Korea ; Longevity ; Renal Dialysis ; Urokinase-Type Plasminogen Activator

Asthma is characterized by airway inflammation induced by immune dysfunction to inhaled antigens. Although respiratory viral infections are the most common cause of asthma exacerbation, immunologic mechanisms underlying virus-associated asthma exacerbation are controversial. Clinical evidence indicates that nitric oxide (NO) levels in exhaled air are increased in exacerbated asthma patients compared to stable patients. Here, we evaluated the immunologic mechanisms and the role of NO synthases (NOSs) in the development of virus-associated asthma exacerbation. A murine model of virus-associated asthma exacerbation was established using intranasal challenge with ovalbumin (OVA) plus dsRNA for 4 weeks in mice sensitized with OVA plus dsRNA. Lung infiltration of inflammatory cells, especially neutrophils, was increased by repeated challenge with OVA plus dsRNA, as compared to OVA alone. The neutrophilic inflammation enhanced by dsRNA was partly abolished in the absence of IFN-gamma or IL-17 gene expression, whereas unaffected in the absence of IL-13. In terms of the roles of NOSs, dsRNA-enhanced neutrophilic inflammation was significantly decreased in inducible NOS (iNOS)-deficient mice compared to wild type controls; in addition, this phenotype was inhibited by treatment with a non-specific NOS inhibitor (L-NAME) or an specific inhibitor (1400 W), but not with a specific endothelial NOS inhibitor (AP-CAV peptide). Taken together, these findings suggest that iNOS pathway is important in the development of virus-associated exacerbation of neutrophilic inflammation, which is dependent on both Th1 and Th17 cell responses.
Animals ; Asthma/*immunology/virology ; Imines/pharmacology ; Mice ; Mice, Inbred BALB C ; NG-Nitroarginine Methyl Ester/pharmacology ; Nitric Oxide Synthase Type II/antagonists & inhibitors/*metabolism ; RNA, Double-Stranded/metabolism ; Th1 Cells/*immunology ; Th17 Cells/*immunology