The cardiac performance is regulated by the intergration of preload, afterload, contractility (inotropism), heart rate and synergy of ventricular contraction, which are the major determinants that govern the stroke volume and cardiac output. Valvular heart disease may be considered to impose two different types of stress on the cardiac chamber proximal to the lesion. There are either pressure overload(increased after load) or volume overload(increased preload). The compensatory mechanism of the pressure overload and volume overload offer to hypertrophy and dilatation of the chamber. Hypertrophy, increased muscle mass, calls upon the development of greater systolic force. Dilatation, overfilled chamber volume enables increased strength and extent of shortening by Frank Starling's mechanism. In these view, we shall discuss the hemodynamic parameters; cardiac output, stroke volume, ventricular end-diastolic pressure, and the rate of ventricular pressure rise(peak dp/dt), mitral valve gradient and pulmonary circulation. The authors had an opportunity to study 40 cases of mitral valvular heart disease which were accepted during the left ventricular angiography at the cardiac catheterization room and at the fields of operative findings during the period Jan. 1977, throught Sept. 1980, at the Department of Internal Medicine, National Medical Center. The following conclusions were drawn: 1) Cardiac index was 2.65 L/min/m2in average, among 18 cases with mitral stenosis and 2.54 L/min/m2 in average, among 15 cases with mitral valve area of less than 1.0 cm2. Cardiac index was 2.58 L/min/m2in average, among 19 cases with mitral stenoinsufficiency and 3.43 L/min/m2 in average, among 3 cases with pure mitral insufficiency. 2) The mean right ventricular end-diastolic pressure elevated more than 0-8 mmHg were found in 12 cases with mitral stenosis out of 18 cases and mean miral valve area was 0.8m2. The mean left ventricular end-diastolic pressure was also elevated more than 0-12 mmHg in 6 cases out of 12 cases with mitral stenosis in addition to right ventricular failure. These 12 cases of mitral stenosis had cardiac function more than class III clinically. 3) 15 cases with mitral valve area, less than 1.0cm2 demonstrated left ventricular diastolic filling pressure gradient (MVG) of 17.3mmHg in average, the pulmonary vascular resistance of 568 dyndsecd cm(-5) in average, and the right ventricular peak systolic pressure of 72mmHg in average respectively. In all instances, the right ventricular end-diastolic pressure was 11.2mmHg in average and right ventricular peak dp/dt was 571mmHg in average. 4) Among 22 cases with mitral insufficiency, and/or mitral stenoinsufficiency 16 cases showed mean left ventricular end-diastolic pressure elevated more than 0-12mmHg. 10 cases out of these 16 cases disclosed also right ventricular end-diastolic pressure elevated more than 0-8 mmHg. These 16cases of mitral insufficiency and/or mitral stenoinsufficiency had cardiac function more than class III clinically. 5) 16 cases with mitral insufficiency and/or mitral stenoinsufficiency who had mean left ventricular end-diastolic pressure more than 0-12 mmHg showed pulmonary vascular resistance, 358 dyndsecd cm(-5) in average, systemic vascular resistance, 1621 dyne/sec/cm5 in average and left ventricular peak dp/dt, 768-2102mmHg/sec in range. 6) Pulmonary hypertension elevated more than 50mmHg of pulmonary arterial systolic pressure was found in 14 cases out of 18 case with mitral stenosis and in 10 cases out of 22 cases with mitral stenoinsufficiency and/or mitral insufficiency. Pulmonary vascular resistance, however, was markedly variable.
Angiography ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Dilatation ; Heart Rate ; Heart Valve Diseases ; Hemodynamics* ; Humans ; Hypertension, Pulmonary ; Hypertrophy ; Internal Medicine ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Circulation ; Stroke Volume ; Vascular Resistance ; Ventricular Pressure

Hypertensive encephalopathy is an acute clinical syndrome that shows central nerve dysfunction with sudden and marked elevation in blood pressure. But its pathophysiologic mechanisms, clinical courses and prognosis are still not clear. In order to study clinical manifestations and response to treatment in patients with hypertensive encephalopathy, we reviewed 45 patients with hypertensive encephalopathy who were admitted in Dept. of Internal Medicine, National Medical Center, from January 1975 to December 1984. The following results were obtained: 1) The ratio of male to female was 1.1:1. The peak age of incidence was in the 6th and 7th decade with mean age of 57.5 years. 2) Among 45 patients, only 29 had known history of hypertension and the average duration of hypertension was 8.1+/-3.6 years. 3) The most common sympotm was severe headache (68.9%). And altered consciousness, nausea and/or vomiting, focal neurologic signs and visual disturbance were also common symptoms in decreasing order of frequency. 4) Funduscopic examination showed hypertensive retinopathy in 20 of 24 (91.7%) patients and lumbar puncture revealed increased CSF pressure in 12 of 20 (60%) patients. 5) In most patients, the mean interval to symptomatic improvement was 2.1 days after administration of anti hypertensive agents, but in 6 patients with initial mean arterial blood pressure above 170mmHg, 4 patients showed delayed response and 2 patients were expired.
Antihypertensive Agents ; Arterial Pressure ; Blood Pressure ; Consciousness ; Female ; Headache ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Hypertensive Retinopathy ; Incidence ; Internal Medicine ; Male ; Nausea ; Neurologic Manifestations ; Prognosis ; Spinal Puncture ; Vomiting

PURPOSE: In this retrospective study, we attempted to evaluate the treatment outcome and the prognostic factors of thymoma treated with surgery, radiotherapy and chemotherapy. METHODS AND MATERIALS: Between 1979 and 1998, 55 patients with thymoma were treated at the Seoul National University Hospital. Of these, 11 patients underwent surgery only, 33 patients received postoperative radiotherapy and 11 patients received radiotherapy only. Twenty-three patients had gross total resection and 21 patients subtotal resection. For postoperative radiotherapy, the radiation dose consisted of 41.4-55.8 Gy. The average follow-up was 64 months, and ranged from 2 to 160 months. The sex ratio was 1:1 and the median age was 48 years (15-74 years). Overall survival and disease-free survival were determined via the Kaplan-Meier method, and the log-rank was employed to evaluate for differences in prognostic factor. RESULTS: The five- and 10-year survival rates were 87% and 65% respectively, and the median survival was 103 months. By univariate analysis, only stage ( p=0.0017) turned out to be significant prognostic factors of overall survival. Also, stage ( p=0.0007) was significantly predictive for overall survival in mutivariated analysis. CONCLUSION: This study showed the stage was found to be important prognostic factors, which influenced survival. Especially, as incomplete resection is related with poor results, complete resection is important to cure the invasive thymoma.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Radiotherapy ; Retrospective Studies ; Seoul ; Sex Ratio ; Survival Rate ; Thymoma* ; Treatment Outcome*

No abstract available.
Tinnitus*

The authors analyzed a series of 49 cases of spinal cord tumor confirmed by operation and biopsy at Presbyterian Medical Center, Jeonju, from Jan. 1977 to Dec. 1981. Histologically vertified spinal cord tumors wereneurofibroma(36.7%: 18/49), meningioma(22.5%; 11/49), ependymoma(18.5%; 9/49), metastasis(10.2%; 5/49),astrocytoma(6.1%; 3/49), epidermoid (2.0%;1.49), glioblastoma multiforme(2.0%;1/49), and diffuse non-Hodgkin'slymphoma(2.0%;1.49). The results were as follows; 1. The most frequently encountered tumor was the intraduralextramedulary tumor(55.1%;27/49). The other tumors, in descending order, were intramedullary tumor(26.5%; 13/49),extradural extradural extramedullary tumor(10.2%;5/49), and intra-&extradural extramedullary tumor(8.2%;4/49).The most frequently encoutered tumor was neurofibroma(36.7%; 18/49). Four of the 18 neurofibroma were intra-&extradural extramedullary tumor, and three(3/4) were dumbbell type of neurofibroma. 2. Only 3 cases occurred under20 years of age. They were glioblastoma multiforme, neurofibroma and epidermoid. 3. No sex predominance of spinalcord tumor was seen, but the majority of the meningiomas occurred in females(81.8%). 4. The most frequent site oftumors was the thoracic region(53.1%;26/49). The order sites were the cervical regions(2.0%;1/49) . 5. Thirteencases (26.5%) showed bony changs on preliminary roentgenograms of the spine. None showed bony changes inextradural extramedullary tumor. 6. As a rule, the myelographic deformities produced by intramedullary tumorshowed fairly long fusiform dilatation of the contrast column without displacement of the spinal cord; theextradural extramedullary tumor showed coarse transverse serrated block of the contrast column; and the intraduralextramedullary tumor showed cup defect of the contrast column.
Biopsy ; Congenital Abnormalities ; Dilatation ; Glioblastoma ; Jeollabuk-do ; Meningioma ; Neurofibroma ; Protestantism ; Spinal Cord Neoplasms ; Spinal Cord ; Spine

BACKGROUND: Superficial fungal infections are common diseases acid the prevalence of superficial fungal diseases are not static but change under the influence of various forces such as climate, migration of peoples and development in prophylaxis and therapy. OBJECTIVE: To investigate the present status of superficial dermatiphytoses and some changes on the frequency of the diseases, sex distributions and varieties of the casiative organisms. MEHTODS: The clinical and rnycological aspects of superficial fungal diseases of 3,222 patients from July 1989 to June 1992 were analyzed. Results : 1) The incidence of superficial fungal diseases was 25.4% of total out-patients. 2) The superficial fungal diseases showed a higt incidence in the third(26.4%) and the fourth decade(24.3%). 3) The ratio of male to female was 2.11:1(2,188:1,034). 4) The monthly prevalence of super ficial fungal diseases was high inhuly(17.8%), August(15.2%) and June(1.7%). 5) The incidence of superficial fungal diseases in order of frequency were tinea pedis ,28.1%, tinea cruris(19.5%), onychomycosis(15.6%), tinen orporis(11.5%), tinea manus(7.8%), tinea versicolar(7.8%), candidiasis(7.4%) and tinea capitis(2.3%), 6) Coexisting fungal infections were found in 644 patients(19.9%) and the case of tinea pedis with onychomycosis was the most common. 7) The positive rate of KOH scraping was 54.0% and the positive rate of culture on ordinary Salourauds dextrose agar media was 42.7%. 8) Trichophyton rubr,im was the most common causative orantism of superficial dermatophytes(38.4%), and other in decreasing frequency were Candida albicans(36.9%), Trichophyton mentagrophytes(23.6%) Microsporum canis(0.7%), Trichophyton ferrvgiteum(0.3%) and Epidermophyton floccosum(0.1%). CONCLUSION: These results are not significantly different from those iif previous studies. But the incidence rate of the superficial pungal diseases(25.4%) were higher thar, previous studies and showed a high incidence in young male patients and in the summer. The positiv rate of KOH scraping(54.0%) was lower than previous studies. The most common causative organism was Trichophyton rubrum(38.4 %).
Agar ; Candida ; Climate ; Epidermophyton ; Female ; Glucose ; Humans ; Incidence ; Male ; Microsporum ; Onychomycosis ; Outpatients ; Prevalence ; Sex Distribution ; Tinea ; Tinea Pedis ; Trichophyton

No abstract available.
Lung Injury* ; Lung* ; Paraquat*

Noninvasive prediction of pulmonary arterial pressure is of paramount importance in heart disease. To estimate pulmonary arterial pressure, several echocardiographic techniques, including abnormal pulmonary valve motion, prolongation of RV preejection period/RV ejection time ratio and contrast echocardiography have been proposed. Recently Doppler echocardiography has been known to detect intracardiac blood quantitatively. For assessment of the benefit of several indices by Pulsed Doppler echocardiography for mean pulmonary arterial pressure, 22 patients(mean pulmonary pressure> or =20mmHg; 11, <20mmHg; 11) were compared with the mean pulmonary arterial pressure by cardiac catheterization. In comparison of mean pulmonary arterial pressure(MPAP); 1) Right preejection period / RV ejection time RPEP/RVET;r=0.278 2) Right preejection period / Acceleration time RPEP/AT : r=0.654 3) Acceleration time(AT) AT=-1.55(MPAP)+154.37(r=-0.763) AT=-92.99(log MPAP)+239.41(r=-0.752) AT is less than 105 msec in 9 or 11 pulmonary hypertension and one of 11 normal individual. 4) Acceleration time/ RV ejection time AT/RVET=-136.36(MPAP)+83.31(r=-0.817) AT/RVET=-0.29(log MPAP)+0.81(r=-0.803) 5) (Right preejection period+Decceleration time) / AT (RPEP+DT)/AT=9.6(MPAP)-0.16(r=0.806) (RPEP+DT)/AT=3.86(log MPAP)-2.46(r=0.789) In conclusion AT/RVET, (RPEP+DT)/AT and Acceleration time of 105 msec are valuable indices to estimate mean pulmonary arterial pressure by Pulsed Doppler echocardiogram.
Acceleration ; Arterial Pressure* ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Hypertension, Pulmonary ; Pulmonary Valve

Perforator free flap (PFF) is currently a major reconstructive option for soft tissue reconstruction in adults. Although PFFs have been used commonly, most reconstructive surgeons still hesitate to perform PFFs in children. The main cause of concern is the perceived high failure rate related to the small diameter of children's perforator vessels. We present 8 consecutive cases of successful transfer of thoracodorsal artery (TDA) & anterolateral thigh (ALT) perforator flap in children. Between 2003 and 2005, 8 children(4 to 13 years old) with soft tissue defects of the extremities were reconstructed with TDA & ALT PFFs. All flaps completely survived. There were no problems relating to vascular spasm or occlusion. Range of motion of reconstructed extremities were fully recovered. Among 8 patients, only 1 patient was performed an additional flap thinning procedure. 8 cases of TDA & ALT perforator flaps were successfully transferred in children. PFF is an excellent option in reconstruction of children as well as in adults because of its thinness, long pedicle length, least donor site morbidity and acceptable donor site scar.
Adult ; Arteries ; Child ; Cicatrix ; Extremities* ; Free Tissue Flaps* ; Humans ; Perforator Flap ; Range of Motion, Articular ; Spasm ; Thigh ; Thinness ; Tissue Donors

PURPOSE: Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. METHODS: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia. RESULTS: Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes. CONCLUSION: Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.
Adult ; Anesthesia, General ; Cicatrix ; Facial Nerve ; Facial Nerve Injuries ; Follow-Up Studies ; Humans ; Malocclusion ; Mandible ; Masseter Muscle ; Mouth ; Neck ; Parotid Gland ; Skin