BACKGROUND: Surgical correction of patent ductus arteriosus (PDA) is relatively safe and effective since it does not remain in the category of open-heart-surgery. Although the surgical practice for PDA is performed in almost all hospitals, they contain the problems of anxiety of patients, remained surgical wounds on patients' chests and complications of surgery and general anesthesia. Recently non-surgical methods for the obstruction of PDA have been developed and some of them including buttoned devices are used now. The success rates of these methods approach to 84%. But the problems of embolization, incomplete closure, hemolysis, stenosis of aorta and left pulmonary artery have been reported. We invented new PDA occluder , using stainless steel wire and polyurethane foam. Therefore we investigated the efficacy of occluding blood flow with the new PDA occluder in the vessels of experimental animals. METHOD: Using 304 stainless steel wire which is self-expandable stent, two star-shaped frames were made, each frame forming cone and facing the other's tip. And in the center of the frames polyurethane foam was inserted. 316L stainless steel wire was used to fix the elements described above and some portion of the wire was extracted outside of the frames, shaping hook or round loop with which the occluder could be pulled out in case of misplacement. To create the similar situation to PDA, we made shunts from artery to vein between carotid arteries and jugular veins with surgical bypass grafts or made shunts of direct artery to vein connections without grafts in 4 dogs and 1 pig. Through 8F sheath, we deployed the occluders into the shunts made of 5 grafts or made of 3 arterial ends. Also the occluders were inserted into the femoral artery of dog and iliac artery of pig. After deployment of occluders, angiograms were performed to obscure the efficacy of blocking blood flow and follow-up angiogrms were done in one and two weeks. The animals were sacrificed in one and two weeks to get the tissues including occluders inside. Gross findings were checked about thrombi formation in and around polyurethane foam. RESULTS: The 10 occluders were placed successfully except one site due to misplacement. The occluders successfully blocked the blood flows in all 10 sites within 3 - 60 minutes. Each follow-up angiogram for occluders in one and two weeks revealed good maintenance of blockade in blood flow. Observed gross findings on tissues were packed thrombi formation in the polyurethane foam and membrane formation along the occluder. CONCLUSIONS: This newly developed device revealed good efficacy for occlusion of blood flow including shunts in immediate and follow-up study. Practical method for the delivery of the device and some design modification for proper fitting into the PDA especially for small patients would be required. Longer period of follow-up with more animal experiments for other possible complications including distal embolization would be required also before clinical trial.
Anesthesia, General ; Animal Experimentation ; Animals ; Anxiety ; Aorta ; Arteries ; Carotid Arteries ; Constriction, Pathologic ; Dogs ; Ductus Arteriosus, Patent* ; Femoral Artery ; Follow-Up Studies ; Hemolysis ; Humans ; Iliac Artery ; Jugular Veins ; Membranes ; Polyurethanes ; Pulmonary Artery ; Stainless Steel ; Stents ; Thorax ; Transplants ; Veins ; Wounds and Injuries

PURPOSE: The minimally invasive technique in urologic treatment such as percutaneous cyst aspiration with sclerotherapy is increasing in recent years to treat symptomatic simple renal cyst. However, this method has a high recurrence rate. The laparoscopic approach can be an alternative method which is far less invasive than open surgery and less recurrence rate than sclerotherapy. Furthermore, the retroperitoneal approach can avoid unnecessary intraperitoneal manipulation and thereby reduce complications such as injury and adhesion of the bowel. We evaluated the recurrence rate, hospital stay, and postoperative morbidity of retroperitoneal laparoscopic marsupialization of simple renal cyst. MATERIALS AND METHODS: From July 1996 to May 1997, 27 patients(male 7, female 20) with simple renal cyst, presenting with pain(14 patients), recurrent cyst after percutaneous aspiration(9), and incidentally found renal cyst(4) was managed with retroperitoneal laparoscopic marsupialization of simple renal cyst. Mean patient age and cyst size were 50 years(range 35-66 years) and 7.8cm(range 3.0-12.0cm), respectively. RESULTS: Mean operative time, hospital stay, and follow-up period were 58.9 minutes(range 40-110 minutes), 2.3 days(range 1-4 days) and 14.2 months(range 6-25 months), respectively. There was no recurrence and cytologic and pathologic examinations were benign in all patients. There was no significant difference in the operative time according to the position and the side of the renal cyst. CONCLUSIONS: Retroperitoneal laparoscopic cyst marsupialization is an effective therapy for recurrent or symptomatic large simple renal cyst with low recurrence rate and postoperative morbidity.
Female ; Follow-Up Studies ; Humans ; Length of Stay ; Operative Time ; Recurrence ; Sclerotherapy

BACKGROUND: We compared elderly and adult patients and tried to find a way to make an early diagnosis and proper management for elderly patients with altered mental status in the emergency department(ED). METHODS: During one year, two groups -123 elderly patients over 65 years and 127 adult patients from 20 to 64 years who visited ED in National Police Hospital(NPH)-were selected. Sex, age, arrival time after symptom onset, means of transportation, underlying diseases, causative disease, time of notification to other departments, and pattern of discharge of two groups were analyzed. RESULTS: The average age of the elderly and the adults were 76.43+/-9.51 and 42.12+/-15.0(yrs), respectively. As for the means of transportation, 84% of the elderly used a 911 ambulance service, and 11% used other emergency services. The average times from symptom onset to arrival for two groups were 124 minutes and 69 minutes, respectively. 86.99% of the elderly and 68.38% of the adults had underlying diseases. As for final diagnosis, cerebrovascular disease for the elderly and cardiovascular disease for the adults were the main causes. When patients left the hospital, rate of transfer to other hospital was higher in the elderly(60.2%), and rate of discharge was higher in the adults(15.8%). CONCLUSION: The elderly patients had more intracranial causes and needed longer time for diagnosis than the adult patients. In the case of the patients with intracranial cause who needed an emergency care, they were usually diagnosed at the secondary medical facility and then transferred to the other hospitals for proper treatment causing bad effect on the prognosis of the treatment due to time delay.
Adult ; Aged ; Ambulances ; Cardiovascular Diseases ; Early Diagnosis ; Emergencies ; Emergency Medical Services ; Humans ; Police ; Prognosis ; Transportation

BACKGROUND: The polymerase chain reaction(PCR) assay is rapid, sensitive analytical technique but has problem of high false-positive rate. We applied dUTP-UDG PCR (dU-PCR) method to prevent carryover contamination major source of high false positive in PCR assays, for detection of Mycobacterium tuberculosis. METHODS: The PCRs for detection of M. tuberculosis were performed with P1 and P2 primers based on IS6110 repeated sequence. FTC-2000 was used for capillary PCR and Uno-Thermoblock was used for heating block PCR. In order to evaluate the effect of dU-PCR controlling carryover contamination, PCRs were performed in the presence of UDG and the absence of UDG. To compare the sensitivity of usual dT-PCR with dU-PCR, chromosomal DNA of M. tuberculosis ranging 500pg to 0.5fg were amplified by dT-PCR and dU-PCR method using two different thermocycler, capillary and heating block type, respectively. RESULT: The dU-PCR using UDG prevented carryover contamination by amplicon DNA up to 500pg. By capillay PCR method, the lower limits of detectability of dT-PCR and dU-PCR were 0.5fg and 500fg, respectively, which indicates the sensitivity of dU-PCR was lower than dT-PCR. But by heating block method, the lower limits of detectability of both method of dU and dT-PCR were 0.5fg. So the sensitivity of dU-PCR was same as dT-PCR. CONCLUSION: The dU-PCR by heating-block method was sensitive test for detection of M. tuberculosis that effectively prevent carryover contamination by amplicon.
Capillaries ; DNA ; Heating ; Hot Temperature ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction* ; Tuberculosis

BACKGROUND: Several abnormalities of the autonomic regulation of the heart have been noted after acute myocardial infarction(AMI). Measurement of heart rate(HR) variability has been reported to provide indirect, noninvasive estimate of the cardiac efferent parasympathetic activity. The purposes of this study were to get the information on heart rate variability after AMI and to determine its relation to clinical and hemodynamic data. METHODS: We measured HR variability in 28 patients(23 men and 5 women : mean age, 56.6+/-10.4 years) 3-15days after AMI, in 25 patients with unstable angina and in 21 normal subjects by using triangular interpolation of the frequency distribution histogram om normalto-normal RR intervals from Holter tapes. RESULTS: HR variability was lower in AMI than unstable angina patients(357.9+/-118.6 versus 426.1+/-122.5 msec : p<0.05) and normal subjects(525.1+/-137.4 msec : p<0.025). There was no difference for infarct site, thrombolytic therapy, presence of Q-wave. HR variability was significantly related to mean 24-hour HR, left ventricular ejection fraction(all p<0.0001), left ventricular end diastolic diameter(p<0.05). HR varability was lower in patients belonging to Killip class 2-4 and who reqired the use of diuretics or digitalis(all p<0.05). CONCLUSION: After AMI, HR variabillity was reduced and significantly related to clinical and hemodynamic indexes of severity. Measurement of HR variability early after AMI may offer important clinical information for the early high stratification of patients.
Angina, Unstable ; Autonomic Nervous System ; Diuretics ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Male ; Myocardial Infarction* ; Thrombolytic Therapy

The width of cervical canal and distance of intervertebral space were measured in 83 normal adults and 208 adult patients who complained of related symptoms, as nuchal tightness, shoulder and interscapular pain, paresthesia of arms, etc. The following results were obtained: 1. The average width of spinal canal is more 14mm in roentgen distance. 2. The common symptoms are occipital headache, pain, paresthesia, & tightness. 3. The width of spinal canal & intervertebral space of patients are significantly narrower than those of controls.
Adult ; Arm ; Headache ; Humans ; Paresthesia ; Shoulder ; Spinal Canal ; Spine*

No abstract available.
Pregnancy* ; Purpura*

In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
Autoantibodies ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia* ; Dermatomyositis* ; Dyspnea ; Fibrosis ; Humans ; Immunoglobulins* ; Immunosuppressive Agents ; Inflammation ; Lung Diseases, Interstitial ; Middle Aged ; Pneumonia ; Prognosis ; Respiratory Insufficiency ; Steroids

Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.
Adrenal Insufficiency ; Adrenocorticotropic Hormone* ; Anemia ; Brain ; Fatigue ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperprolactinemia* ; Hypoglycemia ; Hyponatremia ; Hypotension ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nausea ; Pallor ; Pituitary Hormones, Anterior ; Plasma ; Prolactin ; Vomiting ; Water ; Weight Loss

No abstract available.
Autoantibodies* ; DNA*