BACKGROUND: As the pleural inflammation progresses, exudative pleural fluid becomes loculated rapidly with pleural thickening. Complete drainage is important 13 prevent pleural fibrosis, entrapment and depression of lung function Intrapleural urokinase instillation therapy has been advocated as a method to facilitate drainage of gelatinous pleural fluid and to allow enzymatic debriment of pleural surface. This study was designed to investigate the Predictors of effeotiveness of intrapleural urokinase in treatment of loculated pleural effusion METHOD: Thirty-five patients received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French Twenty-two patients had tuberculous pleural effusions, and 13 had non-tuberculous postpneumonic empyemas. A total of 240,000 units of urokinase was dissolved in 240 ml of normal saline and the aliquots of 80mL was instilled into the pleura1 cavity via pig-tail catheter per every 8hr. Effectiveness of intrapleural urokinase instillation therapy was assessed by biochemical markers, ultrasonography, and technical details. A greater than 50% improvement on follow-up chest radiographs was defined as success group. RESULT: Twenty-seven of 35 (77.1%) patients had successful outcome to urokinase instillation therapy. Duration of symptoms before admission was shorter in sucess group (11.8α6.9day) than in failure group (26.62α16.5day) (P<0.05). Amount of drained fluid during urokinsse therapy was larger in success group (917.1α392.7ml) than in failure group (613.8α259.7ml) (P<0.05). Pleural fluid glucose was higher in success group (89.7 α35.9mg/dl) than in failure group (41.2α47.1mg/dl) (P<0.05). Pleural fluid LDH was lower in success group (878.4α654.31U/L) than in failure group (2711.1α973.1IU/L) (P<0.05). Honeycomb septated pattern on chest ultrasonography was observed in six of eight failure group, but none of success group(P<0.05). CONCLUSION: Longer duration of symptoms before admission smaller amount of drained fluid during urokinase therapy, lower glucose value, higher LDH value in pleural fluid examination and honeycomb septation pattern on chest ultrasonography were predictors for failure group of intrapleural urokinase instillation therapy.
Biomarkers ; Catheters ; Depression ; Drainage ; Empyema ; Fibrosis ; Follow-Up Studies ; Gelatin ; Glucose ; Humans ; Inflammation ; Lung ; Pleural Effusion* ; Radiography, Thoracic ; Thorax ; Ultrasonography ; Urokinase-Type Plasminogen Activator*

OBJECTIVE: We evaluated the effects of surfactant therapy in acute lung injury (ALI) induced by E. coli lipopolysaccharide (LPS) endotoxin. METHODS: ALI was induced by intratracheal administration of E. coli LPS endotoxin in rats. The study group was treated with E. coli LPS endotoxin (40 mg/kg) and surfactant (100 mg/kg) intratracheally. The controls were intratracheally injected with LPS endotoxin and same dose of 0.9% normal saline instead of surfactant. Before and after endotoxin instillation, we estimated body weight, respiratory rate (RR) and heart rate (HR). The WBC counts had estimated in blood and bronchoalveolar lavage (BAL) fluid, and the total protein values were measured in BAL fluid. And also, we examined IL-1beta, IL-6 values in BAL fluid and serum. Finally, the histopathologic changes were confirmed with light and electron microscopic study. RESULTS: In the study group, the WBC counts had decreased in BAL fluid (p<0.05) and the IL-1beta and IL-6 values had decreased in serum and BAL fluid (p<0.05). But, there were non-significant decrement in WBC counts of blood and the total protein values in BAL fluid (p>0.05). The RR and HR changes after instillation were also non-significant (p>0.05). Morphologically, the light microscopic examination denoted pathological findings such as infiltration of neutrophils and alveolar macrophages, vascular congestion. In electron microscopic study, there were various sized and shaped lamella bodies, and vacuolization of lamella bodies in alveolar type II cell. CONCLUSION: Surfactant protects effectively the ALI caused by LPS endotoxin in vivo and the protective effects of that may be related to anti-inflammatory action.

Because the penetrating cervical tracheoesophageal injury may be associated with significant morbidity and mortality, it is important to choose the optimal method of diagnosis and management in patient with tracheoesophageal injury. We obtained a satisfactory result from repair of tracheoesophageal injuries using cardiopulmonary bypass. If the bleeding from the unidentified deep injury and the spread of infection could be controlled, the repair using CPB might increase the margin of safety during operation in the similar cases.
Cardiopulmonary Bypass ; Diagnosis ; Hemorrhage ; Humans ; Mortality ; Wounds, Stab*

BACKGROUND: Tuberculous pleurisy has been treated with a combined regimen of corticosteroids-antimicrobial therapy. But whether such combination therapy add to benefits is unknown. We evaluate the effects of corticosteroid and its routine application in relief of clinical symptoms, absorption of pleural effusion, and pleural adhesions. METHODS: A prospective, randomized study of the role of corticosteroid in the treatment of tuberculous pleurisy was performed in 83 patients(nonsteroid group:50 patients, steroid group: 33 patients) from June, 1991 to September, 1994. RESULTS: 1) The mean duration from symptoms(fever, chest pain, dyspnea) to relief was 3.8 days in the steroid group, and 7.4 days in the nonsteroid group(P<0.05). Clinical symptoms including fever, chest pain, sputum and weight loss were relieved more rapidly in the steroid group than other symptoms(weakness, night sweating and dyspnea). 2) Pleural effusion was taken an averge of 88 days in the steroid group and 101 days in the nonsteroid group to be absorbed completely(p>0.05). 3) The incidence of pleural adhesions was 17/33(51.5%) in the steroid group and 32/50(64%) in the nonsteroid group(p>0.05). 4) Side effects of corticosteroids were observed in only one patient causing epigastric pain and discontinuation of drug. CONCLUSION: Corticosteroid exert benefitial role in the more rapid relief of clinical symptoms to patients with tuberculous pleurisy, but absortion of pleural effusion and occurrence of pleural adhesions was not influenced significantly. Therefore, its routine application should be reevaluated.
Absorption ; Adrenal Cortex Hormones ; Chest Pain ; Fever ; Humans ; Incidence ; Pleural Effusion ; Prospective Studies* ; Sputum ; Sweat ; Sweating ; Tuberculosis, Pleural* ; Weight Loss

The 12-lead electrocardiogram (ECG) is an inexpensive bedside tool that most physicians use to make rapid diagnoses such as acute myocardial infarction (AMI), arrhythmia, and conduction abnormalities. Although each lead in the ECG represents electronic information from specific portions of the heart, lead aVR, an augmented unipolar limb lead, is frequently ignored. The aVR lead provides excellent information from the right portion of the heart, including the outflow tract of the right ventricle and basal portion of the septum. In this report, we discuss ST segment elevation changes in lead aVR of serial ECGs in emergency room patients with chief complaints of syncope and chest discomfort.
Acute Coronary Syndrome ; Arrhythmias, Cardiac ; Coronary Vessels ; Electrocardiography ; Electronics ; Electrons ; Emergencies ; Extremities ; Heart ; Heart Ventricles ; Humans ; Myocardial Infarction ; Syncope ; Thorax

BACKGROUND AND OBJECTIVES: Several recent studies have shown that there is an inverse relationship between plasma B-type natriuretic peptide (BNP) and body mass index (BMI) in subjects with and without heart failure. Obesity frequently coexists with diabetes, so it is important to consider the relationship between diabetes and natriuretic peptide levels. We evaluated the influence of diabetes on the correlation of BNP and BMI. SUBJECTS AND METHODS: We examined 933 patients with chest pain and/or dyspnea undergoing cardiac catheterization between Feb. 2006 and Nov. 2007 in the Maryknoll cardiac center who had creatinine levels <2.0 mg/dL and normal systolic heart function. BMI was checked, transthoracic echocardiography was performed, and aminoterminal pro-brain natriuretic peptide (NT-proBNP) was sampled at the start of each case. RESULTS: In 733 non-diabetic patients, mean plasma NT-proBNP levels of non obese individuals (BMI <23 kg/m2), overweight individuals (23< or = BMI <25 kg/m2), and obese individuals (BMI > or =25 kg/m2) showed a significant negative correlation with increasing BMI (856.39+/-237.3 pg/mL, 601.69+/-159.6 pg/mL, 289.62+/-164.9 pg/mL, respectively, p<0.0001). However, in 200 diabetic patients, the correlation between BMI and NT-proBNP was not significant (r=-0.21, p=0.19), and NT-proBNP did not correlate with mitral E/Ea in obese diabetic patients (r=0.14, p=0.56). NT-proBNP was significantly correlated with mitral E/Ea in the non-obese (r=0.24, p=0.008) and non diabetic (r=0.32, p=0.003) groups. Left ventricular (LV) mass index was significantly correlated with NT-proBNP in all BMI groups (r=0.61, p<0.001), and patients with concentric cardiac hypertrophy showed the highest NT-proBNP levels. CONCLUSION: The present study demonstrates that obese patients have reduced concentrations of NT-proBNP compared to non obese patients despite having higher LV filling pressures. However, NT-proBNP is not suppressed in obese patients with diabetes. This suggests that factors other than cardiac status affect NT-proBNP concentrations.
Body Mass Index ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Chest Pain ; Creatinine ; Dyspnea ; Echocardiography ; Heart ; Heart Failure ; Humans ; Natriuretic Peptide, Brain ; Obesity ; Overweight ; Peptide Fragments ; Plasma

BACKGROUND AND OBJECTIVES: The benefit of early statin treatment following acute myocardial infarction (MI) complicated with cardiogenic shock (CS) has not been well studied. We sought to assess the effect of early statin therapy in patients with CS complicating acute MI. SUBJECTS AND METHODS: We studied 553 statin-naive patients with acute MI and CS (Killip class IV) who underwent revascularization therapy between November 2005 and January 2008 at 51 hospitals in the Korea Acute Myocardial Infarction Registry. Patients were divided into 2 groups: those who received statins during hospitalization (n=280) and those who did not (n=273). The influence of statin treatment on a 12-month clinical outcome was examined using a matched-pairs analysis (n=200 in each group) based on the propensity for receiving statin therapy during hospitalization. RESULTS: Before adjustment, patients receiving statin, compared to those not receiving statin, had a more favorable clinical profile, were less likely to suffer procedural complications, and more likely to receive adequate medical therapy. Patients receiving statin had lower unadjusted in-hospital mortality and composite rate of mortality, MI, and repeat revascularization at 12 months, which remained significantly lower after adjustment for patient risk, procedural characteristics, and treatment propensity. CONCLUSION: In CS patients with acute MI undergoing revascularization therapy, early statin treatment initiated during hospitalization was associated with lower rates of in-hospital death and 12-month adverse cardiac events.
Angioplasty ; Hospital Mortality ; Hospitalization ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Myocardial Infarction ; Secondary Prevention ; Shock ; Shock, Cardiogenic

BACKGROUND AND OBJECTIVES: The benefit of early statin treatment following acute myocardial infarction (MI) complicated with cardiogenic shock (CS) has not been well studied. We sought to assess the effect of early statin therapy in patients with CS complicating acute MI. SUBJECTS AND METHODS: We studied 553 statin-naive patients with acute MI and CS (Killip class IV) who underwent revascularization therapy between November 2005 and January 2008 at 51 hospitals in the Korea Acute Myocardial Infarction Registry. Patients were divided into 2 groups: those who received statins during hospitalization (n=280) and those who did not (n=273). The influence of statin treatment on a 12-month clinical outcome was examined using a matched-pairs analysis (n=200 in each group) based on the propensity for receiving statin therapy during hospitalization. RESULTS: Before adjustment, patients receiving statin, compared to those not receiving statin, had a more favorable clinical profile, were less likely to suffer procedural complications, and more likely to receive adequate medical therapy. Patients receiving statin had lower unadjusted in-hospital mortality and composite rate of mortality, MI, and repeat revascularization at 12 months, which remained significantly lower after adjustment for patient risk, procedural characteristics, and treatment propensity. CONCLUSION: In CS patients with acute MI undergoing revascularization therapy, early statin treatment initiated during hospitalization was associated with lower rates of in-hospital death and 12-month adverse cardiac events.
Angioplasty ; Hospital Mortality ; Hospitalization ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Myocardial Infarction ; Secondary Prevention ; Shock ; Shock, Cardiogenic

The incidence of ischemic heart disease has been increased rapidly in Korea. However, the clinical effects of antecedent hypertension on acute myocardial infarction have not been identified. We assessed the relationship between antecedent hypertension and clinical outcomes in 7,784 patients with acute myocardial infarction in the Korea Acute Myocardial Infarction Registry during one-year follow-up. Diabetes mellitus, hyperlipidemia, cerebrovascular disease, heart failure, and peripheral artery disease were more prevalent in hypertensives (n=3,775) than nonhypertensives (n=4,009). During hospitalization, hypertensive patients suffered from acute renal failure, shock, and cerebrovascular event more frequently than in nonhypertensives. During follow-up of one-year, the incidence of major adverse cardiac events was higher in hypertensives. In multi-variate adjustment, old age, Killip class > or =III, left ventricular ejection fraction <45%, systolic blood pressure <90 mmHg on admission, post procedural TIMI flow grade < or =2, female sex, and history of hypertension were independent predictors for in-hospital mortality. However antecedent hypertension was not significantly associated with one-year mortality. Hypertension at the time of acute myocardial infarction is associated with an increased rate of in-hospital mortality.
Acute Disease ; Age Factors ; Aged ; Cerebrovascular Disorders/etiology ; Diabetes Mellitus/etiology ; Female ; Heart Failure/etiology ; Hospital Mortality ; Humans ; Hyperlipidemias/etiology ; Hypertension/*complications ; Male ; Middle Aged ; Myocardial Infarction/complications/*mortality/therapy ; Peripheral Vascular Diseases/etiology ; Predictive Value of Tests ; Registries ; Sex Factors

BACKGROUND AND OBJECTIVES: Metabolic syndrome (MetS) is an important risk factor for cardiovascular disease. However, the clinical outcome of acute myocardial infarction (AMI) with MetS has not been well examined. The purpose of this study was to evaluate the clinical outcomes of AMI patients with MetS. SUBJECTS AND METHODS: We evaluated a total of 6352 AMI patients who had successful percutaneous coronary interventions and could be identified for MetS between 2005 and 2008 at 51 hospitals participating in the Korea Acute Myocardial Infarction Registry. They were divided into 2 groups according to the presence of MetS: the MetS group (n=2493, 39.2%) versus the Non-MetS group (n=3859, 60.8%). In addition, 4049 AMI patients with high levels of low density lipoprotein-cholesterol (LDL-C) (> or =100 mg/dL) among them, were divided into the MetS group (n=1561, 38.6%) versus the Non-MetS group (n=2488, 61.4%). RESULTS: In the overall population, there was no significant difference in 12-month the major adverse cardiac events (MACE) rate between the 2 groups. However, the MetS group showed a significantly higher 12-month MACE rate in the high LDL-C population. Multivariate analysis showed that MetS was an independent prognostic factor for 12-month MACE {hazard ratio (HR) 1.607, 95% confidence interval (CI) 1.027 to 2.513, adjusted p=0.038} and for 12-month target vessel revascularization (HR 1.564, 95% CI 1.092 to 2.240, adjusted p=0.015) in the high LDL-C population. CONCLUSION: MetS patients with AMI in the overall population showed no significant difference in 12-month clinical outcomes. However, in patients with higher LDL-C > or =100 mg/dL, they showed significantly worse clinical outcome than Non-MetS patients. Therefore, it is important to ascertain the presence of MetS in AMI patients, and more aggressive therapy should be strongly considered for AMI patient with MetS.
Cardiovascular Diseases ; Humans ; Korea ; Multivariate Analysis ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Risk Factors