BACKGROUND AND OBJECTIVES: Movement of mitral valve during diastole and blood flow velocity through the valve can be accurately measured using M-mode and pulsed wave Doppler technique, respectively. However, the relationship between mechanical excursion and flow phenomenon at the same cardiac cycle has not been seriously investigated. METHOD: The subjects of this study included twenty cases with normal mitral flow pattern in Doppler echocardiography (Group I, mean age:44+/-20.8years, mean ejection fraction (EF):52+/-20.9%), twenty three cases with relaxation abnormality (Group II, mean age:59+/-11.4years, mean EF:43+/-18.2%) and seventeen cases with restrictive physiology (Group III, mean age: 47+/-15.9years, mean EF: 24+/-11.0%). We measured excursion of mitral leaflets at early (DE) and late (DA) diastole, area of mitral valvular opening using two dimensional calibration on M mode images, and transmitral inflow velocity (E (early ventricular filling)-, A (atrial contraction)-velocity), TVI (time velocity integral) on Doppler echocardiography. RESULTS: DE-excursions (mm) in group I, II, III were 16.8+/-4.7, 14.2+/-3.5, 15.3+/-4.1, DA-excursions (mm) were 9.8+/-3.2, 10.7+/-3.0, 8.3+/-2.7, E-areas (cm2) were 2.8+/-1.3, 2.6+/-0.8, 2.5+/-1.0, A-areas (cm2) were 1.7+/-0.8, 1.7+/-0.7, 2.0+/-0.6, respectively. In E-, A-velocity, deceleration time, E-TVI and A-TVI, there were significant differences among three groups. However, in DE-, DA-excursion, E-, A-area, there were no significant differences among three groups. Between DE excursion and E velocity, DA excursion and A velocity, and total opening area and total TVI in total subjects, significant correlations were absent. CONCLUSION: The mitral excursions and mitral opening areas on M mode images did not show any significant correlations with the mitral inflow velocities and TVI by pulsed Doppler, which suggests that the excursion of mitral leaflets is independent of transmitral inflow.
Blood Flow Velocity ; Calibration ; Deceleration ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Mitral Valve* ; Physiology ; Relaxation

Although ascending aortic aneurysm is a uncommon disease, it has fatal complications such as aortic rupture, dissection, or death. So, experts recommend a preemptive aortic operation. A 77-year-old man with hypertension visited for slow progressive exertional dyspnea and general weakness. Chest X-ray showed deviation of trachea to right, mediastinal widening, cardiomegaly, and bulging of right heart border to right. Transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE) showed marked dilated ascending aorta with wall calcification associated with severe aortic regurgitation and pericardial effusion. Measured diameter of ascending aorta was 12 x 11 cm on Chest Computed Tomography (CT) scan, 8.35 cm on TTE, and 10.2 cm on TEE. Our exam found out the obstructive pneumonia and aortic regurgitation as consequences of complications of huge aneurysm. We report a case of huge ascending aortic aneurysm without any previous aortic operation, aortic complications, trauma, or other etiologic factors.
Aged ; Aneurysm ; Aorta ; Aortic Aneurysm* ; Aortic Rupture ; Aortic Valve Insufficiency ; Cardiomegaly ; Dyspnea ; Heart ; Humans ; Hypertension ; Pericardial Effusion ; Pneumonia ; Thorax ; Trachea

Background: The shelf life policies for central supply department (CSD) sterilized items and other devices should be determined by the healthcare facility's infection control program. We investigated effect of the sterility integrity of the CSD sterilized packs by wrapping-materials, storage period and environment to modify and extend current shelf-life. Methods: The first phase study was from May to October in 2000 and the second phase study was planned to extend further the shelf-life of the sterile packs from April 2001 to June 2002. Six hundred and fourty packs containing small gauze with four wrapping materials(100 times and 50 times washed two-ply reusable cotton, disposable craft paper, and disposable new pouch bag) and the 104 returned set after their shelf-life were stored on the top or middle of shelves or closed cabinets and storage durations from 1 to 20 weeks in the first phase study. The test packs were collected weekly and cultured in the laboratory. Five hundred seventy-six test packs were prepared with three wrapping materials (except 50 times washed cotton and returned set) and stored in the same location as the First phase study and collected and cultured monthly after three months storage (from July 2001) for one year in the second phase study. The temperature and relative humidity was monitored whenever the test pack was collected. Results: The gauze in the test packs were not contaminated until 154 days in the first study phase and until 423 days in the second phase study. The temperature and relative humidity of storage locations were 25.9degrees C and 55.2% in the first phase study and 26.0degrees C and 45.9% in the second phase study, respectively. Conclusions: There was no difference in the sterility integrity of the test packs with different wrapping materials. storage locations and environments. and storage durations. It was possible to extend shelf-life from two weeks to three and six months in the study hospital.
Delivery of Health Care ; Humidity ; Infection Control ; Infertility

PURPOSE: p16 gene, mapped to the 9p21 chromosomal region, has emerged as a candidate tumor suppressor gene in human neoplasm. It is an inhibitor of cyclin-dependent kinase and inhibits Rb phosphorylation. In a variety of tumors including childhood acute lymphoblastic leukemia (ALL), deletion and/or mutation of the p16 gene has been found. Despite their high frequency, the prognostic importance of p16 alterations is still controversial in ALL and has been reported to be either unfavorable or similar to that of other patients. We studied the correlation between loss of p16 protein confirmed by immunohistochemical staining and clinical outcomes of patients diagnosed as ALL. METHODS: We performed an immunohistochemical staining for p16 protein in 74 cases of bone marrow biopsy slide initially diagnosed as ALL between January 1998 and December 2006. We reviewed the clinical manifestations, laboratory findings, treatment outcomes retrospectively. RESULTS: Of 74 slides, 12 were negative for p16 protein. Seven were males and 5 were females with a median age at diagnosis was 5.8 (1.3-18.8) years. Initial WBC were 17,225 (500-403,300)/microL. By immunologic surface marker analysis, 7 patients were early pre-B CALLA (+) and 5 patients were T-cell ALL. Two patients of intermediate risk group had relapsed and died. Three patients had family history of breast cancer. Four patients died and overall survival rates were 53.5+/-18.7%. CONCLUSION: Loss of p16 protein is supposed to be an independent risk factor of childhood ALL associated with poor outcomes. In clinical setting, the clinician must take into account p16 status, not only at the genomic but also at the protein level. Further clinical experience on thoroughly investigated cases will help a better understanding between p16 status and clinical outcomes.
Biopsy ; Bone Marrow ; Breast Neoplasms ; Female ; Genes, p16 ; Genes, Tumor Suppressor ; Humans ; Leukemia ; Male ; Phosphorylation ; Phosphotransferases ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Risk Factors ; Survival Rate ; T-Lymphocytes

We report a case of lipoid pneumo nia in a 57-year-old man who had a history of ingestion of green perilla oil and residual neurologic deficit of cerebral infarction with right hemiparesis. Lipoid pneumonia was diagnosed by bronchoalveolar lavage.
Bronchoalveolar Lavage ; Cerebral Infarction ; Eating* ; Humans ; Middle Aged ; Neurologic Manifestations ; Paresis ; Perilla* ; Pneumonia*

No abstract available.
Biopsy, Fine-Needle* ; Hyperplasia* ; Thoracic Wall* ; Thorax*

The present study investigated the risk of active tuberculosis in patients with inflammatory bowel disease (IBD) treated with vedolizumab or ustekinumab, in actual clinical settings in a country with an intermediate tuberculosis burden. The medical records of 238 patients with IBD who received vedolizumab or ustekinumab were retrospectively reviewed at a tertiary referral center in South Korea. All patients had ≥ 3 months of follow-up duration and underwent a latent tuberculosis infection screening test before initiation of the administration of these drugs. Of the 238 patients enrolled, 181 had Crohn’s disease, and 57 had ulcerative colitis. During the median 18.7 months of follow-up, active tuberculosis did not develop in any patient treated with vedolizumab or ustekinumab. Therefore, we concluded that the risk of tuberculosis appears to be low in patients with IBD treated with vedolizumab or ustekinumab in South Korea.

Hyperprolactinemia is the most common hypothalamo-pituitary disorder encountered in clinical endocrinology. Excluding the drug-induced hyperprolactinemia, the most common cause of this disorder is a pituitary tumor. Prolactinoma is mainly made up of prolactin-secreting cells but pseudoprolactinoma is tumor that does not secrete prolactin itself. The pseudoprolactinoma interrupts the flow of prolactin inhibiting factor, dopamine, from the hypothalamus through the pituitary stalk to the normal pituitary. The differentiation prolactinoma from pseudoprolactinoma is vitally important since true prolactinomas are most commonly responded well in terms of tumor shrinkage to medical treatment using dopamine agonist therapy, whereas pseudoprolactinomas do not. Thus surgical treatment is clearly indicated as first-line treatment if we know that a lesion is a pseudoprolactinoma. We compared prolactinoma with pseudoprolactinoma in clinical and endocrinologic characteristics of 48 cases after immunohistochemical diagnosis. We could not find any differential point of both tumors in clinical and radiological characteristics although some differences were exist. But we had found the relationship between the mean level of pretreatment serum prolactin and the presence of positive immunohistochemical stain for prolactin. The pretreatment serum prolactin level was significantly higher in patients with tumors showing many prolactin immunohistochemical staining cells than in those with none(p<0.05). When the pretreatment serum prolactin exceeded 100ng/ml, the tumors contain 94% of prolactin positive cells in stain. So, if the pretreatment serum prolactin exceeds 100ng/ml, we primarily suspect prolactinoma and medical treatment should be considered. If the pretreatment level below 100ng/ml, we suspect pseudoprolactinoma and surgical treatment should be considered.
Diagnosis ; Dopamine ; Dopamine Agonists ; Endocrinology ; Humans ; Hyperprolactinemia ; Hypothalamus ; Pituitary Gland ; Pituitary Neoplasms ; Prolactin ; Prolactinoma

PURPOSE: Despite the rapid improvement in survival rate from Burkitt lymphoma and mature B-cell lymphoblastic leukemia (B-ALL) in children, a small subset of patients do not respond to first-line chemotherapy or experience relapse (RL). Herein, we report the clinical characteristics and outcomes of these patients. MATERIALS AND METHODS: RL or refractory Burkitt lymphoma and mature B-ALL in 125 patients diagnosed from 1990 to 2009 were retrospectively analyzed. RESULTS: Nineteen patients experienced RL or progressive disease (PD). Among them, 12 patients had PD or RL less than six months after initial treatment and seven had late RL. Seven patients achieved complete response (CR), 11 had PD, and one had no more therapy. Six patients who achieved CR survived without evidence of disease and four of them underwent high-dose chemotherapy (HDC) followed by stem cell transplantation (SCT). However, 11 patients who failed to obtain CR eventually died of their disease. Five-year overall survival (OS) was 31.6+/-10.7%. OS of patients with late RL was superior to that of patients with early RL (57.1+/-18.7%, vs. 16.7+/-10.8%, p=0.014). Achievement of CR after reinduction had significant OS (p < 0.001). OS for patients who were transplanted was superior (p < 0.01). In multivariate analysis, achievement of CR after reinduction chemotherapy showed an association with improved OS (p=0.05). CONCLUSION: Late RL and chemotherapy-sensitive patients have the chance to achieve continuous CR using HDC/SCT, whereas patients who are refractory to retrieval therapy have poor prognosis. Therefore, novel salvage strategy is required for improvement of survival for this small set of patients.
Adolescent* ; B-Lymphocytes* ; Burkitt Lymphoma* ; Child* ; Drug Therapy ; Humans ; Multivariate Analysis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Recurrence ; Retrospective Studies ; Stem Cell Transplantation ; Survival Rate

Obesity has increased continuously in western countries during the last several decades and recently become a problem in developing countries. Currently, anti-obesity drugs originating from natural products are being investigated for their potential to overcome adverse effects associated with chemical drugs. Artemisinic acid, which was isolated from the well-known anti-malaria herb Artemisia annua (AA) L., was recently shown to possess anti-adipogenic effects in vitro. However, the anti-adipogenic effects of AA in animal models have not yet been investigated. Therefore, we conducted daily oral administration with AA water extract in a diet-induced obesity animal model and treated 3T3-L1 cells with AA to confirm the anti-adipogenic effects in the related protein expressions. We then evaluated the physiology, adipose tissue histology and mRNA expressions of many related genes. Inhibition of adipogenesis by the AA water extract was observed in vitro. In the animal model, weight gain was significantly lower in the AA treated group, but there were no changes in food intake volume or calories. Reductions in lipid droplet size and mRNA expression associated with adipogenesis were also observed in animal epididymal fat. This study is the first to report that AA has an anti-obese effects in vivo.
3T3-L1 Cells ; Adipogenesis ; Adipose Tissue ; Administration, Oral ; Animals ; Anti-Obesity Agents ; Artemisia annua* ; Artemisia* ; Biological Products ; Developing Countries ; Eating ; Mice* ; Models, Animal ; Obesity ; Physiology ; RNA, Messenger ; Water ; Weight Gain