A 25 years old sergeant of Dicrocoeliidae infection was studied. This patient was not a spurious infection case and diagnosis was based on rocovery of the characteristic eggs consistently in the feces for 2 month. This case had no history of ingestion of ingestion of ants, land snail of grasshopper. In this case with complaints of flatulence, nausea, loss of appetite and dizziness, physical examination reveald no pathological findings except pale cornea. Liver function tests were observed to be normal and there was slight eosinophilia.
parasitology-helminth-trematoda- Dicrocoeliidae ; case report

BACKGROUND: The exercise stress testing(Treadmill Test) is one of the preferred noninvasive methods of identifying patients with coronary artery disease. ST-segment elevation during or immediately after exercise is uncommon and in most patients, it was associated with prior infarction, left ventricular hypertrophy or left bundle branch block, Exercise-induced ST-segment elevation has been attributed to ventricular wall motion abnormalities, and ischemia due to either coronary vasospasm or ervere proximal coronary stenosis. We examined the clinical, angiographic, and prognostic significance of 16 patients with exercise induced ST-segment elevation. METHODS: 16 patients with exercise-induced ST-segment elevation were retrospectively reviewed. The symptom-limited exercis testing was performedn using a modified Bruce protocol and in patients with acute myocardial infarction(AMI), low level exercise testing(Myocardial infarction protocol) was used. The significant ST-segment elecation was defined as a > or =1mm change present in >1 lead measured at 0.08 sec after J point and in > or =3 consecutive beats. Coronary arteriogram and percutaneous transluminal coronary angioplasty(PTCA) was performed using standard techniques within 7 days of initial exercise testing and a luminal diameter stenosis of >50% was considered significant. RESULTS: 1) We have studied 2076 exercise tests and 16 patients(M/F:15/1, Mean age : 58 years) developed exercise-induced ST-segment elevation. The initial diagnosis were acute myoca rdial infarction(AMI) in 12, variant angina in 2, effort angina in 1 and unstable angina in 1 patient. 9 of 12 patients with AMI were treated with thrombolytic agent(Urokinase 2.5 to 3 million unit) within 6 hours from the onset of chest pain. 2) Mean maximal ST-segment elevation was 2.6mm(range 1-5mm). The leads which showed exercise-induced ST-segment elevation were corresponded to the location of severe coronary stenosis in typical effort angina, to spasm site in variant angina, and to infarction site in AMI. 11 Patients had follow-up exercise testing and showed abolition of exercise-induced ST-segment elevation in 4 of 5 patients with AMI and 1 patient with effort angina after PTCA, and 1 patient with variant angina and 3 of 4 patient with AMI after medication. 3) In 12 patients, coronary angiography was performed, and showed 95% and 90% stenosis at proximal LAD in 2 patients with effort angina and >80% stenosis at proximal or mid lesion of infarct-related artery in 7 patients with AMI. In variant angina, one patient showed normal coronary artery and another patient showed 60% stenosis at mid LAD. On LV angiogram, there were moderate to severe hypokinesia instead of akinesia or dyskinesia at infarction site in all patients with AMI and showed normal LV contractility in patients with effort or variant angina. PTCA were successfully performed in 7 patients(effort angina 2, AMI 5). 4) The clinical follow up for 16 patients were obtained for mean follow-up duration of 17 months and during the clinical follow-up, 1 variant angina patient with mild stenosis at proximal LAD was died with ventricular fibrillation after discontinution of medication. There were CABG due to restenosis in 1 patient and cerebrovascular accident in 1 patient. CONCLUSION: 1) The exercise-induced ST-segment elevation signifies severe ischemia due to either severe proximal coronary stenosis or coronary arterial spasm. In AMI, this findings suggests the residual ischemia(or residual viable myocardium) in addition to left ventricular dyssynergy or aneurysm. 2) Adverse cardiac events can be provented by revascularization in patients who had critical coronary stenosis and by medical therapy in those with coronary vasospasm or mild coronary stenosis.
Aneurysm ; Angina, Unstable ; Arteries ; Bundle-Branch Block ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vasospasm ; Coronary Vessels ; Diagnosis ; Dyskinesias ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; Hypokinesia ; Infarction ; Ischemia ; Phenobarbital ; Retrospective Studies ; Spasm ; Stroke ; Ventricular Fibrillation

Spontaneous rupture of subcapsular liver hematoma in pregnancy is rare but potential life threatening complication of preeclampsia. We experienced a case of spontaneous rupture of subcapsular hematoma of liver that was treated with conservative method. So, we present the case with a brief review of literatures as first report in Korea.
Hematoma* ; Korea ; Liver* ; Pre-Eclampsia ; Pregnancy* ; Rupture, Spontaneous

OBJECTIVES: This study was carried out to evaluate the effects of industrial noise on blood pressure and heart rate. METHODS: Resting blood pressure, hearing loss, and general characteristics of the 102 subjects who were engaged in a factory in Pusan were measured from March to June for two years, in 1998 and 1999. With noise dosimeter, noise exposure level was measured from 8 A.M. to 4 P.M. Ambulatory blood pressure and heart rate were also measured every 30 minutes from 8 A.M. to 10 P. M. RESULTS: Controlling for age, smoking, and Quetelet's index, in subjects of under 40 years old exposed to higher than 85dBA, noise exposure and systolic blood pressure had a statistically significant correlation, and the same result was obtained in all subjects. The daily variability of ambulatory blood pressure and heart rate were observed in older than 40 years old group, but only heart rate in under 40 years old. CONCLUSIONS: The blood pressure and heart rate would be elevated when the workers exposed to noise. And in under 40 years old, the systolic blood pressure was elevated to the workers exposed to higher than 85dBA.
Adult ; Blood Pressure* ; Body Mass Index ; Busan ; Hearing Loss ; Heart Rate* ; Heart* ; Humans ; Noise* ; Smoke ; Smoking

No abstract available.
Drug Therapy*

BACKGROUND: Weaning is the process of switching a patient from mechanical ventilator to spontaneous breathing. A number of different weaning techniques can be employed. At recent study, conventional spontaneous breathing trial was superior to other techniques, such as intermittent mandatory ventilation(IMV) or pressure support ventiation(PSV). But adequate observation time of the spontaneous breathing trial was not determined. We reported the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotrachial tube. In this study, we tried to shorten the spontaneous breathing time from 60 minutes to 30 minutes. If weaning success was predicted after 30 minutes spontaneous breathing, extubation was done without reconnection with ventilator. METHODES: Subjects consisted of 42 mechanically ventilated patients from August 1994 to July 1995. The weaning trial was done when the patients recovered sufficiently from respiratory failure that originally required ventilatory assistance, the patients became alert and showed stable vital sign, and arterial O2 tension was adequated(PaO2>55 mmHg) with less than 40% of inspired oxygen fraction. We conducted a careful physical examination when the patients was breathing spontaneously through the endobronchial tube for 30 minutes. We terminated the trial if a patients was any of following signs of distress; cyanosis, diaphoresis, tachypnea(above 30 breaths per minute), and extreme tachycardia. Patients who had none of this features during spontaneous breathing for 30 minutes were extubated promptly. RESULT: 17 weaning trials of 15 patients were done in 42 mechanically ventilated patients. Successful weaning and extubation was possible in 14 trials of total 17 trials. In this 14 patients, 8 patients were extubated after 30 minutes spontaneous breathing, 3 patients were extubated after 60 minutes spontaneous breathing, and 3 patients needed over 3 hours for extubation from weaning. We found similar overall success rate compared with weaning following a 60 minutes spontaneous breathing trial. CONCLUISON: From the result of present study, we believe that weaning and extubation from mechanical ventilation following a 30 minutes spontaneous breathing with 02 supply through the endotracheal tube is a simple and effective method
Cyanosis ; Humans ; Oxygen ; Physical Examination ; Respiration* ; Respiration, Artificial ; Respiratory Insufficiency ; Tachycardia ; Ventilators, Mechanical ; Vital Signs ; Weaning*

The renal function is under regulatory influence of central nervous system (CNS), in which various neurotransmitter and neuromodulator systems take part. However, a possible role of central GABA-benzodiazepine system on the central regulation of renal function has not been explored. This study was undertaken to delineate the renal effects of diazepam. Diazepam, a benzodiazepine agonist, administered into a lateral ventricle (icv) of the rabbit brain in doses ranging from 10 to 100 microgram/kg, elicited dose-related diuresis and natriuresis along with improved renal hemodynamics. However, when given intravenously, 100 mug/kg diazepam did not produce any significant changes in all parameters of renal function and systemic blood pressure. Diazepam, 100 mug/kg icv, transiently decreased the renal nerve activity (RNA), which recovered after 3 min. The plasma level of atrial natriuretic peptide (ANP) increased 7-fold, the peak coinciding with the natriuresis and diuresis. Muscimol, a GABAergic agonist, 1.0 mug/kg given icv, elicited marked antidiuresis and antinatriuresis, accompanied by decreases in systemic blood pressure and renal hemodynamics. When icv 0.3 microgram/kg muscimol was given 3 min prior to 30 mug/kg of diazepam icv, urinary flow and Na excretion rates did not change significantly, while systemic hypotension was produced. These results indicate that icv diazepam may bring about natriuresis and diuresis by influencing the central regulation of renal function, and that the renal effects are related to the increased plasma ANP levels, not to the decreased renal nerve activity, and suggest that the effects may not be mediated by the activation of central GABAergic system.
Atrial Natriuretic Factor ; Benzodiazepines ; Blood Pressure ; Brain ; Central Nervous System ; Diazepam* ; Diuresis ; Hemodynamics ; Hypotension ; Lateral Ventricles ; Muscimol ; Natriuresis* ; Neurotransmitter Agents ; Plasma ; Rabbits*

PURPOSE: A lateral thoracodorsal fasciocutaneous flap (LTFF) is a local fasciocutaneous flap that has been used in breast reconstructions since the 1980s. Although the LTFF is a wellstudied reconstruction procedure after radical surgery in Western countries, there is no report in Korea. By introducing the LTFF procedure, we suggest an easy reconstruction technique that can be performed by the breast surgeon directly. METHODS: Patients with lateral breast cancer and redundant lateral thoracic region might be candidates for this procedure. The flap consists of the lateral and dorsal extensions of the inframammarian fold as well as an extended line from the anterior axillary line. A quadrantectomy is performed through a planned skin incision, and an axillary lymph node dissection can be performed simultaneously if the sentinel lymph node is positive. The skin and subcutaneous fat with the fascia of the serratus anterior and latissimus dorsi muscle should be dissected carefully. A wedge-shaped flap can be acquired successfully. The lateral breast defect is then reconstructed by a rotation of the flap. The axis of the flap is drawn following the inframammarian fold so that the final scar would be under the brassiere line. RESULTS: Nineteen patients were treated with the LTFF after breast conserving surgery. All tumors were located in lateral breast regions. Seroma occurred in three and partial fat necrosis and partial flap necrosis were observed in each one. The cosmetic result based on four-point scoring system of breast cosmesis showed excellent in seventeen and good in two. CONCLUSION: Despite its long scar line, with appropriate patient selection, a LTFF might be a useful method for breast reconstructions.
Axis, Cervical Vertebra ; Breast Neoplasms ; Breast* ; Cicatrix ; Fascia ; Fat Necrosis ; Female ; Humans ; Korea ; Lymph Node Excision ; Lymph Nodes ; Mammaplasty* ; Mastectomy, Segmental ; Necrosis ; Patient Selection ; Seroma ; Skin ; Subcutaneous Fat ; Superficial Back Muscles

No abstract available.
Jaundice

BACKGROUND: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. METHODS: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. RESULTS: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 +/- 7.9 mm versus 7.3 +/- 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. CONCLUSIONS: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.
Arm ; Clavicle* ; Consensus ; Elbow ; Extremities ; Hand ; Humans ; Ligaments* ; Prospective Studies ; Seoul ; Shoulder ; Shoulder Fractures ; Skin ; Suture Anchors ; Sutures*