BACKGROUND: Recently, Doppler echocardiography has been widely used to evaluate left ventricular(LV) diastolic filling. However, There are only limited date about the influence of LV systolic function on the pattern of left ventricular diastolic filling. METHODS: To evaluate the changes of Doppler echocardiographic parameters of left ventricular filling induced by variations in left ventricular systolic function in dilated cardiomyopathy(DC) with heart failure(HF), 25 patients(M : F=14 : 11) with DC and HF, and 21 age-matched normal subjects(M : F=13 : 8) were examined by ECG, phonocardiography and echocardiography. From the Doppler recording, A2D(time from second heart sound to the onset of early diastolic mitral flow), peak velocity at early diastole(E) and late diastole(A), ratio of E to A velocity(E/A) and flow velocity integral(FVI) were measured. RESULTS: In 22 patients with DC and HF without mitral regurgitation(MR), A2D was significantly prolonged(119.5+/-12.7 vs 92.4+/-14.1msec, p<0.01), and early diastolic peak velocity and E/A velocity ratio were decreased as compared with the normal subjects(E=0.39+/-0.08 vs 0.57+/-0.12m/sec, p<0.01, E/A : 0.87+/-0.19 vs 1.33+/-0.19 vs 1.33+/-0.18, p<0.05). There were significant correlations between A2D and FVI(r=+0.73, p<0.01), and between E/A velocity ratio and FVI(r=-0.78, p<0.01). However, in 3 patients with MR, A2D(88.7+/-12.1msec), E(0.56+/-0.05m/sec), and E/A(1.32+/-0.12) were similar to those in normal subjects, despite of decreased FVI(12.0+/-0.9cm). CONCLUSIONS: These data show that a change of left ventricular systolic function in patients without MR may influence a diastolic filling pattern of left ventricle but not in patient with MR, and suggest that MR masks left ventricular distolic filling abnormalities.
Cardiomyopathy, Dilated* ; Echocardiography ; Echocardiography, Doppler* ; Electrocardiography ; Heart ; Heart Sounds ; Heart Ventricles ; Humans ; Masks ; Phonocardiography ; Ventricular Function, Left*

No abstract available.
Coronary Artery Disease* ; Coronary Vessels*

Strumal carcinoid of ovary is an unusual form of monodermal ovarian teratoma with thyroid-like follicles admixed with typical carcinoid tumor pattern. Most of them arise in dermoid cyst or in mature solid teratoma. Recently we experienced a case of strumal carcinoid postoperatively and report this case with a brief review of the concerned literatures.
Carcinoid Tumor* ; Dermoid Cyst ; Female ; Ovarian Neoplasms ; Ovary* ; Teratoma

E.S.T. is performed not only for the treatment but also for the diagnosis of biliary tract diseases. E.S.T. serves as a diagnostic aid for some of biliary tract diseases which require such procedures as a peroral cholangioscopy or biopsy of the biliary duct for precise diagnosis and further differential diagnosis. The diseases of our patients were diagnosed by clinical findings and such diagnostic maneuvers as abdominal ultrasonography, intravenous cholangiography, percutaneous transhepatic chorangiography(P.T.C.), endoscopic retrograde chorangiopancreatography(E.R.C.P.), In all the two cases, abdominal ultrasonography revealed dilated extrahepatic duct, but biliary trees were not visualized at E.R.C.P. In one of the two cases, P.T.C. revealed a filling defect with dilated common bile ducts(CBD) but we could not make a differential diagnosis of CBD stone from CBD cancer. In another of the two cases, on which intravenous cholangiography was done, we could not see CBD. For the purpuse of precise diagnosis and further differential diagnosis, we performed EST and then ERCP thraugh widened papillae. With those procedures, CBD stones were shown.
Bile ; Biliary Tract Diseases ; Biopsy ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnosis, Differential ; Humans ; Ultrasonography

Idiopathic hypertrohpic cranial pachymeningitis is rare, and is essentially a diagnosis of exclusion. A 53-year-old man presented with headache and visual loss in the right eye, first experienced a month earlier. MR images depicted a mass in the right cavernous sinus. At T1-weighted imaging, both the mass and the thickened dura mater present in both fromted lobes were isointense, while at while T2-weighted imaging, the signal intensity of both the mass and the dura mater was low. After the injection of contrast medium, pachymeningeal enhancement was observed. We report the radiologic findings in a case of idiopathic hypertrophic cranial pachymeningitis, confirmed surgically and pathologically.
Cavernous Sinus ; Diagnosis ; Dura Mater ; Headache ; Humans ; Meningitis* ; Middle Aged

No abstract available.
Humans ; Nephritis, Interstitial* ; Nephrotic Syndrome*

PURPOSE: Because of the unavailability of marrow transplantation, umbilical cord blood (CB) is increasingly being used. We evaluated the potential of ex vivo expansion and clonality in CD34+ cells separated from cord blood source and mobilized peripheral blood (PB) in a serum-free media. METHODS: The CD34+ cells, selected from CB and mobilized PB, were expanded with hematopoietic growth factors. They were then cultured for burst-forming units of erythrocytes (BFU-E), colony-forming units of granulocytes and monocytes (CFU-GM) and colony-forming units of megakaryocytes (CFU-Mk) at culture days 0, day 4, day 7, and day 14 with various growth factors. RESULTS: The CB-selected CD34+ cells showed significantly higher total cell expansion than those from the PB at day 7 (2 fold increase than PB). The CB-selected CD34+ cells produced more BFU-E colonies than did the PB on culture at days 7 and at day 14. Also, the CB-selected CD34+ cells produced more CFU-Mk colonies than did the PB on culture at day 4 and at day 7. CONCLUSION: The ex vivo expansion of the CB cells may be promising in producing total cellular expansion, CFU-Mk and BFU-E compared with PB for 7 to 14 days. The growth factors combination including megakaryocyte growth and development, flt3-ligand and interleukin-3 showed more expansion in the view of total cells and clonal maintenance compared with less combination.
Bone Marrow ; Culture Media, Serum-Free ; Erythrocytes ; Erythroid Precursor Cells ; Fetal Blood* ; Granulocytes ; Growth and Development ; Intercellular Signaling Peptides and Proteins ; Interleukin-3 ; Megakaryocytes ; Monocytes ; Stem Cells

PURPOSE: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. METHODS: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. RESULTS: The adapted MASD clinical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. CONCLUSION: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.
Dermatitis, Irritant ; Education ; Evidence-Based Nursing ; Evidence-Based Practice ; Humans ; Intertrigo ; Korea ; Organizational Policy ; Skin Care ; Skin

OBJECTIVES: The misdiagnosis of delirium may result in a delay of correct diagnosis and appropriate treatment of the delirium. Additionally, aggravation of physical illnesses can occur. The objective of this study was to investigate patient characteristics in cases of misdiagnosed delirium upon psychiatric consultation in a university hospital. METHODS: Subjects included patients with delirium among all who we had consulted over a 12 week span. Psychiatric diagnosis was made by two well-trained psychiatrists by means of the DSM-IV-TR. Cognitive function, level of delirium, and physical function were evaluated by the Korean version of Mini Mental Status Examination (MMSE-K), the Delirium Rating Scale-Revised-98 (DRS-R-98), the Clinical Global Impression-Severity (CGI-S), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), and the Global Assessment of Functioning Scale (GAF). In addition, we collected socio-demographic information, date of admission and consultation, present causes of consultation, and speculated psychiatric diagnoses made by referring physicians. RESULTS: Among 45 subjects with delirium, only 28 patients (62%) were diagnosed with delirium by referring physicians at the time of consultation. The remaining 17 patients (38%) had been diagnosed with other illnesses. The group of misdiagnosed patients tended to have a longer duration of formal education than those that had been correctly diagnosed. CONCLUSION: Early diagnosis and intervention of delirium can minimize subsequent problems related to delayed diagnosis. Therefore, it is vital to identify the factors related to misdiagnoses by referring physicians. This study showed that a longer duration of formal education is a contributing factor for the misdiagnosis of delirium. Longer education may cover up the typical symptoms of delirium. This can keep referring physicians from making a correct diagnosis. This study was a pilot study investigating diagnostic accuracy of delirium by referring physicians. Additional, well-controlled studies are warranted.
Delayed Diagnosis ; Delirium ; Diagnostic Errors ; Early Diagnosis ; Humans ; Mental Disorders ; Pilot Projects ; Psychiatry

BACKGROUND AND OBJECTIVES: The purpose of this study is to examine clinical characteristics and outcome in patients with cardiogenic shock or ongoing cardiogenic shock by acute coronary syndrome who underwent intraaortic balloon pump(IABP) support, and to identify factors predictive of in-hospital mortality. MATERIALS AND METHODS: Thirty-two consecutive patients with IABP support from 1994 to 1997 were analyzed retrospectively. RESULTS: The causes for insertion of IABP are cardiogenic shock(31%), unstable hemodynamics during angiography or angioplasty(31%), ventricular tachycardia(15%), mechanical complications(15%), and ongoing chest pain(6%). The overall survival rate was 47%. Revascularization procedures were done in 23 cases(72%) in whom inhospital survival rate was 52%. The mortality rate was significantly higher in patients with cardiogenic shock(80%) and mechanical complications(100%) including ventricular septal defect and acute mitral regurgitation, but lower with intractable ventricular tachycardia. Differences between survivors and nonsurvivors were not significant in regard to clinical characteristics, extent of coronary artery disease, time to IABP, time to coronary artery bypass graft, and clamping time, but only duration of IABP is longer in nonsurvivors. CONCLUSIONS: Emergent uses of IABP in patients with intractable ventricular tachycardia may be effective in maintaining hemodynamics before revascularization procedures, but patients with pump failure by cardiogenic shock or mechanical complications have higher mortality rates.
Acute Coronary Syndrome ; Angiography ; Constriction ; Coronary Artery Bypass ; Coronary Artery Disease ; Heart Septal Defects, Ventricular ; Heart* ; Hemodynamics ; Hospital Mortality ; Humans ; Mitral Valve Insufficiency ; Mortality ; Retrospective Studies ; Shock, Cardiogenic ; Survival Rate ; Survivors ; Tachycardia, Ventricular ; Thorax ; Transplants