BACKGROUND: Atrial fibrillation is the most common sustained arrhythmia especially in the elderly. Despite the beneficial effect of anticoagulation to prevent disastrous complication of throm-boembolism, anticoagulation is not widely used in patients with atrial fibrillation. The purpose of this study was to identify the prevalence and clinical characteristics of atrial fibrillation and investigate the current status of anticoagulation in the elderly. METHODS: Through electrocardiographic analysis of 6,138 elderly (> or =65yr) patients from tan. to Dec. 1997, 386 patients with atrial fibrillation was found. Among the 386 patients, 274 patients with available medical records were enrolled for review of clinical findings (associated diseases, risk factor of throm-boembolism, medications) retrospectively. RESULTS: Mean age of population with atrial fibrillation was 72+/-6yr. The prevalence of atrial fibrillation was 6.2% and increased with age (65-69yr: 5.4%, 70-74yr: 6.4%, 75-79yr: 7.5%, 80yr-:9.0%). Atrial fibrillation with valvular hear disease was 27% of patients. Common associated diseases with nonvalvular atrial fibrillation were hypertension (48%), diabetes mellitus (18%), coronary artery disease (25%), congestive heart failure (21%), history of stroke or transient ischemic attack (27%). Anti-coagulation was used in 59% of valvular atrial fibrillation patients without contraindications (prosthetic valve: 100%, native valve: 42%), 24% of nonval-vular atrila fibrillation. Antiplatelet therapy with aspirin was 15%, 30% respectively, Aspirin was used in only 20% of atrial fibrillation patients with contraindication of anticoagulation. CONCLUSION: Atrial fibrillation is prevalent in the elderly. Anticoagulation and antiplatelet therapy in atrial fibrillation appears to be less than optimal.
Aged* ; Arrhythmias, Cardiac ; Aspirin ; Atrial Fibrillation* ; Coronary Artery Disease ; Diabetes Mellitus ; Electrocardiography ; Heart Failure ; Humans ; Hypertension ; Ischemic Attack, Transient ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Stroke ; Triacetoneamine-N-Oxyl

OBJECTIVE: The purpose of the current study is to investigate the effect of the prosthetic disc nucleus replacement on the mobility and height of the intervertebral disc and adjacent segments. METHODS: Thirteen patients who underwent L4-L5 prosthetic disc nucleus replacement were included in this study. A retrospective review of clinical and radiological data was conducted. The L4-L5 disc height and sagittal rotation angle of L3-L4, L4-L5, L5-S1 were measured in the static and dynamic lateral radiographs pre- and postoperatively. RESULTS: There were seven men and six women whose mean age was 37 years(range, 24-49 years). The mean follow-up period was nine months(range, 6-14 months). In all cases the L4-L5 motion segment demonstrated angular motion between flexion and extension with a mean of 4degrees(+/-2.3degrees) of sagittal rotation angle. The disc height increased from preoperative levels by 117%. There was no difference in angular motion of adjacent segments between pre- and postoperative data. CONCLUSION: The prosthetic disc nucleus replacement after discectomy is shown to restore the disc height and maintain segmental mobility.
Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc* ; Male ; Retrospective Studies

PURPOSE: Liver cell damage after ischemia and reperfusion injury has been a major cause of death after liver surgery. Yet there have been no exact and practical guidelines for assessing liver cell damage after ischemia and reperfusion injury. The aim of this study was to estimate the liver cell viability after ischemia and reperfusion injury. METHODS: A 70% partial liver occlusion model with employing Spraque Dawley Rats was used. The ATP content of the liver tissue, the palmitic acid metabolic rate and the histologic change (H/E, TUNEL stain) were all measured at 30 minute intervals to assess liver cell viability during 120 minutes of ischemia. At 24 hours reperfusion after 30, 60 and 120 minutes ischemia, the same parameters and the AST/ALT level in the blood were measured. RESULTS: The ATP content was decreased below 20% compared to normal liver after ischemia, but there were no significant changes in the histology and the palmitic acid metabolic rate during 120 minutes ischemia. At 24 hours reperfusion after 30, 60 and 120 minutes ischemia, the ATP content was decreased to around 50% in all the groups and the palmitic acid metabolic rate was decreased 90.9+/-2.4%, 80.0+/-5.3% and 79.1+/-7.7%, respectively, compared to the control liver. But histologic change was not as great as the change in the ATP content and the palmitic acid metabolic rate. CONCLUSION: Judging by these results, liver has relatively good tolerance during ischemia, but after reperfusion, the liver showed damage depending on the duration of ischemia. This study might be very helpful as a guide line of liver damage after ischemia and reperfusion in both clinical practice and basic research.
Adenosine Triphosphate ; Animals ; Cause of Death ; Cell Survival* ; In Situ Nick-End Labeling ; Ischemia* ; Liver* ; Palmitic Acid ; Rats* ; Reperfusion Injury* ; Reperfusion*

A number of Helicobacter species may confound experimental data because of their association with disease progressing in various kinds of laboratory animals. Screening of Helicobacter species is particularly desirable, because they are prevalent in commercial and research animal facilities. The aim of the present study was to compare three diagnostic methods [e.g. Helicobacter stool antigen kit (HpSA), polymerase chain reaction (PCR) and rapid urease test (RUT)] for the identification of Helicobacter spp. in stools or gastric biopsy specimens collected from eight dogs suffering from gastritis. The gastroscopic biopsy specimens were tested using RUT and PCR, while stool specimens were evaluated using both HpSA and PCR. DNAs from the gastric biopsies and stool specimens were analyzed by both a consensus PCR that amplified the RNA polymerase beta-subunit-coding gene (rpoB) of Helicobacter spp. and a species-specific PCR to amplify the urease B gene of Helicobacter heilmannii, Helicobacter pylori, and Helicobacter felis. Helicobacter spp. were detected in 62.5% of the dogs, while H. heilmannii and H. felis were identified in 37.5 and 25% of the dogs, respectively. The HpSA did not efficiently detect Helicobacter spp. in the stool samples compared to the RUT and PCR assays, both of which successfully detected Helicobacter spp. in the two sample types. Finally, we recommend that consensus PCR with stool specimens could be used before the species-specific PCR for identifying Helicobacter species in laboratory dogs.
Animals ; Animals, Laboratory ; Biopsy ; Cats ; Consensus ; DNA ; DNA-Directed RNA Polymerases ; Dogs* ; Felis ; Gastritis ; Helicobacter felis ; Helicobacter heilmannii ; Helicobacter pylori ; Helicobacter* ; Mass Screening ; Polymerase Chain Reaction ; Urease

BACKGROUND: This study was purposed to identify the knowledge and performance level of the infection control guidelines and to improve their performance level of infection control for those nurses who care patients directly. METHODS: This study was based on the survey questionnaires about infection control guidelines with the total 626 nurses in Seoul and Kyunggi areas for the period between May 26, 2003 and July 14, 2003. RESULTS: The average knowledge level of infection control was 0.84 +/-0.07 (score range 0-1) and the average performance level of the infection control was 4.44+/-10.27 (score range 0-5). The correlation between knowledge and performance of the infection control showed positive correlation (r=.39; P<.001). The knowledge and performance level of the 'Prevention of the central catheter infection' were higher than other infection control guidelines. The performance levels of the 'Prevention of the surgical site infection' were lower than other infection control guidelines. The correlation between knowledge and performance of the 'Prevention of the nosocomial pneumonia' (r=.389; P<.001). 'Prevention of the urinary tract infection' (r=.325; P<.001), 'Prevention of the central catheter infection (r=.290; P<.001) and 'Intravascular infection control' (r=.446; P<.001) showed positive correlation. CONCLUSION: The study demonstrated that the nurses' knowledge and performance of infection control guidelines showed positive correlation. So the education on the infection control is required indispensably and it would contribute to reduce the hospital infection rate by performing the right treatment on the infection control with the basis of accurate knowledge.
Catheters ; Cross Infection ; Education ; Gyeonggi-do ; Humans ; Infection Control* ; Seoul ; Urinary Tract ; Surveys and Questionnaires

No Abstract available.
Infection Control*

BACKGROUND: Intimal hyperplasia and vascular remodeling are major mechanisms of restenosis after coronary artery angioplasty. Angiotensin II causes restenosis by stimulating cell proliferation and vascular constriction and nitric oxide prevents restenosis by inhibiting cell proliferation and stimulating vascular dilatation. Angiotensin converting enzyme (ACE) and nitric oxide synthase (NOS) are the main determinants of the activity of the angiotensin II and the nitric oxide. In this study, we tested whether the genetic polymorphisms of the ACE and the NOS gene are the risk factors of restenosis and whether the effect of the genetic polymorphisms in stent group is different from that in balloon angioplasty group. We also tested whether there are interactions among the polymorphisms. METHODS: We determined ACE I/D polymorphism and NOS A/B and G/T polymorphism in 219patients (77 patients (81 lesions) in stent group and 142 patients (181 lesions) in balloon angioplasty group) who underwent PTCA and follow up coronary angiography in Seoul national university hospital from January 1996 to May 1999. RESULTS: Restenosis (50% of reference diameter) was observed in 78/262(30%) lesions (18/81(22%) lesions in stent group, 60/181(33%) lesions in balloon angioplasty group). ACE DD genotype is the significant risk factor for increment of late luminal loss and loss index in stent group. In stent group, means of the late luminal loss and loss index of the lesions of the DD genotype are 1.12+/-0.61mm and 74.7+/-38.3% and those of the non-DD genotype are 0.72+/-0.77mm and 44.9+/-67.5% but DD genotype is not the risk factor for restenosis after balloon angioplasty. The restenosis rate, late luminal loss and loss index are not significantly different according to NOS polymorphisms. No significant interaction among the polymorphisms is observed. CONCLUSION: ACE DD genotype is a significant risk factor for restenosis after stent insertion but is not a risk factor for restenosis after balloon angioplasty in Korean. This result reflects the different mechanism of restenosis after stent insertion and balloon angioplasty. NOS polymorphisms are not associated with restenosis and no interaction between the polymorphisms is observed.
Angioplasty* ; Angioplasty, Balloon ; Angiotensin II ; Angiotensins* ; Cell Proliferation ; Constriction ; Coronary Angiography ; Coronary Vessels ; Dilatation ; Follow-Up Studies ; Genotype ; Humans ; Hyperplasia ; Korea* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Peptidyl-Dipeptidase A* ; Phenobarbital ; Polymorphism, Genetic ; Risk Factors ; Seoul ; Stents

BACKGROUND AND OBJECTIVES: No-reflow is an important phenomenon for limiting the prognosis of patients following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Coronary stenting is the current standard procedure for primary PCI in AMI. However, stenting is suspected to cause more microembolization, and no-reflow phenomenon. This study was performed to elucidate the risk factors for the no-reflow phenomenon following primary PCI with stenting, in patients with AMI. SUBJCETS AND METHODS: The clinical, angiographic and procedure related parameters were reviewed in patients with AMI that had undergone primary PCI, with stent implantation, within 12 h of the onset of chest pain, at Seoul National University Hospital, Yonsei University Hospital Cardiovascular Center and Chungbuk National University Hospital (n=183). RESULTS: 29 patients (16%) showed no-reflow phenomenon (final TIMI flow grade less than 3). Conventional risk factors for coronary artery disease were not significant risk factors for the no-reflow phenomenon. In a univariate analysis, a high initial CK-MB level (>50 IU) (8.45% vs. 21.9%, p=0.04), low left ventricular ejection fraction (LV EF) (<50%) (19% vs. 5%, p=0.03) and long pre-dilatation balloon inflation time (>30 sec) (31% vs. 15%, p=0.04) were significant risk factors of the no-reflow phenomenon. A low LV EF and long pre-dilatation balloon inflation time were significant risk factors in a multivariate analysis. CONCLUSION: LV dysfunction at presentation and a long pre-dilatation balloon inflation time were independent risk factors for the no-reflow phenomenon following primary PCI with stenting for AMI. Preventive measures against the no-reflow phenomenon should be considered in patients with these risk factors.
Chest Pain ; Chungcheongbuk-do ; Coronary Artery Disease ; Humans ; Inflation, Economic ; Multivariate Analysis ; Myocardial Infarction ; No-Reflow Phenomenon* ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors* ; Seoul ; Stents* ; Stroke Volume

BACKGROUND AND OBJECTIVES: No-reflow is an important phenomenon for limiting the prognosis of patients following primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Coronary stenting is the current standard procedure for primary PCI in AMI. However, stenting is suspected to cause more microembolization, and no-reflow phenomenon. This study was performed to elucidate the risk factors for the no-reflow phenomenon following primary PCI with stenting, in patients with AMI. SUBJCETS AND METHODS: The clinical, angiographic and procedure related parameters were reviewed in patients with AMI that had undergone primary PCI, with stent implantation, within 12 h of the onset of chest pain, at Seoul National University Hospital, Yonsei University Hospital Cardiovascular Center and Chungbuk National University Hospital (n=183). RESULTS: 29 patients (16%) showed no-reflow phenomenon (final TIMI flow grade less than 3). Conventional risk factors for coronary artery disease were not significant risk factors for the no-reflow phenomenon. In a univariate analysis, a high initial CK-MB level (>50 IU) (8.45% vs. 21.9%, p=0.04), low left ventricular ejection fraction (LV EF) (<50%) (19% vs. 5%, p=0.03) and long pre-dilatation balloon inflation time (>30 sec) (31% vs. 15%, p=0.04) were significant risk factors of the no-reflow phenomenon. A low LV EF and long pre-dilatation balloon inflation time were significant risk factors in a multivariate analysis. CONCLUSION: LV dysfunction at presentation and a long pre-dilatation balloon inflation time were independent risk factors for the no-reflow phenomenon following primary PCI with stenting for AMI. Preventive measures against the no-reflow phenomenon should be considered in patients with these risk factors.
Chest Pain ; Chungcheongbuk-do ; Coronary Artery Disease ; Humans ; Inflation, Economic ; Multivariate Analysis ; Myocardial Infarction ; No-Reflow Phenomenon* ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors* ; Seoul ; Stents* ; Stroke Volume

Marfan syndrome may be associated with various cardiovascular complications, but expanding abdominal aneurysm is a relatively rare complication. A 32 year old male patient was admitted to S.N.U.H. because of pulsating abdominal mass and back pain. The patient was diagnosed as a case of expanding abdominal aortic aneurysm and annuloectasia of aorta due to Marfan syndrome. Abdominal aneurysm was located from 3 cm below the origin of left renal artery to left common iliac artery. Abdominal aneurysm was operated successfuly. The size of abdominal aneurysm was about 2815cm. The pathological findings of surgically removed abdominal aortic wall showed loss of elastic fibers and fragmentation of fibers in media. A case of expanding abdominal aortic aneurysm due to Marfan's syndrome was reported with a review of literatures.
Adult ; Aneurysm* ; Aorta ; Aortic Aneurysm, Abdominal ; Back Pain ; Elastic Tissue ; Humans ; Iliac Artery ; Male ; Marfan Syndrome* ; Renal Artery