BACKGROUND: In an effort to improve the diagnostic accuracy of the exercise electrocardiography (ECG) to detect coronary artery disease, exercise-induced changes in Q, R and S wave amplitudes has been evaluated in conjunction with or without ST segment changes. We measured the exercise-induced changes in Q, R and S wave amplitudes, and calculated the Athens QRS score to assess its diagnostic value. MATERIALS AND METHOD: Fifty patients who underwent the exercise test and MIBI myocardial scan and were proved to have coronary artery diameter stenosis > or =50% in coronary angiography were included in the patient group. Data of forty-nine persons showing negative findings in the exercise test and MIBI scan were used as control. The exercise test was performed according to the modified Bruce protocol using Marquette case 16. Exercise ECG was positive in 58% (29/50) of the patient group. The Q, R and S wave amplitudes at peak exercise were subtracted from the values of standing position at rest to obtain Athens QRS score. RESULTS: The mean age of patients and control were 54.5+/-9.4 years and 49.8+/-11.4 years respectively (p=NS), and their exercise capacity was 8.5+/-3.1 mets and 9.8+/-1.9 mets respectively (p=NS). The values of delta(R-Q-S)V5 + delta(R-Q-S)aVF and delta(R-Q-S)aVF were significantly lower in patients than the control (0.85+/-6.60 mm vs 3.72+/-5.09 mm, p=0.017, -0.60+/-4.76 mm vs 1.00+/-2.72 mm, p=0.030), and the values of deltaQV5 and deltaSaVF were significantly higher in patients than the control (-0.045+/-0.65 mm vs -0.41+/-0.78 mm, p=0.012, -0.84+/-1.90 mm vs -1.62+/-1.60 mm, p=0.009). However, the values were too widely overlaped between the patients and the control to give diagnostic cutoff points. CONCLUSION: It seems that exercise QRS scores do not have additive diagnostic value for coronary artery disease.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Electrocardiography ; Exercise Test ; Humans

Thirty one free vascularized fibula bone grafts were performed for treatment of osteonecrosis of the femoral head in 26 patients, 24 men and 2 women aged from 16 to 48(mean:32 years). Twenty one patients had unilateral disease. Five patients had bilateral disease underwent staged bilateral free vascularized fibula grafts three months apart. Associated etiological factors included alcohol(9 patients), steroid(7 patients), and trauma(one patient). The condition was considered idiopathic in the remaining 9 patients. Radiologic staging by Ficat included stage 1 in one hip, stage II in 15 hips, stage III in 14 hips, and stage IV in one hip. A skin island flap was used for monitoring purpose for the grafted fibula. One monitoring, flap was necrotized due to vascular occlusion but the fibula bone graft was left in place to use as a nonvascularized bone graft. Average follow-up period was 21 months in 31 hips. Pain was relieved in 28 hips(93.3 percent) and aggravated in 2 hips(6.7 per cent). On radiographic evaluation, 26 hips(86.7 per cent) demonstrated excellent preservation of the femoral head contour. Progressive collapse of the femoral head (greater than 1-2 mm) occurred in 2 hips, i mm depression in one hip with stage III and 2 mm collapse in one hip with stage IV. In conclusion, the free vascularized fibula bone graft is an excellent treatment modality for preserving the femoral head and relieving symptoms in cases of the osteonecrosis of the femoral head.
Depression ; Female ; Fibula* ; Follow-Up Studies ; Head* ; Hip ; Humans ; Male ; Osteonecrosis* ; Skin ; Transplants

The number of cancers in the head and neck areas has been increasing due to the increasing life span of the patients and a free flap is a common procedure to reconstruct defect in the head and neck area. From March 1990 to February 1998, 105 patients underwent 110 free flap operations after head and neck cancer ablation and they were reviewed retrospectively. Among 110 free flaps, 93 are forearm flaps, 6 jejunal flaps, 5 vascularized fibular osteocutaneous flaps, 2 lateral arm flaps, 2 rectus abdominis myocutaneous flaps and 1 latissimus dorsi muscle flap and 1 latissimus dorsi myocutaneous flap. Sixty-five radial forearm flaps and 4 ulnar forearm flaps were utilized in patched type and 24 radial forearm flaps in tubed type mainly for the reconstruction of intraoral and hypopharyngeal defects. Sis jejunal flaps were utilized for the esophageal reconstruction and 5 vascularized fibular osteocutaneous flaps for the mandibular reconstruction. The remaining flaps were for the reconstruction of other areas of head and neck.Overall survival rate of the flap was 95.5%. Immediate complications were fistula formation(3 cases), total flap loss (4 cases) or partial flap loss(3 cases) and donor site problems(10 cases). Superior thyrodial artery was the most commonly used recipient artery(89 cases) which was followed by facial artery, lingual artery and transverse cervical artery. Size discrepancy was not remarkable between the donor and recipient arteries. However, there was usually a marked size discrepancy between donor and recipient veins. More than two venous anastomoses were performed to increase the success rate of the flap surgery. An average follow-up period was 38 months ranging from 3 months to 6 years. There was no patient who died during or right after the operations, but 23 patients died due to recurrence of tumors or underlying heart disease during the follow-up period. Remaining patients lived well excluding 6 late postoperative complications such as 4 cases of esophageal stenosis and 2 cases of osteoradionecrosis. We conclude that free flap reconstruction after head and neck cancer ablation improves the quality of life and minimizes the loss of function.
Arm ; Arteries ; Esophageal Stenosis ; Fistula ; Follow-Up Studies ; Forearm ; Free Tissue Flaps* ; Head and Neck Neoplasms* ; Head* ; Heart Diseases ; Humans ; Mandibular Reconstruction ; Myocutaneous Flap ; Neck ; Osteoradionecrosis ; Postoperative Complications ; Quality of Life ; Rectus Abdominis ; Recurrence ; Retrospective Studies ; Superficial Back Muscles ; Survival Rate ; Tissue Donors ; Veins

We report on a 28 years old female with recurred cardiac myxomas who presented with dizziness, headache, and blurred vision. She had an excision of biatrial atrial myxomas 10 years age. Varying sized multiple cerebral aneuysms and myxomas in left atrium and left ventricle were found on a cerebral angiogram and echocardiogram, respectively. After wide excision including interatrial septum and part of left ventricular septum, her symptoms were much improved.
Adult ; Dizziness ; Female ; Headache ; Heart Atria ; Heart Ventricles ; Humans ; Intracranial Aneurysm ; Myxoma* ; Ventricular Septum

OBJECTIVES: This research used queueing theory to analyze changes in outpatients' waiting times before and after the introduction of Electronic Medical Record (EMR) systems. METHODS: We focused on the exact drawing of two fundamental parameters for queueing analysis, arrival rate (λ) and service rate (µ), from digital data to apply queueing theory to the analysis of outpatients' waiting times. We used outpatients' reception times and consultation finish times to calculate the arrival and service rates, respectively. RESULTS: Using queueing theory, we could calculate waiting time excluding distorted values from the digital data and distortion factors, such as arrival before the hospital open time, which occurs frequently in the initial stage of a queueing system. We analyzed changes in outpatients' waiting times before and after the introduction of EMR using the methodology proposed in this paper, and found that the outpatients' waiting time decreases after the introduction of EMR. More specifically, the outpatients' waiting times in the target public hospitals have decreased by rates in the range between 44% and 78%. CONCLUSIONS: It is possible to analyze waiting times while minimizing input errors and limitations influencing consultation procedures if we use digital data and apply the queueing theory. Our results verify that the introduction of EMR contributes to the improvement of patient services by decreasing outpatients' waiting time, or by increasing efficiency. It is also expected that our methodology or its expansion could contribute to the improvement of hospital service by assisting the identification and resolution of bottlenecks in the outpatient consultation process.
Delivery of Health Care ; Electronic Health Records ; Hospitals, Public ; Humans ; Outpatients

Hemangiopericytoma of the kidney is extremely rare, which is very much resembled a renal cell carcinoma. It tends to grow slowly but occasionally had demonstrated rapid infiltration and distant metastasis. The incidence and degree of its malignancy appears to be low. Herein we report a case of hemangiopericytoma which was developed from left kidney in 42 old man and treated with radical nephrectomy.
Carcinoma, Renal Cell ; Hemangiopericytoma* ; Incidence ; Kidney ; Neoplasm Metastasis ; Nephrectomy

PURPOSE: This study attempted to investigate the frequency, duration, and risk factors of antibiotic-associated diarrhea (AAD) in infants hospitalized due to febrile urinary tract infection (UTI). This is a basic research on the probiotics used in the prevention and treatment of AAD in infants. METHODS: Medical records of the infants aged 3-6 months hospitalized in Gachon University Gil Hospital from January 2008 to September 2010 due to the febrile UTI were retrospectively reviewed. The episodes of loose or watery stool were investigated for frequency, onset, and duration. Those who had AAD and those who did not (non-AAD) were compared. The antibiotic regimens and the episodes of diarrhea were investigated in AAD group. RESULTS: Total 147 infants were included. Fifty-four (36.7%) showed AAD. Intravenous third-generation cephalosporin (3rd CS) single therapy was used for 102 patients (69.4%), the 3rd CS and non-3rd CS combination therapy for 24 (16.3%), and non-3rd CS combination therapy for 21 (14.3%). There was no significant difference in the dose of cefotaxime between AAD and non-AAD group (P=0.601). According to the antibiotic therapies above, in AAD group, there was no significant difference in the onset and duration of diarrhea respectively (P=0.717, P=0.830). Although the frequency of diarrhea was higher for the 3rd CS and non-3rd CS combination therapy subgroup with 9.25+/-5.30 times/day than the other two subgroups (7.58+/-2.97 times/day in 3rd CS single therapy subgroup, 6.75+/-4.40 times/day in non-3rd CS combination therapy subgroup), there was no statistical significance (P=0.078). CONCLUSION: AAD seems common to the infants aged 3-6 months with febrile UTI, regardless of regimen and amount of antibiotics in usual dosage. Further research on the effects of probiotics used in the prevention and treatment of AAD in infants is warranted.
Aged ; Anti-Bacterial Agents ; Cefotaxime ; Child ; Diarrhea ; Humans ; Infant ; Medical Records ; Probiotics ; Retrospective Studies ; Risk Factors ; Urinary Tract ; Urinary Tract Infections

BACKGROUND: Nonrheumatic atrial fibrillation is common in elderly and associated with an increased risk for thromboembolism. Left atrial spontaneous echo contrast(SEC) and thrombus. which are easily detected by transesophageal echocardiography(TEE) in patients with rheumatic mitral valve disease and atrial fibrillation, have been known as markers of thromboembolism. However, most of the previous studies on left atrial SEC and thrombus were performed in rheumatic mitral valve disease or various conditions including rheumatic mitral valve disease. Therefore this study was underaken in order to investigatd 1) the prevalence of left atrial SEC and thrombus, and 2) clinical and echocardiographic variables related to left atrial SEC and thrombus in nonrheumatic atrial fibrillation. METHODS: In patients with estabished atrial fibrillation over 7 days, we examined the clinical gistory and performed transthoracic echocardiography(TTE) and TEE simultaneously. Enlisted patients were those without rheumatic mitral valve disease, prosthetic valves, previous thromboembolism, and recent anticoagulant therapy. RESULTS: 1) Left atrial SEC was detected in 32(62.7%) of 51 patients and left atrial thrombus in 10(19.6%). All thrombi were located in the left atrial appendage. 2) In univariate analysis, SEC positive group showed higher prevalence of congestive heart failure(CHF)(56.3% vs 0%, p<0.001), lower ejection fraction(42.2+/-14.1% vs 50.8+/-9.7%, p<0.05), lower left atrial appendage blood flow velocity(peak positive flow velocity ; 18.7+/-11.1cm/sec vs 32+/-12.4cm/sec, p<0.01, and peak negative flow velocity ; 21.4+/-12.4cm/sec vs 31.9+/-12.8cm/sec, p<0.01) than SEC negative group. Multivariate analysis identifed CHF as an independent variable related to left atrial SEC(p=0.02, Odds ratio ; 2.38, 95% CI ; 1.18-4.82). 3) In univariate analysis. left atrial thrombus positive group showed higher prevalence of CHF(70% vs 26.8%, p<0.05), larger left atrial demension(34+/-3.4mm/m2 vs 30.6+/-4.6mm/m2, p<0.05) than thrombus negative group. Multivariate analysis identifed CHF as an independent variable related to left atrial thrombus(p=0.04, Odds ratio ; 4.30, 95% CI ; 1.11-16.68). 4) Left atrial thrombus is more frequent in SEC positive group than in SEC negative group(28.1% vs 5.3%), however, there was no statistical significance(p=0.07). CONCLUSION: 1) Left atrial SEC is common in nonrheumatic atrial fibrillation and significantly related to CHF. 2) Left atrial thrombus is frequently detected in SEC positive patients, however, it is more realted to CHF than left atrial SEC itself.
Aged ; Atrial Appendage ; Atrial Fibrillation* ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Mitral Valve ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Thromboembolism ; Thrombosis*

BACKGROUND: Twenty-four-hour ambulatory blood pressure(ABP) monitoring has become increasingly popular for diagnosing and treating hypertension. Therefore the reference value of normotensive subjects was necessary for interpretation of hypertensive subjects. Several studies were reported on reference values in normotensive subjects. The purpose of this study was to determine 24-hour ABP in normotensive Korean adults stratified for sex and five age groups. This study also assessed ABP in relation to a family history of hypertension, smoking and body mass index(BMI). METHODS: ABP monitoring was performed in 200 healthy normotensive volunteers(ranged in age from 20 to 69 years, five decades, 20 men and 20 women per each decade), over 24 hours, taking measurement at 30-min intervals. The 24-hour interval was divided into day-time(6am-10pm) and night-time(100pm-6am) periods. Mean ABP and pressure loads(percentage of systolic readings>140mmHg, diastolic readings>90mmHg) were obtained. RESULTS: The mean ABP in 200 subjects was 113+/-8.6/72+/-6.9mmHg over 24 hours, 117+/-9.7/75+/-7.0mmHg during day-time, and 106+/-9.8/67+/-8.3mmHg at night-time, and pressure loadd averaged 5.1+/-7.4/7.9+/-8.9% over 24 hours. The +2 standard deviation(SD) as the upper limit of normal was 130/86mmHg over 24 hours in 200 subjects. The mean ABP and pressure load were 116+/-7.6/74+/-7.6mmHg and 6.4+/-8.3/10.1+/-10.2% in 100 subjects of men, and 110+/-8.3+/-70+/-6.6mmHg, 3.7+/-6.0/5.7+/-6.8% in women. Mean ABP and pressure load showed significant difference in relation to age group and sex, however, no significant difference in relation to a family history of hypertension or smoking. In relation to BMI group, diastolic blood pressure and diastolic pressure load were significantly different.
Adult* ; Blood Pressure* ; Female ; Humans ; Hypertension ; Male ; Reference Values ; Smoke ; Smoking

PURPOSE: The authors accessed the anthropometric measurements of fourty non-cleft normal a three-month- old infant and using this obtained data as a basic guideline, authors applied the modified Noordhoff technique for the treatment of bilateral cleft lip. METHODS: Over a period of 10 years, a total of 21 bilateral cleft lips were operated. 13 cases of complete and 8 cases of incomplete bilateral cleft lip and palate. In the complete type of bilateral cleft palate, elastic head cap and passive intraoral appliance were applied at 1 to 2 week of age for 2 months duration. The definitive cheiloplasty was performed at 3 months of age using the modified Noordhoff technique. RESULTS: After a follow-up period ranging one to nine years, most patients presented with cosmetically and functionally satisfying results, with an exception of two cases where an undesired peaking effect of the vermilion and dimpling of the vermilion mucosa was encountered. CONCLUSION: Accessing the anthropometric measurements of fourty non-cleft normal three-month-old infant and using this obtained dara as a guideline, the modified Noordhoff technique can be applied to either complete or incomplete bilaterally cleft lip providing more naturally pleasing and cosmetically satisfying scars that lie in harmony with the philtral ridges, lip tubercle positioned just below the vermilion and a distinct white line and Cupid's bow.
Cicatrix ; Cleft Lip* ; Cleft Palate ; Follow-Up Studies ; Head ; Humans ; Infant ; Lip ; Mucous Membrane ; Palate