Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.
Atrial Flutter ; Atrioventricular Node ; Electric Stimulation ; Humans ; Pacemaker, Artificial ; Sick Sinus Syndrome* ; Sinoatrial Node

No abstract available.
Fibronectins* ; Plasma* ; Pre-Eclampsia*

To investigate effect of fatigue and anticipation on lower extremity joint load during a side-cutting maneuver in female collegiate soccer players, thirteen female collegiate soccer players whose right leg dominant participated in this study. Three dimensional motion analysis system and a force plate were used to record the 45degrees side cutting maneuver. In the first, anticipated and unanticipated cutting were measured in the pre-fatigue condition. Second, participations performed the fatigue protocol by the squat exercise with weight lifting. And then, two different type of cutting task were measured again after fatigue condition. The cutting direction let known before start their running in case of the anticipated cutting, the random signal of cutting direction were presented in the unanticipated condition. In the results, the most influential variable was anticipation factor. Lower limb angles represented significantly flexed posture during unanticipated cutting than anticipated condition. Maximum knee flexion moment represented significantly higher in unanticipated cutting than anticipated cutting. Adduction and internal rotation moment of lower limb joint decreased in unanticipated cutting. Fatigue factor was influenced by the initial contact angles of the ankle joint. Lower limb angles at the initial ground contact indicated more erect posture in post-fatigue condition. The unanticipation factor had more effect on locomotors ability of lower limb in this study. Therefore, the sensory-motor training to adapt to unanticipated situation should be considered for the injury prevention training program.
Ankle Joint ; Anterior Cruciate Ligament ; Fatigue ; Female ; Humans ; Joints ; Knee ; Leg ; Linear Energy Transfer ; Lower Extremity ; Posture ; Running ; Soccer ; Weight Lifting

OBJECTIVE: The goal of study is the evaluation of clinicofunctional outcomes and fusion success rates of unilateral posterior lumbar interbody fusion(PLIF) using cages. METHODS: The authors conducted retrospective study of 81 patients who underwent unilateral PLIF using cages. The outpatient notes, standard hospital charts, and pre-and postoperative imaging studies were analyzed. In this study pre-and postoperative back pain, radiating pain, fusion success rates, pseudoarthrosis, clinicofunctional outcome, and complications were evaluated. Follow-up duration ranged from 3 to 8 years. RESULTS: Eighty-one patients underwent unilateral PLIF using 98 cages(TFC:37, CH cage:25, Novus cage 36). Two-level fusion was performed in 17 patients. There were 48 men(59%) and 33 women(41%). Seventh decade was most common(47%). The most common site of PLIF was at L4-5 space(69.4%) and left side(58%) was prevalent. Fusion was successful in 91 out of 98 levels(92.8%) and pseudoarthrosis was observed in five patients(7 level, 7%). The clinicofunctional results by Prolo scale were as follows:good(score 8-10):80.3%, moderate(score 6-7):14.8%, poor(score 5 or less 5):4.9%. Device migration was observed in six cases:5(20%) of 25 CH cages and 1(2.8%) of 36 Novus cages. CONCLUSION: Unilateral PLIF using cage is one of method to decrease the rates of iatrogenic complications in patient of unilateral symptomatic spinal instability while preserving normal anatomic structures with good fusion success rates and clinicofunctional results after surgery.
Back Pain ; Follow-Up Studies ; Humans ; Outpatients ; Pseudarthrosis ; Retrospective Studies

OBJECTIVE: Extracranial carotid artery aneurysm is a rare vascular disease. In this study, we present our experience with extracranial carotid artery aneurysm and we review the related articles with addressing different treatment options and their results. METHODS: Between 2003 and 2011, 11 patients (mean age : 52.7 years) were diagnosed to harbor extracranial carotid artery aneurysms. Five patients underwent various surgeries and 2 patients were treated by endovascular methods. Four patients were managed conservatively. RESULTS: There were no perioperative/periprocedural mortality or morbidity related to the treatment of extracranial carotid artery aneurysms. During follow-up (mean follow-up : 39.3 months), 1 patient died of an unrelated cause and 2 other patients underwent stenting and/or angioplasty due to asymptomatic progressive stenosis of the treated site. CONCLUSION: Aneurysm can be treated with low periprocedural risk by utilizing various therapeutic modalities. Long-term follow-up is mandatory to check for stenosis around the treatment site.
Aneurysm ; Angioplasty ; Carotid Arteries ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Stents ; Vascular Diseases

Sixty patients with hilar bile duct cancer were operated on during a period of nine years. The tumor was resected in 45 patients (resection rate:75.0%). A hilar resection with regional lymph-node dissection was performed in 27 patients, and various types of hepatic resections were added in 18 patients. A potentially curative resection was achieved in 20 patients (curative resection rate:44.4%). There were two operative deaths (operative mortality:4.4%). The overall cumulative five-year survival rate was 25.6%. Six patients survived for more than five years. The survival was superior in patients with a curative resection and in those with a combined hepatic resection, but this result was statistically insignificant. Regional lymph-node metastasis, gross type, histologic grade, and perineural invasion were significant prognostic factors. We conclud that improved survival in hilar bile duct cancers can be achieved by a radical resection with acceptable morbidity and mortality.
Bile Duct Neoplasms* ; Bile Ducts* ; Bile* ; Humans ; Mortality ; Neoplasm Metastasis ; Survival Rate

BACKGROUND: Bronchoscopy is an essential procedure for identifying the bleeding site and evaluating cause of hemoptysis. However, it is controversial regarding to the timing of bronchoscopy in patients with hemoptysis. Early bronchoscopy, which was performed during hemoptysis or with 48hour after cessation of bleeding, was better for identifying the site of bleeding compared with delayed bronchoscopy, which was performed 48 hours after cessation of bleeding. The diagnostic yield of identifying the bleeding site by bronchoscopy was variable in reported literature and the safety of early bronchoscopy was not mentioned in previous literature. Therefore, we evaluated the efficacy and safety of early bronchoscopy in patients with hemoptysis. METHOD: From October 1994 to August 1996 in Samsung Medical Center, bronchoscopy was performed in patients with hemoptysis. Early bronchoscopy was performed prospectively during hemoptysis or within 48 hours after cessation of bleeding from May 1995 to August 1996. Delayed bronchoscopy group included patients who did not recieved early bronchoscopy at the same period or in whom bronchoscopy was performed 48 hour after cessation of bleeding from October 1994 to May 1995. RESULTS: Early bronchoscopy group was performed 73 times in 71 patients. Delayed bronchoscopy was performed in 57 times in 55 patients. There was no difference as to amount and underlying cause of hemoptysis between both groups. Indentification of bleeding site by visualizing active bleeding was significantly higher in early bronchoscopy(38.3%) than delayed bronchoscopy group (8.7%) (p<0.05). Indentification of bleeding site by bleeding after clot removal was 8 in early and 10 in delayed bronchoscopy. Indentification of bleeding site by visualizing active bleeding and bleeding after clot removal was 36 in early and 15 patients in delayed bronchoscopy(p>0.05). Causes of hemoptysis was found in 18 patients in early and 16 patients in delayed bronchoscopy group. patients who had early bronchoscopy underwent surgery. We diagnosed the site of bleeding in 4 patients preoperatively. In 3 patients we made a treatment plan promptly right after bronchoscopy. Among early bronchoscopy group, bleeding over 100cc during bronchoscopy occurred in 2 patients. In early bronchoscopy group there was no other major complication during bronchoscopy. CONCLUSION: In patients with hemoptysis, early bronchoscopy which performed within 48 hours after cessation of bleeding was more effective procedure for indentifying the bleeding site than delayed bronchoscopy which was performed after 48 hour cessation of bleeding.
Bronchoscopy* ; Hemoptysis* ; Hemorrhage ; Humans ; Prospective Studies

OBJECTIVES: Although bronchoscopy is an important diagnostic tool for lung disease, patients compliance is low due to discomfort. Recently, midazolam which has a favorable anterograde amnesia effect and short action duration, has been used to relieve patients discomfort during bronchoscopy. Midazolam was investigated in order to see the beneficial effect and safety during bronchoscopy. METHODS: The study design was single blind, randomized, prospective. 102 patients were included, in whom bronchoscopy was performed between June, 19% and October, 1995 at Samsung Medical Center. They were categorized into midazolam group and control group. Patients were asked about the amnesic effect, discomfort of procedure and the willingness to repeat procedure. The consciousness level of patients during procedure, patient cooperation during procedure and ease of procedure were also reported by bronchoscopists. RESULTS: 1) The difference of oxygen saturation between two groups: There was no significant difference in oxygen saturation between midazolam group and control group before and after bronchoscopy. During procedure, however, mean oxygen saturations in midazolam group (90+/-6.4%) was significantly lower than in control group (93+/-4.7%)(p<0.05). 2) Evaluations by patients (1) Effect of amnesia: 41 patients (82%) in midazolam group could not recall the procedure but 52 patients (100%) recalled the entire procedure in control group. A favorable amnesic effects could be found in midazolam group(p<0.05). {2) The discomfort during the procedure: 43 patents(86%) did not experience discomfort from procedure in midazolam group but 25 patients(48%) complained of discomfort in control group (p<0.05). (3) Most patients except two(96%) were willing to repeat fiberoptic bronchoscopy in midazolam group but 13 patients (25%) answered that they would never repeat bronchoscapy. There was a statistically significant difference between two groups in the willingness to repeat bronchocopy (p<0.05). 3) The evaluations by bronchoscopists Cooperations of the patients and ease of procedure were not different between two groups. The patients in midazolam group except eight could not respond to verbal stimuli but most patients were awakened during procedure in control group(p<0.05). CONCLUSION: Midazolam is a good sedative agent for a patient to give a favorable amnesia, reduction of discomfort during bronchoscopy. We concluded that midazolam is a safe and useful sedative agent and midazolam may be used routinely during bronchoscopy. Monitoring of oxygen saturation, however, is essential to prevent severe hypoxia during procedure.
Amnesia ; Amnesia, Anterograde ; Anoxia ; Bronchoscopy* ; Compliance ; Consciousness ; Humans ; Lung Diseases ; Midazolam* ; Oxygen ; Patient Compliance ; Prospective Studies*

OBJECTIVE: Sonography is a noninvasive and safe bedside imaging modality that provides rapid and repeatable real-time radiological evaluations without a radiation hazard. However, sonography has not gained widespread acceptance as a diagnostic tool in adult brain disease because of limited imaging resolution through the bony window. We investigated the diagnostic potential and clinical usefulness of bedside brain sonography through surgical bone defects in neurosurgical patients. METHODS: We evaluated twelve patients, each of whom had undergone a decompressive craniectomy, via bedside sonography, and performed comparison CT or MRI for all patients. RESULTS: We obtained reliable information regarding anatomical structure displacement, ventricle systems, intracranial fluid collection, presence and distribution of cerebral infarctions, and hemorrhages. We performed several interventional trials under sonography guidance, including aspiration of entrapped fluid collection and insertion of an external ventricular drainage catheter into a collapsed and displaced ventricle cavity. CONCLUSION: Bedside sonography through surgically created bone defects is a non-invasive method that physicians can repeat as required with no radiation hazard, and it is of particular value in emergent and critical situations when conventional neuroimages are unobtainable. Bedside sonography can be a first-line monitoring tool, in lieu of CT, for critically ill patients with surgical cranial defects.
Adult ; Brain ; Brain Diseases ; Catheters ; Cerebral Infarction ; Critical Illness ; Decompressive Craniectomy ; Displacement (Psychology) ; Drainage ; Hemorrhage ; Humans ; Neurosurgery ; Ultrasonography, Doppler

Rheumatoid arthritis patients have an increased risk of subclinical cardiovascular disease, and they also have a high prevalence of carotid disease and peripheral arterial disease as a form of vasculitis. Rheumatoid arthritis patients have an increased cardiovascular mortality rate and an increased premature death rate, and they have a higher incidence of atherosclerosis. Myocardial infarction due to vasculitis is a rare complication for patients with rheumatoid vasculitis. We report here on a case of a patient with multiorgan involvement who developed myocardial infarction, right carotid artery occlusion and left renal artery occlusion secondary to his rheumatoid vasculitis.
Arthritis, Rheumatoid ; Atherosclerosis ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Stenosis ; Humans ; Incidence ; Mortality ; Mortality, Premature ; Myocardial Infarction* ; Peripheral Arterial Disease ; Prevalence ; Renal Artery ; Rheumatoid Vasculitis* ; Vasculitis