For the determination of the usefulness of the pulsed Doppler echocardiographic diagnosis of ASD. We evaluated 185 children with congenital heart disase by subxiphoid approach. ASD was diagnosed when abnormal flow was recorded in right atrium. ASD was proved by surgery in 33 of 185 children with congenital heart disease, and all children had sugical correction of their heart deformities. On pulsed Doppler echocardiographic exmination, abnormal flow was recorded in 32 of the 33 children with ASD and 3 of 152 children without ASD. This pulsed Doppler echocardiographic diagnosis of ASD by abnormal flow in right atrium has sensitively of 97% and specificity of 98%. High correlation was found between the estimates of Qp/Qs ratio by Doppler and Fick method(r=0.90, P<0.01). So we concluded that pulsed Doppler echocardiographic diagnosis of ASD was specific and sensitive method and careful pulsed Doppler echocardiographic examination may avoid the unnecessary cardiac catheterizetion in patients with ASD.
Child ; Congenital Abnormalities ; Diagnosis ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Heart ; Heart Atria ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Sensitivity and Specificity

To study the therapeutic effect of ribavirin, a broad spectrum antiviral agent, for chronic hepatitis B in pediatric patients, 24 patients who were diagnosed as chronic hepatitis B (elevated SGOT and SGPT and positive HBsAg and HBeAg for more than 6 months) at the pediatric department of Yeungnam University Hospital from Mar. 1, 1985 to Sep. 30, 1986 were randomly divided into two groups. Ribavirin was administered to 11 patients in dose of 15mg/kg/day and 13 patients were control group and both groups were followed for 12 months. Serum HBsAg and HBeAg were measured with RIA (Ausria-II and Abbott-HBe, respectively) and compared in P/N ratio (counts per minute of patient's sample/counts per minute of normal serum). There were no statistically significant reductions in P/N ratios of HBsAg and HBeAg in both groups between prior to the therapy and 12 months follow-up period. It seems that ribavirin does not have the therapeutic effect on chronic hepatitis B in children. Also, there were no noticeable side effects from ribavirin therapy.
Alanine Transaminase ; Aspartate Aminotransferases ; Child* ; Follow-Up Studies ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Ribavirin*

No abstract available.
Diagnosis* ; Ductus Arteriosus, Patent* ; Echocardiography, Doppler, Pulsed* ; Sensitivity and Specificity*

Neuroblastoma is the most common extracranial solid tumor of childhood which presents various clinical symptoms depending on the primary and metastatic sites. However, it has been rarely reported that sudden onset of blindness was the chief complaint of neuroblastoma. A four years old boy was admitted to the Yeungnam University Hospital with the chief complaint of a sudden onset of blindness due to a distant metastasis of abdominal neuroblastoma to the sphenoid sinus. On admission, both side pupils were dilated without light reflex, fundoscopy showed pale optic disk, electroretinogram was subnormal and visual evoked potential showed no response. The liver was palpable in 3 ½ finger breadth from the right costal margin and adult fist sized mass was palpable in the right flank. Skull X-ray showed destructed sphenoid bone and clinoid process and brain CT scan showed tumor mass in the sphenoid sinus and left orbit. Ultrasonogram and CT scan of the abdomen showed large tumor masses around the right kidney and para-aortic and retropancreatic lymph node. IVP showed displaced right calyceal system with preserved contour. Left supraclavicular lymph node which appeared after admission was biopsied and it showed poorly differentiated neuroblasts. He was treated according to the multiagent chemotherapy schedule for stage IV neuroblastoma patient of children's cancer study group. Abdominal tumor masses and sphenoid sinus mass were markedly reduced after 2 courses of the combination chemotherapy of cyclophosphamide, vincristine, DTIC, adriamycin and VM-26. Eventhough the blindness was not improved, the patient has been in good clinical codition.
Abdomen ; Adult ; Appointments and Schedules ; Blindness* ; Brain ; Cyclophosphamide ; Dacarbazine ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Evoked Potentials, Visual ; Fingers ; Humans ; Kidney ; Liver ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Neuroblastoma* ; Optic Disk ; Orbit ; Pupil ; Reflex ; Skull ; Sphenoid Bone ; Sphenoid Sinus ; Teniposide ; Tomography, X-Ray Computed ; Ultrasonography ; Vincristine

Insulin resistance is a prominent feature of diabetic state and has heterogeneous nature. However, the pathogenetic sequence of events leading to the emergence of the defect in insulin action remains controversial. It is well-known that prolonged hyperglycemia and hyperinsulinemia are one of the causes of development of insulin resistance, but both hyperglycemia and hyperinsulinemia stimulate glucose uptake in peripheral tissue. Therefore, it is hypothesized that insulin resistance may be generated by a kind of protective mechanism preventing cellular hypertrophy. In this study, to evaluate whether the acutely increased glucose uptake inhibits further glucose transport stimulated by insulin, insulin sensitivity was measured after preloaded glucose infusion for 2 hours at various conditions in rats. And also, to evaluate the mechanism of decreased insulin sensitivity, insulin receptor binding affinity and glucose transporter 4 (GLUT4) protein of plasma membrane of gastrocnemius muscle were assayed after hyperinsulinemic euglycemic clamp studies. Experimental animals were divided into five groups according to conditions of preloaded glucose infusion: group I, basal insulin (14+/-1.9 micronU/ml) and basal glucose (75+/-0.7 mg/dl), by normal saline infusion; group II, normal insulin (33+/-3.8 micronU/ml) and hyperglycemia (207+/-6.3 mg/dl), by somatostatin and glucose infusion; group III, hyperinsulinemia (134+/-34.8 micronU/ml) and hyperglycemia (204+/-4.6 mg/dl), by glucose infusion; IV, supramaximal insulin (100+/-2.2 mg/dl), by insulin and glucose infusion; group V, supramaximal insulin(4813+/-687.9 micronU/ml) and hyperglycemia (233+/-3.1 mg/dl), by insulin and glucose infusion. Insulin sensitivity was assessed with hyperinsulinemic euglycemic clamp technique. The amounts of preloaded glucose infusion(gm/kg) were 1.88+/-0.151 in group II, 2.69+/-0.239 in group III, 3.54+/-0.198 in groupIV, and 4.32+/-0.621 in group V. Disappearance rates of glucose (Rd, mg/kg/min) at steady state of hyperinsulinemic euglycemic clamp studies were 16.9+/-3.88 in group I, 13.5+/-1.05 in group II, 11.2+/-1.17 in group III, 13.2+/-2.05 in group IV, and 10.4+/-1.01 in group V. A negative correlation was observed between amount of preloaded glucose and Rd )r=-0.701, p<0.001) when all studies were combined. Insulin receptor binding affinity and content of GLUT4 were not significantly different in all experimental groups. These results suggest that increased glucose uptake may inhibit further glucose transport and lead to decreased insulin sensitivity.
Animals

No abstract available.
Adult* ; Humans ; Lung* ; Pneumocytes* ; Pneumonectomy* ; Rabbits*

BACKGROUND & OBJECTIVES: Severe hemispheric infarction(SHI) reportedly has various range of high mortality. Recently it has been reported that more aggressive therapeutic intervention, such as decompressive hemicraniectomy or mild hypothermia might has potential benefits in the management of SHI. However, the mortality and the prognosis of Sill under the conservative treatment were rarely studied yet in Korea. METHODS: Sixty-six patients with CT proven SHI were subjected among 1649 acute stroke patients registered at the Hallym Stroke Data Bank since Jan. 1993. We analyzed the computerized databases for the mortality and compared inclusively demographic features, clinical characteristics, etiology, therapy modalities and CT findings of fatal group with those of survivors. RESULTS: Twenty-five patients were expired among 66 SI-il patients(mean age: 64.9+/-11.5, male to female ratio;37:29). The mean time to expire was 160.4 hours. The fatal group had a significantly higher incidence of cardioembolism. uncontrolled BP during the acute stage, and extensive infarction territory(MCA+ACA). Risk factors for ischemic stroke such as hypertension, hyperlipidemia. smoking, previous stroke history, diabetes mellitus. and old age were not related to mortality low densities and hyperdense MCA signs on brain imaging were not different between two groups. CONCLUSIONS: The early mortality rate of Sill under the conservative care was 38% in a referral hospital of Korea. intractable hypertension in the acute stage, cardioembolism and extent of infarct area may have predictable values of early mortality of SHI.
Diabetes Mellitus ; Female ; Humans ; Hyperlipidemias ; Hypertension ; Hypothermia ; Incidence ; Infarction ; Korea ; Male ; Mortality* ; Neuroimaging ; Prognosis ; Referral and Consultation ; Risk Factors ; Smoke ; Smoking ; Stroke ; Survivors

Venous angioma and cavernous angioma have its own distinctive characteristics in the pathological, radiological, and clinical points of view. However, the chances of coexistence of two disease entities as the neuroimaging techniques developed, and highlight the possibility made us suspect that they might share the same pathogenesis. When they coexist, the clinical symptoms are almost always caused by cavernous angioma. Here, we report 2 cases of cavernous angioma coexisting with a venous angioma in the posterior fossa presenting acute brainstem dysfunction.
Brain Stem ; Hemangioma* ; Hemangioma, Cavernous* ; Neuroimaging

Objective: When mass casualty incidents occur in Korea, disaster medical assistance teams (DMATs) and public health disaster response teams (PHDRTs) treat casualties at the scene. However, the appropriateness of their on-site responses has not been assessed so far. In this study, we evaluated their response and the variations in their response according to the accessibility of medical care. Methods: We analyzed mass casualty incidents that were reported to the Disaster Emergency Medical Service Situation Room of the National Emergency Medical Center from July 2014 to December 2018. We divided the accident locations into medically underserved areas (MUAs) and adequately served areas (ASAs) and compared the responses of the two teams in each area. Results: Of the 61 incidents, 20 occurred in MUAs, and 41 occurred in ASAs. In MUAs compared to ASAs, time from DMATs' dispatch to arrival was longer (48 [40-58.5] vs. 23 [18-32], P<0.001) but the time taken by the PHDRTs did not vary between two areas (19 [14-35] vs. 15.5 [9-24.5], P=0.263). In MUAs, the time elapsed from the PHDRTs' dispatch to arrival was less than that of the DMATs (48 [40-58.5] vs. 20 [15-35], P<0.001). In MUAs, the distance of the PHDRTs from the scene was lower (31.4 [25-50.95] vs. 13.6 [5.3-19.7], P=0.001) and more members were dispatched to the scene than the DMAT (5 [4-6] vs. 9 [5-10.5], P=0.013). Conclusion Because of the low accessibility to the scene in MUAs, DMATs took a long time to initiate medical support . To provide adequate disaster medical support, the PHDRTs must be specialized and trained.

Upper extremity deep vein thrombosis (DVT) is an unusual condition compared to lower extremity DVT, and it represents about 10% of all DVTs. We report a case of upper extremity DVT after clavicle fracture and immobilization.