No abstract available.
Down Syndrome* ; Leukemia, Megakaryoblastic, Acute*

BACKGROUND: Early diagnosis and proper therapy of malfunctioning prosthetic heart valves remain a challange. Transthoracic echocardiography(TTE) is the diagnostic procedure of choice for the evaluation of malfunctioning prosthetic heart valves. Howerver, TTE may be limited owing to poor acoustic windows. Some of these limitations can be overcome by transesophageal echocardiography(TTE). METHODS: The study comprised 33 consecutive patients(20 male and 13 famale patients, age range 20 to 59) in congestive heart failure after remote mitral valve replacement with bioprosthesis. The patients were examined between 1987 and 1994. All the 33 patients were studied by TTE and 19 patients among these patients furthermore by TEE. The morphology of the explanted bioprosthesis was confirmed by surgery in all cases. RESULTS: The abnormalities of the bioprosthesis were diagnosed correctly by TTE in 32 cases. The more detailed morphology of the valves could be observed by TEE(19 cases). Only in one case a small thrombus in left atrium was overlooked in TTE examination, on the otherhand it was detectedd by TEE. The severity grade of mitral regurgitation was estimatedca. I' severer by TEE in 8 cases. In all TEE examination spontaneous echocontrast was observed in left atrium. The bioprostheses from CE(Carpentier-Edwards) showed higher tendency to cuspal tearing and perforation. CONCLUSION: TTE is the diagnostic procedure of choice on patients with bioprosthetic mitral valve replacement. TTE examination confirms immediately clinical diagnosis of bioprosthetic failure. The transesophageal approach promises more detailed informations about lesions of the degenerated bioprosthetic valves and left atrium.
Acoustics ; Bioprosthesis ; Diagnosis* ; Early Diagnosis ; Echocardiography, Transesophageal* ; Estrogens, Conjugated (USP)* ; Heart Atria ; Heart Failure* ; Heart Valves ; Humans ; Male ; Mitral Valve Insufficiency ; Mitral Valve* ; Thrombosis

No abstract available.
Myelitis, Transverse*

No abstract available.
Regeneration*

OBJECTIVES: Hemophilia B has been known to result from more than 500 kinds of mutations. And it is difficult to find out a mutation specific for each family. Therefore, linkage analysis of DNA polymorphism within or near the factor IX gene has been frequently used in the clinical practice for molecular genetic diagnosis of hemophilia B. But the ethnic variation makes more difficult to apply useful markers in Caucasian population. To investigate the usefulness of the MseI and HhaI polymorphism in Korean population, we analysed the MseI and HhaI polymorphism. METHODS: Forty-five normal Korean and thirteen parents of the hemophilia B patients, using PCR and restriction enzyme analysis. RESULTS: The heterozygosity rate of MseI polymorphism was 49.7% and that of HhaI polymorphism was 25.5%. CONCLUSION: These data indicated that PCR-based analysis of MseI and HhaI polymorphism of factor IX was useful in molecular genetic diagnosis of hemophilia B in Korean population.
Diagnosis* ; DNA* ; Factor IX* ; Hemophilia A* ; Hemophilia B* ; Humans ; Molecular Biology* ; Parents ; Polymerase Chain Reaction ; Prenatal Diagnosis ; Restriction Mapping

We noticed a group of thoracolumbar and lumbar spine fractures showing a unique fracture pattern that consisted of 1) superior disc injury, 2) crush fracture of the upper half of the vertebral body, 3) sagittal fracture of the lower half of the vertebral body, 4) bone fragments in the spinal canal, and 5) lamina fracture. Some of these fracture patterns were present in type B burst fracture of Denis classification. The purpose of this study was to compare the difference between crush-cleavage fracture and type B burst fracture in the viewpoint of neural canal involvement and neurologic status, and functional outcome with surgical treatment. Ten cases were identified as crush-cleavage fractures in 22 type B burst fractures during a 5 year period from Mar. 1989 to Jun. 1993 at the Department of Orthopedic Surgery of Chonbuk National University Hospital. Four out of 10 crush-cleavage fractures and 4 out of 12 type B burst fractures were paraparetic. Crush-cleavage fracture must be an unstable thoracolumbar comminuted fracture, but there were no significant differences in the neural canal involvement, incidence of neurologic deficit, and in the functional outcome, compared with type B burst fracture (P>0.05). It could be classified as a progressed form of type B burst fracture in Denis classification, or as a burst-split fracture in Magerl classification in the anatomical viewpoint. In conclusion, crush-cleavage fracture must be a variant of burst fracture.
Classification ; Fractures, Comminuted ; Incidence ; Jeollabuk-do ; Neural Tube ; Neurologic Manifestations ; Orthopedics ; Spinal Canal ; Spine

Purpose: This study aimed to explore the difficulties and coping that advanced practice nurses (APNs) experience in home health nursing field. Methods: The participants were 12 APNs who had experience in home health nursing for over 5 years. Data were collected through two focus group interviews between August and September, 2017. The results were analyzed using a qualitative content analysis. Results: Out of 10 sub-categories and 29 codes, 4 categories emerged: “crushed by the responsibilities as the only healthcare professional”, “worn out by family who interfere with work”, “anxiety about my safety being threatened” and “using self-learned know-hows”. Conclusion APNs face difficulties due to the environmental characteristics of the homes, the characteristics of chronically critically ill (CCI) patients and their families, and legal or systematical limitations when dealing with problems based on their personal competence. In order to ensure that professional nursing care is more readily provided to CCI patients through home health nursing services in local communities, it is imperative that support systems at the organizational and institutional levels be established in a systematic way to resolve the issues faced by APNs.

No abstract available.
Diagnosis*

BACKGROUND: The aim of this randomized double-blinded study was to determine the optimal concentration of alfentanil with 0.15% ropivacaine for postoperative patient-controlled epidural analgesia. METHODS: Forty five patients undergoing major abdominal surgery under general anesthesia were assigned to groups receiving patient-controlled thoracic epidural analgesia with 0.15% ropivacaine + 45 microgram/ml alfentanil (Group I), 75microgram/ml alfentanil (Group II), 150 microgram/ml alfentanil (Group III). The incidence of side effects and additional analgesic use, VAS (visual analog pain scale) on resting and coughing, and patient's satisfaction were checked for 24 hours after a loading dose injection. RESULTS: The VAS on coughing and resting 1 hour after the loading dose injection were significantly lower in Groups II and III than in Group I. The patients in group II were more satisfied with the result than those in Group I. CONCLUSIONS: A combination of 0.15% ropivacaine and 75microgram/ml alfentanil for thoracic epidural analgesia after major abdominal surgery provides the best analgesia with minimal side effects and a higher level of patient's satisfaction.
Alfentanil* ; Analgesia ; Analgesia, Epidural* ; Anesthesia, General ; Cough ; Humans ; Incidence

BACKGROUND:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. MATERIAL AND METHOD: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. RESULT: Mean age was 68+/-1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 +/-0.81 and mean aortic cross-cramp time was 69.84+/-18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23+/-10.62% preoperatively to 58.14+/-9.88% postoperatively(p<0.05). Postoperative complication was pneumonia in 2 patients, acute renal failure in 2 patients, sternal wound infection in 1 patient, and postoperative myocardial infarction in 1 patient. There were two postoperative deaths. The causes of deaths were low output syndrome in one patient, and sepsis due to pneumonia in the other patient. The hospital mortality was higher in the elderly group(4.4 versus 2.86%) but was not statistically significant(p>.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27+/-12.51 vs 15.55+/-6.99 days; p<0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean: 23.58+/-19.56 months). There was no late mortality of cardiac origin. CONCLUSION: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.
Acute Kidney Injury ; Age Factors ; Aged* ; Cause of Death ; Coronary Artery Bypass* ; Coronary Vessels* ; Emergencies ; Follow-Up Studies ; Hospital Mortality ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Sepsis ; Stroke Volume ; Survivors ; Wound Infection