Torsades de pointes is characterized by paroxysms of ventricular tachycardia at rates typically greater than 200 beats/min in which QRS morphology shows alternating polarity in an undulating pattern so that the complexes appear to be twisting about the beseline;this arrhythmia is virtually always associated with prolongation of the QT interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administred. Torsades de pointes was diagnosed in 4 patients;the first with hypokalemia, the second with congenital QT prolongation syndrome, the third with amiodarone, the fourth with organophosphorous and hypokalemia. Treatment of these patients consisted of potassium supply, isoproterenol, lidocaine, phenobarbital, tenormin, phenytoin, cardioversion, atropine. Three patients improved successfully, but one patient died, as a direct result of the ensuing ventricular fibrillation and cardiac arrest on one hour after admission.
Amiodarone ; Arrhythmias, Cardiac ; Atenolol ; Atropine ; Electric Countershock ; Fatal Outcome ; Heart Arrest ; Humans ; Hypokalemia ; Isoproterenol ; Lidocaine ; Phenobarbital ; Phenytoin ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes* ; Ventricular Fibrillation

BACKGROUND: The exercise stress testing(Treadmill Test) is one of the preferred noninvasive methods of identifying patients with coronary artery disease. ST-segment elevation during or immediately after exercise is uncommon and in most patients, it was associated with prior infarction, left ventricular hypertrophy or left bundle branch block, Exercise-induced ST-segment elevation has been attributed to ventricular wall motion abnormalities, and ischemia due to either coronary vasospasm or ervere proximal coronary stenosis. We examined the clinical, angiographic, and prognostic significance of 16 patients with exercise induced ST-segment elevation. METHODS: 16 patients with exercise-induced ST-segment elevation were retrospectively reviewed. The symptom-limited exercis testing was performedn using a modified Bruce protocol and in patients with acute myocardial infarction(AMI), low level exercise testing(Myocardial infarction protocol) was used. The significant ST-segment elecation was defined as a > or =1mm change present in >1 lead measured at 0.08 sec after J point and in > or =3 consecutive beats. Coronary arteriogram and percutaneous transluminal coronary angioplasty(PTCA) was performed using standard techniques within 7 days of initial exercise testing and a luminal diameter stenosis of >50% was considered significant. RESULTS: 1) We have studied 2076 exercise tests and 16 patients(M/F:15/1, Mean age : 58 years) developed exercise-induced ST-segment elevation. The initial diagnosis were acute myoca rdial infarction(AMI) in 12, variant angina in 2, effort angina in 1 and unstable angina in 1 patient. 9 of 12 patients with AMI were treated with thrombolytic agent(Urokinase 2.5 to 3 million unit) within 6 hours from the onset of chest pain. 2) Mean maximal ST-segment elevation was 2.6mm(range 1-5mm). The leads which showed exercise-induced ST-segment elevation were corresponded to the location of severe coronary stenosis in typical effort angina, to spasm site in variant angina, and to infarction site in AMI. 11 Patients had follow-up exercise testing and showed abolition of exercise-induced ST-segment elevation in 4 of 5 patients with AMI and 1 patient with effort angina after PTCA, and 1 patient with variant angina and 3 of 4 patient with AMI after medication. 3) In 12 patients, coronary angiography was performed, and showed 95% and 90% stenosis at proximal LAD in 2 patients with effort angina and >80% stenosis at proximal or mid lesion of infarct-related artery in 7 patients with AMI. In variant angina, one patient showed normal coronary artery and another patient showed 60% stenosis at mid LAD. On LV angiogram, there were moderate to severe hypokinesia instead of akinesia or dyskinesia at infarction site in all patients with AMI and showed normal LV contractility in patients with effort or variant angina. PTCA were successfully performed in 7 patients(effort angina 2, AMI 5). 4) The clinical follow up for 16 patients were obtained for mean follow-up duration of 17 months and during the clinical follow-up, 1 variant angina patient with mild stenosis at proximal LAD was died with ventricular fibrillation after discontinution of medication. There were CABG due to restenosis in 1 patient and cerebrovascular accident in 1 patient. CONCLUSION: 1) The exercise-induced ST-segment elevation signifies severe ischemia due to either severe proximal coronary stenosis or coronary arterial spasm. In AMI, this findings suggests the residual ischemia(or residual viable myocardium) in addition to left ventricular dyssynergy or aneurysm. 2) Adverse cardiac events can be provented by revascularization in patients who had critical coronary stenosis and by medical therapy in those with coronary vasospasm or mild coronary stenosis.
Aneurysm ; Angina, Unstable ; Arteries ; Bundle-Branch Block ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vasospasm ; Coronary Vessels ; Diagnosis ; Dyskinesias ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; Hypokinesia ; Infarction ; Ischemia ; Phenobarbital ; Retrospective Studies ; Spasm ; Stroke ; Ventricular Fibrillation

No abstract available.
Cervix Uteri* ; Female ; Lymph Nodes* ; Neoplasm Metastasis*

We report a case of childhood dermatomyositis t.hat developed in a 10-year-old boy. Skin lesion showed malar erythema, Gottron's papule, and poikiloderma those were compatible with dermatomyositis. And other clinical, laboratory, and histopathologic findings supported the diagnosis of derrnatomyositis. We treated him with oral corticosteroid, the lesion was improved and regular periodic follow up was attempted. From summary of all data of patient, this case was typical Brunsting type of childhood dermatomyositis.
Child ; Dermatomyositis* ; Diagnosis ; Erythema ; Follow-Up Studies ; Humans ; Male ; Skin

It now appears that in addition to being a target for immunologic injury, the epidermis actively participate in various immunologic processes and thus may serve as the peripheral limb of the immune system. For example, keratinocytes produce the cytokines including IL-1 and in certain inflammatory diseases characterized by accumulation of T lymphocytes, kerationchtes aberrantly express HLA-DR antigen. In this study, the effect of interferon-gamma on keratinocytes IL-1alpha production were invesigated by radioimmunoassay, using as a model cultured keratinocytes stimulated with 30U/ml of recombinant-Interferon-gamma(IFN), IFN and 1microgram/ml of PMA(IFN-PMA), IFN-gamma and 25microgram/ml of LPS(IFN-LPS), PMA, and LPS. The expression of HLA-DR antigen and the effect of IFN-gammaon the proliferation of kerationcytes were also evaluated. The results were as follows: 1. The proliferation of keratinocytes was significantly inhibited in the IFN, IFN-PMA, and IFN-LPS groups compared with the control. The proliferation of kerationcytes in PMA and LPS groups was not inhibited. 2. The percent of HLA-DR positive kerationcytes was 62.5+/-3.1%, and 65.8+/-2.6% in IFN, IFN-PMA, and IFN-LPS group, respectively. There were no HLA-DR expression in the control, PMA, and LPS groups. 3. The amounts of IL-lalpha were 22.58+/-8.41, 49.32+/-13.01, 57.02+/-14.99, 96.98+/-43.17, 22.30+/-4.26, and 44.60+/-20.51 fmol in supernatant of control, IFN, IFN-PMA, IFN-LPS, PMA, and LPS group, respectively. The differences between IFN and control, IFN-PMA and PMA, and IFN-LPS and LPS were significant (P<0.05). The produciton of IL-1alphawas enhanced by IFN, but not PMA and LPS. The IL-1alpha induced by IFN and PMA was higher than that induced by IFN or PMA alone. The IL-1alpha induced by IFN and LPS was higher tthan that induced by IFN or LPS alone. 4. The amounts of IL-1alpha were 59.82+/-11.57, 70.15+/-25.22, 73.50+/-17.15, 63.67+/-32.38, 48.62+/-4.81, and 50.92+/-15.01 fmol in cell lysate of control, IFN, IFN-PMA, IFN-LPS, PMA, PMA, and LPS groups, respectively. The amount of IL-1alpha in IFN-PMA was significantly increased as compared to PMA(P<0.05). 5. The total amounts of IL-1alpha were 82.40+/-8.98, 119.47+/-21.88, 130.52+/-8.12, 160.66+/-34.51, 70.92+/-1.15, and 95.53+/-27.89 fmol in the control, IFN, IFN-PMA, IFN-LPS, Pma, and LPS groups, respectively, The differences between IFN and control, control, IFN-PMA and PMA and IFN-LPS and LPS were signigicant (P<0.05) the production of IL-1alpha was enhanced by IFN, but not PMA and LPS. The IL-1alpha induced by IFN and PMA was higher than that induced by PMA. The IL-1alpha induced by IFN and LPS was higher than that induced by IFN or LPS alone. In summary, the results indicate that when kerationcytes are activated by IFN-gamma, they are actively participating in the immunologic reaction by the increasing production of IL-1alpha.
Cytokines ; Epidermis ; Extremities ; HLA-DR Antigens ; Immune System ; Interferon-gamma ; Interleukin-1 ; Keratinocytes* ; Radioimmunoassay ; T-Lymphocytes

Treatment of infected nonunions of long bone is confronted with various difficult problem, e.g. eradication of infection and osseous union even in the presence of devastating infection. To solve this problem various method were proved including exerternal fixation, electrical stimulation and functional casting method with some success. Intreating these difficult infected nonunions, we adopted another program which includes through debridment of the infected and necrotic soft tissue and bone, autogenous bone graft, rigid internal fixation of fragments and ope.n drainage of the wound until union of the fracture. We treated 8 cases of infected nonunions with this method from march, 1980 to september 1983 and results are as follows: 1. Satisfactory union was obtained within average 5 months. 2. In some cases pus drainage continued even after osseous union but it was easily controlled after removal of fixation devices. 3. After bone union and removal of internal fixation devices, some kind of protective measures, e.g. crutches and braces were used for about 6 montes to prevent refracture. 4. In conclusion our method is considered to be an effctive means is treating infected nonunion of fractures.
Braces ; Crutches ; Drainage ; Electric Stimulation ; Internal Fixators ; Methods ; Suppuration ; Transplants ; Wounds and Injuries

Under the assumption that people go through stages in making dietary behavior change, this study was attempted to apply the stages of a change model for fat intake by examining the associations of social psychological variables with stages of change in dietary fat reduction. Derived from social psychological theories, 10 social psychological variables on motivational beliefs(6), social influence(3) and self-efficacy(1) related specifically to selecting every day diets low in fat were constructed. Fat and energy intakes were assessed by a short form semi-quantitative food frequency questionnaire. The associations of stages of change with motivational beliefs, social influence, and self-efficacy variables and energy and fat intakes were assessed in 333 female adults from large cities in Korea. Dietary stage groups differed significantly on most of the social psychological variables in ways predicted by theory. Motivational factors that lead to a psychological state of readiness to take action were important in the early stages of the dietary change process. Social influences were more important in the stages as people decide to take action. Self efficacy and motivational beliefs, particularly, reduction of perceived barriers were important in maintaining fat reduction behavior. The results of our study indicate differences in stages of change in fat reduction behavior in terms of nutrient intakes and social psychological correlates and suggests that adding a time dimension to social psychological models increases our understanding of dietary change, which assist us in designing nutrition education interventions that are more appropriately targeted by stage of change.
Adult* ; Diet ; Dietary Fats ; Education ; Female* ; Humans ; Korea ; Models, Psychological ; Psychological Theory ; Self Efficacy ; Surveys and Questionnaires

PURPOSE:The objective of this study was to identify the effectiveness of continued breast feeding and maternal identity between rooming-in and not rooming-in groups of mothers in post partum care. METHOD: The subjects were selected by convenient sampling, with 95 women in childbirth completing a questionnaire. The data were collected on the 2nd day after delivery by questionnaire, and after the 4th and 8th weeks by telephone interview. Measures used in this study included general characteristics, breast feeding related characteristics, and the maternal identity scale revised by Koh(1996). The data were analyzed with the SPSS program, and the Chi-test and t-test were used to identify the effect on breast feeding and maternal identity. RESULTS:Continued breast feeding up to 4 weeks after deliverly was not statistically significant between rooming-in and not rooming-in group, but beyond 8 weeks of deliverly, it was significantly different in rooming-in group(p<.01). Maternal identity was significantly higher in rooming-in group than in not rooming-in group(p<.01). CONCLUSIONS: Mothers preferred rooming-in system because it helped breast feeding and baby care. Rooming-in system provides self confidence in taking care of baby, knowledge about breast feeding and stimulates early phase lactation. We recommend rooming-in system in hospitals to promote breast feeding and maternal identity. Nurses are encouraged to discuss prenatal breast feeding before delivery and rooming-in care should be planned individually for continuation of breast feeding and formation of maternal identity.
Breast Feeding* ; Female ; Humans ; Interviews as Topic ; Lactation ; Mothers ; Parturition ; Surveys and Questionnaires ; Rooming-in Care

Forearm bone fracture is a common injury in childhood. But there are many difficult problem to solve in treatment of the forearm bone fractures which are not encountered in the treatment of fracture of the other long bone. Forearm bone fracture in children differ from those in adult in a number of ways. The rapidity of healing, fuctional recovery together with the frequency of delayed or nonunion consitute the main features. More interesting, a deformity resulting from malunion may correct as bone growth proceeds. From August, 1973 to July, 1983, we have reviewed 66 cases of forearm bone fractures under 14 year old and which were treated in the Department of Orthopedic Surgery, Hanyang University Hospital. The results were as follows: 1. 56 cases(84.8%) were male and most cases occured in school age. 2. 40 cases(60.7%) were both forearm bone fractures and most common site of the fracture was the distal 1/3 3. The most common cause of the fractures was falling from height. Simple fracture was most common and greenstick fracture was next. Closed fractures were 61 cases (92.4%) and open fractures were 5 cases (7.6%) . 4. In roentgenologically, the younger the child was, the more rapid the duration of bone union was. Average duration of roentgenological union in conservative group was 8. 1 weeks, and that in operative group was 10. 1 weeks. So conservative group was more rapid in roentgenological bone union than operative group. 5. Accarding to the follow study of remodelling, the young the child and the nearer the fracture line was to the epiphyseal plate, the greater the potentialities for spontaneous correction were. 6. 62 cases (94.0%) showed excellent fuctionat result. According to 4 cases (6.0%) which showed good fuctional result, posterior angulation 17 degree, anterior angulation 15 degree and medial angulation 17 degree after reduction became more than 10 degree after remodelling.
Accidental Falls ; Adult ; Bone Development ; Child ; Congenital Abnormalities ; Forearm ; Fractures, Bone ; Fractures, Closed ; Fractures, Open ; Growth Plate ; Humans ; Male ; Orthopedics

BACKGROUND: Uncomplicated myocardial infarction is often the harbinger of future cardiac events such as unstable angina pectoris,recurrent myocardial infarction or death. The feasibility and safety of exercise testing performed soon after myocardial infarction have been established but the prognostic value of exercise test after myocardial infarction remain inconclusive. The object of this study is to determine whether exercise test results can be utilized to predict of future cardiac events after uncomplicated myocardial infarction. METHODS: The study group comprised 149 patients with an uncomplicated myocradial infarction. A low level exercise test was performed before discharge from the hospital 8 to 10 days after myocardial infarction. The exercise thst results was considered positive if there was new > or =1mm horizontal or downsloping ST segment depression at 0.08 sec after the J point compared with baseline. The patients were followed for the development of new cardiac events. RESULTS: 1) The exercise test after acute myocardial infarction was performed in 149 patients without complication. The mean duration of exercise test was 14 min(range 1-20 min) and the mean work-load(Metabolic equivalents) was 3.7+/-1.1 METs. 2) 37 patients had ST-segment depression, 13 had ST-segment elevation and 27 had an inadequate blood pressure response to exercise. During the exercise, there were angina in 5 patients, dyspnea in 17 and no symptom in 127 patients. 3) During the follow-up period(1 to 75 month, mean 27.4 month), 29 patients experienced post-myocardial infarction angina, 1 had recurrent myocardial infarction, 4 had revascularization therapy(PTCA 2, CABG 2),5 had ischemic cardiomyopathy and 5 died a cardiac death. 4) The patients with cardiac events such as cardiac death, myocardial infarction and post MI angina had a significantly shorter exercise duration(13.1+/-4.0 and 14.6+/-2.7min, p<0.05), lower exercise tolerance(3.5+/-1.0 and 3.9+/-1.0 METs, p<0.05) and lower peak heart rate(117 +/- and 126+/-5, p<0.05). 5) The ST-segment depression, lower exercise tolerance(<3.0 METs) and history of hypertension were associated significantly with cardiac events(p<0.05) but ST-segment elevation, inadequate blood pressure response to exercise, the use of thrombolytic agents and non-Q wave infarction did not predict future cardiac events. Conclusions: The exercise test after acute myocardial infarction is safe and of limited value for predicting patients at risk of cardiac events in the follow-up period. The ST-segment depression and lower exercise tolerance(<3.0 METs) can predict cardiac events and the prognosis of the patients of this group can be improved with aggressive management and careful follow-up.
Angina, Unstable ; Blood Pressure ; Cardiomyopathies ; Death ; Depression ; Dyspnea ; Exercise Test* ; Fibrinolytic Agents ; Follow-Up Studies ; Heart ; Humans ; Hypertension ; Infarction ; Myocardial Infarction* ; Prognosis