Hospice Care ; Hospices ; Humans ; Palliative Care ; Renal Dialysis

Patients with cerebrovascular accidents often have abnormal electrocardiograms in the absence of known organic heart disease. In 1901 harvey Cushing has discovered sinus bradycardia in CVA patients. Burch, Myers and Abildskov were the first to report electrocardiographic abnormalities in CVA. Since then many reports have appeared in the literature. This study was done utilizing brain C-T scan to varify and localize the site of CVA, for purposes of correlation of the CVA with abnormalities of electrocardiogram. We obtained the following results. 1. Among 250 cases of CVA, 107 cases were excluded due to pre-existing cardiac disease, abnormal serum electrolyte and early death. 2. Among 143 cases, intracranial hemorrhage were 62.9% and brain infarction were 37.1%. 3. In intracranial hemorrhage, normal electrocardiographic finding were only 4.5%. Q-Tc prolongation revealed 64.5%. 4. In brain infarction, normal electrocardiographic finding was only 5.7%. Q-Tc prologation revealed 64%.
Bradycardia ; Brain ; Brain Infarction ; Electrocardiography* ; Heart Diseases ; Humans ; Intracranial Hemorrhages ; Stroke

Although lymphoma may involve any part of gastrointestinal tract either primary or secondary, esophageal involvement is rare. Secondary esopahgeal involvement of lymphoma is showing an incidence between 0% and 6% with autopsy series and lesser then 1% in living patients. The occurrence of a tracheoesophageal fistula(TEF) in patient with lymphoma is even more rare. We describe one case of TEF due to secondary esophageal invasion of T-cell lympboma and review the literature, with particular attention to chest CT and esophagoscopic finding, and endoscopic biopsy result.
Autopsy ; Biopsy ; Gastrointestinal Tract ; Humans ; Incidence ; Lymphoma ; Lymphoma, T-Cell* ; T-Lymphocytes* ; Tomography, X-Ray Computed ; Tracheoesophageal Fistula*

BACKGROUND: Atherosclerotic cardiovascular disease and metabolic syndrome are both rapidly increasing in Koreans due to the new westernized eating habits and the aging of the population. The pulse wave velocity (PWV) reflects arterial stiffness and it may be used as an indicator of atherosclerosis. This study was conducted to investigate the association of the PWV with metabolic syndrome. METHODS: Among 1438 persons who visited the Internal Medicine Clinic or Health Center of a general hospital in Seoul, Korea, 384 adults (age range: 30-69 years old) were selected as study subjects. Those patients with cardiovascular disease or other systemic disease were excluded, but the patients with hypertension and diabetes mellitus were included. Ninety four (25.4%) subjects were classified as patients with metabolic syndrome when jointly applying the WHO Asia-Pacific criteria and NCEP ATPIII criteria. RESULTS: The PWV was higher in the older aged group and in the men compared to the other group. The greater the number of diagnostic criteria of the metabolic syndrome subjects had, the higher was their PWV. After adjustment for age, gender, blood pressure, BMI and fasting blood glucose, a PWV change of 1.0 m/sec increased the risk of metabolic syndrome by 1.31 times (95% CI: 0.81-2.09). The risk of metabolic syndrome was 7.62 times higher among the subjects with a PWV greater than 7.5 m/sec (95% CI: 1.07-54.42), as compared with that of subjects with a PWV less than 7.5 m/sec. CONCLUSIONS: The PWV may independently increase the risk of metabolic syndrome as a non-linear pattern. A prospective study needs to be conducted to confirm the meaning of PWV as a risk factor for metabolic syndrome, and especially to determine the cut off point.
Adult ; Aging ; Atherosclerosis ; Blood Glucose ; Blood Pressure ; Cardiovascular Diseases ; Diabetes Mellitus ; Eating ; Fasting ; Hospitals, General ; Humans ; Hypertension ; Internal Medicine ; Korea ; Male ; Prospective Studies ; Pulse Wave Analysis* ; Risk Factors ; Seoul ; Vascular Stiffness

BACKGROUND: Exercise induced ST-segment depression in patients after coronary angioplasty is frequently observed but the mechanism responsible for exercise induced myocardial ischemia early after successful coronary angioplasty is poorly understoodd. The object of this study is to investigate potential determinants of this phenomenon by analizing the clinical, exercise testing, and angiographic characteristics in patients with exercise induced ST-segment depression. METHODS: The study group comprised 13 patients with exercise induced ST-segment depression(Positive group,M:12, mean age:59+/-9year) and 26 patients without exercise induced ST-segment depression(Negative group, M; 22, mean age; 55+/-13 year) after succeessful coronary angioplasty in single vessel disease. We compared preangioplasty clinical, angiographic, and hemodynamic variables in group with positive and negative results on exercise testing after successful PTCA. RESULTS: 1) Clinical characteristics: The initial diagnosis were acute myocardial infarction in 5, unstable angina in 8 patients at positive group, and 16 and 10 patients at negative group, respectively. There were no significant different in initial diagnosis, risk factor for coronary artery disease, and medication used before exercise test at between two groups. 2) Cornary angiography and PTCA: The maximal ballooning size were significantly smaller in positive group than negative group(2.7+/-0.5 vs 3.1+/-0.4mm, 2.9+/-0.4mm, vs 3.2+/-0.4mm, respectively(p<0.05) but there were no significantly different in ejection fraction, end-diastolic volume, end-systolic volume before PTCA. degree of stenosis of lesion before and after PTCA, total ballooning time, balloon pressure, lesion site and infarction relation of lesion at between two groups. 3) Exercise test: The mean time from angioplasty to the performance of exercise testing were 9.5+/-4.0 days in positive group and 6.1+/-4.5 days in negative group. The mean depression of ST-segment was 1.5+/-0.5mm and was predominantly noted in lateral leads(V4-6)(9/13:69%). There were no significantly different in total exercise time, rate-pressure product, and metabolic equivalents-exercise time at positive and negative group. But positive results at follow up exercise test were significantly higher in positive group(p<0.05). CONCLUSION: There were no definite determinating factors for exercise induced ST-segment depression early after successful coronary angioplasty by analizing the clinical, angiographic, and exercise testing variables. The pathophysiologic mechanism of this findding remain to be elucidated, especially for association of microvascular functional alternation.
Angina, Unstable ; Angiography ; Angioplasty* ; Constriction, Pathologic ; Coronary Artery Disease ; Depression* ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction ; Myocardial Ischemia ; Risk Factors

BACKGROUND AND OBJECTIVES: This study was performed to determine the predictive factors for edge dissection (ED) and clinical significance of ED after coronary stenting. MATERIALS AND METHODS: The study group comprised 215 patients (243 lesions, mean age 59 years, 157 male) in whom coronary stents were implanted between June, 1994 and June, 1998. By angiography, EDs were categorized into minor (a very focal segment <5mm from the stent margin), major (>5mm with prominent adventitial staining and >50% of lumen compromize), and acute closure. RESULTS: 1.ED occurred in 30 (12.3%, minor 15, major 12) out of 243 lesions. Twelve of 30 EDs were located at the distal margin of the stent and occurred during high pressure. 2.Development of ED after stenting significantly correlated with severity of stenosis at the stent margin (> or =30%, 19/30 vs. 33/213, p=0.0001), degree of angulation (>45 0 , 16/30 vs. 48/213, p=0.0001), and calcification in the lesion (2/30 vs. 4/213, p=0.02). 3.There was no significant difference in clinical success rate between two groups (27/30 vs. 175/185, NS). 4.CRR in major and acute closure EDs (n=12) were significantly higher in patients treated with repeated angioplasty than in patients treated with additional stents (5/6 vs. 1/8, p=0.02). CONCLUSIONS: EDs after coronary stenting are relatively common and lesion's characteristics such as severity of stenosis (> or =30%) at the stent margin, angulation (>45 0 ), and calcification of the lesion are predictive factors for EDs. EDs are not associated with early adverse clinical events. However, CRR was significantly higher in patients treated by repeated angioplasty in major and acute closure EDs.
Angiography ; Angioplasty ; Constriction, Pathologic ; Follow-Up Studies* ; Humans ; Stents*

PURPOSE: Serum aspartate aminotransferase (AST) is an enzyme widly used in the diagnosis of acute liver disease. It is also highly sensitive in cases of myocardial infarction and muscular injury. This study is designed to ascertain the utility of AST for diagnosis in emergency room. METHODS: From July 2001 to September 2002, 98 patients with AST greater than ten times (400 U/L) the normal range were identified by the biochemistry laboratory in the Emergency Medical Center of Chonnam National University Hospital. The patients 'clinical records were studied to determine the diagnosis, the clinical course, the physical finding on arrival, the past history, other serological and imaging studies, etc. RESULTS: The most common cause of elevated AST level was hepatic in origin (74 cases, 75.5%). Other causes were soft tissue injury (13 cases, 13.3%) and myocardial infarction (11 cases, 11.2%). In group with hepatic causes for raised AST, 21 (28.3%) patients had pancreaticobiliary desease, 20 (27.0%) patients were in conditions producing hepatic ischemia, 18 (24.3%) patients had hepatocellular desease, 6 (8.1%) patients had traumatic liver injury, and 4 (5.4%) patients had malignancy. The hepatic ischemia was caused by sepsis (6 cases, 30.0%), heart failure (6 cases, 30.0%), hypoxia (5 cases, 25.0%), and prolonged hypotension (3 cases, 15.0%). CONCLUSION: The main cause of a notably increased serum AST level is known to be hepatocellular disease, but this study for emergency patients revealed that other causes, such as hepatic ischemia, traumatic liver injury, and muscular disease, were also remarkable. When the level of serum AST is abnormally high, the clinician must consider not only hepatocellular disease but also prolonged hypotension, circulatory collapse, hypoxia, traumatic liver injury, etc.
Anoxia ; Aspartate Aminotransferases ; Biochemistry ; Diagnosis ; Emergencies* ; Emergency Service, Hospital ; Heart Failure ; Humans ; Hypotension ; Ischemia ; Jeollanam-do ; Liver ; Liver Diseases ; Muscular Diseases ; Myocardial Infarction ; Reference Values ; Sepsis ; Shock ; Soft Tissue Injuries

BACKGROUND: This study was undertaken to compare the outcome of supervised and home exercises with respect to range of motion (ROM), pain, and Single Assessment Numeric Evaluation (SANE). We further correlated the ROM recovery and pain reduction as well. METHODS: The study included 49 patients who underwent arthroscopic rotator cuff repair. Rehabilitation was initiated after 4 weeks of immobilization. A total of 29 patients performed supervised exercise 3 times a week. Standardized education and brochures for review were provided to the remaining 20 patients who insisted on home rehabilitation. Statistical analysis was performed for comparing pain Numerical Rating Scale (NRS), SANE, and ROM. In addition, we also evaluated the correlation between pain and ROM. RESULTS: Comparison of the two groups revealed no significant differences in forward flexion, internal rotation, abduction, and pain NRS. However, SANE at the 9th week (63.8 vs. 55.0, p=0.038) and improvement of external rotation from the 5th to the 9th week (17.6 vs. 9.3, p=0.018) were significantly higher in the supervised exercise group as compared to the home exercise group. Correlation of pain NRS with forward flexion, external rotation, internal rotation and abduction were statistically not significant (correlation coefficient=0.032 [p=0.828], −0.255 [p=0.077], 0.068 [p=0.642], and −0.188 [p=0.196], respectively). CONCLUSIONS: The supervised rehabilitation after arthroscopic rotator cuff repair showed better improvement in external rotation and higher SANE score after 4 weeks of rehabilitation exercise. However, no statistically significant correlation was observed between the recovery of ROM and short-term pain relief.
Education ; Exercise ; Humans ; Immobilization ; Pamphlets ; Range of Motion, Articular ; Rehabilitation ; Rotator Cuff ; Shoulder

BACKGROUND: This study was designed to determine the relationship of propranolol pharmacokinetic parameters with portosystemic shunt in CCl4-induced cirrhotic rats. METHODS: Cirrhotic rats(n=6) were induced by intramuscular injection of CCl4 in olive oil(two time per weeks) for 12 weeks. Controls (n=6) were injected intramuscularly with the same dose of olive oil for 12 weeks. We evaluated the amount of portosystemic shunt by thallium-201 per rectal scintigraphy. After intravenous bolus injection of propranolol (2mg/kg) to rats, the serum propranolol concentrations were analyzed by a HPLC-fluorimetric detector system. Pharmacokinetic parameters such as C0, AUC, t(1/2(beta)), and CLp were determined in each group. Then, a small amount of heptic tissue was obtained and subjected to determination of the hepatic collagen content by quantitating 4-hydroxyproline and were inspected by microscope after hematoxylin and eosin stain. RESULTS: In liver biopsy, liver fibrosis progressed in CCl4-induced cirrhotic rats. The serum concentrations of propranolol were significantly (p < 0.01) elevated in CCl4-induced cirrhotic rats. Mean amount of 4-hydroxyproline, mean H/L ratio, and mean AUC in CCl4-induced cirrhotic rats was significantly (p < 0.01) higher than that in control rats. There was a relationship between AUC, H/L ratio, and amount of 4-hydroxyproline. CONCLUSION: H/L ratio may help in the selection of drug dosage (especially blood flow dependent drug) in pre-clinical studies for chronic liver disease during the drug development process.
Animals ; Carbon Tetrachloride Poisoning/*complications ; Chromatography, High Pressure Liquid ; English Abstract ; Liver Cirrhosis, Experimental/*metabolism/physiopathology ; Portal System/physiopathology ; Propranolol/*pharmacokinetics ; Rats ; Rats, Sprague-Dawley ; Thallium Radioisotopes/diagnostic use

Atopic dermatitis (AD) is the most prevalent inflammatory skin condition, with approximately 80% of cases originating in childhood and some emerging in adulthood. In South Korea, the estimated prevalence of AD ranges between 10% and 20% in children and 1% and 3% in adults. Severe/recalcitrant AD manifests as a chronic, relapsing skin disorder, persisting with uncontrolled symptoms even after topical steroid treatment. Corticosteroids and systemic immunosuppression, conventionally the standard care for difficult-to-treat diseases, cause numerous undesirable side effects. When AD persists despite topical steroid application, systemic therapies like cyclosporine or systemic steroids become the second treatment strategy. The desire for targeted treatments, along with an enhanced understanding of AD’s pathophysiology, has spurred novel therapeutic development. Recent advances introduce novel systemic options, such as biological agents and small-molecule therapy, tailored to treat severe or recalcitrant AD. Notably, dupilumab, a monoclonal antibody inhibiting interleukin 4 and 13, marked a transformative breakthrough upon gaining approval from the U.S. Food and Drug Administration (FDA) in 2017, leading to a paradigm shift in the systemic treatment of AD. Furthermore, both dupilumab and Janus kinase inhibitors, including baricitinib, abrocitinib, and tofacitinib, now approved by the Korean FDA, have established their applicability in clinical practice. These innovative therapeutic agents have demonstrated favorable clinical outcomes, effectively addressing moderate to severe AD with fewer side reactions than those associated with previous systemic immunosuppressants. This review summarizes the latest advancements and evidence regarding systemic treatments for AD, including newly approved drugs in Korea.