Cardioprotective effect of fimasartan, a new angiotensin receptor blocker (ARB), was evaluated in a porcine model of acute myocardial infarction (MI). Fifty swine were randomized to group 1 (sham, n=10), group 2 (no angiotensin-converting enzyme inhibitor [ACEI] or ARB, n=10), group 3 (perindopril 2 mg daily, n=10), group 4 (valsartan 40 mg daily, n=10), or group 5 (fimasartan 30 mg daily, n=10). Acute MI was induced by occlusion of the left anterior descending artery for 50 min. Echocardiography, single photon emission computed tomography (SPECT), and F-18 fluorodeoxyglucose cardiac positron emission tomography (PET) were performed at baseline, 1 week, and 4 weeks. Iodine-123 meta-iodobenzylguanidine (MIBG) scan was done at 6 weeks for visualization of cardiac sympathetic activity. Left ventricular function and volumes at 4 weeks were similar between the 5 groups. No difference was observed in groups 2 to 5 in SPECT perfusion defect, matched and mismatched segments between SPECT and PET at 1 week and 4 weeks. MIBG scan showed similar uptake between the 5 groups. Pathologic analysis showed similar infarct size in groups 2 to 5. Infarct size reduction was not observed with use of fimasartan as well as other ACEI and ARB in a porcine model of acute MI.
3-Iodobenzylguanidine ; Angiotensin II Type 1 Receptor Blockers/therapeutic use ; Angiotensin Receptor Antagonists/*therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Animals ; Anterior Wall Myocardial Infarction/*drug therapy/physiopathology ; Biphenyl Compounds/*therapeutic use ; Cardiotonic Agents/*therapeutic use ; Disease Models, Animal ; Echocardiography ; Fluorodeoxyglucose F18 ; Perindopril/therapeutic use ; Positron-Emission Tomography ; Pyrimidines/*therapeutic use ; Random Allocation ; Swine ; Tetrazoles/*therapeutic use ; Tomography, Emission-Computed, Single-Photon ; Valsartan/therapeutic use ; Ventricular Function, Left/*physiology

We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3+/-2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5+/-2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.
Acute Disease ; Age Factors ; Aged, 80 and over ; *Angioplasty, Balloon, Coronary ; Electrocardiography ; Female ; Hospital Mortality ; Humans ; Male ; Myocardial Infarction/*diagnosis/mortality/therapy ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Registries ; Treatment Outcome

PURPOSE: There is no report about psychopathological effect causing by disc herniation. The disease could impose psychopathological influence on the social life, the treatment period, and response to the treatment. This study was to evaluate retrospectively the psychopathological influence of lumbar disc herniation (LDH) among Korean 19-year-old males. MATERIALS AND METHODS: We compared the Korean military multiphasic personality inventory (KMPI) profiles of 74 LDH cases with the KMPI profiles of 150 controls. The LDH groups were categorized to 2 groups according to the presence of thecal sac compression by disc materials, and evaluated the relation between the KMPI and LDH. RESULTS: The decrease of the faking-good response scale and increase of the faking-bad response scale were observed more in the LDH group than in the normal volunteer group (p<0.05). The neurosis set such as anxiety, depression and somatization was markedly increased in the LDH group compared to the normal volunteers group (p<0.05). The scale of personality disorder was also increased more in the LDH group (p=0.002). The differences of KMPI scales were not correlated with the severe pathology of LDH. CONCLUSION: Young male with LDH may tend to have more abnormal results of multiphasic personality inventory test compared to the normal volunteers, suggesting that LDH may be related to the psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate and treat the psychopathological aspects in patients with LDH.
Adolescent ; Anxiety ; Case-Control Studies ; Depression ; Humans ; Intervertebral Disc Displacement/*psychology ; Lumbar Vertebrae/pathology ; Male ; *Personality Assessment ; Personality Inventory ; Retrospective Studies

Acute graft-versus-host disease (GVHD) is one of the most severe complications following allogeneic stem cell transplantation (SCT), and involvement of the gut has been associated with increased mortality and a poorer response to high-dose systemic corticosteroids. For over a decade, oral beclomethasone dipropionate (BDP) has been studied in the treatment of acute gastrointestinal GVHD, as a monotherapy, or in combination with systemic corticosteroids. Here we report, for the first time in Korea, the efficacy of oral BDP (8 mg/day for 25 days) in 3 adults with acute lymphoblastic leukemia who developed steroid-refractory gastrointestinal GVHD (grade III) after myeloablative conditioning SCT (1 matched sibling transplant, 2 matched unrelated transplants). All patients responded completely to oral BDP treatment. Oral BDP is safe and effective for the control of steroid-refractory acute gastrointestinal GVHD.
Adrenal Cortex Hormones ; Adult ; Beclomethasone ; Graft vs Host Disease ; Humans ; Korea ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Siblings ; Stem Cell Transplantation ; Transplants

BACKGROUND: Arthroscopic shoulder surgery is often associated with severe postoperative pain. It is important to control pain in this setting, not only to improve the patient's well-being but also to facilitate rehabilitation. The aim of this study was to investigate the efficacy of a continuous suprascapular nerve block for pain relief after arthroscopic shoulder surgery. METHODS: Forty patients (20 in each group) scheduled for elective arthroscopic shoulder surgery received a suprascapular nerve block and a catheter was introduced before surgery. The patients were received standardized general anesthesia. After surgery, a single bolus of normal saline (Group I) or 0.2% ropivacaine (Group II) 6 ml was injected through a catheter in each group. All patients received either a continuous infusion of normal saline (Group I) or a continuous infusion of 0.2% ropivacaine (Group II) through the catheter at a rate of 3 ml/hr plus a bolus of 3 ml with a lock out time of 30 min. Pain relief was assessed at 2, 4, 8, 12, 24 hours using visual analog scale (VAS) and verbal pain scores (VPS). RESULTS: VAS and VPS were lower in the ropivacaine group (Group II) than in the normal saline group (Group I). There were no complication in either group. CONCLUSIONS: Continuous suprascapular nerve block using 0.2% ropivacaine is a safe and efficacious treatment for postoperative shoulder pain.
Anesthesia, General ; Catheters ; Humans ; Nerve Block* ; Pain, Postoperative ; Rehabilitation ; Shoulder Pain ; Shoulder* ; Visual Analog Scale

Motor neuropathy of a lower extremity is well recognized potential complication of procedures performed on patients in a lithotomy position. Mechanisms of nerve injury are unclear but the incidence of perioperative nerve injuries can be reduced if anesthetists are aware of their causes and pathophysiolgies. It is important to note that reduced duration in lithotomy position may reduce the risk of lower extremity neuropathies. We experienced two case of common peroneal nerve palsy after lithotomy positioning. Diagnosis was based on history, a clinical examination and electrophysiologic studies. A neurologic examination revealed hypersthesia over the dorsum of the left foot with inability to perform active dorsiflexion. Electrophysiologic studies showed delayed latency and low amplitude of nerve action potential.
Action Potentials ; Diagnosis ; Foot ; Humans ; Incidence ; Lower Extremity ; Neurologic Examination ; Paralysis* ; Peroneal Nerve*

OBJECTIVE: The aim of this study was to assess the effect of intramural uterine myoma in patients with a normal endometrial cavity on IVF-ET cycle outcome. This study was also investigated to find out whether medical supression or myomectomy needs to precede to IVF-ET. METHODS: The subjects were 300 infertile patients who got IVF-ET from January 1999 to December 2002 at the Department of Obstetrics and Gynecology in Kyungpook National University Hospital, and they were divided into myoma group of 97 patients and non-myoma group of 203 ones. This study group did not include patients found to have large myoma (>or= 7 cm), or myoma distorting the uterine cavity. RESULTS: Compared with the results of IVF-ET according to the presence of intramural uterine myoma, pregnancy rate and implantation rate between two groups had no statistically significant differences (p>0.05). Further comparisons within the myoma group showed no difference in pregnancy rate by number of myomas or site of myomas (p>0.05). CONCLUSION: Intramural uterine myoma not distorting the uterine cavity is considered to have no effect on the outcome of IVF-ET and no difference in the pregnancy rate according to the number of myomas or site of myomas. Therefore, these findings suggest that medical treatments or myomectomy before IVF-ET is not necessary to those infertile patients with intramural uterine myomas not distorting the uterine cavity.
Gyeongsangbuk-do ; Gynecology ; Humans ; Infertility ; Leiomyoma ; Myoma* ; Obstetrics ; Pregnancy Rate

BACKGROUND: alpha-Bungarotoxin, decamethonium or lidocaine has a neuromuscular blocking effect. The aim of this study was to evaluate the pharmacodynamic properties of these drugs at the neuromuscular junction and the reversal effects of antagonists in vitro. METHODS: The effects of evoked twitch tension response have been studied on the isolated phrenic nerve hemidiaphragm preparation of the rat, using a single twitch (0.1 Hz) and the train of four (TOF; 2 Hz for 2 s) stimulation. The cumulative concentration effect and TOF ratio at each point of twitch depression after alpha-bungarotoxin, decamethonium or lidocaine were measured mechanomyographically. The EC50 and EC95 of alpha-bungarotoxin, decamethonium or lidocaine were calculated using an inhibitory sigmoid Emax model. The reversal effects of various doses of neostigmine, pyridostigmine or 4-aminopyridine (4-AP) to the partial neuromuscula r block produced by EC50 of alpha-bungarotoxin, decamethonium or lidocaine were determined. RESULTS: The EC50 and EC95 of alpha-bungarotoxin, decamethonium or lidocaine were 0.179 and 0.320 microgram/ml, 17.07 and 26.84 microgram/ml or 76.80 and 105.70 microgram/ml. TOF fade was produced by alpha-bungarotoxin or decamethonium but not by lidocaine. Neostigmine or pyridostigmine did not reverse the partial neuromuscular block induced by alpha-bungarotoxin, decamethonium or lidocaine. However, 4-AP produced a dose-dependent recovery of the twitch response (P < 0.05). CONCLUSIONS: alpha-Bungarotoxin, decamethonium or lidocaine produced different degree of TOF fade, and it means that this may be due to different site of action of these drugs. 4-AP reversed effectively the partial neuromuscular block induced by alpha-bungarotoxin, decamethonium or lidocaine, whereas neostigmine or pyridostigmine did not.
4-Aminopyridine ; Animals ; Bungarotoxins* ; Colon, Sigmoid ; Depression ; Lidocaine* ; Neostigmine ; Neuromuscular Blockade* ; Neuromuscular Junction ; Phrenic Nerve ; Pyridostigmine Bromide ; Rats*

PURPOSE: To investigate the influence of sensory impairment and vascular insufficiency on the development and treatment of diabetic foot lesions. MATERIALS AND METHODS: From July 1995 to June 1997, 25 subjects with diabetic foot lesions were treated with an average follow-up of 19.6 months (range, 12-35 months). Sensory evaluation was performed with the Semmes-Weinstein monofilaments and a 256 cycles-per-second tuning fork, Vascular testing was performed with IMEXLAB 9,000 workstation in 24 of 25 subjects. RESULTS: In 22 of 25 patients, they could not perceive 5.07 monofilament and also could not feel vibration. In 6 patients, the vascular flow was normal, and there were mild insufficiency in 10 patients and severe insufficiency in 8 patients. The degree of vascular insufficiency correlated with the severity of the lesion (Wagner classification) and also with the result of the treatment. Despite severe vascular insufficiencies, foot lesions could be treated by forefoot amputations in 7 of 8 patients. Overall there were 9 recurrences after initial healing. CONCLUSIONS: This study shows that it is essential to educate patients on taking care of their foot because most of them do not have protective sensation. Vascular insufficiency may be related to the severity of the lesions and the result of treatment. We have to pay continuous attention to these patients for early detection of recurrence after initial treatment of the foot lesions.
Amputation ; Diabetic Foot* ; Follow-Up Studies ; Foot ; Humans ; Ischemia* ; Recurrence ; Sensation ; Vibration

PURPOSE: To evaluate the nation-wide results of statistics related to the neonatal period of 1996, we collected data of a total of 64 hospitals in Korea (42 university hos- pitals and 22 general hospitals). METHODS: We obtained the results of 129,175 inboms and 9,379 outborns, and analyzed the statistics of live-births, ig, distribution of live-births by gestational age and birth weight, incidence of pre-term infants and low birth weight infants (LBWI), neonatal mortality, and incidence of discharge against medical advice (DAMA). RESULTS: According to birth weight, incidence of LBWI, normal birth weight, infant and high birth weight infants was 3.6%, 86.6% and 9.8%, respectively in the case of inborn group. But incidence of LBWI was higher in outborn group as compared with the inbom group. According to gestational age, incidence of preterm, term, and post-term was 11.1%, 87.1Yo and 1.8% respectively in the inbom group. The incidence of preterm in outborn group was higher than that of inborn group, because of the influnce of transpor- tation of high risk neonates to 2nd or 3rd levels of neonatal intensive care units (NICU). Overall neonatal mortality per 1,000 live-births was 9.3 in the inborn group amd 37.6% in the outborn group. These data revealed a high neonatal mortality, because the numbers of DAMA cases was also included. The incidence of DAMA was 0.44% and 1.15% in inborn and outborn groups, respectively. The percentage of the DAMA among the numbers of neonatal mortality was 47.2-48.8M in the inborn group. CONCLUSIONS: We obtained the statistics related to live-birth, incidence of prematurity and LBWI, neonatal mortality, and incidence of DAMA in Korea. The data revealed high levels of neonatal mortality (which included the sum of neonatal death and the number of DAMA) and incidence of DAMA in Korea at present. To achieve a low-level of neonatal mortality, more efforts to decrease the incidence of DAMA are needed. Also, a greater facility for NICU and a stronger support system from a nation-wide govemment policy and system of insurance are seen to be necessary.
Birth Weight ; Gestational Age ; Humans ; Incidence* ; Infant ; Infant Mortality* ; Infant, Low Birth Weight ; Infant, Newborn ; Insurance ; Intensive Care Units, Neonatal ; Korea* ; Parturition*