BACKGROUND AND OBJECTIVES: We investigated the predictors of the recovery of depressed left ventricular ejection fraction (LVEF) in patients with moderate or severe left ventricular (LV) systolic dysfunction after acute myocardial infarction (MI). SUBJECTS AND METHODS: We analyzed 1307 patients, who had moderately or severely depressed LVEF (<45%) on echocardiography soon after acute MI and who underwent a follow-up echocardiography, among 27369 patients from the Korea Working Group on the Myocardial Infarction Registry. Patients were categorized into two groups according to recovery of LVEF: group I with consistently depressed LVEF (<45%) at the follow-up echocardiography and group II with a recovery of LVEF (> or =45%). RESULTS: Recovery of LV systolic dysfunction was observed in 51% of the subjects (group II, n=663; DeltaLVEF, 16.2+/-9.3%), whereas there was no recovery in the remaining subjects (group I, n=644; DeltaLVEF, 0.6+/-7.1%). In the multivariate analysis, independent predictors of recovery of depressed LVEF were as follows {odds ratio (OR) [95% confidence interval (CI)]}: moderate systolic dysfunction {LVEF > or =30% and <45%; 1.73 (1.12-2.67)}, Killip class I-II {1.52 (1.06-2.18)}, no need for diuretics {1.59 (1.19-2.12)}, non-ST-segment elevation MI {1.55 (1.12-2.16)}, lower peak troponin I level {<24 ng/mL, median value; 1.55 (1.16-2.07)}, single-vessel disease {1.53 (1.13-2.06)}, and non-left anterior descending (LAD) culprit lesion {1.50 (1.09-2.06)}. In addition, the use of statin was independently associated with a recovery of LV systolic dysfunction {OR (95% CI), 1.46 (1.07-2.00)}. CONCLUSION: Future contractile recovery of LV systolic dysfunction following acute MI was significantly related with less severe heart failure at the time of presentation, a smaller extent of myonecrosis, or non-LAD culprit lesions rather than LAD lesions.
Diuretics ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Korea ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Stroke Volume ; Troponin I

BACKGROUND: Propofol and remifentanil are used for tracheal intubation in the absence of neuromuscular blocking agents. We hypothesized that the addition of sevoflurane to propofol and remifentanil would improve intubation conditions and provide hemodynamic stability. METHODS: Seventy-six patients scheduled for elective surgery were randomly allocated to be ventilated with either 4% (group I) or 7% sevoflurane (group II) after propofol injection (2 mg/kg). All patients received remifentanil (1 microgram/kg) 30 seconds after administration of propofol. Ninety seconds after remifentanil was given, laryngoscopy and tracheal intubation were performed. Intubation conditions and hemodynamic changes were evaluated. RESULTS: The overall incidence of clinically acceptable intubation conditions was significantly higher in group II (92%) than group I (58%) (P = 0.001). Scores for vocal cord position, coughing, and limb movement were significantly better in group II (P < 0.05). Mean blood pressure remained significantly lower than the pre-induction level throughout the investigation in both groups (P < 0.001), but there was no incidence of bradycardia or hypotension requiring treatment. CONCLUSIONS: Tracheal intubation without neuromuscular blocking agents can be achieved safely and reliably by adding 7% sevoflurane to propofol (2 mg/kg) and remifentanil (1 microgram/kg).
Blood Pressure ; Bradycardia ; Cough ; Extremities ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Intubation ; Laryngoscopy ; Methyl Ethers ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Piperidines ; Propofol ; Vocal Cords

BACKGROUND/AIMS: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. METHODS: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a median of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. RESULTS: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87;HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). CONCLUSIONS: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation.
Acute Coronary Syndrome ; Biomarkers ; C-Reactive Protein ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Troponin ; Troponin I

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.
Adult ; alpha-Thalassemia ; Anemia, Hemolytic, Congenital* ; beta-Thalassemia ; Bilirubin ; Cell Membrane ; Diagnosis ; Elliptocytosis, Hereditary ; Erythrocyte Indices ; Female ; Hemoglobinopathies ; Humans ; Internal Medicine ; Jaundice ; Korea* ; L-Lactate Dehydrogenase ; Male ; Oxidoreductases ; Pallor ; Pathology, Molecular ; Pediatrics ; Phosphopyruvate Hydratase ; Prevalence ; Pyruvate Kinase ; Reticulocyte Count ; Retrospective Studies* ; Sex Ratio ; Surveys and Questionnaires

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is one of the most important armamentarium against various hematologic malignancies or some solid tumors. We investigated the number of patients who might need transplants and compared with that of actual transplants to conceptualize current status and circumstances of HSCTs in Korean children. METHODS: Questionnaires were sent to Korean Society of Hematopoietic Stem Cell Transplantation (KSHSCT) members who were taking care of children with malignancies or hematologic diseases. Almost all of the newly diagnosed patients between Jan, 1st and Dec, 31st, 2003 were enrolled in the study. RESULTS: Seven hundred forty eight children (male to female ratio = 1.4:1) were enrolled. The median age was 6.1 years old (8 days~28.8 years old). Malignant diseases consisted of 695 cases (92.9%), and among them almost half were hematologic malignancies. The participating members speculated that HSCTs should be indicated in 285 children (38.1%) which included 209 allogeneic, and 76 autologous transplants. In reality, however, allogeneic HSCTs were performed only in 140 children (67.0%) with the median interval of 5.9 month, and autologous transplants in 44 children (57.9%) with 8.3 month. In autologous setting, all the patients received peripheral blood stem cells (PBSCs), whereas bone marrow (61%), cord blood (34%), and PBSC (5%) were used in allogeneic HSCTs. Donor types were as follows: unrelated donor (37%), cord blood (34%), sibling donor (25%), and family (4%). The reasons for not performing HSCTs were unfavorable disease status or death, no availability of suitable donor, economical situation, and refusal by parental preferences. Under the strict insurance regulations, many transplants were not covered by insurance. More autologous transplants were performed without insurance coverage than allogeneic HSCTs (P=0.013). Those cases were advanced cases and HLA mismatch transplants for allogeneic setting, and relatively rare diseases still awaiting favorable results of transplants for autologous setting. CONCLUSION: HSCTs are essential part of treatment strategies for children with various diseases. Unfortunately, however, a third of patients who were in need of transplants did not receive HSCTs due to various reasons. It is necessary to expand unrelated donor pool or cord blood banks for the cases lacking HLA-identical sibling donors. Also medical insurances should cover HSCTs for rare diseases as well as for less favorable but novel situations where there are no suitable alternatives.
Autografts ; Bone Marrow ; Child* ; Disulfiram ; Female ; Fetal Blood ; Hematologic Diseases ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Insurance ; Insurance Coverage ; Parents ; Rare Diseases ; Siblings ; Social Control, Formal ; Stem Cells ; Tissue Donors ; Unrelated Donors ; Surveys and Questionnaires

PURPOSE: Childhood acute immune thrombocytopenic purpura (ITP) is a benign hematologic disease. Therapy does not affect the natural history of the illness. We evaluated the clinical and laboratory findings, treatment and prognosis of childhood acute ITP in Korea through a retrospective multicenter study. METHODS: We analyzed retrospectively the data of 1, 829 children with acute ITP through survey of 33 hospitals among 43 hospitals in Korea from Sep. 1992 to Aug. 2001. RESULTS: Male to female ratio was 1.3: 1 and the median age at the diagnosis of ITP was 2.9 (0.1 17) years. Median duration of follow up was 6 months. One hundred and forty nine cases of the total 1, 829 patients (8.1%) received no treatment. The initial median platelet count of the non-treated group was 42, 500/mm3. Among the 861 cases who were followed up over 6 months, 315 cases (36.6%) progressed into chronic ITP. Associated with this high rate of chronicity of childhood acute ITP patients in Korea, we must consider the fact that acute ITP patients with fast improvement in the first episode tend not to follow up. Considering that fact, the rate of chronicity becomes 17.2% of the 1, 829 acute ITP patients. The treated group used many kinds of treatment methods. Intravenous immunoglobulins (IVIG) with or without prednisolone (PD) (67.5%) were the most commonly used regimens. In the group treated with IVIG alone, the platelet count began to rise above 50, 000/mm3 at 2.6 days, 100, 000/mm3 at 3.7 days and 150, 000/mm3 at 4.9 days. Four hundred and twenty two cases of the 1, 686 (25.0%) cases followed up after first episode of ITP relapsed. The relapse rate was significantly higher in older patients and in girls than in younger patients and in boys (P< 0.05). The chronicity of ITP statistically increased with age (P< 0.05) and that was the only valuable factor. CONCLUSION: Despite the fact that childhood acute ITP is a pretty common disaese, there is no agreement on the best treatment method for this disease. The establishment of Korean treatment guideline of childhood acute ITP, based on an analysis of multicenters, seems to be needed.
Child ; Diagnosis ; Female ; Follow-Up Studies ; Hematologic Diseases ; Humans ; Immunoglobulins, Intravenous ; Korea* ; Male ; Natural History ; Platelet Count ; Prednisolone ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic* ; Recurrence ; Retrospective Studies

PURPOSE: To determine the effects of power and coagulation time on lesion size of ex-vivo bovine liver using microwaves. MATERIALS AND METHODS: Six bovine livers were divided into two groups(first group: 30W output, secondgroup: 60W output) and microwave coagulation was performed for 30, 60, and 120 sec. thermal injury site was thenobserved by means of sonography, and the maximal transverse diameter of the echo-change portion after microwave coagulation was measured. On the section of specimen, maximal transverse diameters of the thermal injury site weremeasured by gross inspection and compared with the result of sonographic measurement. RESULTS: Maximal transversediameters of hyperechoic lesions of the first group, as seen on sonography were 8.3 mm, 12.2mm, and 15.6mm, andthe maximal transverse diameters of thermal injury sites on gross specimens were 9.1mm, 12.0mm, and 15.1mm,respectively. Maximal transverse diameters of hyperechoic lesions of the second group, as seen on sonography, were12.1 mm, 17.4 mm, and 21.2 mm and maximal transverse diameters of thermal injury sites on gross specimens were13.2 mm, 16.0 mm, and 20.0 mm, respectively. Statistically maximal transverse diameters of hyperechoic lesions, asseen on sonography, correlated closely with the gross findings of maximal transverse diameters of thermal injurysites(p<0.05). CONCLUSION: Maximal transverse diameters of thermal injury sites were significantly increased asthe output of the microwave coagulator and the duration of coagulation time increased(p<0.05).
Animals ; Liver ; Microwaves* ; Ultrasonography

BACKGROUND AND OBJECTIVES: Dual-chamber pacing is commonly used as a pacing mode maintaining at-rioventricular synchrony. However, traditional technique for atrial J lead implantation is relatively time-consuming and not easy to get optimal sites for both atrial and ventricular leads, especially for less-experienced operators. We developed a new "push technique" for atrial J lead implantation. MATERIALS AND METHOD: This study included sixty-two consecutive patients (26 males 36 females, 55+/-10 years, 56 patients received DDD and 6 received AAI pacemakers) from Jan. 1992 through Dec. 1996. Atrial J leads were implanted using a "push technique", that is, simply advancing a straightened lead while holding the stylet in the pacing lead at the junction of the superior vena cava and the right atrium. We evaluated the early and long-term result of atrial J lead implantation by the "push technique". RESULTS: 1) Atrial leads were successfully inserted by the first or second trial of the "push technique" in the 62 patients (100%). The sensed P wave amplitude was 3.1+/-1.0 mV, pacing threshold 0.6+/-0.2 V at the pulse width of 0.5 ms, impedance 547.4+/-118.5 ohms at 5 V. 2) During follow-up of 28.1+/-15.7 months, significant changes in the pacing parameters and the dislodgement of atrial leads were not seen. CONCLUSION: The early and long-term result of atrial J lead implantation by the "push technique" was excellent. This "push technique" can be used as an easy alternative technique for atrial J lead implantation.
Dichlorodiphenyldichloroethane ; Electric Impedance ; Female ; Follow-Up Studies ; Heart Atria ; Humans ; Male ; Vena Cava, Superior

BACKGROUND: To evaluate the clinical efficacy of Simvastatin, a HMG-CoA reductase inhibitor, We ibsweved the changes of clinical characteristics and lipid profiles after Simvastatin administration in patients with hypercholesterolemia. METHODS AND RESULTS: Simvastatin 10mg was given once daily for 12 weeks in 35 patients (60+/-6.0 years : 14 male, 21 female) with hypercholesterolemia. High density lipoprotein-cholesterol (HDL-C) was increased from 38+-10 to 45+-9mg/dl(p<0.05). Simvastatin significantly decreased total cholesterol(TC) from 235+-15 to 181+-21mg/dl(23.0%), low-density lipoprotein cholesterol (LDL-C) from 164+-19 to 104+-18mg/dl(36.5%), TC/HDL-C from 7.0+-2.0 to 4.4+-1.1, LDL-C/HDL-C from 4.9+-1.7 to 2.5+-0.8(p<0.01 respectively). Apo B was decreased by 31%(119+-19 to 87+-15mg/dl), apo B/A1 ratio was decreased by 41%(1.2+-0.2 to 0.7+-0.2) amd lipoprotein(a) edcreased by 12%(33+-22 to 29+-17), while apo A1 was increased by 25%(104+-18 to 130+-23mg/dl, p<0.01 respectively). No patients complained of chest pain, but two had skin rashes. Creatine kinase and creatinine were not changed in all patients. CONCLUSIONS: Somvastatin is an effective and well tolerated cholesterol lowering agent in patients with hypercholesterolemia.
Apolipoprotein A-I ; Apolipoproteins ; Apolipoproteins B ; Chest Pain ; Cholesterol ; Creatine Kinase ; Creatinine ; Exanthema ; Humans ; Hypercholesterolemia* ; Lipoprotein(a) ; Lipoproteins ; Male ; Oxidoreductases ; Simvastatin*

BACKGROUND: Reversibly dysfunctional myocardium caused by chronic reduction of coronary perfusion was named as hibernating myocardium. The clinical characteristics, however, was not well studied. METHOD: To observed the effects of revascularization on regional wall motion(RWM) abnormalities in patients with chronic ischemic heart disease, letf ventriculogram and dipyridamole stress Tl reinjection scan with reinjection imagine were done in 60 patients with angina or old myocardial infarction before and after PTCA. Subjects were divided into two groups, group A(21 patients, improved RWM after PTCA) and group B(39 patients, no change or aggravated RWM after PTCA). RESULTS: There were no significant differences in age and sex distribution between two group. Single vessel disease was more prevalent in group A (7/21, 33.3%) than in group B(1/39, 2.6%, p<0.05), and old myocardial infarction was more prevalent in group B(24/39, 61.5%) compared to group A(7/21, 33.3%, p<0.05). Reversible perfusion defects on Tl scan were found in 19 patients, 15 of whom(78.9%) showed improved RWM after PTCA. CONCLUSION: Hibernating myocardium was more prevalent in single vessel disease and angina patients. Sensitivity of Tl reinjection scan for detection of viable myocardium was 78.9%.
Coronary Artery Disease* ; Coronary Vessels* ; Dipyridamole ; Hibernation* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium* ; Perfusion ; Sex Distribution