BACKGROUND/AIMS: To analyze the clinical effects of continuing to smoke in patients with acute myocardial infarction (AMI), clinical outcomes of those continuing or ceasing smoking were compared. METHODS: In total, 498 patients with AMI who underwent percutaneous coronary intervention (PCI) from January to December 2007 were enrolled. Of these patients, 407 (63.9 +/- 11.9 years, males 70%) with 1-year follow-ups were analyzed. Based on risk factors for smoking, patients were divided into two groups: Group I (smokers, n = 164, 57.9 +/- 11.2 years) and Group II (nonsmokers, n = 243, 68.0 +/- 10.6 years). Additionally, Group I patients were subdivided by cessation of smoking after discharge: Group IA (current smokers, n = 95, 56.8 +/- 10.5 years) and IB (past smokers, n = 69, 59.4 +/- 12.0 years). Clinical characteristics, coronary angiographic and procedural findings, and 1year major adverse cardiac events (MACE) were analyzed. RESULTS: During the 1-year follow-up period, MACE developed in 112 patients (27.6%) and death in 42 patients (10.3%). In terms of smoking habits at admission, there was no significant difference in the 1-year MACE between current smokers (Group I) and nonsmokers (Group II). In the subgroup analysis, there were no significant difference in clinical characteristics between Groups IA and IB. Mortality was significantly higher in Group IA than in Group IB during the 1-year clinical follow-up (11% vs. 0%; p = 0.005). CONCLUSIONS: Of the AMI patients who underwent PCI, mortality was significantly higher in current smokers than in past smokers after PCI.
Follow-Up Studies ; Humans ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Risk Factors ; Smoke ; Smoking

BACKGROUND AND OBJECTIVES: Transcatheter occlusion (TCO) may be an alternative method for the surgical closure of a secundum atrial septal defect (ASD) below 20 mm in diameter. We performed this study in order to evaluate the safety and feasibility of an Amplatzer septal occluder for closing ASD bigger than 20 mm in diameter percutaneously. SUBJECTS AND METHODS: Thirty three of 39 patients presenting with ASD were included in this study (3 patients with a large defect over 32mm and 3 with multiple defects were excluded). The median age was 8.6 years (2.2 - 54) and median weight was 27 kg (10.7 - 85). The mean defect size was 15+/-3 mm as measured by transthoracic echocardiogram, 17+/-5 mm by transesophageal echocardiogram, and 21+/-6 (11 - 32) mm by balloon stretched diameter. The balloon stretched diameter was larger than 20 mm in 20 of 33 patients. The mean Qp/Qs was 2.3+/-0.7. The mean device size was 22+/-6 mm and the mean fluoroscopic time was 13+/-7 min. RESULTS: The device was successfully implanted in 29 of 33 patients. The 4 patients in which implantation failed showed a left disc protrusion into the right atrium. Three of these patients were treated surgically, and one underwent a successful second attempt of TCO 12 months after the first trial. Complete closure was obtained in 30 patients in follow-up. The complications encountered included;cobra-shaped deformity of the device (3), transient AV block (Wenckebach) (1), embolization of the radioopaque marker into the left atrial appendage (1), failure in the first device (1), and mild mitral regurgitation at 3 months follow-up due to device protrusion into the mitral valve (1). CONCLUSION: The Amplatzer septal occluder appears to be a promising device for TCO of ASD up to 32 mm in diameter, however, long-term follow-up in a large number of patients is warranted.
Atrial Appendage ; Atrioventricular Block ; Congenital Abnormalities ; Follow-Up Studies ; Heart Atria ; Heart Septal Defects, Atrial* ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Septal Occluder Device*

PURPOSE: Brainstem auditory evoked response(BAER) is used as screening test for hearing disorders, damages of the central nervous system and congenital anomalies. We studied the difference values according to gender and stimulation sites in normal full-term infants. METHODS: We performed BAER in 38 male and 28 female normal full-term infants, delivered in the Gil Medical Center, Gachen Medical School, from March to July 1996, aged one to seven days. Amplitude I, V, V/I and latency I, III, V and interpeak latency(IPL) I-III, III-V, I-V were measured at 90, 60, 45, 30 dB. Data were analyzed between both sex and between both ears with Student t-test. RESULTS: There were no significant difference in male and female group with the same side's stimulation. At 90 dB, amplitude I of left ear stimulation was significantly higher than right in male and female. Amplitude V/I of right ear stimulation was significantly higher than left ear stimulation in total only. At 90 dB, latency I of right was significantly longer than left in male and female. Latency III of right was longer significantly in total only. IPL I-III, I-V was significantly longer in left than right in male and total. At 60 dB intensity, all data except latency I in total, showed no significant difference. CONCLUSIONS: Interpreting BAER, stimulation site and intensity should be considered. and further studies will be needed for the evaluation of the difference between left and right ear.
Brain Stem* ; Central Nervous System ; Ear* ; Evoked Potentials, Auditory* ; Female* ; Hearing Disorders ; Humans ; Infant* ; Male* ; Mass Screening ; Schools, Medical

PURPOSE: Acute immume thrombocytopenic purpura (ITP) is relatively common hematologic disease in children. Most acute ITP is recovered within 6 month spontaneously and the complication is rare. But 10~20% of the ITP patient became a chronic form. Infection with Epstein-Barr virus (EB virus) in developing country usually occurs during infancy and early childhood. Acute ITP associated with EB virus is likely to develop chronic ITP in current literatures. We studied the pattern of laboratory findings in long term follow up of ITP with EB virus infection. METHODS: One hundred and seventy nine patients diagnosed with ITP admitted to the division of pediatric hematology, Gachon Medical Center and Hanyang University Hospital between Mar. 1991 and Jun. 2001 were reviewed retrospectively. Serologic test for EB virus was available for 57 patients and 25 of them were follow up at least 6 months. Evidence of acute EB virus infection was defined as a positive Viral Capsid Antigen (VCA) IgM or positive Anti VCA IgG and negative Ebstein-Barr virus Nuclear Antigen (EBNA). Complete remission (CR) was defined as a recovery of platelet count of more than 100 109/L and partial remission (PR) as a recovery of platelet count of 50~100 109/L, maintained for at least 6 months. RESULTS: Sixteen out of 57 patients were associated acute EB virus infection. Of this group, 8 patients were follow up at least 6 months. Forty one of 57 with no evidence of acute EB virus infection, 17 were follow up at least 6 months. The clinical and laboratory data was not different significantly in children with and without acute EB virus infection in admission. In EB virus infection group of 6 months follow up, platelet count was significantly lower than control group in 6 months follow up (P=0.006). Five patients of 8 (63%) with acute EB virus infection had chronic ITP and 2 of 17 (12%) with no evidence of EB virus infection had chronic ITP in follow up 6 months. CONCLUSION: Patients with EB virus associated ITP tended to resolved more slowly than those without EB virus infection and also showed tendency to become chronic ITP.
Capsid ; Child ; Developing Countries ; Follow-Up Studies ; Hematologic Diseases ; Hematology ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Platelet Count ; Purpura, Thrombocytopenic ; Purpura, Thrombocytopenic, Idiopathic* ; Remission, Spontaneous ; Retrospective Studies ; Serologic Tests

Incontinentia pigmenti (IP) is a rare multisystemic ectodermal disorder, which is characterized by vesicular, verrucous, and pigmented cutaneous lesions, and is frequently associated with various developmental defects of the eye, CNS, teeth, hair, and nail. It is regarded as an X-linked dominant genetic disorder. We recently experienced a case with IP, who presented with irregular, reticular, and slate-gray to brown colored pigmentation on the whole body at birth. Skin lesions were much improved by 6 month of age. The mother of this infant had the history of same cutaneous lesions in her neonatal period, suggesting that these lesions had familial tendency.
Ectoderm ; Hair ; Humans ; Incontinentia Pigmenti* ; Infant ; Mothers* ; Nuclear Family* ; Parturition ; Pigmentation ; Skin ; Tooth

The large size and vascularity of the neonatal adrenal glands are vulnerable to traumatic and asphyxial injuries. This condition varies in presentation, which the most common is an abdominal mass alone or mass with jaundice and anemia. Some infants show signs of adrenal insufficiency. Abdomial ultrasonogram is the most valuable diagnostic tool. To result in adrenal insuffiency, hemorrhage must involve both adrenals and at least 90% of the adrenocortical tissue must be destroyed. To affect infant may show signs of hypovolemic shock, electrolyte imbalance and metabolic acidosis. Treatment for adrenal insufficiency must be immediate and vigorous, and consists of intravenous glucose, fluid, and electolyte replacement. And conservative treatment failure is candidate for steroid replacement. We experienced a case of bilateral hemorrhage with adrenal insufficiency, who improved with hydrocortisone.
Acidosis ; Adrenal Glands ; Adrenal Insufficiency* ; Anemia ; Glucose ; Hemorrhage* ; Humans ; Hydrocortisone ; Infant ; Jaundice ; Shock ; Treatment Failure ; Ultrasonography

BACKGROUND/AIMS: The aims of this study were to determine subgoups of functional dyspesia and to evaluate the short-term effect of cisapride in patients with functional dyspepsia in Korea. METHODS: 1025 patients, with a mean age of 42.6 years, with symptoms of functional dyspepsia, were recruited consecutively and upper gastrointestinal symptoms were investigated by interview in 41 hospitals in Korea. In an open, multicenter trial, 1025 patients received Smg of cisapride three times a day (TID) for at least .2 weeks for the treatment of symptoms of functional dyspepsia. When necessary, the dose of cisapride was increased to 10mg TID and the duration of therapy was extended to 4 weeks. RESULTS: The most frequently reported symptoms of functional dyspepsia were epigastric discomfort or fullness (85%), bloating (70%), belching (53%), early satiety (52%) and epigastric pain (46%) retrospectively. Subgroups of functional dyspepsia were as follows; dysmotility-like 73.5%, ulcer-like 39.7%, reflux-like 13.0%, and unspecified dyspepsia 14.0%. However, 33.2% of subjects with functional dyspepsia could be classified into more than one subgroup. Upper gastrointestinal symptoms were decreased to average 50.3% (range; 42.2 to 59.2%) after 2 weeks of cisapride treatment and to 25% (19.2 to 29.9%) after 4 weeks. cisapride therapy resulted in good or excellent improvement in 59.0% of the patients after two weeks, in 75% of patients after 4 weeks. Adverse events were occurred in 52 patients (5.8% of all patients), most commonly, loose stools or diarrhea (3.5%), abdominal pain (1.1%), and dizziness (0.3%). The majority of adverse events was mild and transient in nature and led to premature discontinuation of treatment in 4 patients. CONCLUSIONS: Although the majorities of patients with functional dyspepsia have dysmotility like symptoms in Korea, there is such overlap among the dyspepsia subgroups. Most patients responded well to a short therapeutic trial with cisapride without significant side effects.
Abdominal Pain ; Cisapride* ; Diarrhea ; Dizziness ; Dyspepsia* ; Eructation ; Humans ; Korea* ; Retrospective Studies

PURPOSE: The human fetus is primarily dependent on the placenta for its nutrition. However, as the fetus matures, it swallows increasing amounts of amniotic fluid, which contributes to the growth of fetus. Accordingly fetuses with congenital obstruction of the gut at high level have a reduced capacity for intestinal absorption of amniotic fluid. We undertook a study to investigate the effect of congenital gut obstruction on fetal growth. METHOD: A retrospective review of the records of all patients presenting congenital gut obstruction over 6-year period (from 1992 to 1997) in Chung-ang Gil hospital was performed. Patients with a complete proximal obstruction were included in group A; patients with incomplete or lower obstruction were included in group B. RESULT: 1) The ratio of male to female was 1.5:1. The mean birth weight and gestational age were 2.89+/-0.60kg and 38.7+/-0.20weeks. The mean birth weight and gestational age in group A were 2.68+/-0.69kg and 37.8+/-0.25weeks. The mean birth weight and gesnal age in group B were 2.980.54kg and 39.1+0.17weeks. There was significant difference between group A and B (P<0.01). 2) Significant differences were found between group A and B in prematurity and growth retardation rate (P<0.01). No significant difference was found between group A and B in associated anomaly rate (P>0.05). 3) In group A, 3 (42.8%) of 7 patients with associated anomalies had IUGR, whereas 8 (40.0%) of 20 patients without associated anomalies had IUGR (P>0.05). The corresponding figures for group B were 23.0% and 14.8%, respectively (P>0.05). CONCLUSION: Congenital gut obstruction causes IUGR by reducing intestinal absorption of amniotic fluid and the effect of IUGR is more pronounced as the obstruction is proximal to jejunum rather than distal to it.
Amniotic Fluid ; Birth Weight ; Female ; Fetal Development* ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Humans ; Intestinal Absorption ; Jejunum ; Male ; Placenta ; Retrospective Studies ; Swallows

PURPOSE: Hypoxic-ischemic encephalopathy is a major neurologic problem and one of the most important perinatal causes of neurological morbidity. Evaluation of the presence, extent, and subsequent evolution of hypoxic-ischemic lesions may be very important. We studied the significance of imaging modality through the analysis of brain MRI findings of hypoxic-ischemic encephalopathy during neonatal period and comparison with findings of brain ultrasonography. METHODS: We analysed the forty-seven infants retrospectively who were diagnosed as hypoxic-ischemic encephalopathy and underwent brain MRI and ultrasonography from Jan. 1992 to May 1996. RESULTS: 1) The mean gestational age and birth weight of the twenty-seven infants who were premature were 32.8+/-2.08weeks and 1.97+/-0.44kg respectively. The mean gestational age and birth weight of twenty infants who were fullterm were 39.3+/-1.04weeks and 2.98+/- 0.93kg respectively. The primary hypoxic-ischemic insults occurred during antenatal, intrapartum and postnatal period. 2) The findings of brain MRI were classified into periventricular leukomalacia, encephalomalacia, basal ganglia lesion, focal parenchymal hemorrhage, ventriculomegaly without other lesion and normal finding. 3) Three infants among twenty-five infants with periventricular leukomalacia, four infants among seven infants with basal ganglia lesion and six infants among seven infants with focal parenchymal hemorrhage were not diagnosed by brain ultrasonography. 4) All of ten infants with encephalomalacia and four infants with ventriculomegaly without other lesion were diagnosed by brain ultrasonography. CONCLUSIONS: MRI can diagnose the hypoxic-ischemic lesions which would not be possible by brain ultrasonography. Therefore MRI is the imaging modality of choice for diagnosis in infants with hypoxic-ischemic encephalopathy. We believe that the benefits of MRI outweigh its somewhat higher cost, lack of portability and monitoring difficulties.
Basal Ganglia ; Birth Weight ; Brain ; Diagnosis ; Encephalomalacia ; Gestational Age ; Hemorrhage ; Humans ; Hypoxia-Ischemia, Brain* ; Infant ; Infant, Newborn ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging* ; Retrospective Studies ; Ultrasonography

PURPOSE: Hypoxic-ischemic encephalopathy is a major neurologic problem and one of the most important perinatal causes of neurological morbidity. Evaluation of the presence, extent, and subsequent evolution of hypoxic-ischemic lesions may be very important. We studied the significance of imaging modality through the analysis of brain MRI findings of hypoxic-ischemic encephalopathy during neonatal period and comparison with findings of brain ultrasonography. METHODS: We analysed the forty-seven infants retrospectively who were diagnosed as hypoxic-ischemic encephalopathy and underwent brain MRI and ultrasonography from Jan. 1992 to May 1996. RESULTS: 1) The mean gestational age and birth weight of the twenty-seven infants who were premature were 32.8+/-2.08weeks and 1.97+/-0.44kg respectively. The mean gestational age and birth weight of twenty infants who were fullterm were 39.3+/-1.04weeks and 2.98+/- 0.93kg respectively. The primary hypoxic-ischemic insults occurred during antenatal, intrapartum and postnatal period. 2) The findings of brain MRI were classified into periventricular leukomalacia, encephalomalacia, basal ganglia lesion, focal parenchymal hemorrhage, ventriculomegaly without other lesion and normal finding. 3) Three infants among twenty-five infants with periventricular leukomalacia, four infants among seven infants with basal ganglia lesion and six infants among seven infants with focal parenchymal hemorrhage were not diagnosed by brain ultrasonography. 4) All of ten infants with encephalomalacia and four infants with ventriculomegaly without other lesion were diagnosed by brain ultrasonography. CONCLUSIONS: MRI can diagnose the hypoxic-ischemic lesions which would not be possible by brain ultrasonography. Therefore MRI is the imaging modality of choice for diagnosis in infants with hypoxic-ischemic encephalopathy. We believe that the benefits of MRI outweigh its somewhat higher cost, lack of portability and monitoring difficulties.
Basal Ganglia ; Birth Weight ; Brain ; Diagnosis ; Encephalomalacia ; Gestational Age ; Hemorrhage ; Humans ; Hypoxia-Ischemia, Brain* ; Infant ; Infant, Newborn ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging* ; Retrospective Studies ; Ultrasonography