BACKGROUND AND OBJECTIVES: The current guidelines recommend an early invasive strategy for patients suffering with non-ST segment elevation myocardial infarction (NSTEMI). However, there is still debate about the timing of revascularization in patients with NSTEMI. To analyze the clinical efficacy of the timing of revascularization, we compared the in-hospital clinical outcome of NSTEMI patients from the Korea Acute Myocardial Infarction Registry (KAMIR) between the early and selective invasive therapeutic groups. SUBJECTS AND METHODS: Between Nov. 2005 and Apr. 2007, 2762 acute NSTEMI patients (mean age=64.6+/-12.8 years, 1847 males) were enrolled in the KAMIR. The therapeutic strategy of NSTEMI was categorized into early invasive treatment (within 48 hours, Group I mean age: 63.1+/-13.1 years, 1085 males) and selective invasive treatment (Group II mean age: 66.5+/-12.1 years, 762 males). The initial clinical status and the in-hospital mortality and morbidity rate were compared between these two groups. The in-hospital outcomes were also compared between the two groups according to each level of the Thrombolysis In Myocardial Infarction (TIMI) risk score. RESULTS: There were significant differences in the mortality and morbidity rate between the groups (6.5% vs. 10.3%, respectively, p<0.001). According to TIMI risk score, there were no significant differences of mortality and morbidity for the low to moderate risk patients (5.3% vs. 7.8%, respectively, p=0.123 for the risk score 0-2, 6.4% vs. 8.7%, p=0.139 for the risk score 3-4). CONCLUSION: Early invasive treatment improves the hospital outcome for the high-risk NSTEMI patients. The use of abciximab, a low ejection fraction, a high Killip class, a high TIMI risk score and old age are the predictive factors of in-hospital mortality and morbidity.
Angioplasty ; Hospital Mortality ; Humans ; Korea ; Mortality ; Myocardial Infarction* ; Prognosis ; Thrombolytic Therapy

BACKGROUND AND OBJECTIVES: The Duke treadmill exercise score (DTS) has been used to stratify patients with coronary artery disease into low-, moderate-, and high-risk groups. To determine the coronary angiographic and myocardial scintigraphic correlates of these scores, we have compared the degree of risk assessed by the DTS and with those obtained by angiography and SPECT. SUBJECTS AND METHODS: The subjects were classified into low risk (DTS >or= 5), moderate risk ( 4 > DTS >or= -11) and high risk (DTS < -11) groups according to their DTS. To evaluate the agreement in the risk assessment, 102 patients with angiographically proven coronary artery disease, were assessed for the extent of their coronary artery disease by the number of stenotic vessels, and from their exercise Tc-99m MIBI myocardial SPECT findings. RESULTS: Of the 102 subjects, 52 (51%) had one-vessel, 25 (24.5%) had two-vessel, and 25 had three-vessel disease. With the results of the coronary angiography and SPECT, the patients were re-classified into three groups; group 1 (n=20) had three-vessel disease and/or >10 abnormal segments, group 3 (n=41) had one vessel disease and less than 5 abnormal segments, and group 2 (n=41) included the remaining subjects. Based on the DTS, 37 (36%) were in the low-risk, 44 (43%) in the moderate risk, and 21 (21%) in the high risk groups. In the low-risk DTS patients, 32.4% were in group 1, 35.2% in group 2 and 32.4% in group 3. In relation to the subjects with moderate risk DTS, there were 9, 16 and 55% in groups 1, 2 and 3, respectively. Whereas, there were 19, 24 and 57% in groups 1, 2 and 3 with high risk DTS subjects, respectively. CONCLUSION: Although considerable overlap exists, the degree of risk assessed from the angiography and SPECT findings were different from those by DTS. We suggest that patients classified into the low-risk DTS group may have extensive coronary artery disease, or myocardial perfusion SPECT abnormalities, whereas patients in the high-risk DTS group may be normal, or have mild coronary artery disease or mild SPECT abnormalities.
Angiography ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Exercise Test ; Humans ; Perfusion ; Radionuclide Imaging ; Risk Assessment* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: The purpose of the study was to determine the value of exercise electrocardiography in predicting the area of myocardial ischemia. METHOD: Seventy-six anginal patients with a perfusion defect in one vessel territory on exercise 99mTc-MIBI myocardial perfusion scan were studied. Each patient underwent exercise electrocardiograhy using modified Bruce protocol. Exercise electrocardiography was interpreted as abnormal when the horizontal or downsloping depression in ST segment was 0.1 mV or greater at 80 msec after the J point during exercise. Forty-eight patients had exercise induced ST-segment depression. RESULT: Twenty-five patients had exercise induced ST-segment depression in single lead-group and 23 patients had in multiple lead-groups. In 18 patients (18/23) with exercise induced ST-segment depression in multiple lead-groups, the perfusion defect involved the apical area on myocardial perfusion scanning and in 21 patients (21/25) with ST-segment depression in single lead-group, the perfusion defect did not involve the apical area. In patients without perfusion defect in the apical area, ST-segment depression in anterior lead-group (V1 to V4) was associated with myocadial perfusion defects in left anterior descending artery territories in five of five cases (100%), ST-segment depression in lateral lead-group (I, aVL, V5, V6) was associated with defects in left circumflex artery territories in six of six cases (100%), and ST-segment depression in inferior lead group (II, III, aVF) was associated with defects in right coronary artery territories in nine of ten (90%) (p<0.01). In patients with perfusion defect in the apical area, exercise induced ST-segment depressions were observed in multiple lead-groups (18/22). CONCLUSION: ST-segment depression on 12 lead exercise electrocardiography was a good predictor of the site of myocadial ischemia in anginal patients with single vessel territory ischemia when ST-segment depression developed in single lead group. However, ST-segment depressions in mutiple lead-groups suggested that the perfusion defect involved the apical area and did not predict the site of myocardial ischemia.
Angina Pectoris* ; Arteries ; Coronary Vessels ; Depression ; Electrocardiography* ; Humans ; Ischemia ; Myocardial Ischemia ; Perfusion*

BACKGROUND: Because of the ubiquity of Legionella species in aquatic environments, molecular epidemiological analysis of Legionella isolates is important in investigation for source of infection and subsequent control of nosocomial legionellosis. In association with an unusual cluster of nosocomial pneumonia with Legionella in a tertiary-care hospital, we performed an environmental surveillance with molecular epidemiological study of Legionella isolates. METHODS: We randomly collected 20 samples of environmental and portable water from the hospital where three cases of Legionella pneumonia occurred consecutively during the period of 5 months. We detected Legionella from the samples by using both culture and polymerase chain reaction(PCR), and analyzed Legionella isolates from patients and environmental samples together with 12 reference strains by ribotyping using HpaI and EcoRI. RESULTS: Legionella was isolated from 3 out of 20(15%) samples by culture, and detected in 9 of 20(45%) by PCR. Ribotyping analysis showed that 2 patients' and 2 environmental isolates from a faucet of the patient's room and an air handling unit shared the same pattern which was also identical to that of Legionella pneumophila serogroup 6, a reference strain. CONCLUSION: The study showed that the hospital environments were contaminated with at least 2 Legionella species including L. pneumophila serogroup 6, and indicated that an unusual cluster of Legionella pneumonia occurred in the hospital was possibly linked to the contamination of a faucet with L. pneumophila serogroup 6.
Environmental Monitoring ; Epidemiologic Studies* ; Humans ; Legionella pneumophila ; Legionella* ; Legionellosis ; Pneumonia* ; Polymerase Chain Reaction ; Ribotyping ; Water

BACKGROUND: Bone marrow scintigraphy using Tc-99m labeled antigranulocyte antibody has been reported to be able to evaluate bone marrow status. We have performed antigranulocyte antibody scan and hematopoietic activity in order to identify bone marrow status in patients with hematologic diseases. METHODS: Sixty-nine patients were enrolled in this study from October 1995 to May 1997. Images were acquired at four and twenty-four hour after injecion of 20mCi 99mTc labeled antigranulocyte antibody (BW 250/183). Patients were divided into four groups according to scintigraphic findings, those with increased marrow uptake (marrow expansion), decreased uptake, focal defect and normal findings. RESULTS: Leukemias and myelodysplastic syndromes frequently showed bone marrow expansion. Seventeen of 21 patients (81%) with AML, and all of ALL and biphenotypic leukemias showed bone marrow expansion. Five of 6 with CML, all Hodgkin's diseases and 3 of 4 MDS also showed marrow expansion. In contrast, all aplastic anemia patients showed decreased marrow uptake, and extra-axial noted in 2 patients with aplastic anemia. All of ten patients with multiple myeloma and 2 of 4 (50%) with Hodgkin disease showed focal marrow defects. Three of 11 with non-Hodgkin lymphoma and 4 of 21 with AML also showed focal marrow defects. CONCLUSION: Bone marrow scintigraphy using antigranulocyte antibody has clearly demonstrated the distribution of bone marrow in various hematologic diseases. Thus, it seems to be a useful method in the assessment of bone marrow status in patients with hematologic disease.
Anemia, Aplastic ; Bone Marrow ; Hematologic Diseases* ; Hodgkin Disease ; Humans ; Leukemia ; Lymphoma, Non-Hodgkin ; Multiple Myeloma ; Myelodysplastic Syndromes ; Radionuclide Imaging

BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitations of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric antibiotic regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. METHODS: Medical records of adults (> 15 years of age) hospitalized for CAP or pulmonary tuberculosis between March 1995 and February 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer to "atypical" pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum with compatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinical response to anti-tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of respiratory pathogens from all body sites, and their clinical significance were evaluated. RESULTS: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria, 246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171 (71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44 (18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococcal streptococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable : E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae, and A. baumannii and K. pneumoniae), S. aureus (2 definite and 2 probable), and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8 isolates). The rates of admission to the intensive care unit and of using assisted ventilation were 18% and 9.3% respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but all seven isolates from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolates of K. pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. CONCLUSION: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test to "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which will be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.
Adult ; Anti-Bacterial Agents ; Anti-Infective Agents ; Cefotaxime ; Chungcheongnam-do ; Coinfection ; Diagnosis ; Fever ; Gentamicins ; Haemophilus ; Hospitals, University* ; Humans ; Hypothermia ; Incidence ; Influenza, Human ; Intensive Care Units ; Korea ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Mortality ; Mucormycosis ; Mycobacterium ; Mycobacterium tuberculosis ; Mycoplasma ; Penicillins ; Pneumonia* ; Prospective Studies ; Seoul ; Serologic Tests ; Sputum ; Streptococcus pneumoniae ; Tachypnea ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary ; Ventilation

Twenty-four factories registered at the Ministry of Labor as factories using or producing cadmium in 1991 were investigated to know the present state of occupational exposure to cadmium in 1992. Nine factories among 24 stopped using or changed to other substances and 1 factory didn't produce any more, but delivered it to other factories through imports. Therefore, only 14 factories were producing or using cadmium. But, alloying materials were uspplied to about 20 and more factories, however, they couldn't be investigated because of limited information. Three factories had less than 50 workers were 3, 6 had 50-300 and 5 had more than 300. About 167 workers were exposed to cadmium. According to the classification by process, there were 4 alloy processes, 2 refinary, 2 elctroplating, 2 dry cell making, 1 industrial battery and 1 copper refinary. 8 factories used metal cadmium, 3 cadmium oxide, 2 cadmium sulfide, and 1 cadmium hyroxide. One factory was importing cadmium stearates only and supplying them to the PVC making factories. The amount of metal cadmium producing in 2 refinary factories was about 50-65 ton per month. The other cadmium compounds were imported. According to exposure level of cadmium in air of the 10 factories examined, each factory could be divided into high, moderate and low exposure groups. 1 battery recycling factory and 3 alloy factories were in the high exposure group and their mean air concentrations were 0.06679, 0.05481, 0.02492, and 0.003mg/m3, respectively. Refinary and industrial battery making factories were in the middle exposure group and their mean air concentrations were 0.00773 and 0.00613 mg/m3, respectively. Finally, low exposure group were copper smelting, dry cell case making, duplicator drum making and electroplating factory and their mean air concentrations were 0.00096, 0.00071, 0.00057 and 0.00054 mg/m3 respectively.
Alloys ; Cadmium Compounds ; Cadmium* ; Classification ; Copper ; Electroplating ; Korea* ; Occupational Exposure* ; Osmeriformes ; Recycling ; Stearates

No abstract available.
Adenosine* ; Dipyridamole* ; Dobutamine* ; Exercise Test*

No abstract available.
Occupational Health*

No abstract available.
Adenosine* ; Diagnosis* ; Radionuclide Imaging*