PURPOSE: Dispatcher-assisted telephone instruction during cardiopulmonary resuscitation (CPR) improves the quality of CPR performed by laypersons. However, in Korea, CPR instruction guidelines for bystanders have not made. We therefore studied the effects of verbal instruction on the quality of chest compression. METHODS: Data from two randomized, double-blinded, controlled trials using identical methodology were combined to obtain 175 records for analysis. Subjects were randomized into either a "push as hard as you can and fast" (n=87) or "push down 5~6 cm, 100~120 rate/min" (n=88), verbal instructions in the 2011 Korea Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Data were recorded via a Resusci(R) Anne SkillReporter(TM), Laerdal Medical mannequin. Primary outcome measures included chest compression depth and chest compression rate per minute. RESULTS: The average compression depth and speed of chest compressions did not significantly differ between the two verbal instructions. CONCLUSION: The verbal istructions provided by telephone based on the 2011 Korean Guidelines for CPR and ECC are not effective. The instructions for high quality CPR of layperson should therefore be studied.
Cardiopulmonary Resuscitation* ; Emergencies ; Heart Massage ; Korea ; Manikins ; Methods ; Outcome Assessment (Health Care) ; Telephone* ; Thorax ; Verbal Learning

BACKGROUND: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. METHODS: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. RESULTS: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8+/-7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4+/-3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7+/-4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). CONCLUSION: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.
Anoxia ; Compliance ; Dyspnea ; Heart ; Humans ; Insurance ; Insurance Coverage ; Korea ; Lung ; Lung Neoplasms ; Male ; Medical Records ; National Health Programs ; Oxygen ; Partial Pressure ; Prescriptions ; Pulmonary Disease, Chronic Obstructive ; Respiratory Insufficiency ; Stress, Psychological ; Telephone

BACKGROUND: Although the reports on re-operative coronary revascularization (redo-CABG) have increased, there are only limited reports on redo-CABG using arterial grafts. The aim of this study was to analyze the safety and feasibility of using various arterial grafts for redo-CABG. MATERIAL AND METHOD: A consecutive series of patients who underwent 33 redo-CABGs from March 2001 to July 2008 were retrospectively reviewed. We performed conventional CABG in 17 patients, on-pump beating CABG in 7, off-pump CABG in 7 and minimally invasive direct coronary artery bypass in 2. The grafted that were used included 34 internal thoracic arteries (ITA), 14 radial arteries, 14 right gastroepiploic arteries and others. Arterial composite grafts were constructed in 26 patients. Of these, a previously patent in-situ left ITA was re-used as the in-flow of a composite graft in 10 patients. RESULT: No hospital deaths or major wound problems occurred. The post-operative complications included 2 myocardial infarctions (6%), 1 intra-aortic balloon pump insertion (3%), 5 cases of atrial fibrillation (15.1%) and 3 neurologic complications (9.1%). The mean follow-up duration was 31.1+/-22.7 months and the 3 year survival rate was 86.4%. There were 4 late deaths (2 cardiac deaths) and no recurrent angina during the follow-up period. CONCLUSION: Redo-CABG with using various arterial grafts is currently a safe, feasible procedure, but further investigation and long term follow-up are needed.
Atrial Fibrillation ; Coronary Artery Bypass ; Follow-Up Studies ; Gastroepiploic Artery ; Humans ; Mammary Arteries ; Myocardial Infarction ; Radial Artery ; Reoperation ; Retrospective Studies ; Survival Rate ; Transplants

PURPOSE: The presence of epicanthal fold and the absence of supratarsal fold are characteristics of Korean eyelids. There has been many surgical procedures to eliminate medial epicanthal fold but those procedures focus on the lengthening of horizontal palpebral fissure and the shortening of intercanthal distance so that the shape of eye had tendency to be sharp. The authors suggest that the supermedial shifting of epicanthal fold enhance the aesthetic result. METHODS: From Sep 2006 to May 2007, total 17 women(mean age 22) with Type III epicanthal fold underwent epicanthoplasty using author's modified Uchida method. The design for epicanthoplasty was drawn superolaterally along epicanthal fold and split V-W plasty was done to shift the epicanthal fold superomedially. Also non-incisional double-eyelid operation was underwent. RESULTS: The epicanthal fold was shifted in superomedially, intercanthal distance was shortened and double-eyelid was achieved. The patients were satisfied with the result and no major complication was noted. CONCLUSION: This method can be effective in correcting the epicanthal fold of Korean eyelid by shifting the epicanthal fold superomedially to make the shape of eye aesthetically without noticeable scar.
Cicatrix ; Eyelids ; Humans ; Sterilization, Tubal*

BACKGROUND: Serotonin transporter gene-linked polymorphism region(5-HTTLPR) and catechol-O-methyltransferase(COMT) genes are thought to be important factors in some personality traits and the etiology of anxiety disorder. The goal of this study was to determine the role of these genes in personality traits. METHOD: The participants included 116 healthy adults with no history of psychiatric disorders and other physical illness for the last 6 months. All participants were tested by Temperament and Character Inventory(TCI). The 5-HTTLPR, COMT val158met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with t-test and ANOVA. RESULT: There were possible relationships of the 5-HTTLPR with self-transcendence(P=0.050) and COMT val158met polymorphism with cooperativeness(P=0.053). CONCLUSION: We found associations between 5-HTTLPR, COMT polymorphisms and the some TCI character dimensions. Further studies of polymorphisms of other genes and their interactions may clarify the complex relationship between personality and genes.
Adult ; Anxiety Disorders ; Humans ; Polymorphism, Genetic ; Serotonin Plasma Membrane Transport Proteins ; Temperament

BACKGROUND: Since Ross and Sormeville first reported the use of aortic homograft valve for correction of pulmonary atresia in 1966, homograft valves are widely used in the repair of congenital anomalies as conduits between the pulmonary ventricle and pulmonary arteries. On the basis of these results, we have used it actively. In this report, we describe our experience with the use of cryopreserved valved homograft conduits for infants and children requiring right ventricle to pulmonary artery connection in various congenital cardiac anomalies. MATERIAL AND METHOD: Between January,1996 and December 2001, 27 infants or children with a median age of 16 months(range 9days to 18years) underwent repair of RVOTO using homograft valved conduit by two surgeons. We studied 22 patients who have been followed up at least more than one year. The diagnosis at operation included pulmonary atresia with ventricular septal defect (n=13), truncus arteriosus (n=3), TGA or corrected TGA with RVOTO (n=6). Homograft valved conduits varied in size from 15 to 26 mm (mean, 183.82 mm). The follow-up period ranged from 12 to 80.4 months (median, 48.4 months). RESULT: There was no re-operation due to graft failure itself. However, early progressive pulmonary homograft valve insufficiency developed in one patient, that was caused by dilatation secondary to the presence of residual distal pulmonary artery stenosis and hypoplasia after repair of pulmonary atresia with ventricular septal defect. This patient was required reoperation (conduit replacement). During follow-up period, there were significant pulmonary stenosis in one, and pulmonary regurgitation more than moderate degree in 3. And there were mild calcifications at distal anastomotic site in 2 patients. All the calcified homografts were aortic in origin. CONCLUSION: We observed that cryopreserved homograft conduits used in infant and children functioned satisfactorily in the pulmonic position at mid-term follow-up. To enhance the homograft function, ongoing investigation is required to re-establish the optimal strategy for the harvest, preservation and the use of it.
Allografts ; Child ; Constriction, Pathologic ; Cryopreservation ; Diagnosis ; Dilatation ; Follow-Up Studies* ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Infant ; Pulmonary Artery ; Pulmonary Atresia ; Pulmonary Valve Insufficiency ; Pulmonary Valve Stenosis ; Reoperation ; Transplantation, Homologous ; Transplants ; Truncus Arteriosus

BACKGROUND: Many surgical techniques for ischemic mitral regurgitation (IMR) have been used with their excellent results and advantages. Here, we report our simple posterior annuloplasty techniques using vascular graft strip with their early results. MATERIAL AND METHOD: Twenty two patients (13 male) underwent the operations for IMR (excluding the papillary muscle rupture) from December 2001 to January 2003. Preoperative risk factors were low ejection fraction (<35%, n=9), hypertension (n=13), diabetes (n=9), and renal failure (Cr>2.5, n=4). The wide dissection beneath the both vena cavae and interatrial groove after bicaval cannulation enabled the easy exposure of mitral valve even in the small left atrium. After eight or nine interrupted sutures in posterior annulus for anchoring the 6 mm width vascular graft strip, symmetric (n=8) or asymmetric (n=14) annuloplasty were done. Combined surgeries were CABG (n=21), Dor procedures (n=3), tricuspid valve annuloplasty (n=1), Maze operation (n=1), and aorto-right subclavian artery bypass (n=1). RESULT: Except for one surgical mortality, all the patients were doing well and the mean grade of regurgitation was decreased from 2.95 to 0.88, however the ejection fraction had not changed significantly just before discharge. Post-operative valve function evaluated before discharge revealed no residual regurgitation in 8 (including 1 patient with mild stenosis due to over reduction), minimal in 11, mild in 2, and mild to moderate regurgitation in 1. One patient who had ischemic cardiomyopathy and renal failure died of the arrhythmia during the hemodialysis. CONCLUSION: These observations suggest that the annuloplasty with vascular graft strip could be a safe and cost effective techniques for ischemic mitral regurgitation. However, the long term evaluation for the mitral valve function should be defined for the final conclusion.
Arrhythmias, Cardiac ; Cardiomyopathies ; Catheterization ; Constriction, Pathologic ; Heart Atria ; Humans ; Hypertension ; Mitral Valve ; Mitral Valve Insufficiency ; Mortality ; Myocardial Ischemia ; Papillary Muscles ; Renal Dialysis ; Renal Insufficiency ; Risk Factors ; Subclavian Artery ; Sutures ; Transplants* ; Tricuspid Valve

OBJECTIVE: Peripheral blood mononuclear cells (PBMC) in culture release a biologically active human chorionic gonadotropin (hCG). This effect is detectable during pregnancy with a maximum between the 16th and 19th week. HCG plays an important role for the corpus luteum rescue during the early gestational age and possibly for the immunotolerance. This study was performed to investigate the relationships between the productivity of cultured PBMC of pregnant women and the ability to maintain early pregnancy, and whether 12-o-tetradecanoyl-phorbol-13-acetate (TPA) increases hCG sectetion by cultured PBMCs. MATERIALS AND METHODS: PBMC were obtained from 20 pregnant women between 16th to 19th week of gestation , and cultured with TPA. Culture cells were harvested and hCG mRNA were extracted and RT-PCR were performed. Culture supernatants were collected and hCG concentration were determined by commercial RIA methods. RESULTS: The mean age was 31.0 years old, 19 of 20 (95%) pregnant women's PBMC secereted hCG and expressed hCG mRNA, but in control group exept male hepatitis B patient, none of them produced hCG. TPA activated expression of hCG in PBMC in linear manner. CONCLUSION: Pregnant women's cultured PBMC secreted hCG, but not in non-pregnant or male. We could confirm the mRNA of hCG in PBMC as well in the placental control. The productivity of hCG in PBMC might be closely related with maintenance of early pregnancy.
Chorionic Gonadotropin ; Corpus Luteum ; Efficiency ; Female ; Gestational Age ; Hepatitis B ; Humans ; Male ; Pregnancy* ; Pregnant Women ; RNA, Messenger

A 58-year-old male patient visited our hospital for epigastric discomfort and dysphagia which had developed 5 months earlier. He was diagnosed with esophageal cancer at the mid-thoracic level based on radiologic, endoscopic, and histologic examinations. An esophagectomy(Ivor Lewis technique) was done to treat the esophageal cancer. He was doing well until the 20th postoperative day when he began to complain of cough, sputum, fever and chills, Subsequently, thereafter, abdominal pain and generalized abdominal tenderness developed on the 22nd postoperative day. Upon gastrofiberscopy and esophagographic examinations, he was diagnosed with gastrobronchial fistula and an emergency operation was performed. On operative findings, the gastric fundus was perforated and directly connected to the abscessed cavity of the right upper lobe due to a gastric ulcer. We, herewith, report this case after review of the literature.
Abdominal Pain ; Abscess ; Chills ; Cough ; Deglutition Disorders ; Emergencies ; Esophageal Neoplasms* ; Esophagectomy* ; Fever ; Fistula* ; Gastric Fundus ; Humans ; Male ; Middle Aged ; Sputum ; Stomach Ulcer* ; Ulcer

Myoepithelioma is a benign tumor composed of sheets and islands of various proportion of spindle, plasmacytoid, epitheloid, and clear cells. We are reporting of a 38-year-old woman with an extremely rare neoplasm of the trachea, myoepithelioma. The patient had an right neck mass and diagnosed presumptively as the thyroid tumor with tracheal invasion. Resection and anastomosis of the trachea with partial thyroidectomy was done. The tumor was a well circumscribed mass with solid growth pattern and composed of spindle and epitheloid cells, which were positive for S-100 protein and smooth muscle actin. In electron microscopy, a large amount of microfilaments in the cytoplasm and layers of basement membrane-like materials in the intercellular spaces were observed, which are characteristics of myoepithelioma. Patient has been well for 8 months postoperatively.
Actin Cytoskeleton ; Actins ; Adult ; Cytoplasm ; Extracellular Space ; Female ; Humans ; Islands ; Microscopy, Electron ; Muscle, Smooth ; Myoepithelioma* ; Neck ; S100 Proteins ; Thyroid Gland ; Thyroidectomy ; Trachea ; Tracheal Neoplasms