, Gil Ja Shin Percutaneous mitral balloon valvuloplasty was introduced by Dr. Inoue in 1984 and it is now widely used in the treatment of mitral stenosis due to its simple design to use.
From September 1993 to January 1996, 11 cases of percutaneous mitral balloon valvuloplasty were performed at the Ewha Womans University Hospital.
Following the percutaneous mitral balloon valvuloplasty, the mitral valve opening area was increased from 1.18±0.34cm2 to 1.91±0.62cm2(p<0.001). The mean mitral valve diastolic pressure gradient was decreased from 14.35±6.00mmHg to 5.41±4.03mmHg.(p<0.001) The NYHA functional class was improved significantly. Among 11 cases, 1 case(9%) was failed to expand mitral valve opening area and another 1 case developed grade 2 of mitral regurgitation. But there was no life threatening complication such as cardiac tamponade.
It is concluded that percutaneous mitral balloon valvuloplasty with Inoue alloon is an effective and simple method for most patient with mitral stenosis who do not have thrombi.
, Il Hwan Moon To determine the possibility of for sexual transmission of hepatitis C virus, we report a study on 26 cases of type C liver disease that were evaluated in the Department of Internal Medicine of the Ewha Womans University(Mok-dong hospital) over a period of 22 months from January of 1994 to October of 1995. The results were as follows,
1) There were 1 acute hepatitis case, 19 chronic hepatitis cases, and 6 liver cirrhosis cases.
2) The positive rate of anti-HCV of spouse was 3.8%. The positive rate was not significant compared to control group(total age adjusted prevalence).
3) The positive rate of anti-HCV of spouse was not significantly related with duration of mar-riage or severity of disease.
Intrafamilial spread of HCV by sexual transmission is one of the route for transmission of disease. But these result suggested it was uncommon route of transmission of hepatitis C.
, Yeon An Sung, Nan Ho Kyung Diabetic peripheral neuropathies are one of the most frequent complications of diabetes, and multiple metabolic and vascular disturbances are involved in the pathogenetic mechanisms of diabetic neuropathies.
Thirty patients with diabetic neuropathies from ischemic peripheral vascular disease were received cilostazol, an antithrombotic and vasodilating drug, 200mg a day in two divided doses for eight weeks at the Ewha Womans University Hospital. We analysed the eff-ects between before and efter treatment with cilostazol.
1) Total 30 patients were studied : 21 patients wre female and 9 patients were male. Their mean age was 60.2±9.9 years, and mean duration of diabetes was 8.0±4.9years. As comp-lications, 47% of them had retinopathy and 30% of them nephropathy.
2) No significant difference was found in physical findings, metabolic control states, CBC, blood chemistry and lipid levels before and after cilostazol treatment.
3) The score of resting pain and numbness were significantly decreased, and cold sensation and claudication were decreased after cilostazol treatment.
4) The score of arterial pulsation and Doppler wave was decreased, and the ankle pressure index was increased from 1.04±0.07 to 1.08±0.13 after cilostazol treatment, but there was no statistical significance.
5) Adverse effects were noted in 20% of cilostazol treated patients, 3 cases of headache, 2 facial flush and palpitation and 1 rash and urticaria, respectively.
6) The assessment of overall improvement of the disease, including "markedly improved", "improved" and "slightly improved" amounted to 63%. The assessment of overall safety of the drug, including "safe" and "almost safe" amounted to 80%. The assessment of overall utility of the drug, including "very useful", "useful" and "slightly useful" amounted to 63%.
Cilostazol was useful in the treatment of diabetic patients with peripheral vascular disease accompanied by ischemic symptoms to improve subjective symptoms and blood flow.
, Do Young Kim, Il Hwan Moon Hepatocellular carcinoma(HCC), a highly malignant tumor with a poor prognosis, is one of the common cancers in Korea like other Asian and African countries. Despite of recent advances in diagnostic and surgical techniques, early diagnosis of HCC is difficult and chance of surgical resection is still very low due to the multiplicity of tumor and associated liver cirrhosis. Transcatheter arterial chemoembolization(TAE) is a proven effective method of treating HCC regardless of operability.
The current study was undertaken on 111 cases to evaluate the survival period of the pat-ients with HCC and to find their prognostic factors.
The results were as follows:
1) The mean age of the patients was 54.8 years, with a range from 33 to 79 years. The highest incidence of age was in the 6th decade and the male to female ratio was 4.6:1.
2) The survival period of the patients was significantly related to serum albumin, SGOT, bilirubin and treatment(TAE).
3) The survival period was not significantly related to size and type of tumor.
4) The revised staging systems by Primack and Okuda were not significantly related to the survival period. But Child's classification was significantly related to the survival period.
5) The median survival period of TAE group was 11 months while non-TAE group was 0.5 month(p=0.0023).
6) Multivariate Cox regression analysis showed that the treatment modality(TAE or non-TAE group) was the factor with the greatest relative risk and an independent prognostic value.
Accordingly, it is suggested that TAE is an effective method for treating unresectable HCC, and the prospective investigations on TAE are needed.
, Young-Sun kim, Sa-Young Park, Jin-Hyuk Choi, Soon-Nam Lee, Hwa-Soon Chung Thrombohemorrhagic complications in chronic myeloproliferative disease(CMPD) including chronic myelogenous leukemia(CML) are not rare. Lower incidence of disordered hemostasis is reported in CML compared with other CMPD. The mechanism of thrombohemorrhagic complications might be a consequence of qualitative platelet abnormalites and prolonged bleeding time rather than that of thrombocytosis. Although defect of platelet function has been extensively investigated, there was no established consistent correlation between clinical bleeding and number and function of platelet. The most common site of bleeding complications in the CMPD is superficial mucosa. Bleeding in deep tissue and viscera is very unusual. We report a case of CML which developed a huge spontaneous retroperitoneal hematoma.
, Sa Yong Park, Ki Nam Shim, Doe Young Kim, Il Hwan Moon, Jeong Hyun Yoo Cirrhotic patients may exhibit circulatory derangement and renal dysfunction during the clinical course. Renal dysfunction on cirrhosis can occur without specific causative factors. This functional renal failure in cirrhosis is considered as a consequence of renal vasoconstriction. These alteratons of renal hemodynamics are already present in the early phase of the disease, even in the condition that the conventional kidney function tests are normal. A new method for noninvasive evaluation of arterial tone is duplex Doppler sonography. Among the various sonographic indices proposed, the renal resistive index(RI) is the most widely used for the estimation of intrarenal arteriolar vascular resistence.
This study was performed to evaluate the role of Doppler sonography in early detection of renal dysfunction and to assess the clinical significance of RI. In 25 cirrhotic patients without overt kidney failure and ten control subjects, the RI of the acurate artery in both kidneys was measured by Doppler sonography. The mean RI of cirrhotic group was significangly higher than that of control subjects(0,68±0.08 vs -0.62±0.05,p<0). Accordiing to Child class, the RI showed increasing tendency from A to C, through witout statistical significance. In this study, the RI was significantly inversely correlated with 24hr urinary sodium amount(r=-0.39, p<0,05)and correlated with serum creatinine(r=6.60,p<0.01). This study indicates that the measurement of RI is a sensitive method to assess intarenal hemodynamics and to detect early changes of the renal dysfunction in cirrhotic patients.
, Eun Mi Nam, Si Hoon Park, Gil Ja Shin, Woo Hyung Lee, Bong Suk Shim We describe an unusual 30-year-old female patient with a history of refractory hypertension and hypokalemia. She was diagnosed as primary aldosteronoism with bilateral adrenal hyperplasia 8 years age and blood pressure has been controlled with spironolactone 200mg/day, nifedipine 40mg/day, Cardura 4mg/day and oral potassium supplement till these days.
Recently refractory high blood pressure was developed and about 5×4×4.5cm sized left a-drenal mass was observed by abdominal CT. The hypertension and hypokalemia was controlled by left adrenalectomy.
, Haing Won Woo This study investigated the correlations between childhood sexual abuse and the severity of psychopathology symptoms in adulthood and the usefulness of adult psychiatric symptoms, diagnoses, and medications as factors in the identification of patients who have been sexually abused in childhood.
The subject of this study were 21 childhood sexually abused female inpatients and 22 nonabused female inpatients(psychiatric control group). All subjects were interviewed and completed self report instruments that focused of childhood sexual histoy of trauma, and current general psychiatric symptoms, dissociative symptoms.
Sexually abused broup showed significantly higher rates of divorce than psychiatric control group. Relative to psychiatric control group, sexually abused group have more hospitalization, higher proportion of more suicidal symptoms and more often major pharmacological tratment. Sexually abused group manifested significantly higher levels of dissociative symptoms and general psychiatric symptoms, including interpersonal sensitivity, psychoticism, obsessive compulsive and global severity index.
Findings suggest that childhood sexual abuse is associated with adult psychiatric symptoms, especially dissociative symptoms and work as etiology of psychopathology of boderline personalitiy disorder.
, Haing-Won Woo Posttraumatic stress disorder(PTSD), which has a life prevalence of 1%, can occur after expo-sure to a traumatic event that carries the risk of severe injury or death to itself.
The characteristic clinical features of PTSD are reexperiencing the events, increased arousal, and persistent avoidance or numbing of resposiveness. Authors reported that four survivors from Sampoong collapse suffered from symptoms of PTSD, guilty feeling, depressed mood, panic symptoms, claustrophobia, and suicidal threat since their injuries.
Interestingly, the psychotic symptom scale in self rating SCL-90-R(symptom checklist-90-revision) was somewhat high(>65)in three of them.
This study was planned to help the diagnosis of borderline leprosy by application of the
, Hae Young Choi, Ki Bum Myung, Eun Ae Park Subcutaneous fat necrosis of the newborn is a spontaneously regressing disorder of healthy fullterm of postterm infants, characterized by symmetric, firm, erythematous to violaceous sub-cutaneous nodules and plaques. Histopathologically, subcutaneous fat necrosis with granu-lomatous panniculitis and needle-shaped clefts in the cytoplasm of foamy and multinucleated histiocytic giant cells are diagnostic.
We report an uncomplicated case of subcutaneous fat necrosis in a 21-day-old, normally delivered male infant, which developed on the fourth day of life and spontaneously regressed in 4 months.
, Gyu Ryong Choi, Soo Seung Choi There are several types of research methodology in the medical research papers. Each of these research methodologies establish their proper purposes in the medical resarches. This study was performed to examine the frequencies and types of research methodologiy for the purpose of providing the prospective aspects.
We reviewed 765 research papers in the Ewha Medical Journal, from 1978 to 1995. The research paper were included all kinds of papers in the Ewha Medical Journal such as review articles, oiginal articles, case reviews and so on. And we classified the research metho-dologies into case study, clinical trial, observational study, experimetal study and study for di-agnostic methods.
Case study was most commonly used study design(332 papers,43.4%), followed by experimental study(185 papers, 24.2%). In the 1970s, case report(44.1%) was the most com-monly used study design and enxt was experimental study(17.7%). In the 1980s, also the most commonly used study design was case report(48.7%) and experimental study(24.9%) was mark-edly increased than 1970s. Not only the experimental study(24.8%)but also clinical trial(16.1%)was outstandingly increased in the 1990s. Especially experimental study and clinical trial in the clinical research papers were increased more and more to the 1990s. The most common paper volume was December(35.9%)in the Ewha Medical Journal. The differences of research metho-dology among basic science, medical part and surgical part were significant(p<0.01).
The authors suggested that the Ewha Medical Journal have been changed in the aspects of methodology, but have more qualitative arguementations on research metho-dology which are indispensable activities of prospective the Ewha Medical Journal.
This study was performed to know the safety and efficacy of limited min-ithoracotomy, which is a new method of operative procedure modified from minithoracotomy.
Eleven consecutive patients who underwent a limited minithoracotomy for the treatment of primary spontaneous pneumothorax from Jan.1.1994 to Dec.31.1995 were reviewed with medical records, laboratory and x-ray findings, and followed by reaching patient by phone or interviewing at the outpatient department.
The indication of these consecutive 11 patients were recurrent pneumothrorax 4 cases, continuous air leaking 7 cases, and visible bullae on chest x-ray or chest CT 2 cases. There were 12 limited minithoracotomies in 11 patients including on bilateral limited minithoracotomy. Average operative time was 54 minutes. There was no conversion to extended thoracotomy from limited minithoracotomy. No postoperative bleeding or infection was oberved. One patient showed prolonged air leak after operation who had multiple bullae resected from his left upper and lower lung, and was discharged 18 days after operation with good condition. Another patient experienced air sucking during chest tube removal on 4th postoperative day and discharged on 9th day after operation. Other patients wre discharged within 5th postoperative day. Average hospital stay after operation was 5.4 days. All eleven patients were followed up for 12±7.7months. There was no recurrences of pneumothorax.
These results suggest that limited minithoracotomy is choice of treatment when primary spontaneous pneumothorax patient requires surgery.
, Jun Hyeok Song, Kyu Man Shin Cysticercosis is the most frequent parasitosis of the central nervous system. Often medical treatment does not influence on ventricular or cisternal cysts or doesn't prevent the occurence of complications, such as hydrocephalus. So a considerable group of patients require surgical procedures, especially in cases of neural compression or intracranial hypertension or epilepsy. Recently stereotactic endoscopic removal of intraaxial small lesions using a stereotactic guiding tube and a fine endoscope was reported. We tried to control the symptomatic neurocy-sticercosis using the stereotatic endoscopic system.
We operated 4 cases of neurocysticercosis. Cerebrospinal fluid(CSF)analysis, enhanced com-puterized tomogram(CT) and magnetic resonance image(MRI) scan were performed. There were no specific findings in CSF analysis. CT and MRI scan showed single intraparenchymal lesion in 2 cases, one was cystic and the other was solid, multiple intraventricular cysts with obstructive hydrocephalus in 1 case and mixed type in 1 case. Seizures occured in all patients, partial sensory type in 3 cases who had reciprocal intraparenchymal lesion, generalized type in 1 case who had obstructive hydrocephalus by multple ventricular cysts.
For parenchymal lesions, we planned stereotactic open system endoscopic surgery with variable forceps, laser and suction. Cystic forms were removed successfully but in solid form additional transgyral microscopic removal was needed. In intraventricular lesions, we first placed stereotactic guiding tube via frontal burr hole, then replaced this to 14 Fr peelaway patheter. Through the peelaway catheter we inserted closed system endoscopy and removed the cysts with variable forceps and suctions. All intraparenchymal and intraventricular lesions were removed without specific complications except transient chemical meningitis in one case.
Stereotactic endoscopic surgery make it possible to operate cystic lesions without dege-neration(vesicular stage)wherever they locate.
Treating of established keloids or hypertrophic scars is difficult, several methods for skeloids treatment have been reported; intralesional steroid injection, application of silastic gel sheet, pressure garment and surgical excision. Three or four combined methods of them produced better results than single method. An attempt was made to assess the value of 2 categories of combined treatment, the category 1 was intralesional steroid injection in combination with pressure garment & silastic gel sheet in treating 43 keloids or hypertrophic scars, the category 2 was surgry in combination with nonsurgical treatments in treating 7 patients. Nonsurgical combined treatment(category 1)was found be effective in the eradication of symptoms(91% symtomatic relief), the texture change(93% success rate) and the height change(56% partial flatteneing & 37% full flattening). Surgery in combination with nonsurgical treatments(category 2) is also recommended as treatment for complicated recurrent keloids. However more cases and longer follow-up are necessary.
Citations
Currently D2 lymph node dissection is considered as minimal extent of dissection in curative resection of gastric cancer. This study was conducted to investigated the patterns of lymph node metastasis of gastric cancer and to validate extent of lympn node dissection.
Among 117 patients with gastric cancer, 35 patients with early gastric cancer and 45 with advanced gastric cancer underwent curative gastric resection were enrolled in this study. Removed lymph nodes were classified as N1(1~6), N2(7~11), N3(12~16) and the boundary of dissection was classified as D1, D2, D3, D3+α according to classification of stomach cancer research association in Korea.
The priportion of early gastric cancer was 30%(35/117). Average number of metas-tatic lymph nodes was 2 in stage II, 6 in stage IIIa, 13 in stage IIIb, 21 in stage IV(p<0.05). 2 patients with early gastric cancer had metastatic lymph node(N1) and their lesions were over 3.0cm in size, depressed in shape. In terms of differentiation, 25(62%) patients with stage I, D1 dissection was carried out in two(5%), D2 dissection in eleven(28%), D3 or D3+α dissection in twenty seven (67%). In the patients with over stage II, there was no D1 dissection, D2 dissection was performed only in 3(7%), D3 or D3+α dissection in 37(92%). Extended lymph node dissection was significantly much higher in advanced cases than in early cases. The average number of resected positive lymph nodes were higher in BORRMANN type III or type IV than in type II(p<0.01, p<0.05 respectively). All patients with positive N2 or N3 lymph nodes revealed the positive N1 lymph nodes. There were 2(25%) skipped metastasis among 8 patients with positive N3 lymph nodes.
At least D2 lymph node dissection is needed for curative resection of gastric cancer in the patients with possible metastasis of N1 lymph nodes, even in the those we early gastric cancer. D3 or D3+α dissection should be performed in the patients with possible metastasis of N2 lymph nodes among advanced gastric cancer, even in the patients without metastasis of N2 lymph nodes selectiely because of skipped metastasis.
The media for assisted fertilization from Medi-Cult is based on a Synthetic Serum Replacement(SSR). The main principle of SSR is a metal iron buffer containing a balanced mixture of iron and trace metals. Recently, Synthetic Serum Supplement(SSS) and Medi-cult are commonly used.
These synthetic substitutes have some advandages, such as safty from viral contamination and no needs of bioassay.
To compare the usefulness between the Medi-cult and Ham's F-10 supplemented with fetal cord serum for the culture medium of in vitro fertilization, fertilization rate, cleavage rate and pregnancy rate were studied. It is concluded that Medi-cult was better than Ham's F-10 supplemented with fetal cord serum according to fertilization rate, cleavage rate, pregnancy rate and ongoing pregnancy, but that differences did not have statistical significance.
Various mechanisms are involved in drug resistance of tumor cells. Among them one such mechanism is the overexpression of the multidrug resistance(mdr1) gene product P-glycoprotein(Pgp) that functions as an energy - dependent drug efflux pump.
The expression of P-glycoprotein by immunohistochemistry was examined in 20 cases of laryngeal squamous cell carcinoma and vocal nodules as a control pump using a newly developed monoclonal antibody(MDR/JSB-1) which is specipic to human mdr1 gene product and recognizes an external epitope of the protein. Mdr1 gene product expression was compared with clinical response to chemotherapy in six patients who received mdr1 dependent drugs.
The results are summerized as follows.
1) Among 20 laryngeal cancer tissues, P-glycoprotein was detected in 8 patients and none of 20 vocal nodules showed expression of P-glycoprotein.
2) There is a correlation in between positive P-glycoprotein staining and tumor differentiation.
3) No correlation in between positive P-glycoprotein standing and tumor stage of tumor site is observed.
4) 2 patients with negative clinical response to chemotherapy among 6 patients who received inductive chemotherapy with cisplatin, vincristine and p pepleomycin revealed positive P-glycoprotein staining.
Therefore, analyzing the expression of P-glycoprotein may play a role when planning chemotherapeutic regimens for patients with head and neck cancer and may be an additional prognostic and diagnostic tools in these patients.
To evaluate the effects of Nd : YAG Laser posterior capsulotomy, I performed posterior capsulotomy on after cataract(72 eyes) by using Q-switched Nd:YAG laser from March 1994 to August 1995.
The results were as follows;
1) 24 aphakic eyes(33.3%), 45 ECCE with PCL inserted pseudophakic eyes(62.5%), 3 KPE with PCL inserted pseudophakic eyes(4.2%) were followed.
2) On performing posterior capsulotomy, the power setting of Nd:YAG laser was ranged from 2.0 to 2.9mJ(62.5%), more than 40 pulses were used in 35 eyes(48.6%).
3) Postoperative visual acuity was improved in 68 eyes(94.4%) and 0.5 or better in 47 eyes(65.3%)
4) Ocular complications after posterior capsulotomy were transient increase of intraocular pressure(8.3%), sustained increased intraocular pressure(4.2%), anterior uvetis(2.8%), vitreous prolapse(2.8%), corneal damage(2.8%), intraocular lens damage(1.4%), cystoid macular edema(1.4%), retinal detachment(1.4%).
As the results, posterior capsulotomy with the Nd : YAG laser offers several advantages over primary or secondary surgical capsulotomy and has fewer complications.
The efficacy and follow-up rate of intravesical therapy after transurethral resec-tion with thiotepa or bacillus Calmette-Guerin(BCG) for Ta/T1 transitional cell carcinoma of bladder was evaluated in 67 patients.
After transurethral resection, thiptepa(60mg) or BCG(120mg, 5×108CFU/mg) was instillated into bladder every week. After 6 consecutive cycles were complicated, treatment results were evaluated with cystoscopy, urine cytology and biopsy of bladder mucosa. Disease free and follow-up rates were expressed with Kaplan-Meier curve and the treatment results were compared.
The effects of treatments were similar in both thiotepa and BCG groups. Overall, disease free rates at 1,2,3,4 and 5 years were 84, 72, 69, 65 and 42% respectively. Follow-up rates of the patients at the same periods were 55, 34, 28, 19 and 14% respectively. Mean time to progression to invasive cancer was significantly shorter than that of simple recurrence(p<0.05).
Intravesical therapy seems to be effective on the prevention of recurrence, re-gardless of the regimen of Ta/T1 bladder cancer. But the long term effect and the preventive role on progression of superficial bladder tumor should be established. In reality, the main lim-iting factor in the management of superficial bladder tumor is extremely high rate of follow-up loss.
, Eun Chul Chung The cavernous malformation is increasingly recognized as a vascular malformation of the brain that presents with seizures, hemohhage, or neurologic deficit. We have identified 24 lesions in 12 patients that were diagnosed cavernous malformation of the brain based on the findings of follow-up magnetic resonance image and sugical biopsy. The location of the lesions were the supratentorial area in 20 and infratentorial area in 4. Ten lesions were seen at the periventricular white matter. Combined venous angioma was noted in 4 patients. The appearance of the lesions classified by signal intensities on MRI was divided into reticular pattern in 11, punctate pattern in 9, hematoma pattern in 3, and cystic pattern in one. Recent hemorrhage was identified at 9 lesions that classified into extralesional type in 5 and intralesion type in 4. Among 9 hemorrhagic lesions, eight lesions were located at the periventricular white matter and six lesions showed reticular patterns. We concludedthat the correlation between the evidence of recent hemorrhage and location and pattern of the lesions should be evaluated to predict possibility of rebleeding of the cavernous malformation.
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