Percutaneous mitral valvuloplasty(PMV) became a treatment modality or mitral stenosis because of its low morbidity, short hospital stay, and low cost. We reviewed clinical and hemodynamic results after PMV for the patients with mitral stenosis in Ewha Womans University Mokdong hospital.

We compared the results of echocardiographic, hemodynamic, and clinical parameters before and after PMV. PMV was performed under fluoroscopic guidance in 21 patients(M:4, F:17, mean age 43±12 years) with mitral stenosis from October 1993 to April 1999. Transesophageal echocardiography(TEE) and Transthoracic echocardiography(TTE) were performed for the evaluation of mitral valve, chamber size, and the presence of left atrial thrombus before procedures. TIE was also used for follow-up evaluation. On presentation, all patients showed at least NYHA class II. Five patients had atrial fibrillation. Two patients with thrombus in the left atrium were included to study group after thrombolytic treatment with coumadin. Echo-score of our patients was not greater than 8.

Mean mitral valve area(MVA) by 2 dimensional or Doppler echocardiography was increased from 1.16±0.36cm² before PMV to 2.06±0.33cm² after PMV. There were marked improvements in transmitral gradients(11.60±5.54mmHg before PMV vs 4.93±2.53mmHg after PMV, p<0.001), left atrial dimension(46.41±14.66mm vs 42.03±15.01mm, p=0.042), and cardiac output(4.21±1.25L/min vs 6.88±9.57L/min, p<0.0001) following PMV, Severe(≥GIII) mitral insufficiency or severe postprocedural complications were not noted. This suggested that all procedure was successful.

The Procedural success rate of PMV in Ewha Womans University Mokdong hospital was 100%. Low echo score of our patients might explain this high procedural success rate. Long-term-follow-up is warranted in the near future.

Although angiotensin converting enzyme inhibitors have provided plausible effect for the management of hypertension and congestive heart failure, it does have drawbacks such as dry cough in as much as 15 to 30% of patients and incomplete blocking of angiotensin II production. Losartan(Cozaar®) is the first angiotensin II receptor antagonist that has become clinically available as an antihypertensive agent. Because the agent effectively blocks the final common pathway of renin-angiotensin system, it is recognized as an ideal drug for the treatment of hypertension.

We tested the antihypertensive effect and clinical safety of Losartan(Cozaar®) 50mg/day in 22 patients(male : 12, female : 10, age : 51±11, range : 33-70) with stage I and II hypertension from July 1998 to October 1999. The patients were enrolled in the study after two weeks of washout period if the patient was using other antihypertensive drugs. Blood pressure and side effects were monitored at zero, second, sixth, and twelfth week. Baseline chemistry was done before drug administration and follow-up chemistry was done at twelfth week.

Losartan(Cozaar®) showed good patient compliance and good antihypertensive effect without significant changes of laboratory results or clinical complications. At twelfth week, mean systolic blood pressure dropped l9mmHg, and mean diastolic blood pressure dropped 11mmHg. The heart rate showed no significant change during the study period. Blood pressure was controlled below 140/90mmHg in 12(54.5%) patients with Losartan 50mg/day. Five patients complained of minor side effects(dizziness, facial numbness, epigastric discomfort, etc) but no patients discontinued medication due to side effects.

Losartan(Cozaar®) is a safe and effective antihypertensive agent for the treatment of stage I and II hypertensive patients as a single once-a-day treatment.

Permanent pacemaker implantation is a worldwide procedure in patients who have hemodynamic instability due to bradyarrythmia or atrioventricular block. We summerized the results of 29 patients who have undertaken permanent pacemaker implantation in Ewha Womans University Mokdong hospital.

Medical records of 29 patients who have undertaken pacemaker implantation were reviewed regarding indications, clinical findings, type of pacemakers, and the results of pacemaker implantations.

The patients had a mean age of 65±15.9 years(M : F=9 : 20).The indications of pacemaker implantation are as follows : sick sinus syndrome(SSS) in 9 patients ; complete atrioventricular block(AV block) in 10, high degree AV block in 8 ; severe AV Wenckebach block in 2. Types of permanent pacemakers included single chamber in 17 patients, and dual chamber in 12 patients. The modes were VVI in 14 patients, DDD in 9 patients, and VDD in 6 patients. Pacemaker syndrome was reported in one case and there were no serious complications such as wound infection, lead fracture, lead displacement, or migration of generators.

Patients with SSS and high degree and complete AV blocks were successfully treated with permanent pacemaker implantation in Ewha Womans University Mokdong hospital.

Sydney system in the classfication of histologic gastritis recommends the grading of Helicobacter(H.) pylori density, activity and chronic inflammation. CLO test is a rapid urease test to diagnose H. pylori infection. The relation between the grading of gastritis and the positivity of the CLO test has not been well studied. Accordingly, this study was performed to investigate the positive rate of the CLO test according to the grade of gastritis.

One hundred consecutive endoscopy patients had two antral biopsies for CLO test and histopathologic examination. H. pylori density, activity and inflammation were each graded into 0, 1, 2, and 3.

1) CLO test was positive in 52 among 100 cases(52%) and among the CLO test positive cases, forty five(86.5%) became positive within 1 hour.

2) The positive rate of the CLO test increased according to the grade of H. pylori density, mucosal activity and chronic inflammation.

3) The group(n=45) who turned positive within 1 hour showed higher grade of H. pylori density than the group(n=7) who turned positive from 1 to 24 hour.

It was thought that the grade of histologic gastritis reflected the positive rate of the CLO test and reaction time to a positive CLO test is related to H. pylori density.

Sepsis and its associated complication of disseminated intravascular coagulation (DIC) are considered to be a major cause of morbidity and mortality in the newborn infants. Antithrombin(AT) is a single chain glycoprotein in plasma and belongs to the family of the serpins. It is an important anticoagulant protein acting as a heparin cofactor. However, it's effects and action in preterm infants are not clearly defined. The objective of this study was to determine whether AT III was effective in treatment of DIC in the premature infants.

We studied 52 preterm infants with clinical and laboratory diagnosis of DIC from November 1998 to October 1999. We examined the AT III, platelet, prothrombin time(PT), activated partial thromboplastin time(aPTT), fibrinogen, fibrinogen degradation product(FDP), and D-dimer before and after the treatment with AT III.

1) AT III concentrates were administerd for a mean of 3.6 days. Plasma AT III concetrations were elevated significantly(p<0.001) in all cases to a mean level of 134.5%.

2) Hematologic data(PT, aPTT, Fibrinogen, FDP) was significantly improved in definitive DIC group after AT III treatment(p<0.05).

3) The incidence of complications of DIC patients were slightly higher in definitive DIC group than in suspected DIC group, but there was no statistically significant difference. And AT III concentrate were well tolerated in all patients.

This data suggested that AT III therapy was effective to improve the clinical and laboratory findings without significant side effects in the premature infants with DIC.

This study attempts to evaluate the clinical manifestations and causative drugs of drug eruptions at Ewha Womans University Tongdaemun Hospital by retrospective study of outpatients, inpatients and consulted patients(number : 121, duration : 1994. 1 - 1999. 5).

1) Most drug eruptions occurred in patients at the age of 20 - 39 years old.

2) The cutaneous manifestations of drug eruptions in the order of frequency were as follows : exanthematous eruption, fixed drug eruption, acneiform eruption, purpura, urticaria, bullous eruption, lichenoid eruption, Stevens-Johnson syndrome, and acute generalized exanthemic pustulosis.

3) Drug eruption developed most frequently from 24 hours to 3 days of drug intake.

4) Most common causative drugs were antibiotics, followed by antipyretics and analgesics.

5) Laboratory abnormalities were leukocytosis(22.5%), eosinophilia(14.5%), abnormal AST/ALT(11.4%), abnormal IgE titer(8.3%), and leukopenia(5.6%).

The most frequent clinical feature of the drug eruption were exanthematous in nature and the most common causative drugs were antibiotics, as suspected.

Since too many patients take various unidentified drugs at drug stores in Korea, physicians need to exercise special care in prescribing drugs and evaluating patients with drug eruption.

The molecular pathogenesis of the schizophrenia has been extensively studied. The dopamine hypothesis is well-known possible mechanism in the etiology of schizophrenia and dopamine D2 receptor gene(DRD2 gene), one of the dopamine receptor genes, is believed to be a candidate gene for schizophrenia because D2 receptor has high affinity for the antipsychotic drugs. Some researchers have been studied for the variant of the DRD2 gene(Ser311→Cys) and suggest positive association of this polymorphism and schizophrenia in Japanese schizophrenic patients. However, following studies did not support that results. So the author investigated polymorphism of the dopamine D2 receptor gene(Ser3l1→Cys311) in a total of 42 schizophrenic patients and 50 controls.

To compare the Cys variant status between the schizophrenic patients and control group and to investigate the allelic pattern of DRD2 gene, PCR(polymerase chain reaction) and MASA((Mutated Allele Specific Amplification) were performed in 42 cases of schizophrenic patients' and 50 normal controls' whole blood. Schizophrenic patients clinical characteristics, family history of mental illness and response to therapy were examined.

The following results were summarized. 1) The detection of homozygote for Cys allele and heterozygote of Ser/Cys was one and one case in 42 schizophrenic patients, respectively. 2) None with Cys allele or any heterozygote was detected among 50 control groups. 3) So frequencies of Cys311 among 42 schizophrenics were three(3.6%). but there is no statistical significance. 4) There is no correlations between clinical characteristics of schizophrenic patients and Cys alleles.

There is no statistical difference in allele frequency of DRD2 Cys311 variant between schizophrenia and control groups. So this result was in line with the previous studies which did not show evidence of association between schizophrenia and D_2 receptor polymorphism(Ser311→Cys 311).

One-lung anesthesia offers advantages during thoracic surgery, but has the disadvantage of causing hypoxemia and affects the respiratory mechanics.

We investigated the peak inspiratory airway pressure(PIP) and compliance during one-lung ventilation using different tubes.

In healthy 12 patients undergoing thoracic surgery, left-sided double lumen endobronchial tube was inserted. In 10 patients, Univent tube was inserted and fixed the blocker using the bronchofiberscope. The PIP, compliance, end-tidal CO₂ and SpO₂ were measured using a Capnomac Ultima® during two-lung and right one-lung ventilation.

During two-lung ventilation, there was no difference between the two groups During one-lung ventilation PIP increased and compliance decreased significantly than two-lung ventilation. In the double lumen tube group, PIP increased significantly and compliance decreased significantly than Univent tube group. There was no significant changes in the end-tidal PCO₂ and SpO₂.

Univent tube provide lesser changes of PIP and compliance during one-lung anesthesia in supine position than double lumen endobronchial tube.