Depression and Anxiety Trend according to Family Function in Children

BACKGROUND: Family environment has an important effect on the development of children. During childhood and adolescence, depression and anxiety are common forms of psychopathology. Therefore, the relationship between family function and depression anxiety in children was investigated in this study. This research was intended to aid management of children in the field of primary care. METHODS: This study was based on the survey administered to 193, 4th grade students of two elementary schools in the area of Sung-buk in Seoul, Korea, in May, 2003. We investigated family function, depression and anxiety by self-rating using the Smilkstein's Family APGAR, the Kovacs's CDI and the Reynolds's RCMAS. At the same time, home environment characteristics (Family Structure, Parental Religion, Parental Education and Monthly Household Income) were investigated. RESULTS: There were no significant differences in home environment characteristics between Family APGAR groups (P>0.05). CDI scores were significantly higher for children whose parents had education levels of middle school or lower (P0.05). CDI score was significantly different between Family APGAR groups (P <0.05). And, RCMAS scores was significantly higher in poor family function groups than good family function groups according to Family APGAR groups (P<0.01). Both CDI and RCMAS scores was negatively correlated with Family APGAR scores (r=-0.376, P<0.01) (r=-0.266, P<0.01) and CDI score was positively correlated with RCMAS scores (r=0.711, P<0.01). CONCLUSION: In groups where the Family APGAR score was lower, both CDI and RCMAS scores were significantly lower. Accordingly, when caring for children, family physicians should heed to their family function and know that it has an effect on children's emotions.

The Comparison of Clinical Outcomes between GnRH Agonist Long Protocol and GnRH Antagonist Short Protocol in Oocyte Donation Cycles / 대한불임학회지

OBJECTIVES: To assess and compare the clinical outcomes between GnRH agonist long protocol and GnRH antagonist short protocol in oocyte donation program. MATERIALS AND METHODS: Of total 18 oocyte donation cycles, controlled ovarian hyperstimulation (COH) were performed with GnRH agonist long protocol and GnRH antagonist short protocol in initial 9 cycles and later 9 cycles, respectively. Oral estradiol valerate and progesterone in oil were administrated to all recipients for endometrial preparation. Oral estradiol administration was started from donor cycle day 1 after full shut down of gonadal axis with GnRH agonist in patients with ovarian function. Progesterone was injected from oocyte retrieval day of donor initially, then continuously till pregnancy 12 weeks if pregnancy was ongoing. We compared the parameters of clinical outcomes, such as number of the retrieved oocytes, fertilization rate, high grade embryo production rate, clinical pregnancy rate, implantation rate, ongoing pregnancy rate, COH duration, total gonadotropin dose for COH between GnRH agonist long protocol group and GnRH antagonist group. Statistical analysis was performed using Mann-Whitney test, p0.05). Duration and total gonadotropin dose for COH were 10.94+/-1.70 days and 43.78+/-6.8 vials in 18 cycles, 12.00+/-1.73 days and 48.00+/-6.93 vials in agonist group, 9.88+/-0.78 days and 39.55+/-3.13 vials in antagonist group, respectively. in GnRH agonist long protocol group, significantly longer duration and higher gonadotropin dose for COH were needed (p= 0.012). CONCLUSION: in oocyte donation program, clinical outcomes from controlled ovarian hyperstimulation with GnRH antagonist were comparable to those from GnRH agonist long protocol group, so controlled ovarian hyperstimulation with GnRH antagonist may be effective as GnRH agonist long protocol. At least there may not be harmful effects of GnRH antagonist on oocyte development and quality.

Relation between Coronary Flow Reserve using Transesophageal Echocardiography and Duke Treadmill Score in Patients with Microvascular Angina

PURPOSE: The triad of chest pain, normal coronary arteries and a positive stress test has been called microvascular angina. The link between coronary flow reserve(CFR) and Duke treadmill score(DTS) in patients with microvascular angina remains elusive. METHODS: We studied 108 subjects (M:F=8:60, mean age 54+/-9 yrs) with chest pain and normal coronary angiogram. Exercise treadmill test(ETT) was performed by Bruces protocol and the equation for calculating DTS was DTS=xercise time- (5xST deviation)-(4x exercise angina), with 0=one, 1=onlimiting, 2=exercise-limiting. The coronary flow velocity at diastole(PDV) using Transesophageal echocardiography (TEE) was obtained from the proximal left anterior descending coronary artery and coronary flow reserve(CFR) was calculated as the ratio of hyperemic PDV after the intravenous infusion of dipyridamole(0.56 mg/kg) to baseline PDV. RESULTS: 1) CFR was 3.04+/-0.45 in group with negative ETT and 2.19+/-0.62 in group with positive ETT(p or =+ on DTS(p< 0.001 versus low-risk, respectively). 3) DTS was significantly related to CFR (r=.704, p<0.001). CONCLUSION: The composite DTS is closely related to CFR using TEE and might be a useful tool that can help clinicians determine the severity of ischemia and evaluate the efficacy of treatment in patients with microvascular angina.

A case of Ebstein's anomaly prenatally diagnosed by fetal sonography / 대한산부인과학회잡지

No abstract available.

Diagnostic Value of Dipyridamole Tc-99m Tetrofosmin SPECT for Detection of Coronary Artery Disease

Background and Objects: Tc-99m tetrofomsin is a recently developed myocardial perfusion agent. We examined the diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT. MATERIALS AND METHOD: 61 patients underwent one-day rest/dipyridamole Tc-99m tetrofosmin SPECT. 26 patients had history of myocardial infarction. Coronary angiography, performed within 1 week after SPECT study, revealed normal coronary arteries or insignificant coronary artery stenosis in 19 and 22 patients (when considering > or = 50% or > or = 70% reduction of luminal diameter as significant stenosis). RESULTS: Number of male was 39 (63.9%) and mean age was 59 (range 32 - 84). The diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT for detection of coronary artery disease (> or = 50% and > or = 70% coronary artery stenosis, respectively) was as follows: sensitivity 90.5%, 90.0%, specificity 73.7%, 66.7%, positive predictive value 88.4%, 83.7%, negative predictive value 77.8%, 77.8% and predictive accuracy was 85.2%, 81.9% respectively. The overall sensitivity and specificity of dipyridamole Tc-99m tetrofosmin SPECT for detection of individual coronary stenosis (> or = 50% and > or = 70% coronary stenosis by coronary angiography) were 64.6%, 64.1% and 86.4%, 85.7% respectively. In patients without myocardial infarction, sensitivity 76.5%, specificity 76.5%, positive predictive value 83.3%, negative predictive value 76.5% and predictive accuracy was 80.0%. CONCLUSION: One-day rest/stress dipyridamole Tc-99m tetrofosmin myocardial SPECT is a useful noninvasive method for detection of coronary artery disease.

Comparison of Coronary Angiographic Findings between Patients with and Those without Stable Angina Pectoris Prior to Acute Myocardial Infarction

BACKGROUND: Many investigators found that there were more severe and extensive atherosclerosis in patients with stable angina pectoris than those with unheralded acute myocardial infarction(AMI). But coronary angiographic findings in patients with or without stable angina pectoris(SAP) prior to acute myocardial infarction are somewhat controversial. And in many articles that compared the coronary angiographic findings between patients with and those without angina prior to acute myocardial infarction, the definition of angina and significant coronary artery stenosis were not uniform. So, coronary angiographic finding were compared between patients with and those without stable anginal pectoris prior to AMI according to scoring system suggested by Bogarty. METHOD: Coronary angiography was performed in 141 patients with AMI. Angiographic findings of patients with SAP prior to AMI were compared to those without SAP prior to AMI. Risk factors of coronary artery disease were also compared. RESULTS: 1) Numbers of the patients with SAP were 34(24%) and those without SAP were 107(76%). 2) Numbers of stenosed vessels, Numbers of tenosed lesions, extent index and percent of diffuse pattern were higher in SAP group(p<0.05). 3) Numbers of diseased vessels and occluded lesions were not different between two groups(Pvalue was 0.07 and 0.5, respectively). 4) patients with SAP were older than those without SAP(p = 0.03). 5) Sex ratio and prevalence of hypertension, diabetes and smoking were not different between two groups. 6) Lipid profiles were not different between two groups. CONCLUSION: Patients with SAP prior to AMI had more severe and extensive atherosclerosis than those without stable angina pectoris prior to AMI.

Comparison of Coronary Angiographic Findings between Patients with and Those without Stable Angina Pectoris Prior to Acute Myocardial Infarction

BACKGROUND: Many investigators found that there were more severe and extensive atherosclerosis in patients with stable angina pectoris than those with unheralded acute myocardial infarction(AMI). But coronary angiographic findings in patients with or without stable angina pectoris(SAP) prior to acute myocardial infarction are somewhat controversial. And in many articles that compared the coronary angiographic findings between patients with and those without angina prior to acute myocardial infarction, the definition of angina and significant coronary artery stenosis were not uniform. So, coronary angiographic finding were compared between patients with and those without stable anginal pectoris prior to AMI according to scoring system suggested by Bogarty. METHOD: Coronary angiography was performed in 141 patients with AMI. Angiographic findings of patients with SAP prior to AMI were compared to those without SAP prior to AMI. Risk factors of coronary artery disease were also compared. RESULTS: 1) Numbers of the patients with SAP were 34(24%) and those without SAP were 107(76%). 2) Numbers of stenosed vessels, Numbers of tenosed lesions, extent index and percent of diffuse pattern were higher in SAP group(p<0.05). 3) Numbers of diseased vessels and occluded lesions were not different between two groups(Pvalue was 0.07 and 0.5, respectively). 4) patients with SAP were older than those without SAP(p = 0.03). 5) Sex ratio and prevalence of hypertension, diabetes and smoking were not different between two groups. 6) Lipid profiles were not different between two groups. CONCLUSION: Patients with SAP prior to AMI had more severe and extensive atherosclerosis than those without stable angina pectoris prior to AMI.

Predictors of Thromboembolism in Severe Mitral Stenosis

OBJECTIVE: Systemic emboli related to atrial thrombi in severe mitral stenosis are a well known complication of percutaneous ballooon dilatation of the mitral valve(PMV). The purpose of this study was to identify factors that predicted left atrial thrombi and systemic embolism in patients with severe mitral stenosis. METHODS: Retrospective study of 79 patients with severe mitral stenosis by analysis of videotape having the record for transthoracic(TTE) and transesophageal echocardiography(TEE) was done over a 24 month period. RESULTS: The twenty eight patients(35%) had left atrial thrombus, and fifteen patients(19%) had experience of systemic embolization. Both appeared most commonly in the ages of 50 years. In thrombus group, the incidence of atrial fibrillation was more frequent(p=0.001), left atrial size larger(p=0.0014), and mitral valve area(p=0.0353) and ejection fraction of left atrial appendage(p=0.037) were lesser than non-thrombi group. In left atrial appendage(LAA) thrombus group, the left atrial dimension(p=0.0282) and the ejection fraction of LAA(p=0.008) were lesser than those in the left atrial thrombus group. In embolism group, the age was older(p=0.0212) and the incidence of atrial fibrillation tended to be more frequent(p=0.05470 than non-embolism group. CONCLUSION: In severe mitral stenosis, the formation of left atrial thrombus was related to presence of atrial fibrillation, size of left atrial dimension and area of mitral valve. And the thrombus of LAA was related to low ejection fraction of left atrium. The predictors of embolism in severe mitral stenosis were age and the presence of atrial fibrillation. The TEE was the useful diagnostic tool in detecting the thrombus of left atrium and LAA before PMV and the patients with predictors of thromboembolism should be treated more actively in severe mitral stenosis.

Evaluation of Coronary Flow Reserve by Transesophageal Doppler Echocardiography in Patients with Chest Pain and Normal Coronary Angiogram

BACKGROUND: The measurement of coronary flow reserve(CFR) is essential for assessing the flow capacity in patients with angina and normal coronary angiogram. Transesophageal Doppler echocardiography(TEE) is a noninvasive method of assessing coronary flow velocity in the proximal portion of left anterior descending coronary artery. This study was designed prospectively to evaluate the usefulness of measurement of CFR by TEE in patients with chest pain and normal coronary angiogram. METHODS: We studied 49 subjects with chest pain and normal coronary angiogram. Exercise treadmil test by Bruce's protocol was positive in 26 subjects (TMT+group, M : F=8 : 18, mean age 55+/-8) and negative in 23 subjects (TMT-group, M : F=7 : 16, mean age 50+/-12). None of these subjects had previous history of myocardial infarction, atrial fibrillation, significant valvular heart disease, variant angina, wall motion abnormality on ventriculogram and ejection fraction below 50%. After transthoracic echocardiography(H-P Sonos 1000, 2.5 MHz), peak diastolic(PDV) and peak systolic coronary flow velocity(PSV) of proximal portion of left anterior descending coroanry artery by TEE(H-P Sonos 1000, 5 MHz, Single plane) were obtained in resting condition, 4 and 6 minutes after dipyridamole injection(DPY, 0.56mg/kg i.v.), and 2 minutes after aminophyline injection(100mg i.v.). CFR was computed as ratio of the average PDV after DPY to resting PDV. RESULTS: 1) TMT(+) group showed higher incidence of history of typical angina and greater wall thickness than TMT(-) group(P < 0.005). 2) The PDV, PSV and PDV/PSV ratio were significantly increased 6min after DPY IV in both groups as compared to rest(P < 0.05) and decreased to previous level after APL IV. 3) There was no significant difference in double products between rest and DPY IV. 4) CFR was significantly greater in TMT(-) group than in TMT(+) group(P < 0.0005). CONCLUSIONS: TEE using DPY is a useful noninvasive method to evaluate the coronary flow reserve in patients with chest pain and normal coronary angiogram. The influences of physiologic variables in measuring CFR by TEE should be investigated further.

Measurement of Coronary Flow Velocity by Transesophageal Doppler Echocardiography: Preliminary Study for Clinical Application

BACKGROUND: The estimation of coronary flow velocity(CFV) is essential for assessing the impaired coronary flow reserve in patients whith angina pectoris and normal coronary arteries. But, intracoronary blood flow velocity measurement remains invasive,requiring cardiac catheterization and can not be repeated without risk during serial follow-up study. Transesophageal Doppler echocardiography(TEE) is a new noninvasive method of assessing CFV in the proximal portion of left anterior descending coronary artery. This study was performed to clarify the value of TEE in evaluating CFV, to compare the coronary flow patterns among various cardiac diseases, to estimate the coronary flow dynamics according to change of blood pressure, and to evaluate the parameters influencing CFV. METHODS: We studied 95 subjects, 51 men and 44 women, mean age 46. Normotensive subjects were 29, hypertensive patients 41, aortic stenosis 5, aortic regurgitation 4, mitral stenosis 8, and others 8. After transthoracic echocardiography(H-P Sonos 1000,2.5 MHz), transesophageal echocardiography was performed using a 5-Hz(omniplane)transesophageal probe connected to a H-P Sonos 1000 to assess CFV in the proximal portion of left anterior descending coronary artery. Doppler evaluation of left anterior descending coronary blood flow velocity was obtained in restiong conditions and after sublingual administraion of nitroglycerim(0.6mg), Blook pressure and heart rate were monitored thoughout the entire procedure. RESULTS: 1) The detection rate of CFV by TEE was 89.5%. 2) The morphology of CFV in proximal left anterior descending coronary artery was biphasic(greater diastolic and smaller systolic). 3) The baseline CFV in hypertensive patients was greater than in normotensive subjects(p<0.05) but there was no difference between two groups in diastolic/systolic CFV ratio. 4) The diastolic CFV and diastolic/systolic CFV ratio in patients with aortic stenosis were greater than in normotensive subjects(p<0.05). 5) The CFV was significantly decreased after administration of nitroglycerin(p<0.05) and the decrement of CFV correlated closely with the decrement of systolic(r=0.65, p<0.05) and diastolic blood pressure(r=0.57, p<0.05). 6) Major parameters influencing CFV were systolic blood pressure and heart rate. CONCLUSION: The CFV is influenced by various parameters and the TEE may be a useful, noninvasive tool to investigate the coronary flow dynamics.

Clinical Value of Exercise TI-201 SPECT in Patients with Chest Pain and Normal Coronary Angiogram

BACKGROUND: The interest of patients with chest pain and normal coronary arteries has been increased since 1960. From the year 1973, the syndrome representing these characteristics has been classified as syndrome X. Treadmill test and exercise TI-201 SPECT are important in the diagnosis of syndrome X. This study was designed to evaluate the clinical value of exercise TI-201 SPECT and the difference of clinical characteristics between exercise TI-201 SPECT positive(Group A) and negative (Group B) in patients with chest pain and normal coronary angiogram. METHODS: Twenty seven patients with chest pain and normal coronary angiogram underwent echocardiogram and exercise TI-201 SPECT. Patients received 2 mCi of thallium intravenously during exercise, redistribution images were performed 4 hour later and second dose of 1 mCi of thallium was injected at rest immediately thereafter. These three sets of image(stress, redistribution and reinjection) were analyzed. RESULTS: 1) 12 of 16 patients in Group A, none of 11 patients were positive on exercise treadmill test(p<0.005). 2) The incidence of systemic hypertension in Group A was significant greater than Group B(p<0.05). 3) The left ventricular end diastolic pressure was significantly higher in Group A than in Group B (p<0.05). CONCLUSION: The exercise TI-201 SPECT is a useful method to evaluate the patients with chest pain and normal coronary angiogram and the reversible perfusion defects on the exercise TI-201 SPECT might be related to systemic hypertension and elevated left ventricular end diastolic pressure.

Changes of Responses of Autonomic Nervous System in Patients after Myocardial Infarction

BACKGROUND: The autonomic nervous system plays a critical role in triggering ventricular arrhyhmia and sudden death early after acute myocardial infarction. This study was designed to determine whether or not vagal and sympathetic responses are impaired after myocardial infarction and to evaluate the utility of physiologic stress tests for assessing autonomic dysfunction after myocardial infarction. METHODS: 8 male patients with acute myocardial infarction(Group A) and old myocardial infarction(Group B) were studied with 8 control subjects of coinciding age and sex. 5 physiologic stress tests(deep breathing, sudden standing, Valsalva maneuver, ice bag application on the face, 70degrees headd-up tilt test) were performed. RESULTS: 1) Variation in heart rate during deep breathing, Standing-up, Valsalva maneuver, and ice bag application on the face was less in Group A than in Group B or Group C. 2) There was no significant difference in variation of heart rate between Group B and Group C. 3) Variation in heart rate caused by 70degrees tilt was not significantly different among the three groups. CONCLUSION: Early after myocardial infarction, parasympathetic responses were significantly impaired, whereas sympathetic responses remained intact. Heart rate variability using physiologic stress test may be provide a means of detecting autonomic dysfunction after acute myocardial infarction.

A case of primary malignant lymphoma of the thyroid associated with Hashimoto's thyroiditis / 대한암학회지

No abstract available.

A case of left atrial myxoma with increased interleukin-6 / 대한내과학회지

No abstract available.

A case of acute myocardial infarction with polycythemia vera / 대한혈액학회지

No abstract available.

Experimental Study on Ventricular Fusion in Wolff-Parkinson-White Syndrome

WPW syndrome is the most common variaty of preexcitaton syndrome in which whole or part of ventricular muscle is activated by the atrial impulse earlier than would be expected if the impulse reached the ventricle by way of normal conduction system alone. WPW syndrome result from existence of accessory muscle bridge(atrio ventricular connection) between atrium and ventricle. The ventricular complex observed in WPW syndrome during periods of sinus rhythm is the result of fusion, with intial phase of ventricular activation representing excitation via accessory pathway and later forces produced by excitation of residual portions of ventricle via normal His-purkinje system. The variations in QRS aberrancy in WPW syndrome depend on varying degree of preexcitation. This experimental study was undertaken to increase our knowledge on the ventricular fusion in WPW syndrome through epicardial mapping after experimental induction of ventricular preexcitaion of WPW type. In 5 normal dogs, the heart was widely exposed through transverse thoracotomy and positioned in a pericardial cradle, then electric wires were fixed on the epicardium of right atrium and ventricular bases(anterobasal and posterobasal) areas of right ventricle, anterobasal and poaterobasal areas of left ventricle for atrial and ventricular pacing. Epicardial mapping was then performed during atrial pacing alone and during atrioventricular sequential pacing at the same rate. Atrioventricular sequential pacing was done with various short AV intervals(60-110 msec) for the purpose of premature stimulation on ventricular base. In mapping we used the grid system which consisted of 29 areas to cover the right ventricle and 23 areas to cover the left ventricle. We drew 9 epicardial ishochrone maps in 5 dogs. The epicardial data during atrio-ventriclar sequential pacing were then compared with those during atrial pacing at an identical rate to study the ventricular fusion in WPW syndrome. The results were as follows; 1) The preexciting wave spread radially from the stimulated basal area to the right and left(or anterior and posterior wall) and the apex. 2) Preexciting wavefronts collided with the normal wavefronts in a wide range of ventricular activation time. 3) Preexcitation widened according to the degree of the shortening of the AV interval. 4) The duration of ventricular activation was greater in preexcited ventricles than in normally activated ventricles. The more prematurely the ventricle was stimulated, the greater the duration of ventricular activation was.