Initial Seizure Threshold in Brief-Pulse Bilateral Electroconvulsive Therapy in Patients with Schizophrenia or Schizoaffective Disorder

OBJECTIVE: The present study aimed to report the initial seizure threshold (IST) of a brief-pulse bilateral electroconvulsive therapy (BP-BL ECT) in Korean patients with schizophrenia/schizoaffective disorder and to identify IST predictors. METHODS: Among 67 patients who received ECT and diagnosed with schizophrenia/schizoaffective disorder based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, we included 56 patients who received 1-millisecond BP-BL ECT after anesthesia with sodium thiopental between March 2012 and June 2018. Demographic and clinical information was gathered from electronic medical records, and a multiple regression analysis was conducted to identify predictors of the IST. RESULTS: The mean age of the patients was 36.9±12.0 years and 30 (53.6%) patients were male. The mean and median IST were 105.9±54.5 and 96 millicoulombs (mC), respectively. The IST was predicted by age, gender, and dose (mg/kg) of sodium thiopental. Other physical and clinical variables were not associated with the IST. CONCLUSION: The present study demonstrated that the IST of 1-ms BP-BL ECT following sodium thiopental anesthesia in Korean patients was comparable to those reported in previous literature. The IST was associated with age, gender, and dose of sodium thiopental.

Effect of revascularization strategy in patients with acute myocardial infarction and renal insufficiency with multivessel disease

BACKGROUND/AIMS: The aim of this study was to compare the risk of complications and outcome between infarct-related artery (IRA)-only revascularization and multivessel (MV) revascularization in patients with acute myocardial infarction (MI) with renal insufficiency and MV disease. METHODS: A total of 1,031 acute MI patients with renal insufficiency and MV disease who were registered in the Korea Working Group on Myocardial Infarction were enrolled. They were divided into two groups (IRA-only revascularization group, n = 404; MV revascularization group, n = 627), and investigated the cumulative incidence of major adverse cardiac events (MACE) and the incidence of complications after percutaneous coronary intervention (PCI). RESULTS: Complications after PCI occurred in 19.9% of all patients (206/1,031). Complications after PCI occurred more frequently in the MV revascularization group compared with the IRA-only revascularization group (20.1% [126/627] vs. 15.3% [62/404], respectively; p = 0.029]. The overall in-hospital mortality rate was 6.3%, and there was no significant difference between the groups (5.2% in the IRA-only revascularization group vs. 7.0% in the MV revascularization group; p = 0.241). The total incidence of MACE was 11.1%, and there was no significant difference between the groups (11.6% in the IRA-only revascularization group vs. 10.7% in the MV revascularization group; p = 0.636). CONCLUSIONS: The incidence of complications after PCI was significantly lower in the IRA-only revascularization group compared with the MV revascularization group. However, there were no significant difference in the 12-month outcomes between groups in patients with acute MI and renal insufficiency with MV disease.

Characteristics, In-Hospital and Long-Term Clinical Outcomes of Nonagenarian Compared with Octogenarian Acute Myocardial Infarction Patients

We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3+/-2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5+/-2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.

Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent / 전남의대학술지

An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13x5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.

Successful Treatment of a Ruptured Subclavian Artery Aneurysm Presenting as Hemoptysis with a Covered Stent / 전남의대학술지

An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13x5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.

A Case of Intrahepatic Choledochal Web That Was Diagnosed by Percutaneous Transhepatic Cholangioscopy and It Was Treated with Balloon Dilatation: Review of the Korean Cases / 대한소화기내시경학회지

Choledochal web is an extremely rare disease and it is frequently associated with bile duct stone that causes biliary obstruction and cholangitis. Most cases of choledochal web have been found incidentally during a surgical procedure or on autopsy because of its rare incidence and the absence of specific clinical manifestations. Yet making an early diagnosis has become feasible with the development of radiologic studies. All twelve cases of choledochal web, reported in Korea, were located in the extrahepatic duct, and were diagnosed with an operation, endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. We report here on a case of intrahepatic choledochal web that was well visualized by percutaneous transhepatic choledochoscopy and it was treated with balloon dilatation.

The Safety Assessment of Percutaneous Transhepatic Transpapillary Stent Insertion in Malignant Obstructive Jaundice: Regarding the Risk of Pancreatitis and the Effect of Preliminary Endoscopic Sphincterotomy / 대한소화기학회지

BACKGROUND/AIMS: Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track. METHODS: A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were devided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group. RESULTS: The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614). CONCLUSIONS: Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention.

The Anti-apoptotic Effect of Adrenomedullin on Vascular Endothelial Cells in Radiocontrast Media-induced Apoptosis / 대한신장학회지

PURPOSE: Because vascular endothelial cells play a pivotal role in the vascular diseases, damage of vascular endothelial cells lead to progression of vascular disease. Apoptotic damage of cells is an important mechanism in vascular disease. Therefore, several growth factors that have antiapoptotic effect may have a protective role in maintaining a cell function in apoptotic cell injury. In this study, we examined the effects of adrenomedullin on apoptosis in iopromide-induced endothelial cell injury. METHODS: Human umbilical vein endothelial cells were incubated with nonionic radiocontrast agent, iopromide and/or adrenomedullin. Apoptosis was assessed quantitatively using FACScan after annexin V-FITC and propidium iodide staining, and by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) stain. Signaling pathway was evaluated by Western blot analysis of phospho-Akt and Akt. RESULTS: Iopromide-induced apoptosis in human umbilical vein endothelial cells was increased in a dose-dependent manner. Adrenomedullin prevented iopromide-induced apoptosis in human umbilical vein endothelial cells in a dose dependent manner. Wortmannin, phosphatidylinositol 3-kinase inhibitor, decrease the adrenomedullin-induced antiapoptotic effect. CONCLUSION: These results suggest that adrenomedullin protects vascular endothelial cells from iopromide-induced apoptosis by regulating the activity of Akt.

A Comparison of the effect of Oral Misoprostol and Vaginal Misoprostol on the Labor Induction at Term / 대한산부인과학회지

OBJECTIVE: To compare the safety and the efficacy of oral 100 microgram versus vaginal 50 microgram misoprostol for labor induction at term. METHODS: Eighty patients with indicated for labor induction were randomized to receive either oral misoprostol 100 microgram or 50 microgram of vaginal misoprostol. In both groups, the dosage was repeated every 6 hours, if needed, to a maximum of four doses. We compared the Bishop score during labor induction, average interval from induction to delivery, vaginal delivery rate within 12 hours and 24 hours, mode of delivery, neonatal outcomes, and maternal complications between two groups. RESULTS: In two groups, demographic characteristics were similar. Regarding the change of Bishop score checked after 4 hours and 8 hours, it was statistically shown that the score was significantly high in oral misoprostol group compared to vaginal misoprostol group (5.9+/-1.4 vs. 5.1+/-1.1, p<0.05; 8.6+/-2.3 vs. 7.1+/-2.1, p<0.05). In nulliparous women, the average interval from induction to delivery was shorter in oral misoprostol group than in vaginal misoprostol group (927.4+/-344.7 minutes vs. 1130.6+/-297.0 minutes, p<0.01). In multiparous women, the average interval from induction to delivery was shorter in oral misoprostol group than in vaginal misoprostol group (674.2+/-110.4 minutes vs. 831.1+/-181.6 minutes, p<0.01). There was no clinical or statistical difference between two groups in mode of delivery, cesarean section rate, fetal heart rate abnormalities, tachysystole, hyperstimulation syndrome, meconium staining and fetal outcome (Apgar score at 1 and 5 minutes, birth weight). CONCLUSION: These results suggest that oral misoprostol 100 microgram is more effective for cervical ripening and induction of labor than vaginal misoprostol 50 microgram.

Correlation and measurement between stress of mother and fetus using heart rate variability / 대한산부인과학회지

OBJECTIVE: The maternal stress measurement from the heart rate variability and the fetal stress measurement from the fetal heart rate variability in non-stress test (NST) were conducted and the correlation between two measurements was calculated. METHODS: From June 2004 to August 2004, 30 cases who visited for antenatal care and admitted at our hospital above 27 weeks of pregnancy were analyzed for tests. The test consists of simultaneous 20-minute non-stress test and 5-minute stress test in stable state of supine position. From measurement and analysis of fetal heart rate variability in NST and maternal stress, three factors -- balance of an autonomic nervous system, an activity of a sympathetic nervous system, and an activity of a parasympathetic nervous system -- were calculated and analyzed. RESULTS: A Pearson correlation coefficient of the LF/HF ratio of mother and fetus did not show the high significance for the whole population (whose value was -0.014), but after clustering the population according to the gestational age, LF/HF ratio, norm LF, and norm HF for mothers in 38 weeks of pregnancy showed highly positive correlation -- the values were 0.760 (p-value 0.011), 0.569, and 0.569, respectively; the cluster of mothers in 38 weeks was the largest one in the population. And value of a mother in four different week also showed positive correlation (0.801). CONCLUSION: A noninvasive method for measurement of fetal stress was suggested and positive correlation between maternal stress and fetal stress was observed. Thus positive feedback may be expected by maternal stress relieving methods, such as aroma therapy and psychosocial support, and the possibility and basis for the evaluation of the effectiveness on maternal and fetal stability by prenatal education was settled.

Postnatal Development of Brain Natriuretic Peptide-immunoreactive Neuron in the Hypothalamus of the Rat / 체질인류학회지

Brain natriuretic peptide (BNP) is a neuropeptide, isolated from porcine brain that is homologous with atriopeptin. Magnocellular neurosecretory cells located in the paraventricular nucleus and supraoptic nucleus synthesize and secrete neurohormones. The purpose of this study was to investigate distribution of BNP immunoreactivity throughout the rat hypothalamus from the day of birth to 30 days and adult using immunoperoxidase and immunofluorescent staining. The first BNP immunoreactive neurons appeared in the paraventricular and supraoptic nucleus at P10. In adult, BNP immunoreactivity was widely distributed throughout regions of the hypothalamus including dorsomedial hypothalamic nucleus, ventromedial hypothalamic nucleus, arcuate nucleus and internal layer of median eminence. The intensity of BNP immunoreactivity was weak in almost all hypothalamic nuclei except the paraventricular and supraoptic nuclei. BNP immunoreactivity was first observed in the lateral hypothalamic area at P15. In retrochiasmatic supraoptic nucleus, BNP immunoreactivity was first observed at P20 and remarkably distributed in adult. In the present study, distinct localization of BNP immunoreactivity was in the hypothalamic cell bodies and fibers. Although the role of BNP in the brain is yet to be determined, these results indicate that BNP in the neurons of hypothalamus play important role in the regulation of a variety of neurosecretory functions as a neuromodulator during postnatal development of the hypothalamus.

Postnatal Development of Brain Natriuretic Peptide-immunoreactive Neuron in the Hypothalamus of the Rat / 체질인류학회지

Brain natriuretic peptide (BNP) is a neuropeptide, isolated from porcine brain that is homologous with atriopeptin. Magnocellular neurosecretory cells located in the paraventricular nucleus and supraoptic nucleus synthesize and secrete neurohormones. The purpose of this study was to investigate distribution of BNP immunoreactivity throughout the rat hypothalamus from the day of birth to 30 days and adult using immunoperoxidase and immunofluorescent staining. The first BNP immunoreactive neurons appeared in the paraventricular and supraoptic nucleus at P10. In adult, BNP immunoreactivity was widely distributed throughout regions of the hypothalamus including dorsomedial hypothalamic nucleus, ventromedial hypothalamic nucleus, arcuate nucleus and internal layer of median eminence. The intensity of BNP immunoreactivity was weak in almost all hypothalamic nuclei except the paraventricular and supraoptic nuclei. BNP immunoreactivity was first observed in the lateral hypothalamic area at P15. In retrochiasmatic supraoptic nucleus, BNP immunoreactivity was first observed at P20 and remarkably distributed in adult. In the present study, distinct localization of BNP immunoreactivity was in the hypothalamic cell bodies and fibers. Although the role of BNP in the brain is yet to be determined, these results indicate that BNP in the neurons of hypothalamus play important role in the regulation of a variety of neurosecretory functions as a neuromodulator during postnatal development of the hypothalamus.

A Confocal Laser Scanning Microscopic Study on the Distribution and Fluorescent Intensity of NPY-IR in the Cerebral Cortex of the Head Irradiated Rats / 체질인류학회지

The purpose of this study, the effects on the cerebral cortex of the rats after brain irradiation was to investigate the change of distribution and morphology of neuropeptide-Y (NPY) neurons. Radiation was produced by the linear accelerator 6MV X-ray. The animals were categorized into control and experimental groups and we use 45 Sprague-Dawley rats weighing about 200 ~250 gm. The head areas of the animals were positioned within the radiation field of 15 cmx20 cm and with the radiation depth of 2 cm. Sodium chloral hydrate-anesthetized rats were exposed to the radiation with the dose rate of 240 cGy/min. The total dose was 1,800 cGy(rad). Animals were sacrificed on 2 hours, 5 hours, 1 day, 2 days, 3 days, 1 week, weeks, 3 weeks after brain irradiation. Using ABC immunohistochemistry, morphology and distribution of neuropeptide-Y immunoreactive neurons (NPY-IR)were studied on the cerebral cortex of the control and brain-irradiated rats. We used light and confocal laser scanning microscopy (CLSM). The following results were obtained : 1. On control group, NPY-IR neurons were found in all layers of the primary motor and sensory cerebral cortex, and the NPY-IR neurons were concentrated within the layer II, III, IV, V and VI. The typical NPY-IR perikarya was bipolar and multipolar shape. 2. On 2 hours, 5 hours after X-irradiation, decreased number of NPY-IR neurons were detected in the primary motor and sensory cerebral cortex of the rats. Also shrunken and transformed NPY-IR neurons were detected in the primary motor and sensory cerebral cortex of the rats. 3. On 1 day, 2 days, 3 days after X-irradiation, morphology and distribution of NPY-IR neurons in the primary motor and sensory cerebral cortex was generally restored. 4. On 1 week, 2 weeks, 3 weeks after X-irradiation, morphology and distribution of NPY-IR neurons in the primary motor and sensory cerebral cortex was almost similar to control group. 5. In optical serial section analysis of NPY-IR neurons, high intensity of immunofluorescence were observed in a part of the 8 ~11 sections of the control and all irradiated groups. In optical single section analysis of NPY-IR neurons, red color (high fluorescence intensity) were observed in a part of 6, 7 sections of the control and all irradiated groups. From the above results, it was concluded that the release of neurotransmitters and transcapillary leakage of blood substance were occurred on 2 hours, 5 hours, 1 day after X-irradiation, but the condition was generally restored on 3 days and 7 days following X-irradiation.

A Case of Persistent Cloaca with Meconium Peritonitis / 대한산부인과학회잡지

Persistent cloaca is a very rare congenital malformation with the incidence of 1/50,000-250,000 births. This malformations have a single common perineal opening for the genital, urinary and gastrointestinal tracts. Because of wide spectrum of abnormal anatomy involving upper urinary tract, gastrointestinal systems, cardiovascular system, central nervous system, and respiratory system, prenatal diagnosis is difficult through ultrasound during pregnancy. It has been reported that if the anomalies are diagnosed early, they can be corrected surgically. We present a case of persistent cloaca with meconium peritonitis and hydrometrocolpos confirmed by neonatal surgery after emergency cesarean section.