Clinical Characteristics of the Patients with Myocardial Rupture after Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Myocardial ruptures, including: ventricular free wall rupture (VFWR) and ventricular septal rupture (VSR), after acute myocardial infarction (AMI), are fatal complications. Recently, ubiquitous use of echocardiographs, and other imaging techniques, allows us to diagnose these complications in the antemortem period. Thus, this study retrospectively evaluated the clinical characteristics of patients with myocardial ruptures following AMI. SUBJECTS AND METHODS: 620 patients that had had AMIs, between January 1999 and June 2001, were analysed for the purpose of this study. Myocardial ruptures were diagnosed from their clinical symptoms, echocardiographs, and pericardiocenteses or cardiac catheterizations. The clinical characteristics of the patients with myocardial ruptures (n=15) were compared to those patients with myocardial infarction, without rupture (n=397), from their Q waves. RESULTS: The patients with myocardial ruptures were older than those without (67+/-9.7 years vs 60+/-11.7 years, p<0.05), and ruptures were more frequent in women (66.7% vs 25.2%, p<0.001). The frequency of systemic hypertension, DM, and the distribution of infarction sites were similar in both groups. Also, clinical characteristics between patients with VFWR, and those with VSR, were similar. Of the patients with VFWR (n=8), 7 suddenly died, and 1 was alive directly following surgery. Of the patients with VSR (n=7), 4 died. CONCLUSION: Myocardial rupture is a fatal complication of AMI, which is more frequent in women, and the patients with ruptures, in our study, were older than those without.

Supracricoid partial laryngectomy in recurrent or advanced laryngeal cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Advanced or recurrent laryngeal cancers after chemoradiotherapy were mainly treated by total laryngectomy because of inadequate surgical margin, multifocal recurrent site, and delayed diagnosis. Recently, voice preservation through conservative laryngeal surgery in case of advanced or recurrent laryngeal cancer with strict application of surgical indication became possible. In this study, authors studied the usefulness of surpracricoid partial laryngectomy (SCPL) for advanced or recurrent laryngeal cancers is discussed. MATERIALS AND METHOD: Twenty-five laryngeal cancer cases of cricohyoido-epiglottopexy (CHEP) or cricohyoidopexy (CHP) from May 1996 through April 2001 were analysed retrospectively. In recurrent cases after radiotherapy, there were 8 cases with glottic T1, 6 with T2, 3 with T3, one with T4, one with supraglottic T2 and T3. In advanced cases without radiotherapy, there were 3 cases with glottic T3 and 2 with supraglottic T3. Evaluation of oncological and functional results were conducted. The mean follow-up period was 29.1 months. RESULTS: Local recurrence occurred in 1 patient (4.3%) and cricoid perichondritis in 5 patients (21.7%), laryngocutaneous fistula in 1 patient (4.3%) after the operation. Four patients (17.3%) had to be treated with completion laryngectomy. Voice function was preserved in 19 patients (82.7%). CONCLUSION: Our experience with supracricoid partial laryngectomy with CHEP or CHP suggests that this technique can be a valuable alternative to the total laryngectomy in the recurrent or advanced laryngeal cancer.

The Comparative Study of Mucociliary Clearance with Long-term Hypertonic Saline versus Normal Saline Nasal Wash of Normal Person and Patients after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal irrigation, a conventional therapy for both surgical and nonsurgical patients with a history of chronic rhinosinusitis, aids in the clearance of secretions, debris, and intranasal crusts. This is important in the postoperative period to reduce the risk of adhesions and to promote ostiomeatal patency. The objective of this study was to compare the effects of a long-term nasal irrigation with hypertonic saline (3.0%) versus isotonic saline (0.9%) in the normal and postoperative group. MATERIALS AND METHODS: We studied the transit time of nasal mucociliary clearance with a saccharine test. In the normal control group I (n = 20), the mean transit times (MTTs) were measured before and after the irrigation with atomized saline of 0.9%, 2%, 3%, 4% and 5% concentrations. In the normal control group Il (n=19), MTTs were measured before and after the atomized 0.9%, 3% saline irrigation for two months. In the postoperative group (n=10), MTTs were measured after the irrigation with saline of 0.9% (right nasal cavity) & 3% (left nasal cavity) for one month. The symptom scores about nasal stuffiness, rhinorrhea and the amount of nasal lavage contents were recorded daily. RESULTS: In the normal control group I, MTT of 3% saline irrigation was significantly shortened than those of isotonic and other hypertonic saline irrigation. In the normal control group II, MTT of 3% saline irrigation was gradually and significantly shortened compared with those of isotonic saline for two months. In the postoperative group, 3% saline irrigation had a significantly shorter MTT for one month and had a significantly more nasal lavage contents during 1st week than isotonic saline irrigation. CONCLUSION: A 3% hypertonic saline would be useful as a long-term nasal washing solution in both surgical and non-surgical patients with a history of chronic rhinosinusitis.

Short-term prognostic value of CRP in the patients with acute coronary syndrome

BACKGROUND AND OBJECTIVES: Acute coronary syndrome occurs most commonly in the setting of atherosclerotic coronary artery disease, but there is little information concerning the mechanism responsible for the transition from stable to unstable coronary atherosclerotic plaque. Hypothetically, several microorganism(Chlamydia pneumonia, Cytomegalovirus and Helicobacter pylori) and their inflammatory reaction have been suggested as a causative motive in progression of acute coronary syndrome. Although it is unclear whether the serum level of CRP as a inflammatory parameter is concerned with previous inflammatory change or myocardial necrosis, CRP apper to be predictive of higher risk for cardiac event in the patients with acute coronary syndrome. Our objective was to evaluate whether the inflammatory parameters(CRP, ESR and WBC count) is useful in predicting the short-term cardiac risk within 30 days. MATERIALS AND METHOD: One hundred and ten patients with acute coronary syndrome were enrolled from April 1998 through August 1998. Blood samples were collected at 1st hour, 24th hour, 48th hour and 7th day and tested for CRP, ESR, WBC count and CK-MB level. Values of 323 normal were used as control. All patients were followed up for 30 days and assessed for the presence of cardiac complications. RESULTS: Peak CRP value of the patients with acute myocardial infarction(3.4+/-3.85 mg/dL, n=2) was higher than that of the patients with unstable angina(0.7+/-0.93 mg/dL, n=8, p2 mg/dL, n=0), the cardiac complication rate was higher than the low-CRP group(< or =2 mg/dL, n=0) (43.3% vs 2.5%, p<0.05). Peak CRP value was correlated with age(r=.191, p=.045), pulse rate(r=.186, p=.008), left ventricular ejection fraction(r=0.384, p<0.001), peak ESR(r=.383, p<0.001) and peak WBC count(r=.307, p=.001), but not with peak CK-MB level. CONCLUSION: Elevated CRP level in patients with acute coronary syndrome seems to be a valuable prognostic factor for the development of cardiac complications within 1 month after admission.

Expression and Distribution of Beta 2 Adrenergic Receptor mRNA in the Rat eye

Beta adrenergic receptors(beta-ARs) were detected in retina, trabecular meshwork, iris and ciliary body in eye of human, cat, rabbit, and bovine using in vitro autoradiography and majority of the beta-ARs found in eye are the beta2 subtype. Recently, the beta2-AR gene has been cloned from hamster, human, rat and monkey using molecular biological methods. Expression of beta2-AR mRNA were demonstrated in smooth muscle, kidney, ovary, brain, adipose tissue, heart, epithelial cells, thymus, lung and liver. However, studies about expression and distribution of beta2-AR mRNA in the eye have not been done yet. Author have characterized the expression of beta2-AR mRNA in rat eye using in situ hybridization with 35S-UTP riboprobe. beta2-AR mRNA was expressed in corneal epithelium and stroma, ciliary epithelium, vessels of ciliary body, choroidal vessel, and retina. In contrast it was not expressed in iris and sclera in the rat eyes. These results support the hypothesis that beta2-AR mRNA may be synthesized in the various ocular tissue and its characterized distribution suggests partially that beta2-ARs are related with aqueous production and blood supply of the eye.

Corneal Incision Phacoemulsification and Trabeculectomy: combined Surgery at Separated site

We reviewed 9 eyes which underwent combined phacoemulsification and trabeculectomy at separate site. Phacoemulsification was performed using corneal incision and trabeculectomy was performed at one superior quadrant using a limbus-based conjunctival flap with mitomycin C(0.2mg/ml, 3-5 minutes). Six eyes received 3-piece folable silicone lenses and 3 eyes received 1-picec PMMA(diameter 5.5mm) lenses. Mean preoperatie intraocular pressure (IOP) was 23.4+/-8.7mmHg. Mean follow-up period was 12.7(range 6-21)months. The mean postoperative IOP at 1, 6, 12 months were 14.6+/-4.8mmHg, 13.8+/-4.4mmHg, 16.6+/-6.8mmHg, respectively. Seven eyes achieved a final fisual acuity of 0.7 or better. One patient developed vision-impairing complications; flat anterior chambe and anterior dislocation of silicone lens. Other complications include posteror synechiae(4 eyes), capsular opacities (3 eyes), lens decentration with capsular contracture(1 eye). These rusults suggest that combined corneal incision phacoemulsification and trabeculectomy at separate site offers an effective technique to control postoperative intraocular pressure in patients with coexsisting cataract and glaucoma, though this procedure is not devoid of complications.

Clinical Analysis of Ocular Injuries induced by Power Lawn Mowers

The authors analysed 22 patients who were admitted to Gyeongsang National University Hospital because of ocular injuries induced by Power lawn mowers from March 1, 1991 to December 31, 1994. All of the patients were males. The average age of the patients was 43.3(range 15-69). Most injuries occured between June and September. Perforating injuries were developed in 8(36.4%) of 22 eyes and non-perforating injuries in 14(63.6%) eyes. The type of injuries were lens damage(10/22), vitreous hemorrhage(8/22), iridodialysis(4/22), intraocular foreign body(3/22), endophthalmitis(2/22), retinal detachment(1/22), and choroidal rupture(1/22). The prognosis was poor when the eyeball was perforated. Therefore safety goggles are absolutely needed for prevention of ocular injuries induced by Power lawn mowers.

Chemomyectomy Effect of Doxorubicin and Verapamil on Orbicularis Oculi in Rabbit

Doxorubicin has characteristic chemomyectomy effect of the eyelid without disturbing other eyelid structures, but the major side effect of doxorubicin is the potential for eyelid skin injury as a result of the drug's toxicity in both animal and clinical studies. Verapamil may be used to reduce the dose of doxorubicin and the number of injections that would amplify the toxic effects of doxorubicin. This study was performed to determine whether there is an increase in the toxic effect of the doxorubicin as a result of verapamil pretreatment of the muscle. After 0.5mg, 1.0mg, and 2.0mg doxorubicin was injected in lower eyelids of each group, and equal dose of doxorubicin was injected fo11owing 1.0mg of verapamil injection in lower eyelid of each group, muscle cell loss were measured by light microscopy and side effect was observed. In verapamil and doxorubicin injection group, there was significant differences in the amount of preseptal muscle and even in the pretarsal muscle than the doxorubicin injection group in all doxorubicin doses. Verapamil, injected with a range of doses of doxorubicin, caused suhstantia11y increased muscle loss in the eyelid, compared with injection of doxorubicin alone. Skin ulceration, entropion or ectropion were not visible. Clinically, verapamil cotreatment might be useful to decrease the dose of doxorubicin injected and/or the total number of injections.