BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.
Adult ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography* ; Extremities* ; Fatigue ; Heart Septal Defects, Atrial* ; Humans

BACKGROUND AND OBJECTIVES: ovastatin, a HMG-CoA reductase inhibitor, is known to show antiproliferative effects on VSMC after vessel injury, but a large amount of the drug is needed orally for this purpose. This study investigated the effects of lovastatin given locally to injured carotid arteries of rats on reducing neointimal hyperplasia. MATERIALS AND METHOD: Lovastatin was given perivascularly to balloon-injured carotid arteries of 21 rats in 1 microM to the low-dose group, and 30 microM to the high-dose group. The control group was treated with pluronic gel only. Two weeks later, the lumen area, neointimal areas and the number of actively proliferating cells were obtained and compared. RESULTS: eointimal area was 0.113+/-0.032 mm2, 0.065+/-0.017 mm2, 0.072+/-0.017 mm2 in the control, low-dose and high-dose groups respectively. The area was significantly smaller in the treatment groups (p<0.05), but no significant difference was observed between the treatment groups. The number of actively proliferating cells per mm2 of neointimal area were 714.5+/-227.4, 688.4+/-333.7, and 1526.3+/-744.0 in the groups respectively, and the number was significantly high in the high-dose group (p<0.05). CONCLUSION: Local administration of lovastatin is effective in reducing neointimal hyperplasia after vascular injury, but extremely high doses are not needed locally for this purpose.
Animals ; Carotid Arteries* ; Carotid Artery Injuries* ; Hyperplasia* ; Lovastatin* ; Oxidoreductases ; Rats* ; Vascular System Injuries

BACKGROUND: Increased homocysteine levels are an independent risk factor for coronary artery disease (CAD). A common genetic mutation (nucleotide 677 C-to-T) in methylenetetrahydrofolate reductase (MTHFR), an enzyme required for efficient homocysteine metabolism, creates a thermolabile enzyme with reduced activity. Homozygotes of MTHFR mutation represent 5% to 12% of general population in Canada, America, and Japan. In this study, we examined the distribution of the MTHFR genotypes in CAD patients and healthy volunteers and the association between the genotypes and the total homocysteine level (tHcy). METHODS: We screened 60 Korean patients with CAD (CAD group) and 97 healthy volunteers (control group) for the MTHFR 677 C-to-T mutation. Fasting and post-methionine-load tHcy level, folic acid, and vitamine B12 level were determined with other clinical variables in CAD group. RESULTS: The frequency of the MTHFR V/V homozygous genotype was 20% in CAD group (with 40% heterozygous and 40% wild type) and 14% in control group (with 48% heterozygous and 38% wild type). In CAD group, homozygotes of MTHFR mutation had significant higher fasting tHcy level than wild type (homozygote, 18.83+/-6.37 micromol/L: wild type, 12.36+/-3.21 micromol/L: p<0.01). The tHcy level correlated with the age (r=0.425, p<0.01), the folate level (r=-0.534, p<0.01), and the presence of the mutant MTHFR gene (r=0.565, p<0.01) after adjustment of other clinical variables. CONCLUSION: We find that homozygotes of MTHFR mutation have higher homocysteine level independent of folic acid in patients with CAD. Large case-control study needed to confirm whether MTHFR mutation increases the risk of CAD independent of plasma tHcy level.
Americas ; Canada ; Case-Control Studies ; Coronary Artery Disease* ; Coronary Vessels* ; Fasting ; Folic Acid ; Genotype* ; Healthy Volunteers ; Homocysteine* ; Homozygote ; Humans ; Japan ; Metabolism ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Plasma ; Risk Factors ; Vitamins

BACKGROUND AND OBJECTIVE: Precise assessment of lesion severity is fundamental for the clinical decision making in the patients with coronary artery disease. Coronary angiography has limitation to projection imaging techniques. Intravascular ultrasound (IVUS) has been known to be a gold standard of morphological severity of coronary stenosis. Fractional flow reserve (FFR) is known to be a lesion specific functional index of epicardial stenosis that can be derived from intracoronary pressure assessed during maximal vasodilation. The objective of this study was to investigate the validity of fractional flow reserve for stenosis severity in comparison with IVUS. METHODS: The study population consisted of 24 patients with angina pectoris (M:F=19:5, age: 58+/-12 yrs). The IVUS and intracoronary pressure wire performed at 26 lesions after diagnostic coronary angiography. We measured angiographical diameter stenosis (DST), minimal luminal diameter (MLD), minimal luminal area (MLA) and reference area stenosis (r-AST). FFR was defined by the ratio of distal mean coronary pressure (Pd) to aortic mean pressure (Pa). RESULTS: FFR showed significant correlation with both r-AST (r=-0.93, p<0.00001) than DST (r=-0.79, p<0.0001). When the lesions with MLD less than 1.1 mm were excluded, considering the limitation of IVUS for the thickness of its catheter, FFR showed excellent correlation with r-AST with higher correlation coefficient (r=-0.96, p<0.00001). FFR showed significant correlation with MLA (r=0.87, p=0.0001) or MLD (r=0.83, p=0.0005). CONCLUSION: FFR with excellent correlation with r-AST measured by IVUS seems to be a useful lesion specific functional index for the assessment of coronary stenosis in angina patients.
Angina Pectoris ; Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Decision Making ; Humans ; Phenobarbital ; Ultrasonography* ; Ultrasonography, Interventional ; Vasodilation

Cerebral rete mirabile is a unusual form of chronic cerebrovascular occlusive disease characterized usually by bilateral stenosis of distal internal carotid arteries and their vicinity, by a hazy network of collateral circulation at the base of brain called moyamoya vessels and clinically by recurring hemispheric ischemic attack in children. We have reported here 2 cases of cerebral rete mirabile in children and performed newly developed operative procedure which we think is an ideal surgical method for treatment of this disease in children and is compared with other surgical treatment.
Brain ; Carotid Artery, Internal ; Child* ; Collateral Circulation ; Constriction, Pathologic ; Humans ; Ischemia ; Surgical Procedures, Operative

Cervical traction has been widely used as an essential method for the treatment of cervical fracture-dislocation. This report, however, was a case in which hazardous effect of traction due to unreduced huge fragment was demonstrated only by cervical CT scan. Surprisingly plain X-rays could not demonstrated this condition. It was apparent that skeletal traction resulted in further injury of the spinal cord. Surgical removal of unreduced huge fragment was accomplished completely and interbody fusion was followed. Postoperative CT findings showed complete removal of fragment and decompression of the spinal cord as well as gratifying interbody fusion. CT scanning is imperative to evaluate the cervical fracture-dislocation and blind skeletal traction may be hazardous.
Decompression ; Spinal Cord ; Spinal Cord Injuries ; Tomography, X-Ray Computed* ; Traction

From January, 1984 to January, 1985 twelve patients with unstable fracture and fracture-dislocation of the thoraco . lumbar spine with neurologic deficits were treated with Harrington Instrument. Fixation by Harrington Instrumentation appeared to provide stabilization, reduction and return of neural function. Author performed Harrington Instrumentation with experience of 12 cases of unstable thoraco . lumbar spine fructure and fracture-dislocation with neurologic deficits. Results were as follows : 1) Spinal fracture and fracture-dislocation were most common in thoraco . lumbar Junction. 2) Harrington Instrumentation was very effective for keeping the spine stability in unstable fracture. 3) Six cases (50%) had a complete neurologic deficit and six cases (50%) had a incomplete neurologic deficit, two cases of the six patients with complete neurologic deficits recovered slightly but two cases with incomplete neurological deficit gained complete recovery. 4) During the postoperative period, early ambulation was possible and average admission period were 71 days. 5) Correction of spinal deformity. A. Average value of kyphotic angle (12.5 degrees). B. Average value of Iw(Index of weding) (1.32). C. Displacement was completely corrected in eight patients (100%).
Congenital Abnormalities ; Early Ambulation ; Humans ; Neurologic Manifestations ; Postoperative Period ; Spinal Fractures ; Spine*

A total of 32 cases of cervical myelography via lateral c1-2 puncture using water-soluble metrizamide was evaluated. Twenty seven cases were suspected to have herniated cervical disc and five cases, spinal cord tumor. Patients were placed in prone position with head and neck slightly extended on the radiolucent operating table. Puncture was performed using 22-guage spinal puncture needle placed at the junction of the middle and posterior one-third of the bony spinal canal and 4-6mm inferior to the arch of atlas on lateral projection. The needle was positioned posterior to the spinal cord into the subarachnoid space. The author could obtain more clear images with less amount of contrast medium than doses used in conventional cervical myelography via lumbar route. The were relatively few adverse reactions and no considerable complications have been encountered with a new cervical water-soluble metrizamide myelography via C1-2 puncture.
Head ; Humans ; Metrizamide* ; Myelography* ; Neck ; Needles ; Operating Tables ; Prone Position ; Punctures* ; Spinal Canal ; Spinal Cord ; Spinal Cord Neoplasms ; Spinal Puncture ; Subarachnoid Space

Patients with hemifacial spasm were treated with a radiofrequency stimulating assisted percutaneous radiofrequency facial nerve coagulation around the stylomastoid foramen. The initial series of 18 cases of facial spasm are described. The series included 10 men and 8 women, aged from 19 to 75 years. All patients had classical type intractable persistent hemifacial spasm. Although severe facial weakness was made after the procedure to control the heperactive dysfunction of facial nerve in all patient immediately after making lesion, all of them recovered within 6 months follow-up. The longest follow up has been 26 months and only one patient had repeated procedure who experienced recurrence of hemifacial spasm 6 months after initial procedure. The procedure is simple, easy to perform and has no definite complication except transient facial palsy.
Facial Nerve ; Facial Paralysis ; Female ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Male ; Recurrence ; Spasm

Myelomengocele is one of the most common congenital anomalies. The exact incidence of myelomeningocele is not known, but it is about one to three per 1000 live births. The long term results of treatment of infants born with myelomeningocele are disappointing. So many factors must be considered in deciding the treatment of the patients, such as clinical state of the patients, family's attitude, socioeconomic factors, and ethical and moral aspects. Authors performed clinical study of 71 cases of spina bifida cystica for past 10 years and the results are as follows : 1) Of the 71 cases, 51 cases(71.8%) were myelomeningocele and 20(28.2%) were meningocele. There was no sexual difference. 2) Admissions within 24 hours after birth were only 21 cases(29.5%). 3) Familial tendency and the relation to the number of childbearings were not observed. Majority of the cases were born in the families of low socioeconomic state. 4) Of the 71 cases, 17 cases(23.9%) were associated with hydrocephalus and 3(4.2%) with Arnold-Chiari malformation. 5) 39 cases(76.5%) of myelomeningocele showed definite neurological deficit but all cases of meningocele were quite normal neurologically. 6) Operation was performed in only 24 cases(47.1%) of 51 myelomeningocele.
Arnold-Chiari Malformation ; Humans ; Hydrocephalus ; Incidence ; Infant ; Live Birth ; Meningocele ; Meningomyelocele* ; Parturition ; Socioeconomic Factors ; Spina Bifida Cystica