The antihypertensive effect of verapamil, a calcium channel blocker, was studied in 12 cases of essential hypertension (mean age 49, range 24-64). After 6 weeks administration (80-160mg t.i.d.), the following results were obtained : 1) Before medication, average systolic and diastolic blood pressure was 176.3/108.6mmHg. After completion of therapy, blood presure fell significantly down to 154.8/94.2mmHg (p<0.01). 2) Heart rate decreased slightly from average 74.3 per minute prior to medication to 69.3 per minute at the end of study (p<0.01). 3) Side effects, among which constipation was most common, were mild and did not compel any patient to diacontinue therapy. In conclusion, verapamil seems to be a safe and effective first-line drug for hypertension along with diuretics or beta blockers.
Blood Pressure ; Calcium Channels ; Constipation ; Diuretics ; Heart Rate ; Humans ; Hypertension ; Verapamil*

We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.
Atrial Septum ; Korea ; Myxoma* ; Recurrence*

BACKGROUND: Stimulation of iNOS with subsequent release of NO may play a critical role in pathophysiology or host defense reactions. NO can be produced by several cell types that reside in the skin. Increasing data indicate that NO serves as an autocrine and paracrine mediators in diverse and complex cellular processes throughout the skin. OBJECTIVE: The aim of the present study was to elucidate whether dendritic epidermal T cell can express iNOS and generate NO. In addition to that, this study was to evaluate whether NO may play a certain role in IL-3 production of activated dendritic epidermal T cell. METHODS: iNOS mRNA was isolated by RT-PCR at 12, 24, 48, 72 hours after stimulation and NO was measured by the Griess method. IL-3 levels were assessed with a basic cell proliferation bioassay system using supernatants from T cells cultured in 96 well plates. Units of IL-3 in the culture supernatants were measured using the cytokine-dependent DA-1 cell line. RESULTS: 1. NO generation was increased by UVB 100mJ/cm2 irradiation, concanavalin-A and lipopolysaccharide stimulation in dendritic epidermal T cell. The amount of NO was highest in LPS. 2. The expression of iNOS was increased by UVB 100mJ/cm2 irradiation, concanavalin-A and lipopolysaccharide stimulation in dendritic epidermal T cell. Induction of iNOS revealed peak at 72 hours after concanavalin-A and lipopolysaccharide stimulation, but in UVB irradiation that of iNOS was not observed except at 48 hours. 3. NO may play a role in IL-3 production in activated dendritic epidermal T cell. CONCLUSION: The results strongly suggest that the expression of iNOS and NO production in dendritic epidermal T cell are upregulated by UVB, concanavalin-A and lipopolysaccharide, and NO may play a role as mediator in IL-3 production of activated dendritic epidermal T Cell as autocrine manner.
Biological Assay ; Cell Line ; Cell Proliferation ; Interleukin-3* ; RNA, Messenger* ; Skin ; T-Lymphocytes

Reentrant tachycardias can often be terminated by discrete pacing stimuli that penetrate the reentrant circuit. Antitachycardia pacemaker PASAR 4172 (Programmable Automatic Scanning Arrhythmia Reversion, Model 4172, Telectronics) is designed to detect tachycardia automatically and subsequently to deliver programmed one or two extrastimuli to revert to sinus rhythm. We experienced two patients, one paroxysmal supraventricular tachycardia and one paroxysmal ventricular tachycardia, who had had frequent and often prolonged episodes of tachycardia that responded poorly to pharmacologic antiarrhythmic therapy. Each patient underwent a detailed preimplantation clinical electrophysiological study in order to determine the number of stimuli required for termination of tachycardia, the most satisfactory site for electrode placement, and the tachycardia termination zone. During the follow-up period of 7 to 11 months after implantation of PASAR 4172, no patient complained of an episode of sustained tachycardia although they experienced symptoms of an impending attack. We conclude that antitachycardia pacemaker PASAR 4172 is a safe, effective, and well tolerated method for the therapy of drug resistant paroxysmal supraventricular tachycardia and paroxysmal ventricular tachycardia.
Arrhythmias, Cardiac ; Electrodes ; Follow-Up Studies ; Humans ; Tachycardia ; Tachycardia, Paroxysmal* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

BACKGROUND: We studied the accuracy, lateralization criteria of Wada test in patients with temporal lobe epilepsy(TLE). We also evaluated material specific memory and determined the stimulus which can classify best between right and left TLE among four different types of stimuli. METHODS: We examined Wada memory performance in 33 patients(15 left, 18 right) with TLE who underwent surgery and who were good seizure outcome at least 1 year follow-up. Twelve stimuli consited of figures, written words, geometric designs and real objects were presented after Amytal injection. The recognition memory test was performed at 10 minutes after the injection and hemisphere memory performance of each stimulus and total stimuli were obtained by(number of stimuli recognized / number of stimuli presented x 100%). Classification rate, best stimulus for lateralization, and suitable lateralization criteria were determined by discriminant analysis and Chi-square test. Hemispheric memory difference of each stimulus was analyzed by paired-sample Student's t-test in left temporal lobectomy(LTL) and right temporal lobectomy(RTL) groups. RESULTS: No significant difference was observed in pre-Wada memory score and in IQ between LTL and RTL group. The classification rate of Wada test in terms of lateralization by discriminant analysis was 81.82%. The accuracy was 75.8% at 10% and 15% lateralization criteria and was 63.6% and 45.5% at 20% and 25% lateraliza.
Amobarbital ; Classification ; Follow-Up Studies ; Humans ; Memory* ; Seizures ; Temporal Lobe

BACKGROUND: It is well known that there is wide individual variation of responsiveness when parasympathetic nervous system is stimulated physiologically, pathologically, and therapeutically. But no appropriate explanation is present for that yet. So the purpose of this study is to verify individual diversity of vagal tone during resting state and after vagal stimulation and to find factor that may significantly contribute to it. METHOD: We serially measured variation of heart period(VHP : sec) which had been known to be an accurate index of cardiac parasympathetic tone during resting state(VHPb) and after vagal stimulation by ice water application to face(VHPv). And we analyzed correlation between VHPb, VHPv and ratio of VHPv to VHPb(ratio). RESULT: There was wide variation of vagal tone both in resting state (VHPb : 0.025-0.161) and after vagal stimulation (VHPv : 0.087-0.661). VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb could be classified into 3 groups according to stem and leaf distribution(group A : VHPb<0.07, B : 0.07-0.1, C : >0.1). The low VHPb group A showed dramatic increase in vagal tone after vagal stimulation (ratio 2.21-20.24 mean 7.7), on the other hand high VHPb group C did not (ratio 0.80-2.55 mean 1.39). There ws also a significant negative correlation between VHPb and ratio (r=0.69, p<0.001). CONCLUSION: These results suggest that there is wide individual diversity of responsiveness to vagal stimulation and magnitude of vagal tone in resting state is an important factor to determine the responsiveness to vagal stimulation.
Child* ; Hand ; Heart ; Humans ; Ice ; Parasympathetic Nervous System ; Water

The clinical utility of thallium-201 SPECT combined dwith pharmacologic vasodilation induced by oral dipyridamole as an alternatiove to intravenous dipyridamole was incestigated in 21 patients who had concomitant coronary arteriography. Tomographic images were assessed visually. Sensitivity & specificity for overall detection of coronary artery disease were 93.7% and 80% respectively. Sensitivity & specificity for identification of indevidual diseased vessels were 84.6% and 87.5% for the left anterior descending artery, 75% and 84.6% for the right coronary artery, 60% and 100% for the left circumflex artery, respecitively. Of the 26 patients unergoing thallium scintigraphy 11 patients(42.3%) had some adverse effects between 20 and 50 minutes after oral dipyrdamole ingestion, including headache(26.9%), chest pain(26.9%), electrocardiographic changes(19.2%), and nausea(11.5%). Intravenous aminophylline was used to resolve these adverse effects in 8 patients & most of the adverse effects were subsided within 10 minutes. There was no ventricular arrhythmias, myocardial infarctions or deaths. In conclusion, oral dipyridamole thallium-201 SPECT is safe and accurate test for the overall detection of coranary artery disease and identification of disease in individual arteries. Furthermore it is useful for determining the necessities of coronary reperfusion and prognstically stratiofying the patients with coronary artery disease.
Aminophylline ; Angiography ; Arrhythmias, Cardiac ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Dipyridamole* ; Eating ; Electrocardiography ; Humans ; Myocardial Infarction ; Myocardial Perfusion Imaging* ; Myocardial Reperfusion ; Radionuclide Imaging ; Sensitivity and Specificity ; Thallium ; Thorax ; Tomography, Emission-Computed, Single-Photon* ; Vasodilation

In order to observe the changes in left ventricular function during coronary artery occlusion and reperfusion, left anterior descending (LAD) coronary arteries in the anesthetized dogs were occluded for 1 hour and then reperfused for 4 hours. Hemodynamic indexes of global systolic and diastolic function and regional wall thickness changes as a regional contractile index were measured during occlusion and reperfusion. The results were as follows; 1) Indexes of global systolic function (left ventricular peak systolic pressure, peak positive dP/dt) and global diastolic function (peak negative dP/dt, time constant, left ventricular end-diastolic pressure) showed deterioration in early occlusion period (10-30 minutes) but gradually improved even if coronary occlusion persisted. Reperfusion did not induce significant changes except that peak positive dP/dt transiently deteriorated 30 minutes after reperfusion and left ventricular end-diastolic pressure decreased 1.5-2 hours after reperfusion. 2) Indexed of regional function (i.e, end-diastolic thickness and % systolic thickening of anterior left ventricular wall) deteriorated by 10 minutes' occlusion which persisted during the entire occlusion period. Reperfusion induced no significant improvement in regional contractile function compared with occlusion 60 minutes' data, which suggested reperfusion for 4 hours after 1 hour's LAD occlusion may be insufficient for the ischemic region to recover its contractility. 3) Reperfusion arrhythmia (ventricular tachycardia) was noted in most (6/9) of the dogs, one of which deteriorated into ventricular fibrillation and the others spontaneously converted to normal sinus rhythm.
Animals ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels* ; Dogs ; Hemodynamics ; Reperfusion* ; Ventricular Fibrillation ; Ventricular Function, Left*

Painful nociceptive informations are well known to be transferred from nociceptors through spinal dorsal horn not only in different pathways but also in diverse nature depending on the type of noxious stimuli. There have been some controversies about the role of neuropeptide somatostatin in the transmission of the nociceptive information to the dorsal horn cells of the spinal cord. We performed the study in order to elucidate the effects of somatostatin on transmission of noxious stimuli in the spinal dorsal horn, comparing with those of morphine. Using carbon-filamented microelectrode, the single cell activities of wide dynamic range(WDR) neuron were recorded extracellularly at the lumbosacral enlargement of the spinal cord in cats after noxious mechanical(squeeze), thermal(heat lamp), and cold(dry ice) stimulation to the receptive field. The sciatic nerve was stimulated electrically to evoke, A4-fiber and C-fiber each other. Data were compiled into single pass time histograms or postsimulus time histograms. Twenty micro-gram of somatostatin was injected intravenously to study the changes of single cell activities in 20 minutes, which were compared with the effects of morphine(2m/kg). Then naloxone was administrated(0.1mg/kg) to know whether it antagonized the effects of somatostatin and morphine And those finding were also observed in inverted WDR cells. In WDR cell, somatostain decreased the cellular responses to noxious heat stimuli in 6cell(n=9), but increased those to cold stimuli in 4 cells(n=6). And the responses to noxious mechanical stimuli were so diverse that they were slightly increased in 7 cells(164%), decreased in 5 cells, and were not changed in 6 cells(n=18). A-response, the response to peripheral Ad-afferent activation, showed a tendency to be facilitated(n=6/9), while C-response had a slightly depressed tendency(n=4/9). Morphine strongly suppressed the responses of dorsal horn neurons to noxious heat(n=9/13), cold(n=2/2), mechanical stimuli(n=16/19) and electrical A-response(n=7/10), C-response(n=6/7). Following subsequent injection of naloxone, the effects of morphine on noxious stimuli evoked response were fully reversed but those of somatostatin were not antagonized. There was significant difference between the reversal effects of naloxone on morphine and somatostatin(p<0.05). From the above results it is concluded that somatostatin suppresses the transmission of nociceptive heat stimuli, especially via C-fiber, while facilitates that of nociceptive mechanical and cold stimuli via Adelta-fiber in spinal dorsal horn cells. Also the somatostatin appears to have different nociceptive mechanism from morphine.
Animals ; Cats* ; Horns ; Hot Temperature ; Microelectrodes ; Morphine* ; Naloxone ; Neurons ; Neuropeptides ; Nociceptors ; Peripheral Nerves* ; Posterior Horn Cells* ; Sciatic Nerve ; Somatostatin* ; Spinal Cord

The pattern of periodic sharp wave complexes (PSWC) was widely accepted as the most characteristic electroencepalographic(EEG) abnormality in Creutzfeldt-Jakob disease (CJD) although it may be lacking in prodromal and terminal stages. The EEG abnormalities are often asymmetric. We compared PSWC with 18F-FDG PET and brain MRI finding to know the signifcance of PSWC. All the patients had typical clinical courses and symptoms of CJD. Three patients were pathologically verified. Three patients were in full stage and two in terminal stage of CJD. We analysed PSWC in digital EEG and compared the regions of maximal PSWC amplitudes with 18F-FDG PET and brain-MRI finding in regard to lateralization and localization. Regarding lateralization, the maximal amplitudes of PSWC were observed over left frontal area in two patients and over right frontal region in three. Three patients in full stage had PET hypometabolism in the same hemisphere as PSWC were lateralized. Their brain MRI showed abnormal basal ganglia intensities but no sever brain atrophy. Two patients in terminal stage had PSWC lateralized in right frontal region but in PET one had left frontoparietal and the other bilateral global hypometabolism. Their brain-MRI showed severe cortical atrophy in the same hemisphere as PET hypometabolism was observed. Regarding all patients in full or terminal stage had maximal PSWC in frontal region, which were not consistent with PET and MRI findings. Cortical lesions in MRI were well corresponding with PET hypometabolism but not with PSWC. These results suggest that PSWC could reflect the hemisphere with more CJD activities in full stage, but could not localize the region where PET and MRI showed abnormalities, suggesting that the generation of PSWC could be related with the involvement of subcortical structures in CJD.
Atrophy ; Basal Ganglia ; Brain ; Creutzfeldt-Jakob Syndrome* ; Electroencephalography ; Fluorodeoxyglucose F18 ; Humans ; Magnetic Resonance Imaging