Although potential hematologic complications of carbamazepine (CBZ) have been well known, the cardiac effects of CBZ are not widely appreciated. We report two cases of severe bradyarrhythmia induced by the usual dosage of CBZ. Two elderly patients complained of chest discomfort and dyspnea after CBZ medication. Their EKGs showed sinus bradycardia with junctional escape rhythm. After the discontinuation of CBZ, cardiac conduction abnormality were resolved. Even though cardiac side effect of CBZ is rare, it is potentially lethal in elderly patients.
Aged* ; Arrhythmias, Cardiac ; Bradycardia* ; Carbamazepine* ; Dyspnea ; Electrocardiography ; Humans ; Thorax ; United Nations

BACKGROUND: Normally major forward pulmonary venous flow(PVF) into left atrium occurs during systole and early diastole. This is followed by the reversal of the PVF with atrial contraction during late diastole. Chronic increase of left atrial pressure and volume, and decrease of the left atrial compliance might alter the PVF pattern in patients with mitral stenosis. Moreover, the cardiac rhythm could be changed from sinus rhythm(SR) to atrial fibrillation(AF) with the progression of the disease. To elucidate the effect of these changes on PVF, we performed transesophageal echocardiographic(TEE) Doppler examination in 20 patients of mitral stenosis who were going to be taken Percutaneous mitral commissurotomy(PMC). METHOD: We measured the velocities of the PVF by TEE pulsed Doppler examination, and compared it with the hemodynamic parameters measured by cardiac catheterization in 20 patients of mitral stenosis who underwent the PMC. The SR was found in 12 patients and the rest showed established AF. RESULTS: 1) Doppler variables measured by TEE. 2) Hemodynamic parameters measured by cardiac catheterization. 3) In patients with SR, S-PV, S-VTI and S-FVTI showed negative correlation with mean LAP(r=-0.66, -0.67, -0.71, respectively, p<0.05). However in AF group, there is no correlation between Doppler variables and mean LAP. CONCLUSION: In mitral stenosis with SR, systolic PVF decreases with the increase of mean left atrial pressure and finally, diastolic PVE becomes predominant with the development of AF.
Atrial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Compliance ; Diastole ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Atria ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Systole

BACKGROUND AND OBJECTIVES: The endothelium plays an important role in maintaining vascular tone and function. Essential hypertension may be associated with alterations in endothelial function. The effects of antihypertensive agents on endothelial function have not been fully evaluated in human hypertension and data on the forearm circulation of humans are controversial. The aim of this study was 1) to evaluate the endothelial function in hypertensive patients 2) to investigate whether vitamin C administration has benefit on the endothelial function and 3) to determine whether treatment with ACE inhibitor improve endothelial dysfunction in hypertensive patients. MATERIALS AND METHODS: The endothelial function was estimated using venous occlusion plethysmography(VOP) in 8 hypertensive patients and 8 healthy volunteers. The patients in the hypertension group were treated with enalapril, then examined again. The change of the forearm blood flow(FBF) was measured with the acetylcholine infusion through brachial artery and also with intra-arterial vitamin C. The measurement of forearm volume change was repeated for 7 times each stage. RESULTS: Forearm blood flow response to acetylcholine was significantly enhanced with inra-arterial infusion of vitamin C in hypertensive group before antihypertensive treatment(302+/-58 % --< 446+/-43 %). Co-infusion of L-NMMA, an inhibitor of nitric oxide synthase, blunted forearm blood flow response to acetylcholine(Vit C(+; 446+/-43 % --< Vit C +L-NMMA; 229+/-23 %). After antihypertensive treatment with enalapril for 2 months in hypertensive group, endothelium-dependent vasorelaxation (vasodilatory response to acetylcholine) was significantly improved in treated group compared to before enalapril treatment(302+/-58 % --< 643+/-78 %). CONCLUSIONS: Even though the mechanisms leading to depressed endothelial function in essential hypertension remains to be elucidated, our study shows that vitamin C and ACE inhibitor result in demonstrable improvement by a mechanism that is probably related to antioxidant activity.
Acetylcholine ; Antihypertensive Agents ; Ascorbic Acid* ; Brachial Artery ; Enalapril ; Endothelium ; Forearm ; Healthy Volunteers ; Humans ; Hypertension* ; Nitric Oxide Synthase ; omega-N-Methylarginine ; Vasodilation ; Vitamins*

Isometric tension recording was performed in the transverse strips of porcine coronary arteries and rabbit aorta to observe the effects of the endothelium and endothelium-derived relaxing factor(EDRF) on vasomotor tone and to test the hypothesis that alcohol may have the deleterious effect on endothelium-dependent vasorelaxation. Tension-development by vasoconstrictor was markedly attenuated in the endothelium-intact strips compared to the endothelium denuded strips. Administration of hemoglobin(10-5M) to inhibit the action of EDRF increased tension selectively in the endothelium-infarct strips, which is suggestive of basal EDRF secretion. Nitro L-arginine(10-5M). an analogue of L-arginine(10-4M) partially reversed the inhibitory effect of nitro L-arginine. Ethyl alchol inhibited bradykinin-induced endothelium-dependent vasorelaxation of porcine coronary artery in dose dependent manner. These data suggest that the protective effect of vascular endothelium to the action of vasoconstirctor can be explained by exercise of basal EDRF release and damaged endothelium would be a great risk of induction of vasospasm. Also we believe that there is a relationship of competive inhibition between L-arginine. a precursor of EDRF, and its analogues on the action of EDRF and alcohol intake would be hazardous to the patients with coronary artey disease because its inhibitory action on endothelium-dependent vasorelaxation may evoke myocardial ischemia.
Aorta ; Arginine ; Coronary Vasospasm ; Coronary Vessels* ; Endothelium* ; Endothelium, Vascular ; Ethanol* ; Humans ; Myocardial Ischemia ; Spasm* ; Vasodilation

BACKGROUND: Atrial fibrillation is the most common sustained arrhythmia especially in the elderly. Despite the beneficial effect of anticoagulation to prevent disastrous complication of throm-boembolism, anticoagulation is not widely used in patients with atrial fibrillation. The purpose of this study was to identify the prevalence and clinical characteristics of atrial fibrillation and investigate the current status of anticoagulation in the elderly. METHODS: Through electrocardiographic analysis of 6,138 elderly (> or =65yr) patients from tan. to Dec. 1997, 386 patients with atrial fibrillation was found. Among the 386 patients, 274 patients with available medical records were enrolled for review of clinical findings (associated diseases, risk factor of throm-boembolism, medications) retrospectively. RESULTS: Mean age of population with atrial fibrillation was 72+/-6yr. The prevalence of atrial fibrillation was 6.2% and increased with age (65-69yr: 5.4%, 70-74yr: 6.4%, 75-79yr: 7.5%, 80yr-:9.0%). Atrial fibrillation with valvular hear disease was 27% of patients. Common associated diseases with nonvalvular atrial fibrillation were hypertension (48%), diabetes mellitus (18%), coronary artery disease (25%), congestive heart failure (21%), history of stroke or transient ischemic attack (27%). Anti-coagulation was used in 59% of valvular atrial fibrillation patients without contraindications (prosthetic valve: 100%, native valve: 42%), 24% of nonval-vular atrila fibrillation. Antiplatelet therapy with aspirin was 15%, 30% respectively, Aspirin was used in only 20% of atrial fibrillation patients with contraindication of anticoagulation. CONCLUSION: Atrial fibrillation is prevalent in the elderly. Anticoagulation and antiplatelet therapy in atrial fibrillation appears to be less than optimal.
Aged* ; Arrhythmias, Cardiac ; Aspirin ; Atrial Fibrillation* ; Coronary Artery Disease ; Diabetes Mellitus ; Electrocardiography ; Heart Failure ; Humans ; Hypertension ; Ischemic Attack, Transient ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Stroke ; Triacetoneamine-N-Oxyl

PURPOSE: To assess the mode of a polyethylene liner failure in total hip replacement using a Harris-Galante II acetabular component. MATERIALS AND METHODS: A retrospective review was performed and 128 consecutive primary total hip arthroplasties were analyzed in 111 patients who had a second-generation Harris-Galante cup. All patients were followed up for a minimum of five years, with a mean follow up of 7.4 years (range, 5 to 12.9 years). A total of 26 cups (20.2%) were revised at the time of the latest follow up. The medical records, radiographs, surgical notes, and retrieved components were analyzed in order to determine the precise causes of the revision. RESULTS: Twenty-two cases (17.3%) were found to have experienced problems with the polyethylene liner. Three types of liner failure were identified; metallosis associated with polyethylene liner wear (14 cases), excessive wear without metallosis necessitating a revision (6 cases), and polyethylene liner dissociation without gross evidence of wear (2 cases). CONCLUSION: This study find that polyethylene liner failure is the main cause of the revision of this component. Early surgical intervention needs to be performed before fatal metal damage occurs in order to avoid metallosis, and severe bone stock damage in cases of excessive polyethylene wear.
Acetabulum* ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Hip ; Humans ; Medical Records ; Polyethylene* ; Retrospective Studies

PURPOSE: To evaluate the midterm result of patients who underwent rotational acetabular osteotomy for the treatment of acetabular dysplasia. MATERIALS AND METHODS: The clinical and radiographic outcomes of 36 patients, who underwent rotational acetabular osteotomy between January 1987 and September 1998, were evaluated after a minimum followup of five years. The mean follow-up period was 8.6 years. The clinical evaluation included recording the level of pain, the ambulation status and range of motion according to the d'Aubigne and Postel system. Radiographic analysis included the C-E angle of Wiberg, the acetabular roof obliquity, and arthritis grade of Tonnis. RESULTS: The average Postel score increased from 12.5 points preoperatively to 15.7 points at the final follow up. All the radiologic indices improved after surgery. In five hips (13.1%), there was a progression of arthritis prior to surgery. CONCLUSION: Rotational acetabular osteotomy is a valuable procedure for preventing the progression of early osteoarthritis in patients with a dysplastic hip. However the results were unsatisfactory for hips with more advanced osteoarthritis.
Acetabulum* ; Arthritis ; Follow-Up Studies* ; Hip Joint ; Hip* ; Humans ; Osteoarthritis ; Osteotomy* ; Range of Motion, Articular ; Walking

BACKGROUND AND OBJECTIVES: Epistaxis is often regarded as trivial disease, but it may cause serious situation and requires hospital admission. With the advent of nasal endoscopy, localizing the precise location of nasal bleeding is possible in most cases and enables direct treatment rather than simple nasal packing. We analyzed the epistaxis patients who require hospital admission during recent 10 years. MATERIALS AND METHODS: One hundred and one patients who required hospital admission from January 1990 to December 1999 due to intractable or recurrent epistaxis were included in this study. Records of the hospital admission were reviewed and analyzed retrospectively. RESULTS: Male patients were predominant (72.1%) and the highest age distribution was in the 50's. Intervals between the initial attack of epistaxis and medical attention was 2-5 days (60.4%). The mean duration of hospital stay was 5-10 days (49.5%). The precise localization of bleeding point was possible in 98 cases (81.6%), whereas some sites of bleeding revealed Little's area (35.0%) and nasal turbinates (28.3%). The most frequent preexisting structural abnormality and systemic illness were nasal septal deviation and hypertension. In hypertension patients, the predominant age distribution was in the 60's (28.6%), and there was no difference in the bleeding frequency and the mode of management. CONCLUSION: We analyzed the epistaxis patients who required hospitalization. Nasal endoscopy enabled precise localization of the epistaxis and prompt focused management rather than conservative management.
Age Distribution ; Endoscopy ; Epistaxis* ; Hemorrhage ; Hospitalization ; Humans ; Hypertension ; Length of Stay ; Male ; Retrospective Studies ; Turbinates

No abstract available.
Skin* ; Tacrolimus* ; Wounds and Injuries*

Previous studies have shown that experimental canine coronary or rabbit cardtid qrtery stenosis that is associated with endothelial injury results in a typical pattern of blood flow characterized by gradual decreases in arterial flow followed by restorations of flow to normal values. This pattern of flow, called cyclic flow reduction(CFR), is the consequence of recurrent platelet aggregation at the site of the stenosis and endothelial injury and subsequent dislodgement of the thrombus. This study was designed to test the efficacy of verapamil in ingibiting in vivo platelet aggregation in a rabbit model of cardotid artery stenosis and ecdothelial injury. Carotid blood flow was measured continuously with a electromagnetic flowmeter probe that is positioned proximal to the constrictor. During placement of constrictor and angioplasty balloon, CFR developed in 8 of 20 rabbits with a mean frequency of 10.0+/-2.2 cycles/h. CFRs were observed for 30min, and IV verapamil was administered till declining of blood pressure(up to 100ug/kg). After intravenous verapamil, the mean frequency of CFR insignificantly decreased to 8.7+/-2.1 cycles/h(p=ns). After 20mg/kg of aspirin were given intravenously, the CFR were abolished in 5 rabbits, the mean frequency of CFR decreased in 1 rabbit, and no significant change was observed in 2 rabbits. It is concluded that verapamil is relatively ineffective in inhibiting in vivo platelet aggregation at doses that don't change hemodynamics significantly.
Angioplasty ; Arteries ; Aspirin ; Carotid Stenosis* ; Constriction, Pathologic ; Flowmeters ; Hemodynamics ; Magnets ; Platelet Aggregation ; Rabbits ; Reference Values ; Thrombosis ; Verapamil*