Retinal vein occlusion(RVO)is the second most common form of retinal vascular disease next to diabetic retinopathy. Systemic risk factors such as hypertension, diabetes, cardiovascular disease, blood dyscrasia and ocular risk factors such as short axial length, glaucoma, papilledema, thyroid ophthalmopathy have been shown to be associated with RVO. It is usually unilateral disease, and bilateral occurrene of RVO is relatively uncommon. CRVO rarely occurs bilaterally with a short interval between two eyes. Having experienced a case of bilateral CRVO within one month in a 75-year-old female with short axial length, primary open angle glaucoma, hypertension and hypercholesterolemia, we report this case with literature review.
Aged ; Cardiovascular Diseases ; Diabetic Retinopathy ; Female ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Hypercholesterolemia ; Hypertension ; Papilledema ; Retinal Vein* ; Retinaldehyde ; Risk Factors ; Thyroid Gland ; Vascular Diseases

PURPOSE: To report a case of Wegener's granulomatosis misdiagnosed as ocular tuberculosis. METHODS: A 65-year-old man who was treated with anti-tuberculosis medications as suspected pulmonary tuberculosis was referred from the department of internal medicine for visual loss over months. His initial visual acuity was counting fingers at 30 cm in the right eye and there was a chorioretinal scar involving the macula on fundus examination. At that time, we thought that the lesion was a tuberculosis-related chorioretinal scar and so he was treated with anti-tuberculosis medications. There was a recurrent bilateral anterior uveitis during three months from the initial visit. RESULTS: After 14 months, he was examined by otorhinolaryngologist due to a saddle nose deformity and Wegener's granulomatosis was diagnosed based on positive Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and nasal mucosal biopsy. At that time, ocular examination revealed the necrotizing scleritis in both eyes and orbital CT showed bony destruction of medial and inferior orbital wall without proptosis in both eyes. We had treated with oral cyclophosphamide and prednisone. CONCLUSIONS: We experienced a case of Wegener's granulomatosis with chorioretinal scar misdiagnosed as ocular tuberculosis. In conclusion, we should differentially diagnose Wegener's granulomatosis from suspected ocular tuberculosis.
Aged ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Cicatrix ; Congenital Abnormalities ; Cyclophosphamide ; Cytoplasm ; Exophthalmos ; Fingers ; Humans ; Internal Medicine ; Nose ; Orbit ; Prednisone ; Scleritis ; Tuberculosis, Ocular* ; Tuberculosis, Pulmonary ; Uveitis, Anterior ; Visual Acuity ; Wegener Granulomatosis*

BACKGROUND: The two most commonly used drugs as a stressor during wtress echocardiography are dipyridamole and dobutamine. The purpose of this study was to compare diagnostic accuracies of dipyridamole and dobutamine stress echocardiography for fixed coronary artery disease and evaluate complications related to the two agents in the same patients. METHODS: 30(M : 5=19 : 11, age=56+/-8.8yr) consecutive patients without history of previous myocardial infarction underwent coronary angiography, dipyridamole and dobutamine stress echocardiography in random order. Dipyridamole was infused up to 0.84mg/Kg for 10 minutes during clinical, ECG and echocardiographic montioring. Dobutamine was infused in dose increments from 5 to 40microg/Kg/min under the same condition. Positive criteria for myocardial ischemia by echocardiography was now regional wall mation abnormatity or worsening of regional wall motion after stress. Significant coronary disease was defined as more than 70% stenosis by coronary angiography. RESULTS: The sensitivity and specificity of both stress echocardiography were same, 82% and 92% respectively. In a single vessel disease the sensitivity of dipyridamole echocardiography was 75% and dobutamine echocardiography was 83% without statistical difference. The correlation of ischemic free time during both stress test was 0.375. During dipyridamole infusion no test was prematurely terminated because of side effects, but 3 patients(10%) developed severe hypertension and ventricular arrytricular arrythmia during dobutamine infusion and test was terminated. CONCLUSION: Thus, by this prospective direct comparison of both stress test, dipyridamole and dobutamine stress echocardiography have similar diagnostic accuracies for the detection of coronary artery disease. But during dobutamine infusion, careful monitoring for hemodynamic changes arrythmia is required for possible serious complications.
Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Sensitivity and Specificity

PURPOSE: To report a case of Klebsiella pneumoniae endogenous endophthalmitis secondary to renal or urinary tract infection such as emphysematous pyelonephritis. METHODS: A-56-year-old woman with diabetes mellitus and emphysematous pyelonephritis was reterred to us in consultation for visual loss in her right eye for 5 days. Ophthalmologic evaluation and intervention were performed. RESULTS: Culture revealed Klebsiella pneumoniae from vitreous tap of the right eye. Systemic antibiotics, intravitreous antibiotics injection and vitrectomy were performed, but the eye showed progressive worsening to phthisis. CONCLUSIONS: A high index of suspicion of Klebsiella pneumoniae endogenous endophthalmitis must be carried in patients with renal or urinary tract infection such as emphysematous pyelonephritis as well as hepatobiliary disease such as pyogenic liver abscess.
Anti-Bacterial Agents ; Diabetes Mellitus ; Endophthalmitis* ; Female ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess, Pyogenic ; Pyelonephritis* ; Urinary Tract Infections ; Vitrectomy

BACKGROUND: The presence of diastolic mitral regurgitation has been described in patients with complete atrioventricular(AV) block, aortic valve regurgitation, hypertrophic and restrictive cardiomyopathy, and in patients with long diastolic filling period in atrial fibrillation. However, because of rare incidence and difficulty in making diagnosis of this phenomenon, the frequency and hemodynamic effects of diastolic AV valve regurgitation(DAVVR) and relationship of electrocardiographic(ECG) parameters with DAVVR in patients with complete heart block have not been reported in Korea. METHODS: To evaluate the frequency, hemodynamic effects of DAVVR and relation of ECG parameters with DAVVR in patients with complete AV block, we studied 14 consecutive patients with complete AV block by means of two dimensional and Doppper echocardiography. RESULTS: The DAVVR was observed in all cases of complete AV block except 3 cases on temporary pacemaker. The peak velocy of diastolic mitral and tricuspid valve regurgitaton were 105+/-23cm/sec and 98+/-30cm/sec, respectively. The peak and mean pressure gradient of diastolic mitral regurgitation were 4.7+/-1.7mmHg and 3.1+/-1.5mmHg respectively, and the peak and mean pressure gradient of diastolic tricuspid regurgitation were 4.1+/-2.6mmHg and 2.7+/-2.1mmHg, respectively. There was regular interval between p-wave of ECG and onset of diastolic AV valve regurgitation, which was 215+/-12msec, Diastolic AV valve regurgitation disappeared immediately after recovery of complete AV block to sinus rhythm or insertion of DDD-type permanent pacemaker in all cases. CONCLUSION: In Conclusion, the DAVVR was observed in all cases of complete AV block except cases on temporary pacemaker insertion and its hemodynamic effect was mild. There was regular interval between p-wave of ECG and the onset of diastolic AV valve regurgitation.
Aortic Valve ; Atrial Fibrillation ; Atrioventricular Block* ; Cardiomyopathy, Restrictive ; Diagnosis ; Echocardiography ; Electrocardiography ; Heart Block ; Hemodynamics ; Humans ; Incidence ; Korea ; Mitral Valve Insufficiency ; Tricuspid Valve ; Tricuspid Valve Insufficiency

BACKGROUND: QT dispersion(QTD=QTmax-QTmin) on the 12 lead ECG has been known to reflect regional variation of ventricular repolarization, and thus a marker of an increased risk of arrhythmia events. Late potential(LP) on signal averagina ECG(SAECG) is independent risk factor of ventricular arrhythmia following acute myocardial infaction(AMI). However, the relation between LP and QTD as indicator of electrophysiologic instability in AMI remains to be determined. METHOD: To determine whether there is a difference in QTD between in parients with AMI during acute phase and in normal control and whether thrombolytic therapy is assiciated with a reduction in QTD, and to determine the relationship between change of QTD and late potential on SAECG, we studied 71 patient with AMI(male 54, female 14, mean age 57yrs) and 23 controls(malw 17, female 6, mean age 58yrs). QT interval was measured on a standard 12 lead ECG in patients with AMI on admission, 2 hours after urokinase IV and 10-14 days post-AMI, and QT dispersion was calculated by difference of maximal and minimal corrected QT interval(QTmax-QTmin). A signal averaged ECG was recorded in 36 patients before discharge and coronary angiogeaphy(CAG) was performed in all patients 10-14 days post-AMI. RESULT: QTD is significantly increased in AMI compared to control(78.7+/-39.5ms vs. 24.6+/-22.3ms, P < 0.01). In patients who received thrombolytic therapy with urokinase, QTD is decreased from 75.0+/-34.4ms to 53.9+/-36.0ms(P < 0.01), whereas there is no significant change in patients who did not received thrombolytic therapy(84.8+/-47.6ms vs. 78.9+/-36.2ms, NS). There in no difference in QTD between patients with positive LP(68.4+/-23.6ms) and those with negative LP(77.8+/-32.1ms) on admission, those with positive LP(66.6+/-27.6ms) and those with negative LP(56.0+/-26.4ms) after 10-14days post-AMI. But magnitude of change of 10-14 days post-AMI QTD in patients with negative LP is larger than those with positive LP(-21.7+/-33.4ms vs. -1.8+/-15.2ms, P=0.06). CONCLUSION: QTD in acute phase of AMI is significantly reduced by the thrombolytic therapy. Patients with negative late potential tent to have greater QTD reduction within 14 days after AMI. These finding suggest that QT dispersion in patients with AMI can be reduced by early recanalization and its reduction is associated with the presence of late potential.
Arrhythmias, Cardiac ; Electrocardiography ; Female ; Humans ; Myocardial Infarction* ; Risk Factors ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator

No abstract available.
Humans ; Polyamines*

BACKGROUND: The restoration of anterograde flow in the infarct-related artery(IRA) may improve electrophysiological consequences and survival. Patients with occluded IRA are more likely than those with patent IRA to have late potentials on signal-averaged electrocardiogram(SAEKG). The natural history of late potentials in the acute phase after AMI was reported to vary in recent studies and requires further investigation. Therefore, we investigated 1) whether parameters of SAEKG and incidence of late potentials are changed in 2 weeks after AMI, and 2) whether the status of IRA, ejection fraction, ventricular premature beats(VPB) on Holter and the use of thrombolytic agent can influence the developement of late potentials. METHOD: SAEKGs were performed in 40 patients with acute myocardial infarction(AMI, mean age : 56.6yr) and 20 normal controls(mean age : 53.0yr). SAEKGs were recorded first in 48 hours and then 2 weeks after AMI. Late potential were considered to be positive if two of the three following criteria were identified : 1) duration of filtered QRS complex>118ms, 2) duration of HFLA signal>40 ms, and 3) RMS voltage<20microV. RESULT: 1) The duration of filtered QRS complex and HFLA signal in patients with AMI in 48 hours and 2 weeks were longer than in the controls(p<0.01, p<0.05. respectively), and the RMS voltage in only 2 weeks was lower than in the controls(p<0.05). 2) There was no significant difference in the 3 parameters of SAEKG between 48 hours and 2 weeks after AMI, but the incidence of late potentials increased from 35%(14/40) to 42.5%(17/40). Of the 26 patients with a normal initial SAEKG, 3(11.5%) had late potentials in 2 weeks, whereas none of the patients with positive late potentials on initial SAEKG was normalized in 2 weeks. 3) The ejection fraction, the degree of VPB on the Holter EKG and the history of thrombolyic therapy in patients whose late potentials were positive were not different from those in patients with normal SAEKG. 4) In the 3 parameters of SAEKG, RMS voltage in patients with occluded IRA was significantly lower than in those with open IRA(p<0.05), and the incidence of late potentials were higher in the patients with occluded IRA(75%) than in those with open IRA(28.6%)(p<0.05). CONCLUSION: The incidence of late potentials on SAEKG after AMI was modestly increased in 2 weeks, but the development of late potentials was not influenced by the degree of frequently in patients with occluded IRA. These findings may indicate that the development of late potential after AMI tends to increase even in 2 weeks, and that the occlusion in IRA may unfavorably alter the electrophysiological state identified by SAEKG.
Arteries* ; Electrocardiography ; Humans ; Incidence ; Myocardial Infarction* ; Natural History ; Stroke Volume

BACKGROUND: Delapril, a recently developed nonsulfhydry(SH) angiotensin converting enzyme inhibitor, was known to have more prolonged duration of action. In order to investigate the efficacy and safety of delapril, patients with essential hypertension were studied. METHODS: The study subject consisted of 37 patients(mean age : 50.4 years, 15 male, 22 female). Because 4 of 37 patients dropped out due to side effects of delapril, the antihypertensive efficacy was evaluated in the remaining 33 patients. Delapril was administered orally in a daily dose of 30-120mg in two divided doses for 10 weeks after the administration of a placebo for 2 weeks. RESULTS: Delapril decreased systolic blood pressure significantly from a baseline value of 162.4+/-18.8mmHg to 142.9+/-20.9mmHg(p<0.01) and diastolic blood pressure from 103.2+/-5.0mmHg to 92.8+/-10.4mmHg(p<0.01) after 2 weeks of therapy, and maintained this effect throughout the study period. The efficacy rates were 72% for systolic pressure, 75% for diastolic pressure. The cumulative efficacy rate was 48% at 30mg/day, 66% at 60mg/day, and 73% at 120mg/day. Heart rate did not change until after 8 weeks, when they modestly decreased(p<0.05), through the 10th week(NS). Side effects were noticed in 12 out of 37 cases(32.4%). The main symptoms included dry cough(7 cases, 18.9%), headache(2 cases, 5.4%), dizziness(1 case, 2.7%), dry mouth(1 case, 2.7%) and angioedema(1 case, 2.7%). Six of the 7cases of dry cough were in women, and 3 caes discontinued the drug due to intractable cough. Angioedema in the oropharynx occurred in 1 patient and caused severe dyspnea which was relieved by the discontinuation of the medication. There was no significant change in CBC and biochemical variables. CONCLUSIONS: A daily dose of delapril in two divided doses is effective in decreasing blood pressure in patients with essential hypertension, and safe when an awareness of possible side effects is taken into account.
Angioedema ; Blood Pressure ; Cough ; Dyspnea ; Female ; Heart Rate ; Humans ; Hypertension* ; Male ; Oropharynx ; Peptidyl-Dipeptidase A

BACKGROUND: To investigate the effects of nitroglycerin(NTG) and dipyridamoie(DIP) on the perfusion of ischemic myocardium during total occlusion of one coronary vessel and with 3 graded partial occlusion of its collateral supplying vessel, myocardial contrast echocardiography(MC-Echo) was performed on seven pentobarbital anesthetized open chest dogs. METHODS: After a left thoracotomy was done, the left anterior descending coronary artery(LAD) was dissected for ligation to produce total LAD occlusion and left circumflex coronary artery(LCX) was separated to place an electromagnetic flow probe and, distally, screw occluder to restrict LCX flow by 50% and 90% of the preocclusion value. MC-Echo images were made by bolus injections of a 5ml of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix) and normal saline(2 : 3 by volume) into the aortic root, and then the echocontrast defect area(EDA) with planimeter, peak echocontrast intensity(PEI) and the echocontrast washout halftime(WHT) with videodensitometer were measured. A 100microg of NTG was administered by bolus injection in the aortic root and was followed by 5mg of DIP after the hemodynamic effect of the NTG has been abolished. MC-Echo images were obtained after each infusion of NTG and DIP, first 60 minutes after total LAD occlusion with intact LCX flow, next with a 50% restriction of LCX flow, and third with a 90% restriction of LCX flow. RESULTS: 1) During total LAD occlusion with intact LCX flow : The EDA measured 60 minutes postocclusiom(PO) of LAD(14.2%) was smaller than that 3 minutes PO(20.5%, p<0.01). After NTG, systolic and diastolic blood pressure(BP) was decreased(p<0.01, p<0.05, respectively) and heart rate(HR) was not changed. The mean EDA(15.1%) was not changed, but an increase in EDA occurred in cases of which the diastolic BP fell by more than 20mmHg, and/or the systolic BP was less than 80mmHG after NTG, After DIP, BP and HR were unchanged. The PEI was increased and WHT was shortened in the nonischemic area, reflecting an increase in myocardial perfusion to a normal zone. However, the EDA(17.0%) was increased(p<0.05). The increase in EDA was more prominent in cases with good collaterals. This finding indicates that DIP cases coronary steal from the ischemic myocardium to the normal myocardium through the collaterals. 2) During total LAD occlusion with a 50% restriction of LCX flow : BP and HR were not altered. EDA, PEI and WHT were the same as those taken during intact LCX flow. After NTG, BP was decreased(p<0.01), but HR were not different from baseline values, After DIP, BP and HR remaince unchanged and EDA(16.2%) was increased(p<0.05). PEI was decreased(p<0.05) and WHT was delayed(p=0.054), indicating that DIP impaired any further increase of perfusion in ischemic myocardium. 3) During total LAD occlusion with a 90% restriction of LCX flow : Systolic and diastolic BP were decreased(p<0.05), but HR was unchanged. EDA(20.2%) was increased as compared to those during intact LCX flow(p<0.01). NTG decreased the EDA(17.6%, p<0.05) despite decrease in BP(p<0.01), while DIP did not alter the hemodynamics or EDA(20.7%). The PEI and WHT after infusion of both NTG and DIP were not different from baseline values. CONCLUSION: 1) Dipyridamole causes coronary steal from ischemic myocardium when the flow of collateral supplying vessel is intact or restricted by 50%, but not during 90% restriction of flow, suggesting the degree of stenosis of collateral supplying vessels is a determinant of coronary steal. 2) The beneficial effect of nitroglycerin to ischemic myocardium was largely determined by the extent of collateral flow and its effect on hemodynamics.
Animals ; Constriction, Pathologic ; Coronary Occlusion* ; Coronary Vessels ; Dipyridamole* ; Dogs* ; Echocardiography ; Heart ; Hemodynamics ; Ligation ; Magnets ; Meglumine ; Myocardial Ischemia ; Myocardium ; Nitroglycerin* ; Pentobarbital ; Perfusion* ; Sodium ; Thoracotomy ; Thorax*