As a part of fundamental studies for establishing appropriate electrocardiographic criteria of left ventricular hypertrophy for Koreans, 39 various criteria proposed by 25 authors were applied to 500 Koreans and the reliability of each criterion was analysed based upon cardiothoracic ratios in the chest teleroentgenograms. The subjects analysed in this study included cardiac and non-cardiac patients as well as healthy adults: in all of them electrocardiograms and chest roentgenograms were obtained on the same day. Both true and false positivities of the precordial voltage criteria were extremely high, whereas those of voltage criteria of the extremity leads and the remainder of various criteia were qutie low except for the point score system of Romhilt and Estes, which revealed relatively high true positivity and low false positivity. True positivities of all precordial voltage criteria were higher in males than in females. Their false positivities were also higher in males, except for criteria SV1>==24mm, RV1<==1mm and RV6>RV5, which were higher in females. No significant differences were noted between males and females, however, in the true and false positivities in the voltage criteria of the extremity leads. True and false positivities of the other criteria excluding various voltage criteria were also slightly higher in males than in females. In females, true positivities of the precordial voltage criteria were not closely related to the cardiothoracic ratios, whereas those of voltage criteria of the extremity leads and of the other criteria excluding voltage criteria were higher in those with greater cardiothoracic ratios. In males, however, true positivities of nearly all the criteria, including precordial voltage criteria, were higher in those with increased cardiothoracic ratios. In both males and females, criteria SV1>==24mm, RV1<==1mm, RV5>==33mm, RV6>RV5, RV6>==26mm, ventricular activation time(VAT) and left axis deviation(LAD) revealed low true and false positivities indicating that these criteria were of little practical values. In females, true positivitieies of criteria RaVF>==20mm or 21mm and VAT in V(5-6)>==0.66sec. were zero, indicating that these criteria were totally impractical. Both true and false positivities of almost all precordial voltage criteria were higher in Koreans than in Westerns but those of the voltage criteria of the extremity leads were similar in both groups. The remainder of the criteria revealed lower true positivities in Koreans than in Westerns but false positivities were similar in both groups. These facts denote that higher false positivities of electrocardiographic criteria of left ventricular hypertrophy proposed by the western authorities, when applied to Koreans, are mainly due to the precordial voltage criteria. Criteria with a high true positivity and low false positivity indicating., more reliable and more appropriate for Korean males, were RV6>20mm, RV(5-6)>==27mm and SV2+RV(5-6)>45mm in the precordial leads, RaVL>==7.6mm in the extremity leads and point score system. In females, they were similar to those in males except that criterion SV1+RV(5-6)>35mm was more appropriate than SV2+RV(5-6)>45mm. However, these selected criteria also revealed higher false positivities in Koreans than in Westerns, and obviously still further studies are needed to establish more reliable criteria for Koreans.
Adult ; Male ; Female ; Humans

Renal blood flow was measured by single injection technique of HippuranI13 in 13 patients with chronic glomerulonephritis and 11 control subjects. There was a significant decrease in renal blood flow in chronic glomerulonephritis particulary in those with elevated blood urea nitrogen. Renal blood flow was inversely proportionate to renal vascular resistance but no correlation was noted between renal blood flow and creatinine clearance.
Blood Urea Nitrogen ; Creatinine ; Glomerulonephritis* ; Humans ; Renal Circulation* ; Vascular Resistance

The cardiac performance is regulated by the intergration of preload, afterload, contractility (inotropism), heart rate and synergy of ventricular contraction, which are the major determinants that govern the stroke volume and cardiac output. Valvular heart disease may be considered to impose two different types of stress on the cardiac chamber proximal to the lesion. There are either pressure overload(increased after load) or volume overload(increased preload). The compensatory mechanism of the pressure overload and volume overload offer to hypertrophy and dilatation of the chamber. Hypertrophy, increased muscle mass, calls upon the development of greater systolic force. Dilatation, overfilled chamber volume enables increased strength and extent of shortening by Frank Starling's mechanism. In these view, we shall discuss the hemodynamic parameters; cardiac output, stroke volume, ventricular end-diastolic pressure, and the rate of ventricular pressure rise(peak dp/dt), mitral valve gradient and pulmonary circulation. The authors had an opportunity to study 40 cases of mitral valvular heart disease which were accepted during the left ventricular angiography at the cardiac catheterization room and at the fields of operative findings during the period Jan. 1977, throught Sept. 1980, at the Department of Internal Medicine, National Medical Center. The following conclusions were drawn: 1) Cardiac index was 2.65 L/min/m2in average, among 18 cases with mitral stenosis and 2.54 L/min/m2 in average, among 15 cases with mitral valve area of less than 1.0 cm2. Cardiac index was 2.58 L/min/m2in average, among 19 cases with mitral stenoinsufficiency and 3.43 L/min/m2 in average, among 3 cases with pure mitral insufficiency. 2) The mean right ventricular end-diastolic pressure elevated more than 0-8 mmHg were found in 12 cases with mitral stenosis out of 18 cases and mean miral valve area was 0.8m2. The mean left ventricular end-diastolic pressure was also elevated more than 0-12 mmHg in 6 cases out of 12 cases with mitral stenosis in addition to right ventricular failure. These 12 cases of mitral stenosis had cardiac function more than class III clinically. 3) 15 cases with mitral valve area, less than 1.0cm2 demonstrated left ventricular diastolic filling pressure gradient (MVG) of 17.3mmHg in average, the pulmonary vascular resistance of 568 dyndsecd cm(-5) in average, and the right ventricular peak systolic pressure of 72mmHg in average respectively. In all instances, the right ventricular end-diastolic pressure was 11.2mmHg in average and right ventricular peak dp/dt was 571mmHg in average. 4) Among 22 cases with mitral insufficiency, and/or mitral stenoinsufficiency 16 cases showed mean left ventricular end-diastolic pressure elevated more than 0-12mmHg. 10 cases out of these 16 cases disclosed also right ventricular end-diastolic pressure elevated more than 0-8 mmHg. These 16cases of mitral insufficiency and/or mitral stenoinsufficiency had cardiac function more than class III clinically. 5) 16 cases with mitral insufficiency and/or mitral stenoinsufficiency who had mean left ventricular end-diastolic pressure more than 0-12 mmHg showed pulmonary vascular resistance, 358 dyndsecd cm(-5) in average, systemic vascular resistance, 1621 dyne/sec/cm5 in average and left ventricular peak dp/dt, 768-2102mmHg/sec in range. 6) Pulmonary hypertension elevated more than 50mmHg of pulmonary arterial systolic pressure was found in 14 cases out of 18 case with mitral stenosis and in 10 cases out of 22 cases with mitral stenoinsufficiency and/or mitral insufficiency. Pulmonary vascular resistance, however, was markedly variable.
Angiography ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Dilatation ; Heart Rate ; Heart Valve Diseases ; Hemodynamics* ; Humans ; Hypertension, Pulmonary ; Hypertrophy ; Internal Medicine ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Circulation ; Stroke Volume ; Vascular Resistance ; Ventricular Pressure

INTRODUCTION AND OBJECTIVES: Retinoic acid (RA) is known as a potent chemopreventive agent in bladder tumor. Recently, RA has gained attention for up-regulation of transduced gene expression via long terminal repeat (LTR) transcriptional promotion. In this study, we investigated the possible dual effect of RA, growth inhibition and up-regulation of transduced gene expression which contains LTR promoter in human bladder carcinoma cell lines. MATERIALS AND METHODS: Human bladder carcinoma cell lines CY-24, J-82, HT-1197, ATCC) were transduced with Moloney murine leukemia virus containing cDNA of TNF-alpha. The growth of transduced and parent cell line was measured by tetrazolium based colorimetric assay (MTF). Transduced TNF-alpha gene expression was determined by ELISA method. RESULTS: TNF-alpha production was increased approximately twofold after treatment with RA (10 uM) in all three cell lines. This increase was dependent on RA concentration. RA treatment of transduced and parent cell line resulted in dose dependent inhibition of cell proliferation(up to 80% inhibitionwith 10 uM RA) in all parental and transduced cell lines. CONCLUSIONS: These results indicate that RA shows dual effect in cytokine gene transduced bladder carcinoma cells with retroviral vector containing LTR promoter and could be a supplement to the gene therapy of bladder cancer.
Cell Line* ; DNA, Complementary ; Enzyme-Linked Immunosorbent Assay ; Gene Expression* ; Genetic Therapy ; Humans* ; Moloney murine leukemia virus ; Parents ; Terminal Repeat Sequences ; Tretinoin* ; Tumor Necrosis Factor-alpha* ; Up-Regulation ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Zidovudine

BACKGROUND AND OBJECTIVES: The objective of this study was to assess the in-hospital clinical outcome and 6 months follow-up angiographic results after flexible balloon expandable MultiLink coronary stenting. The impact of post-stenting excessive high pressure balloon dilation on late outcome is controversial. The other purpose was to investigate the impact of post-stenting high pressure balloon dilation (HPD group > or =14 atm) on clinical and angiographic outcome in comparison to moderate pressure dilation (MPD group < 14 atm). MATERIALS AND METHOD: The MultiLink stents were implanted in 124 patients (mean age 58+/-9, M/F=94/30) with 128 lesions. Post-stenting high pressure balloon dilation was performed to have less than 10% of residual stenosis and smooth in-stent lumen without IVUS guidance. RESULTS: The indications for stenting were elective in 88 lesions (69%), suboptimal angioplasty results in 27 lesions (21%), and bail-out in 13 lesions (10%). The incidence of in-hospital major adverse cardiac events was 1.6% and major vascular complication rate was 3.2%. The follow-up angiography was performed in 86 patients (69%) at 7.9+/-2.6 months. The angiographic restenosis rate was 22.7%. The acute gain of HPD group had a tendency to be higher than MPD group (HPD:MPD=2.33+/-0.51 mm:2.22+/-0.44 mm, p=0.08) and the late loss of MPD group had a tendency to be lower than HPD group (MPD:HPD=0.86+/-0.73 mm:0.95+/-0.84 mm, p=0.09). And the net gain and restenosis rate of both groups were similar respectively (HPD:MPD=1.38+/-0.94 mm:1.36+/-0.83 mm, p=ns, HPD:MPD=22.5%:22.9%, p=ns). CONCLUSION: The MultiLink coronary stent system is a safe and effective device with high procedural success rate and also has the acceptable angiographic restenosis rate for the treatment of coronary artery disease. The post-stenting excessive high pressure balloon dilation might not be necessary during the deployment of MultiLink stent.
Angiography ; Angioplasty ; Constriction, Pathologic ; Coronary Artery Disease ; Follow-Up Studies* ; Humans ; Incidence ; Stents*

BACKGROUND AND OBJECTIVES: The elderly is the fast growing segment of the population in Korea. Elderly patients undergoing coronary revascularization are considered a high-risk group. Few data exist that relate the results of stenting in treating coronary artery disease in the elderly population. This study sought to compare the short- and long-term outcomes of elderly patients undergoing coronary artery stenting with those of younger patients. METHODS: All elderly patients 70 years of age who underwent coronary artery stenting between January 1997 and July 1999 (n = 106) at our centers were compared to the patients <70 who underwent coronary artery stenting during the same time period (n = 597). METHODS: Elderly patients presented with lower ejection fraction (52.9% vs. 57.4%, p = 0.001), more unstable angina (47% vs. 31%, p = 0.003), and more multivessel disease (67% vs. 51%, p = 0.005) than younger patients. Major in-hospital complications including death (0.9% vs. 0.5%, p = NS), procedural acute Q-wave myocardial infarction (0.9% vs. 0.3%, p = NS), and emergency CABG (0% vs. 0.3%, p = NS) did not differ between two groups. And also vascular complication rate was similar between two groups(1.9% vs. 1.0%, p = NS). Angiographic follow-up, obtained in both groups, demonstrated similar restenosis rates (26.5% vs. 24.9%, p = NS). Long-term clinical follow-up at 12 months showed major adverse cardiac events including death, acute myocardial infarction, and repeat revascularization were significantly higher in elderly patients than in younger patients (18.3% vs. 12.6%, p = 0.04). CONCLUSIONS: Elderly patients with higher risk factors who underwent coronary artery stenting had similar rates of in-hospital procedural complications and similar rates of 6 months angiographic restenosis, compared to younger patients. Overall rates of major adverse cardiac events in the elderly population at 12 months postcoronary artery stenting were significantly higher than those of younger patients.
Aged* ; Angina, Unstable ; Arteries ; Coronary Artery Disease ; Coronary Vessels* ; Emergencies ; Follow-Up Studies* ; Humans ; Korea ; Myocardial Infarction ; Risk Factors ; Stents*

BACKGROUND: This study was undertaken to investigate the outcome of composite graft aortic root replacement using coronary button reimplantation technique for the treatment of aneurysms of the ascending aorta involving the aortic root. MATERIAL AND METHOD: Between April 1995 and September 2001, 54 patients having aortic root replacement with a composite valve graft using direct coronary button reimplantation were reviewed retrospectively. Left ventricular dysfunction was present in 14 patients(25.9%), aortic regurgitation in 48(89%), and Marfan's syndrome in 17(31.5%). The indications for operation were annuloaortic ectasia in 29 patients(53.7%), aortic dissection in 11(20.4%), aneurysms of the ascending aorta involving aortic root in 12(22.2%), and aortitis in 2(3.7%). Six patients(11.1%) had previous cardiac or ascending aortic operations. Concomitant procedures were arch replacement in 21 patients(38.9%), coronary artery bypass graft in 7(13%), mitral valve repair or replacement in 4(7.4%), and others in 6. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 18+/-9 minutes, 177+/-42 minutes, and 127+/-31 minutes, respectively. RESULT: There was 1 early death(1.9%). Mean follow-up was 24.6+/-19.5 months. There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage. The Kaplan-Meier survival rate was 98.0+/-2.0% and 93.1+/-5.1% at 1 and 6 years, respectively. Two patients required reoperation owing to a false aneurysm at the root anastomosis site anda malfunction of prosthetic aortic valve(3.8%). Staged operation for dissection of the remaining thoracoabdominal aorta was performed in 1 patient. The freedom rate from reoperation was 97.8+/-2.0% and 65.3+/-26.7% at 1 and 6 years, respectively. CONCLUSION: This study suggests that composite graft aortic root replacement using open button technique is a safe and effective therapy for a variety of aneurysms of the aortic root, resulting in good early and mid-term results. Careful follow-up of all patients following composite graft root replacement is important for the good long-term results.
Aneurysm ; Aneurysm, False ; Aorta ; Aortic Valve Insufficiency ; Aortitis ; Cerebral Hemorrhage, Traumatic ; Coronary Artery Bypass ; Dilatation, Pathologic ; Follow-Up Studies ; Freedom ; Humans ; Marfan Syndrome ; Mitral Valve ; Reoperation ; Replantation* ; Retrospective Studies ; Survival Rate ; Transplants* ; Ventricular Dysfunction, Left

BACKGROUND: Reoperations on the aortic root or the ascending aorta are being performed with increasing frequency and remain a challenging problem.This study was performed to analyze the results of reoperations on the ascending aorta and aortic root. MATERIAL AND METHOD: Between May 1995 and April 2001,30 patients had reoperations on the ascending aorta and aortic root and were reviewed retrospectively.The mean interval between the previous repair and the actual reoperation was 56 months(range 3 to 142 months).Seven patients(23.3%)had two or more previous operations.The indications for reoperations were true aneurysm in 7 patients(23.3%),prosthetic valve endocarditis in 6(20%),false aneurysm in 5(16.7%),paravalvular leak associated with Behcet's disease in 4(13.3%),malfunction of prosthetic aortic valve in 4(13.3%),aortic dissection in 3(10%),and annuloaortic ectasia in 1(3.3%).The principal reoperations performed were aortic root replacement in 17 patients(56.7%),replacement of the ascending aorta in 8(26.7%),aortic and mitral valve replacement with reconstruction of fibrous trigone in 2(6.6%),patch aortoplasty in 2(6.6%), and aortic valve replacement after Bentall operation in 1(3.3%).The cardiopulmonary bypass was started before sternotomy in 7 patients and the hypothermic circulatory arrest was used in 16(53.3%).The mean time of circulatory arrest,total bypass,and aortic crossclamp were 20 +/- 12 minutes,228 +/- 56 minutes,and 143 +/- 62 minutes,respectively. RESULT: There were three early deaths(10%).The postoperative complications were reoperation for bleeding in 7 patients(23.3%),cardiac complications in 5(16.7%),transient acute renal failure in 2(6.6%), transient focal seizure in 2(6.6%),and the others in 5.The mean follow-up was 22.8 +/- 20.5 months.There were two late deaths(7.4%).The actuarial survival was 92.6 +/- 5.0%at 6 years. One patient required reoperation for complication of reoperation on the ascending aorta and aortic root(3.7%).The 1-and 6-year actuarial freedom from reoperation was 100%and 83.3 +/- 15.2%,respectively.One patient with Behcet's disease are waiting for reoperation due to false aneurysm,which developed after aortic root replacement with homograft.There were no thromboembolisms or anticoagulant related complications. CONCLUSIONS: This study suggests that reoperations on the ascending aorta and aortic root can be performed with acceptable early mortality and morbidity,and adequate surgical strategies according to the pathologic conditions are critical to the prevention of the reoperation.
Acute Kidney Injury ; Aneurysm ; Aorta* ; Aortic Valve ; Cardiopulmonary Bypass ; Dilatation, Pathologic ; Endocarditis ; Follow-Up Studies ; Freedom ; Hemorrhage ; Humans ; Mitral Valve ; Mortality ; Postoperative Complications ; Reoperation ; Seizures ; Sternotomy ; Thromboembolism

In off-pump coronary artery bypass grafting (CABG), multiple proximal anastomosis may increase the risk of cerebral embolism (air, debris) and aortic injury (dissection, pseudoaneurysm). Radial artery (RA) has no intraluminal valve such as saphenous vein. We applied Cabrol technique using aortic root replacement for proximal anastomosis in off-pump CABG. Cabrol technique using RA graft can reduce numbers of proximal anastomosis and reduce number of aortic manipulation in off-pump CABG. We report a Cabrol technique for proximal anastomosis in off-pump CABG with RA graft.
Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Intracranial Embolism ; Radial Artery* ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Transplants*

Allografts* ; Aortic Valve Insufficiency* ; Transplantation, Homologous