BACKGROUND: The electrocardiogram may provide valuable information regarding the identity of the culprit coronary artery and the location of obstructing lesion within the artery, which may be of guidance in selecting the therapeutic modality. Previous studies have concluded that changes in lateral leads (I, aVL, V5, V6) are predictive of left circumflex coronary artery obstruction in inferior wall acute myocardial infarction. Elect-rocardiographic criteria for determining the location of the obstructing lesion, however, have not been well established. The purpose of this study is to investigate the patterns of ST segment depression in lateral leads in inferior wall acute myocardial infarction and the obstruction site of culprit artery according to ST segment depression in lateral leads. METHODS: We examined 78 patients with inferior wall acute myocardial infarction analizing their electrocardiogram and coronary angiography which performed during acute hospitalization. RESULTS: Of the fifty-five patients in which the culprit artery could be determined, 1)in 41 the culprit artery was the right coronary artery (19 proximal to the right ventricular branch and 22 distal), and in 14 the left circumflex coronary artery (7 proximal to the first obtuse marginal branch or involving a high first obtuse marginal branch, and 7 with distal obstruction). 2)Significant ST depression (ST< or =1 mm) in leads I and aVL was more common in right coronary artery obstruction (p<0.05 and p=0.01 respectively) than left circumflex artery. 3)It was difficult to define the location of obstruction with ST segment change of lateral precordial leads (V5, V6). CONCLUSIONS: In acute inferior wall myocardial infarction, ST segment depression in lateral limb leads (I, aVL) can be indicative of the right coronary artery obstruction and the ST segment depression pattern in lateral precordial leads was not indicative of the site of obstruction.
Arteries ; Coronary Angiography ; Coronary Vessels ; Depression* ; Electrocardiography ; Extremities ; Hospitalization ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction*

BACKGROUND: The valve area derived from the Gorlin formula has been used clinically for decades as an index of severity on the assessiment of valve stenosis, in spite of some limitations on Gorlin formula studied in aortic stenosis and mitral bioprostheses. It had been shown that Gorlin valve area varied if the hemodynamic conditions during measurement are changed. Valve resistance has been proposed as an alternative hemodynamic indicator, but initially this index was not used because it was unlikely to remain constant at different flow rates. Recently valve resistance provided a better indices of hemodynamic obstruction than mitral valve area, and these stenotic indices usually estimated by angiographic method and we studied the valve resistance by Doppler echocardiographic measurement. METHOD AND RESULT: To compare the clinical implication about these stenotic indices measured by echcoardiography and cardiac catheterization, we studied 41 patients of mitral stenosis with normal sinus rhythm. The results were as follows ; 1) In catheterization, increased heart rate, mean pressure gradient and decreased diastolic time was observed, but mitral area, resistance, cardiac output and mitral flow was not different. 2) Linear regression analysis showed negative correlation of mitral valve resistance and Gorlin mitral area(echocardiography r=-0.84, catheterization r=-0.84)(p<0.001). 3) Correlation coefficeint of mitral valve area and mitral valve resistance between echocardiography(r=0.87) and catheterization(r=0.82) showed positive correlation(p<0.001). CONCLUSION: These results suggest that mitral valve resistance by echocardiography is a useful method in the evaluation of the severity of mitral stenosis.
Aortic Valve Stenosis ; Bioprosthesis ; Cardiac Catheterization* ; Cardiac Catheters* ; Cardiac Output ; Catheterization ; Catheters ; Constriction, Pathologic ; Echocardiography ; Echocardiography, Doppler* ; Heart Rate ; Hemodynamics ; Humans ; Linear Models ; Mitral Valve Stenosis* ; Mitral Valve*

B-lineage non-Hodgkin lymphoma may aberrantly coexpress T-cell markers. In general population, however, cases of diffuse large B-cell lymphomas with CD3 co-expression are rare because the CD3 marker is the most lineage specific T-cell antigen. We report a case of CD3 coexpressed diffuse large B-cell lymphoma in a 47-year-old male patient presented with dyspepsia who had transplanted a kidney 17 years ago. An esophagogastroduodenoscopy displayed an ulcerated mass in the gastric antrum. The pathology of the mass was monomorphic post-transplant lymphoproliferative disorder - specifically, CD20- and CD3-positive diffuse large B-cell lymphoma. Resection of the mass and postop chemotherapy were performed. A follow-up computerized tomography showed disapperance of tumor. No recurrence was observed until 7 month after treatment. Nevertheless, the patient's renal function gradually aggrevated and progressed to end stage renal disease. As far as we know, this is the first case of diffuse large B-cell lymphoma with CD3 coexpression after kidney transplant.
B-Lymphocytes ; Dyspepsia ; Endoscopy, Digestive System ; Follow-Up Studies ; Humans ; Kidney ; Kidney Failure, Chronic ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Lymphoproliferative Disorders ; Male ; Middle Aged ; Neoplasm Transplantation ; Pyloric Antrum ; Recurrence ; T-Lymphocytes ; Transplants ; Ulcer

Thirty-one patients with previously untreated and locally advanced nasopharyngeal caner were retrospectively reviewed for comparing the effects of radical radiotherapy alone with that of combining chemotherapy and radiotherapy from 1983 to 1989 at Kangnam St. Mary's Hospital. 23/31 were evaluable for recurrence and survival. There were 8 patients for stageIII , and 15 patients for stageIV. Eleven patients were treated with radical radiation therapy alone (am I). Twelve patients were given 1~3 courses of cisplatin-5FU or cisplatin-bleomycin-vincristine prior to radiation therapy (am II). The two arms were comparable in patients characteristics of 11 radiotherapy patients, complete response was 55% (6/11) and partial response 45% (5/11). Among 12 patients after induction chemotherapy, complete response was 25% (3/12) and partial response 75% (9/12). After subsequent radiotherapy, complete response was increased to 83% (10/12) and partial response was 17% (2/12). Treatment failure was 36% (local recurrence; 3/11, and regional recurrence; 1/11) in arm l and 33% (local recurrence; 1/12, regional recurrence; 2/12 and distant metastasis; 1/12) in arm II. There was no significant difference in survival between am I and arm II (p>.05). The toxicities of treatment were acceptable. More controlled clinical trails must be completed before acceptance of chemotherapy as part of a standard radical treatment for locally advanced nasopharyngeal cancer.
Arm ; Drug Therapy ; Humans ; Induction Chemotherapy ; Nasopharyngeal Neoplasms ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Treatment Failure

In the past 60 years the maternal mortality rate has declined rnarkedly. Nevertheless, death associated with childbirth is still a major public health problem. For women delivered of live infants, the leading causes of mortality are acute pulmonary embolism(mostly thromboembolic), pregnancy-induced hypertension, hemorrhage, and infection. Currently, the common cause of maternal rnortality are pulmonary embolisrn. Though acute pulmonary embolism is a potentially fatal disorder, when properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death. However, the diagnosis of acute pulmonary embolism is still a challenge for clinicians because of its nonspecific and variable clinical features. Pulmonary angiography, admittedly the 'gold standard' technique for this diagnosis, is costly, invasive, and not universally available. Noninvasive procedures such as lung scan has certainly simplified the diagnostic approach. However, lung scan is diagnostic in only 30 to 50% of patients, and many institutions lack nuclear medicine facilities. Thus, alternative imaging techniques are needed for the noninvasive diagnosis of pulmonary embolism. Echocradiography is rapid, practical and sensitive technique for the identification of right ventricular overload following acute pulmonary embolism. Echocardiographic identification of patients with right ventricular dysfunction is important because aggressive intervention with thrombolytics, certain inotropic and vasoactive agents, or embolectomy may improve outcome. We report herein two cases of acute pulmonary embolism after cesarean section. Certain clinical findings, hemodynamic values, and particularly, echocardiographic signs can indentify right ventricular dysfunction after pulmonary embolisrn. The patients was immediately treated mth intravenous heparin and inotropic support, which induced a rapid improvement of the clinical and hemodynamic parameters.
Angiography ; Cause of Death ; Cesarean Section* ; Diagnosis ; Echocardiography* ; Embolectomy ; Female ; Hemodynamics ; Hemorrhage ; Heparin ; Humans ; Hypertension, Pregnancy-Induced ; Infant ; Lung ; Maternal Mortality ; Mortality ; Nuclear Medicine ; Parturition ; Pregnancy ; Public Health ; Pulmonary Embolism* ; Ventricular Dysfunction, Right

BACKGROUND AND OBJECTIVES: Large volume reduction after hemodialysis in patients with chronic renal failure alters the preload. We investigated the cardiac function by total ejection isovolume (TEI) index- a new simple, readily reproducible Doppler echocardiographic index combining systolic and diastolic function- before and after dialysis. MATERIALS AND METHOD: Thirty-one patients on maintenance hemodialysis including 6 diabetes and 13 hypertensives without known organic heart disease and with normal systolic function were enrolled. They were divided into two groups according to ultrafiltration volume at the study dialysis session, group 1 (2.5kg or less) and group 2 (more than 2.5 kg). They are 46+/-12 years old on average. We examined two-dimensional, M-mode, pulsed wave and tissue Doppler before and after dialysis immediately. TEI index was calculated by dividing the sum of the isovolumic relaxation time (IVRT) and isovolumic contraction time (ICT) by the ejection time. RESULTS: After dialysis, significant decrease of body weight was noted, but baseline heart rate, blood pressure, Left ventricular (LV) ejection fraction and LV mass index were not changed significantly. LV end-diastolic volume was decreased significantly after dialysis in all group, and end-systolic volume was decreased significantly in total and group 2. Peak early E velocity and ratio of E to the peak late (A) velocity (E/A) from mitral inflow signal were decreased significantly after dialysis in all group and deceleration time of early filling phase was prolonged in total and group 1, but A and IVRT did not change significantly. Of the septal mitral annulus motion, Ean velocity and Ean/Aan ratio was decreased, but no significant change was noted in the lateral annulus. The TEI index did not chage significantly after dialysis in all group. CONCLUSION: A new simple echocardiographic TEI index can be used to measure the global myocardial function in patients with chronic renal failure before and after dialysis, relatively independent of preload change.
Blood Pressure ; Body Weight ; Deceleration ; Dialysis ; Echocardiography ; Heart Diseases ; Heart Rate ; Humans ; Kidney Failure, Chronic ; Relaxation ; Renal Dialysis* ; Ultrafiltration

BACKGROUND: Mortality and morbidity of the patients with chronic renal failure frequently related to cardiovascular disease, especially to Hypertension. The present study was performed to assess the value of arnbulatory blood pressure(ABP) monitoring in determining the adequacy of blood pressure(BP) control, and its relationship to echocardiographic findings in hemodialysis (HD) patients. SUBJECT AND METHODS: Twenty adult patients who had been on regular hemodialysis treatment for median duration of 23 rnonths were studied. 24 hour ABP monitoring was performed using a non-invasive ABP monitor. All of the study population were non diabetic. Casual BP (CBP) was defined as the average of two measurements obtained at two HD sessions, one preceding and the one following the ABP recordings, and was calculated for both the predialysis and postdialysis phases. Cardiac echocardiography was performed in each patient to determine interventricular septal thickness(IVS), left ventricular posterior wall thickness(LVPW), left ventricular fractional shortening(FS), and left ventricular mass index(LVMI). RESULTS: 1) 17(85%) of patients showed left ventricular hypertrophy in echocardiography. LVMI was positively correlated with systolic BP load(r=0.45, p<0.05). But, the correlation between LVMI and diastolic BP load was not statistically significant. 2) IVS shoved positive correlation to 24hr systolic and diastolic blood pressure load, but LVPW did not show correlation to any subset of 24h-ABP monitoring data except daytime sysrolic BP load. 3) LVMI showed correlation to day-time systolic BP load, but it did not show correlation to night-time BP load. 4) Casual BP did not show correlation to echocardiographic data. CONCLUSIONS: These results suggest that 24hr ABP monitoring is more useful and accurate method than CBP to determine the degree of LVH and control of blood pressure in hemo- dialysis patients with hyertension.
Adult ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Cardiovascular Diseases ; Dialysis ; Echocardiography* ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Mortality ; Renal Dialysis*

BACKGROUND AND OBJECTIVES: The second derivative of a photoplethysmogram (SDPTG) is a simple, convenient and non-invasive technique for pulse wave analysis. The SDPTG index correlates with age and other risk factors of atherosclerosis in the Japanese population, but has not yet been described in the Korean population. The purposes of this study were to analyze the age-related changes in the SDPTG of healthy subjects (study 1), and investigate the differences in the SDPTG of patients with hypertension, compared with those of normotensive subjects (study 2). We also compared the differences in the SDPTG between coronary artery disease (CAD) patients and normal subjects (study 3), to test the clinical usefulness of SDPTG in the evaluation of atherosclerosis. SUBJECTS AND METHODS: We consecutively studied 235 healthy adults, 40 with essential hypertension and 42 with CAD. Their SDPTG were recorded in the sitting position using a Fukuda FCP-3166. RESULTS: In study 1, the b/a ratio increased with age, whereas the c/a, d/a and e/a ratios decreased. The SDPTG aging index (AGI)(y) increased with age (x)(r=0.71, p=0.000;y=22.731x+54.571). In study 2, the patients with hypertension showed a lower average d/a ratio (-0.47+/-0.15 vs. -0.38+/-0.15, p=0.02) and higher average SDPTG AGI (-0.09+/-0.34 vs. -0.26+/-0.37, p=0.011) than the normotensive subjects. In study 3, the patients with CAD had higher average b/a ratio (-0.47+/-0.19 vs. -0.59+/-0.17, p=0.001) and SDPTG AGI (-0.01+/-0.41 vs. -0.23+/-0.40, p=0.004) than the normal subjects. In a logistic regression analysis, the SDPTG AGI was a significant determinant of CAD (p=0.046). CONCLUSION: The SDPTG aging index may be useful in the evaluation of vascular aging and damage due to hypertension and atherosclerosis.
Adult ; Aging ; Asian Continental Ancestry Group ; Atherosclerosis ; Coronary Artery Disease ; Humans ; Hypertension ; Logistic Models ; Photoplethysmography ; Pulse Wave Analysis ; Risk Factors

BACKGROUND AND OBJECTIVES: Ventricular premature beat (VPB) with a left bundle branch block morphology and an inferior axis usually originates from the right ventricular outflow tract (RVOT) and is a frequent clinical problem. Although some investigators have suggested that RVOT VPBs are associated with RVOT ventricular tachycardia, few data are available on patients with RVOT VPBs. The purpose of this study was to determine the clinical characteristics and prognosis of RVOT VPB. SUBJECTS AND METHODS: The study subjects were 161 consecutive patients with frequent RVOT VPBs on standard electrocardiography. All patients underwent clinical examinations, echocardiography and 24-hour ambulatory electrocardiography. Among these patients, 50 were followed up for a period averaging 28.5+/-18.1 months. RESULTS: No structural cardiac abnormalities were found in 149 (92.5%) of the 161 patients with frequent RVOT VPBs. The prevalence of complex VPBs was relatively high (101 of 161 patients: 62.7%) on initial 24-hour electrocardiography. In the case of the 50 follow-up patients, there was no significant difference in mean frequency of RVOT VPBs between baseline and follow-up study (636+/-482/hour vs. 569+/-502/hour, p=NS). Furthermore, VPBs tended to persist over the follow-up period in the majority (92%) of patients with frequent RVOT VPBs. Five patients (10%) developed nonsustained ventricular tachycardia, 2 (4%) sustained ventricular tachycardia and 1 (2%) died suddenly. Antiarrhythmic drugs are effective in decreasing the frequency of VPBs, and beta-blockers especially seem to be effective in decreasing the severity of VPBs. CONCLUSION: In the patients with frequent RVOT VPBs, sustained ventricular tachycardia or sudden death could develop. Therefore, careful observation is required in patients with frequent RVOT VPBs.
Anti-Arrhythmia Agents ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Complexes, Premature* ; Death, Sudden ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Follow-Up Studies ; Humans ; Prevalence ; Prognosis ; Research Personnel ; Tachycardia, Ventricular ; Ventricular Premature Complexes

BACKGROUND: Long term athletic training is associated with an increase in left ventricular diastolic cavity dimension, wall thickness, and mass. These changes in left ventricular morphology represent an adaptation to increased ventricular load and are generally described as the “athlete's heart”. In the present study, we used echocardiography to evaluate the left ventricular structure and function in track athletes. METHODS: We studies 48 males(average age 22 years)by Doppler and echocardiography, which consisted of 12 normal controls, 36 track athletes(12 long distance track, 12 sprint, 12 jump). These athletes were trained regularly for 3-19 years(average 9±4 years). RESULTS: 1) At rest, left ventricular diastolic and systolic diameter, systolic interventricular septal wall thickness, diastolic and systolic posterior wall thickness, and left ventricular end diastolic and systolic dimension were larger in long distance track athletes than in the controls. 2) Left ventricular mass was larger in long distance track athltes and sprinter than controls. 3) After maximum exercise, left ventricular diastolic and systolic diameter, systolic interventricular septal wall thickness, diastolic and systolic posterior wall thickness, and left ventricular end diastolic and systolic dimension increased more significantly in long distance track athletes than in the controls. But, in sprinters, the left end systolic diameter, diastolic and systolic interventricular septal thickness, and left end diastolic and systolic dimensions were increased. 4) At rest, the E/A and Ei/Ai of the mitral flow in long distance track athletes increased more than in the controls. But there were no differences of parameters of mitral and aortic flow between long distance track athletes and controls after maximum exercise. CONCLUSIONS: The left ventricular mass of long distance and sprint track athletes were lager Than controls. In the long distance track athletes, the left ventricular structural and functional changes before and after maximum exercise were prominent. In the sprinters, after maximum exercise, the left ventricular structural and functional changes were prominent.
Athletes ; Echocardiography ; Echocardiography, Stress ; Heart Ventricles ; Humans ; Sports