No abstract available.

Experiments were performed to investigate the effects of pinealectomy on the renin-angiotensin system in Sprague-Dawley rats. The results obtained were as follows. 1) There was no differences of systolic blood pressure, heart rate, water intake, and plasma electrolytes between pinealectomized and sham-operated rats. 2) Renin activity in plasma and pituitary gland did not differ in two experimental groups. 3) The pituitary gland contained the renin activity of about 50pg AI/hr/mg of wet weight. The results suggest that the pineal gland has no correlation with cardiovascular and renin-angiotensin system.
Angiotensins ; Animals ; Blood Pressure ; Cardiovascular System ; Drinking ; Electrolytes ; Heart Rate ; Pineal Gland ; Pituitary Gland ; Plasma ; Rats ; Rats, Sprague-Dawley* ; Renin ; Renin-Angiotensin System*

The effects of dehydration on vasopressin and oxytocin immunoreactive neurons in the hypothalamus was investigated by using a immunohistochemistry. Adult Mongolian gerbil[Meriones unguiculates] were deprived of drinking water. Dehydrated animals were sacrificed on the 7th, 14th and 21st day of water retriction. The results are as follows : 1. The body weights were decreased about 1.8% daily. On the 21st day of dehydration, they were shown up to 45% compare to the control. 2. In the hypothalamus of the control group, majority of vasopressin and oxytocin immunoreactive neurons were located in the supraoptic and paraventricular nuclei. 3. Changes due to dehydrated stimulation were mainly observed in vasopressin immunoreactive neurons. And these changes in supraoptic nuclei were more severe than those in paraventricular nucleus. Size of vasopressin immunoreactived cells and of areas were increased as to proceed the dehydration. The numbers of those were increased on the 7th day of dehydration, and then they were continously decreased. 4. Although oxytocin immunoreactive neurons were slightly changed in numbers during dehydration, they were not shown conspicuous changes compare to vasopressin immunoreactive neurons. Thus it is appeared that vasopressin secretory neurons in the hypothalamus of Mongolian gerbil are affected by osmotic stress induced dehydration while oxytocin neurons may be affected by other factors.
Adult ; Animals ; Body Weight ; Dehydration* ; Drinking Water ; Gerbillinae* ; Humans ; Hypothalamus* ; Immunohistochemistry ; Neurons* ; Osmotic Pressure ; Oxytocin* ; Paraventricular Hypothalamic Nucleus ; Supraoptic Nucleus ; Vasopressins* ; Water

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

Moyamoya disease(MMD) is defined as the development of collateral anastomosis pathways, associated with bilateral chronic progressive stenosis of the carotid fork. We have reviewed the types of presentation, angiograms, and single photon emission computed tomographs(SPECT). Ninety-nine patients were divided into three groups (aged below 5 years, between 5 and 15 years, and 16 or over) to investigate whether there were differences in clinical presentation and hemodynamic characteristics between the age groups. Mean age of the 99 patients was 13.6 years and the mean duration of symptoms was 26.2 months. In the 17 children aged less than five, the duration of symptoms was shorter(4.8 months) than in older patients(p<0.05). The former presented mostly with cerebral infarction(59%) with a widespread cerebral perfusion defect(50%). Among 56 children who were 5 to 15 years old, 42 (75%) presented with transient ischemic attacks and 10(18%) with cerebral infarction; the latter was less frequent in this age group than in other age groups. Twelve(46%) out of 26 adult patients had hemorrhage at the initial diagnosis, which was the most frequent presentation in this age group. Stenosis of the posterior cerebral artery was detected in 27% of adult MMD patients, while it was detected in 39% of children. Moreover, no case showed widespread perfusion defects in the adult group. The results suggest that the patterns of presentation and the hemodynamic features differ according to the age at which initial major symptoms occur. Children aged less than five suffer rapid progression of the disease and severe cerebral pefusion defect, and should therefore undergo early surgery. The less frequent involvement of MMD in the posterior circulation and better-preserved cerebral perfusion are characteristic findings of the disease in adults, and this seems to account for its delayed onset.
Adolescent ; Adult ; Cerebral Infarction ; Child ; Constriction, Pathologic ; Diagnosis ; Hemodynamics* ; Hemorrhage ; Humans ; Infarction ; Ischemic Attack, Transient ; Moyamoya Disease* ; Perfusion ; Posterior Cerebral Artery

BACKGROUND: Although there have been many studies on the risk factors for coronary artery disease, the etiology and risk factor of coronary artery spasm has not yet been determined. The objective of this study was to examine the risk factors for coronary vasospasm through a comparison of patients with angiographically determined vasospastic angina and patients without vasospasm and normal coronary artery. METHODS: Intracoronary injection of acetylcholine in order (20microg, 50microg, 100microg) were administered to all patients (Total 81:34 males, 47 females : mean age 50 years) who had a history of chest pain with normal or near normal coronary arteriographic fingings. After documentation of vasospasm in major epicardial coronary arteries by acetylcholine (Ach)-provocated dcoronary angiography, various risk factors (smoking, hypertension, diabetes, drinking and hyperlipidemia) were compared between patients with vasospasm and patients without vaspasm. RESULTS: 24 patients showed significant luminal narrowing (> or =75%)(Vasospasm group) and 57 patients showed no significant change (Control). Vasospasm group were suffered from typical chest pain in 92% of patients but control complained typical chest pain in 51% of subjects. The sites of vasoconstriction induced by Ach were LAD (11 cases), LCX (4 cases), RCA (11 cases) and vasoconstriction occurred 2 vessels (LAD and LCx) at the same time in two cases. The amount of Ach to provocate vasoconstriction was 20~50microg (90%) and there were no difference between left and right coronary arteries. The ratio of smoker was more frequent in the vasospasm group than control (58.3% vs 30.4%, p=0.046). But total cholesterol, low density lipoprotein, high density lipoprotein, triglycerides, apolipoprotein A, apolipoprotein B, lipoprotein (a), diabetes and body mass index, drinking were not statistically significant between two groups. CONCLUSION: Smoking appears to be a major risk factor for vasospastic angina by endotheilal dysfunction without significant coronary artery narrowing. But other fisk for coronary artery disease may not contribute to coronary vasospasm.
Acetylcholine* ; Angiography ; Apolipoproteins ; Body Mass Index ; Chest Pain ; Cholesterol ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels* ; Drinking ; Female ; Humans ; Hypertension ; Lipoprotein(a) ; Lipoproteins ; Male ; Phenobarbital ; Risk Factors* ; Smoke ; Smoking ; Spasm* ; Triglycerides ; Vasoconstriction

The cholelithiasis and common bile duct(CBD) stone are rare problems among children. Endoscopic retrograde cholangiopancretogram(ERCP) and endoscopic sphincterotomy are rarely commomly utilized in the treatment of children, primarily because there are fewer indications. ERCP is an established procedure for visualization of the biliary tract. Endoscopic sphincterotomy with stone extraction has been accepted as the treatment of choice for CBD stone removal in adults. However, the role and value of these procedures in children are not as clear. We experienced a case of CBD stone in 3-year-old boy, who suffered reccurent jaundice and abdominal pain. The boy was administrated and was diagnosed with a mild abnormal gallbldder on ultrasound. Laboratory data showed obstructive jaundice, so, an ERCP was performed and identified that the child had a distal CBD stone. An Endoscopic sphincterotomy was then performed. After the sphincterotomy, the stone passed the Ampulla of Vater spontaneously without the use of a Dormia basket or Forgathy catheter.
Abdominal Pain ; Adult ; Ampulla of Vater ; Bile ; Biliary Tract ; Catheters ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Cholelithiasis ; Common Bile Duct* ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Sphincterotomy, Endoscopic* ; Ultrasonography

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND: A group of patients with chest pain and normal coronary angiograms without spasm of epicardial artery is known to have decreased coronary flow reserve in response to vasodilatory stimuli, but the mechanisms responsible for the impairment of vasodilatory reserve are undefined. The purpose of this study was to determine whether dysfunction of coronary microvascular endothelium contributes to the reduced vasodilatory responses in patients with chest pain and normal coronary angiograms. METHODS: Twenty patients, 12(group A) with and 8(group B) without ST depression on exercise ECG or 24 hours ambulatory ECG. with chest pain and normal coronary angiograms and no spasm of epicardial coronary artery. were studied. As the endothelium-independent vasodilator, acetylcholine at doses of 20microg, 50microg and 100microg, and as the endothelium-independent vasodilator, nitroglycerin 200microg were infused into left coronary artery. The functional response of coronary vasomotion was studied with atrial pacing. By themodilution pacing catheter. great cardiac vein flow(GCVF) was measured. The changes in the diameter of proximal and distal of left anterior descending artery were analyzed. RESULTS: Intracoronary acetylcholine increased GCVF by 12.3% with 20microg(NS),by 38.9% with 50microg(p<0.05) and by 14.8% with 100microg(NS). The changes in GCVF with 20microg and 50microg dose of acetylcholine were positively related with those with atrial pacing(r=0.59 and r=0.62, respectively), but not at dose of 100microg(r=0.12). Thus, patients with diminished flow response with atrial pacing had reduced endothelium-dependent dilation with low dose acetylcholine. Also changes in GCVF with atrial pacing and acetylcholine were smaller in the patients of group A than group B. However, the changes in GCVF to nitroglycerin was not related with the changes with acetylcholine and did not differ between A and B group, indicating this vasodilatory response was not associated with the endothelium-independent vasodilation. Acetylcholine caused similar degree of change in diameter at proximal and distal epicardial artery in two groups and their changes were not related with changed in GCVF with acetylcholine, suggesting the changes in GCVF with acetylcholine were mainly influenced by the changes at the level of microvasculature. CONCLUSION: In patients with chest pain and normal coronary angiograms without spasm of epicardial artery, reduced vasodilatory response with atrial pacing was associated with the impairment of endothelium-dependent dilation at the level of coronary microvasculature, suggesting the endothelial dysfunction of coronary microvessels is one of the causes of inducible myocardial ischemia.
Acetylcholine ; Arteries ; Catheters ; Chest Pain* ; Coronary Vessels ; Depression ; Electrocardiography ; Endothelium ; Humans ; Microvessels* ; Myocardial Ischemia ; Nitroglycerin ; Spasm ; Thorax* ; Vasodilation ; Veins