BACKGROUND: The autonomic nervous control of the cardiovascular system has been thought to have a diurnal variation in its activity. This variation could be an important underlying mechanism for the circardian distribution of cardiac events such as angina pectoris attack, transient myocardial ischemia, and some arrhythmia. The vagal cardiac function is commonly impaired in patients with coronary artery disease. Recently, an assessment of parasympathetic and sympathetic activities is now possible using neart rate spectral analysis. The spectral density of R-R interval variability contains two major components, high frequency (HF) power spectral density (<0.25Hz) and low frequency (LF) power spectral density (<0.15Hz), which have magnitudes that are quantitative markers of cardiac vagal activity and sympathetic activity with vagal modulation, respectively. METHODS: We analyzed the spectral components of R-R interval variability from 24 hour ambulatory holter monitoring in 20 controls and 20 patients with angina pectoris. The patients had no clinical evidence of hypertension, acute myocardial infarction, heart failure, arrhythmia or diabetes mellitus. Recording continued for 24 hours while the subject undertook his normal work and leisure activities. For power spectral analysis, 1024 hours beats was sampled at early morning, afternoon, evening and during sleeping. RESULTS: The spectral component of R-R interval variability was unaffected by the time of day during the waking period, althought a significant decrease in LFCCV and HFCCV was observed during sleeping in controls(p<0.001). In comparison of two groups, patients with angina pectoris showed markedly diminished HFCCV values during waking period except during sleeping period. The R-R interval and LF/HFCCV and LF/HFCCV ratio at transient ischemic attack in patients with angina pectoris. CONCLUSION: Autonomic cardiac control during the waking period shows little variation with the time of day in both groups. We observed that vagal cardiac function was reduced in patients with coronary artery disease by heart rate spectral analysis. It is suggested that ischemic changes in patients with coronary artery disease underlying reduced vagal cardiac function is associated with increased sympathetic activity.
Angina Pectoris* ; Arrhythmias, Cardiac ; Cardiovascular System ; Coronary Artery Disease ; Diabetes Mellitus ; Electrocardiography, Ambulatory ; Heart Failure ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Ischemic Attack, Transient ; Leisure Activities ; Myocardial Infarction ; Myocardial Ischemia

No abstract available.
Dinoprost* ; Female ; Laparoscopes* ; Pregnancy ; Pregnancy, Tubal*

Emphysematous pyelonephritis is rare but frequently fatal disease that usually occures in diabetic patients, 6cases having been reported in Korea. We have experienced a case of simultaneously occuring emphysematouspyelonephritis and emphysematous cystitis in 54 years old female patient, which have never been reported in Korea,and got satisfactory improvement with medical treatment.
Cystitis ; Female ; Humans ; Korea ; Pyelonephritis

No abstract available.
Female ; Menstrual Cycle* ; Pregnancy Rate* ; Pregnancy*

We report a case of polycythemia vera combined with coagulation disorder. The patient was 54 years old man who complained of continuous bleeding after incision of skin abscess 20days ago. Laboratory tests were revealed prolonged aPTT and slightly prolonged PT. Coagulation factor, I, VIII, IX, XI and fibrinogen decreased, however FDP did not increased. It appears that patient with polycythemia vera have chronic activation of coagulation system, probably initiated by activation of factor XII. Platelet aggregation test to ADP, collagen, epinephrine was also revealed poor response.
Abscess ; Adenosine Diphosphate ; Blood Coagulation Factors ; Collagen ; Epinephrine ; Factor XII ; Fibrinogen ; Hemorrhage ; Humans ; Platelet Aggregation ; Polycythemia Vera* ; Polycythemia* ; Skin

Loeffler's endocarditis is a recognized complication of diseases associated with eosinophilia. This disease is considered to be a part of the idiopathic hypereosinophilic syndrome, which is characterized by persistently elevated blood eosinohil counts with symptoms and signs of organ involvement especially in the heart, nervous system, and bone marrow. We have experienced a case of Loeffler's endocarditis in a 51 years old man who complained of leg pain due to acute closure of left iliac artery by emboli. We found left ventricular mural thrombus by echocardiography and confirmed Loeffler's endocarditis by endomyocardial biopsy. We present a case with the review of literatures.
Biopsy ; Bone Marrow ; Echocardiography ; Eosinophilia ; Heart ; Humans ; Hypereosinophilic Syndrome* ; Iliac Artery* ; Leg ; Middle Aged ; Nervous System ; Thromboembolism ; Thrombosis

There have been some case reports of the coexitence of extraadrenal pheochromocytoma and renal artery stenosis. Some reporters proposed that their coexistence may be associated through a common pathophysiological mechanism mediated by catecholamine secretion. Also some noted that trasient renal artery stenosis due to a spasm was induced by the catecholamines released from pheochromacytoma. We report a case of left paraaortic extraadrenal pheochromacytoma that had a transient oral captopril test positive result. After 5 days alpha-antagonist reduced the vasospastic response of catecholamines. After surgical removal of the tumor, plasma catecholamines and urinary vanillymandelic acid concentrations as well as the blood pressure level, were restored to normal.
Blood Pressure ; Captopril* ; Catecholamines ; Pheochromocytoma* ; Plasma ; Renal Artery Obstruction ; Spasm

The idiopathic long-QT syndrome is an infrequent inherited disorder, characterized by prolonged QT interval and by the occurrence of life-threatening tachyarrhythmia, particularly in association with emotional or physical stree. In its characteristic presentation, with obvious QT prolongation and stree induced syncope with torsades de points, the diagnosis is straightforward for physicians aware of the disease. But sometimes in cases of borderline QT prolongation and vague symptom, a correct diagnosis is delayed and frequently misdiagnosed as a seizure disorder. The mortality of untreated symptomatic patients with LQTS exceeds 20% in the year after their first syncopal episode and aapproaches 50% within 10 years. But this high mortality rate has been significantly reduced by the use of pharmacological or surgical antiadrenergic therapy or both. So early detection of the disease and antiadrenergic treatment sympathetic innervation to the heart. Second, there was intrinsic gene abnormality in the mechanisms responsible for cardiac repolarization. We report one case of LQTS in a 24 years old female patient who had been suffering from stree related syncope. Her initial EKG had prologed QT interval(588msec) and increased QT intrval dispersion(200msec). In the Holter monitor, long and short cycle sequence induced (pause-dependent) torsades de pointes was detected. She has been treated by beta-blocker and has maintained her condition without recurrence of the symptoms.
Diagnosis ; Electrocardiography ; Epilepsy ; Female ; Heart ; Humans ; Long QT Syndrome ; Mortality ; Recurrence ; Syncope ; Tachycardia ; Torsades de Pointes ; Young Adult

Background: Spine-hip discordance (SHD) increases fracture risk. However, its prevalence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and investigated the cause of SHD in patients with hip fractures. Methods: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients underwent dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Society of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to determine the cause of discordance. Results: Among 1,220 eligible patients, 130 were excluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. Conclusions Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.

PURPOSE: This study is to evaluate the clinical significance and possible etiologies of abnormal neurosonographic findings that revealed linear or branching linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants. METHODS: Analysis of 2,866 cranial sonograms (US) and doppler ultrasonography obtained from 1,150 patients identified 53 patients with linear hyperechoic vascular lesions in the thalami or basal ganglia. Patients with only punctate or coarse, nonlinear lesions of echogenicity in these lesions were excluded. Clinical records in 53 patients were reviewed for documentation of congenital cytomegalovirus (CMV) infection, rubella, syphilis, toxoplasmosis, chromosomal abnormality and other major diagnoses. Brain computed tomography (CT) had been performed in 23 of the 53 patients and these images were compared with the cranial sonograms. RESULTS: There were five CMV infection, two congenital syphilis, three Down syndrome, and one Patau syndrome patients. Other major diagnoses encountered included perinatal asphyxia, ventriculomegaly, intraventricular hemorrhage, periventricular leukomalacia, small-for-gestational age, prematurity with hyaline membrane disease, multiple congenital anomalies, neonatal seizure, meningitis, congenital choroid plexus cyst, neonatal hyperbilirubinemia, congenital heart disease, bronchopulmonary dysplasia and others. Brain CT found small calcification in basal ganglia from one patient. Resolution of lesions found in 5 cases with follow-up US studies. CONCLUSION: A broad etiologic basis for linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants indicates complete screening for possible various etiologies.
Asphyxia ; Basal Ganglia* ; Brain ; Bronchopulmonary Dysplasia ; Choroid Plexus ; Chromosome Aberrations ; Cytomegalovirus ; Diagnosis ; Down Syndrome ; Follow-Up Studies ; Heart Defects, Congenital ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Hyperbilirubinemia, Neonatal ; Infant ; Infant, Newborn* ; Leukomalacia, Periventricular ; Mass Screening ; Meningitis ; Rubella ; Seizures ; Syphilis ; Syphilis, Congenital ; Toxoplasmosis ; Ultrasonography* ; Ultrasonography, Doppler