1.Diagnostic Significance of Pseudonormalization during Treadmill Exercise Test in Ischemic Heart Disease.
Moo Yong RHEE ; Rak Kyeong CHOI ; In Soo KIM ; Chang Won LEE ; Duk Whan JANG ; Hong Soon LEE ; Soo Woong YOO ; Hak Choong LEE
Korean Circulation Journal 1995;25(1):5-10
BACKGROUND: The interpretation of electrocardiographic change in treadmill exercise test is difficult when the test is performed in patients with abnormal resting electrocardiography. In patients with primary nagative T wave, normalization of primary negative T wave(pseudonormalization)is not uncommon finding during treadmill exercise test. The mechanism of pseudonormalization is uncertain and the interpretation is difficult. Thus this study was performed to evaluate the diagnostic significance of pseudonormalization during treadmill exercise test. METHODS: 200 cases who showed primary negative T wave at rest were included in this study. The results were classified as positive, borderline positive, borderline negative, negative, non-diagnostic and pseudonormalization. RESULTS: Pseudonormalization during treadmill exercise test was oberved in 78(39%) of the 200 cases who had primary negative T wave at rest. Coronary angiography and left ventriculography were performed in 13(mean age 56+/-7 year, male vs. female 1:2.25) of 78 cases who showed pseudonormalization during exercise. They had no history of acute myocardial infarction and no abnormalities such as abnormal Q wave, left ventricular hypertrophy,bundle branch block,right ventricular hypertrophy and QRS widening above 0.1ms in resting electrocardiography. There were significant stenosis in only 3 cases; 2 cases in left anterior descending coronary artery and 1 case in right coronary artery. CONCLUSION: In treadmill exercise tests, pseudonormalization appears as non-specific finding for the diagnosis of ischemic heart disease becuase it is observed in either patients with or without coronary artery stenosis.
Constriction, Pathologic
;
Coronary Angiography
;
Coronary Stenosis
;
Coronary Vessels
;
Diagnosis
;
Electrocardiography
;
Exercise Test*
;
Female
;
Humans
;
Hypertrophy
;
Male
;
Myocardial Infarction
;
Myocardial Ischemia*
2.Pulse Oximetry and Skin Temperature Gradient as Diagnostic Tools of Successful Caudal Block.
Duk kyung KIM ; Kyoung Min LEE ; Won Kyoung KWON ; Chung Sik OH ; Sung Whan JANG
Korean Journal of Anesthesiology 2007;53(6):S19-S25
BACKGROUND: Though caudal block is a relative simple technique, it has not been widely used in adults because of a high failure rate. We assumed that any tests to quantify the changes of sympathetic tone in the affected areas would be excellent indicators of successful block. We tested the usefulness of two candidates (pulse oximetry plethysmographic waveform amplitude measured at 5th toe and calf minus 5th toe skin temperature gradient) as indicators of successful caudal block. METHODS: In 45 adult patients undergoing anal surgery with caudal block, these two variables were simultaneously measured at 2-min intervals for 20 min. A two-fold increase in the plethysmographic waveform amplitude from baseline and skin temperature gradient of 0oC were predefined as test criteria of successful block. RESULTS: While the sensitivity, specificity, positive predictive value, and negative predictive value of the skin temperature gradient test were 45.9%, 100%, 100%, and 9.1%, those of the plethysmographic waveform test were 86.5%, 100%, 100%, and 28.6%. The plethysmographic waveform test showed a significantly higher discriminative capacity than the skin temperature gradient test (94.9% vs. 48.7%, P < 0.05) CONCLUSIONS: Unlike the skin temperature gradient test, the plethysmographic waveform test showed a considerably high validity in detecting successful block. Considering its simple and real time monitoring potentials together with a high failure rate of caudal block in adults, we cautiously recommend it as a supplemental diagnostic tool to predict successful block, especially when verbal communication with patient is difficult.
Adult
;
Humans
;
Oximetry*
;
Sensitivity and Specificity
;
Skin Temperature*
;
Skin*
;
Toes
3.Comparison between Myocardial Infarction and Congestive Heart Failure Using by Heart Rate Variability Analysis of 24 hours Holter Monitoring.
Duk Whan JANG ; Chang Won LEE ; In Seok BAIK ; Soon Chul BAE ; Cheol Woo KIM ; Jae Goo KWON ; Hong Soon LEE ; Soo Woong YOO
Korean Circulation Journal 1996;26(3):674-680
OBJECTIVES: Power spectrum analysis decomposes the heart rate signal into its frequency components and facilitates separation of sympathetic (low frequency) and parasympathetic (high frequency) activity. In congestive heart failure, augmented sympathetic tone and decreased parasympathetic tone were found. Autonomic nervous system was normalized 6 months after myocardial infarction. So we compared the autonomic nervous system activity by the heart rate variability in congestive heart failure and old myocardial infarction. METHODS: The protocol involved 20 healthy subjects (Group 1), 5 congestive heart failure patients not caused by myocardial infarction (Group 2), 4 congestive heart failure patients due to myocardial infarction and 11 old myocardial infarction patients without heart failure. We took 24 hour Holter monitoring by Del Mar Avionic tape recorder. All Holter tapes were analyzed with use of Model 563 Stratascan Holter Analysis System. We computed power spectra on each 256 sec segment of each hour during 24 hour recording. So, RR interval, SD of RR interval by time domain, and LF, HF, LF/HF ratio, Total PSD by frequency domain were measured. RESULTS: In congestive heart failure, nocturnal HF peak and diurnal variation of LF/HF ratio was decreased relative to healthy subjects. Nocturnal HF peak in old myocardial infarction was not visualized. All of LF, HF and Total PSD in congestive heart failure and old myocardial infarction patients relative to healthy subjects. CONCLUSION: On heart rate variability analysis using by 24 hour Holter monitoring, abnormal autonomic nervous activity was demonstrated in congestive heart failure and old myocardial infarction patients relative to healthy subjects.
Autonomic Nervous System
;
Electrocardiography, Ambulatory*
;
Estrogens, Conjugated (USP)*
;
Heart Failure*
;
Heart Rate*
;
Heart*
;
Humans
;
Myocardial Infarction*
;
Spectrum Analysis
4.Signal Averaged Electrocardiography Using Holter Tape in Patients without Heart Disease.
Soon Chul BAE ; Seok Jun MOON ; Jae Goo KWON ; Duk Whan JANG ; Chang Won LEE ; Hong Soon LEE ; Soo Woong YOO ; Moo Yong RHEE ; Hak Choong LEE
Korean Circulation Journal 1997;27(1):42-48
BACKGROUND: Ventrlcular tachyarrhythmias are major cause of sudden cardiac death in patients after myocardial infarction and their accurate detection seems to be important in prevention of sudden cardiac death. Clinical findings, treasmill test, holter monitoring and coronary angiography have been used to search for high risk group in sudden cardiac death. Recently electrographysiologic stimulation has been to this, but it is not practical, because of high cost and invasiveness. Signal averaged electrocardiogram(SAECG) may be helpful in prediction of high risk group in sudden cardiac death. So we try to know the values of SAECG in Korean patients without heart disease. RESULTS: 1) The mean value and standard deviation of Time domain analysis is as follows ; fQRS : 106.8+/-12.3ms, RMS : 36.2+/-21.5(micro)V, LAS : 27.2+/-8.1ms. 2) The mean value and standard deviation of Spectral turbulence analysis is a follows ; LSCR : 58.6+/-3.9, ISCM : 95.2+/-0.8, ISCSD : 71.8+/-15.7, SE : 6.9+/-1.8. CONCLUSION: There was no significant difference between male and female. Time domain analysis shows significant differences among each hour but spectral turbulence analysis did not. Spectral turbulence analysis shows high specificity.
Coronary Angiography
;
Death, Sudden, Cardiac
;
Electrocardiography*
;
Electrocardiography, Ambulatory
;
Female
;
Heart Diseases*
;
Heart*
;
Humans
;
Male
;
Myocardial Infarction
;
Sensitivity and Specificity
;
Tachycardia
5.The clinical evaluation of selective neck dissection on tuberculouscervical lymphadenitis.
Young Hoon CHUN ; Young JANG ; Dong Whan KIM ; Sang Hyun KIM ; Yong Jae KIM ; Duk Hee CHUNG ; Jong Ouck CHOI ; Kwang Yoon JUNG
Korean Journal of Otolaryngology - Head and Neck Surgery 1992;35(3):414-418
No abstract available.
Lymphadenitis*
;
Neck Dissection*
;
Neck*
6.A Case of Granulomatous Pancreatitis Caused by Syphilis.
Won Gyu CHOI ; Chang Won LEE ; Hong Joon PARK ; In Seok BAEK ; Jang Won KIM ; Duk Whan JANG ; Seung Il WOO ; Soon Chul BAE ; Jae Joong BAIK ; Hak San KIM
Korean Journal of Medicine 1997;52(5):696-701
Granulomatous pancreatitis is a granulomatous inflammatory disease of the pancreas and can he described only in infectious granulomas and pancreatic involvement by systemic granulomatosis. Sarcoidosis, isolated pancreatic involvement without systemic granulomatosis or a manifestation of systemic sarcoidosis, is more common cause of granulo-mataus pancreatitis than infectious granuloma. There has been some reports show a characteristic histological finding of the pancreatic involvement of sarcoidasis. Noncaseating granuloma is thought to be the characteristic finding of pancreatic sarcoidosis. But granulomatous pancreatitis caused by syphilis in a syrnptomatic patient is a very rare disease and, till now, to our knowledge, only a case was reported in 1987, Germany. We experienced a 55-year-old female patient with granulomatous pancreatitis caused by tertiary syphilis who presented as a recent onset jaundice, diarrhea, fatigue and vague epigastric discomfort. Radical pancreaticoduo-denectomy was performed, which showed noncaseating granulomatous pancratitis with vasculitis. To our knowledge, this is the first case of granulomatous pancreatitis caused by syphilis in Korea. We hereby report a case of granulomatous pancreatitis caused by syphilis with a brief review of literature.
Diarrhea
;
Fatigue
;
Female
;
Germany
;
Granuloma
;
Humans
;
Jaundice
;
Korea
;
Middle Aged
;
Pancreas
;
Pancreatitis*
;
Rare Diseases
;
Sarcoidosis
;
Syphilis*
;
Vasculitis
7.Acute and Long-Term Angiographic Outcomes of Side Branch Stenosis after Randomized Treatment of Zotarolimus-, Sirolimus-, and Paclitaxel-Eluting Stent for Coronary Artery Stenosis.
Bong Ki LEE ; Young Hak KIM ; Duk Woo PARK ; Sung Cheol YUN ; Jung Min AHN ; Hae Geun SONG ; Jong Young LEE ; Won Jang KIM ; Soo Jin KANG ; Seung Whan LEE ; Cheol Whan LEE ; Jae Hwan LEE ; In Whan SEONG ; Seong Wook PARK ; Seung Jung PARK
Journal of Korean Medical Science 2012;27(12):1499-1506
This was designed to assess the outcomes of side branch (SB) stenosis after implantation of three drug-eluting stents (DES). From 2,645 patients in the ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary Lesions) Trial, 788 patients had 923 bifurcation lesions with SB > or = 1.5 mm were included. SB was treated in 150 lesions, including 35 (3.8%) receiving SB stenting. Of untreated SB with baseline stenosis < 50%, the incidences of periprocedural SB compromise was similar in the zotarolimus (15.8%), sirolimus (17.2%), and paclitaxel (16.6%) stent groups (P = 0.92). At follow-up angiography, delayed SB compromise occurred in 13.9%, 3.2%, and 9.4% (P = 0.010) of these groups. When classified into four groups (< 50%, 50%-70%, 70%-99%, and 100%), 9.0% of untreated SB were worsened, whereas improvement and stationary were observed in 9.6% and 81.4%. In a multivariable logistic regression model, main branch (MB) stenosis at follow-up (%) was the only independent predictor of SB stenosis worsening (odds ratio, 1.03; 95% confidence interval, 1.01-1.04; P < 0.001). After MB stenting in bifurcation lesions, a minority of SB appears to worsen. DES with strong anti-restenotic efficacy may help maintain SB patency.
Acute Disease
;
Aged
;
Blood Vessels/physiopathology
;
Cardiovascular Agents/*therapeutic use
;
Coronary Angiography
;
Coronary Stenosis/*drug therapy/physiopathology/radiography
;
Drug-Eluting Stents/*adverse effects
;
Female
;
Follow-Up Studies
;
Humans
;
Logistic Models
;
Male
;
Middle Aged
;
Myocardial Infarction/etiology/radiography
;
Myocardial Revascularization
;
Odds Ratio
;
Paclitaxel/*therapeutic use
;
Predictive Value of Tests
;
Sirolimus/*analogs & derivatives/*therapeutic use
;
Thrombosis/etiology
;
Treatment Outcome
8.Assessment of Autonomic Disturbance by 24-hour Heart Rate Variability in Patients with Liver Cirrhosis.
Chul Woo KIM ; Jae Goo KWON ; Min Su CHAE ; Hye Sook AHN ; Young Jung CHO ; Chang Won LEE ; Duk Whan JANG ; Moo Yong RHEE ; Hak San KIM ; Hong Soon LEE ; Soo Woong YOO
Korean Journal of Medicine 1997;53(3):371-379
OBJECTIVE: Heart rate variability(HRV) is helpful to diagnosis autonomic disturbance and sympathetic-parasympathetic imbalance in patients with myocardial infarction and diabetes mellitus. Patients with liver cirrhosis demonstrate reduced blood pressure despite increased heart rate and increased cardiac output, indicating a fall in peripheral vascular resistance. Autonomic disturbance may contribute to this phenomenon. The aim of the present study is to evaluate the degree of autonomic disturbance and the circadian rhythm of autonomic nervous system by estimating HRV with 24 hour-Holter recorder, METHODS: 24 hour-HRV with Del Mar Avionics 563 Holter recorder and cardiovascular reflex tests were carried out on 32 patients with liver cirrhosis and 20 control subjects. We evaluated the presence of autonomic disturbance, and assessed quantitatively the autonomic disturbance. RESULTS: 1) Among cardiovascular reflex tests, Valsalva test, standing test and deep breathing test were showed a significantly decreased response in liver cirrhosis compared with control groups. 2) The standard deviation of 24hours average R-R intervals were showed a significantly decrease in liver cirrhosis than control groups(P<0.0001). The HRV of low frequency(LF. P<.D.001), high frequency(HF, P<0.0001) and total power spectral density (P<0.0001) in liver cirrhosis were statistically lower than control. 3) The LF/HF ratio of patients with liver cirrhosis was showed higher than control at night CONCLUSION: Non-invasive assessment of 24 hour-HRV has a few advantages in the diagnosis and degree of autonomic disturbance, evaluation of diurnal variation of autonomic tone.
Autonomic Nervous System
;
Blood Pressure
;
Cardiac Output
;
Circadian Rhythm
;
Diabetes Mellitus
;
Diagnosis
;
Heart Rate*
;
Heart*
;
Humans
;
Liver Cirrhosis*
;
Liver*
;
Myocardial Infarction
;
Reflex
;
Respiration
;
Vascular Resistance
9.Echocardiographic Prediction of Severe Mitral Regurgitation after Percutaneous Mitral Valvuloplasty with the Inoue Balloon.
Jin Seock JANG ; Duk Hyun KANG ; Jong Min SONG ; Cheol Whan LEE ; Myeong Ki HONG ; Jae Kwan SONG ; Seong Wook PARK ; Seung Jung PARK
Korean Circulation Journal 2001;31(12):1311-1317
BACKGROUND AND OBJECTIVES: This study was designed to predict the development of severe mitral regurgitation (MR) following percutaneous mitral valvuloplasty (PMV) in patients with a favorable morphology of the mitral valve (MV). SUBJECTS AND METHODS: We prospectively examined 253 patients with severe mitral stenosis from 1997 to 2000. Echocardiographic evaluation of MV morphology was performed prior to PMV. We proposed commissural calcification, severe relative prolapse, and uneven thickening of MV as predictors of MR following PMV and defined the MR risk group as patients with any of these 3 features. The balloon size was expressed as the value of the effective balloon dilating area divided by the body surface area. The larger balloon group was defined as patients in whom balloon size>3.8 cm 2/m 2 was selected for PMV. The development of severe MR was defined as the presence of MR> or = 3 + on echocardiography following PMV. RESULTS: Severe MR developed in 14 (5.5%) patients. On multiple logistic regression analysis, the MR risk group (p<0.001) and balloon size (p=0.009) were the only significant independent predictors of severe MR following PMV. A sensitivity and specificity of a Padial MR score >8 and MR risk group was 43%, 88% and 71%, 86% respectively. In the MR risk group, severe MR developed in 8 (53.3%) of 15 patients of the larger balloon group as compared with 2 (6.9%) of 29 patients of the smaller balloon group (p=0.001). CONCLUSION: Echocardiography can identify patients with a high risk of developing MR after PMV and the use of a smaller Inoue balloon may prevent severe MR in selected patients.
Body Surface Area
;
Echocardiography*
;
Humans
;
Logistic Models
;
Mitral Valve
;
Mitral Valve Insufficiency*
;
Mitral Valve Stenosis
;
Prolapse
;
Prospective Studies
;
Sensitivity and Specificity
10.Anesthesia for Liver Transplantation in a Patient with Hepatic Failure Combined with Primary Renal Failure: A case report.
Duk Kyung KIM ; Hae Kyoung KIM ; Tae Yop KIM ; Jeong Ae LIM ; Yang Lyoul KIM ; Sung Whan JANG
Korean Journal of Anesthesiology 2007;53(4):547-553
Renal failure frequently accompanies advanced hepatic failure. Even if adequate renal function is not considered as a prerequisite for transplant candidacy, impaired renal function prior to liver transplantation has been regarded as an independent risk factor of graft dysfunction and mortality. Liver transplantation in such a patient also presents a number of challenges to the anesthesiologists. Optimal fluid therapy, prompt and aggressive correction of electrolytes and metabolic disturbances, careful selection of anesthetic techniques and agents, and close monitoring of cardio-respiratory function help reduce the graft failure and perioperative mortality. In such cases, continuous renal replacement therapy (CRRT) is used with increasing frequency during or after the surgery. So, anesthesiologists need to understand the basic principles, potential applications, and anesthetic implications of several CRRT options. We therefore present the anesthetic experience in a patient with hepatic failure combined with primary renal failure, successfully managed during or after liver transplantation.
Anesthesia*
;
Electrolytes
;
Fluid Therapy
;
Humans
;
Liver Failure*
;
Liver Transplantation*
;
Liver*
;
Mortality
;
Renal Insufficiency*
;
Renal Replacement Therapy
;
Risk Factors
;
Transplants