No abstract available.
Cardiac Resynchronization Therapy*

Sodium nitrorusside (SNP) is used for induced hypotension to decrease bleeding in operation site by direct relaxation of vascular smooth muscles. It is known that the infusion of SNP increases plasma renin activity (PRA) and this activation of renin-angiotensin system is one of physiologic mechanism opposing the hypotensive action. Captopril, the renin-angiotensin converting enzyme inhibitor, could reduced the dose of SNP during induced hypotension through blocking of the cardiovascular effect of renin-angiotensin system. The present study investigates the effect of captopril on PRA, aldosterone, elecholamines and electroytes and whether the pretreatment with captoril can reduce the dose of SNP. Forty patients who needed the induced hypotension for maxillofacial reconstructive surgery were studied. They were pertained to ASA class I and II and classified to 4 groups. Ten patients were pretreated with captopril 3 mg/kg, 10 min. before induction. And ten patients were 1 mg/kg, the other ten patients were 0.5 mg/kg and remainder served as control group. Blood samples for analysis were drawn according to the time sequence of SNP infusion; Stage 1; after the induction and before SNP infusion Stage 2; 30 min. after SNP (when mean arterial pressure was 60-70 torr) infusion Stage 3; before stopping infusion of SNP Stage 4; 30 min. after stopping infusion of SNP The results were as follows: 1) The duration of anesthesia were not stastically different among four groups. 2) Total dose of SNP were significantly decreased in each captopril group. 3) PRA and each value of control group were significantly increased compared with stage l. But there were no significant increase in stages 2, 3, 4 compared with control group PRA. 4) Aldosterone level of all captopril groups were decreased in all stage compared with control group. 5) Epinephrine and norepinephrine were significantly incerased in control group and returned to control level after stopping of SNP infusuon. In captopril group 3 mg/kg, norepinephrine of stage 2.3.4 were not significantly increased than stage l. Epinephrine in captopril 3 mg/ kg group, there were no significant changes except for stage 2. 6) While sodium was decreased in stage 3,4 compared with stage 1 in control group, potassium and chloride were not changed. In summary, captopril can reduce significantly the total dose of SNP required to produce induced hypotension during operation.
Aldosterone* ; Anesthesia ; Arterial Pressure ; Captopril* ; Catecholamines* ; Electrolytes* ; Epinephrine ; Hemorrhage ; Humans ; Hypotension* ; Muscle, Smooth, Vascular ; Nitroprusside* ; Norepinephrine ; Plasma* ; Potassium ; Relaxation ; Renin* ; Renin-Angiotensin System ; Sodium*

No abstract available.
*Echocardiography, Doppler ; Female ; Heart Failure, Diastolic/*mortality/*ultrasonography ; Humans ; Male ; Renal Insufficiency, Chronic/*mortality

Congenital absence of the pericardium is a rare cardiac malformation and is most often asymptomatic. It is usually discovered as an incidental finding. Physical examination, chest radiography, and electrocardiogram are often unremarkable. Echocardiography provides valuable information, and sometimes computed tomography or magnetic resonance imaging is needed for subsequent confirmation.
Echocardiography ; Electrocardiography ; Incidental Findings ; Magnetic Resonance Imaging ; Pericardium* ; Physical Examination ; Radiography ; Thorax

Chronic hypophosphatemia caused by decreased intestinal absorption or increased renal clearance, may lead to rickets or osteomalacia independently of other predisposing abnormalities. The conditions commonly associated with increased renal clearance of phosphate are X-linked hypophosphatemic rickets, tumor associated rickets/osteomalacia, RTA and Fanconi syndrome. Recently we experienced 3 men with adult-onset, histologically proven osteomalacia associated with increased renal clearance of phosphate. None of them had a family history of bone disease, tumors or other tubular defects. All of these had remarkable biochemical and clinical improvement with medical treatment such as 1, 25-dihydroxyvitamin D and phosphate supplementation. Although we did not find tumors yet, we could not rule out the possibility of tumor-associated osteomalcia since it often takes several years to make a diagnosis because of small size, benign nature and unusual location of tumors. Thus, careful long-term follow up for tumor occurrence will be maintained in these patients with sporadic nonfamilial hypophosphatemic osteomalacia.
Bone Diseases ; Diagnosis ; Familial Hypophosphatemic Rickets ; Fanconi Syndrome ; Follow-Up Studies ; Humans ; Hypophosphatemia ; Intestinal Absorption ; Male ; Osteomalacia ; Rickets

The residual tense false lumen following surgical repair of aortic dissection remains one of the most difficult and challenging postsurgical problems. Percutaneous fenestration of the dissecting membrane under the guidance of intravascular ultrasound has been recently introduced to depressurize the tense false lumen. A 63-year-old woman who underwent repair of acute type I dissection was readmitted because of claudication and numbness of the left lower extremity. Angiography, computed tomography, and magnetic resonance imaging clearly showed a dissection flap starting from the thoracic aorta distal to the left subclavian artery. Compressed true lumen by the markedly enlarged tense false lumen was also noted in the double-channeled descending thoracoabdominal aorta. Under intravascular ultrasound guidance, the intimal flap was punctured with a Brockenbrough needle advanced to the true lumen through a femoral artery, and then, a balloon catheter was introduced over the guidewire which was placed across the dissection flap. Desired fenestration was obtained successfully by inflation of the balloon without complications. After procedure, symptoms resolved promptly and she is currently(clinical follow-up of 12 months postfenestration) ambulating without claudication. In conclusion, percutaneous fenestration of the intimal flap is a technically feasible and an effective alternative procedure to surgical repair for restoration of perfusion to an ischemic extremity in selected patients complicated with aortic dissection.
Angiography ; Aorta ; Aorta, Thoracic ; Catheters ; Extremities* ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Hypesthesia ; Inflation, Economic ; Ischemia* ; Lower Extremity ; Magnetic Resonance Imaging ; Membranes ; Middle Aged ; Needles ; Perfusion ; Subclavian Artery ; Transcutaneous Electric Nerve Stimulation ; Ultrasonography

There were many researches, which qualitative or quantitative assays were performed about fibrinolysis and the degree of activation of coagulation system. Authors measured fibrinogen degradation products(FbDP) and fibrin degradation products(FbDP) by monoclonal enzymeimmunoassay, instead of polyclonal method in 12 cases of cardiopulmonary bypass(CPB). 1) The increase of FgDP after sternotomy is verifying the significant fibrino(geno) lysis occured by stimulation of sternotomy. 2) By the result that FgDP was significantly increased compared with FbDP, primary fibrinogenolysis is more important phenomenon than secondary fibrinolysis during CPB. 3) FbDP and FgDP were most significantly increased immediately before the end of CPB and after CPB. 4) Increased FgDP was decreased after CPB but FbDP was still elevated 5 hours after CPB. According to the above results, CPB induced primary fibrinogenolysis and secondary fibrinolysis in open heart surgery.
Cardiopulmonary Bypass ; Fibrin Fibrinogen Degradation Products* ; Fibrin* ; Fibrinogen* ; Fibrinolysis ; Heart* ; Plasma* ; Sternotomy ; Thoracic Surgery*

BACKGROUND AND OBJECTIVE: Mitral annulus velocity measured by doppler tissue imaging (DTI) has been used as a method of evaluation of the left ventricular diastolic function. This study was aimed to evaluate the left ventricular diastolic function using the mitral annulus velocity measured by DTI in the patients with hypertension. METHODS AND SUBJECTS: One hundered twenty nine patients with blood pressure above 140/90mmHg and age sex matched 123 normotensive subjects were studied. For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical four chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocities were easily obtained from all subjects. In the hypertension group, mitral annulus E'velocity was significantly lower than normotensive controls (5.4 1.3 cm/sec vs 6.5 1.8 cm/sec, p<0.001) and mitral annulus A' velocity was significantly higher than normotensive controls (8.6 1.4 cm/sec vs 7.9 1.1 cm/sec, p<0.001). In comparison with patients with normal LVML(IV mass index in hypertension group and subjects with normal LVMI in normotensive controls, mitral annulus E'velocity was reduced in patients with normal LVMI in hypertension group compared with subjects with normal LVMI in normotensive controls (5.6 1.4 cm/sec vs 6.7 1.8 cm/sec, p<0.001). CONCLUSION: Mitral annulus velocity measured by DTI could be used as one of the parameters in evaluating the early changes of left ventricular diastolic function in the patient with hypertension.
Blood Pressure ; Humans ; Hypertension*

No abstract available.
Heart ; Heart Failure

This report describes a case of portal hypertension caused by periportal tuberculous lymphadenitis. There were a few reports of portal hypertension associated with tuberculosis. A 27-year-old man was admitted to the hospital because of recurrent hematemesis for 7 days. There was a history of mediastinal tuberculous lymphadenitis 3 years earlier that was treated with isoniazide, rifampin, ethambutol, and pyrazinamide for 2 years. Clinical evaluation revealed esophageal variceal bleeding and main portal vein obstruction by enlarged periportal lymph nodes. The patient underwent distal splenorenal shunt. Pathologic examination of the excised periportal lymph node revealed chronic granulomatous inflammation with central caseous necrosis. Thereafter the patient took antituberculous medication for 12 months. The patient has not re-bled 3 years since the shunt operation.
Adult ; Case Report ; Human ; Hypertension, Portal/*etiology/therapy ; Male ; Tuberculosis, Lymph Node/*complications