No abstract available.
Cardiac Resynchronization Therapy*

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

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*

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

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

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: Left atrial thrombi(LAT) and spontaneous echo contrast(SEC) are known as major risk factors for thromboembolic complication in patients with mitral valvular heartdisease. Recent clinical introduction of transesophageal echocardiography(TEE) makes it possible to improve the diagnostic accuracy of these risk facors compared to conventional transthoracic echocardiography(TTE). The aims of the present study were to evaluate diagnostic accuracy of TEE for detection of LAT and to determine if clinical and echocardiographic variables can predict the presence of LAT and/or SEC at TEE. METHODS: From July 1991 to April 1993, both TTE and TEE were performed in 84 patients with mitral valvular heart disease before open heart surgery. The incidence and diagnostic accuracy of TTE and TEE for LAT detection were confirmed at surgery for mitral valve replacement in all cases. Biplane with 5.0 MHz transducer was used in TEE. The following clinical and transthoracic echocardiographic variables were analyzed:age, totoal or recent embolism, atrial fibrillation, left atrial dimension, ejection fraction, mitral valve area, and mitral regurgitation. RESULT: 1) THe sensitivity of TEE for detection of LAT was 100%, which was significantly higher than that of TTE(60.8%). There was no statistical difference in specificity of both techniques(98.3% vs 93.4%). In eleven patients (11/24,45.8%), LAT was confined to the left atrial appendage and TEE was far superior to TTE(sensitivity : 100% vs 27.2%) in detection of appendegeal thrombi. 2) SEC was found in 43 patients(51.2%). Patients with SEC had higher rates of LAT(p<0.001) and embolic episodes (p=0.001) than patients without SEC. There was no association between the severity of SEC and the embolic episodes. 3) Patients with SEC or LAT were characterized by more frequently associated with recent embolic episodes, smaller mitral valve orifice, abscence of mitral regurgitation than those without SEC and LAT. CONCLUSION: TEE is superior to TTE in detection of LAT and appendegeal thrombi. SEC is frequently noted in TEE and also strongly associated with left atrial blood stasis and left atrial thrombi in mitral valve disease.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Echocardiography, Transesophageal* ; Embolism ; Heart Valve Diseases* ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Risk Factors ; Sensitivity and Specificity ; Thoracic Surgery ; Thrombosis* ; Transducers

No abstract available.