OBJECTIVE: To investigate the frequency, type and severity of cardiac abnormalities in the patients with ankylosing spondylitis and undifferentiated spondyloarthopathy. METHODS: A history, clinical examination, standard 12 lead electrocardiography, two dimensional, M mode, and Doppler echocardiographies were performed on 19 patients with ankylosing spondylitis, 15 patients with undifferentiated spondyloarthropathy and 21 normal controls. RESULTS: 1) Cardiac abnormalities were detected in 8 patients(42.1%) with ankylosing spondylitis. 2) Cardiac abnormalities were detected in 8 patients(53.3%) with undifferentiated spondyloarthropathy including 2 patients with aortic valve abnormalities(mild aortic insufficiency, aortic valve thickening. 3) Cardiac abnormalities were detected in one (4. 8%) among normal controls (mild tricuspid regurgitation). 4) There were sinus bradycardias on electrocardiography in 2 patients among patients witn anl;ylosing spond!litis and in 1 patient among undifferentiated spondyloarthropathy. But there was no conduction disturbance in both groups. 5) The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. 6) The mean age, mean disease duration, presence of uveitis, peripheral arthritis, HLA-B27, enthesopathy, Schober test and chest expansion in the patients with ankylosing spondylitis and undifferentiated spondyloarthropathy with cardiac abnormalities were not different from those in the patients without cardiac abnormalities. CONCLUSION: The frequency of cardiac abnormality was higher in patients with ankylosing spondylitis and undifferentiated spondyloarthropathy than in normal controls. The frequency, type and severity of cardiac involvement in patients with ankylosing spondylitis were not different from those in patients with undifferentiated spondyloarthropathy.
Aortic Valve ; Aortic Valve Insufficiency ; Arthritis ; Bradycardia ; Electrocardiography ; HLA-B27 Antigen ; Humans ; Rheumatic Diseases ; Spondylarthropathies* ; Spondylitis, Ankylosing* ; Thorax ; Uveitis

No abstract available.
Mucous Membrane* ; Prolapse* ; Vitelline Duct*

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.
Brain ; Humans ; Intracranial Aneurysm* ; Mortality ; Paresis ; Vasospasm, Intracranial

The literature concerning cerebral vasospasm associated with subarachnoid hemorrhage(SAH) due to ruptured intracranial aneurysm contains no definitive study of patients to determine whether there is (1) any clinical picture consistently present coincident with known cerebral vasospoasm, (2) any relationship between mortality and known vasospasm, and (3) any relationship between serious brain damage(morbidity) and known vasospasm. To answer these important questions, experience with 138 consecutive acute SAH patients due to ruptured intracranial aneurysm was studied. The results were (1) The vasospasm was seen in 61 patients(44.2%) and the clinical vasospasm was seen in 41 patients(29.8%);(2) The average interval between last SAH and vasospasm was 8.3 days;(3) The most common neurological deficit was a hemiparesis or a hemiplegia;(4) There is no relationship between mortality and vasospasm.
Brain ; Humans ; Intracranial Aneurysm* ; Mortality ; Paresis ; Vasospasm, Intracranial

Peripheral nervous system involvement is common in systemic vasculitis, occurring most frequently in the polyarteritis nodosa (PAN) group of disorders and in rheumatoid vasculitis. Within the polyarteritis nodosa group of systemic necrotizing vasculitides, three subgroups have been described: classic polyarteritis nodosa, Churg-Strauss syndrome, and an overlap syndrome. Three patients with evidence of systemic vasculitis and peripheral neuropathy were clinically and electrophysiologically investigated. All cases presented clinically with mononeuropathy multiples considered typical pattern of ischemic involvement of the peripheral nerve. The causes included polyarteritis nodosa, its Churg-strauss variant, and the overlap syndrome. Pain and weakness were frequent symptoms. Nerve conduction studies were abnormal In all cases. Necrotizing vasculitis was present as pathologic findings in two cases. All patients were treated with prednisolone alone or in combination with other immunosuppressive agents or with plasmapheresis.
Churg-Strauss Syndrome ; Humans ; Immunosuppressive Agents ; Mononeuropathies* ; Neural Conduction ; Peripheral Nerves ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Plasmapheresis ; Polyarteritis Nodosa ; Prednisolone ; Rheumatoid Vasculitis ; Systemic Vasculitis ; Vasculitis*

The hepatopulmonary syndrome is defined as the triad of liver disease, an increased alveolar-arterial gradient while breathing room air, and evidence of intrapulmonary dilatation. Other cardiopulmonary abnormalities(such as pleural effusion or decreased lung volumes) are common and may coexist in patients with the hepatopulmonary syndrome. An abnormal dilatation of intrapulmonary capillaries is evidenced by Tc 99m-MAA perfusion scan, contrast-enhanced echocardiography, and pulmonary angiography. We have experienced a case of hepatopulmonary syndrome in a fi7 year old woman with liver cirrhosis who complained of severe dyspnea and cyanosis. Her arterial blood gas analysis (ABGA) showed severe hypoxemia(PaO2 59mmHg), suggesting the hepatopulmonary syndrome, which was confirmed with the contrast-enhanced echocardiography. It showed delayc4 opacification of left side chambers during agitated saline injection', thus, intrapulmonary shunt was confirmed. So we report a case of hepatopulmonary syndrome with a rewiew of literature.
Angiography ; Blood Gas Analysis ; Capillaries ; Cyanosis ; Dihydroergotamine ; Dilatation ; Dyspnea ; Echocardiography ; Female ; Hepatopulmonary Syndrome* ; Humans ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; Lung ; Perfusion ; Pleural Effusion ; Respiration

BACKGROUND: Rheumatoid arthritis(RA) is a systemic disease not infrequently involing the heart. It has been known that pericardial effusion, most commonly observed cardiac abnormality in patients with RA, and other cardiac manifestations such as conduction disturbances, valve thickenings, and enlargement of left atrium or aorta are associated with RA. We have determined the nature and extent of cardiac manifestations of RA in comparison with those of control group by echocardiographic examination. METHOD: 27 patients with RA(4 males and 23 females, mean age=47 +/-13 years) and 22 control subjects(3 males and 19 females, mean age+43 +/- 11 years) were randomly selected. Standard two-dimensional, M-mode and doppler echocardiographic examination were done on each group of subjects. RESULTS: 1) Pericardial effusions were more commonly detectd in patients with RA than control group(55.6% vs 22.7%, p<0.01). There were no significant differences in the amount of pericardial effusion according to the duration and the stage of RA. 2) Thickness of each cardiac valve was thicker in patients with RA than control group. But, there were no statistical significance between them. 3) The left ventricular mass index(LVMI) and the diameter of aorta showed a trend to increase in patients with RA(109.5 +/-28.0 g/m(2) vs 94.2 +/-24.6 g/m(2), p=0.054). 4) The diameter of left atrium was more lager in patients with RA(35.1 +/- 4.0mm vs 31.6 +/- 4.5mm, p=o.005). 5) The E/A ratio of mitral valve was statistically significantly lower in patients with RA(RA:control=1.2 +/- 0.5 : 1.7 +/- 0.4, p=0.01). CONCLUSION: The asymptomatic patients with RA more frequently show cardiac abnormalities such as pericardial effusion, valve thickening, decrease of E/A ratio than control group. So two-dimensional echocardiography is necessary for early, noninvasive and accurate evaluation of asymptomatic cardiac abnormalities in patients with RA.
Aorta ; Arthritis, Rheumatoid ; Echocardiography ; Female ; Heart ; Heart Atria ; Heart Valves ; Humans ; Male ; Mitral Valve ; Pericardial Effusion

Chronic rejection is a major barrier to long-term renal allograft survival. Cyclosporine, though effective at reducing the graft loss due to acute rejection, has had little impact on the incidence of chronic rejection. Between December 1984 and April 1995, 221 patients received a primary living donor kidney transplantation. In our study, 154 patients(70%) never had an episode of acute rejection, 22% had only one, and 8% had more the one. The incidence of chronic rejection was 12% in those who had no acute rejection, 39% in those with one or more rejection episode. The 5-year graft survival was 28% for recipients with biopsy-proven chronic rejection versus 83% for without(P<0.001). In an univariate analysis, donor age, serum creatinine level at 1 and 2 year post transplantation, cyclosporine dosage at year(<4 mg/kg vs >or=4 mg/kg) were significant risk factors for chronic rejection. In a logistic regression of multivariate analysis, we found that risk factors for chronic rejection were acute rejection episode(P<0.0001) and donor age(P<0.01).
Allografts* ; Creatinine ; Cyclosporine ; Graft Survival ; Humans ; Incidence ; Kidney Transplantation ; Living Donors ; Logistic Models ; Multivariate Analysis ; Risk Factors* ; Tissue Donors ; Transplants

BACKGROUND AND OBJECTIVES: It is known that both hypercholesterolemia and aging cause endothelial dysfunction, but which has the greater effect is less well known. A useful, non-invasive method for the evaluation of endothelial function is flow-mediated dilation (FMD) of the brachial artery (BA) employing high-resolution ultrasound. This study was performed to evaluate the effect of serum cholesterol and age on endothelial function in women utilising the above method. SUBJECTS AND METHODS: 21 of the 37 women in this study (mean age 46+/-15 years, range 24-72), had hypercholesterolemia (>or=200 mg/dL) and 16 had normocholesterolemia (<200 mg/dL). None of the subjects suffered classic risk factors associated with atherosclerosis other than hypercholesterolemia. The inner diameter of the right BA was measured at the peak of ECG R wave, from a longitudinal section taken by an 8.0-MHz B-mode linear-array ultrasonic transducer. Scans were taken at rest, during reactive hyperaemia (endothelium-dependent dilation;EDD), again at rest, and following sublingual nitroglycerin (endothelium-independent dilation;EID). RESULTS: From simple linear regression analyses, the serum cholesterol levels were found to be negatively related to the EDD of the BA at an age <50 years (r=-0.63, p<0.01), and also >or=50 years (r=-0.54, p<0.05). Serum cholesterol levels were not significantly related to the EID, regardless of age. In contrast, age was not related to EDD or EID in either normocholesterolemic or hypercholesterolemic subjects. CONCLUSION: These results suggest hypercholesterolemia has a greater effect than age in impairing the endothelial function in women.
Age Factors ; Aging ; Atherosclerosis ; Brachial Artery ; Cholesterol ; Electrocardiography ; Endothelium ; Female ; Humans ; Hypercholesterolemia* ; Linear Models ; Nitroglycerin ; Risk Factors ; Transducers ; Ultrasonics ; Ultrasonography ; Vasodilation

Currently, infliximab is given for disease control for active rheumatoid arthritis (RA) patients despite methotrexate treatment. However, the efficacy and safety of infliximab in Korean patients has not been assessed appropriately. Therefore, we performed placebo-controlled, double-blind, randomized study and extension study. One-hundred forty-three patients with active RA were randomized to receive placebo or infliximab 3 mg/kg intravenously at week 0, 2, 6, 14, and 22 with methotrexate maintenance. Primary endpoint was American College of Rheumatology 20% improvement criteria (ACR20) at 30 week. After the clinical trial, patients on placebo (Group 1) and patients on infliximab who showed ACR20 response (Group 2) were treated with infliximab through another 84 week for evaluation of safety. During clinical trial, patients in infliximab group showed higher ACR20 at week 30 than patients in placebo group (50.1% vs 30.6%, P=0.014). A total of 92 patients participated in the extension study. The maintenance rate of infliximab was 62.0% at 84 weeks of extension study. The overall rate of adverse events was not different between Group 1 and Group 2. In Korean patients with active RA despite methotrexate treatment, infliximab in combination with methotrexate is effective and the long-term treatment with infliximab is well tolerated. (ClinicalTrials.gov No. NCT00202852, NCT00732875)
Adult ; Aged ; Antibodies, Monoclonal/*therapeutic use ; Antirheumatic Agents/*therapeutic use ; Arthritis, Rheumatoid/*drug therapy ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Male ; Methotrexate/*therapeutic use ; Middle Aged ; Placebo Effect ; Republic of Korea ; Severity of Illness Index ; Time Factors ; Treatment Outcome