OBJECTIVES: To investigate the role of ATP-sensitive potassium channel (KATP) during sustained ventricular fibrillation (VF), the effects of gliburide, a specific blocker of KATP channel and PCO400, an KATP opener, were studied in isolated and perfused swine right ventricular free walls (n=). METHODS: Recording of single cell transmembrane potentials was performed and constructed action potential duration restitution (APDR) curve by plotting APD 90%(APD90) versus preceding diastolic interval (DI). RESULTS: All isolated tissues fibrillated spontaneously. In this preparation, stable VF could persist over a 4-hour period if it was allowed to continue undisturbed (n=). Gliburide (1-5 uM) increased DI without significant changes in APD90 during VF, resulting in more regularization of VF. Higher concentration (10-20 uM) increased both APD90 and DI, and converted to monomorphic ventricular tachycardia (MVT) through the transitional period characterized by APD alternans. PCO400 (1-2.5 uM) caused a significant shortening of APD during MVT and a period of APD alternans became more evident before conversion from MVT to VF. Gliburide eliminated profibrillatory effect of PCO400. This antifibrillatory action of gliburide was accompanied by gradual decrease in the maximum slope of APDR curve during VF. CONCLUSION: KATP channel blockade causes a transition from VF to MVT via lengthening of DI and APD alternans, concomitantly with a reduction of the slope of APD restitution curve.
Action Potentials ; Membrane Potentials ; Potassium Channels ; Swine ; Tachycardia, Ventricular ; Ventricular Fibrillation*

Chondroid syringoma is a sweat gland tumor that is composed of a mixture of epithelial cells and mesenchymal tissue. It is most frequently located on the head and neck. Chondroid syringoma is a firm intradermal or subcutaneous nodule. Histologically, the epithelial component consists of tubulocystic structures and aggregates of epithelial cells as well as single scattered epithelial cells throughout the stroma. It rarely contains osteoid stroma, and there are only a few reports of cases associated with ossification. We describe here an unusual chondroid syringoma associated with marked ossification.
Adenoma, Pleomorphic* ; Epithelial Cells ; Head ; Neck ; Sweat Glands

No abstract available.
Brugada Syndrome* ; Bundle-Branch Block* ; Death, Sudden, Cardiac*

BACKGROUND: Arterial stiffening may affect regional myocardial function in hypertensive patients with normal ejection fraction (EF). METHODS: Brachial-ankle pulse wave velocity (PWV) was measured in 70 patients, of mean age 48 +/- 14 years, with untreated hypertension and EF > 55%. Using two-dimensional-speckle tracking echocardiography, we measured longitudinal and circumferential strain (epsilon) and strain rate (SR). Basal and apical rotations were measured using short axis views. RESULTS: The mean systolic and diastolic blood pressure in these patients was 152 +/- 15 mmHg and 92 +/- 11 mmHg, respectively. The mean value of PWV was 1578 +/- 274 cm/s. PWV significantly correlated with age (r = 0.682, p < 0.001), body mass index (r = -0.330, p = 0.005), systolic blood pressure (r = 0.386, p = 0.001) and pulse pressure (r = 0.509, p < 0.001). PWV also significantly correlated with septal E' velocity (r = -0.570, p < 0.001), E/A ratio (r = -0.414, p < 0.001), E/E' ratio (r = 0.589, p < 0.001), systolic global longitudinal epsilon (r = 0.300, p = 0.012) and early diastolic SR (SRE) (r = -0.479, p < 0.001) suggesting impaired abnormal relaxation. PWV was also correlated with basal rotation (r = -0.301, p = 0.011) and basal-to-apical twist (r = -0.256, p = 0.032). The increases in apical rotation and basal-to-apical twist were attenuated in patients with PWV > 1700 cm/s compared to those with PWV < or = 1400 cm/s or those with PWV 1400-1700 cm/s. CONCLUSION: In hypertensive patients with normal ejection fraction, arterial stiffening contributes to impaired systolic and diastolic function of the regional myocardium. Compensatory increases in ventricular twist were diminished in patients with advanced stage of vascular stiffening.
Axis, Cervical Vertebra ; Blood Pressure ; Body Mass Index ; Echocardiography ; Humans ; Hypertension ; Myocardium ; Pulse Wave Analysis ; Relaxation ; Sprains and Strains ; Track and Field ; Vascular Stiffness

A 34-year-old man, who had been treated with an endoscopic injection of a mixture of n-butyl-2-cyanoacrylate (Histoacryl) and Lipiodol for control of variceal bleeding 6 months previously, presented with an intracardiac mass in the right atrium (RA). Two-dimensional echocardiography revealed an intracardiac mass in the RA that appeared to extend from the inferior vena cava. The origin of the sclerosant was traced by computed tomography (CT). This is a very rare case in which the sclerosant migration route was demonstrated by CT scan. The findings of this case suggest that the systemic migration of sclerosant into an intracardiac chamber should be considered in patients with an intracardiac mass, especially with a history of previous sclerotherapy for variceal bleeding.
Adult ; Echocardiography ; Embolism ; Enbucrilate ; Esophageal and Gastric Varices ; Esophagus ; Ethiodized Oil ; Heart Atria ; Hemorrhage ; Humans ; Sclerotherapy ; Vena Cava, Inferior

Neurogenic pulmonary edema (NPE) leading to cardiopulmonary dysfunction is a potentially life-threatening complication in patients with central nervous system lesions. This case report describes a 28-yr woman with life-threatening fulminant NPE, which was refractory to conventional respiratory treatment, following the rupture of an aneurysm. She was treated successfully with extracorporeal membrane oxygenation (ECMO), although ECMO therapy is generally contraindicated in neurological injuries such as brain trauma and diseases that are likely to require surgical intervention. The success of this treatment suggests that ECMO therapy should not be withheld from patients with life-threatening fulminant NPE after subarachnoid hemorrhage.
Adult ; Brain/radiography ; Decompressive Craniectomy ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Intracranial Aneurysm/complications/*diagnosis ; Pulmonary Edema/*diagnosis/etiology/therapy ; Subarachnoid Hemorrhage/etiology ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: A reduction of the coronary flow reserve (CFR) following successful percutaneous coronary intervention (PCI) is related to microvascular impairment. Embolization of atherosclerotic debris during PCI is a possible explanation for the finding of abnormal coronary Doppler flow following PCI. SUBJECTS AND METHODS: The CFR and intravascular ultrasound (IVUS), both before and after PCI, were recorded in 69 lesions of 69 patients with coronary artery disease. An abnormal CFR was defined as one with no change or a decrease after successful PCI. RESULTS: The patients were divided into abnormal (n=17) and normal CFR (n=52) groups. After stenting, the hyperemic flow velocity was significantly lower in the abnormal CFR group (39.3+/-12.6 vs. 48.9+/-15.4 cm/s, p=0.022). 94 and 29% of the abnormal group had soft plaques and lipid cores, respectively, compared with 62 and 2% in the normal CFR group (soft plaque: p=0.029, lipid core: p=0.002). The abnormal CFR group had smaller post-procedural vessels (15.1+/-4.2 vs. 18.2+/-4.9 mm2, p=0.039) and plaque areas (6.8+/-2.7 vs. 9.9+/-3.8 mm2, p=0.006). Furthermore, the abnormal CFR group showed less vessel expansion (1.7+/-5.5 vs. 5.0+/-3.9 mm2, p=0.018) and greater plaque loss (4.1+/-5.3 vs. 0.7+/-3.4 mm2, p=0.009). The abnormal CFR group had an increased CK-MB following PCI (4 patients, 23.5% vs. 2 patients, 3.8%, p=0.029). In a multivariable analysis, the only predictor of an abnormal CFR was the presence of a lipid core within the plaque. CONCLUSION: Soft plaques, the presence of a lipid core and a large reduction in plaques increase the risk of microembolization during the PCI procedure.
Coronary Artery Disease ; Humans ; Percutaneous Coronary Intervention ; Stents* ; Ultrasonics ; Ultrasonography*

Absent right superior vena cava in visceroatrial situs solitus is rare. It has been known the absent right superior vena cava is usually accompanied with persistent left superior vena cava. And this anomaly could be combined witk additional congenital heart disease and rhythm disturbances. We experienced one case of absent right superior vena cava accompanied by persistent left superior vena cava, secundum type atrial septal defect, and transient post-operative sinus node dysfunction.
Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Sick Sinus Syndrome ; Vena Cava, Superior*

BACKGROUND: In acute myocardial infarction, left ventricular remodeling, which was influenced by infarct size, location, and patency of infarct related artery(IRA), is a important prognostic factor for chronic heart failure and survival. Recently, several reports suggested that patent IRA does not always mean true myocardial reperfusion, and myocardial contrast echocardiography(MCE) may be a useful tool for assessing infarct size and viability of infarcted myocardium. So, we investigated the association between the degree of myocardial reperfusion assessed by MCE and long term change of left ventricular volume in acute anterior wall myocardial infarction patients who had patent IRA. METHODS: The study population was consisted of 17 patients with first acute anterior wall myocardial infarction patients who had patent left anterior descending artery by thrombolytic therapy or rescue PTCA. MCE was done immediately after coronary angiography within two weeks of myocardial infarction onset and analyzed by semiquantitative method to get opacification index. For analysis of left ventricular ejection fraction, wall motion abnormality and left ventricular volume, echocardiogram was taken within 2 weeks of myocardial infarction oneset and 9 months later in each case. Wall motion abnormality was quantified as wall motion index. According to serial changes of left ventricular volume, patients were divided into two groups ; group 1(less than 10% increase of LV volume at follow-up compared to intial echocardiographic exam) and group 2(more than 10% increase of left ventricular volume). We compared the opacification index of infarcted myocardium, wall motion abnormality, and ejection fraction between the two groups. RESULTS: Initial left ventricular volume and ejection fraction were not different between group 1 and group 2, but the opacification index was lower and initial wall motion index higher in group 2 than group 1. Opacification index, wall motion index, ejection fraction and left ventricular volume were closely correlated in the whole cases. By multivariate ananlysis, opacification index was the only significant factor predicting left ventricular volume increment. CONCLUSION: Myocardial reperfusion, which is closely correlated with ejection fraction and wall motion abnormality, acts as a independent predictor of left ventricular dilatation after acute anterior wall myocardial infarction. This result suggests that assessment of microvascular integrity with myocardial contrast echocardiography may be a valuable indicator to predict long-term change of left ventricular volume, although this is suggestive result in a limited number of patients.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Angiography ; Dilatation ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Myocardial Reperfusion* ; Myocardium ; Stroke Volume ; Thrombolytic Therapy ; Ventricular Remodeling

BACKGROUND AND OBJECTIVES: Circulating B-type natriuretic peptide (BNP) has been used as a marker of left ventricular hypertrophy and heart failure, and known to be increased after exercise in healthy men as well as patients with left ventricular dysfunction. However, the relationship between exercise duration and BNP level, and the determinants of circulating BNP concentration during exercise have not been fully elucidated. For these reason, we measured circulating BNP level during exercise, and exercise-induced changes of cardiac function by echocardiography in healthy men. MATERIALS AND METHODS: Ten healthy male volunteers (mean age 27+/-3 year-old) underwent symptom-limited bicycle ergometer in supine position for 30 min. The workload started at 25 W for 6 min with increment of 50 W every 3 min. Blood samples for BNP were obtained at baseline, every 1 min for first 3 min, 25 W, 75 W, 125 W, peak exercise and 10 min after resting. RESULTS: BNP level was increased only at peak exercise (mean:5.3+/-0.5 vs 7.7+/-4.1 pg/ml, median:5.0 vs 6.3 pg/ml, p<0.05), not during submaximal exercise, and sustained 10 minutes after exercise (190+/-25 watt, 14.9+/-12 min). Peak BNP level was significantly correlated with baseline BNP level (r=0.723, p<0.05), E' (0.18+/-0.04 vs 0.29+/-0.08 m/sec, r=-0.649, p<0.05) and E/E' (4.18+/- 0.87 vs 5.66+/-2.31, r=0.769 p<0.01) by bivariate correlation analysis, but correlated with only baseline BNP level by multiple linear regression analysis (p<0.05). CONCLUSION: Circulating BNP concentration was minimally increased only after peak exercise in young healthy men, not increased at submaximal exercise The BNP concentration after exercise is only determined by baseline BNP level, not by duration and workload of exercise.
Echocardiography ; Echocardiography, Stress ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular ; Linear Models ; Male ; Natriuretic Peptide, Brain* ; Supine Position ; Ventricular Dysfunction, Left ; Volunteers