beta-receptor antagonist as antihypertensive agent has adverse effect such as vasoconstriction, bronchoconstriction and aggravation of atherosclerosis. So beta-receptor antagonist with alpha-receptor blocking property has been studied for avoidance of adverse effects of beta-receptor antagonist. Nipradilol, a new beta-receptor antagonist with alpha-receptor blocking property was administrated in 30 essential hypertensive patients for 10 week in order to evaluate the antihypertensive effects and adverse effects. The results were as follows: 1) Nipradilol was effective in 20 patients(67%) on systolic blood pressure 22 patients (73%) on diastolic blood pressure at the end of 10 weeks treatment. 2)Before medication, mean systolic and diastolic blood pressure in sitting position were 160+/-14mmHg and 102+/-18mmHg,and after 10 weeks of medication, mean systolic and diastolic blood pressure were significantly declined to 143+/-22mmHg and 89+/-12mmHg(p<0.001). 3) There was no significant change in pulse rate, from 78+/-12 beats per minute the beginning of the treatment to 75+/-11 beats per minute after 10 week of treatment. 4) There was no significant changes in sodium, potassium, GOT, GPT, bilirubin, alkalin ephosphatase, BUN, creatinine, LDH, CPK and lipid. 5) The adverse effects of nipradilol were bradycardia(7%), dyspnea(3%), chest discomfort(3%) and headache(3%). In summary, nipradilol seemed to be effective antihyertensive drug in treating mild to moderate hypertension.
Atherosclerosis ; Bilirubin ; Blood Pressure ; Bronchoconstriction ; Creatinine ; Heart Rate ; Humans ; Hypertension ; Potassium ; Sodium ; Thorax ; Vasoconstriction

Antihypertensive and beta-adrenoceptor blocking effect of long-acting propranolol were observed in the outpatient department, Department of Internal Medicine, National Medical Center during the period between December, 1981 and May, 1982. The clinical effects of long-acting propranolol were compared with those of conventional propranolol and following results were obtained. 1) Direct cross-over from conventional propranolol 20mg three times a day for several days to long-acting propranolol 160mg once daily was not accompanied by appreciable side effect and there was fairly good antihypertensive effect either in systolic or diastolic pressure. 2) Antihypertensive and bata-adrenoceptor blocking effect of long-acting propranolol 160mg once daily were comparable to those of conventional propranolol 40mg three or four times a day. The compliance of the patients to long-acting propranolol once daily was naturally better than that to conventional propranolol which must be taken three to four times daily. 3) In several cases of trial, the patients who tolerated the long-acting propranolol 160mg per day also well tolerated the regimen of long-acting propranolol 320mg per day, 4) The regimen of long-acting propranolol once daily was recommendable to those patients who were on beta-blocking agents for prolonged period of time for their indications such as hypertension and other chronic cardiovascular diseases, in view of the aspects of good patient compliance, good antihypertensive and beta-blocking effect.
Blood Pressure ; Cardiovascular Diseases ; Compliance ; Humans ; Hypertension ; Internal Medicine ; Outpatients ; Patient Compliance ; Propranolol*

BACKGROUND: This study examined the efficacy of patient-controlled epidural analgesia (PCEA) for post-cesarean section pain control and compared the suitability of four different volumes of continuous background infusion (CBI). METHODS: Sixty patients were received 0.125% bupivacaine with 5 g/ml fentanyl by PCEA (2 ml of demand dose and 10 minutes of lockout interval) and CBI. Experimental groups were divided four groups according to the volumes of CBI; 1 ml/hr, 2 ml.hr, 3 ml/hr and 4 ml/hr of CBI during 48 hours postoperatively. RESULTS: Total amount of fentanyl and bupivacaine consumption was significantly higher in 1ml/hr of CBI group than 2 ml/hr of CBI group during first 24 hours, and in 4 ml/hr of CBI group than 1 ml/hr and 3 ml/hr of CBI group during second 24 hours. CBI/maximum hourly demand dose was 15~23%. There is no significant difference between the groups in pain score, side effects and patient's satisfaction. CONCLUSIONS: This study suggests that two or three ml/hr of CBI can provide the most effective postoperative analgesia and the optimal ratio of CBI/maximum hourly demand dose is about 20%.
Analgesia ; Analgesia, Epidural* ; Bupivacaine ; Fentanyl ; Humans

No abstract available.
Humans ; Twins* ; Umbilical Cord*

Hypertensive encephalopathy is an acute clinical syndrome that shows central nerve dysfunction with sudden and marked elevation in blood pressure. But its pathophysiologic mechanisms, clinical courses and prognosis are still not clear. In order to study clinical manifestations and response to treatment in patients with hypertensive encephalopathy, we reviewed 45 patients with hypertensive encephalopathy who were admitted in Dept. of Internal Medicine, National Medical Center, from January 1975 to December 1984. The following results were obtained: 1) The ratio of male to female was 1.1:1. The peak age of incidence was in the 6th and 7th decade with mean age of 57.5 years. 2) Among 45 patients, only 29 had known history of hypertension and the average duration of hypertension was 8.1+/-3.6 years. 3) The most common sympotm was severe headache (68.9%). And altered consciousness, nausea and/or vomiting, focal neurologic signs and visual disturbance were also common symptoms in decreasing order of frequency. 4) Funduscopic examination showed hypertensive retinopathy in 20 of 24 (91.7%) patients and lumbar puncture revealed increased CSF pressure in 12 of 20 (60%) patients. 5) In most patients, the mean interval to symptomatic improvement was 2.1 days after administration of anti hypertensive agents, but in 6 patients with initial mean arterial blood pressure above 170mmHg, 4 patients showed delayed response and 2 patients were expired.
Antihypertensive Agents ; Arterial Pressure ; Blood Pressure ; Consciousness ; Female ; Headache ; Humans ; Hypertension ; Hypertensive Encephalopathy* ; Hypertensive Retinopathy ; Incidence ; Internal Medicine ; Male ; Nausea ; Neurologic Manifestations ; Prognosis ; Spinal Puncture ; Vomiting

1) Daily dose was 10-20mg Q.D. for 12 weeks. 2) Mean systolic and diastolic pressure were decreased by 49mmHg(25.9%), and 18mmHg(16.8%) respectively. But there was no significant change in heart rate before and after treatment. 3) Systolic and diastolic blood pressure were stably maintained on the whole day. 4) There were no significant side effects except two cases of aggravated congestive heart failure and hypertension. 5) There were no significant changes on hematologic & biochemical parameters before and after treatment.
Blood Pressure ; Heart Failure ; Heart Rate ; Hypertension ; Nitrendipine*

A clinical review was made on 48 cases with cor pulmonale who were admitted to medical department, National Medical Center, between 1973 and 1982, and the results were as follows : 1) Teh age of subjects ranged from 26 to 88, and their mean was 51. male to female ratio was 1.6:1 and majority of them were in their 6th and 7th decade. 2) COPD was the most common cause of cor pulmonale but pulmonary tuberculosis had also a considerable portion. Less commonly it was caused by chest deformity which was mainly from spine tuberculosis and kyphoscoliosis. 3) Almost all patients were admitted with over heart failure. 4) Laboratory features showed indirect evidence of heart failure and pulmonary hypertension in chest X-ray films, RVH patterns in EKG and hypoxia and hypertcapnea with metabolic compensation in arterial gas analysis. 5) The case fatality rate was one-forth and that from kyphoscoliosis was especially high(80%).
Anoxia ; Compensation and Redress ; Congenital Abnormalities ; Electrocardiography ; Female ; Heart Failure ; Humans ; Hypertension, Pulmonary ; Male ; Mortality ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Heart Disease* ; Spine ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary ; X-Ray Film

A modern development of ambulatory ECG monitoring gave great advances in the diagnosis and evaluation of various cardiac conditions. Fifteen cases of ischemic heart disease, 11 cases of nonischemic heart disease, 5 cases of noncardiac disease and 9 cases of normal healthy subjects were studied from January 1980 to July 1981 in national Medical Center, with the following results: 1) The heart rate was decreased during night time, with less decreasing tendency in patients with ischemic heart disease. 2) Among 30 cases, including 12 patients with ischemic heart disease, who didn't show arrhythmia on routine 12 lead ECG, 12 cases, including 6 patients with ischemic heart disease, showed arrhythmia on Holter monitoring. 3) Among 5 cases with ischemic heart disease who showed premature ventricular contraction on day time monitoring, 2 cases didn't show premature ventricular contraction on nigh time monitoring. 4) The S-T segment and T wave were changed during night time in 2 cases with ischemic heart disease and in 2 normal subjects. From these results, we could assert that Holter monioring or ambulatory ECG tracing would be a good method for diagnosis and evaluation of ischemic heart disease, and other cardiac conditions. Several another studies with this equipment have to be performed and would give more distinctive outcomes.
Arrhythmias, Cardiac ; Diagnosis ; Electrocardiography ; Electrocardiography, Ambulatory* ; Heart Diseases ; Heart Rate ; Humans ; Myocardial Ischemia ; Ventricular Premature Complexes

The cardiac performance is regulated by the intergration of preload, afterload, contractility (inotropism), heart rate and synergy of ventricular contraction, which are the major determinants that govern the stroke volume and cardiac output. Valvular heart disease may be considered to impose two different types of stress on the cardiac chamber proximal to the lesion. There are either pressure overload(increased after load) or volume overload(increased preload). The compensatory mechanism of the pressure overload and volume overload offer to hypertrophy and dilatation of the chamber. Hypertrophy, increased muscle mass, calls upon the development of greater systolic force. Dilatation, overfilled chamber volume enables increased strength and extent of shortening by Frank Starling's mechanism. In these view, we shall discuss the hemodynamic parameters; cardiac output, stroke volume, ventricular end-diastolic pressure, and the rate of ventricular pressure rise(peak dp/dt), mitral valve gradient and pulmonary circulation. The authors had an opportunity to study 40 cases of mitral valvular heart disease which were accepted during the left ventricular angiography at the cardiac catheterization room and at the fields of operative findings during the period Jan. 1977, throught Sept. 1980, at the Department of Internal Medicine, National Medical Center. The following conclusions were drawn: 1) Cardiac index was 2.65 L/min/m2in average, among 18 cases with mitral stenosis and 2.54 L/min/m2 in average, among 15 cases with mitral valve area of less than 1.0 cm2. Cardiac index was 2.58 L/min/m2in average, among 19 cases with mitral stenoinsufficiency and 3.43 L/min/m2 in average, among 3 cases with pure mitral insufficiency. 2) The mean right ventricular end-diastolic pressure elevated more than 0-8 mmHg were found in 12 cases with mitral stenosis out of 18 cases and mean miral valve area was 0.8m2. The mean left ventricular end-diastolic pressure was also elevated more than 0-12 mmHg in 6 cases out of 12 cases with mitral stenosis in addition to right ventricular failure. These 12 cases of mitral stenosis had cardiac function more than class III clinically. 3) 15 cases with mitral valve area, less than 1.0cm2 demonstrated left ventricular diastolic filling pressure gradient (MVG) of 17.3mmHg in average, the pulmonary vascular resistance of 568 dyndsecd cm(-5) in average, and the right ventricular peak systolic pressure of 72mmHg in average respectively. In all instances, the right ventricular end-diastolic pressure was 11.2mmHg in average and right ventricular peak dp/dt was 571mmHg in average. 4) Among 22 cases with mitral insufficiency, and/or mitral stenoinsufficiency 16 cases showed mean left ventricular end-diastolic pressure elevated more than 0-12mmHg. 10 cases out of these 16 cases disclosed also right ventricular end-diastolic pressure elevated more than 0-8 mmHg. These 16cases of mitral insufficiency and/or mitral stenoinsufficiency had cardiac function more than class III clinically. 5) 16 cases with mitral insufficiency and/or mitral stenoinsufficiency who had mean left ventricular end-diastolic pressure more than 0-12 mmHg showed pulmonary vascular resistance, 358 dyndsecd cm(-5) in average, systemic vascular resistance, 1621 dyne/sec/cm5 in average and left ventricular peak dp/dt, 768-2102mmHg/sec in range. 6) Pulmonary hypertension elevated more than 50mmHg of pulmonary arterial systolic pressure was found in 14 cases out of 18 case with mitral stenosis and in 10 cases out of 22 cases with mitral stenoinsufficiency and/or mitral insufficiency. Pulmonary vascular resistance, however, was markedly variable.
Angiography ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Dilatation ; Heart Rate ; Heart Valve Diseases ; Hemodynamics* ; Humans ; Hypertension, Pulmonary ; Hypertrophy ; Internal Medicine ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Circulation ; Stroke Volume ; Vascular Resistance ; Ventricular Pressure

No abstract available.
Female ; Pregnancy ; Pregnancy, Ectopic*