BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.
Arterial Pressure ; Blood Pressure* ; Central Nervous System ; Cross-Over Studies ; Electroconvulsive Therapy* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Mood Disorders ; Oxygen ; Psychotic Disorders ; Seizures ; Tachycardia

It is well known that there is close relation of the left atrial pathology to atrial fibrillation(AF) in patients with mitral valvular disease. To evaluate such relation is existed or not in the right atrium, the right atrial wall biopsy was performed in 31 patients with mitral valvular disease during valve surgery. The specimens obtained were interpretated by the pathologist who had no information about the patients. The specimens were graded according to severity of morphological change. In Grade I, the atrial myocardium is degenerated and has moderate fibrosis in it. Grade II shows the atrial myocardial layer of the atrium and severe degenerated with pre and postoperative heart rhythm. Four patients had Grade I change and 3 patients among them had pre and postoperative AF. Eleven patients had Grade III changes and 9 among them had pre and postoperative AF. The results show there is strong tendency that the patients with pre and postopeative AF had Grade III change in the right atrium and the relation of the right atrial pathology to AF is same as that of the left atrium.
Atrial Fibrillation* ; Biopsy ; Fibrosis ; Heart ; Heart Atria ; Humans ; Myocardium ; Pathology*

A total of the 16 cases of rheumatic vavular heart desease were examined in order to compare fibrillatriy F wave with left atrial size and biopsy findings from October 1986 to April 1987 at the Ewha Womans University Hospital. The results were as follows : 1) Of the 16 patients, there were 5 males and 11 females. The mean age of the patients was 41.9+/-12.7 years old. 2) Among the 16 patients PTF-V1 was lesser than -0.04nn-sec, the left atrial size measured by M-mode echocardiography was 57.1+/-8.9mm. Inverse correlation between PTF-V1 and the left atrial size measured by M-mode echocardiography was observed(P<0.01). 3) No significant correlation between PTF-V1 and left atrial was found(P>0.01). 4) There was a tendency that the size of the left atrium was, the more degeneration, necrosis and fibrosis of the left atrial wall appeared through pathological findings.
Atrial Fibrillation ; Biopsy* ; Echocardiography ; Female ; Fibrosis ; Heart ; Heart Atria ; Heart Valve Diseases* ; Humans ; Male ; Necrosis

To identify the developmental characteristics of intermediate filaments, the expressions of various cytokeratines (CK), desmin and vimentin in fetal (14032 weeks of gestations) and adult epidermis were studied immunohistochemically. The primary antibodies used were CK7, 8, 10, 14, 18, AE8, 5D3, and MNFl16 for cytokeratins, D33 for desmin, and V9 for vimentin. At 14 weeks of gestation, the epidermis consisted of basal cells and periderm. The periderm exhibited positive staining for CK8 and AE8, and weak staining for MNF116 and D33. The basal cells showed positive staining for MNF116 and D33. The epidermis did not reacted for CK7, 10, 14, 18, 5D3, and V9 at this period. At 16-20 weeks of gestation, the epidermis was composed of basal, intermediate, and periderm layers. The periderm was positive for CK8, 18, AE8, MNF116, and D33. The intermediate cells were positive for CK10 and the basal cells CK14, MNF116, and D33. Few cells were stained positively with V9 among the basal cells. At 24-32 weeks of gestation, the epidermis exhibited no longer positive reactions for CK8, 18, AE8 and D33. The intermediate cells were positive for CK10. Immunoreactivity for MNF116 was noted in intermediate layer just above the basal layer. CKl4, MNFl16, D33, and often V9 were expressed in basal cells. The expressions of CK7 and 5D3 were not observed at any period of gestation. In adult epidermis, basal cells exhibited positive staining for CKl4, MNFl16, and D33. The intermediate cells were strongly positive for CK10, and weakly positive for CK7, 8, and MNFl16. The cells positive for V9 were often present among the basal cells. These results indicate that CK8 and 18 may serve as useful markers for periderm, CK10 for intermediate cells, CKl4 for basal cell, and suggest that the vimentin immunoreactive cells in basal cell layer are Langerhans cells.
Adult ; Antibodies ; Desmin ; Epidermis* ; Fetus* ; Humans* ; Immunohistochemistry ; Intermediate Filaments ; Keratins* ; Langerhans Cells ; Pregnancy ; Vimentin

In order to evaluate the effecacy of 2D-Doppler echocardiography for the measurement of pulmonary flow(Qp), systolic flow(Qs), the ratio of pulmonary flow and systemic flow and systemic flow(Qp/Qs), 19 membranous ventricular septal defect patients were examined in the period from July, 1986 to October, 1987 at Ewha Women's university hospital. The measurement of Qp, Qs, Qp/Qs by 2D-Doppler echocardiography were compared with the results by the Fick's method of cardiac catheterization.The following results were obtained. 1) The total of the 19 patients consisted of 15 males and 4 females. The mean age of the patients was 8.2 years. 2) It was found that the Fick's method and 2D-Doppler measurements of Qp (n=19, r=0.67), Qs (n=19, r=0.88), and Qp/Qs ratio(n=19, r=0.62) were highly correlated(p<0.01). 3) It is understood that the measurement of Qp, Qs, Qp/Qs ratio by 2D-Doppler echocardiography were quite useful to the noninvative diagnosis of ventricular septal defect.
Cardiac Catheterization* ; Cardiac Catheters* ; Diagnosis ; Echocardiography* ; Echocardiography, Doppler ; Female ; Heart Septal Defects, Ventricular* ; Humans ; Male

To evaluate the role of MR in the examination of Legg-Calve-Perthes(LCP) disease, we retrospectively analysed the signal intensity of the osseous lesion, thickness of the articlar cartilage, change of surrounding soft tissue. Joint effusion and femoral head containment in 32 cases of LCP diseases in 27 patients. The bony lesion was limited witin the epiphysis in 19 cases(59%) and extended to the physis and metaphysis in 13 cases(41%). The epiphyseal lesion showed homogeneous(26/32) or heterogeneous(6/32) low signal intensity(ST) on T-1 weighted images(T1WI). And homogeneous (16/28) or heterogeneous(12/28)low SI on T-2 weighted images(T2WI). The metaphyseal lesion showed low SI(13/13) on T1WI, and low(9/11) or iso(3/11)SI on T2WI. Associated metaphyseal cyst showed low SI on T1WI and high SI on T2WI. An althought physeal involvement(13/32) was indistinct, the lesion showed increased SI on both T1 and T2WI. Thickening of articular cartilage(32/32), swelling f the ligamentum teres(7/32), synovial hypertrophy(7/32) and joint effsion(27/32) were demonstrated. Lateral subluxation of the femoral head on coronal image indicated incongruity of the femoral head in 25cases(78%) We conclude that MR is an useful tool for the diagnosis as well as treatment planning in LCP disease.
Cartilage ; Containment of Biohazards ; Diagnosis ; Epiphyses ; Head ; Humans ; Joints ; Legg-Calve-Perthes Disease* ; Retrospective Studies

One-hundred ninty five cases with Kawasaki disease who were diagnosed and treated at the Department of Pediatrics, Kyung Hee University Hospital from January 1985 to June 1993, were investigated for their clinical manifestations and laboratory findings, and cardiac complications. The results are as follows: 1) Most patients (92.8%) were under 5 years of the age. 2) Boys were more prevalent than girls, as a ratio of 2.3 : l 3) The incidence of principal symptoms and signs were fever over 5 days (89.8%), bilateral conjunctival injection (78.5%), changes of oral mucosa and lip (82.3%), skin eruption (72.8%), changes in extremities (58.5%), and cervical lymphadenopathy (47.2%). 4) The main laboratory findings observed were anemia (29.2%), leukocytosis (90.8%), thrombocytosis (89.7%), increased ESR (85.1%), positive CRP (100%), increased sGOT (33.3%), increased sGPT (34.9%), pyuria (41.5%), proteinuria (5.6%), microscopic hematuria (9.7%), and abnormalities of EKG (23.5%). 5) Abnormal findings of the heart were found in 27.2% by echocardiogram and coronary aneurysm and dilatation were present in 19.7%. 6) Among 147 cases assessed by echocardiogram, the abnormalities of coronary artery were present in 16 of 92 cases (17.4%) in the aspirin and intravenous gammaglobulin treated group, as compared with 13 of 55 cases (23.6%) in the aspirin treated group.
Alanine Transaminase ; Anemia ; Aspartate Aminotransferases ; Aspirin ; Coronary Aneurysm ; Coronary Vessels ; Dilatation ; Electrocardiography ; Extremities ; Female ; Fever ; Heart ; Hematuria ; Humans ; Incidence ; Leukocytosis ; Lip ; Lymphatic Diseases ; Mouth Mucosa ; Mucocutaneous Lymph Node Syndrome ; Pediatrics ; Proteinuria ; Pyuria ; Skin ; Thrombocytosis

The present study has been undertaken to investigate the values of serum lipids with hypertension and ischemic heart diseases. Serum lipids and lipoproteins were measured from 231 cases of hypertension, 23 cases of angina pectoris, 18 cases of acute myocardial infarction and 67 healthy adults together with normal value as controls. The results obtained were as follows: 1. The mean values of serum lipids in healthy adults were 111.0+/-41.3mg% for triglyceride, 171.2+/-33.5mg% for cholesterol, 175.1+/-36.3mg% for phospholipid, 479.9+/-82.6mg% for total lipid. The values of serum lipoproteins were 219.8+/-46.8mg% for beta-lipoprotein, 93.4+/-53.8mg% for pre beta-lipoprotein and 164.1+/-40.8mg% for alpha-lipoprotein. The values of cholesterol, triglyceride and beta-lipoprotein were gradually increased with aging. 2. The mean values of serum lipids in patients with hypertension were 176.3+/-94.5mg% for triglyceride, 199.7+/-36.9mg% for cholesterol, 207.8+/-38.0mg% for phospholipid, 601.9+/-139.9mg% for total lipid. The values of serum lipoproteins were 266.0+/-73.5mg% for beta-lipoprotein, 147.7+/-89.5mg% for pre-beta-lipoprotein and 187.7+/-56.7mg% for alpha-lipoprotein. The serum lipid values in patients with hypertension were significantly higher than those in healthy controls. 3. The mean values of serum lipids and lipoproteins in patients with angina pectoris were significantly higher than in healthy controls. 4. The serum lipid values in general were higher rather in patients with acute myocardial infarction than healthy controls, but the values of serum phospholipid, pre-beta-lipoprotein and alpha-lipoprotein in them were not significantly higher than those in healthy controls. 5. The values of serum HDL-cholesterol in patients with hypertension, anginal pectoris and acute myocardial infarction were lower than those in healthy controls. The values of serum HDL-cholesterol in all cases were in general higher rather in femal than male.
Adult ; Aging ; Angina Pectoris ; Cholesterol ; Humans ; Hypertension* ; Lipoproteins ; Male ; Myocardial Infarction ; Myocardial Ischemia* ; Reference Values ; Triglycerides

OBJECTIVES: The myelodysplastic syndromes (MDS) are a group of acquired clonal hematopoietic disorders characterized by peripheral cytopenias and a hypercellular or normocellular dysplastic bone marrow. The mechanisms responsible for development of MDS are not known. We performed this study to evaluate the hematopoietic abnormalities and apoptosis in MDS. METHODS: Long-term bone marrow culture (LTBMC) was performed for colony assays, cobblestone area assay, stromal morphologic changes from 7 patients with MDS and 7 normal controls. In situ nick end labeling (ISNEL) method was performed for detection of apoptosis from LTBMC in 7 patients with MDS and 7 normal controls. ISNEL method also performed in bone marrow cell bloc samples in 36 patients with MI3S. RESULTS: Viability of nonadherent cells from LTBMC of patients with MDS was not decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Formation of the cobblestone areas from patients with MDS was slightly decreased compared with normal controls at 1st week, but significantly decreased at 2nd and 3rd weeks compared with normal controls (P<0.0001). Slightly decreased compared with normal controls at 1 week, but significantly decreased at 2 and 3 weeks compared with normal controls (P<0.0001). Stromal layers produced in LTBMC of normal controls and 1 patient with MDS were detected at 1 week and were formed confluent stroma from 3 weeks, but another patients with MDS who did not form a confluent stroma. Patients with MDS had significantly lower colony forming unit granulocyte-macrophage (CFU-GM) compared with normal controls at 1 (P<0.01) and 2 weeks (P<0.001) of LTBMC. Two weeks of LTBMC resulted more profound inhibition of CFU-GM formation than 1 week (P<0.0001). Apoptotic cell death was absent in adherent and non adherent cells from normal controls at 1 and 2 weeks, but massive apoptotic cell death was found in adherent and non adherent cells from patients with MDS at 1 and 2 weeks and the degree of apoptosis was profound at 2 weeks compared with 1 week. Among the 36 patients, fifteen patients demonstrated varying degrees of apoptosis positive cells, 4 having low, 8 intermediates, and 3 high scores. Remaining 21 patients showed absent apoptosis or only occasional positive cells. CONCLUSION: Hematopoietic abnormalities such as a failure of differentiation are caused by the stromal defects and the biologic basis of the apparent paradox of peripheral cytopenias in the face of hypercellular (or normocellular) marrow is related by intramedullary apoptotic cell death of the stromal and hematopoietic cells.
Apoptosis* ; Bone Marrow Cells ; Bone Marrow* ; Cell Death ; Granulocyte-Macrophage Progenitor Cells ; Humans ; In Situ Nick-End Labeling* ; Myelodysplastic Syndromes* ; Stem Cells

A malformation of azygos and hemiazygos system were observed from the cadaver for anatomy practice in College of Medicine, Chungnam National University. The observing results were as followings ; Hemiazygos vein was connected with left superior vena cava and drained into coronary sinus, which engorged enough to fill up with blood about 20cc to 30cc. Communicating pathway from hemiazygos vein to azygos veln wasn't found the diameter of left brachiocephalic vein was very small, about 2mm to 3mm. And, the diameter of left internal jugular vein was smaller than that of right infernal jugular vein. In this case, the azygos and hemiazygos system ceased its development at early embryologic stage(around 7 week embryo) and didn't progress into next stage.
Brachiocephalic Veins ; Cadaver ; Chungcheongnam-do ; Coronary Sinus ; Jugular Veins ; Veins ; Vena Cava, Superior