No abstract available.
Coronary Sinus*

BACKGROUND: The effectiveness for vagal stimulation by ice water aplication to face during metronome-controlled respiration of 15 breaths/minute was examed. The importance of basal vagal tone and sympathovagal interaction in the individual variability of responsiveness to the vagal stimulation was investigated. METHOD: Fifty three 12~13 year old healthy volunteers were included. Vagal tone and sympathovagal interaction before and after application of ice water to the face were assessed by power spectral analysis of RR interval(heart rate) variability. RESULT: Basal heart rate, high frequency power, and low to high frequency power ratio were 81+/-13(58~110 beats/min), 791+/-1061(56~4161 msec2) and 1.08+/-1.22(0.04~4.85) during controlled respiration. After ice water application twenty three children developed 5 more nodal escape beats due to severe bradycardia. Minimum heart rate, high frequency power and low to high power ratio changed to 42+/-12(19~72/min), 1890+/-1882(221~7258msec2) and 0.64+/-0.43(0.12~1.46). The increased ratio of high frequency power, maximum heart rate decrement and its percent after stimulation were 5.44+/-5.62(0.63~24.26), 39+/-14(10~81/min) and 47+/-15(16~81%) respectively. The increased ratio of high frequency power was correlated with basal logarithmic high frequency power(r=-0.60, p=0.0004). Maximum heart rate decrement was correlated with basal logarithmic high frequency power(r=-0.41, p=0.0018) and low to high frequency power ratio(r=0.27, p=0.04). CONCLUSION: Application of ice water to the face during controlled respiration produces powerful vagal stimulation and bradycardia, however, there is a wide individual variability of responsiveness to it. The absolute basal vagal tone contribute to this individual variability.
Bradycardia ; Child ; Healthy Volunteers ; Heart Rate* ; Heart* ; Humans ; Ice* ; Respiration* ; United Nations ; Water*

BACKGROUND: To investigate the possibie difference, if any, between office blood pressure(BP) and home BP may be important in the diagnosis and treatment of hypersensive patients. This report deails the difference between the two BP's and the usefulness of digital electronic sphygmomanometer(DES) for self-monitoring of home BP. METHODS: The BP's of 14 patients with essential hypertension were measured with mercury sphygmomanometers at outpatient department by physician and with DES at home(twice a day) by the patients. Patients were followed up every 2 weeks for 4 weeks and previous 2 weeks' average home BP's were compared with the office BP's of each 2 weeks' end. RESULTS: There was a significant difference between office and home BP(both systolic and diastolic) ; office average BP(151/95mmHg) was higher than home average BP(136/86mmHg). CONCLUSION: Caution may be needed in the interpretation of office BP unless it is measured several times after adequate rest.
Blood Pressure* ; Diagnosis ; Humans ; Hypertension ; Outpatients ; Sphygmomanometers*

BACKGROUND: It is well known that systemic blood pressure oscillates with low(0.04~0.1Hz), mid(0.1~0.15Hz), and high(respiratory) frequency range. But there has been no study about oscillation of pulmonary artery pressure(PAP). METHOD: We measured PAP for 5 minutes in 32 patients of ventricular septal defect and stored them to computer files. Power spectral density curve was obtained. Low, mid, respiratory frequency power were measured by integrating the area within each frequency range below the power density curve. RESULT: The incidence of significant low frequency power(more than 5% of total power) were higher in patients of high PAP and hign Rp/Rs than those of low PAP and Rp/Rs(p<0.01 and p<0.005 respectively). The low frequency power positively correlates with PAP and Rp/Rs(r=0.62, p<0.0005 and r=0.61, p=0.0005 respectively). CONCLUSION: It can be said conclusively that as PAP and pulmonary vascular resistance elevates, the PAP tends to definitively oscillate in low frequency range.
Blood Pressure ; Heart Septal Defects, Ventricular ; Humans ; Incidence ; Pulmonary Artery* ; Vascular Resistance

The sensitivity and specificity of ST segment change on ECG for detection of coronary artery disease(CAD) by pacing stress test were assessed. Among 28 cases with chest pain(mean age 52, M/F : 21/7), 10 patients had normal coronary angiographic finding(Group I), and 18 had coronary artery disease(Group II). Pacing stress test showed high specificity(100%), but low sensitivity(61%) for the diagnosis of CAD. Especially in patients with 1 vessel disease, the sensitivity was only 50%, and positive results were not attained unless there was at least 90% or more stenosis in any of the major branches(LAD, RCA or LCX). But in patients with multivessel disease, the sensitivity was much higher(83%). Lateral(V4-6) or inferior leads(2, 3, aVF) showed ischemic ST segment depression most commonly. Therefore one of the inferior lead and V5 may be a minimum requirement for monitoring pacing-induced ST segment changes. Time constant during isovolumic relaxation showed statistically significant prolongation after pacing only in CAD patient group, suggesting pacing-induced impairment of early left ventricular relaxation.
Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Depression ; Diagnosis* ; Electrocardiography ; Exercise Test ; Humans ; Relaxation ; Sensitivity and Specificity ; Thorax

A case of pulmonary vein aneurysm is presented. Chest X-ray revealed round density along the right cardiac border in right lower lung field. The round density was suspected as solid tumor initially, but the angiocardiogram showed dealyed opacification of right inferior pulmonary vein. So it was confirmed as pulmonary vein aneurysm. This patient took mitral valve replacement because of mitral and aortic regurgitation. Pulmonary vein aneurysm is considered as congenital in origin and pulmonary venous hypertension has its pathogenetic role in enlarging the varix. Pulmonary vein aneurysm probably has little clinical significance although cases of spontaneous rupture have been reported. There are a few reported cases in the literature, but the actual incidence probably is much higher than reported. This is the first to be reported in Korean literature.
Aneurysm* ; Aortic Valve Insufficiency ; Humans ; Hypertension ; Incidence ; Lung* ; Mitral Valve ; Pulmonary Veins* ; Rupture, Spontaneous ; Thorax ; Varicose Veins

Pulsed Doppler echocardiography was performed before and five to fifteen days (mean, 9.3 days) after mitral valve surgery to evaluate the change of pulmonary arterial pressure in 80 patients (29 males and 51 females) with mitral valve disease by preejection period (PEP)/acceleration time (AT) ratio at the right ventricular outflow tract. In 13 patients with pulmonary hypertension (mean pulmonary arterial pressure equal to or greater than 20mmHg), Doppler echocardiography was followed three to twelve months after operation. In 76 patients with a mitral valve prosthesis (15 patients with the Bjork-Shiley valve, 28 patients with the Ionescu-Shiley valve, and 33 patients with the St. Jude valve), mean transmitral pressure gradient and pressure-half time were estimated by continuous wave Doppler echocardiography five to fifteen days after operation. 1) PEP/AT Ratio by pulsed Doppler echocardiography correlated well with the mean pulmonary arterial pressure gradient by cardiac catheterization (r=0.83, p<0.001). 2) After mitral valve surgery, PEP/AT ratio decreased significantly (p<0.001). In group with mean pulmonary arterial pressure equal to or greater than 40mmHg, immmediate postoperative PEP/AT ratio was greater (P<0.05) than that in group with mean pulmonary arterial pressure less than 20 mmHg, but, difference between the preoperative and postoperative PEP/AT ratio was much greater (P<0.001) than that in group with mean pulmonary arterial pressure between 20 and 39 mmHg. 3) In 13 patients, on whom repeated Doppler echocardiography performed, PEP/AT ratio decreased immediately after mitral valve surgery (p<0.001). After then, it decreased further, but, the amount of the decrease was much smaller than immediate one (p<0.001). 4) There was no significant difference in postoperative PEP/AT ratio among the different prosthesis. Mean transmitral pressure gradient and pressure half-time of the Bjork-Shiley, Ionescu-Shiley, and St, jude valves were 3.1 mmhg and 67.3 msec, 2.9 mmHg and 65.3 msec, and 2.7 mmhg and 60.2 msec, repectively. The St.Jude valve had somewhat smaller mean transmitral pressure gradient and pressure half-time, but there was no statistical significance. In conclusion, elevated pulmonary arterial pressure in patients with mitral valve disease decreased greatly within 15 days after operation, and Doppler echocardiography was a useful method in the follow-up of prosthetic mitral valve function.
Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Echocardiography, Doppler ; Echocardiography, Doppler, Pulsed ; Follow-Up Studies ; Humans ; Hypertension, Pulmonary ; Male ; Mitral Valve* ; Prostheses and Implants

The clinical utility of thallium-201 SPECT combined dwith pharmacologic vasodilation induced by oral dipyridamole as an alternatiove to intravenous dipyridamole was incestigated in 21 patients who had concomitant coronary arteriography. Tomographic images were assessed visually. Sensitivity & specificity for overall detection of coronary artery disease were 93.7% and 80% respectively. Sensitivity & specificity for identification of indevidual diseased vessels were 84.6% and 87.5% for the left anterior descending artery, 75% and 84.6% for the right coronary artery, 60% and 100% for the left circumflex artery, respecitively. Of the 26 patients unergoing thallium scintigraphy 11 patients(42.3%) had some adverse effects between 20 and 50 minutes after oral dipyrdamole ingestion, including headache(26.9%), chest pain(26.9%), electrocardiographic changes(19.2%), and nausea(11.5%). Intravenous aminophylline was used to resolve these adverse effects in 8 patients & most of the adverse effects were subsided within 10 minutes. There was no ventricular arrhythmias, myocardial infarctions or deaths. In conclusion, oral dipyridamole thallium-201 SPECT is safe and accurate test for the overall detection of coranary artery disease and identification of disease in individual arteries. Furthermore it is useful for determining the necessities of coronary reperfusion and prognstically stratiofying the patients with coronary artery disease.
Aminophylline ; Angiography ; Arrhythmias, Cardiac ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Dipyridamole* ; Eating ; Electrocardiography ; Humans ; Myocardial Infarction ; Myocardial Perfusion Imaging* ; Myocardial Reperfusion ; Radionuclide Imaging ; Sensitivity and Specificity ; Thallium ; Thorax ; Tomography, Emission-Computed, Single-Photon* ; Vasodilation

Cardiac myxoma is rare and has protean clinical manifestations mimicking various disease. Unless clinician has a high index of suspicion, the diagnosis can be easil missed. However diagnosis is all the more important since surgery can be dramatically successful, where as untreated myxoma invariably leads to death. Cardiac myxoma accounts for 50% of primary cardiac tumor and mainly originates in left atrium.(75%). The features of myxoma can be described under the three headings : Constitutional, obstructive, and embolic. From 1977 to 1985, the authors have experienced 30 cases of cardiac myxoma, one of which recurred. Of 29 patients, 8 were male and 21 were female. Their ages ranged from 11 to 55 years with average of 39.8 years. Constitutional manifestation was found in 25 of the 27 patients, obstructive manifestation in 27, and embolic phenomenon in 5. The diagnosis of myxoma was made on the basis of 2-D echocardiography. The sensitivity was 100%. Except 1 case who refused operation, all received surgical treatment. Immediate postoperative complication occurred in 6 patients(23%). Among them serious complication could be found only in 2 cases(7.7%). During long term follow up there was one recurrence and one patient with right ventricular myxoma has tricuspid regurgitation. In other cases, we could not found any problems.
Diagnosis ; Echocardiography ; Female ; Follow-Up Studies ; Head ; Heart Neoplasms ; Humans ; Male ; Myxoma* ; Postoperative Complications ; Recurrence ; Tricuspid Valve Insufficiency

STATEMENT OF PROBLEM: Since the introduction of the concept of osseointegration in dental implants, high long-term success rates have been achieved. Though the use of dental implants have increased dramatically, there are few studies on domestic implants with clinical and objective long-term data. PURPOSE: The aim of this retrospective study was to provide long-term data on the Implantium(R) implant, which features a sandblasted and acid-etched surface and internal connection with microthreads. MATERIAL AND METHODS: 106 Implantium(R) implants placed in 38 patients at Yonsei University Hospital were examined to determine the effect of various factors on implant success and marginal bone loss, through clinical and radiographic results during a 6 to 30 month period. RESULTS: 1. Out of a total of 106 implants placed in 38 patients, one fixture was lost, resulting in a 99.1% cumulative survival rate. 2. Among the 96 implants which were observed throughout the study period, the survival rates were 97.0% in the maxilla and 100% in the mandible. The survival rate in the posterior regions was 98.9% and 100% in the anterior regions. 3. The mean bone loss during the first year after prosthesis placement was 0.17 mm, while the mean annual bone loss after the first year was 0.04 mm, which was statistically less than during the first year (P < .05). 4. There was no significant difference in marginal bone loss according to age during the first year (P > .05), but after the first year, the mean annual bone loss in patients above 50 years was significantly greater (P < .05) compared with patients under 50 years. 5. No significant difference in marginal bone loss was found according to the following factors: gender, jaw, location in the arch, type of implant (submerged or non-submerged), presence of bone grafts, type of prostheses, and type of opposing dentition (P < .05). CONCLUSION: Based on these results, the sole factor influencing marginal bone loss was age, while factors such as gender, jaw, location in the arch, type of implant, presence of bone grafts, type of prostheses and type of opposing dentition had no significant effect on bone loss. In the present study, the success rate of the Implantium(R) implant with a SLA surface and internal connection with microthreads was satisfactory up to a maximum 30 month period, and the marginal bone loss was in accord with the success criteria of dental implants.
Dental Implants ; Dentition ; Humans ; Jaw ; Mandible ; Maxilla ; Osseointegration ; Prostheses and Implants ; Retrospective Studies ; Survival Rate ; Transplants