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

BACKGROUND AND OBJECTIVES: QT dispersion (QTd) is defined as the difference between the maximum and minimum QT interval in any of the 12 leads of the surface ECG. QTd has been shown to reflect regional variations in ventricular repolarization. Ischemic dilated cardiomyopathy (DCM) may lead to more spatial and temporal dispersion in ventricular repolarization than idiopathic DCM. The purpose of this study was to determine the difference of QTd between patients who had ischemic and idiopathic DCM. MATERIALS AND METHODS: The study population included 30 patients with ischemic DCM and 30 with idiopathic DCM. All standard 12-lead ECGs were examined prospectively by two observers who were unware of the patient's details. RESULTS: QTd in ischemic DCM was significantly higher than that in idiopathic DCM (63+/-32 vs. 44+/-26 msec, p=0.012) and JTd in ischemic DCM was significantly higher than that in idiopathic DCM (48+/-21 vs. 36+/-22 msec, p=0.036). Results did not change when Bazett's QTc and JTc was substituted for QT (QTcd:69+/-33 vs. 52+/-28 p=0.039) and JT (JTcd:56+/-21 vs. 41+/-25 p=0.043). CONCLUSION: Ischemic DCM has increased spatial inhomogeneity of repolarization probably due to more regional myocardial damages compared with idiopathic DCM. The value of QT dispersion as an easily accessible, non-invasive method in predicting the risk of life threatening arrhythmia and overall mortality in patients with dilated cardiomyopathy must be confirmed in prospective trials.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated* ; Electrocardiography ; Heart Failure ; Humans ; Mortality ; Prospective Studies

Primary cardiac lymphoma defined as involving only the heart and pericardium, is very rare and is diagnosed predominantly late in the course of illness or autopsy. This tumor is commonly fatal and until recently were rarely diagnosed antemortem. Recently, it was reported in patients with acquired immunodeficiency syndrome. We report a case of primary cardiac lymphoma in a 56 year old female who showed progressive exertional dyspnea. On echocardiogram and CT scan, large ill defined mass was demonstrated in right atrial and ventricular wall. It was diagnosed as B-cell type lymphoma on open cardiac biopsy.
Acquired Immunodeficiency Syndrome ; Autopsy ; B-Lymphocytes ; Biopsy ; Dyspnea ; Female ; Heart ; Heart Neoplasms ; Humans ; Lymphoma* ; Middle Aged ; Pericardium ; Tomography, X-Ray Computed

BACKGROUND: The number of patients suffering from acute myocardial infarction is on the increase in Korea due to the westernization of life style. Recent improvement of therapeutic stratigies have shown early mortality benefits in acute myocardial infarction. But we don't have data how many patients died and what's the cause of death in these patients. This study aimed to find out the mortality rate, cause of death and it's relevant prognostic factors of myocardial infarction (MI) patients who admitted alive, and to construct a database which will be used to develop a risk stratification strategy for the implementation of new preventive therapeutic modalities, such as implantable cardioverter-defibrillator (ICD). METHODS: Seven hundred and forty two MI patients admitted to our hospital from March, 1999 to August, 2002 were included in this study. The risk factors and survivals were evaluated by medical record searching and telephone survey in these patients. RESULTS: The average age was 64 years-old and 67% was male. During the mean follow up 20.7+/-15.4 months, total 105 cardiac death (14.2%) was occurred and cumulative mortality rate at 1 year and 2 year was 5.69% and 10.80%, respectively. Of the total 129 death, in-hospital death was 68 (cardiac death 48, non-cardiac death 20) and out of hospital death was 60 (cardiac death 57, non-cardiac death 4). When it comes to cause of death, most common cause of cardiac death was malignant arrhythmia. The proportion of malignant arrhythmia in cardiac death was 81.3% and 72% of in-hospital and out of hospital death, respectively. Multivariate analysis showed that old age, low LV ejection fraction and no percutaneous coronary intervention (PCI) treatment were independent risk factors for cardiac mortality. CONCLUSIONS: Myocardial infarction shows still high mortality rate despite the recent development of therapeutic strategy. As post-MI patients with low LVEF or no PCI shows high mortality, the early reperfusion therapy should be encouraged. Additionally, because malignant arrhythmia was one of the most in cause of cardiac death, ICD therapy to prevent sudden cardiac death should be considered in an active manner.
Arrhythmias, Cardiac ; Cause of Death* ; Death ; Death, Sudden, Cardiac ; Defibrillators, Implantable ; Follow-Up Studies ; Humans ; Korea ; Life Style ; Male ; Medical Records ; Middle Aged ; Mortality* ; Multivariate Analysis ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Reperfusion ; Risk Factors ; Telephone

PURPOSE: The goal of this study was to characterize the difficulty index of the items in the skills test components of the class I and II Korean emergency medical technician licensing examination (KEMTLE), which requires examinees to select items randomly. METHODS: The results of 1,309 class I KEMTLE examinations and 1,801 class II KEMTLE examinations in 2013 were subjected to analysis. Items from the basic and advanced skills test sections of the KEMTLE were compared to determine whether some were significantly more difficult than others. RESULTS: In the class I KEMTLE, all 4 of the items on the basic skills test showed significant variation in difficulty index (P<0.01), as well as 4 of the 5 items on the advanced skills test (P<0.05). In the class II KEMTLE, 4 of the 5 items on the basic skills test showed significantly different difficulty index (P<0.01), as well as all 3 of the advanced skills test items (P<0.01). CONCLUSION: In the skills test components of the class I and II KEMTLE, the procedure in which examinees randomly select questions should be revised to require examinees to respond to a set of fixed items in order to improve the reliability of the national licensing examination.
Emergencies* ; Emergency Medical Technicians* ; Humans ; Licensure*

Behcet's disease is multi-systemic vasculitis affecting all sizes of arteries and veins. The prevalence of coronary involvement in Behcet's disease is extremely rare. A 35-year-old woman with one-year history of Behcet's disease was in hospitalized with pseudoaneurysm of left anterior descending coronary artery, which was detected by echocardiography. The patient was successfully treated by implantation of an endovascular graft-stent.
Adult ; Aneurysm, False* ; Arteries ; Coronary Vessels* ; Echocardiography ; Female ; Humans ; Prevalence ; Vasculitis ; Veins

Patients with systemic lupus erythematosus (SLE) are at an increased risk of developing thromboses with antiphospholipid antibodies (aPL). The presence of aPL is related to an increased risk of thrombotic events. However, thromboembolic events can occur in SLE patients without aPL, and pulmonary emboli are rarely reported manifestations of SLE without aPL. Here, we report on a case of massive pulmonary embolism in a 58-year-old woman with aPL-negative SLE. She presented with chest pain and dyspnea, and chest computed tomography (CT) and lung perfusion ventilation scans showed pulmonary thromboembolism. She was administered thrombolytic agents, heparin, and warfarin. Two months later, no remarkable residual thromboembolism was observed on chest CT.
Antibodies, Antiphospholipid* ; Chest Pain ; Dyspnea ; Female ; Fibrinolytic Agents ; Heparin ; Humans ; Lung ; Lupus Erythematosus, Systemic* ; Middle Aged ; Perfusion ; Pulmonary Embolism* ; Thorax ; Thromboembolism ; Thrombosis ; Tomography, X-Ray Computed ; Ventilation ; Warfarin

Imidapril(Tanatril(R)), a newly developed ACE inhibitor, has been used to treat hypertension and congestive heart failure. This study was designed to assess the antihypertensive effect and safety of Imidapril(Tanatril(R)) in patient with essential hypertension. 5-10mg of imidapril(Tanatril(R)) was administered once day in 30 patients with essential hypertension and followed up to 8 weeks. We tested the drug's effectiveness, safety, and the incidence of imidapril induced dry coughs. After 8 weeks of treatment with Imidapril, 76.2%(16/21) of patient showed lowered blood pressure and 47.6% showed normal blood pressure. The overall incidence of adverse effects was 33.3%(7/21). and among these adverse effects. dry cough was shown in only 9.5%. Thus, concluded that imidapril(Tanatril(R)) is as safe and effective as other ACE inhibitors. especially with imidapril showing very little incidence of dry cough compared to other ACE inhibitors.
Angiotensin-Converting Enzyme Inhibitors ; Blood Pressure ; Cough ; Heart Failure ; Humans ; Hypertension* ; Incidence

Purpose: We studied the effect of interleukin-8 (IL-8) as the factor for angiogenesis in the joint fluid of remnantpreserved anterior cruciate ligament reconstruction (RP-ACLR). Materials and methods: We measured 12 cytokines in joint fluid by multiplex assay and assessed the relationship between IL-8 and vascular endothelial growth factor (VEGF) concentrations. The signal intensity and mean sagittal diameter via postoperative magnetic resonance imaging (MRI) scans were evaluated and the stress X-ray image was analyzed at 3, 6, and 12 months after operation. Results: The IL-8 concentration was highest 3 months postoperatively in those patients who underwent RP-ACLR.Clinical data also showed that the signal intensity and stress radiography of the knee graft were significantly better at the early postoperative stage.Discussion: Our results show that IL-8 plays an important role in angiogenesis within 3 months after RP-ACLR. This effect yields better recovery after operation. RP-ACLR patients with high knee stability in clinical data were identical to those with high expression of IL-8 in experimental data. Therefore, IL-8 has been shown to help revascularization and ligamentization of the grafted tendon. These results indicate that IL-8 in RP-ACLR is an important factor for angiogenesis after operation. Unfortunately, the relationship of IL-8 and VEGF in vivo has not been studied. Conclusion Our results showed that the IL-8 concentration was very high within 3 months after RP-ACLR operation. The increase in concentration of IL-8 over time was consistent with the increase in VEGF concentration.In the IL-8 clinical setting, MRI analysis showed that ACL synovialization and tension were better in patients who underwent the remnant preservation method. In addition, it was shown that RP-ACLR may be advantageous for early anterior stability within 1 year post operation and beneficial for tendon graft in the early stage post operation.Taken together, our findings suggest that IL-8 may contribute to angiogenesis which is helpful for revascularization and ligamentization of the graft tendon in the early stages of RP-ACLR.

The purpose of this study was to provide a basis for studying the molecular mechanism of pharmacological action of chlorhexidine digluconate. Large unilamellar vesicles (OPGTL) were prepared with total lipids extracted from cultured Porphyromonas gingivalis outer membranes (OPG). The anthroyloxy probes were located at a graded series of depths inside a membrane, depending on its substitution position (n) in the aliphatic chain. Fluorescence polarization of n- (9-anthroyloxy)stearic acid was used to examine effects of chlorhexidine digluconate on differential rotational mobility, while changing the probes' substitution position (n) in the membrane phospholipids aliphatic chain. Magnitude of the rotational mobility of the intact six membrane components differed depending on the substitution position in the descending order of 16- (9-anthroyloxy)palmitic acid (16-AP), 12, 9, 6, 3 and 2- (9-anthroyloxy)stearic acid (12-AS, 9-AS, 6-AS, 3-AS and 2-AS). Chlorhexidine digluconate increased in a dose-dependent manner the rate of rotational mobility of hydrocarbon interior of the OPGTL prepared with total lipids extracted from cultured OPG, but decreased the mobility of membrane interface of the OPGTL. Disordering or ordering effects of chlorhexidine digluconate on membrane lipids may be responsible for some, but not all of its bacteriostatic and bactericidal actions.
Chlorhexidine* ; Fluorescence Polarization ; Liposomes ; Membrane Lipids ; Membranes* ; Phospholipids ; Porphyromonas gingivalis* ; Porphyromonas* ; Thiram ; Unilamellar Liposomes