BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.
Adult ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography* ; Extremities* ; Fatigue ; Heart Septal Defects, Atrial* ; Humans

BACKGROUND AND OBJECTIVES: Spontaneous progression of severe congestive heart failure is structurally characterized by cellular degeneration and multiple foci of myocardial cell death. The cardiac troponin I (cTnI), one of the subunits of the troponin regulatory complex, binds to actin and inhibits interaction between actin and myosin. cTnI is uniquely expressed in the adult human myocardium, and an increase in its circulating levels is highly indicative of myocardial injury. In this study, we addressed the usefulness of cTnI as a sensitive and specific molecular marker for severity in patients with congestive heart failure. MethodscTnI, creatinin kinase-MB (CK-MB), and myoglobin were assessed in 59 patients with severe congestive heart failure diagnosed by the echo-cardiography and gated equilibrium blood pool heart scan. Also we assesed cTnI, creatinin kinase-MB (CK-MB), and myoglobin in 25 persons without cardiac disease in echocardiography. RESULTS: 1) The cTnI con-centration was 89.6+/-69.3 pg/mL in patients with congestive heart failure and its level was greater than that of the control group (22.4+/-17.1, p=0.001). 2) The cTnI level differed significantly according to left ventricular ejection fraction (EF), 117.3+/-73.8 pg/mL in patients with EF\<40% (28 patients), 66.3+/-44.5 pg/mL in patients with EF> or =40% (31 patients), 22.4+/-17.1 pg/mL in the control group (25 persons) (p=0.001). CONCLUSION: cTnI was useful as a specific and sensitive serum molecular marker in patients of congestive heart failure. And its level reflected the severity of congestive heart failure.
Actins ; Adult ; Cell Death ; Echocardiography ; Equidae ; Estrogens, Conjugated (USP)* ; Heart ; Heart Diseases ; Heart Failure* ; Humans ; Myocardium ; Myoglobin ; Myosins ; Stroke Volume ; Troponin I* ; Troponin*

PURPOSE: To evaluate the efficacy of arthrorscopic ACL repair on femoral side using suture technique. MATERIALS AND METHODS: We performed arthroscopic ACL repair suture technique on femoral side and evaluate the results using the functional grading system of Lysholm and physical examination in 15 cases between July, 1997 and June, 2004 that were able to be followed up for more than 24 months. The mean age was 32.1 years old, the follow up period were 58.7 month. RESULTS: The postoperative Lysholm knee score increased from preoperative mean 17 to postoperative mean 93 by an average of 76 points. Postoperative Excellent group over 90 points were 6 cases(40%), Good group over 75 points were 8 cases(53%), Fair group over 51 points was 1 case(7%). On anterior drawer test, 3 cases showed anterior insta- bility between 0 and 2mm and 2 cases between 3 and 5mm. But other 10 cases did not show anterior instability on anterior drawer test. On stress lateral radiographic evaluation, the mean anterior translation of tibia was 2(0~5)mm. CONCLUSION: We concluded that arthroscopic ACL repair with suture technique is one of the most reliable and effective method to recover the instability and full ROM enabling early rehabilitation.
Anterior Cruciate Ligament* ; Arthroscopy ; Follow-Up Studies ; Knee ; Physical Examination ; Rehabilitation ; Suture Techniques ; Tibia

OBJECTIVE: To consider the relation between MRI findings and clinical subtypes of cerebral palsy (CP). METHOD: The subjects comprised 83 patients with CP. We analyzed the brain MRI findings such as periventricular leukomalacia (PVL), brain atrophy, infarction or hemorrhage, basal ganglia lesion, migration anomaly and delayed myelination with consideration of clinical subtypes of CP. RESULTS: Of the 83 MRI findings, 69 abnormalities (83.1%) were the followings; PVL in 47 cases{17 spastic diplegics (SD), 17 spastic quadriplegics (SQ), 5 spastic hemiplegics (SH), 4 atonic or hypotonic quadriplegics, 2 ataxic quadriplegics and2 mixed quadriplegics (MQ)}, brain atrophy in 6 cases (3 SQ, 1 SD, 1 SH and 1 MQ), infarction or hemorrhage in 7 cases (5 SH and 2 SQ), migration anomaly in 2 cases (1 SQ and 1 SH), delayed myelination in 3 cases (2 SQ and 1 SH) and basal ganglia lesion in 4 cases (3 MQ and 1 atonic quadriplegic). 33 cases of 47 PVL and 2 cases of 6 brain atrophy were preterm CPs. There was no difference in severity of CP between preterm and fullterm CPs. CONCLUSION: The results of this study would be helpful in estimating the brain lesions in various clinical subtypes of CP.
Atrophy ; Basal Ganglia ; Basal Ganglia Hemorrhage ; Brain ; Cerebral Palsy* ; Hemorrhage ; Humans ; Infant, Newborn ; Infarction ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging* ; Muscle Spasticity ; Myelin Sheath

Objective: To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited. Methods: The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert’s test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland–Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted. Results: Ten patients with acute stroke completed the study. Bland–Altman plots revealed good agreements for Albert’s test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively. Conclusion The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.

OBJECTIVE: The validity of olfactory bulbectomized rat as an animal depression model and the possibilities of the NMDA antagonist as an antidepressant would be evaluated by demonstrating structural alterations in their brain MRIs and histological findings of hippocampus. METHODS: Those 8-week old male Sprague-Dawley rats received either an olfactory bulbectomy or sham operation and volume changes at ventricles and caudate nucleus in their brain MRI were acquired at preoperation and postoperation. Those olfactory bulbectomized rats received either memantine, an uncompetitive NMDA antagonist, or normal saline, a placebo, and their brain structural changes in MRI were acquired. At preoperation, postoperation, and postmedication each one of the rats with sham-operation, with memantine, and with placebo was sacrificed to acquire histological impressions. RESULTS: 1) Comparison of the volume changes between preoperation and postoperation showed statistical significance; the volumes of the left and right lateral ventricles (p=0.007, p=0.008) and the third ventricle (p=0.003) increased significantly but the volumes of left and right caudate nucleus decreased (p=0.014, p=0.032), compared to that of the controls. 2) After 6-weeks of memantine administrations, the OB rats revealed more definite recovery in brain MRIs statistically than the controls: the volumes of left and right ventricles and left and right caudate nucleus (p=0.004, p=0.03 ; p=0.04, p=0.05). 3) The hippocampus histological findings of the olfactory bulbectomy showed frequently eosinophilic cytoplasm and hyperchromatic nucleus with shrinkage in CA3. After memantine intake, the hippocampus histological findings returned to nearly normal and showed mixtures of normal cell and abnormal neuron cell. CONCLUSION: The OB models would be valid as an animal model of depression and alterations in their brain MRI images after administrations of NMDA antagonist could be an indicator of antidepressant effects.
Animals ; Brain ; Caudate Nucleus ; Cytoplasm ; Depression* ; Eosinophils ; Heart Ventricles ; Hippocampus ; Humans ; Lateral Ventricles ; Magnetic Resonance Imaging* ; Male ; Memantine* ; Models, Animal ; N-Methylaspartate ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Third Ventricle

BACKGROUND: The patients with mitral stenosis are generally accompanied with impaired pulmonary function. The aim of this study was to evaluate the changes of pulmonary function after percutaneous mitral balloon valvuloplasty (PMV) in that patients. METHODS: PMV was performed in 36 patients with mitral stenosis in Pusan National University Hospital and hemodynamic, echocardiographic and pulmonary function test data before and after PMV were analyzed. RESULT: After PMV, NYHA functional class was improved from 2.2+/-0.6 to 1.2+/-0.4 (p<0.001). The mean left atrial pressure and mean pulmonary arterial pressure significantly decreased from 14.5+/-6.2 mmHg to 5.7+/-4.4 mmHg(p<0.001) and from 25.3+/-10.9 mmHg to 15.5+/-7.4 mmHg (p<0.001), respectively. Cardiac output was slightly decreased from 5.34+/-1.31 L/min to 5.28+/-1.25 L/min (p=0.50). Mean mitral pressure gradient decreased from 13.5+/-5.8 mmHg to 4.4+/-2.1 mmHg (p<0.001) and mitral valvular area significantly increased from 0.86+/-0.19 cm2 to 1.71+/-0.28 cm2 (p<0.001). In pulmonary function test, only MVV and PEF was significantly improved from 77.2+/-23.8% to 88.4+/-27.9% (p<0.01) and 87.1+/-26.8% to 97.5+/-26.4% (p<0.01), respectively. But, VC, FEV1, FEF25-75% and FVC were not changed significantly. In exercise treadmil test, exercise duration was significantly improved from 482.0+/-266.2 sec to 718.0+/-287.5 sec (p<0.001). CONCLUSION: We observed the results of better hemodynamic changes and exercise capacity after PMV. But, there was no significant improvement in pulmonary function after PMV. In our opinion, irreversible pulmonary changes and hemodynamic effect on pulmonary function should be considered.
Arterial Pressure ; Atrial Pressure ; Balloon Valvuloplasty* ; Busan ; Cardiac Output ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Respiratory Function Tests

BACKGROUND: The aims of this study were to assess the etiologies, survival and prognositic factors of patients with chronic cor pulmonale visited Pusan National University Hospital. METHODS: This study included 103 patients with chronic cor pulmonale. There were 67 men and 36 women. The diagnosis of chronic cor pulmonale was primarily based on the presence of underlying lung disorder and echocardiographic finding of enlarged or hypertrophied right ventricle. Other clinical data including patients' symptoms and signs, findings of arterial blood gas analysis, hematologic and biochemical laboratory and pulmonary function test were assessed. RESULTS: The most common underlying lung disorder was pulmonary tuberculosis (59.2%) and chronic obstructive pulmonary disease was the next (28.2%). The survival rate was 57% in one year, 45% in two years, and 34% in three years. The prognostic factors were maximal voluntary ventilation(MVV), forced vital capacity(FVC), FEV1, serum Na, vital capacity(VC), serum albumin and peak expiratory flow(PEF) in univariate analysis. And in multivariate analysis, serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant. CONCLUSION: Pulmonary tuberculosis was the most important underlying lung disorder in chronic cor pulmonale. The survival rate was 57% in one year, 45% in two years, and 34% in three years. Serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant prognostic factors.
Blood Gas Analysis ; Busan ; Diagnosis ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Lung ; Male ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Heart Disease* ; Respiratory Function Tests ; Serum Albumin ; Survival Rate ; Tuberculosis, Pulmonary

OBJECTIVE: The authors undertook a study to compare three intraoperative guidance systems, which are intraoperative ultrasonography, stereotaxy and computer-assisted image-guided surgery (neuronavigation) in terms of time consuming during the preparation of these procedures. In this operative case-based study, we have investigated the ability and benefits of intraoperative grey-scale sonographic examination in the localizing of intracranial hemorrhage (ICH) in the brain. METHODS: We used B-mode ultrasonography (5-MHz, 1.2x2.5 mm sized probe) during 23 procedures (craniotomy or craniectomy ; 17, hematoma aspiration : 6) performed in the acute stage after head injury, hypertensive ICH, ruptured cerebral aneurysm. Seventeen patients who suffered from spontaneous ICH underwent stereotactic hematoma aspiration and fourteen patients underwent hematoma removal using neuronavigation system (spontaneous ICH ; 11, Arteriovenous malformation and aneurysm ; 3). We compared intraoperative ultrasonography-assisted hematoma removal with procedures with stererotaxy or neuronavigation system in respect of detection of the pathology and time consuming for preparation. RESULTS: Mean preparation time for stereotactic hematoma aspiration was 71.2 minutes (50-90 minutes), and mean preparation time for neuronavigation-guided surgery was 52.5 minutes (30-70 minutes). However, only 7.4 minutes (4-20 minutes) were needed for the preparation time of intraoperative ultrasonography. Moreover, intraoperative ultrasonography-guided surgery had many advantages compared to other image-guide surgery, such as capability of real-time monitoring and independency of brain shifting. However, there were several limitations too, which were relatively low resolution, artifact by air bubble during the procedure, and the lower echogenecity of liquified hematomas when a delay of several days was needed. Nevertheless, ultrasound-guided hematoma surgery could serve as minimally invasive treatment whenever hematoma evacuation seems to be advisable, at least as a first attempt. CONCLUSION: Based on this preliminary result, we concluded that intraoperative ultrasonographic examination during the surgical treatment of ICH was a non-invasive, useful, and simple diagnostic tool in the detection of the components and accompanying parts of the lesion. It was more useful than stereotaxy or neuronavigation system in the situation of emergent case such as an impending brain herniation.
Aneurysm ; Arteriovenous Malformations ; Artifacts ; Brain ; Cerebral Hemorrhage* ; Craniocerebral Trauma ; Hematoma ; Humans ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Neuronavigation ; Pathology ; Surgery, Computer-Assisted* ; Ultrasonography*

BACKGROUND: Inappropriate sinus tachycardia(IST) manifests chronic nonparoxysmal sinus tachycardia in healthy individuals and is characterized by consistently elevated heart rate and exaggerated responses to minimal physical activity. Heart rate variability(HRV) using 24-hour Holter monitoring represents one of the methods of evaluating the harmony of autonomic nervous system activity. So, authors investigate the autonomic nervous system activity by the HRV in patients with IST. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through the time domain analysis of heart rate variability with 24-hour Holter monitoring between 23 patients with IST and 23 healthy control subjects. None of the patients had organic heart disease as determined by routine laboratory examination and echocardiography. And then, time domain measures(mean NN, SDNN, SDANN, SD, rMSSD, pNN50) were analyzed. RESULTS: The mean age of patients and control were 38+/-10 and 37 9 years, respectively(p=S). The mean clinical heart rate of patients and control was 104 5/min and 72+/-5/min, respectively(p<0.05). Among the time domain indices, mean of all normal RR intervals(mean NN), standard deviation of all normal RR intervals(SDNN), standard deviation of mean RR interval(SDANN), mean of standard deviations of all normal RR intervals(SD), root mean square successive differences between adjacent normal RR intervals(rMSSD), and percent of difference between adjacent normal RR intervals(pNN50) in the patient group were significantly shorter compared to control group(p<0.01). CONCLUSION: In IST, cardiac vagal influence on the heart rate is blunted.
Autonomic Nervous System ; Echocardiography ; Electrocardiography, Ambulatory ; Heart Diseases ; Heart Rate* ; Heart* ; Humans ; Motor Activity ; Tachycardia, Sinus