No abstract available.
Dialysis* ; Heart Arrest* ; Mesylates*

BACKGROUND AND OBJECTIVES: Several studies have showed a large 'treatment gap' between clinical practice and the guidelines for treating hypercholesterolemia. There is little information on the real practice of managing patients with hypercholesterolemia in Korea. This study was done to investigate the "treatment gap" in the management of Korean hypercholesterolemic patients. SUBJECTS AND METHODS: 500 Hypercholesterolemic patients, who did not receive any lipid-lowering mediation during the prior six months to the index date and who were treated for more than one year thereafter, were included in the study. 100 investigators of general hospitals retrospectively reviewed the medical records of 500 hypercholesterolemic patients. The proportion of patients who reached their cholesterol goal was determined. Logistic regression was used to assess the patient characteristics associated with goal attainment. RESULTS: Of the total 500 patients, 369 patients (73.8%) had coronary heart disease (CHD) or CHD risk-equivalent disease. 86 patients (17.2%) were in the moderate risk group and 45 (9.0%) were in the low risk group. 45% of the CHD/CHD risk equivalent patients showed a baseline LDL cholesterol level of more than 160 mg/dL. The overall trend for the initial choice of the drug level for statin treatment showed a similar pattern among all patients, and this was not influenced by the presence of CHD or the serum lipid level. 77% of patients stayed on the same drug level and 41% of all patients (37% of CHD patients, 52% of non-CHD patients) attained their LDL cholesterol goal during the study period. CONCLUSION: The majority of hypercholesterolemic patients were treated without achieving their goal. More effective treatment of hypercholesterolemia is needed for the prevention of cardiovascular disease.
Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Health Expenditures* ; Hospitals, General ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia* ; Korea* ; Logistic Models ; Medical Records ; Negotiating ; Research Personnel ; Retrospective Studies

PURPOSE: It has been reported in several for factors on the drug compliance of patients, number of drug being taken, symptom, and pharmaceutical dosage form. However, Studies of drug compliance by dosing methodologies of tamsulosin, finasteride combination therapy and symptom relief for benign prostatic hyperplasia has not been performed. Therefore, we studied for symptom and differences in medication adherence in method of administration of tamsulosin, finasteride combination therapy. MATERIALS AND METHODS: The groups were consisted in need of combination therapy of tamsulosin, finasteride on benign prostatic hyperplasia, one had packaged both drugs together (Group A, n=30) and the other were individually packaged both agents (Group B, n=30). International Prostatic Symptom Score (IPSS) were checked on first, 4weeks, and 8weeks. The evaluation was carried out of medicine compliance by checking the number of drugs 4weeks-interval. which was every 4weeks during 8weeks. RESULTS: The properties other than the PSA in both groups, there was no statistically significant differences between patients. In first 4weeks, drug compliance of each Group A and B had tamsulosin 82.6%, 93.3% (p=0.033), finasteride 80.1%, 93.3% (p=0.042), and last 4weeks tamsulosin 80.6%, 93.7% (p=0.013), finasteride 79.5%, 93.7% (p=0.002) were checked. Group C, D had 81.4%, 96.4% (p=0.021) on 4weeks, 80.6%, 97.2% (p=0.011) on 8weeks. CONCLUSIONS: For co-administration of finasteride and tamsulosin are required in patients with benign prostatic hyperplasia, in order to enhance drug compliance, both tablets have to prescript together in one package to be taken at one time is useful.
Compliance ; Dosage Forms ; Finasteride* ; Humans ; Medication Adherence* ; Prostatic Hyperplasia* ; Tablets

BACKGROUND: Platelet plays an important role in the pathogenesis of acute coronary syndrome. Platelet glycoprotein IIb III a is the receptor for fibrinogen, and it plays an important role in the platelet aggregation. It was reported that polymorphism of the platelet glycoprotein III a (PlA1/A2) is related to acute coronary syndrome, especially in young patients. The aims of this study is to evaluate the relationship between platelet glycoprotein III a polymorphism and acute coronary syndrome in Koreans. METHOD: We studied total 208 patients (M: F=131 : 77, mean ages : 57.2+/-9.7). Acute coronary group comprised 110 patients, who underwent coronary angiography with the impression of acute myocardial infarction or unstable angina. Normal group comprised 98 patients who had no significant angiographic lesion. Genomic DNA was extracted from peripheral blood. To determine the frequency of PlA1/A2 genotype, polymerase chain reaction (PCR) was done and the product was restricted with Msp I. 3% gel electrophoresis showed Restriction Fragment Length Polymorphism (RFLP). Clinical profile and risk factor were also reviewed. RESULT: One patient in the acute coronary group is PlA1/A2 heterozygote and all the other are PlA1 homozygote. In normal group, all patients are PlA1 homozygote. The genotypic frequency of PlA1/A2 is consistent with the previous study. CONCLUSION: The genotype frequency of platelet glycoprotein III a gene polymorphism in Koreans is different from that of Caucasian. The allele frequencies of platelet glycoprotein III a is not different between acute coronary syndrome patient and normal control group. Platelet glycoprotein III a polymorphism may not be an hereditary risk factor in Koreans.
Acute Coronary Syndrome* ; Angina, Unstable ; Blood Platelets* ; Coronary Angiography ; DNA ; Electrophoresis ; Fibrinogen ; Gene Frequency ; Genes, vif ; Genotype ; Glycoproteins* ; Heterozygote ; Homozygote ; Humans ; Integrin beta3 ; Myocardial Infarction ; Platelet Aggregation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Risk Factors

BACKGROUND: Platelet plays an important role in the pathogenesis of acute coronary syndrome. Platelet glycoprotein IIb III a is the receptor for fibrinogen, and it plays an important role in the platelet aggregation. It was reported that polymorphism of the platelet glycoprotein III a (PlA1/A2) is related to acute coronary syndrome, especially in young patients. The aims of this study is to evaluate the relationship between platelet glycoprotein III a polymorphism and acute coronary syndrome in Koreans. METHOD: We studied total 208 patients (M: F=131 : 77, mean ages : 57.2+/-9.7). Acute coronary group comprised 110 patients, who underwent coronary angiography with the impression of acute myocardial infarction or unstable angina. Normal group comprised 98 patients who had no significant angiographic lesion. Genomic DNA was extracted from peripheral blood. To determine the frequency of PlA1/A2 genotype, polymerase chain reaction (PCR) was done and the product was restricted with Msp I. 3% gel electrophoresis showed Restriction Fragment Length Polymorphism (RFLP). Clinical profile and risk factor were also reviewed. RESULT: One patient in the acute coronary group is PlA1/A2 heterozygote and all the other are PlA1 homozygote. In normal group, all patients are PlA1 homozygote. The genotypic frequency of PlA1/A2 is consistent with the previous study. CONCLUSION: The genotype frequency of platelet glycoprotein III a gene polymorphism in Koreans is different from that of Caucasian. The allele frequencies of platelet glycoprotein III a is not different between acute coronary syndrome patient and normal control group. Platelet glycoprotein III a polymorphism may not be an hereditary risk factor in Koreans.
Acute Coronary Syndrome* ; Angina, Unstable ; Blood Platelets* ; Coronary Angiography ; DNA ; Electrophoresis ; Fibrinogen ; Gene Frequency ; Genes, vif ; Genotype ; Glycoproteins* ; Heterozygote ; Homozygote ; Humans ; Integrin beta3 ; Myocardial Infarction ; Platelet Aggregation ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Risk Factors

Maze operation could alter P wave morphology in electrocardiogram (ECG), which might prevent exact diagnosis of the cardiac rhythm of patients. However, characteristics of P wave in patients with sinus rhythm after the operation have not been elucidated systematically. Consecutive patients who underwent the modified Cox Maze operation from January to December 2007 were enrolled. The standard 12-lead ECG and echocardiography were evaluated in patients who had sinus rhythm at 6 months after the operation. The average axis of P wave was 65+/-30 degrees. The average amplitude of P wave was less than 0.1 mV in all 12-leads, with highest amplitude in V1. The most common morphology of P wave was monophasic with positive polarity (49%), except aVR lead, which was different from those in patients with enlarged left atrium, characterized by large P-terminal force in the lead V1. There were no significant differences in P-wave characteristics and echocardiographic parameters between patients with LA activity (30.6%) versus without LA activity (69.4%) at 6 months after the operation. In conclusion, the morphology of P wave in patients after Maze operation shows loss of typical ECG pattern of P mitrale: P wave morphology is small in amplitude, monophasic and with positive polarity.
Atrial Fibrillation/*physiopathology/*surgery ; Cardiovascular Surgical Procedures/*methods ; Electrocardiography/*methods ; Female ; Heart Conduction System/*physiopathology/*surgery ; *Heart Rate ; Humans ; Male ; Middle Aged ; Treatment Outcome

17 cases of acute myocardial infarction with no or insignificant narrowing of major coronary arteries on angiogram and without any-other types of heart disease were found in a series of 133 consecutively studied patients with acute myocardial infarction(12,7%). There were no differences in risk factors between groups. Although the infarction site were similar in both groups, the patients with normal coronary arteries had fewer complications during hospitalization(p<0.05) and lesser ST segment change during the exercise test before discharge(p<0.05). In the hemodynamic fingings, cardiac index, left ventricualr and diastolic pressure and resional wall motion were similar in both groups of the patients, but ejection fraction was higher(p<0.05) in the patients with the normal coronary arteries. In conclusion, it could be predicted that the acute myocardial infarction with the normal coronary arteries would have the better prognosis. And a transient coronary occlusion, as the most likely pathogenic mechanism of the acute mtocardial infarction with normal coronary arteries, might be studied in the aspect of the thrombosis following lysis, the coronary artery spasm and the platelet aggregation.
Angiography* ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels ; Exercise Test ; Heart Diseases ; Hemodynamics ; Humans ; Infarction ; Myocardial Infarction* ; Platelet Aggregation ; Prognosis ; Risk Factors ; Spasm ; Thrombosis

BACKGROUND AND OBJECTIVES: There has been a need for functional status measurement tool with better validity than the existing tools such as New York Heart Association Functional Class. Duke Activity Status Index (DASI) is a representative example of a tool that was developed to enhance the validity of measurement by asking the patients about the ability to perform specific activities and scoring the response. Because such a tool must be culture-sensitive, it is desirable to use 'Koreanized' version of the tool. No Koreanized version of the functional status measurement tool has been developed yet. The objective of this study is to develop a Korean version of DASI. MATERIALS AND METHOD: In the developmental phase, a pilot questionnaire asking the ability to perform specific activity was made with reference to existing tools, such as Specific Activity Scale and DASI. Substitution, correction and addition of items were done through the pilot study. Ninety-nine patients was asked to fill developmental version of questionnaire, then underwent treadmill exercise test. Weight for each items were assigned to optimize the correlation between the calculated index (KASI) and total treadmill exercise time. Criteria for categorical functional classification were determined to maximize the agreement between KASI-estimated functional class (KASIFC) and functional class estimated by exercise time. In the validation phase, final version of questionnaire was tested in independent group of 159 patients. The questionnaire was self-administered. Canadian Cardiovascular Society Functional Class (CCSFC) was estimated by the physician who is in charge of treadmill exercise test. RESULTS: In the validation phase, Spearman correlation coefficient between KASI and treadmill exercise time was 0.62(p=.0001) and between CCSFC and exercise time -0.48(p=.0001). KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. These two methods did not differ significantly in categorical classification. CONCLUSION: KASI is more accurate or at least as accurate as the existing tool in estimation of functional status. The characteristics such as self-administration, availability of outcome as a continuous variable are expected to make it a convenient, efficacious and useful tool in various clinical researches.
Classification ; Exercise Test ; Heart ; Humans ; Pilot Projects ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: There has been a need for functional status measurement tool with better validity than the existing tools such as New York Heart Association Functional Class. Duke Activity Status Index (DASI) is a representative example of a tool that was developed to enhance the validity of measurement by asking the patients about the ability to perform specific activities and scoring the response. Because such a tool must be culture-sensitive, it is desirable to use 'Koreanized' version of the tool. No Koreanized version of the functional status measurement tool has been developed yet. The objective of this study is to develop a Korean version of DASI. MATERIALS AND METHOD: In the developmental phase, a pilot questionnaire asking the ability to perform specific activity was made with reference to existing tools, such as Specific Activity Scale and DASI. Substitution, correction and addition of items were done through the pilot study. Ninety-nine patients was asked to fill developmental version of questionnaire, then underwent treadmill exercise test. Weight for each items were assigned to optimize the correlation between the calculated index (KASI) and total treadmill exercise time. Criteria for categorical functional classification were determined to maximize the agreement between KASI-estimated functional class (KASIFC) and functional class estimated by exercise time. In the validation phase, final version of questionnaire was tested in independent group of 159 patients. The questionnaire was self-administered. Canadian Cardiovascular Society Functional Class (CCSFC) was estimated by the physician who is in charge of treadmill exercise test. RESULTS: In the validation phase, Spearman correlation coefficient between KASI and treadmill exercise time was 0.62(p=.0001) and between CCSFC and exercise time -0.48(p=.0001). KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. KASIFC agreed with functional class estimated by exercise time in 77% of cases, disagreed by 1 class in 20% and by 2 classes in 1%. These two methods did not differ significantly in categorical classification. CONCLUSION: KASI is more accurate or at least as accurate as the existing tool in estimation of functional status. The characteristics such as self-administration, availability of outcome as a continuous variable are expected to make it a convenient, efficacious and useful tool in various clinical researches.
Classification ; Exercise Test ; Heart ; Humans ; Pilot Projects ; Surveys and Questionnaires

BACKGROUND: Atherosclerosis is the most important disease that may cause ischemic syndrome in many organs including heart. It is supposed that apoptosis of vascular smooth muscle cells(VSMCs) is closely related to the progression and rupture of atheromatous plaque. Recent studies have documented evidence for elevated level of nitric oxide(NO) within advanced human atheroma and evidence of regression of atheroma by NO. So this study is designed to evaluate whether exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs and which proapoptotic gene(s) is involved in this type of apoptosis. METHODS: Rat VSMCs were cultured and used for experiment at passage 5 through 7. For NO donor, sodium nitroprusside (SNP) and S-nitroso-N-acetylpenicillamine(SNAP) of 0.5, 1, 2, 4mM were exposed to subconfluent VSMCs. The cells were harvested at 6, 12, 24, 48, 72hours after exposure of NO donors. Apoptosis was to be identified by 4, 6-diamidino-2-phenylindole dihydrochloride(DAPI) staining of nuclei and in-situ nick end labeling(TUNEL). The amount of fragmented DNA was analyzed semiquantitatively by diphenylamine(DPA) assay. Immunocytochemical(ICC) staining and western bolt analyses were designed to detect apoptosisrelated gene products, such as Bax-a, Fas and Bcl-2. RESULTS: 1) Decreased mitotic activity was shown after 12 hours exposure of exogenous NO donors, and condensation and margination of chromatin was identified agter 24 hours exposure, by DAPI staining. 2) Percent DNA fragmentation assessed by DPA method was 0,2,9,48,45% at 0,6,12,24,48 hours after exposure of 2mM of NO donors respectively. 3) The expression of Bax-a and Bcl-2 proteins was demonstrated in apoptotic cells by ICC staining. 4) The expression of Bax-a protein in cells under 24 hours exposure of NO donors was elevated by more than 18% of control level on densitometric analysis of western blot. The level of Bcl-2 was suppressed by 26% of control. So, Bax-a/Bcl-2 ratio in cells under exposure of NO donors was elevated to 2.0 from 1.2 of control level. CONCLUSIONS: Exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs, and it is considered that bax-a and bcl-2 genes are involved in this type of apoptosis.
Animals ; Apoptosis* ; Atherosclerosis ; Blotting, Western ; Chromatin ; DNA ; DNA Fragmentation ; Genes, bcl-2 ; Heart ; Humans ; Muscle, Smooth, Vascular* ; Nitric Oxide ; Nitroprusside ; Plaque, Atherosclerotic ; Rats* ; Rupture ; Tissue Donors