OBJECTIVE: Although cor pulmonale due to chronic lung disease was not uncommon, there was uncertainty in its diagnosis due to the difficulty in measuring functional and anatomical changes of right heart and pulmonary vascular system. Among various non-invasive diagnostic methods presented so far, no ideal standard diagnostic criterion has been established. The authors attempted to know positive diagnostic ratio of cor pulmonale and to study the presence of the relationship between these diagnostic criteria when electrocardiographic and echocardiographic diagnostic criteria for cor pulmonale were applied to the patients with chronic lung disease. And we investigated the usefulness of echocardiogaphic diagnostic criteria for the diagnosis. METHODS: One electrocardiographic and two echocardiographic diagnostic criteria were applied to 38 patients with chronic lung disease(21 pulmonary emphysema and 17 chronic advanced pulmonary tuberculosis) for the diagnosis of cor pulmonale. Comparison was also made in their relationship. Then pulmonary artery diameter, measurement of pulmonary function test and echocardiographic examination and radio-nuclear right ventricular ejection faction were compared between the groups to ensure each criterion was satisfied. RESULTS: 1) When the three diagnostic criteria for confirming the cor pulmonale, electrocardiographic rriterion(right ventricular hypertrophy), right ventricular dimension criterion(right ventricular end-diastolic dimension>25mm, RVDd>25mm), and right ventricular wall thickness criterion (right ventricular wall thickness>6mm, RVWT>6mm) were applied to the patients, the positive rate were 32%(12/37), 30%(10/33) and 17%(6/36) respectively. A statistically significant correlation between electrocardiographic criterion and right ventricular wall thickness criterion was found to exist. 2) Various parameters of pulmonary function test and echocardiographic examination were compared in the patient groups with and without cor pulmonale when each non-invasive diagnostic criterion was applied to all patients. Followings are the results. (1) In the positive group on electrocardiographic criteria, vital capacity, forced vital capacity, and arterial oxygen tension were significantly smaller than in the negative group on electrocardiographic criterion(p<0.05), and the echocardiographic parameters of right ventricle, ie. end-diastolic area, end-systolic area, end-diastolic dimension, end-systolic dimension, mid-ventricular short axis and maximal short axis in positive group were significantly larger than in the negative group. (2) In the positive group on right ventricular diastolic dimension criterion(RVDd>25mm), percentage forced expiratory volume in 1 second and forced expiratory flow 25-75% were significantly smaller than in the negative group on right ventricular diastolic dimension criterion. (3) In the positive group on right ventricular wall thickness criterion(RVWT>6mm), vital capacity, forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow 25-75% and arterial oxygen tension were significantly smaller than in the negative group on right ventricular wall thickness criterion. CONCLUSION: When several non-invasive diagnostic criteria for cor pulmonale were applied to the patients with chronic lung disease, there were some differences in its positive diagnostic ratio depending on the applied diagnostic criteria. There was also a statistically significant correlation between electrocardiographic criterion and right ventricular wall thickness criterion. When each diagnostic criterion was applied to the patients, significant differences were found in several parameters resulted from pulmonary function test and echocardiographic examination based on presence or nonpresence of cor pulmonale. But no difference in the ejection fraction measured by radio-nuclear method was shown between cor pulmonale group and non cor pulmonale group. Consequently it was suggested that applying echocardiographic criteria in addition to electrocardiographic criterion for the diagnosis of cor pulmonale in the patients with chronic lung disease is clinically useful.
Axis, Cervical Vertebra ; Diagnosis ; Echocardiography* ; Electrocardiography ; Forced Expiratory Volume ; Heart ; Heart Ventricles ; Humans ; Lung ; Lung Diseases ; Oxygen ; Pulmonary Artery ; Pulmonary Emphysema ; Pulmonary Heart Disease* ; Respiratory Function Tests ; Uncertainty ; Vital Capacity

OBJECTIVE: To evaluate the safety and efficacy of the silicone ring pessary in the management of pelvic organ prolapse. METHODS: This study was evaluated for the clinical analysis of 58 pelvic organ prolapse patients who visited our hospital and weared silicone ring pessary from January 1997, to December 1998. RESULTS: Among 58 patients, failure rate was 13.7%(8/58) and complication rate was 50%(29/58). Main causes of failure were vaginal ulcer(4 cases) and recurrent falling out of pessary(3 cases). Most common problems were recurrent falling out of pessary(10 cases) and vaginal erosion with or without ulcer(9 cases), vaginitis(6 cases). There was no significant difference of failure rates and complication rates between hysterectomized patients and the non-hysterectomized patients. CONCLUSION: In management of pelvic organ prolapse which unsuitable for operation, pessary is noninvasive, simple and effective alternative method.
Humans ; Pelvic Organ Prolapse* ; Pessaries* ; Silicones*

Fiftyeight patients with cardiac neurosis were studied to evaluate the effects of Carteolol 10mg/day. Systolic blood pressure was declined to 122.7+/-17.2mmHg from 137.1+/-23.2mmHg, diastolic blood pressure was declined to 79.6+/-11.1mmHg from 88.2+/-17.5mmHg. Pulse rate was decreased from 83.0+/-10.2 to 73.9+/-6.8per minute. The most frequent subjective symptom was palpitation (74.1%) and effectiveness of therapy for subjective symptom was 91.4%, for usefulness was 93.1%. There was no significant serious side reaction observed. We concluded that Carteolol therapy for the patients with cardiac neurosis could be useful and safe with a small dosage.
Blood Pressure ; Carteolol* ; Heart Rate ; Humans ; Neurocirculatory Asthenia*

In this paper, two unusual cases of fetal giant lymphangiomas diagnosed before delivery is reported in 18 and 26-week pregnant woman. They were diagnosed by ultrasound. Although the cause of lymphangioma is not clearly established, they probably arise from a failure of the developing lymphatic tissue to establish normal connection with the draining lymphatics. These anomalies are most often cervical (about 70~80%) but occasionally present in the axilla (about 10%), thorax and abdomen. Lymphangioma arising at posterior nuchal region is called cystic hygroma. Lymphangioma may be divided histologically into three types ; simple, cavernous or cystic. Ultrasound examination is essential method in prenatal diagnosis of fetal lymphangioma. The differential diagnosis of these fetal lymphangioma should include meningomyelocele, benign cystic teratoma, nuchal edema, encephalocele, and subchorial placenta cyst. About 60 to 70% of lymphangioma is accompanied with chromosomal abnormalities, and most common type is Turner's symdrome (40~80%), but occasionally trisomy 21, 18, 13 and 47 XXY. But chromosomal studies of these cases showed normal findings. The 26-week fetus was IUFD at 29 gestational weeks and terminated by hysterotomy. Other 18-week fetus was terminated by vaginal delivery after intrauterine decompression.
Abdomen ; Axilla ; Chromosome Aberrations ; Decompression ; Diagnosis, Differential ; Down Syndrome ; Edema ; Encephalocele ; Female ; Fetus ; Humans ; Hysterotomy ; Lymphangioma* ; Lymphangioma, Cystic ; Lymphoid Tissue ; Meningomyelocele ; Placenta ; Pregnant Women ; Prenatal Diagnosis ; Teratoma ; Thorax ; Ultrasonography

OBJECTIVE: Our purpose was to evaluate the pregnancy outcome and the advantages of laparoscopic tubal reanastomosis. METHOD: During 16 months, January 1996 to April 1997, thirty-two patient had underwent laparoscopic tubal reanastomosis in Pudang CHA General Hospital. The mean age of the patients was 36.1+/-4.3 years(mean+/-SD; range 26 to 47 years). RESULT: The intrauterine pregnancy rate of laparoscopic tubal reanastomosis was 72.4%(21/29). Data comparing laparoscopic procedure retrospectively to tubal reversal by laparotomy was also evaluated. The mean interval from operation to pregnancy was similar in the two groups (p=0.9). The operation time was sigoificantly longer for laparoscopy (215.3+/-35.5 minutes) than for laparotomy(159.7+/-52.3 minutes). Nevertheless, the intensity of postoperative pain was lower (p<0.05) in patient who underwent laparoscopy than in patient who underwent laparotomy. Also, the mean hospital stay (3.6+/-2.3 days for laparoscopy, 6.1+/-0.5 days for laparotomy) was shortened(p<0.05) after laparoscopy compared with laparotomy. CONCLUSION: Laparoscopic tubal reanastomosis may offer the benefits of lower postoperative pain and shorten recovery time in comparison with laparotomy. Therefore, considering the high pregnancy rate in minimal follow up period of 6 month, laparoscopic tubal reanastomosis could be an alternative procedure to microsurgical laparotomy in patients requesting reversal of sterilization.
Female ; Fertility* ; Follow-Up Studies ; Hospitals, General ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Pain, Postoperative ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies ; Sterilization ; Sterilization Reversal*

Left ventficular ejection times were measured by four different methods in 200 healthy males and females from the polygraphic tracings including an apexcardiogram, a phonocardiogram and a carotid pulse tracing. The results obtained by each method were compared and the adequacy of each method was critically reviewed. It was felt that the method measuring the left ventricular ejection time from the carotid pulse tracing was the most reasonable. However, there was a significant correlation between the carotid-derived values and those obtained by other methods, thus, regression equations for the relationship of the latter values to the fromer were obtainable.
Female ; Humans ; Male

Fractional time intervals during cardiac cycle were determined by means of the analyses of mechanocardiograms in 100 male patients with hypertension and 100 healthy males, which served as controls. The mechanocardiograms anyalyzed in this study were simultaneously recorded electrocardiograms, phoocardiograms, apexcardiograms and carotid pulse tracings. Of various time intervals during systolic in patients with hypertension, the mechanical systole(both C-D and C-A2 intervals), the isovolumic contraction time, the initial phase of ventricular contraction and the ventricular pressure elevation time were significantly prolonged, whereas the protodiastole was significantly shortened. The prolongation of the mechanical systole was caused primarily by the lengthening of the isovolumic contraction time, which resulted from the prolongation of the components of the latter, namely the initial phase of ventricular contraction and the ventricular pressure elevation time. During diastole, there were significant prolongation of the isovolumic relaxation time and the rapid ventricular filling period, and a significant shortening of the slow ventricular filling period. Among these time intervals, the mechanical systole(C-A2 inlerval), the isovolumic contraction time, the ventricular pressure elevation time and the isovolumic relaxation time showed significant positive correlation with blood pressure. On the other hand, the slow ventricular filling period was significantly negatively correlated with blood pressure. These facts suggested that the changes in these time intervals were related to increased afterload and/or resultant myocardial or hemodynamic alterations.
Blood Pressure ; Diastole ; Electrocardiography ; Hand ; Hemodynamics ; Humans ; Hypertension* ; Male ; Relaxation ; Systole ; Ventricular Pressure

Fractional time intervals during cardiac cycle were determined by means of the analyses of mechanocardiograms in 100 male patients with hypertension and 100 healthy males, which served as controls. The mechanocardiograms anyalyzed in this study were simultaneously recorded electrocardiograms, phoocardiograms, apexcardiograms and carotid pulse tracings. Of various time intervals during systolic in patients with hypertension, the mechanical systole(both C-D and C-A2 intervals), the isovolumic contraction time, the initial phase of ventricular contraction and the ventricular pressure elevation time were significantly prolonged, whereas the protodiastole was significantly shortened. The prolongation of the mechanical systole was caused primarily by the lengthening of the isovolumic contraction time, which resulted from the prolongation of the components of the latter, namely the initial phase of ventricular contraction and the ventricular pressure elevation time. During diastole, there were significant prolongation of the isovolumic relaxation time and the rapid ventricular filling period, and a significant shortening of the slow ventricular filling period. Among these time intervals, the mechanical systole(C-A2 inlerval), the isovolumic contraction time, the ventricular pressure elevation time and the isovolumic relaxation time showed significant positive correlation with blood pressure. On the other hand, the slow ventricular filling period was significantly negatively correlated with blood pressure. These facts suggested that the changes in these time intervals were related to increased afterload and/or resultant myocardial or hemodynamic alterations.
Blood Pressure ; Diastole ; Electrocardiography ; Hand ; Hemodynamics ; Humans ; Hypertension* ; Male ; Relaxation ; Systole ; Ventricular Pressure

An analysis of echocardiograms was made in 50 patients with pericardial effusion of various origins, diagnosed by clinical and M-mode echocardiographic examinations. In these cases the estimated volume of pericardial effusion ranged between 40 ml and 999 ml. The width of echo-free space behind the left ventricular wall which reflect the amount of effusion showed a significant positive correlation with the systolic excursion and the diastolic mean velocity of both right and left ventricular epicardial surfaces. The echocardiographic patterns of so-called pseudo-mitral valve prolapse and a notch on the right ventricular epicardial surface during systole were found more frequently in patients with large pericardial effusion. Thus, in pericardial effusion, and echocardiographic examination is useful for the visualization of the abnormal motions of cardiac structures as well as for its diagnosis.
Diagnosis ; Echocardiography* ; Humans ; Pericardial Effusion* ; Prolapse ; Systole

The present study is concerned with angiographic findings of bone tumors in patients who have been admitted to Severance Hospital from April 1968 to March 1971. Angiography of peripheral tumors is a valuabIe procedure in that it provides important information concerning the presence or absence of a tumor, defines its size and extent, and gives indication of malignancy. Angiography as an additional aid in the diagnosis of malignant bone lesions was first presented by dos Santos, Lamas and Caldos (1931). Begg (1955) stated that a normal angiogram of a limb shows that the branches of the main artery follow a slightly curved and undulating course, and that their calibre slowly and progressively decreases. None of these vessels are seen to reach the periosteum, nor is the nutrient artery ever visible. dos Santos (1931) proposed certain angiographic criteria of malignancy, notably the presence of numerous irregular vessels at the transit of the contrast medium from the arteries to the veins. Margulis(1964)stated a large number of malignant neoplasms are highly vascular and present chaotic patterns. Their vessels have irregular lumina and arteriovenous communications are present within them. Areas of intense contrast staining occupy parts of or the entire tumor. This appearance, frequently described, has been assumed to be characteristic of and uniformly encountered in malignant tumors. Angiographies in the present study include 6 cases of Osteogenic sarcoma, 4 cases of Chondrosarcoma, 2 cases of Giant cell tumor, 1 case of Liposarcoma, 1 case of Kaposis sarcoma, 1 case of Hemangioma, 1 case of Metastatic bone tumor, 1 case of Fibrous dysplasia and 1 case of Neurofibromatosis. Angiography was performed 13 times under local and 5 times under the general anesthesis. 20 to 30cc of 50 per cent Hypaque was utilized for examination. Angiographic findings are as follows: 1. HypervascuIarity is seen in osteogenic sarcoma, giant cell tumor, hemangioma and metastatic bone tumor. But neurofibromatosis and fibrous dysplasia are avascular. 2. Irregularity of the vascular net work seems characteristic in osteogenic sarcoma, hemangioma, and metastatic bone tumor. 3. Blood pools are seen prominently in osteogenic sarcoma, giant cell tumor, hemangioma and metastatic bone tumor. but no blood pools in neurofibromatosis and fibrous dysplasia. 4. Arteriovenous shunt is seen in osteogenic sarcoma, chondrosarcoma, hemangioma and metastatic bone tumor. But there is no A-V shunt in giant cell tumor, liposarcoma, Kaposis sarcoma, neurofibromatosis and fibrous dysplasia. 5. Retention of contrast medium is seen prominently in osteogenic sarcoma and hemangioma. But no retention of contrast medium is noted in liposarcoma, neurofibromatosis and fibrous dysplasia. While I do not regard arteriography as a necessary procedure for the differantial diagnosis of all presumptive bone neoplasms, it is indeed valuable in selected cases, in differential diagnosis of bone tumors and in the demonstration of the vascularity and extent of extraosseous soft tissue masses and it can be helpful in selecting an appropriate biopsy site. By indicating the size ar,d vascularity of a lesion and its major blood supply, it may influence the surgical approach.
Angiography ; Arteries ; Biopsy ; Bone Neoplasms ; Chondrosarcoma ; Diagnosis ; Diagnosis, Differential ; Diatrizoate ; Extremities ; Giant Cell Tumors ; Hemangioma ; Humans ; Liposarcoma ; Neurofibromatoses ; Osteosarcoma ; Periosteum ; Sarcoma, Kaposi ; Veins