To assess the diagnostic value of low level predischarge exercise test in the prediction of multivessel disease and left ventricular abnormality rate limited treadmill test, coronary arteriography and left ventriculography were admitted to the coronary care unit at Seoul National University Hospital from February 1985 to April 1986. The following results were obtained; 1) During and immediately after the treadmill test, ischemic ST segment depression were observed in 7 patients (20.6%). On subsequent coronary arteriography, 6 of them were found to have multivessel coronary artery disease. The sensitivity of ST segment depression in prediction of multivessel disease was 31.6%, the specificity was 93.3% and prediction value was 85.7%. 2) In 11 patients (32.3%), the exercise test were discontinued because of anginal pain, fatigue, or dyspnea. The sensitivity of above symptoms in prediction of multivessel disease was 47.4%, the specificity was 86.7% and prediction value was 81.8%. 3) The sensitivity of ST segment depression and/or symptom in prediction of multivessel disease was 68.4%, the specificity was 80%, and the prediction value was 81.25%. 4) The ST segment elevation were observed in 10 patients (29.4%). The sensitivity of ST segment elevation in prediction of complicated left ventricular aneurysm was 58.3%, the specificity was 87.5%, and the prediction value was 70%. 5) No serious complication developed by the treadmill test. It is concluded from above results that low level predischarge treadmill exercise test is useful and safe test in the prediction of multivessel disease and left ventricular aneurysm in patients with recent acute myocardial infarction.
Aneurysm ; Angiography ; Coronary Artery Disease ; Coronary Care Units ; Depression ; Dyspnea ; Exercise Test* ; Fatigue ; Humans ; Myocardial Infarction* ; Sensitivity and Specificity ; Seoul

The coronary arteriography and left ventriculography were performed on 63 patients with acute myocardial infarction who were admitted to coronary care unit of Seoul National University Hospital from September 1984 to October 1986 within 30 days after onset of acute myocardial infarction (median: 16 days) to delineate the extent of coronary artery disease and the left ventricular function. The results were as follows; 1) The ratio of male to female was 59:4 (14.75:1) and 34.9% of all patients were at their 6th decade. 2) The infarction were transmural in 58 patients (92.1%) and nontransmural in 5 patients (7.9%). Among 58 patients with transmural infarction, 33 (56.9%) had anterior wall infarction, 15 (25.9%) had inferior wall infarction and 10 (17.2%) had anteroinferior wall infarction. 3) Among 63 patients, 4 (6.3%) showed completely normal coronary artery on coronary arteriography and 3 (4.8%) had insignificant stenosis (lesser than 50%) reduction in luminal diameter). The 39.7% of all patients had one-vessel disease, 27% two-vessel disease and 22.2% three-vessel disease. 4) Among 58 patients with transmural infarction, 31 (53.4%) showed complete occlusion of infarct related artery. And 73.4% of the patients with inferior wall infarction showed complete occlusion of infarct related artery. None of the patients with non-transmural infarction had complete occlusion. 5) In 21 patients who had the coronary arteriography within 14 days after the onset, 12 (57.2%) showed complete occlusion of infarct related artery and among 42 patients who were studied 15-30 days after the onset, 19(45.2%) showed complete occlusion. 6) Nineteen patients (30.2%) were found to have left ventricular aneurysm. 7) The left ventricular ejection fraction were significantly higher in the patients with non-transmural infarction than in patients with transmural infarction. The difference in left ventricular ejection fraction between the patients with anterior infarction and with inferior infarction, between single vessel disease and multiple vessel disease were not significant. 8) The older age group showed a tendency to have higher prevalence of multivessel disease. 9) As complication of coronary arteriography and left ventriculography, one episode of ventricular fibrillation was observed without mortality. From the above results of this study, it is concluded that coronary arteriography and left ventriculography can be safely performed within 30 days after the onset of acute myocardial infarction: A significant number of patients had normal or minimally diseased coronary artery: more than half of the patients with transmural infarction had complete occlusion of infarct related artery: the patients with nontransmural infarction had better left ventricular function than with transmural infarction.
Aneurysm ; Angiography ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Care Units ; Coronary Vessels ; Female ; Humans ; Infarction ; Male ; Mortality ; Myocardial Infarction* ; Phenobarbital ; Prevalence ; Seoul ; Stroke Volume ; Ventricular Fibrillation ; Ventricular Function, Left

The force-interval relationship of cardiac muscle has been known as not only a fundamental manifestation of beat-to-beat kinetics of intracellular activator calcium which control contractile response but also a potential clinical tool for evaluating cardiac contracile function. In this study were evaluated the force-interval relationship of intact canine left ventricle through mechanical restitution curves by plotting contrctile responses to varying steady state, extrasystolic and postextrasystolic intervals, and compared the force-interval relationships of intact canine left and right ventricles quantitatively. Effects of localized myocardial ischemia on the left ventricular force-interval relationship and relaxtion function were also evaluated 30 minutes after ligating proximal left anterior descending coronary artery through observing contractile and relaxtion responses to various intervals. 1) Mechanical restitution curve of left ventricle showed that left ventricular dp/dt max responses rose stiffly until plateau level with increasing postextrasystolic intervals, then declined with further increment of postextrasystolic intervals. 2) Mechanical restitution curve of left ventricle shifted leftward and upward with shortening of steady state and extrasystolic intervals, which suggest intracellular calcium kinetics during electrical diastole may operate as a mechanism of the force-interval relationship. 3) Steady state contractile responses remained unchanged but maximal contractile responses increased significantly or contractile reserve in intact left ventricle. 4) Normalized force-interval relationships of left and right ventricle were similar quantitatively, which suggest the force-interval relationship is independent of structural factors in intact canine heart. 5) Occlusion of coronary artery lowered absolute values of left ventricular dp/dt max responses to varying postextrasystolic intervals, but didn't show significant changes of normalized dp/dt max responses, which suggest force-interval relationship be also present in spite of localized myocardial ischemia. 6) Responses of normalized left ventricular dp/dt min to varying postextrasystolic intervals were similar to those of normalized dp/dt max but reduced after coronary artery occlusion in the range above 100% dp/dt max response, which may be used for the detection and evaluation of deranged myocardial relaxation in the left ventricle with localized myocardial ischemia.
Calcium ; Coronary Vessels ; Diastole ; Heart ; Heart Ventricles ; Kinetics ; Myocardial Ischemia ; Myocardium ; Relaxation ; Ventricular Function, Left*

No abstract available.
Adenocarcinoma* ; Adenocarcinoma, Papillary ; Stomach

PURPOSE: Operative management of acute cholecystitis in aged patients has been shown to have relatively higher morbidity and mortality. The aim of this study was to determine appropriate management protocols for acute cholecystitis in those more than 70 years old. METHODS: From May 2003 to Dec 2009, we performed this study of patients over 70 years old that were diagnosed with acute cholecystitis (n=257). We excluded patients that had a hepatobilliary malignancy, a previous laparotomy history, secondary cholecystitis, or a high operative risk factor (n=78). Eligible participants were divided into two groups according to the first management of acute cholecystitis. One hundred two of the 179 (group A) had undergone a laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) within 48 hr after arriving at the emergency room; 77 of the 179 (group 2) had PTGBD done as the first management protocol. We divided group 2 into group C (n=47) and D (n=30) according to cholecystectomy or not. We compared clinical outcomes of the two groups. RESULTS: The mean age of patients was 77.5 years old (102 for Group A and 77 for Group B. Univariant analysis of pre-operative clinical findings between groups A and B showed a significant difference only in age and in type of acute cholecystitis, However, the pre-operative co-morbidity of group B was significantly higher than that for group A. Comparing postoperative results between groups A and C, postoperative complications, open conversion rate, and mortality after cholecystectomy were not significantly different. CONCLUSION: PTGBD could be considered as appropriate management in aged patients with acute cholecystitis. Moreover, PTGBD can reduce unnecessary cholecytectomies.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Emergencies ; Gallbladder ; Humans ; Laparotomy ; Postoperative Complications ; Risk Factors

No abstract available.
Carcinoma, Hepatocellular ; Colon ; Neoplasm Metastasis

The Peutz-Jeghers syndrome is an autosomal dominant disease characterized by hamartomatous polyps in the gastrointestinal tract and mucocutaneous melanin pigmentation. Although these polyps are believed to have little potential for malignancy, and the disease was believed to have a relatively benign course, it recently has been recognized that patients with this syndrome are at increased risk for the development of cancer at gastrointestinal and nongastrointestinal sites. A 33-year-old male patient was admitted because of vomiting and abdominal pain for 3 months duration. A diagnosis of Peutz-Jeghers syndrome was made 3 years ago by multiple hamartomatous polyps confined to the colon and mucocutaneous pigmentation. A barium study showed abrupt string like luminal narrowing at the 4th portion of the duodenum. On laparotomy, there was an annular constricting mass involving the serosa of duodenum with multiple metastasis to liver, so a segmental resection of small bowel followed by chemotherapy was performed. The histologic finding was adenocarcinoma.
Abdominal Pain ; Adenocarcinoma* ; Adult ; Barium ; Colon ; Diagnosis ; Drug Therapy ; Duodenum ; Gastrointestinal Tract ; Humans ; Laparotomy ; Liver ; Male ; Melanins ; Neoplasm Metastasis ; Peutz-Jeghers Syndrome* ; Phenobarbital ; Pigmentation ; Polyps ; Serous Membrane ; Vomiting

BACKGROUND: Among the various physiochemical stimuli, hypoxia has been known to cause coronary vasodilation. In contrast to this, endothelial dependent contracting factor(EDCF) was shown to be secreted by hypoxia and overall physiological roles of these apparently contradicting two phenomena are not clear. Although coronary vasodilation is dominant in epicardial coronary artery by hypoxia, collateral circulation may show different response from epicardial coronary artery to the same stimulus and effect of hypoxia on the vasomotor tone of collateral vessels has not been established. METHODS: Left circumflex coronary artery was chronically occluded using Ameriod occluder in the canine model and myocardial blood flow through collateral circulation was measured using microsphere during induced regional hypoxia. RESULTS: 1) Myocardial blood flow measurements during oxygenated and hypoxic solution infusion were 1.11+/-0.11 mg/min/g and 1.12+/-0.10 ml/min/g respectively in normal perfused zone(LAD territory), but in the collateral dependent zone(LCX territory) blood flow decreased significantly during hypoxic solution infusion(0.55+/-0.17 ml/min/g vs 0.43+/-0.21 ml/min/g)(p<0.05). Also myocardial blood flow ratio(LCX/LAD territory) decreased significantly during hypoxic solution infusion(0.49+/-0.16 vs 0.39+/-0.02)(p<0.05). 2) In collateral dependent zone, endocardial and epicardial blood flow ratio showed significant redistribution during hypoxic solution infusion. 3) After verapamil administration, myocardial blood flow in collateral dependent zone increased from 0.43+/-0.21ml/mg/g to 0.56+/-0.23 ml/mg/g(p<0.05). Also myocardial blood flow ratio(LCX/LAD territory) increased from 0.39+/-0.20 to 0.50+/-0.20 to 0.50+/-0.21 after verapamil administration. CONCLUSION: Hypoxia seems to cause vasoconstriction in collateral vessels and redistribution of blood flow in collateral dependent zone and these effects can be reversed by verapamil.
Anoxia* ; Collateral Circulation* ; Coronary Vessels ; Microspheres ; Oxygen ; Vasoconstriction ; Vasodilation ; Verapamil

BACKGROUND: Isolated coronary ostial stenosis presumed to be atherosclerosis in origin is a rare condition reported to have peculiar characteristics-that occurs primarily in premenopausal women, low incidence of risk factors, severe symptoms of short duration with absence of collaterals suggesting rapid development. METHODS: From Feb. 1979 to May. 1991, 11 patients with isolated left coronary ostial stenosis were identified among 2520 coronary angiographies and they were presumed to be athreosclerosis in origin by excluding other alleged causes. RESULTS: There were 5 males and 6 females with mean ages of 47.8+/-9.5 and 51.5+/-7.9 respectively. Clinical presentations were stable angina in 4, unstable angina in 6 patients, and unstable angina after myocardial infarction in 1 patient.Number of risk factors per patient was 0.82+/-0.98. Majority showed a relatively short history of angina(mean 3.6+/-2.8 months). Coronary angiographic findings showed collateral circulation in 7 patients-grade III in 5 of them. There was 1 death related to coronary angiography. Coronary artery bypass surgeries were performed in 7 patients and 5 of them were followed for mean 22+/-8 months without coronary events. CONCLUSIONS: In contrast to the previous reports, isolated left coronary ostial stenosis presumed to be atherosclerosis in orign did not showed female predelication and although their symptom durations were relatively short coronary angiographies showed well developed collaterals in the majority of patients.We experienced one coronary angiography related death in this group of patients. Coronary artery bypass surgery is to be recommended in these patients otherwise contraindicated.
Angina, Stable ; Angina, Unstable ; Atherosclerosis* ; Collateral Circulation ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Bypass ; Female ; Humans ; Incidence ; Male ; Myocardial Infarction ; Risk Factors

PURPOSE: Steroids have anti-inflammatory effects which reduces inflammation and edema of the tissue. Thus, corticosteroids have been used for treatment of croup. The aim this study is to compare and assess the effects of intramuscularly injected dexamethasone and nebulized budesonide in treatment of moderate or severe croup. METHODS: Between July 1995 to June 1996, we have assessed 44 inpatients with croup syndrome, of which 20 patients have been treated by intramuscularly injected dexamethasone and 24 patients by nebulized budesonide. We measured the croup symptom scores and arterial oxygen saturation at initial, at 4 hours, 12 hours and 24 hours after treatment. RESULTS: The sex ratio and mean age of patients were 2.3:1 and 18.7 +/- 9.1 months in budesonide treatment group and 3:1 and 22.3 +/- 13.1 months in dexamethasone treatment group, respectively. There was no significant difference (P>0.05) among the two groups. In budesonide treatment group, the symptom scores were 7.5 +/- 4.5 at initial and 4.5 +/- 1.3 at 4 hours after treatment. These were statistically significant (P<0.005). In the dexamethansone treatment group, the symptom scores were 7.6 +/- 1.2 at initial and 5.1 +/- 1.2 at 4 hours after treatment. They were statistically significant (P<0.005). Arterial oxygen saturations were significantly different (P<0.005) between initial and 4 hours after treatment in both groups. There were no side effects in the budesonide treatment group. CONCLUSION: Nebulized budesonide has the same effects with intramuscularly injected dexamethasone in treatment of croup whether the severity is moderate or extreme. Therefore it should provide an effective means of treatment for moderate or severe croup patients without systemic side effects.
Adrenal Cortex Hormones ; Budesonide* ; Croup* ; Dexamethasone* ; Edema ; Humans ; Inflammation ; Inpatients ; Oxygen ; Sex Ratio ; Steroids