BACKGROUND: This clinical trial was performed to evaluate the hemodynamic and side effects of enoximone, a newly developed phosphodiesterase inhibitor, in moderately severe congestive heart failure in Korean population and to base the development of long acting oral preparations in the future. METHODS: Principal admission criteria for this trial were a left ventricular ejection fraction of less than 45% by radionuclide ventriculography, NYHA functional class II or III and a documented congestive cardiomyopathy. Exclusion criteria were restrictive cardiomyopathy, valvular heart disease, multisystemic lillness and uncontrolled ventricular tachyarrhythmia. The hemodynamic measurements were made by using the thermodilution Swan-Ganz catheter and radial arterial canulation. Enoximone was administered(continuous infusion) for 24 hours after initial bolus. The hemodynamic parameters to be observed were blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance. The clinical reponse, hematology, blood chemistry, and Holter monitoring were checked before and after enoximone trial. RESULTS: The following results are obtained. 1) The included patients were 15 females, 24 males, total 39 patients and mean age of 55.3 years old(28-70 years old). 2) The causes of congestive cardiomyopathy were idiopathic 35(89.9%), hypertensive 3(7.7%), and alcoholic 1(2.6%). 3) The mean ejection fraction measured by radionuclide left ventriculography were 28. 6%. 4) THe cardiac output was significantly increased(50%), and pulmonary capillary wedge pressure(38%), systemic vascular resistance(34%), pulmonary vascular resistance(27%) were significantly decreased during enoximone infusion. 5) NYHA Functional Class was improved by 1 step with enoximone. 6) There were no significant changes in hematology, blood chemistry, and Holter monitoring with enoximone. CONCLUSION: From the above results, the short term intravenous enoximone was very effective in moderately severe congestive heart failure in congestive cardiomyopathy without major adverse effects in Korean.
Alcoholics ; Blood Pressure ; Capillaries ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Catheters ; Chemistry ; Electrocardiography, Ambulatory ; Enoximone* ; Estrogens, Conjugated (USP)* ; Female ; Heart Failure* ; Heart Rate ; Heart Valve Diseases ; Hematology ; Hemodynamics* ; Humans ; Male ; Pulmonary Wedge Pressure ; Radionuclide Ventriculography ; Stroke Volume ; Tachycardia ; Thermodilution ; Vascular Resistance

We experience a case of 34-year-old Turner's syndrome(45, XO) associated with atrial septal defect(secondum type) and mitral valve prolapse who was admitten due to moderate exertional dyspnea. It is well know hat chromosomal abnormality is one of the etiology of congenital heart disease. In case of Turner's syndrome, coarctation of aorta or bocuspid aortic valve is frequently combined, but atrial septal defect simultaneously with mitral valve prolapse is not reported till now in Krea. We report this case with a brief review of the literature.
Adult ; Aortic Coarctation ; Aortic Valve ; Chromosome Aberrations ; Dyspnea ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Mitral Valve Prolapse* ; Mitral Valve* ; Turner Syndrome*

In June of 1983 authors had investigated the occurrence of the avian malaria in the Humboldt penguins imported from Japan to the Farm-land Zoo in central district of Korea. The disease was characterized by acute course and high mortality. The peripheral blood smears from the affected penguins demonstrated different developmental stages of Plasmodium sp. in the mature erythrocytes. The predominant gross lesions noticed were pulmonary and epicardial edema and hepato-splenomegaly. Microscopically the lesions were characterized by extensive reticuloendothelial cell hyperplasia with striking feature of exoerythrocytic schizogony affecting a variety of tissues. The report also signifies the first description of a disastrous epizootic of avian malaria in Korea.
parasitology-protozoa ; malaria ; penguin ; Plasmodium sp. ; hepatosplenomegaly ; case report

Chondromyxoid fibroma (CMF) is a rare, benign tumor of the bone that represents fewer than 2% of all benign tumors of bone. CMF is most often found in the long tubular bones, especially the tibia and femur near the knee joint. Less common sites included the pelvis, fibula, calcaneus and rib. A 54-year-old male patient presented to us with history of swelling and mild, intermittent local pain without any rise in overlying skin temperature in lateral portion of left 7th rib for one-month duration, which was diagnosed as benign rib tumor by plain chest X-ray and CT scan, and treated successfully by excision of rib with good result. Pathologic diagnosis of this tumor was CMF. Without any medical therapy, there was no evidence of recurrence after operation. We report this case and follow-up of the patient.
Calcaneus ; Chondroma ; Diagnosis ; Femur ; Fibroma* ; Fibula ; Follow-Up Studies ; Humans ; Knee Joint ; Male ; Middle Aged ; Pelvis ; Recurrence ; Ribs* ; Skin Temperature ; Thorax ; Tibia ; Tomography, X-Ray Computed

BACKGROUND: One of the unique feature of ambulatory blood pressure monitoring is its ability to describe the variations of BP throughout the day and night. Left ventricular hypertrophy and other measures of target organ damage in hypertension are more closely related to the average 24-h BP than to clinic BP. In addition to the mean levels of BP, the characteristics of the 24-h BP profile might be a further determinant of organ in essential hypertension. METHODS: Data were obtrained from 105 patients with essential hypertension and 44 normal subjects. Echocardiography and 24 hour ambulatory blood pressure monitoring were performed in all subjects. At first, relative wall thickness(RWT) and left ventrcular mass index were calculated from normal subject and normal values(RWT<0.44, LV mass index,120gm/m2) were applied to hypertensive patients which were classified to dipper and non-dipper according to the result of ambulatory monitoring. RESULTS: 1) There were 49 dippers and 56 non-dipper in hypertensive patients subjects. 2) Among the dippers, left ventricular mass index and relative wall thickness were normal in 51%, whereas 8.2% had increased relative wall thickness with normal ventricular mass(concentric remodeling), 32.7% had increased mass with normal relative wall thickness(eccentric hypertrophy) and 8.2% had typical hypertensive concentric hypertrophy. 3) Among the non-dippers, left ventriculat mass index and relative wall thicksness were normal in 40%, whereas 41.8% had eccentric hypertophy, 16.4% had concentric hypertrophy, only 1.8% had concentric remodeling. 4) The incidence of concentric hypertophy was significantly increased in non-dipper subjects(15.2%) than dippers(8.2%), especially in non-dipper female patients. 5) The incidence of concentric remodeling was increased in dipper(8.2%), especially in dipper female patients. 6) There were no difference between left ventricular geometies in duration of hypertension, ejecton fracton, fractional shortening, and cardiac index. 7) There were no difference between dipper and non-dipper subjects in total peripheral resistance except dipper female patients(1,484+/-535 dynes.s.cm5). CONCLUSION: Patterns of left ventricular hypertophy and geometric remodeling in essential hypertension may not be influenced by the duration of hypertension, but by gender, blood pressure level, diurnal rhythm and total peripheral resistance.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Circadian Rhythm ; Echocardiography ; Female ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular ; Incidence ; Monitoring, Ambulatory ; Vascular Resistance

BACKGROUND: Although the net atrioventricular compliance can be obtained by invasive catheterization (Ccath) in mitral stenosis (MS), feasibility of noninvasive echocardiographic calculation of the compliance (Cecho) and its hemodynamic significance were not tested. METHODS: Using valve area by 2D planimetry (A2D) and deceleration slope (dv/dt) of transmitral velocity decay in continuous wave Doppler echocardiographic tracing, Cecho was defined as -A2D/(gamma dv/dt), which was compared with Ccath obtained directly during the catheterization in 30 MS patients with sinus rhythm. Exercise Doppler echocardiography with symptom-limited treadmill was performed in 66 patients with moderate to tight MS: mean mitral gradient (MG) and peak pressure gradient of tricuspid regurgitation (PGTR) at baseline and immediately after exercise were obtained using continuous wave Doppler echocardiographic tracing. Hemodynamic variables including Cecho, MG, PGTR and mitral valve area were analyzed to determine the association with patients' exercise tolerance. RESULTS: Cecho in 30 patients with tight MS (valve area 0.9+/-0.2 cm 2) was 4+/-1 ml/mmHg (2-7 mmHg), which showed a significant correlation with Ccath (r=0.48, p=0.01). Exercise time in 66 patients with moderate to tight MS showed significant negative correlation with resting MG, resting and postexercise PGTR, and positive correlation with Cecho: exercise time in those patients did not show any significant correlation with resting valve area. In multivariate analysis, Cecho and postexercise PGTR were independent factors determining exercise time in MS. CONCLUSIONS: The net atrioventricular compliance in MS can be calculated by noninvasive echocardiography, and it is an important hemodynamic factor determining exercise tolerance in MS.
Catheterization ; Catheters ; Compliance ; Deceleration ; Echocardiography ; Echocardiography, Doppler ; Exercise Tolerance ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Multivariate Analysis ; Tricuspid Valve Insufficiency

BACKGROUND: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of T-PLS(TM) through the comparison of clinical effects of T-PLS(TM) (pulsatile pump) and Bio-pump(TM) (non-pulsatile pump) used for coronary bypass surgery. MATERIAL AND METHOD: The comparison was made on 40 patients who had coronary bypass using T-PLS(TM) and Bio-pump(TM) (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. RESULT: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with T-PLS(TM) (46+/-15 mmHg in T-PLS(TM) vs 35+/-13 mmHg in Bio-pump(TM), p<0.05). The T-PLS(TM)-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant (9.7+/-3.9 cc/min in T-PLS(TM) vs 8.9+/-3.6 cc/min in Bio-pump(TM), p=0.20). There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with T-PLS(TM) (24.5+/-21.7 mg/dL in T-PLS(TM) versus 46.8+/-23.0 mg/dL in Bio-pump(TM), p<0.05). There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with T-PLS(TM), but the death rate was not statistically significant. CONCLUSION: Coronary bypass was operated with T-PLS(TM) (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which Bio-pump(TM) was used. In addition, T-PLS(TM) used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of T-PLS(TM).
Arrhythmias, Cardiac ; Arterial Pressure ; Blood Cells ; Blood Pressure ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Extracorporeal Circulation ; Heart-Lung Machine ; Humans ; Hypertension ; Infarction ; Lung Diseases, Obstructive ; Mortality ; Perfusion* ; Plasma ; Pulsatile Flow ; Renal Insufficiency ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Transplants ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: QT interval on ECG strongly depends on heart rate. Prolonged early phase of repolarization may be responsible for mechanisms of arrhythmogenesis. Investigation of physiologic behavior of QT interval and their relation to cardiac cycle length may explain mechanisms of arrhythmogenesis. The aim of this study is to investigate the physiologic behavior of the QT intervals during various stages of treadmill exercise test in healthy airlines pilots. METHOD: A retrospective analysis of treadmill exercise test ws done in 60 healthy men. Each underwent 10 ECG recordings, which were performed in resting, 1 minute, 2 minute and 3 minute of exercise stage 1, 2 and 3 of Bruce protocol respectively. The QT interval was measured as the time interval from the earliest Q onset to the peak T wave (QTp) in precordial lead V2. RESULTS: The mean heart rate before exercise was 72 +/-5 beats/minute, and at 1, 2 and 3 minute of exercise stage 1, 2 and 3 were 96 +/-8, 97 +/-7, 99 +/-9, 112 +/-9, 117 +/-9, 120 +/-10, 137 +/-12, 145 +/-12 and 152 +/-10, respectively. The d-QTp/d-RR at 1, 2 and 3 minute of exercise stage 1, 2 and 3 were 10.4 +/-5.9, 14.1 +/-5.8, 15.1 +/-6.2, 14.8 +/-4.2, 16.1 +/-3.7, 16.3 +/-3.5, 16.8 +/-2.9, 17.1 +/-3.0%, respectively. The QTp interval respond slowly for rapid changes in cycle length. The change of QTp interval showed a linear correlation with the change of the RR interval (y=0.189x-10.864, r=0.83, P<0.0001). CONCLUSION: The changes in QT interval lagged behind the rapid and sustained changes in the heart rate elicited by treadmill exercise test. It is concluded that the d-QTp/d-RR showed hysteresis in the changes in the RR interval may be useful in assessing in the dynamic regulation of the ventricular repolariza-tion process.
Electrocardiography ; Exercise Test ; Heart Rate ; Humans ; Male ; Retrospective Studies

BACKGROUND: Cicletanine is a new antihypertensive agent, derived from the furopyridine family. It acts directly on vascular smooth muscle by increasing prostacyclin synthesis and decreasing intracytosolic calcium. In order to investigate the efficacy and safety of cicletanine, a clinical study was performed in the patients with mild to moderate essential hypertension. METHOD: The study subject consisted of 30 patients with diastolic blood pressure of 95mmHg~114mmHg(mean age : 55.1+/-7.9 years, 13 males and 17 females). Cicletanine was administrated orally in a daily dose of 100mg Q.D. for 12 weeks after the administration of a placebo for 2 weeks. During cicletanine medication, antihypertensive efficacy, clinical side effects and laboratory changes were monitored. RESULT: Cicletanine decreased mean blood pressure from the baseline value of 123.6+/-3.4mmHg to 108.6+/-7.5mmHg(p<0.001) after 2 weeks, 105.0+/-7.4mmHg after 4 weeks, 103.9+/-6.6mmHg after 6 weeks, 102.5+/-8.9mmHg after 8 weeks, 101.4+/-6.8mmHg after 10 weeks and 99.6+/-6.6mmHg after 12 weeks of medication. There was a highly significant decrease in blood pressure at each of the assessments after 2,4,6,8,10 and 12 weeks of medication when compared to the baseline value(p<0.001). Mean blood pressure after 4 weeks of medication showed a significant decrease when compared to the value after 2 weeks of medication, and the value after 12 weeks of medication showed a significantly decrease when compared to the value after 8 weeks of medication. Heart rate did not change significantly with cicletanine monotherapy for 12 weeks. There was no significant changes in blood chemistry, glucose, lipid and electrolytes. The side effect was pruritus(1 case, 3.3%). CONCLUSION: Cicletanine monotherapy with 100mg once a day regimen was effective and well tolerated in the patients with mild to moderate essential hypertension.
Blood Pressure ; Calcium ; Chemistry ; Electrolytes ; Epoprostenol ; Glucose ; Heart Rate ; Humans ; Hypertension* ; Male ; Muscle, Smooth, Vascular

OBJECTIVE: To compare two testing protocols for evaluating range of motion (ROM) changes in the preloaded cadaveric spines implanted with a mobile core type Charite(TM) lumbar artificial disc. METHODS: Using five human cadaveric lumbosacral spines (L2-S2), baseline ROMs were measured with a bending moment of 8 Nm for all motion modes (flexion/extension, lateral bending, and axial rotation) in intact spine. The ROM was tracked using a video-based motion-capturing system. After the Charite(TM) disc was implanted at the L4-L5 level, the measurement was repeated using two different methods : 1) loading up to 8 Nm with the compressive follower preload as in testing the intact spine (Load control protocol), 2) loading in displacement control until the total ROM of L2-S2 matches that when the intact spine was loaded under load control (Hybrid protocol). The comparison between the data of each protocol was performed. RESULTS: The ROMs of the L4-L5 arthroplasty level were increased in all test modalities (p < 0.05 in bending and rotation) under both load and hybrid protocols. At the adjacent segments, the ROMs were increased in all modes except flexion under load control protocol. Under hybrid protocol, the adjacent segments demonstrated decreased ROMs in all modalities except extension at the inferior segment. Statistical significance between load and hybrid protocols was observed during bending and rotation at the operative and adjacent levels (p < 0.05). CONCLUSION: In hybrid protocol, the Charite(TM) disc provided a relatively better restoration of ROM, than in the load control protocol, reproducing clinical observations in terms of motion following surgery.
Arthroplasty ; Cadaver ; Chimera ; Displacement (Psychology) ; Humans ; Range of Motion, Articular ; Spine ; Track and Field