To determine the effect of percutaneous transluminal coronary angioplasty on the left ventricular diastolic filling in patients with coronary artery disease, diastolic filling was serially examined before, early(within 2 days) and late(5~15 days) after PTCA using pulsed Doppler echocardiography in 14 patients(12 unstable angina; 2 stable angina). The Control group was consisted of 20 normal persons with similar age and sex distribution. The left anterior descending artery was dilated in 10 patients, the right coronary artery in 3 patients, and the circumflex artery in 1 patient. Peak velocity of early diastolic rapid inflow(E), peak velocity of late diastolic inflow (A), A/E ratio, and deceleration time of E wave were measured by pulsed Doppler echocar diography. 1) LVangiogram was performed in 10 patients, and showed normal wall motion in 7 cases and regional hypokinesia in 3 cases. Delta area decreasing rate was 59+/-10%, and LVEDP was 11+/-4 mmHg. 2) A/E ratio was greater in patient group(1.00+/-0.28) than in normal control (0.64+/-0.10) (p<0.05). There was no significant difference in A and E values between two groups. 3) A/E ratio decreased significantly from 1.00+/-0.28(pre-PTCA) to 0.85+/-0.24 (late post-PTCA) (p<0.01), but there was no significant change at early post-PTCA(0.94+/-0.32). Deceleration time also decreased significantly from 213+/-56 msec(pre-PTCA) to 177+/-34 msec (late post-PTCA) (p<0.05), but there was no significant change at early post-PTCA (199+/-34 msec). In conclusion, there was impairment of left ventricular diastolic filling in patients with coronary artery disease which gradually improved after PTCA, and this result probably is related to post-ischemic "stunned" myocardium.
Angina, Unstable ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Humans ; Hypokinesia ; Myocardium ; Sex Distribution

Perforation of the interventricular septum complicating acute myocardial infarction is uncommon. The condition was first described anatomically by Latham in 1845 and the first antemortem diagnosis was made by Brunn in 1923. In both cases, bedside catheterization utilizing a flow directed catheter detected a step up of O2 saturation at the ventricular level, compatible with ventricular septal defect, and two dimensional echocardiogram allowed direct visualization and localization of the postmyocardial infarction VSD. Finally cineventriculogram confirmed them.
Catheterization ; Catheters ; Diagnosis ; Heart Septal Defects, Ventricular ; Infarction* ; Myocardial Infarction

To investigate the significance of precordial ST-segment depression in acute inferior myocardial infarction, electrocardiographic findings in 51 consecutive patients with acute inferior myocardial infarction were analysed with clinical findings and coronary artery angiography. Thirty patients(Group A) had no or <1.0mm ST depression, and twenty one patients(Group B) had > or =1.0mm ST depression in two or more precordial(VI-6) leads were included in this study. Patients in Group B thd greater summed ST-segment elevation in leads II, III, AVF(6.3+/-6.1 vs 2.4+/-2.3mm, p<0.05), higher plasma peak CK levels(1776.8+/-1503.3 vs 5666.6+/-587.7 IU/L, p<0.05), higher plasmal peak CK-MB levels(141.2+/-1553.3 vs 34.1+/-35.7 IU/L, p<0.05), more prevalence of proximal left anterior descending coronary artery disease (46.6% vs 16.6%, p<0.05) than patients in Group A. There was no significant difference between Group A and Group B in the LV ejection fraction, delta area decreasing rate, infarction related asynergy, complications during hospitalization and cardiac events during follow up period. In conclusion, patients with acute inferior myocardial infarction who have associated with precordial ST depression had more extensive myocardial damage probably due to concomitant left anterior descending coronary artery disease.
Angiography ; Coronary Artery Disease ; Coronary Vessels ; Depression* ; Electrocardiography ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Inferior Wall Myocardial Infarction* ; Plasma ; Prevalence

Thymic carcinoid or neuroendocrine tumor of thymus is a very rare disease and has poor prognosis due to frequent recurrence and distant metastasis. A 43-year-old man was refered to our hospital because of Rt. chest pain and tightness. Chest X-ray revealed 7 X 8cm sized mass on Rt. anterior mediastinum. Surgical excision was performed and light microscopic, immunohistochemical and electron microscopic findings were confirmed as atypical thymic carcinoid tumor with thymic cyst. The patient has been followed up without recurrence or distant metastasis postoperatively for 3 months to now. We report a case of atypical thymic carcinoid with thymic cysts.
Adult ; Carcinoid Tumor* ; Chest Pain ; Humans ; Mediastinal Cyst* ; Mediastinum ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Prognosis ; Rare Diseases ; Recurrence ; Thorax ; Thymus Gland

BACKGROUND AND OBJECTIVES: Cochlear blood flow is considered important as one of many causes of various inner ear diseases. Many studies have been performed to prove the decrease in cochlear blood flow as a cause of those diseases. This study was performed to determine the effects of cochlear ischemia induced by AICA occlusion on the relation of cochlear blood flow (CBF) in guinea pigs. MATERIALS AND METHODS: In 3 guinea pigs, the AICA was exposed through the basal portion of the skull with stable systemic blood pressure. The CBF of the basal area was monitored with laser Doppler flowmetry (LDF). The AICA was clamped for several minutes. With different durations, the LDF was measured under systemic blood pressure monitoring. RESULT: The vascular conductance in preocclusion state was 0.09+/-0.04 TPU (tissue perfusion unit)/mmHg. During occlusion of AICA for above 1 minute, abrupt decrease and following slow increase of CBF was observed. CONCLUSION: The autoregulation of CBF was identified, but it was incomplete even under the stable blood pressure. This study can be a good model for evalulation of hearing function during partial cochlear ischemia, but occulusion of labyrinthine artery will be a better choice for complete cochlea ischemia model.
Animals ; Arteries* ; Blood Pressure ; Blood Pressure Monitors ; Cochlea ; Guinea Pigs* ; Guinea* ; Hearing ; Homeostasis ; Ischemia ; Labyrinth Diseases ; Laser-Doppler Flowmetry ; Perfusion ; Skull

A 52-year-old woman with rheumatoid arthritis who had been treated with prednisone and hydroxychloroquine for >12 years presented with chest discomfort and a seizure. She was diagnosed with restrictive cardiomyopathy combined with sick sinus syndrome. A myocardial muscle biopsy was performed to identify the underlying cardiomyopathy, which showed marked muscle fiber hypertrophy, fiber dropout, slightly increased interstitial fibrous connective tissue, and extensive cytoplasmic vacuolization of the myocytes under light microscopy. Electron microscopy of the myocytes demonstrated dense, myeloid, and curvilinear bodies. The diagnosis of hydroxychloroquine-induced cardiomyopathy was made based on the clinical, hemodynamic, and pathologic findings. This is the first case report describing chloroquine-induced cardiomyopathy involving the heart conduction system.
Arthritis, Rheumatoid ; Biopsy ; Cardiomyopathies ; Cardiomyopathy, Restrictive ; Connective Tissue ; Cytoplasm ; Female ; Heart Conduction System ; Hemodynamics ; Humans ; Hydroxychloroquine ; Hypertrophy ; Light ; Microscopy ; Microscopy, Electron ; Middle Aged ; Muscle Cells ; Muscles ; Patient Dropouts ; Prednisone ; Seizures ; Sick Sinus Syndrome ; Thorax

Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.