The pulmonary arterial pressure(PAP) was reported to be higher in essential hypertensives than in normotensives, but the underlying mechanisms for the higher PAP were not known exactly. In order to observe the changes of pulmonary hemodynamics and to get an insight into the mechanism of the pulmonary hypertension, if any, in essential hypertensive patients, the autors performed the cardiac catheterization in 13 normal controls(group A), 14 coronary patients with normal systolic left ventricular function and systemic blood pressure(group B), and 15 essential hypertensives with normal coronary artery and systolic left ventricular function(group C). 1)Pulmonary arterial pressure(PAP) was 19.2+/-3.2/8.1+/-1.9/12.0+/-1.9(s/d/m)mmHg in group A, 25.0+/-6.2/12.8+/-4.0/16.3+/-4.5mmHg in group B, 29.3+/-6.1/12.8+/-4.0/18.2+/-3.6mmHg in group C. The PAP was higher in group B and C than that of group A(p<0.005). 2) Pulmonary vascular resistance(PVR) was 88.2+/-34.9 dyne.sec.cm(-5) in group A. 137.8+/-74.5 dyne.sec.cm(-5) in group B and 173.9+/-77.5 dyne.sec.cm(-5) in group C. In group B and C, PVR was increased compared to that of group A(p<0.05, p<0.005, respectively). 3) Pulmonary capillary wedge pressure(PCWP) was 6.6+/-2.8 mmHg in groupa A. 9.9+/-2.9mmHg, and 9.6+/-3.6 mmHg in group C. PCWP in group B and C were higher than that of group A(p<0.005). 4) Systemic vascular resistance(SVR) was 1298+/-340 dyne.sec.cm(-5) in group A, 1466+/-362 dyne .sec.cm(-5) i group B and 2255+/-439 dyne.sec.cm(-5) in group C. In group C, SVR was increased compared to that of group A and B(p<0.002). 5) Significant correlation was demonstrated between PVR and PCWP in group A(r=-0.74, p<0.05). 6) In group B, significant correlations were shown between PAP and PCWp(r=0.55, p<0.05), between PAP and PVR(r=0.69, p<0.05). 7) In group C, significant correlations were demonstrated between PAP and PCWP(r=0.55, p<0.05), between PVR and SVR(r=<0.51, p<0.01). Above results revealed that PAP and PVR were increased in essential hypertensives without left ventricular failure and this elevated PAPseemed to be affected in part by increased PCWP, and increased PVR in accordance with increased SVR.
Capillaries ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vessels ; Hemodynamics* ; Humans ; Hypertension* ; Hypertension, Pulmonary ; Ventricular Function, Left

Clear cell hidradenoma, generally as an eccrine sweat gland origin, is a fairly uncommon tumor and occurs as a slowly growing, usually solitary nodule. The histological patterns vary from one tumor to another and in different parts of the same tumor. We experienced three cases of clear cell hidradenoma which were diagnosed by the histopathologic examination of the tumor mass removed by surgical excision. Clinical and histopathologic features of each case were reviewed and compared.
Acrospiroma* ; Sweat Glands

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein* ; Catheters* ; Extracorporeal Membrane Oxygenation* ; Heart ; Hernias, Diaphragmatic, Congenital* ; Humans ; Infant, Newborn* ; Oxygen ; Radiography, Thoracic

Two factors of the ventricular function, systolic contractile and diastolic relaxing functions, cooporate in pumping the adequate blood volumes to suffice bodily demands. In some hypertensive patients with marked left ventricular hypertrophy, the intact systolic function of the ventricle associated with clinical symptom of congestive heart failure(CHF), which is considered to be a consequence of diastolic dysfunction. In this study 10 hypertensive patients(group A) complaining of exertional dyspnea or chest pain with increased left ventricular mass index and normal systolic function and 6 normotensive controls(group B) were examined by cardiac catheterization and echocardiography to assess the left ventricular systolic and diastolic function and ventricular responses to constant infusion of nitroprusside. Various systolic and diastolic function indices were measured by cardiac catheterization and echocardiography. 1) The ejection fraction(EF), fractional fiber shortening, mean velocity of circumferential fiber shortening, left ventricular(LV) peak+dp/dt, change of slope of LV peak systolic pressure-volume and pressure-dimension relations in group A were not different from those of group B in the resting states. 2) Diastolic dysfunction was evidenced by prolonged A2D time, decreased OR slope, decreased peak negative dp/dt and increased diastolic time constant 'T' in group A. 3) Cardiac index by thermodilution method was negatively related to left ventricular mass index(LVMI) measured by echocardiography, whereas time constant T was positively related to LVMI. 4) With constant infusion of nitroprusside, LV systolic pressure, LV end-diastolic pressure and pulmonary arterial pressure were decreased, and left ventricular end-systolic stress and stroke work index(SWI) derived from left ventricular pressure-volume loop area were decreased, EF was increased, but time constant T was prolonged and cardiac output(CO) by thermodilution method was decreased in group A. 5) In group B, with constant infusion of nitroprusside, EF, SWI and CO were pratically unaffected and time constant T was not prolonged significantly. These reults suggest that patients with hypertensive hypertrophic left ventricle is associated with diastolic dysfunction, which could further be exacerbated by a vasodilator such as nitroprusside.
Arterial Pressure ; Blood Pressure ; Blood Volume ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Diseases* ; Heart Ventricles* ; Heart* ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Nitroprusside* ; Stroke ; Theophylline ; Thermodilution ; Ventricular Function

The development of the cardiac ganglion was studied by electron microscopy in human fetuses ranging from 30mm to 270mm crown rump length. At 40mm fetus, the cardiac ganglia were observed in the adventitia of both the aorta and pulmonary artery, superior aspect of the left and right atrium, and interatrial septum. The cardiac ganglia were comprised of clusters of undifferentiated cells, neuroblasts, and unmyelinated nerve fibers. The ganglia were small and uncapsulated until 70mm fetus. At 70mm fetus, the cardic ganglia consisted of neuroblasts, satellite cells, and unmyelinated nerve fibers. Each ganglion was ensheathed in a connective tissue capsule. The cytoplasm of neuroblast contained Nissl bodies, mitochondria, coated vesicles, extensive Golgicomplex, and rough endoplasmic reticulum. Synaptic contacts between the cholinergic preganglionic axon and dendrites of postganglionic neuron were first observed. At 100mm fetus, the cardiac ganglia consisted of small clusters of ganglion cells and dendrites, together with supporting elements and blood vessels. During next prenatal stage from 170mm fetus, the ganglion cells were large and each contained a large nucleus with one or more nucleoli. The cytoplasm of ganglion cells contained much rough endoplasmic reticulum and extensive Golgi complex. Cholinergic preganglionic axons were numerous and interposed between the satellite cells. Adrenergic axons were rarely observed. A great number of synaptic junctions between the cholinergic preganglionic axon terminals and the dendrites of postganglinic neuron were found, and a few axosomatic synapses were also observed. Adrenergic nerve terminals did not seem to be involved in the synaptic transmission. The cardiac ganglion cells of the human fetal heart were innervated only by cholinergic nerve.
Adventitia ; Aorta ; Axons ; Blood Vessels ; Coated Vesicles ; Connective Tissue ; Crown-Rump Length ; Cytoplasm ; Dendrites ; Endoplasmic Reticulum, Rough ; Fetal Heart ; Fetus* ; Ganglia ; Ganglion Cysts* ; Golgi Apparatus ; Heart Atria ; Humans* ; Microscopy, Electron ; Mitochondria ; Nerve Fibers, Unmyelinated ; Neurons ; Nissl Bodies ; Presynaptic Terminals ; Pulmonary Artery ; Synapses ; Synaptic Transmission

Cardiac output depends on the ability of systolic ejection and diastolic filling of the heart. M-mode echocardiography can provide accurate clinical assessment of left ventricular systolic and diastolic functions. To see whether there are changes of the left ventricular function in asymptomatic hypertensives and if any kind of dysfunction and whether any relationship between the pattern of the ventricular hypertrophy and type of ventricular dysfunction exists, the authors examined the systolic and diastolic function indices of the left ventricle in 50 normotensives and 88 hypertensives composed of 18 patients without left ventricular hypertrophy(group 1), 40 patients with disproportionate septal thickening (group 2) and 30 patients with concentric left ventricular hypertrophy(group 3). Obtained results were as follows : 1) Blood pressure & left ventricular mass index were increased significantly in each hypertensive group compared to normal control. 2) Ejection fraction & fractional shortening in the hypertensive groups were not different from the normotensive control group. 3) Left ventricular isovolumic relaxation time(A2D time) was prolonged in each hypertensive group, especially in group 3. 4) Left atrial emptying index (AEI) was decreased in each hypertensive group. 5) Left ventricular percent ventricular A wave (% VAW) was increased in all hypertensive groups. Above study suggested that the left ventricular diastolic function could be impaired in the hypertensives without associated systolic dysfunction, and the degree of the diastolic dysfunction was not much affected by the type of left ventricular hypertrophy, but the more prolonged A2D time in the concentric hypertrophy group.
Blood Pressure ; Cardiac Output ; Echocardiography ; Heart ; Heart Ventricles ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Relaxation ; Ventricular Dysfunction ; Ventricular Function, Left

Since CT scanning was introduced in the diagnosis of calcaneal fracture, we became to understand more clearly the pathoanatomy of the injury. However we have to determine if we would or would not take CT scanning by simple radiography in the acute setting and most of the surgeons still use simple radiography in evaluating postoperative result. And also we have to determine the accuracy of reduction and position of screws by simple radiography intraoperatively. The purpose of this report is to determine the accuracy of simple radiography in assessing the pathological anatomy of the intraarticular calcaneal fracture by experimental and clinical studies. This is a combined experimental and clinical studies using four below knee amputation specimens and 15 patients with 19 displaced intraarticular calcaneal fractures treated at Hanil General Hospital between Jan. 1996 and May 1997. The lateral view of the foot was the best radiographic view for visualizing the degree of depression of the posterior facet. With regard to the location of a fracture line, findings of Broden views correlated well with findings on CT in 17 of 19 fractures. With regard to gapping between fragments, the axial view was not satisfactory in the majority of cases(15 of 19 cases). There was no case which showed more than 2 mm of discrepancy between the findings on Broden view and CT. We conclude that we may obtain most of the important informations about the pathological anatomy of the intraarticular calcaneal fracture by simple radiography.
Amputation ; Depression ; Diagnosis ; Foot ; Hospitals, General ; Humans ; Knee ; Radiography* ; Tomography, X-Ray Computed

No abstract available.
Electrocardiography* ; Inferior Wall Myocardial Infarction*

The antianginal effect of oral nicorandil was examined on 15 subjects with angina pectoris who had not been improved by previous treatment with beta blocker and/or calcium antagonists. Nicorandil, 5mg tid, was added to their previous regimen which were composed of beta blocker and/or calcium antagonists, and patients were followed up at least for 6 weeks. The following results were obtained; 1) Frequences of anginal attack were markedly reduced in 11(73%) of 15 patients after the use of nicorandil. 2) After the use of nicorandil, ST segment depression and T wave inversions were improved in 10(66.7%) of 15 patients. 3) In 10 patients who had been taken nicorandil over 12 weeks, 9 patients showed sustained improvement in clinical status, but no significant side effect was noted. 4) In two patients who had undergone exercise tolerance test, significant prolongation in exercise duration were noted. 5) The adverse effects of nicorandil were as follows; headache in 3, insomnia in 3, excessive perspiration, dizziness, thirst, constipation and facial fiushing in 1, respectively.
Angina Pectoris* ; Calcium ; Constipation ; Depression ; Dizziness ; Exercise Tolerance ; Headache ; Humans ; Nicorandil* ; Sleep Initiation and Maintenance Disorders ; Thirst

In order to assess the sensitively and specificity of the pulsed Doppler echocardiography in the aortic regurgitation, 44 patients with valvular heart diseases were examined by pulsed Doppler echocardiography. Every patient was examined in sequence of clinical examination including the physical, M-mode & 2D echocardiographic examination, Doppler technique and then angiocardiography. The obtained results were; 1) Pulsed Doppler echocardiography was very useful in the diagnosis of the aortic regugitation(sensitivity:100%, specificity:90%). 2) Pulsed Doppler echocardiography was especially useful in the detection of the aortic regurgitation in patients who were not detected by physical and conventional echocardiographic examination.
Angiocardiography ; Aortic Valve Insufficiency* ; Diagnosis* ; Echocardiography ; Echocardiography, Doppler, Pulsed* ; Heart Valve Diseases ; Humans ; Sensitivity and Specificity