The systolic time intervals, hemodynamics, and indices of myocardial contractility were measured in 158 normal Koreans with average age of 34(14~69) years by non-invasive technique, i.e. simultaneous recording of ECG, PCG, and carotid and femoral pulse tracing with paper speed 100mm/sec. by cardiograph. 1. Normal values of systolic time intervals were as follows(M+/-SD): QS1was 61.5+/-10.8, ICT 41.9+/-12.0, PEP 10.+/-14, LVET 281+/-24, and QS2 385+/-26 msec. 2. Regression equations of systolic time intervals to pulse rate were as follows: QS1; 0.04 x PR + 60.0 (r=+0.038, p>0.05), ICT; -0.2 x PR + 59.6 (r=-0.234, p<0.01), PEP; -0.2 x PR + 117 (r=-0.162, pp<0.05), LVET; -1.5 x PR + 389 (r=-0.725, pp<0.001), QS2; -1.7 x PR + 507 (r=-0.745, pp<0.001). 3. Each phase of systolic time intervals was affected by various factors: ICT and PEP by pulse rate, diastolic pressure and stroke volume, LVET by pulse rate and stroke volume, QS1by diastolic pressure, and QS2by pulse rate. Multiple linear regression analysis results in the following formulas for prediction of the systolic time intervals from the pulse rate, diastolic pressure and stroke volume: ICT; -0.299PR+0.230Pd-0.139Vs+28.1(r=0.38), PEP; -0.272PR+0.356Pd-0119Vs+104.8 (r=0.39), LVET; -1.475PR+0.167Vs+376.6 (r=0.74). 4. Systolic time intervals were not influenced by height, weight or body surface, but LVET and QS2were prolonged significantly in female group. 5. Normal values of hemodynamics calculated by Wezler's formula were as follows: stroke volume was 68.1+/-21.7ml, stroke index 50.2+/-14.9ml/m2, cardiac output 4.9+/-1.71/min., cardiac index 3.6+/-1.3 1min/m2, peripheral resistance 1696+/-507 dyne sec. cm(-5), and volume elasticity coefficient 1916+/-422 dyne cm(-5). 6. Normal values of non-invasive indices of myocardial contractility were as follows: ICT was 42+/-21 msec. PEP 10.+/-14 msec., 1/PEP2 9.87x10-5+/-2.79x10-5msec., 1/ICT28.56x10-3+/-1.65+/-10-3msec-2., Pd/ICT 1.96+/-0.92 mmHg/msec., Pd/PEP 0.723+/-0.125 mmHg/msec., PEP/LVEE 0.37+/-0.06, LVET/PEP 2.77+/-0.47, and LVET/ICT 7.45+/-3.19. 7. Each index of myocardial contractility was affected by various factors: ICT, PEP, 1/PEP2, PEP/LVET, LVET/PEP and LVET/ICT by pulse rate, diastolic pressure and stroke volume, 1/ICT2by pulse rate, and Pd/ICT and PD/PEP by pulse rate and diastolic pressure. 8. Correlation coefficients between PEP/LVET and other indices were relatively high in PEP, 1/PEP2and LVET/PEP, and relatively low in ICT, 1/ICT2Pd/ICT, Pd/PEP and LVET/ICT.
Blood Pressure ; Cardiac Output ; Elasticity ; Electrocardiography ; Female ; Heart Rate ; Hemodynamics* ; Humans ; Linear Models ; Reference Values ; Stroke ; Stroke Volume ; Systole* ; Vascular Resistance

To determine the level of exercise for dynamic exercise echocardiography and to evaluate the changes of cardiac work loads in normal subjects, the authors performed M-mode echocardiography at rest and during 20degrees supine bicycle exercise in 10 normal subjects with good image of left ventricle. A special, self-made 20degrees supine exercise table was used on which the subject's chest could be immobilized to record echocardiograms during exercise. The recordings were always performed just below the tip of the anterior mitral leaflet. Interpretable left ventricular M-mode echocardiograms were obtained at a submaximal exercise level with mean heart rate of 132+/-21 beat/min. Left ventricular end-diastolic dimension, an index of preload, showed no significant change during exersise. But left ventricular end-systolic dimension decreased significantly(p<0.01) and % fractional shortening increased significantly(p<0.01). Peak-systolic left ventricular wall stress increased signficantly(p<0.01) during exercise but end-systolic wall stress did not. Both end-systolic wall stress/end systolic dimension ratio and systolic blood pressure/end-systolic dimension ratio increased during exercise(p<0.01). The results suggest that dynamic exercise echocardiography is a suitable method measuring various parameters of cardiac mechanics during submaximal exercise, whereas it's not available during maximal exercise.
Echocardiography* ; Heart Rate ; Heart Ventricles ; Mechanics ; Thorax ; Ventricular Function, Left*

The tricuspid valve is not a simple but a complex structure, tricuspid valve complex. This complex is composed of tricuspid orifice, annulus, valve leaflet, chordae tendineae and papillary muscles. There are flew articles about these structures. The authors studied tricuspid valve complex in 53 cases of normal korean adults, such as circumference of tricuspid annulus, the maximum diameter of the tricuspid orifice, height and breadth of the cusps, including commissures, the ratio of rough to clear zone, the number of scallops of posterior cusp, the number, length and pattern of arrangement of the several types of chordae, the number and morphological characteristics of papillary muscles.
Adult* ; Chordae Tendineae ; Heart* ; Humans ; Papillary Muscles ; Pectinidae ; Tricuspid Valve*

BACKGROUND: Uracil nucleotides are stored in platelets and all other cells, and are released into the extracellular space upon stimulation. They show various biological responses but their actions and mechanism are not well understood. This study was conducted to investigate the effects of uridine 5'-triphosphate(UTP) on vascular tone and to identify the characteristics of their receptors. METHODS: Aortic ring preparation were made from the rat descending thoracic aorta. Endo-thelial cells were preserved or removed by gentle rubbing, The basal tension of aortic ring was lgm and isometric contraction were recorded on polygraph using force transducer. RESULTS: In aortic ring Precontracted by 100nM norepinephrine, UTP induced dual effect with various concentrations. UTP elicited endothelium-dependent relaxation at low concentrations(100nM-10microM), and endothelium-independent contraction at high concentrations(more than 30microM). Among uracil nucleotides, UDP was as much effective as UTP in vascular tone, but UMP and uridine were not. UTP(pA50 6.15) was more potent than ATP(5.17), ITP(4.75) and other nucleotides(TTP, GTP, CTP). At basal tension, UTP induced relaxation at low concentrations and contraction at hige concentrations in endothelium-intact ring. But in endothelium-removed ring, UTP elicited only contraction. Prior treatment of aortic ring with suramin, a non-selective P2-purinoceptor blocker, inhibited UTP-Induced relaxation and contraction. Reactive blue-2, a P2gamma purinoceptor blocker, inhibited relaxation only, but alpha, beta-methylene ATP, a P2x Purinoceptor blocker, enhanced contractile response. ATP inhibited the UPT-induced relaxation, but 2-methylthio ATP did not alter the effects of UTP. It means that UTP and ATP act at the same receptor but 2-methylthio ATP does not. CONCLUSION: These results suggest that UTP-induced relaxation is mediated by nucleotide receptors on endothelium and the contraction is mediated by pyrimidinoceptors on vascular smooth muscle.
Adenosine Triphosphate ; Animals ; Aorta ; Aorta, Thoracic* ; Endothelium ; Extracellular Space ; Guanosine Triphosphate ; Isometric Contraction ; Muscle, Smooth, Vascular ; Norepinephrine ; Rats* ; Receptors, Purinergic ; Receptors, Purinergic P2X ; Relaxation ; Suramin ; Transducers ; Uracil Nucleotides ; Uridine Diphosphate ; Uridine Monophosphate ; Uridine Triphosphate ; Uridine*

BACKGROUND: Adenosine 5'-tetraphosphate(ATPP), an endogenous nucleotide, is stored in cells and released into the extracellular space upon stimulation. Some of the biological responses to ATPP were reported, but characteristics of its receptor were not well known. Present study was conducted to investigate the effects of ATPP on mechanical contractility, resting membrane potential and action potential of rat left atrium. METHODS: Left atrium was isolated from Sprague-Dawley rat. Mechanical contraction induced by electrical field stimulation(EFS) was recorded on polygraph using force transducer. With glass microelectrodes(10 MOmega), potential difference across the membrane was measured and recorded on an oscilloscope and a polygraph. RESULTS: ATPP reduced the left atrial contractility with concentration-dependent manner. ATPP also hyperpolarized the resting membrane potential and decreased the action potential duration of the left atrial cell. Nucleotides other than ATPP, such as ATP, ADP, AMP and adenosine, have the same effect as ATPP. However, there is no difference among the nucleotides. Prior treatment of DPCPX, a P1-purinoceptor blocker, inhibited the ATPP-induced negative inotropism and changes of the membrane potential. But suramin, a nonselective P2-purinoceptor blocker, did not alter the effects of ATPP. alpha, beta methylene ADP and adenosine deaminase, which attenuates hydrolysis of adenine nucleotides and inactivates adenosine respectively, did not influence the effects of adenine nucleotides except for adenosine. CONCLUSION: ATPP reduced the mechanical contractility, hyperpolarized the resting membrance potential and decreased duration of action potential of rat left atrium. These effects were induced by ATPP directly, not by adenosine from hydrolyzed ATPP.
Action Potentials ; Adenine Nucleotides ; Adenosine Deaminase ; Adenosine Diphosphate ; Adenosine Triphosphate ; Adenosine* ; Animals ; Extracellular Space ; Glass ; Heart Atria ; Hydrolysis ; Membrane Potentials ; Membranes ; Muscle Contraction ; Nucleotides ; Rats ; Rats, Sprague-Dawley ; Receptors, Purinergic ; Suramin ; Transducers

BACKGROUND: One of the most common side effects of antidepressant medication is orthostatic hypotension, which can be caused by impaired vasoconstriction. This study was designed to compare the inhibitory effects of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), on the contractile responses to alpha1-adrenergic receptor activation and depolarization in isolated rat aorta. METHODS: Vascular rings were suspended for the measurement of isometric tension in a water-jacketed bath filled with Tyrode solution. After pretreatment with antidepressant for 20 min, vasoconstriction induced by norepinephrine (NE) or 35 mM K+ was measured and compared to the control response. RESULTS: Whereas trazodone and tricyclic antidepressants (TCAs) selectively inhibited NE-induced vasoconstriction, SSRIs inhibited depolarization-induced vasoconstriction more potently. The IC50 value of fluoxetine on depolarization- induced vasoconstriction was 3.29 microM, which is consistent with the previous results on L-type Ca2+ currents of cardiac myocyte. Moclobemide, a monoamine oxidase inhibitor, had no effect on vasoconstriction induced by either alpha- adrenergic receptor activation, or depolarization. CONCLUSION: These results suggest that SSRIs, different from TCAs and trazodone, have potent inhibitory actions to depolarization-induced contraction that may be due to blocking Ca2+ entry through L-type Ca2+ channel.
Animals ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Aorta* ; Baths ; Fluoxetine ; Hypotension, Orthostatic ; Inhibitory Concentration 50 ; Moclobemide ; Monoamine Oxidase Inhibitors ; Myocytes, Cardiac ; Norepinephrine ; Rats* ; Receptors, Adrenergic ; Serotonin Uptake Inhibitors* ; Trazodone ; Vasoconstriction*

No abstract available.
Transplants*

To minimize morbidity arising from airway management related to anesthesia, the anesthesiologist performs a through history and physical examination and approaches all patients with well-through-out plans for various eventualities. Numerous anatomic and pathologic abnormalities may lead to difficult tracheal intubation. Failed tracheal intubation is frustrating, increase the risk of pulmonary aspiration, and may contribute to organ ischemia and then it imminently endangers the patients life and necessitates invasive approaches to ventilation. Use of the flexible fiberoptic bronchoscope has become an essential skill for anesthesiologists confronted with anatomic or physiologic abnormalities of the upper airway. The widespread availability of flexible fiberoptic bronchoscope has allowed anesthesiologists to use fiberoptic techniques eariler in airway instrumentation and, thereby, avoid failed intubation and trauma to the airway. This review will focus on practical information that will aid in successful utilization of fiberoptic bronchoscope.
Airway Management ; Anesthesia ; Bronchoscopes ; Humans ; Intubation ; Ischemia ; Physical Examination ; Ventilation

No abstract available.
Neck*

The objective of this study was to develop the Somatic Stress Response Scale (SSRS), and then to use the scale in clinical practice. A preliminary survey was conducted using 109 healthy adults to obtain somatic stress responses. Then, 215 healthy subjects completed a preliminary questionnaire. A comparison was made regarding the somatic stress responses among 191 patients (71 with anxiety disorders, 73 with depressive disorders and 47 with somatoform disorders) and 215 healthy subjects. Factor analysis of the SSRS yielded five subscales: the cardiorespiratory response, somatic sensitivity, gastrointestinal response, general somatic response and genitourinary response subscales. The test-retest reliability for the five subscales and the total score was significantly high, ranging from .86 to .94. The Cronbach's yen afor the five subscales ranged from .72 to .92, and was .95 for the total score. By correlating the five subscales and the total score of the SSRS with the somatization subscale scores of the Symptom Checklist-90-Revised (SCL-90-R), convergent validity was calculated. The correlations were all at significant levels. Each of the disorder groups was significantly higher in scores of the cardiorespiratory response, gastrointestinal response, general somatic response and genitourinary response subscale, and in the total SSRS score than the healthy group. Only the depressive disorder group scored significantly higher on the somatic sensitivity subscale than the healthy group, and they also scored significantly higher on the genitourinary response subscale than the anxiety disorder group did. These results suggest that the SSRS is highly reliable and valid, and that it can be effectively utilized as a measure for research of the somatic symptoms related to stress. It also implies that somatic sensitivity and genitourinary responses are associated with depressive disorders.
Stress, Psychological/*diagnosis ; Somatoform Disorders/*psychology ; *Psychiatric Status Rating Scales ; Middle Aged ; Male ; Humans ; Female ; Depressive Disorder/*psychology ; Demography ; Anxiety Disorders/*psychology ; Aged ; Adult