OBJECTIVES: A retrospective study was performed to clarify the change of lumbar bone mineral density(BMD) according to the duration of hormone replacement therapy(HRT) and the other factors such as age, years since menopause(YSM) and initial BMD in postmenopausal women. METHODS: From January, 1995 to December, 1998 we measured lumbar bone mineral density in 100 postmenopausal women in the department of obstetrics and gynecology, Inha University Hospital. These women had been followed for 2 years after taking HRT. We investigated whether there were any relation between the duration of HRT, age, YSM, initial BMD and change of BMD. RESULTS: Lumbar BMD was increased 2.06% after one year of HRT(p=0.0001) but there was no change of BMD at the 2nd year of HRT(p=0.847). The response to HRT was greatest in those who were oldest(r=0.209 ; p=0.039) and furthest YSM(r=0.209; p=0.039), and consequently among those who had the lowest BMD(r=0.590 ; p=0.0001). CONCLUSION: The bone mass was increased upto 2.06% at the 1st year of HRT but no more progressive increase was occurred. It suggest that intensive HRT is needed at 1st year of therapy. The risk of fracture is not decreased to that of the healthy population inspite of HRT, so the earlier therapy is necessary to prevent osteoporotic fracture despite of intervention.
Bone Density* ; Female ; Gynecology ; Hormone Replacement Therapy* ; Humans ; Obstetrics ; Osteoporotic Fractures ; Retrospective Studies

Takayasu's arteritis is an arteritis of undetermined etiology, which affects the aorta and the proximal portions of its major branches. But aortic regurgitation and coronary artery involvement were unusual manifestations in this disease. We experienced a patient of Takayasu's arteritis who represented these unusual manifestations. Aortogram revealed grade IV aortic regurgitation and proximal segment narrowing of left main coronary artery. A case of Takayasu's arteritis associated with aortic regurgitation and left main coronary artery involvement is reported with a review of literatures.
Aorta ; Aortic Valve Insufficiency* ; Arteritis ; Coronary Vessels* ; Humans ; Takayasu Arteritis*

OBJECTIVE: To assess the relationship between vaginal cytology and bone mineral density in postmenopausal women. METHODS: In 93 postmenopausal women, vaginal cytology smears were taken for maturation index, serum estradiol level and bone mineral density were also taken. the percentage of each cell type found By vaginal cytology was multiplied to its specific value:superficial cells, 1.0; intermediate cell, 0.6; parabasal cell, 0.2 and modified to maturation value. Bone mineral density was measured at lumbar spine using DEXA. RESULTS: The mean bone mineral density was 0.88+/-0.14g/cm2. Mean maturation value was 50.53+/-20.74 and it was related with age and bone mineral density. CONCLUSION: Maturation value of vaginal epithelial cell represents the influence of estrogen on bone mineral density.
Bone Density* ; Epithelial Cells ; Epithelium* ; Estradiol ; Estrogens ; Female ; Humans ; Spine

Preoperative and postoperative echocardiography were performed in 33 patients with isolated ostium secondum atial septal defect(ASD), confirmed by right heart catheterization and operation at Seoul National University Hospital from November 1980 to June 1982. The ratio of right ventricular enddiastolic dimension to leftventricular enddiastolic dimension(RVED/LVED) was compared to the pattern of interventricular septum, before and after operation. In patients with persistent paradoxical septal motion during 2wks after operation, repeated echocardiograms were performed upto 9 months, postoperatively. The results obtained are as follows: 1) The ratio of RVED/LVED in patients with ASD, was 0.95+/-0.35(mean+/-standard deviation), which was significantly larger than that of 14 normal subjects(p<0.005). 2) There was statistically correlation between the ratio of pulmonary blood flow to systemic blood flow(QP/QS) and the ratio of RVED/LVED(r=0.44, p<0.025). 3) Thirty three patients were divided into 3 groups according to the pattern of intervent ricular septal motion.(Group "M": Patients with normal septal motion, Group "B": Patients with paradoxical type B septal motion, Group "A": Patients with paradoxical type A septal motion) Preoperatively, the ratio of RVED/LVED was 0.68+/-0.28 in Group "N" (N=9), and 0.88+/-0.23 in Group B (N=9) and 1.14+/-0.34 io Group "A" (N=15). In Group "A, the ratio of RVED/LVED was significantly larger than of Group "N" (p<0.005). Postoperatively, the ratio of RVED/LVED was 0.51+/-0.13 in Group "N" (n=23), and 0.68+/-0.15 in Group "B" (n=7), and 0.79+/-0.14 in Grop "A" (n=3). In Group "A" and Group "B, the ratio of RVED/LVED was significantly larger than that of Group "N" (p<0.005, p<0.01). 4) Postoperative RVED index(18.9+/-4.9) was significantly decreased, compared with preoperative RVED index(27.6+/-8.9) (p<0.005). But there was no significant change in LVED index, before and after operation. 5) Among 10 patients with persistent paradoxical septal motion, repeated echocardiograms were performed in 5 patients. Interventricular septal motion was normalized in 4 out of 5 patients. Thus the ratio of RVED/LVED has significant correlation with QP/QS and the pattern of interventricular septal motion. These results suggest the evidence that interventricular septal motion is determined by septal position at enddiastiole.
Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Heart Septal Defects, Atrial* ; Humans ; Seoul

Multiple biliary papillomatosis involves an epithelial field change of the intrahepatic and extrahepatic portions of the biliary tree. Pathologically it is benign, occasionally with dysplasia, but the clinical behavior is regarded as having a low-grade malignant potential. Such malignancy is rare but the prognosis is poor if it is impossible to remove the tumor completely. Here, we report one case of multiple biliary papillomatosis in the biliary tree.
Biliary Tract ; Papilloma* ; Prognosis

Most congenital obstructions of right ventricular outflow occur at the infundibular, pulmonary valvular, or pulmonary arterial levels. Less frequently, stenosis is present in the sinus portion of the right ventricle and is caused by an obstructing aberrant muscle bundle or band crossing the chamber below the infundibulum. This abnormality has been called the double chambered right ventricle. We have reviewed our experience with 18 patients with a double chambered right ventricle who had been admitted to the SNUH. 1) Age distribution was from 2 to 36 years old with a mean age of 12.8 years. There were 13 female patients and 5 male patients with a 2.6:1 female to male ratio. 2) The chief complaints of the patients were dyspnea on exertion(50%), known congenital heart disease(27.8%), and cyanosis(16.7%), in that order. The physical findings were grade III-V/VI systolic murmurs and other findings of associated cardiac anomalies. 3) The electrocardiographic findings were as follow: left ventricular hypertrophy(33.3%), right ventricular hypertrophy(22.2%), and biventricular hypertrophy(22.2%), Pressure gradients within the right ventricle were noted in 13 cases(72.2%), and filling defects on right ventricular cineangiography were noted in 14 out of 15 cases(93.3%). The echocardiographic findings were not diagnostic, except for the associated cardiac anomalies. 4) 14 cases were operated with a result of aberrant muscle bundles in the right ventricular cavity. All were removed surgically. 1 case was confirmed by autopsy Other 3 cases(Who had pressure gradients within the right ventricular cavity and filling defects on the right ventricular cineangiogram) showed little symptoms, and there has been a continuous follow up on these patients. 5) The associated cardiac anomalies were as follows: 13 cases(72.2%) of ventricular septal defect, 1 case(5.6%) of bicuspid tricuspid valve, 1 case(5.6%) of persistent left sided superior vena cava, and 1 case(5.6%) of aortic regurgitation. There was 3 cases of isolated double chambered right ventricle(16.5%).
Adult ; Age Distribution ; Aortic Valve Insufficiency ; Autopsy ; Bicuspid ; Cineangiography ; Constriction, Pathologic ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart ; Heart Septal Defects, Ventricular ; Heart Ventricles* ; Humans ; Male ; Systolic Murmurs ; Tricuspid Valve ; Vena Cava, Superior

BACKGROUND: To evaluvate the hypothesis that reperfusion injury and reperfusion arrhythmia could be caused by oxyzen free redicals and that prolonged myocardial dysfunction could be induced by oxyzen free redical. METHODS: Experimnetal model of anesthetized open chest dogs was used. Coronary artery was occluded for 60 minutes and reperfusion was performed 4 hours. In 5 dogs, superoxide dismutase and catalase were infused concomitantly 15 minutes after coronary occlusion to 15 minutes after reperfusion. In 9 dogs, 0.9% saline was infused instead of free redical scavengers. Hemodynamic parameters such as heart rate, left ventricular peak systolic pressure, end-diastolic pressure, peak positive dP/dt, and peak negative dP/dt were analysed. Infarct size was estimated by the unstained area in nitroblue tetrazolium staining and risk area was calculated from the unstained area after methylen blue infusion. Regional systolic function was observed in systolic thickening of ischemic area by echocardiogram. RESULTS: 1) Reperfusion arrhythmia occurred in 67% of control group and in 50% of drug treated group. 2) Systolic hemodynamic parameters such as peak systolic pressure, peak positive dP/dt showed no difference between control and drug-treated group. 3) Diastolic parameters such as end-diastolic pressure and peak negative dP/dt were not different in two groups. 4) Regional systolic parameter measured by systolic thickening in ischemic area improved after reperfusion and continued to be better in drug treated group than in control group. 5) Infarct size, risk area, ratio of infarct size to risk aera were not different in two groups. CONCLUSION: Superoxide dismutase and catalase showed no effect in reducing the infarct size in anesthetized open chest canine model with 60 minutes of coronary occlusion 4 hours of reperfusion. However, postischemic prolonged myocardial dysfunction tended of improve-after reperfusion in drug treated group.
Animals ; Arrhythmias, Cardiac ; Blood Pressure ; Catalase* ; Coronary Occlusion ; Coronary Vessels ; Dogs ; Heart Rate ; Hemodynamics ; Myocardial Infarction* ; Necrosis* ; Nitroblue Tetrazolium ; Reperfusion ; Reperfusion Injury ; Superoxide Dismutase* ; Superoxides* ; Thorax

Despite the high incidence of subdural block (SDB) during epidural anesthesia, the condition is unfamiliar to anesthesiologist. We experienced a case of SDB: severe hypotension, transient hemiplegia, wide extent of block and late onset and recovery from block. The case described is an examples of SDB and should remind anesthesiologist of the clinical course and treatment.
Anesthesia, Epidural* ; Hemiplegia ; Hypotension ; Incidence

In order to observe the changes in left ventricular systolic and diastolic function by repetitive regional myocardial ischemia and reperfusion, left anterior descending artery(LAD) just distal to the first diagonal branch in nine mongrel dogs was obstructed for 1 minute and reperfused for 15 minutes twice (first and second obstruction and reperfusion), and as a third trial repeated obstruction for 5 minutes and reperfusion for 15 minutes was done. Then the last obstruction for 1 minute and reperfusion for 15 mintues was performed. Peak positive dp/dt, left ventricular systolic pressure(LVSP) and systolic thickening were used as systolic parameters and peak negative dp/dt, left ventricular end diastolic pressure (LVEDP) and time constant of isovolumic relaxation were used as diastolic parameters. The results are as follows : 1) After first reperfusion, all systolic and diastolic parameters showed no significant changes except systolic thickening, which fell from the basal line(48.9+/-16.6% versus 59.8+/-10.0%, p<0.05). 2) After second reperfusion, peak positive dp/dt and systolic thickening decreased (1475+/-342mmHG/sec versus 1561+/-307mmHg/sec,p<0.05; 48.2+/-6.1% versus 59.8+/-10.05%, p<0.005 respectively). But LSVP, LVEDP, peak negative dp/dt and T showed no significant changes. 3) After third reperfusion all systolic and diastolic parameters except LVEDP showed significant impairment by 5 minutes of coronary occlusion, which means postischemic prolonged myocardial dysfunction(peak positive dp/dt 1401+/-362mmHg/sec versus 1561+/-307mmHg/sec, p<0.005; LVSP 88.5+/-23.4mmHg versus 97.6+/-25.4mmHg, p<0.05; systolic thickening 41.2+/-8.2% versus 59.8+/-10.0%, p<0.005; peak negative dp/dt -879+/-299mmHg/sec versus -1037+/-297mmHg/sec, p<0.05; T 46.3+/-8.2 msec versus 41.9+/-6.1 msec, p<0.01). 4) All observed systolic and diastolic parameters also revealed myocardial dysfunction after fourth reperfusion(peak positive dp/dt 1348+/-288mmHg/sec versus 1561+/-307mmHg/sec, p<0.0005; LVSP 88.5+/-24.1mmHg versus 97.6+/-25.4mmHg, p<0.005;systolic thickening 32.1+/-8.9 versus 59.8+/-10.0%, p<0.001; peak negative dp/dt -850+/-260mmHg/sec versus -1037+/-297mmHg, p<0.05; LVEDP 6.6+/-1.7mmHg versus 5.4+/-1.3mmHg, p<0.05; T 49.9+/-9.8msec versus 41.9+/-6.1msec, p<0.01). 5) Overall tendencies of myocardidal impairment were statistically significant in each parameter (peak positive dp/dt, p<0.001; systolic thickening, p<0.05; LVEDP, p<0.05; T, p<0.01) except LVSP and peak negative dp/dt. Thus myocardial function was impaired progressively by repetitive regional myocardial ischemia and reperfusion. In conclusion, a 5 minute coronary occlusion results in postischemic prolonged myocardial ischemia and repetitive coronary occlusion and reperfusion may show cumulative effect.
Animals ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels* ; Dogs ; Myocardial Ischemia ; Relaxation ; Reperfusion* ; Repetitive Sequences, Nucleic Acid

Right sided aortic arch is commonly accompanied by congenital heart disease, but abnormally originated left subvlavian artery can be acompression of trachea or esophagus by ducturs arteriosus or ligamentum arteriosus. But right sided aortic arch compressing superior vena cava has not been reported in Korea.We exerienced a case of right sided aortic arch with left subclavian artery compressing the superior vena cava, resulting in superior vena cava syndrome. So we report this case with brief review of literature.
Aorta, Thoracic* ; Arteries ; Esophagus ; Heart Defects, Congenital ; Subclavian Artery ; Superior Vena Cava Syndrome* ; Trachea ; Vena Cava, Superior*