Stasis dermatitis is one of the important skin manifestations of venous stasis. Therefore, the searching for the cause of venous stasis is importrnt. Two cases of stasis dermatitis with inferior vena caval obstruction are reported and possible etiologic factor is discussed. Case I The patient, 38-year-old carpenter, was admitted at Choong Buk Medical Center in April, 1974 with superficial venous engorgement of the lower extremities which had begun to appear two years after severe blunt trauma to both legs in 1962. 5 years prior to admission, abdomial venous engorgement and abdominal fullness developed and was exaggerated gradually. Since 2 years prior to admission, he has been suffered from the recurrent exudative ulcer on the right lower leg The physical examination revealed mild icteric sclera, hepatomegaly, abdominal distension, tortuous venous engorgement on the abdomen, the lateral chest wall and the lower extremities, and edematous scaly brawny pigmentation of the lower legs. Esphagogram showed no esphageal varices. Inferior vena cavogram showed complete obstruction at the level of upper border of 2nd lumbar vertebra and well developed collateral circulation, Findings of skin biopsy on the right lower leg showed moderate acanthosis, increased pigmentation of bosal cell layer in the epidermis, capillary proliferation, diffuse inflammatory cell infiltration with increased fibrosis and hemosiderin granules in the dermis. Case II The patient. 36-year-old farmer, was admitted at Dept. of Dermatology, St. Mary's Hospital, Catholic Medical College in Sept., 1973.The physical examination revealed hepatomegaly, abdominal distension, superficial venous engorgement on the abdomen, the neck and the lower extrcmities, severe edema and pigmentation of the lower legs, and the multiplc. Exudative ulcers on the left lower leg. Liver scanning showed somewhat general enlargement with some mottlings along the margin and relative prominance of the left lobe. Liver biopsy revealed findings of non specific chrcnic hepatitis. Inferior vena cavogram through the left femoral vein showed complete obstruction at the level between 11th and 12th thoracic vertebrae.His peripheral edema and ascites was much subsided after adequate bed rest and the skin lesion improved with scar formation.
Abdomen ; Adult ; Ascites ; Bed Rest ; Biopsy ; Capillaries ; Cicatrix ; Collateral Circulation ; Dermatitis* ; Dermatology ; Dermis ; Edema ; Epidermis ; Femoral Vein ; Fibrinogen ; Fibrosis ; Hemosiderin ; Hepatitis ; Hepatomegaly ; Humans ; Hyperemia ; Leg ; Liver ; Lower Extremity ; Neck ; Physical Examination ; Pigmentation ; Sclera ; Skin ; Skin Manifestations ; Spine ; Thoracic Wall ; Ulcer ; Varicose Veins

BACKGROUND: The electrocardiogram may provide valuable information regarding the identity of the culprit coronary artery and the location of obstructing lesion within the artery, which may be of guidance in selecting the therapeutic modality. Previous studies have concluded that changes in lateral leads (I, aVL, V5, V6) are predictive of left circumflex coronary artery obstruction in inferior wall acute myocardial infarction. Elect-rocardiographic criteria for determining the location of the obstructing lesion, however, have not been well established. The purpose of this study is to investigate the patterns of ST segment depression in lateral leads in inferior wall acute myocardial infarction and the obstruction site of culprit artery according to ST segment depression in lateral leads. METHODS: We examined 78 patients with inferior wall acute myocardial infarction analizing their electrocardiogram and coronary angiography which performed during acute hospitalization. RESULTS: Of the fifty-five patients in which the culprit artery could be determined, 1)in 41 the culprit artery was the right coronary artery (19 proximal to the right ventricular branch and 22 distal), and in 14 the left circumflex coronary artery (7 proximal to the first obtuse marginal branch or involving a high first obtuse marginal branch, and 7 with distal obstruction). 2)Significant ST depression (ST< or =1 mm) in leads I and aVL was more common in right coronary artery obstruction (p<0.05 and p=0.01 respectively) than left circumflex artery. 3)It was difficult to define the location of obstruction with ST segment change of lateral precordial leads (V5, V6). CONCLUSIONS: In acute inferior wall myocardial infarction, ST segment depression in lateral limb leads (I, aVL) can be indicative of the right coronary artery obstruction and the ST segment depression pattern in lateral precordial leads was not indicative of the site of obstruction.
Arteries ; Coronary Angiography ; Coronary Vessels ; Depression* ; Electrocardiography ; Extremities ; Hospitalization ; Humans ; Inferior Wall Myocardial Infarction ; Myocardial Infarction*

BACKGROUND: Hyperlipidemia is the one of the major risk factors causing the atherosclerosis of coronary arteries. Treatment of hyperlipidemia with drugs has been confirmed the effcts of therapy showing a decreased incidence of coronary artery disease. Pravastation is one of the new HMG-CoA reductase inhibitors and we studied the long-term hypolipidemic effects and safety of pravastatin in patients with hyperlipidemia and lipid profile after cessation of pravastatin therapy. METHODS: We studied 27 patients(6 males and 21 females, range of age : 36~67 years) for 14.7 months whose plasma levels of total cholesterol were higher than 250mg% after one month period of diet therapy. Pravastatin was administered 10mg/day and measured lipid profile at 4 weeks interval, and at 2~3 months after cessation of therapy. RESULTS: 1) Pravastatin significantly reduced the plasma total cholesterol, LDL-cholesterol and triglyceride, but HDL-cholesterol was increased significantly after 12 months pravastatin therapy(p<0.05). 2) Two to three months after the cessation of pravastatin therapy, plasma total cholesterol, LDL-cholesterol and triglyceride were significantly increased(p<0.05), but no significant difference was observed for HDL-cholesterol. 3) The clinical and laboratory examinations before and after pravastatin treatment showed no particular abnormal findings. CONCLUSION: These results suggested that long-term pravastatin therapy in patients with hyperlipidemia seems to be very effective and safe. But hyperlipidemia developed again two to three months after the cessation of pravastatin therapy.
Atherosclerosis ; Cholesterol ; Coronary Artery Disease ; Coronary Vessels ; Diet Therapy ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperlipidemias* ; Incidence ; Male ; Plasma ; Pravastatin* ; Risk Factors ; Triglycerides

BACKGROUND: The valve area derived from the Gorlin formula has been used clinically for decades as an index of severity on the assessiment of valve stenosis, in spite of some limitations on Gorlin formula studied in aortic stenosis and mitral bioprostheses. It had been shown that Gorlin valve area varied if the hemodynamic conditions during measurement are changed. Valve resistance has been proposed as an alternative hemodynamic indicator, but initially this index was not used because it was unlikely to remain constant at different flow rates. Recently valve resistance provided a better indices of hemodynamic obstruction than mitral valve area, and these stenotic indices usually estimated by angiographic method and we studied the valve resistance by Doppler echocardiographic measurement. METHOD AND RESULT: To compare the clinical implication about these stenotic indices measured by echcoardiography and cardiac catheterization, we studied 41 patients of mitral stenosis with normal sinus rhythm. The results were as follows ; 1) In catheterization, increased heart rate, mean pressure gradient and decreased diastolic time was observed, but mitral area, resistance, cardiac output and mitral flow was not different. 2) Linear regression analysis showed negative correlation of mitral valve resistance and Gorlin mitral area(echocardiography r=-0.84, catheterization r=-0.84)(p<0.001). 3) Correlation coefficeint of mitral valve area and mitral valve resistance between echocardiography(r=0.87) and catheterization(r=0.82) showed positive correlation(p<0.001). CONCLUSION: These results suggest that mitral valve resistance by echocardiography is a useful method in the evaluation of the severity of mitral stenosis.
Aortic Valve Stenosis ; Bioprosthesis ; Cardiac Catheterization* ; Cardiac Catheters* ; Cardiac Output ; Catheterization ; Catheters ; Constriction, Pathologic ; Echocardiography ; Echocardiography, Doppler* ; Heart Rate ; Hemodynamics ; Humans ; Linear Models ; Mitral Valve Stenosis* ; Mitral Valve*

BACKGROUND: Long term athletic training is associated with an increase in left ventricular diastolic cavity dimension, wall thickness, and mass. These changes in left ventricular morphology represent an adaptation to increased ventricular load and are generally described as the “athlete's heart”. In the present study, we used echocardiography to evaluate the left ventricular structure and function in track athletes. METHODS: We studies 48 males(average age 22 years)by Doppler and echocardiography, which consisted of 12 normal controls, 36 track athletes(12 long distance track, 12 sprint, 12 jump). These athletes were trained regularly for 3-19 years(average 9±4 years). RESULTS: 1) At rest, left ventricular diastolic and systolic diameter, systolic interventricular septal wall thickness, diastolic and systolic posterior wall thickness, and left ventricular end diastolic and systolic dimension were larger in long distance track athletes than in the controls. 2) Left ventricular mass was larger in long distance track athltes and sprinter than controls. 3) After maximum exercise, left ventricular diastolic and systolic diameter, systolic interventricular septal wall thickness, diastolic and systolic posterior wall thickness, and left ventricular end diastolic and systolic dimension increased more significantly in long distance track athletes than in the controls. But, in sprinters, the left end systolic diameter, diastolic and systolic interventricular septal thickness, and left end diastolic and systolic dimensions were increased. 4) At rest, the E/A and Ei/Ai of the mitral flow in long distance track athletes increased more than in the controls. But there were no differences of parameters of mitral and aortic flow between long distance track athletes and controls after maximum exercise. CONCLUSIONS: The left ventricular mass of long distance and sprint track athletes were lager Than controls. In the long distance track athletes, the left ventricular structural and functional changes before and after maximum exercise were prominent. In the sprinters, after maximum exercise, the left ventricular structural and functional changes were prominent.
Athletes ; Echocardiography ; Echocardiography, Stress ; Heart Ventricles ; Humans ; Sports

BACKGROUND: In latent type of hypertrophic obstructive cardiomyopathy, there is no pressure gradient at rest in left ventricular outflow tract(LVOT), but it develops with provocation. Dobutamine increase myocardial contractility and may inducce outflow tract obstruction. To evaluate the usefulness of dobutamine induced outflow tract obstruction as a provocation test, nine patients with latent obstructive cardiomyopathy were studied. METHOD: 680 cases of dobutamine stress echocardiography were reviewed. Nine patients developed late peaking outflow velocity pattern in response to dobutamine infusion(inducible group). Ten patients developed early peaking velocity pattern were included as control group. Left ventricular dimension, outflow tract diameter were measured, and pattern of septal hypertrophy was classified. Changes of peak velocity and acceleration time/ejection time ratio (AT/ET) were measured at rest and peak dose dobutamine. RESULTS: The peak outflow velocity at rest was not different in both groups(1.49±0.45, 1.18±0.11m/sec). Peak velocity and AT/ET ratio were significantly increased in inducible group(4.2±0.9m/sec, 0.66±0.17), but no significant changes were noted in control group. Patients with inducible group had greater septal thickness, smaller outflow tract diameter and greater prevalence of septal bulge morphology. CONCLUSION: These results suggest that dobutamine stress Doppler echocardiography could be a useful provocation test to diagnosis of latent obstructive cardiogyopathy.
Acceleration ; Cardiomyopathies ; Cardiomyopathy, Hypertrophic ; Diagnosis ; Dobutamine ; Echocardiography, Doppler ; Echocardiography, Stress ; Humans ; Hypertrophy ; Methods ; Prevalence

BACKGROUND AND OBJECTIVES: The correlation of anterior inferior cerebellar artery (AICA) vascular loop around cerebellopontine angle (CPA) and otologic symptoms remains controversial. The objective of this study was to evaluate the relationship of the anatomical type of AICA loop and otologic symptoms according to the findings of 3-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) MRI. SUBJECTS AND METHOD: 316 ears from 165 patients were included in this study. Otologic symptoms and the results of pure tone audiometry, auditory evoked potential, and electronystagmography were checked by retrospective chart review. AICA loops were classified by its configuration on 3DFT-CISS MRI. According to their extension depth in internal auditory canal (IAC), the loops were classified as type I (lying within CPA), type II (from porus acusticus to 50% of the length of IAC), and type III (extending beyond 50% of IAC). In addition, the loops were classified as S (small) and L (large) by comparing the thickness of the loop with adjacent facial nerve. RESULTS: The predominant type of AICA loop was type I (62.0%) and type S (72.8%). Ears with type III loop presented significantly higher rate of hearing impairment than those with type I or II. There were no significant differences in pure tone threshold, hearing loss in 3 consecutive frequencies, canal paresis, and AEP latencies among 3 AICA types classified with the depth of the loop. Ears with type S AICA loop showed significantly higher rate of hearing impairment, elevated threshold, hearing loss in 3 consecutive frequencies, and canal paresis than those with type L loop. CONCLUSION: The small diameter of AICA loop had significant association with hearing impairment and otologic test abnormalities. Impaired blood flow through the vascular loop and resultant hypoperfusion of inner ear may be the pathophysiologic mechanism of vestibulocochlear nerve compression syndrome.
Arteries* ; Audiometry ; Cerebellopontine Angle ; Ear ; Ear, Inner ; Electronystagmography ; Evoked Potentials, Auditory ; Facial Nerve ; Fourier Analysis ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Nerve Compression Syndromes ; Paresis ; Retrospective Studies ; Tinnitus ; Vestibulocochlear Nerve

Isolated gonadotropin-releasing hormone (GnRH) deficiency, including Kallmann's syndrome (KS) and idiopathic hypogonadotropic hypogonadism (IHH), is a congenital disorder, which is characterized by a functional deficit in hypothalamic GnRH secretion. Despite recent advances in the understanding of the pathogenesis of the X-linked form of KS as the identification of the KAL gene (Xp22.3), the genetic basis of the sporadic form in female patients remains unclear. Although most searches for mutations in X chromosome have been reported in males, the newly recognized phenomenon of inheritance, such as genomic imprinting and uniparental disomy, raises the possibility of a female phenotype in the X- linked genetic defect. Here, the molecular study of the coding region of the KAL gene (exon 5 to 14) in 10 unrelated females with KS (n=6) or IHH (n=4) is reported. None of the subjects had familial histories of delayed puberty or hypogonadism. Samples from 4 healthy, unrelated female volunteers were used for identification of polymorphisms. PCR of the 10 exons of the KAL gene was performed on genomic DNA. The PCR products of the 10 exons were subject to single strand conformation polymorphism (SSCP) analysis to identify possible mutations. In an SSCP analysis of the amplified fragments (fragment size: 147 to 302bp), no mutations or polymorphisms were found in any of the 10 patients and 4 controls. In conclusion, it is unlikely that KAL gene mutations are a clinically significant cause of sporadic GnRH deficiency in female patients, indicating the existence of defects in unidentified genes that result in the expression of the phenotypes in females.
Adolescent ; Adult ; DNA Mutational Analysis ; Extracellular Matrix Proteins/*genetics ; Female ; Gonadorelin/*deficiency ; Human ; Kallmann Syndrome/*genetics/metabolism ; Nerve Tissue Proteins/*genetics ; Phenotype ; Polymorphism, Single-Stranded Conformational ; Support, Non-U.S. Gov't

In the past 60 years the maternal mortality rate has declined rnarkedly. Nevertheless, death associated with childbirth is still a major public health problem. For women delivered of live infants, the leading causes of mortality are acute pulmonary embolism(mostly thromboembolic), pregnancy-induced hypertension, hemorrhage, and infection. Currently, the common cause of maternal rnortality are pulmonary embolisrn. Though acute pulmonary embolism is a potentially fatal disorder, when properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death. However, the diagnosis of acute pulmonary embolism is still a challenge for clinicians because of its nonspecific and variable clinical features. Pulmonary angiography, admittedly the 'gold standard' technique for this diagnosis, is costly, invasive, and not universally available. Noninvasive procedures such as lung scan has certainly simplified the diagnostic approach. However, lung scan is diagnostic in only 30 to 50% of patients, and many institutions lack nuclear medicine facilities. Thus, alternative imaging techniques are needed for the noninvasive diagnosis of pulmonary embolism. Echocradiography is rapid, practical and sensitive technique for the identification of right ventricular overload following acute pulmonary embolism. Echocardiographic identification of patients with right ventricular dysfunction is important because aggressive intervention with thrombolytics, certain inotropic and vasoactive agents, or embolectomy may improve outcome. We report herein two cases of acute pulmonary embolism after cesarean section. Certain clinical findings, hemodynamic values, and particularly, echocardiographic signs can indentify right ventricular dysfunction after pulmonary embolisrn. The patients was immediately treated mth intravenous heparin and inotropic support, which induced a rapid improvement of the clinical and hemodynamic parameters.
Angiography ; Cause of Death ; Cesarean Section* ; Diagnosis ; Echocardiography* ; Embolectomy ; Female ; Hemodynamics ; Hemorrhage ; Heparin ; Humans ; Hypertension, Pregnancy-Induced ; Infant ; Lung ; Maternal Mortality ; Mortality ; Nuclear Medicine ; Parturition ; Pregnancy ; Public Health ; Pulmonary Embolism* ; Ventricular Dysfunction, Right

BACKGROUND AND OBJECTIVES: Large volume reduction after hemodialysis in patients with chronic renal failure alters the preload. We investigated the cardiac function by total ejection isovolume (TEI) index- a new simple, readily reproducible Doppler echocardiographic index combining systolic and diastolic function- before and after dialysis. MATERIALS AND METHOD: Thirty-one patients on maintenance hemodialysis including 6 diabetes and 13 hypertensives without known organic heart disease and with normal systolic function were enrolled. They were divided into two groups according to ultrafiltration volume at the study dialysis session, group 1 (2.5kg or less) and group 2 (more than 2.5 kg). They are 46+/-12 years old on average. We examined two-dimensional, M-mode, pulsed wave and tissue Doppler before and after dialysis immediately. TEI index was calculated by dividing the sum of the isovolumic relaxation time (IVRT) and isovolumic contraction time (ICT) by the ejection time. RESULTS: After dialysis, significant decrease of body weight was noted, but baseline heart rate, blood pressure, Left ventricular (LV) ejection fraction and LV mass index were not changed significantly. LV end-diastolic volume was decreased significantly after dialysis in all group, and end-systolic volume was decreased significantly in total and group 2. Peak early E velocity and ratio of E to the peak late (A) velocity (E/A) from mitral inflow signal were decreased significantly after dialysis in all group and deceleration time of early filling phase was prolonged in total and group 1, but A and IVRT did not change significantly. Of the septal mitral annulus motion, Ean velocity and Ean/Aan ratio was decreased, but no significant change was noted in the lateral annulus. The TEI index did not chage significantly after dialysis in all group. CONCLUSION: A new simple echocardiographic TEI index can be used to measure the global myocardial function in patients with chronic renal failure before and after dialysis, relatively independent of preload change.
Blood Pressure ; Body Weight ; Deceleration ; Dialysis ; Echocardiography ; Heart Diseases ; Heart Rate ; Humans ; Kidney Failure, Chronic ; Relaxation ; Renal Dialysis* ; Ultrafiltration