Patients with cerebrovascular accidents often have abnormal electrocardiograms in the absence of known organic heart disease. In 1901 harvey Cushing has discovered sinus bradycardia in CVA patients. Burch, Myers and Abildskov were the first to report electrocardiographic abnormalities in CVA. Since then many reports have appeared in the literature. This study was done utilizing brain C-T scan to varify and localize the site of CVA, for purposes of correlation of the CVA with abnormalities of electrocardiogram. We obtained the following results. 1. Among 250 cases of CVA, 107 cases were excluded due to pre-existing cardiac disease, abnormal serum electrolyte and early death. 2. Among 143 cases, intracranial hemorrhage were 62.9% and brain infarction were 37.1%. 3. In intracranial hemorrhage, normal electrocardiographic finding were only 4.5%. Q-Tc prolongation revealed 64.5%. 4. In brain infarction, normal electrocardiographic finding was only 5.7%. Q-Tc prologation revealed 64%.
Bradycardia ; Brain ; Brain Infarction ; Electrocardiography* ; Heart Diseases ; Humans ; Intracranial Hemorrhages ; Stroke

OBJECTIVE: Authors conducted the pilot trial to evaluate whether the virtual reality using mirror therapy induces analgesia and functional improvement to the patients of rheumatoid wrist arthritis. METHOD: Three patients with no symptom or sign of active phase at both wrists were recruited. Voluntary range of motion (ROM) of each wrist over as far as possible was recorded and then the same movement was recorded only over 60% of the previous one after break of 5 minutes. For the virtual reality treatment, the second recorded motion was reconstructed into the another one of as same ROM and spent time as the first one, providing confusing visual information to the patients while patients were instructed to reach only the red flags (60% ROM of 1st one). This exercise was repeated for 5 days. Numerous scales such as VAS, ROM, Michigan Hand Outcomes Questionaire (MHQ), Performance and Satisfaction in Activities of Daily Living (PS-ADL), patient-rated wrist evaluation (PRWE) were evaluated before and after repetition. RESULTS: The increased satisfaction with their hands (satisfaction score of MHQ; 5.8 ± 2.3, [6-30]), improved ADL performances (PS-ADL score: 5.0 ± 3.5, [0-117]), and no side effect were noticed. CONCLUSION: The virtual reality using mirror therapy may be safe and has some analgesic effect, which warrants a clinical trial in the future for the patients of rheumatoid wrist arthritis.
Activities of Daily Living ; Analgesia ; Arthritis ; Arthritis, Rheumatoid* ; Hand ; Humans ; Michigan ; Range of Motion, Articular ; Virtual Reality Exposure Therapy ; Weights and Measures ; Wrist

This erratum is being published to correct the printing error on page 517 of the article. Corrections for Fig. 1 and main text in page 519 are needed. The authors apologize for any inconvenience that this may have caused.

Apolipoprotein (apo) E deficient mouse can produce reproducible fixed stenotic primary atherosclerotic lesion, which reveals failure to remodel of vascular lumen, in the ascending aorta, external carotid, common carotid, iliac, femoral and popliteal arteries. To evaluate the effect of drugs in regarding to both prevention of primary atherosclerotic lesion and vascular remodeling, a systematic analysis of distribution of atherosclerotic lesions was undertaken in chow-fed, 9-momth-old apo E deficient mice, which was administrated drugs including asprin, methotrexate, probucol, sulodexide, diltiazem, cilazapril, trimetazidine, molsidomine, pentoxiphylline and Ginexin (R) for 7 month from 3 month-old. On gross and microscopic examination, formation of primary atheroscleotic lesions could be delated and/or prevented patially by effets of these drugs. On morphometric examination, failure to remodel forming vascular stenosis could not be seen, though relatively mild atherosclerotic lesion occured at vascular tree. These data suggest that the stenotic process in advanced atherosclerotic vessels can be delayed and/or prevented by several drugs including methotrexate, probucol, sulodexide, diltiazem, cilazapril, trimetazidine, molsidomine, pentoxiphylline and Ginexin (R) in vivo state.
Animals ; Aorta ; Apolipoproteins ; Apolipoproteins E* ; Atherosclerosis ; Cilazapril ; Constriction, Pathologic ; Diltiazem ; Humans ; Infant ; Methotrexate ; Mice ; Mice, Knockout* ; Molsidomine ; Popliteal Artery ; Primary Prevention ; Probucol ; Trimetazidine

The association of nephrotic syndrome with a hypercoagulable state and vascular thrombosis is well recognized. In all adult series of nephrotics, venous thrombosis are much more common than arterial thrombosis, which has been mainly reported in children. Intracoronary thrombus is among the rarest arterial thromboses. We present a case of acute myocardial infarction in a 39-year-old women with nephrotic syndrome secondary to membranous glomeluronephritis, in which subsequent coronary angiography showed no evidence of atherosclerotic change and thrombotic occlusion in the left main coronary artery which was successfully treated with intracoronary stent and intravenous abciximab.
Adult ; Child ; Coronary Angiography ; Coronary Vessels ; Female ; Glomerulonephritis, Membranous* ; Humans ; Myocardial Infarction ; Nephrotic Syndrome ; Stents* ; Thrombosis* ; Venous Thrombosis

BACKGROUND: Brief episodic ischemias prior to subsequent prolonged ischemia limit infarct size and attenuate the reperfusion arrythmia. But the effect of ischemic preconditioning on post-ischemic myocardial dysfunction, coronary flow and nitric oxide (NO) remains unclear. METHODS: To investigate the effect of ischemic preconditioning on myocardial function and coronary flow during reperfusion after 15 minutes of global myocardial ischemia, 30 isolated hearts of Sprague-Dowley rats were perfused under constant pressure. Two episodes of three minutes global ischemia followed by 12 minutes of reflow were employed to precondition the hearts. The hearts were randomized to one of three groups : group I had no preconditioning, group II had preconditioning, group III had preconditioning as well as L-arginine pretreatment. Left ventricular developed pressure (LVDP), LV dp/dt, perfused coronary flow, concentration of NO and heart rate were continuously measured. RESULTS: In preconditioning groups (Group II, Group III), LVDP decreased during reflow and was lower than that of the control group. LV dp/dt decreased after reflow and gradually recovered with time but recovered was less in preconditioning groups. Coronary flow increased in the first few minutes after reflow in all groups, but decreased gradually. The decrease of coronary flow was greater in preconditioning groups. NO increased during the first 10 minutes after reflow and then decreased. In preconditioning groups, NO tends to be lower than that in the non-preconditioning group. CONCLUSION: Ischemic preconditioning was not beneficial to post-ischemic myocardial dysfunction, coronary flow and NO concentration in the flow. Cummulative effect of stunning due to repetitive ischemia for preconditioning may be an explanation for worse post-ischemic myocardial dysfunction and coronary flow in preconditioning groups.
Animals ; Arginine ; Arrhythmias, Cardiac ; Heart Rate ; Heart* ; Ischemia ; Ischemic Preconditioning* ; Myocardial Ischemia ; Myocardial Stunning ; Nitric Oxide ; Rats* ; Reperfusion

BACKGROUND: Brief episodic ischemias prior to subsequent prolonged ischemia limit infarct size and attenuate the reperfusion arrythmia. But the effect of ischemic preconditioning on post-ischemic myocardial dysfunction, coronary flow and nitric oxide (NO) remains unclear. METHODS: To investigate the effect of ischemic preconditioning on myocardial function and coronary flow during reperfusion after 15 minutes of global myocardial ischemia, 30 isolated hearts of Sprague-Dowley rats were perfused under constant pressure. Two episodes of three minutes global ischemia followed by 12 minutes of reflow were employed to precondition the hearts. The hearts were randomized to one of three groups : group I had no preconditioning, group II had preconditioning, group III had preconditioning as well as L-arginine pretreatment. Left ventricular developed pressure (LVDP), LV dp/dt, perfused coronary flow, concentration of NO and heart rate were continuously measured. RESULTS: In preconditioning groups (Group II, Group III), LVDP decreased during reflow and was lower than that of the control group. LV dp/dt decreased after reflow and gradually recovered with time but recovered was less in preconditioning groups. Coronary flow increased in the first few minutes after reflow in all groups, but decreased gradually. The decrease of coronary flow was greater in preconditioning groups. NO increased during the first 10 minutes after reflow and then decreased. In preconditioning groups, NO tends to be lower than that in the non-preconditioning group. CONCLUSION: Ischemic preconditioning was not beneficial to post-ischemic myocardial dysfunction, coronary flow and NO concentration in the flow. Cummulative effect of stunning due to repetitive ischemia for preconditioning may be an explanation for worse post-ischemic myocardial dysfunction and coronary flow in preconditioning groups.
Animals ; Arginine ; Arrhythmias, Cardiac ; Heart Rate ; Heart* ; Ischemia ; Ischemic Preconditioning* ; Myocardial Ischemia ; Myocardial Stunning ; Nitric Oxide ; Rats* ; Reperfusion

The authors analyzed the surgical results of posterior C1-C2 fusion in 18 cases of atlantoaxial instability. Posterior C1-C2 wiring with bone fusion(11 cases), C1-C2 transarticular screw fixation(6 cases), and occipitocervical fusion(1 case) have been performed for unstable odontoid process fractures(10 cases), transverse ligament injury(4 cases), os odontoideum(3 cases), rheumatoid C1-2 instability(1 case). Follow-up examination was performed in all patientts after a mean postoperativeduration of 39.9 months. Follow-up x-rays showed successful stabilization in 17 cases(94%). Postoperative neurological evaluation showed improvement in 16 cases(89%), stabilization in 2 cases(11%) and there was no major operative complication.
Follow-Up Studies ; Ligaments ; Odontoid Process

Atracurium, one of the newly developed nondepolarizing muscle relaxants, is remarkable due to the intermediate duration of action from the other previously known nondepolarizing agents and the broad safety margin in patients with renal or liver disease. There have been many reports suggesting that the pharmacologic effects of the nondepolarizing muscle relaxants are influenced by dosage. In this study, we attempted to identify the specific mechanism of muscle relaxation of atracurium. Particular attention was paid to the actually delivered atracurium dose and to the degree of muscle relaxation in rabbits. The results were as follows; 1) In the atracurium 0.4 mg/kg group, the onset of action was shortened and in the atracurium 0.6 mg/kg group, it was shortened more significantly. 2) The duration of action was increased with the increase of dose: the mean duration was 895 seconds in the atracurium 0.1 mg/kg group, 1,113.7 seconds in the 0.2 mg/kg group, and 1,199.3 second is in the 0.4 mg/kg group. It was prolonged to 1,730 seconds in the atracurium 0.6mg/kg group. 3) The spontaneous recovery index showed no differences in the atracurium 0.1 mg/kg group, 0.2 mg/kg group and 0.4 mg/kg group (196.7 sec., 195.0 sec, 202.7 sec. each). But in the atracurium 0.6 mg/ kg group, it was markedly prolonged to 334 seconds. In conclusion, atracurium, like other nondepolarizing agents, produces a dose related duration of action in muscle relaxation.
Atracurium* ; Humans ; Liver Diseases ; Muscle Relaxation* ; Rabbits*

OBJECTIVE: Surgical management of invasive pituitary tumor is challengeable with conventional transsphenoidal approach(TSA) or pterional intradural approach alone. Gross total resection of pituitary adenoma influences its prognosis favorably, so transcavernous approach(TCA) is essential in invasive pituitary tumor. This study is performed to evaluate and analyze the surgical results of TCA in cases of invasive pituitary adenoma. METHODS: From November 1995 to May 2002, nine cases of invasive pituitary adenoma were treated. The authors reviewed medical records and radiological findings. Pterional transzygomatic or orbitozygomatic transcavernous approach was selected for tumors extended below or above the third ventricle floor respectively and intradural removal of tumor with suprasellar extension was combined. Surgical results including hormonal function, recurrence, completeness of tumor resection, and postoperative complications were evaluated and analyzed. RESULTS: Eight patients were treated with TSA followed by TCA and one with TCA alone. Total resection was achieved in seven cases, subtotal resection in one, and partial resection in one. Postoperative complications included temporary third nerve palsy in four cases and facial paresthesia in two. There was no recurrence during follow-up period. CONCLUSION: Transcavernous approach alone or combined with TSA is essential surgical procedure for total removal of invasive pituitary adenomas with acceptable morbidities.
Cavernous Sinus ; Follow-Up Studies ; Humans ; Medical Records ; Oculomotor Nerve Diseases ; Paresthesia ; Pituitary Neoplasms* ; Postoperative Complications ; Prognosis ; Recurrence ; Third Ventricle