The electrocardiographic and echocardiographic analysis was made on 23 patients with atrial septal defect of ostium secundum type, who were confirmed by right heart catheterization under admission at hanyang University Hospital from january 1979 to July 1981. Following results were obtained: 1) In the 23 patients, 13 were male and 10 female. Their ages ranged from 6 to 45 years, mean age being 19.9 years. 2) In 18 patients(78.3%), the QRS axis was between +90degrees and +150degrees. No significant correlations could be demonstrated between QRS axis and some hemodynamic parameters(right ventricular systolic pressure, pulmonary artery mean pressure and pulmonic to systemic flow ratio), and also, between QRS axis and the size of right ventricular dimension index. 3) Right ventricular outflow tract hypertrophy, right ventricular hypertrophy and complete right bundle branch block pattern in Lead V3R or V1were observed in 95.7% of ostium secundum defect. No significant correlations could be found between types of QRS complexes and some hemodynamic parameters(right ventricular systolic pressure, pulmonary artery mean pressure and pulmonic to systemic flow ratio), and also, between types of QRS complex and the size of right ventricular dimension index. 4) The mean amplitude of S wave in precordial Lead V6was 7.6mm. There was a definite correlation between the amplitude of S wave in Lead V6and right ventricular systolic pressure. No significant correlations could be demonstrated betwen the amplitude of s wave in Lead V6and some hemodynamic parameters(pulmonary artery mean pressure and pulmonic to systemic flow ratio), and also, the size of right ventricular dimension index. 5) Right ventricular dimension index was increased in all cases but one. A significant correlation was found between the size of right ventricular dimension index and pulmonary artery mean pressure, whereas no significant correlation could be demonstrated between the size of right ventricular dimension index and pulmonic to systemic flow ratio. 6) 95.7% of 23 patients with ostium secudum defect showed paradoxical septal motion was proved not to be associated with other congenital heart disease by cardiac catheterization. The pulmonic to systemic flow ratio in groups of septal motion type A was significantly increased than that of normal septal motion group, whereas no significantl relation between types of septal motion and the size of right ventricular dimension index was observed.
Arteries ; Axis, Cervical Vertebra ; Blood Pressure ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography* ; Electrocardiography* ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Hemodynamics ; Humans ; Hypertrophy ; Hypertrophy, Right Ventricular ; Male ; Pulmonary Artery

BACKGROUND AND OBJECTIVES: N-cadherin is known to be expressed in neuroectodermal tissue such as central nervous system and various mesodermal origin tissues such as kidney and heart. We investigated N-cadherin expression in the endocardial cushion in developing rat heart by immunohistochemical method. MATERIALS AND METHOD: Fetal rat hearts at the 11th, 13th, 15th, 17th, and 19th day of gestation and the 1st day neonatal rat heart were used. Hematoxylin and eosin stain was performed for normal cardiogenesis, and immunohistochemistry was performed for the expression of N-cadherin in interventricular septum(IVS) during cardiogenesis in rat. RESULTS: Ventricular wall and membranous part of the IVS showed positive reaction with anti-N-cadherin at the 11th day of gestation. Membranous part of IVS was begun to show tracely positive reaction at the 15th day of gestation, and thereafter the immunoreactivity was increased with maturation. At the 17th day of gestation mesenchymal cells in membranous muscular part of the IVS showed positive reaction. The similar immunoreactivity of membranous and muscular parts of IVS were shown at the 19th day of gestation. CONCLUSION: As the immunoreaction of mesenchymal cells in the membraneous part of IVS to anti-N-cadherin was increased with time, it is suggested that mesenchymal cells in membranous part of IVS were differentiated into the cardiomyocytes.
Animals ; Cadherins* ; Central Nervous System ; Endocardial Cushions ; Eosine Yellowish-(YS) ; Heart* ; Hematoxylin ; Immunohistochemistry ; Kidney ; Mesoderm ; Myocytes, Cardiac ; Neural Plate ; Pregnancy ; Rats*

Five cases of cerebral arteriovenous malformation(AVM) are presented, which underwent total extirpation using the operating microscope. The following are considerations which favor the total extirpation of AVM and the advantages of using the operating microscope, including the rationale for non-use of hypotensive anesthesia or mannitolization which is commonly used in intracranial aneurysm surgery: 1) Relatively small sized AVMs are found to show a high rate of large intracerebral hematoma, including that the degree of bleeding from the malformed vessels is not related to the size of the AVM. 2) The operating microscope facilitates the following procedures: a) determination of the extent of the malformed vessels. b) clipping feeders. c) identification of red vein and laminar flow. d) preservation of normal brain tissue.
Anesthesia ; Brain ; Hematoma ; Hemorrhage ; Intracranial Aneurysm ; Intracranial Arteriovenous Malformations* ; Mannitol ; Veins

Metabolic acidosis (MA) is associated with increased proteolysis, increased osteoclast activity and blunted cardiac muscle response, but the effect of MA on various clinic al parameters in CAPD patients is not well known. To evaluate the effects of MA on serum albumin level and other nutritional parameters in CAPD patients, we studied 106 CAPD patients retrospectively who have had monthly biochemical measurement and urea kinetic studies every 6 months for more than 2 years. The patients were divided into three groups according to their mean total CO2 (tCO2) level of the 2-year follow-up (Group l; mean tCO2 < 22mM/L, Group ll; 22mM/L < or = mean tCO2 < 26mM/L, and Group lll; mean tCO2 > or = 26mM/L), and the clinical, biochemical, and urea kinetic data were compared among the three groups. 1)The mean age of the subjects was 46.9+/-12.2 years with a sex ratio of 1.2:1, the mean CAPD duration 28.3+/-21.8 months, mean body weight (Bwt) 59.0+/-8.9kg, %Bwt/IBW 104.1+/-11.5%, %LBM/Bwt 75.5+/-11.1% and well-nourished patients by subjective global assessment (SGA) were 65%. 2)The mean BUN, creatinine, total protein and albumin of all patients were 55.6+/-13.6mg/dL, 12.3+/-3.5mg/dL, 6.6+/-0.7g/dL and 4.0+/-0.4g/dL, respectively. In urea kinetic study, the mean NPCR, weekly Kt/ Vurea, SCCr and RRF were 0.96+/-0.16g/kg/day, 2.02+/-0.37, 63.7+/-18.4L/week/1.73m2, and 0.99+/-1.32ml/ min, respectively. 3)The mean age was significantly higher in group l (51.0+/-10.8) than those of group ll (47.0+/-12.4) and lll (42.6+/-11.4) (P<0.05). %Bwt/IBW of group l (114.4+/-15.8%) was also significantly higher than those of group ll (104.6+/-12.6%) and lll (103.5+/-13.7 %) (P<0.05), but there were no significant differences in sex ratio, CAPD duration, %LBM/Bwt, and SGA among the three groups. 4)The mean tCO2 in group l, group ll, and group lll were 20.6+/-1.2mM/L, 23.9+/-1.1mM/L, and 27.3+/-0.8mM/L, respectively. Compared to group lll, group l had significantly higher BUN (61.1+/-14.3 vs. 46.1+/-7.2mg/dL, P<0.05) and serum albumin (4.04+/-0.31 vs. 3.75+/-0.39g/dL, P<0.05), in spite of comparable dialysis dose and albumin loss into dialysate. 5)NPCR (1.02+/-0.21g/kg/day vs. 0.88+/-0.14g/kg/ day, P<0.05) and ultrafiltration volume (1.4+/-0.4 vs. 1.0+/-0.3, P<0.05) were significantly higher in group l than those of group lll. But there were no significant differences in Kt/Vurea, SCCr, RRF, and 24-hour dialysate loss of protein/albumin among the three groups. 6)No differences were observed among the three groups in the changes of body weight, %Bwt/IBW, %LBM/Bwt, BUN, albumin, NPCR, and RRF from the baseline values after the 2-year follow-up. 7)There were significant inverse correlations between the mean tCO2 level and NPCR (r=-0.33, P<0.001), %Bwt/IBW (r=-0.32, P<0.001), RRF (r=-0.29, P<0.005), and serum albumin level (r=-0.24, P<0.05). But, creatinine, %LBM/Bwt, and Kt/Vurea did not show any correlation with the mean tCO2 level. 8)Using stepwise multiple regression analysis, NPCR (beta=-0.3491, P<0.001), %Bwt/IBW (beta=-0.046, P<0.001), and ultrafiltration volume (beta=-0.0012, P< 0.005) were independent factors affecting the mean tCO2 level. In conclusion, low total CO2 level in long-term CAPD patients may reflect increased protein intake and mild to moderate degree of metabolic acidosis may not affect the nutritional status of well-dialyzed CAPD patients.
Acidosis* ; Body Weight ; Creatinine ; Dialysis ; Follow-Up Studies ; Humans ; Myocardium ; Nutritional Status ; Osteoclasts ; Peritoneal Dialysis, Continuous Ambulatory* ; Proteolysis ; Retrospective Studies ; Serum Albumin* ; Sex Ratio ; Ultrafiltration ; Urea

Arytenoid subluxation or recurrent laryngeal nerve paralysis may result from injury to the larynx following endotracheal intubation or blunt laryngeal trauma. Early diagnosis is important for appropriate treatment and better prognosis. A 62-years-old man was admitted for cholecystectomy. He was intubated without any difficulty and nasogastric tube was inserted with the help of laryngoscope and Magill forcep before surgery. He had a weak voice and hoarseness after atraumatic extubation and those symptoms did not improve even 2 days after. Indirect laryngoscopy, videolaryngotelescopy, electromyography(EMG) and computed tomographic findings revealed anterior, inferior subluxation of left cricoarytenoid cartilage associated with left thyroarytenoid muscle denervation and resultant unilateral vocal cord palsy. Conservative treatment for 40 days after the operation and follow-up examination was done. The voice quality was improved and indirect laryngoscopy examination showed that right vocal cord crossed midline in a attempt to meet its paralyzed counterpart on phonation.
Anesthesia, General* ; Cartilage ; Cholecystectomy ; Denervation ; Early Diagnosis ; Follow-Up Studies ; Hoarseness ; Intubation, Intratracheal ; Laryngeal Muscles ; Laryngoscopes ; Laryngoscopy ; Larynx ; Paralysis* ; Phonation ; Prognosis ; Recurrent Laryngeal Nerve* ; Surgical Instruments ; Vocal Cord Paralysis ; Vocal Cords ; Voice ; Voice Quality

The authors performed clear lens extraction to treat severe high myopia more than 12 diopters (D) of 24 eyes. The changes in spherical equivalent (S.E). visual acuity improvement, and the complications were evaluated during the average 15 months follow-up period. A scleral pocket incision and continuous curvilinear capsulohexis was made and lens extraction was performed via phacoeomulsification and low power posterior chamber intraocular lens was implanted. The postoperative refractive error targets were -1.0 D in 16 eyes. and -3.0 D in 8 eyes. Sixty-two percent(15/24 eyes) of eyes were within +/-1 D of targeted refractive error and 91.7%(22/24 eyes) of eyes were within +/-2 D of targeted refractive error. The postoperative uncorrected visual acuities were increased in all cases and 95.8%(23/24 eyes) of eyes gained two or more lines. There were increase in uncorrected visual acuity achieving 20/200 or more from 0% to 95.8%(23/24 eyes) postoperatively. The postoperative corrected visual acuities were increased in 83.3%(20/24 eyes) and 75%(15/20 eyes) among them gained two or more lines. The corrected visual acuity of 20/40 or better were increased from 41.7%(10/24 eyes) preoperatively to 79.2%(19/24 eyes) postoperatively. Posterior capsular opacification was developed in one eye and YAG laser posterior capsulotomy was performed at 4 months postoperatively. No retinal break, no retinal detach ment, no cystoid macular edema were developed during the follow-up period. In conclusion, the clear lens extraction was effective method for correction of severe high myopia but longer follow-up of large number of cases is needed to fully assess the complications.
Follow-Up Studies ; Lasers, Solid-State ; Lenses, Intraocular ; Macular Edema ; Myopia* ; Posterior Capsulotomy ; Refractive Errors ; Retinal Perforations ; Retinaldehyde ; Visual Acuity

The authors have performed EIAB surgery on four patients. They were affected by progressive stroke with middle cerebral artery occlusion, reversible ischemic neurologic deficits with middle cerebral artery stenosis, traumatic middle cerebral artery occlusion and traumatic internal carotid occlusion in the high cervical region. Our experience on the anastomoses between extracranial artery and a branch of the middle cerebral artery, although not extensive, give us the opportunity to examine some aspects of the problem and to raise some questions.
Arteries ; Constriction, Pathologic ; Humans ; Infarction, Middle Cerebral Artery ; Middle Cerebral Artery ; Neurologic Manifestations ; Stroke

This study was designed to compare the smoothness by glazing method with that by polishing method after 48 specimens of Ceramco II block, one of porcelain materials used for PFM, were baked according to the manufacturer's directions. The specimens were roughened with new green stone at 15,000rpm for 30 seconds and sandblasted with 25microliteraluminum oxide for 15 seconds. They were divided into 4 groups at random, and 4 groups were prepared as follows : Group I : specimens were autoglazed and overpolished with polishing system. Group II specimens were polished with only polishing system. Group IIIspecimens were glazed after adding glazing liquid, vitachrom "L"-fluid (vita zahnfabrik co. Germany) to the rough surface Group v : specimens were just autoglazed Using the surface roughness tester, Ra, Rmax, and Rz were estimated 5 times per specimen, and recording process of mean value was repeated 3 times. The results were as follows : 1. The Ra of group I and group IIwas lower than group IIIand group IV (p<001). 2. There was lower value of Rz in group I and group II than group III and group IV (p<001). 3. The Rmax of group I(overpolished with polishing system after autoglazing) and group II(polished with only polishing system) was lower than group III(glazed after adding glazing liquid) and group IV (autoglazed) (p<001). 4. There was not a statistically significant difference between group I and II and between group III and IV (p>001). 5. The roughness was increase in order of group I,II,III,IV in SEM
Dental Porcelain*

It is well known that optokinetic responses are disturbed in the parietal lobe lesion. Also such a lesion manifests visual field defect. Authors predicted a superficial brain lesion sparing optic radiation in the parietal lobe, which might interfere optokinetic nystagmus. As a control group, one hundred healthy adults were examined and all of them showed normal symmetric optokinetic responses. In the study group, ten cases of cerebral paragonimiasis with their cystic formation in the posterior parieto-occipital area involving mostly Brodmann's are 18 and 19, seven cases of various brain tumors and eight cases of craniocerebral injury were observed for optokinetic nystagmus with correlation to visual field.
Adult ; Brain ; Brain Neoplasms ; Craniocerebral Trauma ; Humans ; Nystagmus, Optokinetic* ; Paragonimiasis ; Parietal Lobe ; Visual Fields

The authors accessed the effects of heart rate and age to echocardiographic right ventricular systolic time intervals in 27 cases with normal pulmonary artery pressure and correlation of pulmonary hemodynamic parameters with echocardiographic right ventricular systolic time intervals in 76 cases with congenital and acquired valvular heart diseases. The results were as follows; 1) As heart rate increased there was a diminution of the length of right ventricular ejection time(RVET)(r=0.642), but no significant changes in the length of right ventricular pre-ejection period(RVPEP) and the ratio of RVPEP/RVET were found. 2) As age increased there was an increase in the ratio of RVPEP/RVET(r=0.46), but no significant changes in the length of RVPEP and RVEF were found. 3) In patients with the RVPEP/RVET of 0.3 or more this ratio can predict that pulmonary artery systolic pressure is >30mmHg(sensitivity : 83%, specificity : 96%, accuracy 88%), pulmonary artery mean pressure >20mmHg(sensitivity : 87%, specificity : 96%, accuracy 90%), and pulmonary artery diastolic pressure >15mmHg(sensitivity : 86%, specificity : 90%, accuracy : 88%). 4) In patients with the RVPEP/RVET of 0.4 or more this ratio can predict that pulmonary artery systolic pressure is >50 mmHg(sensitivity : 75%, specificity : 98%, accuracy : 92%), pulmonary artery mean pressure >40mmhg(sensitivity : 93%, specificity : 96%, accuracy : 96%), pulmonary artery diastolic pressure >25mmHg(sensitivity : 75%, specificity : 98%, accuracy : 92%), pulmonary vascular resistance >6 units(sensitivity : 70%, specificity : 96%, accuracy : 89%), and Rp/Rs >0.25(sensitivity : 86%, specificity : 95%, accuracy : 93%). In conclusion, pulmonary hypertension, increased pulmonary vascular resistance and pulmonary arteriolar obstructive disease can be predicted by echocardiographic measurement of RVPEP/RVET.
Blood Pressure ; Echocardiography* ; Heart Rate ; Heart Valve Diseases ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Pulmonary Artery* ; Sensitivity and Specificity ; Systole ; Vascular Resistance*