Hypertensive left ventricular hypertrophy(LVH) was considered to be a physiologic adaptation to the increased afterload of left ventricle, but recent studies revealed that LVH was one of the most important target organ damage in essential hypertensive patients & cardiovascular morbidity was increased in patients with hypertensive LVH. Hypertensive LVH could be classified into three types : concentric LVH, disproportionate septal thickening(DST), and left ventricular dilatation. Relatively high incidence of DST in hypertension has bee reported after clinical introduction of echocardiogram. But, the mechanisms for the development of DST and its clinical significance have not been elucidated exactly. In order to assess left ventricular diastolic function in hypertensives with DST, the authors performed phonocardiogram, M-mode, and pulsed Doppler echocardiogram in 15 normotensive control(group A : 5 male, 10 female, 44.4+/-7.7 years), 15 hypertensives without LVH(group B : 5 male, 10 female, 45.5+/-8.6 years), 85 hypertensives with DST(group C : 9 male, 16 female, 47.5+/-8.6 years) and 15 hypertensives with concentric LVH(group D : 8 male, 7 female, 47.7+/-6.1 years). The obtained results were as follows : 1) Left ventricular ejection fraction was 71.6+/-6.3% in group A, 71.9+/-7.5% in group B, 731+/-7.0% in group C, and 70.3+/-10.3% in group D. Ejection fraction was not significantly different in each other group. 2) Left ventricular mass index(LVMI) by echocardiogram was 87.8+/-20.6g/m
Adaptation, Physiological ; Bees ; Deceleration ; Dilatation ; Female ; Heart Ventricles ; Humans ; Hypertension ; Hypertrophy ; Incidence ; Male ; Relaxation ; Stroke Volume

Two factors of the ventricular function, systolic contractile and diastolic relaxing functions, cooporate in pumping the adequate blood volumes to suffice bodily demands. In some hypertensive patients with marked left ventricular hypertrophy, the intact systolic function of the ventricle associated with clinical symptom of congestive heart failure(CHF), which is considered to be a consequence of diastolic dysfunction. In this study 10 hypertensive patients(group A) complaining of exertional dyspnea or chest pain with increased left ventricular mass index and normal systolic function and 6 normotensive controls(group B) were examined by cardiac catheterization and echocardiography to assess the left ventricular systolic and diastolic function and ventricular responses to constant infusion of nitroprusside. Various systolic and diastolic function indices were measured by cardiac catheterization and echocardiography. 1) The ejection fraction(EF), fractional fiber shortening, mean velocity of circumferential fiber shortening, left ventricular(LV) peak+dp/dt, change of slope of LV peak systolic pressure-volume and pressure-dimension relations in group A were not different from those of group B in the resting states. 2) Diastolic dysfunction was evidenced by prolonged A2D time, decreased OR slope, decreased peak negative dp/dt and increased diastolic time constant 'T' in group A. 3) Cardiac index by thermodilution method was negatively related to left ventricular mass index(LVMI) measured by echocardiography, whereas time constant T was positively related to LVMI. 4) With constant infusion of nitroprusside, LV systolic pressure, LV end-diastolic pressure and pulmonary arterial pressure were decreased, and left ventricular end-systolic stress and stroke work index(SWI) derived from left ventricular pressure-volume loop area were decreased, EF was increased, but time constant T was prolonged and cardiac output(CO) by thermodilution method was decreased in group A. 5) In group B, with constant infusion of nitroprusside, EF, SWI and CO were pratically unaffected and time constant T was not prolonged significantly. These reults suggest that patients with hypertensive hypertrophic left ventricle is associated with diastolic dysfunction, which could further be exacerbated by a vasodilator such as nitroprusside.
Arterial Pressure ; Blood Pressure ; Blood Volume ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Diseases* ; Heart Ventricles* ; Heart* ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Nitroprusside* ; Stroke ; Theophylline ; Thermodilution ; Ventricular Function

We retrospectively analysed plain radiographs and MR imaging of 16 conventional osteosarcoma cases(8 children, 8 adults) which underwent amputations or limb salvage operations. Pathologic correlation was performed with gross and microscopic sections to evaluate 1) whether the open epiphyseal plate can function as a barrier against transphyseal spread of osteosarcoma and 2) the diagnostic value of MR imaging for the detection of the detection of the epiphyseal involvement of osteosarcoma. In children with open epiphyseal plates, conventional radiographs suggested transphyseal tumor growth in one of eight cases(12.5% and MR imaging in seven cases(87.5%). Pathologic examination confirmed epiphyseal involvement in six of seven cases noted with MR imaging(75%). On the the other hand, in adult patients with closed epiphyseal plates, conventional radiographs showed transphyseal tumor growth in six of eight cases(75%), while MR imaging and pathologic exam demonstrated tumor invasion in all cases(100%). We conclude that open epiphyseal plate does not function as and effective barrier against tumor extension, and MR imaging is an excellent method in detecting the extent of transphyseal tumor growth.
Adult ; Amputation ; Child ; Growth Plate ; Hand ; Humans ; Limb Salvage ; Magnetic Resonance Imaging* ; Methods ; Osteosarcoma* ; Retrospective Studies

Cardiac output depends on the ability of systolic ejection and diastolic filling of the heart. M-mode echocardiography can provide accurate clinical assessment of left ventricular systolic and diastolic functions. To see whether there are changes of the left ventricular function in asymptomatic hypertensives and if any kind of dysfunction and whether any relationship between the pattern of the ventricular hypertrophy and type of ventricular dysfunction exists, the authors examined the systolic and diastolic function indices of the left ventricle in 50 normotensives and 88 hypertensives composed of 18 patients without left ventricular hypertrophy(group 1), 40 patients with disproportionate septal thickening (group 2) and 30 patients with concentric left ventricular hypertrophy(group 3). Obtained results were as follows : 1) Blood pressure & left ventricular mass index were increased significantly in each hypertensive group compared to normal control. 2) Ejection fraction & fractional shortening in the hypertensive groups were not different from the normotensive control group. 3) Left ventricular isovolumic relaxation time(A2D time) was prolonged in each hypertensive group, especially in group 3. 4) Left atrial emptying index (AEI) was decreased in each hypertensive group. 5) Left ventricular percent ventricular A wave (% VAW) was increased in all hypertensive groups. Above study suggested that the left ventricular diastolic function could be impaired in the hypertensives without associated systolic dysfunction, and the degree of the diastolic dysfunction was not much affected by the type of left ventricular hypertrophy, but the more prolonged A2D time in the concentric hypertrophy group.
Blood Pressure ; Cardiac Output ; Echocardiography ; Heart ; Heart Ventricles ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Relaxation ; Ventricular Dysfunction ; Ventricular Function, Left

OBJECTIVE: To examine the stiffness of finger joints with StifMeter among the patients with rheumatoid arthritis and to calculate the absolute value of the stiffness with a unit of power and to compare the values of the StifMeter with visual analog scale about stiffness (VASstiff). METHOD: Subjects were 53 rheumatoid arthritis patients (male 8, female 45) with disease duration at least 6 months. StifMeter was made up of 10 graded springs of a same spring-constant. Stiffness and pain by VAS and StifMeter, finger circumference and pinch strength were measured at outpatient clinic as well as questionaire, prospectively. Laboratory data were reviewed from medical records to verify the state of disease. We compared StifMeter with VASstiff and VASpain. RESULTS: Mean score of StifMeter was 5.59 on the right side and 5.53 on the left. The corrected values of the StifMeter with a unit of power were 0.01684 on the right side and 0.01672 on the left side. VASstiff score was positively correlated with that of StifMeter. The older the age, the higher the score of VASstiff that was positively correlated with that of StifMeter. The longer the duration of disease, the higher the score of VASstiff that was positively correlated with that of StifMeter. CONCLUSION: StifMeter is a semi-objective method which may be of value in the measurement of finger joint stiffness.
Ambulatory Care Facilities ; Arthritis, Rheumatoid ; Female ; Finger Joint* ; Fingers* ; Humans ; Medical Records ; Pinch Strength ; Prospective Studies ; Visual Analog Scale

For the evaluation of the left ventricular diastolic function in mild to moderate hypertensive patients without left ventricular hypertrophy, 15 hypertensive patients (group A) and 15 normotensive subjects (group B) were examined by 2-D guided M-mode echocardiography. Various systolic and diastolic indices were derived from computer-assissted analysis of differential curves of left ventricular dimension and posterior wall thickness. The systolic and diastolic function indices of each of the two groups were compared. The results were as follows : 1) There were no significant differences in ejection fraction, left ventricular peak ejection rate and posterior wall thickening rate between two groups. 2) There were no significant differences in % ventricular A wave, left ventricular peak filling rate and posterior wall peak relaxation rate between two groups. 3) One third filling rate was 2.07+/-0.41 EDD/sec in group A and which was significantly lower than 3.29+/-0.88 EDD/sec of group B. Above result suggests that computer-assisted analysis of differential curves of left ventricular dimension and posterior wall thickness could be helpful in the early detection of diastolic dysfunction, and that left ventricular diastolic dysfunction in its early filling period may develop in the mild to moderate hypertensive patients even before left ventricular hypertrophy develops.
Echocardiography ; Humans ; Hypertrophy, Left Ventricular* ; Relaxation

A 15 year-old boy who was supposed to have had rheumatic myocarditis manifested acute heart failure and transient left ventricular hypertrophy in the early phases of the disease process. Serial echocardiographic examination was very helpful to follow the clinical course and observe the anatomic and functional changes of the heart in conjunction with the clinical status.
Adolescent ; Echocardiography ; Heart ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular* ; Male ; Myocarditis*

Catopril, an angiotensin converting enzyme inhibitor, was administrated in 30 hypertensive patients(mild 8, moderate 12, severe 10 cases)for 12 weeks or longer in order to observe the hypertensive effects. Changes in quality of life, side effects, electrocardiogram and left ventricular mass index(LVMI) by 2D-guided M-mode echocardiography were also evaluated before and after captopril. 1) After 12 weeks treatment with 25 to 150mg of captopril alone, blood pressures were lowered markedly in 16(53%), moderatly in 5(17%) and midly in 2(7%), while the addition of 25mg hydrochlorthiazide to captopril in the patients who showed no satisfactory responses the blood pressure were lowered markly in 21(70), moderately in 6(20%) and mildly 3(10%) out of 30 patients studied. The average of blood pressure of the 30 subjects were systolic 180.7+/-20.7mmHg(M+/-SD) and diastolic 113.2+/-12.5 before treatment, which were lowered to 148+/-15.8 and 92.5+/-8.0mmHg respectively after 12 weeks(P<0.005). 2) Heart rates were not changed with captopril and/or hydrochlorothiazide. 3) Quality of life improved markedly in 5(17%) and slightly in 12(40%) out of 30 subjects. 4) Complete blood cell count, urinalysis and serum enzymes followed revealed no significant changes. 5) By electrocardiographic follow-up studies 1 out of 13 subjects with LVH, 1 out of 4 LAH, 1 out of 2 ST-T changes were revealed to improved to normal. 6) In 25 out of 30 cases left ventricular mass indices(LVMI) were above 125g/m2 before treatment, among which 15 cases were followed with satisfactoriness good quality of the echocardiographic recorings and the LVMI was reduced from 169.6+/-40.7 to 141.7+/-40.9g/m2(P<0.01). 7) Undesirable side effects were dry cough 3, skin rash 2, dysgeusia 1 and renal dysfunction 1. 8) Considering the blood pressure lowering effects, life quality changed and side effects together the captopril was considered very useful in 8(27%) and useful in 16(53%) out of 30 subjects. Above results suggest that captopril can be prescribed as an effective initial single agent or with in combinations with thiazide for the treatment of hypertensive of various severities with acceptably low side effects.
Blood Cell Count ; Blood Pressure ; Captopril* ; Cough ; Dysgeusia ; Echocardiography ; Electrocardiography ; Exanthema ; Follow-Up Studies ; Heart Rate ; Humans ; Hydrochlorothiazide ; Peptidyl-Dipeptidase A ; Quality of Life ; Urinalysis

Myocardial bridge is not a rare congenital malformation of the coronary artery which takes an intramural course. Most of the lesions are found in proximal half of the left anterior descending coronary artery, but one which occurs in the left circumflex artery is extremely rare. During systole, the intramural coronary artery is compressed by contraction of over bridging ventricular muscle, therefore blood flow distal to the lesion in impaired and angina pectoris or acute myocardial infarction may occur. We experienced a 54-year-old man who complained of severe precordial pain during exercise and at rest for several months, and was diagnosed as myocardial bridging in the left circumflex coronary artery by coronary arteriography. Thus we report this case with literature review.
Angina Pectoris ; Angiography ; Arteries ; Coronary Vessels* ; Humans ; Middle Aged ; Myocardial Bridging ; Myocardial Infarction ; Systole

A new angiotensin converting enzyme inhibitor, enalapril, was administered in 20 hypertensive patients (7 mild, 6 moderate and 7 severe hypertensives) for 8 weeks or longer in order to see the blood pressure lowering effects. Additionally the left ventricular mass index was measured by 2-D guided M-mode echocardiography before and after enalapril therapy, and subjective symptoms and laboratory findings were also followed. The results were as follows: 1) After 8 weeks of enalapril treatment (the doses form 10 mg to 20mg once a day) blood pressure were lowered markedly in 10, moderately in 4, mildly in 4 cases, but the blood pressures were not lowered in 2 cases with severe hypertension. The means of the blood pressures of the group were lowered form 182.1+/-19.2 to 148.0+/-26.0mmHg in systolic and from 111.9+/-14.7 to 95.1+/-17.1mmHg in diastolic after 8 weeks of treatment (p<0.001). 2) Heart rates were not changed significantly with enalapril. 3) The symptoms of insomnia and headache were reported to be improved after enalapril in 13 cases. 4) No discernable changes in CBC and serum level of creatinine were observed. But the random urine protein was decreased in 6 cases with proteinuria in routine urinalysis. The serum lipid profile was not significantly changed, but in the 2 cases in which the ratio of total to HDL-cholesterol was above 5.0, the ratio fell to below 5.0. 5) There was no significant EKG change after enalapril. 6) In 9 cases out of 13 cases with the left ventricular mass index (LVMI) above 125g/m2 BSA, LVMI was followed by echocardiography after enalapril. LVMI was significantly decreased in 8 of 9 cases and mean values after enalapril was decreased from 183.1+/-88.0g/m2 BSA to 150.8+/-61.3g/m2 BSA (p<0.0025). 7) Side effects after enalapril administration were transient dizziness in 4 cases and ageusia in 2 cases. Above results suggest that the enalapril could be an initial choice in the treatment of essential hypertension as a single oral agent in once a day regimen resulting in good antihypertensive effects, improvement of subjective symptoms, regreassion of the left ventricular hypertrophy and few side effects.
Ageusia ; Blood Pressure ; Creatinine ; Dizziness ; Echocardiography ; Electrocardiography ; Enalapril* ; Headache ; Heart Rate ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Peptidyl-Dipeptidase A ; Proteinuria ; Sleep Initiation and Maintenance Disorders ; Urinalysis