BACKGROUND: Low frequency oscillation of systemic artery pressure was known as the marker of sympathetic modulation. Recently the low frequency oscillation of pulmonay artery pressure in pulmonary hypertensive patient was reported. But no further study about its quantitative relationshop and phasic coupling between the low frequency oscillation of pulmonary artery pressure and systemic artery pressure. Power spectral analysis with autoregressive algorithm and cross spectral analysis are powerful tool for investigation these relationship. METHOD: Analog signals of simultaneous measured left pulmonary and femoral artery pressure in thirty one patients with ventricular septal defect were digitized and stored. After modeling each time series with autoregressive algorithm, power spectral density function was obtained by calculation the frequency response function of each model, and then low frequency power was computed. Cross spectral density function provided squared coherence and phase spectrum. Phase between the low frquency oscillation of the two signal was measured from the phase spectrum when the squared coherence is above 0.5. RESULTS: The advantage of using autoregressive model was that the power spectral density function was continous and sharp spectral peak was usually found. In patients with Rp/Rs<0.25, the low frquency power of pulmonary artery pressure(12+/-12) was significantly smaller than that of the systemic artery pressure(144+/-242). In patients with Rp/Rs>or=0.25, there was no significant difference between the low frequency power of pulmonary artery pressure(384+/-461) and that of the systemic artery pressure(752+/-1241). In patients with Rp/Rs>or=0.25, it was more probable that low frequency oscillation of pulmonary and systemic artery pressure was timely coherent(sqaured coherence>0.5) than in patient with Rp/Rs<0.25. And their phase difference was 0~1.96 radian. CONCLUSION: Autoregressive algorithm is a more powerful tool for spectral analysis than the method of conventional spectrum estimation. When pulmonary vascular resistance remains low, the low frequency oscillation of pulmonary artery pressure was negligible compared to systemic artery pressure. But as pulmonary vascular resistance elevates, the low frequency power of pulmonary artery pressure is much the same as that of systemic artery pressure, and there is a explicit time realtionship that pulmonary artery pressure leads the systemic artery pressure about 0~3 seconds in the low frequency range.
Arteries ; Femoral Artery ; Heart Septal Defects, Ventricular ; Humans ; Hypertension, Pulmonary ; Pulmonary Artery ; Pulmonary Circulation* ; Vascular Resistance

No abstract available.
Accidents, Traffic* ; Aggression*

The giant intra-articular osteochondroma of the knee is very rare and is probably result of synovial metaplasia of the fibrous capsule or of the adjacent connencive tissue of a joint, and of the fragment of articular cartilage. The gross findings and histology are consistent with the osteochondroma. The authors experienced a case of giant intra-articular osteochondroma of the right knee in a 19 years old man who had history of knee injury when he was 16 years old. The mass was excised and the symptome was relieved.
Cartilage, Articular ; Joints ; Knee Injuries ; Knee ; Metaplasia ; Osteochondroma

BACKGROUND: To evaluate the influence of changes in mitral valve area (MVA) and left atrial pressure on pulmonary vein flow (PVF) we analyzed PVF with transesophageal echocardiography (TEE) before, after and one-year after percutaneous mitral valvuloplasty (PMV) in patients with mitral stenosis (MS) in sinus rhythm. METHODS: PMV was guided with TEE. Follow-up TEE was done about one year after PMV. MVA and transmitral mean gradient (TMG) were measured. Systolic velocity (S), diastolic velocity (D), atrial reversal velocity (AR), their time-velocity integral (S-TVI, D-TVI, AR-TVI) and their ratio (S/D ratio, S-TVI/D-TVI ratio were evaluated. RESULTS: The number of patients was twenty-two (F:20). The age was 39+/-9 years (range:26-64). Follow-up duration was 16+/-6 months (range:7-28). MVA increased from 0.9+/-0.2 cm2 to 1.9+/-0.3 cm2 after PMV and decreased to 1.7+/-0.3 cm2 on follow-up TEE significantly. TMG decreased from 15.4+/-4.3 mmHg to 5.5+/-1.9 mmHg after PMV and was 6.2+/-2.4 mmHg on follow-up. S increased significantly on follow-up at both pulmonary vein (PV). D increased on follow-up at left PV. S/D ratio increased on follow-up at both PV. AR increased on follow-up at both PV. S-TVI increased after PMV at left PV and increased on follow-up at both PV. D-TVI had no change. S-TVI/D-TVI ratio increased on follow-up at left PV. AR-TVI increased on follow-up at right PV. CONCLUSIONS: The main changes after PMV in patients with MS in sinus rhythm were increasing tendency in S, S-TVI, S/D ratio, S-TVI/D-TVI ratio and AR. And these changes were statistically significant on follow-up TEE rather than immediately after PMV.
Atrial Pressure ; Echocardiography* ; Echocardiography, Transesophageal ; Follow-Up Studies ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Pulmonary Veins

BACKGROUND: Balloon mitral valvuloplasty is a favorable procedure as a therapy for mitral stenosis because it minimizes morbidity and shorten hospital stay compared with surgical mitral commissurotomy or mitral valve replacement. Recent reports about concomitant transesophageal echocardiography guide in addition to fluoroscopy suggest that transesophageal echocardiograpy can provide additional benefits during balloon mitral valvuloplasty especially in transseptal puncture, balloon positioning, evaluation of immediate result, and early detection of complications. We performed this study to identify the potential benefits of on-line transesophageal echocardiography guide during balloon mitral valvuloplasty. METHOD: We performed balloon mitral valvuloplasty under on-line transesophageal echocardiography guide in addition to fluoroscopy in 70 patients(male:14, female:56, mean age:44+/-13) with rheumatic mitral stenosis from May 1995 to May 1996. Thirty-two(46%) patients had atrial fibrillation. Included patients were symptomatic with more than NYHA class 2 symptom. Patients with mitral valve score more than 11 and mitral regurgitation more than 2/4 were excluded. Inoue balloons were utilized in all cases. RESULTS: The average mitral valve area increased from 0.9+/-0.2cm2 before valvuloplasty to 1.8+/-0.4cm2 after valvuloplasty(p<0.0001). The averagetransmitral pressure gradient measured by continuous wave Doppler decreased from 14+/-6mmHg before valvuloplasty to 5+/-2mmHg after valvuloplasty(p<0.0001), and the average left atrial pressure measured by catheterization decreased form 22+/-8 mmHg before valvuloplasty to 11+/-5mmHg after valvuloplasty(p<0.0001). The average procedure time was 64+/-22 minutes(ranged from 13 to 150 minutes) and the average fluoroscopy time was 19+/-15 minutes(ranged from 1 to 94 minutes). Two patients underwent surgery due to severe mitral regurgitation associated with papillary muscle rupture which developed after valvuloplasty. In one patient, transesophageal echocardiography detected pericaridal tamponade during the procedure and the transducer was quickly switched to transthoracic transducer to guide the pericardial puncture site. The pericardial tamponade was drained with pigtail catheter and the patient underwent balloon mitral valvuloplasty successfully a week later. Four patients were pregnant at the time of the valvuloplasty procedure and the valvuloplasty was successfully performed with minimal fluoroscopy time(1-3 minutes) without complications in all four patients. Five patients had thrombus in left atrial appendage, but the transesophageal echocardiography was useful in monitoring the ballon position during the procedure and the valvuloplasty was successfully performed without embolic complications in all five patients. CONCLUSION: The transesophageal echocardiography is a very useful guiding adjunct during balloon mitral valvuloplasty in transseptal puncture, balloon positioning, evaluation of immediate result, early detection of complications, and shortening fluoroscopy time especially in pregnant women.
Atrial Appendage ; Atrial Fibrillation ; Atrial Pressure ; Cardiac Tamponade ; Catheterization ; Catheters ; Echocardiography, Transesophageal* ; Female ; Fluoroscopy ; Humans ; Length of Stay ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Papillary Muscles ; Pregnant Women ; Punctures ; Rupture ; Thrombosis ; Transducers

BACKGROUND: Percutaneous mitral balloon valvuloplasty(PMV) is a good treatment modality for patient with mitral stenosis(MS). But it is considered relatively contraindicated in patients with left artrial thrombi because of high risk of embolism. Limitted studies have suggested the feasibility of PMV in patients with left atrial appendage(LAA) thrombi. This study was performed to evaluate the feasibility and safty of PMV in patients with LAA thrombi using Inoue balloon under the transesophageal echocardiographic (TEE) monitoring. METHOD: PMV was performed in 5 patients diagnosed as MS with LAA thrombi from October, 1995 to July, 1996. Four cases were female, and one case was male. Their mean age was 525(46-58years old). Two of them had history of cerebrovascular accident(CVA). The duration of anticoagulant treatment was 6-49 moths. All patients underwent PMV using Inoue balloon catheter under the TEE monitoring. RESULTS: EKG finding of all 5 patients were atrial fibrillation(Af). Their mitral valve score were 5-10(Mean score was 82). Transmitral mean pressure gradient was decreased from 14.62.1 to 5.82.0mmHg, and mitral valve increased from 0.840.43 to 1.720.19 after PMV. There was no procedure related complication. In 3 cases of them LAA thrombi diappeared in the follow up TEE. In two patients, the LAA thrombi were calcified and remained unresolved at the time of follow up TEE( 6month-and 12 month-F/U, eath). CONCLUSION: Although the reported number of PMV in patients with LAA thrombi is small in this study, we believe that, with special precaution and TEE monitoring, LAA thrombi is no longer an absolute contraindication to PMV.
Atrial Appendage* ; Balloon Valvuloplasty* ; Catheters ; Echocardiography ; Electrocardiography ; Embolism ; Female ; Follow-Up Studies ; Humans ; Male ; Mitral Valve ; Moths

BACKGROUND: We studied how periodic and complex heart rate dynamic changes as pulmonary artery pressure increases in 32 infants with ventricular septal defet. In addition, we tested the possibility that the dynamical changes can be used to noninvasively predict the pulmonary artery pressure. METHODS: During cardiac catherterization, mean pulmonary artery pressure was measured and, at the same time, 5minute segments of continous electrocardiographic recording was stored. High-(>0.15 hertz) and low-(0.03-0.15 hertz) frequency components of heart rate variability were computed using spectral analysis. Yhe overall complexity of heart rate time series was quantified by its approximate entropy. RESULT: Pulmonary hypertensive infants(mean pulmonary artery pressure>20mmHg, n=17) had significantly lower low-(p<0.05)and high-(p<0.05) frequency power and lower approximate entropy(p<0.0001) than pulmonary normotensive infants(mean pulmonary artery pressure20mmHg, n=15). The mean pulmonary artery pressure was significantly correlated not with the spectral powers but with approximate entropy(=-0.51, P=0.0001). Conclusion: It can be concluded that, in infants, pulmonary hypertension induced by left-to-right shunt lesions suppress both periodic and complex heart rate oscillation and that mean pulmonary artety pressure can be predicted by calculating approximate entropy of heart trate variability.
Electrocardiography ; Entropy ; Heart Rate* ; Heart Septal Defects, Ventricular* ; Heart* ; Humans ; Hypertension, Pulmonary ; Infant* ; Pulmonary Artery*

No abstract available.
Blood Flow Velocity* ; Ductus Arteriosus* ; Humans ; Infant, Newborn* ; Ultrasonography*

BACKGROUND: Coronary arteriovenous(AV) fistula is a rare congenital disease, and seldom produce symptoms during childhood. However late complications can occur including congestive heart failure, myocardial ischemia, and bacterial endocarditis. Therefore surgical repair is recommended even if the patients are asymptomatic. In these days many investigators are interested in transcatheter embolization because of high procedural success rate without risks and morbidity associated with cardiac surgery. METHODS: Five patients(4 females and 1 male) of coronary AV fistula were treated with transcatheter coil embolization. All had symptom of chest pain. In coronary angiograms fistulous tracts were originated from left anterior descending artery(LAD) and drained to main pulmonary artery(MPA) in 4 cases. The other case had abnormal vessel from left circumflex artery(LCX) to bronchial artery. Transcatherter coil embolization were done with Judkins left guiding catheter, 018 inch Tracker or 3F Microferret catheter, and 018 inch coils. RESULTS: The fistula tracts were completely occluded in 3 cases after coil emboilzation. In 2 cases with multiple fistular vessels, major fistula were occluded, but minor vessels remained. There were no procedure related complications. CONCLUSION: Transcatheter coil embolization may be an effective treatment modality in coronary AV fistula with excellent result and minimal complications.
Arteriovenous Fistula* ; Bronchial Arteries ; Catheters ; Chest Pain ; Embolization, Therapeutic* ; Endocarditis, Bacterial ; Female ; Fistula ; Heart Failure ; Humans ; Myocardial Ischemia ; Research Personnel ; Thoracic Surgery

PURPOSE: In mammals, alphaand beta-defensins are antimicrobial peptides that are expressed in various epithelial and phagocytic cells. Human beta-defensin-1 and -2 (hBD-1, hBD-2) have recently been shown to be expressed in various epithelial cells. Vaginal mucosa can be a target of vaginitis and the site of uropathogens' colonization that precedes urinary tract infections. Therefore, innate host defense mediators like antimicrobial peptides in the vaginal mucosa are important. Estrogen and progesterone receptors have been shown to be expressed in the vaginal squamous epithelium. Sex hormones like estrogen and progesterone may cause vaginal atrophy or susceptibility to uropathogens. So, we performed this study to investigate the expression patterns of hBD-1 and -2 mRNA in vaginal squamous epithelium (VSE) with using lipopolysaccharide (LPS), 17beta-estradiol and progesterone. MATERIALS AND METHODS: Normal VSE cells that were retrieved from vaginal tissue during vaginoplasty were primarily cultured in keratinocyte growth medium and they we allowed to undergo their 3rd passage. Modulation of the expressions of hBD-1 and -2 mRNA by various stimuli (LPS 0.5microgram/ml, E2 2nM, P 1micrometer) was measured by semiquantitative reverse transcription polymerase chain reaction (RT-PCR). RESULTS: HBD-1 and -2 were constitutively expressed in the normal VSE cell lines, but the hBD-2 expression was not significant. A marked increase of the constitutive expression of hBD-2 mRNA was observed upon stimulation with LPS, but not upon stimulation with E2. A moderate decrease of the constitutive expression of hBD-2 mRNA upon stimulation with LPS was observed with administering progesterone. CONCLUSIONS: These expressions of hBD-2 mRNA may have important roles in the innate host defense of the urogenital area. Artificial intake of progesterone may lead to susceptibility via a decrease of defensins.
Atrophy ; beta-Defensins ; Cell Line ; Colon ; Defensins ; Epithelial Cells* ; Epithelium ; Estrogens ; Gonadal Steroid Hormones ; Humans ; Keratinocytes ; Mammals ; Mucous Membrane ; Peptides ; Phagocytes ; Polymerase Chain Reaction ; Progesterone* ; Receptors, Progesterone ; Reverse Transcription ; RNA, Messenger ; Urinary Tract Infections ; Vagina ; Vaginitis