Blunt thorax trauma may produce a variety of cardiac lesions, which may occur alone or in combination. Nonpenetrating perforation of interventricular septum with chordae rupture of tricuspid valve is a infrequent pathologic event. A 40-years-old worker was transfered to hospital with increasing symptoms of right heart failure following a blunt compressing chest trauma with a huge overolling cement pipe(Wt.680kg) 6 weeks ago. The immediately diagnosed serial rib fracture of the left thorax cage and dislocation of the left acromoclavicular joint were treat conservatively. A conventional transthoracic color Doppler and two dimensional echocardiogram detected traumatic ventricular septal defect with bilatral shunt and tricuspid regurgitation. An additional transesophageal color echocardiopraphic demonstrated the ruptured chordae tendineae of the tricuspid septal leafet, which prolapsed deeply into the right atrium. The conventional color Doppler echocardiopraphy enhances the ability to detect the presence of a ventricular septal perforation and valve dysfunction in a patient with cardiac contusion. The transesophageal echocardiopraphy is a useful semiinvasive tool for the detailed morphological evaluation of atrioventricular valves and their substructure.
Chordae Tendineae ; Contusions ; Dislocations ; Echocardiography* ; Heart Atria ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Joints ; Rib Fractures ; Rupture* ; Thorax* ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Ventricular Septal Rupture*

A 63 year old male suffered from a acute huge inferolateral and posterior myocardial infarction with vertricular septal perforation(1x1.5cm). Cardiogenic shock and ventricular tachycardia occured on the 3rd day in hospital. After cardiopulmonary resuscitation the deteriorated condition of the patient was improved by intraaortic balloon counterpulsation(IABP). The invasive diagnostic procedure(LV angiography and coronary angiogram) was carried out under the employment of IABP and artificial ventrilation. The patients has recovered from the operation(coronary artery bypass graft and VSD patch op) and myocardial infarction. Because of recurrent aspiration pneumonia the patient was nourished per gastrostomy. He died 3 month later due to upper gastrointestinal bleeding.
Angiography ; Arteries ; Cardiopulmonary Resuscitation ; Counterpulsation* ; Employment ; Gastrostomy ; Hemorrhage ; Humans ; Inferior Wall Myocardial Infarction* ; Male ; Middle Aged ; Myocardial Infarction ; Pneumonia, Aspiration ; Shock, Cardiogenic* ; Tachycardia, Ventricular ; Transplants ; Ventricular Septal Rupture*

No abstract available.
Echocardiography, Transesophageal* ; Foramen Ovale, Patent*

No abstract available.
Coronary Vessels*

Segmental Spinal Instrumentation(S.S.I.) is more effective means of managing unstable thoraco-lumbar spine fractures than traditional Harrington Rod Instrumentation as an operative procedure which afforded rigid internal fixation with stability and needed minimal external immobilization. Early return to normal activity and successful rehabilitation are facilitated by efficient stabilization with S.S.I. Fifty-nine patients with fractures and fracture-dislocations of thoraco-lumbar spine were treated by Harrington Rod Instrumentation (29 patients) and S.S.I. (30 patients) at this hospital from June 1979 to July 1984. We have analysed the results of these treatment and obtained following conclusions: 1. S.S.I. is more rigid internal fixation than Harrington Rod Instrumentation. a) no or minimal external immobilization b) early ambulation and rehabilitation c) lowered complications 2. There was no significant difference in correction rate, loss of correction, and neurologic recovery between Harrington Rod Instrumentation and S.S.I.
Early Ambulation ; Humans ; Immobilization ; Rehabilitation ; Spine ; Surgical Procedures, Operative

PURPOSE: The present study was conducted to gather valid data for promoting public eye health among adolescent contact lens wearers by investigating the current practices of contact lenses wearers. METHODS: A questionnaire regarding use and care of contact lenses was distributed to middle and high school students. A total of 920 students (472 males, 448 females) were enrolled and the purpose of the study was explained to the students. RESULTS: Among all student, 49% had myopia (male 44%, female 54%) and 12% hyperopia (male 12%, female 13%). In addition, 70% of the subjects chose to wear glasses for vision correction, 27% (male 4%, female 50%) reported they have worn contact lenses and 64% of those were soft contact lenses. The age for starting contact lenses was between 14-16 years of age (63%). Most students (95%) purchased their contact lenses from an optical store. Many (89%) cleaned the contact lenses with cleaning solution on a daily basis, however, only 25% of the students received instructions on how to clean the lens properly. Common complaints associated with use in descending order were hyperemia (31%), foreign body sensation (19%), tearing (16%), pruritis (13%), and keratitis (9%). The subjects reported that the main cause of complications was due to the users' lens handling (93%). CONCLUSIONS: The present study findings showed many adolescents have misleading knowledge regarding use of contact lenses. There is a need for better education of young contact lens users regarding the contact lens care.
Adolescent* ; Contact Lenses ; Contact Lenses, Hydrophilic ; Education ; Eyeglasses ; Female ; Foreign Bodies ; Glass ; Humans ; Hyperemia ; Hyperopia ; Keratitis ; Male ; Myopia ; Pruritus ; Surveys and Questionnaires ; Sensation ; Tears

No abstract available.
Coronary Vessels* ; Echocardiography, Transesophageal* ; Sinus of Valsalva*

No abstract available.
Coronary Vessels* ; Electrocardiography* ; Spasm*

No abstract available.
Coronary Vasospasm* ; Heart Arrest* ; Verapamil*

BACKGROUND: There is a clinical need for a simpler measurement of global cardiac function incorporating elements of both systole and diastole. Doppler time index is theoretically regarded as a sensitive index of global left ventricular perfomance and defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET). This study was designed to determine the clinical usefulness of the Doppler time index in patients with left ventricular diastolic dysfunction as well as systolic dysfunction. METHODS: The study population consisted of 23 patients with hypertension as a diastolic dysfunction group, 16 patients with low ejection fraction as a systolic dysfunction group and 31 subjects with normal LV function. The ejection fraction (EF) was measured using M-mode echocardiography. Doppler profiles such as IVCT, IVRT and ET were obtained from Doppler echocardiography. The Doppler time index [ (IVCT+RT)/ET] was calculated from each Doppler velocity profiles. RESULTS: IVRT, IVRT/ET and (IVCT+VRT)/ET were significantly increased in the diastolic dysfunction group (120.5+/-19.5 msec, 0.45+/-0.1, 0.64+/-0.2, respectively:p<0.001, p<0.001, p<0.001, respectively) compared with normal subjects (66.1+/-17.4 msec, 0.25+/-0.0, 0.41+/-0.1). IVCT and IVRT were significantly increased and ET was significantly shortened in systolic dysfunction group (75.4+/-25.7, 144.0+/-39.5 msec, 242.7+/-46.5 msec respectively:p<0.001, p<0.05, p<0.05, respectively) compared with diastolic dysfunction group (50.4+/-23.0 msec, 120.5+/-19.5 msec, 276.8+/-44.6 msec, respectively). IVCT/ET, IVRT/ET and (IVCT+IVRT)/ET also were increased in patients with systolic dysfunction group (0.32+/-0.1, 0.61+/-0.2, 0.93+/-0.2 respectively:p<0.01, p<0.01, p<0.001, res-pectively) compared with diastolic dysfunction group (0.19+/-0.1, 0.45+/-0.1, 0.64+/-0.2). Ejection fraction calculated by M-mode parameters was significantly correlated with (IVCT+IVRT)/ET (correlation coefficient - 0.605, p<0.001). CONCLUSION: The Doppler time index was significantly difficient from normal subjects in patients with isolated LV diastolic dysfunction as well as in those with systolic dysfunction. Thus, this index can be used as a sensitive indicator of myocardial performance.
Diastole ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Relaxation ; Systole ; Ventricular Dysfunction, Left