OBJECTIVES: Risperidone is a new antipsychotic drug developed to overcome the therapeutic limitation of conventional antipsychotics. It responses to negative as well as positive symptoms by blocking both dopaminergic and serotonergic receptors, causing no significant side effects such as agranulocytosis and seizure. It is, however, not known whether it induces any serious cardiovascular side effects as evoked by other conventional antipsychotic drugs. The aims of this study were to evaluate the effect of risperidone on cardiovascular function, and to discuss the factors affecting the cardiovascular function. METHODS: For 42 patients(22 males and 20 females) diagnosed as schizophrenia, schizophreniform disorder or schizoaffective disorder according to the DSM-IV classification, the cardiovascular fuctions such as heart rate, systolic and diastolic blood pressure, PR interval, QRS interval and QT inerval were successively checked before and after 2 weeks and 4 weeks risperidone administration. Furthermore, variables such as body weight, Brief Psychiatric Rating Scale(BPRS), Clinical Global Impression(CGE), Extrapyramidal Symptom Rating Scale(ESRS), Anticholinergic Rating Scale(ARS), serum cholesterol level, serum triglyceride level, serum high-density-lipoprotein level, serum WBC, serum Hb, serum platelet level, prothrombin time and partial thromboplastin time were also analyzed before and after 2 weeks and 4 weeks risperidone administration. RESULTS: 1) Risperidone treatment resulted in a significantly decreased heart rate and increased QT interval after 4 weeks administration(p<0.005 respectively). 2) The scores of BPRS and CGI were significantly decreased after 2 weeks and 4 weeks risperidone adminisration as compared with baseline(p<0.001 respectively). The scores of ESRS and ASRS were significantly increased after 2 weeks and 4 weeks risperidone administration as compared with baseline(p<0.001 respectively). 3) There were positive correlations between heart rate after 4 weeks and total dose(p<0.05). Blood pressure was significantly(p<0.05) correlated with sex(higher in male) and significantly(p<0.05) positive correlated with body weight. QT interval was significantly(p<0.05) correlated with sex(longer in female) and smoking history(shorter in smokers). CONCLUSIONS: Risperidone could induce significant change in heart rate and Q-T interval. Therefore, the cardiovascular safety for risperidone should be reconsidered according to the duration and dosage increase.
Agranulocytosis ; Antipsychotic Agents ; Blood Platelets ; Blood Pressure ; Body Weight ; Cholesterol ; Classification ; Diagnostic and Statistical Manual of Mental Disorders ; Heart Rate ; Humans ; Male ; Partial Thromboplastin Time ; Prothrombin Time ; Psychotic Disorders ; Risperidone* ; Schizophrenia ; Seizures ; Smoke ; Smoking ; Triglycerides

No abstract available.
Factor VIII* ; Hemophilia A* ; Humans

BACKGROUND: To describe the fast experience of case-leased advanced cardiac life support(ACLC) course in Korea. METHODS: We have given case-based ACLC course to 13 nurses(6 emergency nurses, 4 coronary care unit muses, 3 professors) and 17 physicians(4 emergency physicians, 12 emergency residents, 1 intem). We performed the case-based ACLS course according to 1992 American Heart Association guidelines and recommendations for advanced cardiac life support by american ACLS instructors(1 pulmonologist, 4 critical care nurses). We performed final theoretical written test and 2 times written survey (immediate and 100th day after the course) about the course. RESULTS: On final written test, all practitioners answered at leasts 70% of the questions correctly. There was no significant difference between nurses and physicians(86.2+/-3.6 of physicians and 82.5+/-6.8 of nurses, p=0.06). 90%of participants considered that case-based advanced cardiac life support was acceptable. 100th day after the course, 93%of participants answered that ACLS course have been helpful on his/her job and also want retraining of ACLS course. 70%of participants considered that ideal ACLS training committee in Korea is the Korean Society of Emergency Medicine. CONCLUSION: Case-based ACLS course is a useful educational method far physicians and nurses in Korea. In the future, we should organize Korean resuscitation committee and then make guidelines for ACLS, and then continuously educate physicians and nurses.
Adult* ; Advanced Cardiac Life Support ; Alprostadil ; American Heart Association ; Coronary Care Units ; Critical Care ; Emergencies ; Emergency Medicine ; Humans ; Korea* ; Resuscitation

No abstract available.
Child* ; Humans ; Pheochromocytoma*

We report the case of a 42-year-old male who was admitted to the hospital with progressive dyspnea. Cardiomegaly and diffuse pulmonary edema were visible on chest X-ray and multiple oral and genital ulcers on physical examination. On admission, echocardiography revealed mitral valve prolapse (MVP) predominantly involving a basal portion of the posterior leaflet, with severe mitral regurgitation. A successful mitral valve replacement with St. Jude #29 was performed, after pre-treatment with prednisolone for 2 weeks. Fifteen months following the operation, the patient expired from severe pulmonary edema and secondary pneumonia. This case demonstrates, for the first time in the literature, an unusual feature of mitral prolapse in the basal portion with severe mitral regurgitation in a patient with Behcet's disease. As suggested by this case, we should consider an atypical type of MVP as a possible inflammatory involvement of the heart in patients with Behcet's disease.
Adult ; Behcet Syndrome ; Cardiomegaly ; Dyspnea ; Echocardiography ; Heart ; Heart Valve Prolapse ; Humans ; Inflammation ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Prolapse ; Physical Examination ; Pneumonia ; Prednisolone ; Prolapse ; Pulmonary Edema ; Thorax ; Ulcer

BACKGROUND: The goal of successful resuscitation is not only to stop the process of ischemia as soon as possible but also to overcome the secondary injury process after resuscitation, which involves a complex interplay of mechanisms. Brain damage accompanying cardiac arrest and resuscitation is frequent and devastating. Cells die by one of two mechanisms: necrosis or delayed neuronal death. Delayed neuronal death may require protein synthesis. Neurons in the CA1 subfield of the hippocampus are selectively vulnerable to death after injury by ischemia and reperfusion. Death of these neurons occurs after an interval of 1 or 2 days. We assessed the effects of a protein synthesis inhibitor, cycloheximide(CHX), on hippocampal neuronal death of rats by using the ventricular fibrillation cardiac arrest(VFCA) model. METHODS: The effect of CHX(3mg/kg, s.c.) on hippocampal neuronal death was studied in two groups of 18 rats each, one group being subjected to a 2-min VFCA and the other to a 3-min VFCA. Each group was divided into three subgroups: control(group I,II) without subcutaneous injection of CHX, 'exp-12' of group I/II treated with CHX 12 hours after return of spontaneous circulation (ROSC), and 'exp-24' of group I/II treated with CHX 24 hours after ROSC. The coronal sections of the hippocampus levels were stained with hematoxylin-eosin after 72 hours of survival. The histologic damage score(HDS) was used to assign a score to the total number of damaged neurons counted in each of the hippocampal CA1 subfields. RESULTS: 1. There were not significan differences in heart rates, blood pressures, blood sugar, and blood gas in group I & II during the pre-arrest steady state or at 5 min and 30 min after ROSC. 2. In group I & II, the HDS, were significantly reduced in rats(I exp-12, 1.1+/-0.6; I exp-24, 1.3+/-0.5; II exp-12, 1.4+/-0.7; and II exp-24, 1.8+/-0.8) treated with CHX 12 hours or 24 hours after ROSC than control rats(I, 2.5+/-0.9, II, 2.9+/-0.8)(p<0.05). CONCLUSION: These results suggest that delayed hippocampal neuronal death from ischemic insult after ventricular fibrillation cardiac arrest followed by resuscitation can be prevented by a protein synthesis inhibitor, CHX. Further experimental studies of the action mechanism of protein synthesis inhibitors to delayed neuronal death and clinical applications are required.
Animals ; Blood Glucose ; Brain ; Heart Arrest* ; Heart Rate ; Hippocampus ; Injections, Subcutaneous ; Ischemia ; Necrosis ; Neurons* ; Protein Synthesis Inhibitors ; Rats* ; Reperfusion ; Resuscitation ; Ventricular Fibrillation*

We studied the association of nonspecific bronchial hyperresponsiveness with general characteristics, exposure concentration, respiratory symptoms, chest x-ray findings, past histories and pulmonary function. We determined bronchial hyperresponsiveness by methacholine challenge test. And we conducted a respiratory symptom questionnaire and performed spirometry on 111 workers occupationally exposed to isocyanates in various industries. About 21.6% of subjects had bronchial hyperresponsiveness. No significant differences were observed between the hyperresponsive and non-responsive group with respect to age, sex, employment period, height, and smoking histories cough and breathlessness were significantly associated with the bronchial hyperresponsiveness. The hyperresponsive group had more experience of bronchitis and asthma in the past than the non-responsive group. The lower FEV1 and FEV1 % were closely related with bronchial hyperresponsiveness. Bronchial hyperrespoosiveness seems to be associated with some of respiratory symptoms, past histories and pulmonary function parameters in workers exposed to isocyanates.
Asthma ; Bronchitis ; Cough ; Employment ; Isocyanates* ; Methacholine Chloride ; Occupations ; Surveys and Questionnaires ; Smoke ; Smoking ; Spirometry ; Thorax

This is an analysis of 75 cases of written interdepartmental consultations submitted to our department during January 1973 to December 1973. In all, 67 cases were surgical, 8 cases were non-surgical and, of which, 66 cases were for elective cases and 6 cases were for emergency cases, including 5 non-operative cases, and post-operative consultations were 3 cases. Among the 67 surgical cases, 4 cases of surgery were postponed according to our advice. The analysis was as follows; 1 Age; 58.6% were over 40 years old, which included 25.3% over 60 pears old. 2. Sex; male was 49.3% and female was 50.7%. 3. The consultation rate was 2.9% (consultation cases 75; total operation cases 2583). The number of monthly consultations was 7 cases on average. 4. The highest number of departmental consulations were requested from general surgery (42.7%), then from orthopedic department (30.7%), from internal medicine (8.0%), and from eye department (8.0%) respectively. 5. In pre-operative diagnosis of the consultations, around 45 diseases were encountered. 6. The problems of the consultations were varied in 153 subjects; 30.1% of the consulted problems were cardiovascular origins, including hypertension (8.5%), severe anemia (7.1%), and ECG abnormalities (5.9%). 23.5% of the consulted problems were respiratory dysfunction and 21.6% of the problems were endocrinological and metabolic disorders. 7. 3.9% of the problems were therapeutic pain control and/or block. Pain clinics were recently started in our country, in this regards, a joint clinic staff may help to operate the pain clinic efficiently. 8. There were 67 pre-operative surgical consultations (95.5%) and 3 post-operative consulations (4.5%). 9. Through this study, anesthesiologists are requested to have a much broad medical and surgical knowledge to keep their high standard of the speciality.
Anemia ; Diagnosis ; Electrocardiography ; Emergencies ; Female ; Humans ; Hypertension ; Internal Medicine ; Joints ; Male ; Orthopedics ; Pain Clinics ; Pyrus ; Referral and Consultation

Choroidal detachment after retinal detachment surgery is relatively common but preoperative choroidal detachment is very rare. We reviewed three cases of choroidal detachment associated with primary rhegmatogenous retinal detachment to see whether there were common features that may be of help in early diagnosis and treatment. The patients were elderly and presented with markedly decreased vision, profound hypotony and inflammatory cells in anterior chamber. Indirect ophthalmoscopy revealed rhegmatogenous retinal detachment with choroidal detachment and proliferative vitreoretinopathy. They were treated with preoperative and postoperative steroid and undergone surgery including vitrectomy. The follow-up periods were 8, 6 and 2 months respectively. Choroidal detachment disappeared, successful reattachment of retina was achieved and corrected visual acuity was improved in all cases. Choroidal detachment associated with rhegmatogenous retinal detachment seems to be associated with hypotony, intraocular inflammation and unstable vascular system. Careful assessment and proper management including surgical procedure seem to improve its prognosis.
Aged ; Anterior Chamber ; Choroid* ; Early Diagnosis ; Follow-Up Studies ; Humans ; Inflammation ; Ophthalmoscopy ; Prognosis ; Retina ; Retinal Detachment* ; Retinaldehyde* ; Visual Acuity ; Vitrectomy ; Vitreoretinopathy, Proliferative

BACKGROUND: Circardian variation in the onset of cardiovascular events includig sudden cardiac death, myocardial infarction and ventricular arrhythmias has been discribed. The frequency of ventricular premature complexes has also been reported to demonstrate a pattern consisting of a daytime peak and nightime nadir. We tried to see if the same circardian pattern is found in dilated cardiomyopathy patients. We have also studed how various modifying factors such as left ventricular ejection fration and ACE inhibitor use may affect the circardian pattern. METHOD: 24-hour ambulatory electrocaridiographic monitorings were performed in 50 dilated cardiomyopathy patients and 20 control subjects. Patients were prospectively divided in 2 groups based on LVEF and ACE inhibitor use. RESULTS: In dilated cardiomyopathy patients, the expected morning increase in VPC frequency is absent and show a peak in evening. This pattern is not correlated with heart rate. Evening peak is more prominent in low LVEF group and ACE inhibitor non-user group. CONCLUSION: In dilated cardiomyopathy patients, VPC frequency show a peak in the evening.
Arrhythmias, Cardiac ; Cardiomyopathy, Dilated* ; Death, Sudden, Cardiac ; Heart Rate ; Humans ; Myocardial Infarction ; Prospective Studies ; Ventricular Premature Complexes*