Diabetes mellitus is known to be associated with a specific cardiomyopathy. This is evident from the clinical-pathological work and the epidemiologic data. An investigation was made in this study to determine whether diabetic cardiomyopathy in rats is associated with an alteration of biochemical characteristics of cardiac contractile proteins. Rats were made diabetic with intravenous injection of streptozotocin and hearts removed 8 weeks later for the isolation of myofibrils. The basal ATPase activity of myofibrils from diabetic hearts was significantly lower than that of the controls, suggesting the presence of some subtle structural and conformational changes in diabetic myofibrils. The activating effect of Mg ions on the myofibrillar actomyosin system of rat heart muscle was also demonstrated. Sodium dodecylsulfate gel electrophoresis showed the presence of myosin heavy chain, light chain 1 and 2, actin and troponin but failed to reveal differences in the patterns of these contractile proteins of light subunits between diabetics and controls. The deficiency in utilization of energy rich phosphates by the myofibrillar protein may be one of of the main mechanisms of cardiodepression observed in diabetic hearts. The cardiac myofibrillar ATPase activity may be one of useful measurements in evaluating pathophysiological states of cardiac contractile proteins.
Actins ; Actomyosin ; Adenosine Triphosphatases* ; Animals ; Cardiomyopathies ; Contractile Proteins ; Diabetes Mellitus ; Diabetic Cardiomyopathies ; Electrophoresis ; Heart ; Injections, Intravenous ; Ions ; Myocardium ; Myofibrils ; Myosin Heavy Chains ; Phosphates ; Rats* ; Sodium ; Streptozocin ; Troponin

The antihypertensive effect of nicardipine was studied in 31 cases of essential hypertension and following results were obtained. 1) Daily dose was 30-60mg for 10 weeks. 2) Mean systolic and diastolic pressure were decreased by 39.5mmHg 921%) and 17.2mmHg(15%) respectively(P<0.005) and in 84% of cases, good or fair control of blood pressure was proved. 3) There was no significant change in heart rates before and after treatment. 4) There were no significant side effects except two cases of mild headache and facial flushing which subsided spontaneously.
Blood Pressure ; Flushing ; Headache ; Heart Rate ; Hypertension ; Nicardipine*

The effects of KCI continus tablet(K-Contin(R)) on the serum level of K and uric acid during hydrochlorothizide therapy(25mg/day) were evaluated in 30 patients with essential hypertensien. The results are as follows : 1) During hydrochlorothiazide therapy(25mg/day), 23% of all patients showed hypopotassemia(<3.5mEq/1) while no patient developed hypopotassemia after potassium supplement therapy(8 mEq/day). 2) During the period of K supplement, the level of serum uric acid showed less elevation. 3) The side reaction of KCI continus tablet were mild indigestion which developed in two patients and disappeared soon without any particular treatment. In conclusion, the KCI continus tablet is useful in the prevention of hypopotassemia during chronic diuretic therapy.
Dyspepsia ; Humans ; Hydrochlorothiazide ; Hypokalemia ; Potassium ; Uric Acid*

This study was performed to evaluate the method of quantification of exercise thallium-201(201Tl) myocardial perfusion imaginges(M.P.I.) for the detection of coronary artery disease. Exercise 201 Tl MPI were interpreted objectively, reproducibly, quantitatively and easily by a computer assisted technique-Circumferential profile method. Exercise 201Tl MPI and redistribution images were taken in 32 patients(9 cases of post infarction angina, 13 cases of angina pectoris, 8 cases of atypical chest pain, 1 case of arrhythmial and 1 case of caridac neurosis). The results obtained were as follows: 1) Exercise 201Tl MPI of 3 cases of angina pectoris demonstrated transient perfusion defect in 5 cases, persistent perfusion defect in 2 cases, transient and persistent perfusion defect in 1 cases and no perfusion defect in 5 cases. Exercise 201Tl MPI of 9 case of post-infarction angina revealed persistent perfusion defect in 7 cases and transient and persistent perfusion defect in 2 cases. 201Tl MPI of 8 cases of atypical chest pain showed transient perfusion defect in 1 case and no perfusion defect in 7 cases. There was no perfusion defect in 1 case of arrhythmia and another case of cardiac neurosis. 2) The location of persistent perfusion defects in several views of 201Tl MPI in 9 case of postinfarction angina were consistent with those of infarction area in the electrocardiogram. 3) While visual analysis interpreted three cases to have no perfusion defect and one case to have transient perfusion defect respectively, objective analysis revealed that one of them had transient perfusion defect, another of them had persistent perfusion defect and the other had transient and persistent perfusion defect. 201Tl MPI of three cases could be done easily by circumferential profile method, which were difficult to interprete by subjective visual analysis. The results indicate that Exercise 201Tl MPI interpreted by circumferential profile analysis would be an objective, quantitative and noninvasive method for the detection of ischemic change and location in coronary artery disease.
Angina Pectoris ; Arrhythmias, Cardiac ; Chest Pain ; Coronary Artery Disease ; Electrocardiography ; Infarction ; Myocardial Ischemia* ; Neurocirculatory Asthenia ; Perfusion

Background: As the population of patients with end-stage renal disease has grown older, the proportion of patients with poorly preserved vasculature has concomitantly increased. Thus, arteriovenous grafts (AVG) have been used more frequently to access blood vessels for hemodialysis. Despite this increasing demand, studies of AVG are limited. In this study, we examined the surgical outcomes of upper-limb AVG creation. Methods: Among the arteriovenous fistula formation procedures performed between January 2014 and March 2019 at Dankook University Hospital, 42 cases involved AVG creation. We compared patients in whom the axillary vein was used (group A; brachioaxillary AVG [B-Ax AVG]; n=20) with those in whom upper limb veins were used (group B; brachiobasilic AVG or brachioantecubital AVG; n=22). Results: The 1-year primary patency rate was higher in group A than in group B (57.9% vs. 41.7%; p=0.262). The incidence of postoperative complications was not significantly different between groups. Conclusion AVG using the axillary vein showed no major differences in safety or functionality compared to AVG using other veins. Therefore, accounting for age, underlying disease, and expected patient lifespan, B-Ax AVG can be considered an acceptable surgical method.

Chronic mitral regurgitation may be well tolerated for decades because of favorable conditions like increased preload and decreased afterload. However, in some patients with underlying overt myocardial dysfunction, opertive correction of mitral regurgitation may result in persistent left ventricular dysfunction. Myocardial dysfunction in mitral regurgitation initially occurs subclinically and may becoma irreversible before symptoms of congestive heart failure develop. In order to identify latent myocardial dysfunction, we evaluated prognostic values of several indices from patient's characteristics, echocardiogram, cardiac catheterization data and contrast left ventriculogram in 49 patients with chronic mitral regurgitation who received mitral valve replacement. The patients were defined as Groups I who had improved symptoms with decreased left ventricular end-diastolic dimension after operation and Group II who had persistent symptoms and progressed left ventricular end-diastolic dimension, or not decreased until left ventricular end-diastolic dimension 60mm after operation. The results were as follows: 1) There was no significant difference in age, sex, duration of symptoms, preoperative NYHA functional status, and aortic cross clamping time during operation between Group I and Group II. 2) There was no significant difference in echocardiographic left ventricular end-diastolic dimension between group I and group II. There were significantly more dilated left ventricular end-diastolic dimension of Group II than that of Group I and significantly more depressed fractional shortening of Group II than that of Group I. There was significantly more increased end-diastolic wall stress of Group II than of Group I. 3) There was no significant difference in cardiac index, mean pulmonary artery pressure, mean pulmonary capillary wedge pressure and left ventricular end-diastoic pressure between Group I and Group II. 4) There were significantly more increased end-diastolic volume index and end-diastolic volum index of Group II than those of Group I, but no significant difference in ejection fraction between Group I and Group II. There was significantly more decreased ratio of end-diastolic circumferential midwall stress to end-diastolic volume index of Group II than that of Group I. 5) In Group I, end-systolic dimension, end-systolic dimension and end-systolic wall stress were decreased significantly after operation. In Group II, end-systolic dimension was decreased significantly after operation. 6) Values for combination of end-systolic left ventricular dimension greater than 28mm/m2 and end-systolic wall stress greater than 190mmHg predicted a Group II outcome with a sensitivity of 88.2%, a specificity of 93.8%, positive predictive value of 88.2% and negative predictive value of 93.8%. Values of combination of end-systolic left ventricular dimension greater than 28mm/m2 and fractional shortening less than 32% predicted a Group II outcome with a sensitivity of 88.2% a specificity of 90.6%, positive predictive value of 83.3% and negative predictive value of 93.5%, a specificity of 90.6%, positive predictive valve of 83.3% and negative predictive value of 93.5%. According to the above results, noninvasive hemodynamic variables such as end-systolic left ventricular dimension, fractional shortening and end-systolic wall stress would be useful guideline for follow-up and determining the optimal time for surgical intervention in patients with chronic mitral regurgitation.
Cardiac Catheterization ; Cardiac Catheters ; Constriction ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Hemodynamics ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sensitivity and Specificity ; Ventricular Dysfunction, Left

BACKGROUND: The concept of myocardial injury after coronary occlusion is changing in recent years. Brief episode of ischemial induces reversible myocardial injury and repeated brief ischemic insults might cause myocardial necrosis due to cummulative damages. Recent observations showed that brief episodes of ischemia have protective effects on the myocardium increasing the myocardial tolerance to a subsequent sustained ischemic insult. This phenomenon is termed ischemic preconditioning and can be noticed after a variety of protocols in multiple species of experimental animals. This study was planned to 1) measure the changes of hemodynamic parameters and the ischemic damage of insulted myocardium during ischemic preconditioning, and 2) compare the infarct sizes with or without preconditioning. METHODS: Using canine model of a single 90 minutes' occlusion of left anterior descending coronary artery and 240 minutes' reperfusion, 14 mongrel dogs were randomized to with(n=7) or without(n=7) ischemic preconditioning such as four 5 minutes' occlusion and 5 minutes' reperfusion, Changes of hemodynamic parameters and extents of the ischemic myocardial damages during preconditioning were observed. And using in vitro myocardial staining with monastral blue and triphenyl tetrazolium chloride, we compared the infarct sizes and risk areas in two groups of occlusion and reperfusion canine model with and without preconditioning. RESULTS: 1) Heart rate was significantly decreased after first 5 minutes' occlusion compared with those of basal control(151+/-27 VS 163+/-25 BPM, p<0.05) without further changes in subsequent ischemic insults. Left ventricular systolic pressure was significantly decreased after first 5 minutes' occlusion(109.0+/-19.9 VS 130.6+/-23.3mmHg, p<0.005), and after first 5 minutes' reperfusion and second 5 minutes' occlusion compared with those of basal control(111.3+/-29.8, 109.9+/-17.2 VS 130.6+/-23.3mmHg respectively, p<0.05), without further changes during remaining ischemia. Left ventricular end diastolic pressure and maximum +dp/dt were not changed. Peak -dp/dt was decreased significantly after first and second 5 min occlusion(943.7+/-294.4, and 962.1+/-281.5) from basal control level(1168.2+/-358.8mmHg, p<0.05). Thereafter no change was noted during remaining preconditioning. The changes in rate-pressure product were same as those of left ventricular systolic pressure(first 5 minutes occlusion ; 17.3+/-3.7 VS 21.2+/-3.5, p<0.005, second 5 minutes' occlusion ; 17.9+/-5.3, 18.1+/-3.4 VS 21.2+/-3.5, p<0.05). 2)Transmyocardial lactate extraction ratio was significantly decreased in early phase of ischemic preconditioning(17.5+/-11.3 VS 25.2+/-9.9%, p<0.05). 3) Hemodynamic parameters such as heart rate, left ventricular systolic pressure, left ventricular end-diastolic pressure, maximum +dp/dt, peak -dp/dt and rate-pressure product were changed similarly in both control and precontioned groups. 4) There was no significant difference of mean myocardial blood flows in infarct zones, which represent collateral blood flow, after 5 minutes' brief occlusion and 60 minutes of sustained occlusion in preconditioned group. 5) The infarct area/risk area ratio was significantly reduced in preconditioned group(27.0+/-9.6 VS 5.6+/-3.1%, p<0.005), but the risk area/left ventricular area ratio showed no difference in the two groups. CONCLUSIONS: These findings suggest that, in the early phase of brief repeated occlusion and reperfusion, myocardial ischemic damage accompaning systolic and diastolic myocardial dysfuctions develops and myocardial protective effect of ischemic preconditioning was obtained at the same time. Ischemic preconditioning group demonstrated reduced infarct sizes compared to those of control group after 90 minutes' sustained ischemia and reperfusion in canine acute myocardial infarction model.
Animals ; Blood Pressure ; Coronary Occlusion ; Coronary Vessels* ; Dogs ; Heart Rate ; Hemodynamics ; Ischemia ; Ischemic Preconditioning* ; Lactic Acid ; Myocardial Infarction ; Myocardial Reperfusion ; Myocardium ; Necrosis ; Reperfusion

PURPOSE: This study was done to identify the state of internet addiction and to investigate the relationships among internet addiction, depression and suicidal ideation in adolescents. METHOD: Participants were 1,670 high school students in an urban city. The Internet Addiction Scale was used to measure internet addiction, the DISC-MDD-SQ was used to measure depression, and the Suicidal Ideation Questionnaire-JR was used to measure suicidal ideation. RESULT: 38.1% of participants were perceived to be in the early stages of internet addiction and 1.5% reported heavy addiction. Overall the internet addiction scale score was 37.57(+/-12.52). The differences of internet addiction in sample characteristics were found to be significant in rank in class. The differences in DISC-MDD-SQ and IAS scores among the states of internet addiction were statistically significant. The level of internet addiction correlated positively to the level of depression and suicidal ideation. CONCLUSION: Based upon these findings, there were significant positive correlations among Internet addiction, depression, and suicidal ideation in adolescents. As schools are often the first line for the identification of potential life-threatening behaviors, nurses, especially school-based health professionals, need to be cognizant of measures and procedures for the assessment of Internet addiction, depression, and suicidal ideation.
Adolescent ; *Adolescent Psychology ; Behavior, Addictive/diagnosis/*psychology ; Depression/diagnosis/*psychology ; Female ; Humans ; *Internet ; Male ; Suicide/*psychology

Prosthetic valve endocarditis(PVE) is not infrequent and one of the serious complications of cardiac valve replacement despite advances in antimicrobial therapy, diagnostic techniquens and surgical procedures. Although the incidence of PVE may be declining, the absolute number of cases of this infection is increasing. In patients with a prosthetic valve, fever, a regurgitant heart murmur, peripheral manifestations of infective endocarditis and postitive blood cultures, the diagnosis of PVE is evident. We have reviewed our experience with 13 patients with PVE from October 1976 through August 1983. During this period valve replacements were performed in 686 patients, with an infection rate of 1.9%. PVE currently accounts for approximately 14% of the total number of cases of infective endocarditis seen at Seoul national University Hospital. PVE occurred more often after multiple valve replacement than after replacement of single valve alone. Blood cultures were positive in 69% cases of PVE. Systemic emboli could be seen in 54% of patients with PVE and overall mortality was about 23%.
Diagnosis ; Endocarditis* ; Fever ; Heart Murmurs ; Heart Valves ; Humans ; Incidence ; Mortality ; Seoul

To validate ventricular diastolic phase parameters of reconstructed transmitral flow rate curve by M-mode, 2-dimensional and pulsed Doppler Echocardiography, these parameters were compared with same parameters by left ventriculography. The study population was 22 patients who received both coronary arteriography and echocardiographic examination. Transmitral flow rate curve and left ventricular filling volume curve were reconstructed from transmitral flow velocity curve by pulsed Doppler, mitral annulus diameter by two diameter by two dimensional and diastolic motion of both mitral leafltes by M-mode echocardiography. From left ventriculography, left ventricular filling volume curve and transmitral flow rate curve were made using area-length method by Sandler and Dodge. From trasmitral flow fraction, 1/2 diastolic time filling fraction, normalized peak filling volume, 1/3 diastolic time filling fraction, 1/2 diastolic time fraction, normalized peak early filling rate and ratio of early to late peak filling rate were measured. Correlation between same parameters derived from echocardiography and left ventriculography were observed. 1) Total diastolic filling volume:correlation coefficient r=0.47, P<0.05. 2) 1/3 diastolic time filling fraction:correlation coefficient r=0.90, P<0.001. 3) 1/2 diastolic time filling fraction:correlation coefficient r=0.80, P<0.001. 4) Normalized peak early filling rate:correlation coefficient r=0.57, P<0.01. 5) Ratio of early to late peak filling rate:correlation coefficient r=0.85, P<0.001. Therefore, left ventricular diastolic phase parameters of reconstructed transmitral flow rate curve using, M-mode, 2-dimensional and pulsed Doppler echocardiography seems to be useful for the noninvasive evaluation of the left ventricular diastolic function.
Angiography ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Humans