BACKGROUND: The dipyridamole and dobutamine stress echocardiography have been studied as a non-invasive diagnostic test in coronary artery disease. Recently, some authors have extended the usefulness of these tests to predicting the prognosis of myocardial infarction patients. But as far as we know, there was no literature which tried boh tests to the same infarcted patients group. So, we performed both tests in the 23 infarcted patients to compare and evaluate both tests as predicting the prognosis in myocardial infarction. METHODS: Patients underwent (1) two-dimensional echocardiography under basal condition and after dipyridamole infusion for 4 minites at the dose of 0.14mg/kg/min, (2) another two dimensional echocardiography under basal and during dobutamine infusion at each dose of 5 to a maximum of 20microg/kg/min at 1 or 2 days after dipyridamole stress echocardiography, and (3) coronary and left ventricular angiography. Preinfusion and peak infusion images were analyzed independently by two different observers using Nova Micro Sonic soft were(DataVueII and ColorVue II analysis system). The segmental wall motions were scored as follows ; hyperkinetic : 1, normal : 2, hypokinetic : 3, akinetic : 4. THe test response was considered positive if abnormal wall motion and reduced myocardial thickening were observed during drug infusion at the vascular distributions except the akinetic infarcted segment identified during basal condition. The coronary angiography was analyzed by measuring the maximal luminal diameter stenosis with caliper and 50% or greater diameter narrowing was considered significant. The sensitivity and specificity were calculated by comparing echocardiographic prediction and angiographic findings. RESULTS: 1) Among 22 patients with sufficient image in dipyridamole stress echocardiography, 13 patients have myltivessel coronary disease without resting akinesia of non-infarcted segments. Only 5 patients showed positive findings in dipyridamole stress echocardiography(sensitivity, 38.4%). Among 9 patients who has single or minimal disease, 9 patients were negative finding(specificity, 100%). 2) Among 21 patients with sufficient image in dobutamine stress echocardiography, 12 patients have multivessel coronary disease without resting akinesia of non-infarcted segments. 7 patients showed positive finding in dobutamine stress echocardiography(sensitivity, 58.3%). Among 9 patients who has single or minimal disease, 8 patients showed negative finding(specificity, 88.8%). 3) In hemodynamic changes, dipyridamole stress echocardiography showed significant changes in heart rates and double products and dobutamine stress echocardiography showed significant changes in heart rates, systolic blood pressure and double products. 4) There was no significant side effect during both stress tests inacute and old myocardial infarction patients. CONCLUSION: 1) The dobutamine and dipyridamole stress echocardiography are safe and easy test for myocardial infarction patients. 2) The dobutamine stress echocardiography has higher sensitivity than dipyrdamole stress echocardiography for identifying multivessel coronary disease in myocardial infarction patients but the dose of both drugs were relatively small to get the adequate results. So the high dose of drugs must be tried in feature study.
Angiography ; Blood Pressure ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Diagnostic Tests, Routine ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Exercise Test ; Heart Rate ; Hemodynamics ; Humans ; Myocardial Infarction* ; Phenobarbital ; Prognosis ; Sensitivity and Specificity

BACKGROUND: Evaluating the segmental wall motion of left ventricle is important in patients with myocardial infarction for choosing therapeutic modality and predicting prognosis. Radionuclide Multigated Angiography(MUGA) is a reliable noninvasive method for the evaluation of left ventricular performance. Methods : MUGA scan(LV ejection fraction, phase image histogram, regional wall motion) was performed and analyzed in 45 patients with myocardial infarction(31 : acute MI, 14: old MI) and 13 normal controls. RESULTS: 1) The LVEF of acute and old MI group was significantly reduced and the SDph of acute and old MI group was significantly increased as compared with that of control group(p<0.05). 2) In acute MI group, the LVEF of group without, IV Urokinase was more reduced than that of group with IV Urokinase and the SDph of group without IV Urokinase was more increased than that of group with IV Urokinase(p<0.05). As a result of wall motion scoring, the linear correlation exists between SDPh and sum of wall motion scoring(r=0.62, p<0.01). 3) In MI group, the LVEF of anterior wall MI was more reduced than that of inferior wall MI and the SDPh of anterior wall MI was more increased than that of inferior wall MI(p<0.05). 4) In acute anterior wall MI, the reverse correlation exists between LVEF and SDPh and the linear correlation exists between sum of wall motion scoring and SDPh(r=-0.73, 0.72, p<0.01). But there are no statistical significances of correlation between them in acute inferior MI(r=-0.44, 0.42, p>0.05), in old anterior MI(r=-0.65, 0.47, p>0.05) and in old inferior MI(r=-0.47, 0.46, P>0.05). CONCLUSION: These results suggest that Phase angle(SDPh) is thought to be valuable index to evaluate left ventricular function with application of other indeces in Myocardial infarction. Left ventricular function measured by SDph in acute or anterior MI is lower than old or inferior MI.
Heart Ventricles ; Humans ; Myocardial Infarction* ; Prognosis ; Urokinase-Type Plasminogen Activator ; Ventricular Function, Left

Acquired nasolacrimal duct obstruction may result from chronic infection, lacrimal stones, anatomical variations such as aberrant ethmoid cells, facial fractures, or complications following nasal surgery. In Korea, there has been no reported case of secondary nasolacrimal duct obstruction due to a retention cyst in the lacrimal sac. Recently, the authors encountered a 65-year-old female patient who presented with epiphora, was diagnosed with a lacrimal sac retention cyst, and was successfully treated with endoscopic marsupialization.

Lipoprotein(a)[Lp(a)] is a LDL-like particle with a glycoprotein called apo(a) attached to its apoB through disulfide bond. Many case-control studies support the opinion that plasma Lp(a) levels were associated with coronary artery disease. This study was conducted to assess the relationship between plasma Lp(a) level and coronary artery disease in Korean population. Serum levels of Lp(a), in addition to other lipids and known clinical risk factors for coronary artery disease were determined in 92 subjects undergoing coronary angiography. Among them 30 patients had no obstruction in the coronary artery(cath-control group), while the others revealed the presence of coronary artery stenosis more than 50%(CAD group). The Lp(a) levels of the CAD group were significantly higher the those of cath-control group(31.8+/-25.0mg/dl vs 14.6+/-11.9mg/dl, p<0.005). Other lipids except triglycerides(166.9+/-70.5mg/dl vs 116.2+/-56.1mg/dl, p<0.005) were not significantly different between two groups. The patients with significant coronary artery disease of two or more vessels were found to have higher Lp(a) levels than those of one vessel disease. Lp(a) levels had no relations with other lipids, diabetes, smoking, hypertension and age. Stepwise discriminant analysis revealed that Lp(a) was the best discriminator among risk factors for coronary artery disease. These results suggested that Lp(a) level was a significant independent risk factor for coronary artery disease.
Apolipoproteins B ; Case-Control Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Glycoproteins ; Humans ; Hypertension ; Lipoprotein(a)* ; Plasma ; Risk Factors* ; Smoke ; Smoking

BACKGROUND: Minimally invasive cardiac surgery has emerged as a new approach to the conventional median sternotomy. The suggested advantages of the minimally invasive technique includes improved cosmesis, simplicity of opening and closing the chest, less postoperative pain, less risk of infection and bleeding, early rehabilitation, and reduced length of hospital stay. MATERIAL AND METHOD: Between March 1997 and December 1997, we performed 36 cases of minimally invasive cardiac surgery via three different approaches ; right paramedian, transverse sternotomy and mini-sternotomy with upper sternal split. RESULT: There was no operative mortality. Postoperative complications were atrial fibrillation in 4 patients, bleeding that required reoperation in 1 patient, and delayed wound closure in 1 patient who underwent 3rd redo operation. Average length of skin incision was 9.1+/-0.9 cm. Average duration of stay in the intensive care unit was 48+/-29 hours and the patients were discharged 10+/-7 days after the operation. CONCLUSION: In spite of the difficulties in defibrillation, deairing, and cardiac decompensation, minimally invasive approaches will be applied increasingly because of the suggested advantages.
Atrial Fibrillation ; Hemorrhage ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Pain, Postoperative ; Postoperative Complications ; Rehabilitation ; Reoperation ; Skin ; Sternotomy ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery* ; Thorax ; Wounds and Injuries

BACKGROUND: Left main coronary artery (LMCA) angioplasty is another option in the surgical treatment for LMCA disease because of its advantages over the conventional coronary artery bypass grafting (CABG). MATERIAL AND METHOD: Between July 1994 and December 1997, 15 patients underwent left main coronary angioplasty for the stenoses of LMCA. There were 8 males and 7 females with the mean age of 53.3+/-8.8 years. The locations of the LMCA stenoses were proximal one-third of the LMCA in 9, middle one-third in 1, distal one-third in 3, and the whole length of the LMCA in 2 cases. Nine patients had peripheral coronary lesions in addition to the LMCA stenosis. The LMCA was approached anteriorly with or without transsection of the main pulmonary artery. The angioplasty was performed with onlay patch widening using an autologous pericardium (14 cases) or saphenous vein (1 case). Additional graftings were required in 9 cases, and both LMCA angioplasty and right coronary ostial angioplasty were done in 1 case. RESULT: There was no operative mortality. One case needed redo CABG due to the stenosis of the angioplasty site which developed 4 months postoperatively. Coronary angiography was performed in 8 cases one year postoperatively, and revealed good patency of the angioplasty site except for one who showed 50% stenosis at the angioplasty site. No patient complained of angina with a mean follow up of 23+/-11 months. CONCLUSION: Surgical angioplasty of the LMCA stenosis can be performed in selected cases with safety and good mid-term results.
Angioplasty* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Female ; Follow-Up Studies ; Humans ; Inlays ; Male ; Mortality ; Pericardium ; Pulmonary Artery ; Saphenous Vein ; Transplants

Purpose: To evaluate the clinical and radiographic results of primary bipolar arthroplasty during average 9.8-year period, using a non-cemented Multilock femoral stem and a biarticular acetabular cup. Materials and Methods: This study included 24 patients (29 hips) who underwent primary bipolar hemiarthroplasties with Multilock femoral stems and biarticular cups and who could be followed for more than seven years. Clinically, we evaluated the Harris Hip scores and patient complaints of thigh and inguinal pain. We also evaluated the radiographic measurements around the femoral stems and the bipolar cups. Results: The average Harris Hip score improved from 57.4 points to 91.6 points; and 3 (10.3%) hips were associated with thigh pain and 4 (13.8%) hips with inguinal pain. Around the femoral stem there was a non-progressive radiolucent line less than 1 mm in length in 4 (13.8%) hips and osteolysis was present in 6 (20.6%) hips. With respect to the stability of the fixations, there was osseous ingrowth in 26 (89.7%) hips and fibrous ingrowth in 3 (10.3%) hips. Around the acetabulum there was osteolysis in 5 (17.2%) hips, proximal migration of the cup in 2 (6.9%) hips, and erosion of the acetabular cartilage in 10 (34.5%) hips. There were 3 (10.3%) biarticular cups, which were converted to total hip arthroplasties, but no femoral stems were revised. The overall failure rate of the primary operations was 10.3%. Conclusion: The current study demonstrated favorable results after bipolar hemiarthroplasties with Multilock femoral stems. However, the osteolysis that occurred around the femoral stems and the acetabula emerged as a problem after the total hip arthroplasties. In particular, it is expected that the osteolysis would increase over time and become the main cause for the need for surgical revision.
Acetabulum ; Arthroplasty ; Cartilage ; Follow-Up Studies* ; Hemiarthroplasty* ; Hip ; Humans ; Osteolysis ; Reoperation ; Thigh

In order to investigate the efficacy and safety of oral fosinopril, a new phosphorus containing angiotensin converting enzyme inhibitor, a single dose of 10 to 20mg was administered in 23 hypertensive patients with diastotic blood pressure above 95mmHg and all other anti-hypertensive agents were not administered during 4 weeks of study. Blood pressure and heart rate were measured on the 2nd and 4th week of therapy. The complete blood count with platelet count, blood chemistry by SMA-12 and serum electrolytes were performed at the begining and 4th week of therapy. The urinalysis and electrocardiography were performed at the beginning and 4th week of therapy. Any kinds of side effects were actively questioned by the examining physicians. The following results were obtained : 1) At the beginning and 4th weeks of therapy, the average systolic and diastolic pressure were 170.0+/-17.6/101.6+/-6.1mmHg, 142.7+/-15.1/87.3+/-6.7mmHg respectively. The systolic and diastolic blood pressure were declined statistically significantly(p<0.05) throughout the period of treatment and diastolic blood pressure of all subjects except 3 patients(86%) was maintained below 90mmHg after 4th week of treatment. 2) There was no significant change in the pulse rate before and after therapy. 3) There were no significant changes in blood chemistry, serum electrolytes, hematologic findings, urinalysis and electrocardiographic findigns. 4) side effect were developed in 5 patients(23%) with dry cough, 3 patients(13%) with headache and 2 patients with facial edema but side effects were mostly mild in nature without potenitally serious episodes. These results suggested that antihypertensive therapy with onec-daily fosinopril was effective and well tolerated in essential hypertensive patients.
Antihypertensive Agents ; Blood Cell Count ; Blood Pressure ; Chemistry ; Cough ; Edema ; Electrocardiography ; Electrolytes ; Fosinopril* ; Headache ; Heart Rate ; Humans ; Hypertension ; Peptidyl-Dipeptidase A ; Phosphorus ; Platelet Count ; Urinalysis

PURPOSE: We measured serum lycopene concentration and compared it in normal subjects, normal tension glaucoma (NTG), primary open angle glaucoma (POAG) patients. METHODS: We investigated serum lycopene concentration on 226 subjects, which were divided into 3 groups : group 1 with 136 normal subjects, group 2 with 24 NTG patients, group 3 with 66 POAG patients. Serum concentration of lycopene was measured by high performance liquid chromatography (HPLC). RESULTS: Mean age was 64.1+/-9.2 years old in group 1, 56.4+/-1.2 years old in group 2, 53.8+/-5.3 years old in group 3. Sex ratio (male:female) was 1:1 in group 1, 1.18:1 in group 2, 0.94:1 in group 3 respectively. Serum lycopene concentration was 6.44+/-0.34 microgram/dl in group 1, 2.55+/-0.44 microgram /dl in group 2, 2.17+/-0.27 microgram /dl in group 3 respectively. CONCLUSIONS: Serum lycopene concentration was significantly lower in NTG, POAG patients than normal subjects (P<.05). Further nutritional survey is necessary for new modality of treatment of glaucoma.
Chromatography, Liquid ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Low Tension Glaucoma ; Nutrition Surveys ; Sex Ratio

We evaluated the antihypertensive effect of amlodipine, a calcium channel bloker, in 35 cases of essential hypertention. After 12 weeks' administration(5~10mg q.d.), the following results were obtained : 1) The systoloic and diastolic blood pressure were decreased significantly(170.3+/-12.2mmHg vs 143.7+/-13.0mmHg p<0.01 and 104.7+/-5.9mmHg vs 87.8+/-6.5mmHg, p<0.01, respectively) but the heart rate was independant of amlodipine administration. 2) The systolic blood pressure was lowered by 20mmHg or more in 26(76.5%) of 34 patients and the diastolic pressure was lowered by 10mmHg or more in 26(76.5%) of 34 patients at 12 weeks after amlodipine administration. 3) The adverse effects of amlodipine were dizziness in 5, edema in 5, indigestion in 3, constipation in 2, headache, flushing, insomnia in 1 patient respectively and only one of them discontinued amlodipine administration due to severs facial flushing and skin eruption.
Amlodipine* ; Blood Pressure ; Calcium Channels ; Constipation ; Dizziness ; Dyspepsia ; Edema ; Flushing ; Headache ; Heart Rate ; Humans ; Skin ; Sleep Initiation and Maintenance Disorders