OBJECTIVE: To assess the relationship between vaginal cytology and bone mineral density in postmenopausal women. METHODS: In 93 postmenopausal women, vaginal cytology smears were taken for maturation index, serum estradiol level and bone mineral density were also taken. the percentage of each cell type found By vaginal cytology was multiplied to its specific value:superficial cells, 1.0; intermediate cell, 0.6; parabasal cell, 0.2 and modified to maturation value. Bone mineral density was measured at lumbar spine using DEXA. RESULTS: The mean bone mineral density was 0.88+/-0.14g/cm2. Mean maturation value was 50.53+/-20.74 and it was related with age and bone mineral density. CONCLUSION: Maturation value of vaginal epithelial cell represents the influence of estrogen on bone mineral density.
Bone Density* ; Epithelial Cells ; Epithelium* ; Estradiol ; Estrogens ; Female ; Humans ; Spine

Aortic stenosis is the most frequent type of valvular heart disease in adult. Approximately 2-7% of the population over the age of 65 suffer from aortic valve stenosis. Due to the increasing average life expectancy in Korea, degenerative aortic stenosis is increasing and becoming a troublesome health problem in older population. Because older patients with severe degenerative aortic stenosis have many other medical conditions so they are not suitable candidate for surgery. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for patients with high perioperative risk. We report a successful TAVI case in severe aortic stenosis patient with high perioperative risk.
Adult ; Aortic Valve Stenosis ; Heart Valve Diseases ; Humans ; Korea ; Life Expectancy

OBJECTIVES: A retrospective study was performed to clarify the change of lumbar bone mineral density(BMD) according to the duration of hormone replacement therapy(HRT) and the other factors such as age, years since menopause(YSM) and initial BMD in postmenopausal women. METHODS: From January, 1995 to December, 1998 we measured lumbar bone mineral density in 100 postmenopausal women in the department of obstetrics and gynecology, Inha University Hospital. These women had been followed for 2 years after taking HRT. We investigated whether there were any relation between the duration of HRT, age, YSM, initial BMD and change of BMD. RESULTS: Lumbar BMD was increased 2.06% after one year of HRT(p=0.0001) but there was no change of BMD at the 2nd year of HRT(p=0.847). The response to HRT was greatest in those who were oldest(r=0.209 ; p=0.039) and furthest YSM(r=0.209; p=0.039), and consequently among those who had the lowest BMD(r=0.590 ; p=0.0001). CONCLUSION: The bone mass was increased upto 2.06% at the 1st year of HRT but no more progressive increase was occurred. It suggest that intensive HRT is needed at 1st year of therapy. The risk of fracture is not decreased to that of the healthy population inspite of HRT, so the earlier therapy is necessary to prevent osteoporotic fracture despite of intervention.
Bone Density* ; Female ; Gynecology ; Hormone Replacement Therapy* ; Humans ; Obstetrics ; Osteoporotic Fractures ; Retrospective Studies

BACKGROUND AND OBJECTIVES: A variety of experimental heterotopic heart transplantation models have been developed for the purpose of this study. However most were complicated and used extracorporeal circulation. A new and simple experimental working heterotopic intrathoracic heart transplantation model has been developed in dogs, which could be performed without support of extracorporeal circulation. MATERIALS AND METHODS: Six mongrel dogs were used for the three heterotopic heart transplantation experiments. The heterotopic hearts were transplanted in the right thoracic cavity using a right thoracotomy. The superior vena cava and left atrial cuff of the donor heart was anastomosed to the superior vena cava and left atrium of the recipient heart. Consequently, the aorta and pulmonary artery were anastomosed to the ascending aorta and right atrial appendage of the recipient heart, without cardiopulmonary bypass. The electrocardiograms of the donor and recipient hearts were measured by electrodes placed at the ventricular apexes and on the skin. RESULTS: The donor hearts survived for 10, 6 and 18 days after transplantation, without any immunosuppressive agents or anticoagulants. The electrocardiograms of both hearts could be measured using the electrodes. There were no wave or voltage changes on electrocardiography. CONCLUSION: This working heart model of heterotopic intrathoracic transplantation, without cardiopulmonary bypass, may be useful in studies for various purposes, i.e., the effects of different pharmacological agents on the conduction system of the denervated heart and the hemodynamic changes of the recipient with auxiliary support of the transplanted heart.
Animals ; Anticoagulants ; Aorta ; Atrial Appendage ; Cardiopulmonary Bypass* ; Dogs ; Electrocardiography ; Electrodes ; Extracorporeal Circulation ; Heart Atria ; Heart Transplantation* ; Heart* ; Hemodynamics ; Humans ; Immunosuppressive Agents ; Models, Theoretical* ; Pulmonary Artery ; Skin ; Thoracic Cavity ; Thoracotomy ; Tissue Donors ; Transplantation, Heterotopic ; Vena Cava, Superior

Sinus of Valsalva aneurysms are rare cardiac anomalies and are usually caused by the separation of the aortic wall media from the valve ring tissue. These aneurysms frequently rupture into the low-pressure areas like the right ventricle and right atrium, rarely do they rupture into the left atrium, left ventricle, pericardial sac, or pulmonary artery. Cerebral infarction has been reported as a rare complication of unruptured sinus of Valsalva aneurysm. We experienced very rare two cases of Valsalva aneurysms of right coronary sinus dissecting into the interventricular septum in patients with cerebral infarction. In two cases these aneurysms ruptured into the left ventricle. These aneurysms were excised and the defect was closed with autopericardium. At the end of the surgical repair, coaptation was found to be insufficient and aortic valve replacement was undertaken.
Aneurysm* ; Aortic Valve ; Cerebral Infarction* ; Coronary Sinus ; Heart Atria ; Heart Ventricles ; Humans ; Pulmonary Artery ; Rupture ; Sinus of Valsalva*

BACKGROUND: Normally major forward pulmonary venous flow(PVF) into left atrium occurs during systole and early diastole. This is followed by the reversal of the PVF with atrial contraction during late diastole. Chronic increase of left atrial pressure and volume, and decrease of the left atrial compliance might alter the PVF pattern in patients with mitral stenosis. Moreover, the cardiac rhythm could be changed from sinus rhythm(SR) to atrial fibrillation(AF) with the progression of the disease. To elucidate the effect of these changes on PVF, we performed transesophageal echocardiographic(TEE) Doppler examination in 20 patients of mitral stenosis who were going to be taken Percutaneous mitral commissurotomy(PMC). METHOD: We measured the velocities of the PVF by TEE pulsed Doppler examination, and compared it with the hemodynamic parameters measured by cardiac catheterization in 20 patients of mitral stenosis who underwent the PMC. The SR was found in 12 patients and the rest showed established AF. RESULTS: 1) Doppler variables measured by TEE. 2) Hemodynamic parameters measured by cardiac catheterization. 3) In patients with SR, S-PV, S-VTI and S-FVTI showed negative correlation with mean LAP(r=-0.66, -0.67, -0.71, respectively, p<0.05). However in AF group, there is no correlation between Doppler variables and mean LAP. CONCLUSION: In mitral stenosis with SR, systolic PVF decreases with the increase of mean left atrial pressure and finally, diastolic PVE becomes predominant with the development of AF.
Atrial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Compliance ; Diastole ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Atria ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Systole

BACKGROUND: To evaluvate the hypothesis that reperfusion injury and reperfusion arrhythmia could be caused by oxyzen free redicals and that prolonged myocardial dysfunction could be induced by oxyzen free redical. METHODS: Experimnetal model of anesthetized open chest dogs was used. Coronary artery was occluded for 60 minutes and reperfusion was performed 4 hours. In 5 dogs, superoxide dismutase and catalase were infused concomitantly 15 minutes after coronary occlusion to 15 minutes after reperfusion. In 9 dogs, 0.9% saline was infused instead of free redical scavengers. Hemodynamic parameters such as heart rate, left ventricular peak systolic pressure, end-diastolic pressure, peak positive dP/dt, and peak negative dP/dt were analysed. Infarct size was estimated by the unstained area in nitroblue tetrazolium staining and risk area was calculated from the unstained area after methylen blue infusion. Regional systolic function was observed in systolic thickening of ischemic area by echocardiogram. RESULTS: 1) Reperfusion arrhythmia occurred in 67% of control group and in 50% of drug treated group. 2) Systolic hemodynamic parameters such as peak systolic pressure, peak positive dP/dt showed no difference between control and drug-treated group. 3) Diastolic parameters such as end-diastolic pressure and peak negative dP/dt were not different in two groups. 4) Regional systolic parameter measured by systolic thickening in ischemic area improved after reperfusion and continued to be better in drug treated group than in control group. 5) Infarct size, risk area, ratio of infarct size to risk aera were not different in two groups. CONCLUSION: Superoxide dismutase and catalase showed no effect in reducing the infarct size in anesthetized open chest canine model with 60 minutes of coronary occlusion 4 hours of reperfusion. However, postischemic prolonged myocardial dysfunction tended of improve-after reperfusion in drug treated group.
Animals ; Arrhythmias, Cardiac ; Blood Pressure ; Catalase* ; Coronary Occlusion ; Coronary Vessels ; Dogs ; Heart Rate ; Hemodynamics ; Myocardial Infarction* ; Necrosis* ; Nitroblue Tetrazolium ; Reperfusion ; Reperfusion Injury ; Superoxide Dismutase* ; Superoxides* ; Thorax

BACKGROUND: Hypotension is the most frequent side effect of spinal anesthesia. Unilateral spinal anesthesia may be advantageous because it reduce the extent of spinal block. The aim of this study was to compare the incidence of hypotension and the difference of heart rate between unilateral and conventional bilateral spinal anesthesia. METHODS: Seventy patients were randomly allocated into two groups, which both received 2.0 ml (10 mg) of 0.5% hyperbaric bupivacaine. In group 1, local anesthetic was injected for two minutes with the needle orifice turned toward the dependent side; the lateral position was maintained for 20 minutes (unilateral, n = 35). In group 2, local anesthetic was injected through a cranially directed needle orifice, then patients were immediately turned supine (conventional, n = 35). Observers recorded noninvasive hemodynamic variables, as well as loss of cold and touch sensation and motor block on both side. RESULTS: In the unilateral group, 16 patients (45.7%) showed a unilateral loss of cold sensation and 23 patients (65.7%) had no motor block on the nondependent side for the duration of the study, whereas all conventional patients had bilateral distribution of spinal block (P < 0.001). The incidence of hypotension was higher in the conventional (22.9%) than unilateral group (5.7%) (P < 0.01). Considering the mean changes from baseline values of arterial blood pressure, patients of the conventional group showed greater decreases in systolic arterial blood pressure at 40, 50, 60, and 70 min (P < 0.05). Maximum percentage changes from baseline values of systolic arterial blood pressure and heart rate were greater in the conventional group (-17.8 +/- 9.8% and -19.7 +/- 10.4%) than in unilateral group (-14.6 +/- 5.5% and -16.9 +/- 11.2%). CONCLUSIONS: Unilateral spinal anesthesia reduces the incidence of hypotension during spinal anesthesia.
Anesthesia, Spinal* ; Arterial Pressure ; Bupivacaine* ; Heart Rate ; Hemodynamics ; Humans ; Hypotension* ; Incidence* ; Needles ; Sensation

Despite the high incidence of subdural block (SDB) during epidural anesthesia, the condition is unfamiliar to anesthesiologist. We experienced a case of SDB: severe hypotension, transient hemiplegia, wide extent of block and late onset and recovery from block. The case described is an examples of SDB and should remind anesthesiologist of the clinical course and treatment.
Anesthesia, Epidural* ; Hemiplegia ; Hypotension ; Incidence

Because of the possibility of increased the risk of soft tissue or bone infection, surgeon have been somewhat reluctant to use the anterior cervical approach in spinal injury patients who had previously undergone tracheostomy. The authors investigated whether the use of a Caspar plate in such patients during anterior cervical fixation altered the risk of infection. We analyzed the mechanism and level of injury, operative procedures, post-operative course and infection in 12 cervical injury patients with previous tracheostomy. The procedure had been performed on the day of injury because of semicoma resulting from combined head injury in two cases, and because of multiple rib fracture with hemothorax, and old age with chronic obstructive lung disease in one case each; it had been performed between 1-6 days after injury because of high fever with pneumonia and atelectasis in eight cases. The interval between tracheostomy and anterior fixation was 5-20(average, 13) days. During clinical follow-up at 8-21 (average, 16) months, bone union without infection was observed in all patients. The authors concluded that in patients with cervical cord injury, tracheostomy did not increase the risk of infection in subsequent anterior cervical fixation using a Caspar plate.
Craniocerebral Trauma ; Fever ; Follow-Up Studies ; Hemothorax ; Humans ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Disease, Chronic Obstructive ; Respiratory Insufficiency ; Rib Fractures ; Spinal Injuries ; Spine* ; Surgical Procedures, Operative ; Tracheostomy*