Essential hypertension is an important public health problem in Korea-being common, asymptomatic, easily treatable, and often leading to lethal complication in left untreated. The number of patients with hypertension has been significantly increased, and this factor may be an importnat one responsible for the increase in cardivascular mortality during past 20 years in Korea. As the drug therapy for hypertension needs longer period, it is very important to evaluate the efficacy and the adverse effects. Thirty patients(17 men and 13 womon) with essential hypertension were evaluated in this study. All patients had received oral Isradipine 1.25~2.5mg b.i.d. for 8 weeks. 1) The systolic and diastolic pressure were decreased significantly(166.8+/-9.0mmHg vs 147.3+/-12.0mmHg, p<0.001 and 100.3+/-4.0mmHg vs 90.3+/-6.1mmHg, p<0.001, respectively) 2) Heart rate, body weight, laboratory tests, chest X-ray, ECG studies were not changed significantly. 3) The systolic pressure was lowered by 20mmHg or more in 17 cases(56.7% of total), and the diastolic pressure was lowered by 10mmHg or more in 20 cases(66.7% of total) at 8 weeks after Isradipine administration. 4) The adverse effects of Isradipine were edema in 3(10%), constipation in 2(6.7%), headache in 2(6.7%), and insomnia, dizziness and dry mouth in 1 patient respectively, and none of them discontinued Isradipine administration due to adverse effects. In many patients with essential hypertension there is an effective response to Isradipine, even though there may be some mild adverse effects.
Blood Pressure ; Body Weight ; Constipation ; Dizziness ; Drug Therapy ; Edema ; Electrocardiography ; Headache ; Heart Rate ; Humans ; Hypertension ; Isradipine ; Korea ; Male ; Mortality ; Mouth ; Public Health ; Sleep Initiation and Maintenance Disorders ; Thorax

A reproducible noninvasive technique for measuring right ventricular ejection fraction (RVEF) was developed using first pass quantitative radionuclide angiocardiography. Tests were carried out in the right anterior oblique position with a computerized multicrystal scintillation camera with high count rate capabilities. RVEF was calculated on beat to beat basis from the high frequency components of the background-corrected right ventricular time-activity curve. The following results were obtained; 1) In 10 normal adults, RVEF averaged 50.9+/-8.2. In 20 patients with chronic obstructive lung diseases (COPD), RVEF was 37.9+/-6.1% and significantly lower than that of normal persons(P<0.005). 2) There was meaningful correlation between RVEF and forced expiratory volume (FEVI) in patients with COPD (r=0.51). And there was significant difference of RVEF between 13 patients with FEVI less than IL/min (6 patients with right ventricular failure, 7 patients with patients without that) and 7 patients with FEVI IL/min or more (35.7+/-6.0%, 42.1+/-3.2% respectively. P<0.005). 3) All 6 patients with clinical manifestation of right heart failure had abnormal RVEF and had FEVI less than IL/min, which was significantly lower than that of 14 patients without clinical manifestation of right heart failure (33.6+/-4.8%, 39.8+/-5.6%, respectively. P<0.005). 4) In 14 patients without clinical manifestation of right heart failure, 11 patients among whom 7 patients had FEVI less than IL/min, had abnormal RVEF.
Adult ; Angiocardiography ; Forced Expiratory Volume ; Gamma Cameras ; Heart Failure ; Humans ; Lung Diseases, Obstructive* ; Pulmonary Disease, Chronic Obstructive ; Radionuclide Ventriculography* ; Stroke Volume ; Ventricular Function, Right*

A 26-year-old man with a one-year history of asthma and sinusitis presented with bilateral pleural effusions, patch basilar infiltrates on a chest x-ray and a pericardial effusion on an echocardiogram. The peripheral blood showed marked eosinophilia. An obstructive pattern was also observed during the pulmonary fuction test, which was responsive to bronchodilator inhalation. Nerve conduction studies showed right sural neuropathy. Thoracentesis yielded an acidotic exudative effusion with low glucose, low C3 and eosinophilia. An open lung biopsy revealed an eosinophilic interstitial pneumonitis associated with a necrotizing eosinophilic vasculitis, and granulomatous inflammation foci. In the literature, pleural effusions were reported in 29 percent of Churg-Strauss patients, but the number of effusions was low and their characteristics have not been well described. This report describes the characteristic findings of pleural fluid and its histologic features in a case of classical Churg-Strauss syndrome.
Adult ; Asthma ; Biopsy ; Churg-Strauss Syndrome* ; Eosinophilia ; Eosinophils ; Glucose ; Humans ; Inflammation ; Inhalation ; Lung ; Lung Diseases, Interstitial ; Neural Conduction ; Pericardial Effusion ; Pleural Effusion* ; Sinusitis ; Thorax ; Vasculitis

A number of noninvasive technics have been advocated as reflecting left ventricular performance. These methods include systolic time intervals, echocardiography and imaging of the left ventricular chamber with radionuclides during systole and diastole. Radionuclide evaluation of left ventricular function by means of the gamma camera and gating currently appears to be the most reliable noninvasive method for approximating angiographic evaluation of left ventricular performance. Utilizing the radionuclide angiography, we measured the left ventricular function in 19 normal healthy control, 60 patients with coronary artery diseases 7 patients with dilated cardiomyopathy, 5 patients with hypertension. 1) Left ventricular ejection fraction decreased in 12 patients with anterior myocardial infarction (39.9+/-11.6%), 17 patients with inferior myocardial infarction (49.9+/-8.4%) and 7 patients with dilated cardiomyopathy (19.0+/-5.8%), and there was a statistically significant difference compared with 19 normal control group (63.5+/-8.2%)(p<0.005). However there were no statistically significant difference between normal control group, patients with hypertension (58.8+/-7.6%) and patients with angina pectoris (60.1+/-6.5%). 2) Left ventricular ejection fraction decreased in both anterior and inferior myocardial infarction, and there was a statisically significant difference between both groups (p<0.01). All 13 patients with acute myocardial infarction had abnormal LVEF (40.5+/-9.1%) whcih was significantly lower than that of 16 patients with old myolardial infarction (50.1+/-10.5%)(p<0.01).
Angina Pectoris ; Cardiomyopathy, Dilated ; Coronary Artery Disease* ; Coronary Vessels* ; Diastole ; Echocardiography ; Gamma Cameras ; Humans ; Hypertension ; Infarction ; Inferior Wall Myocardial Infarction ; Myocardial Infarction ; Radioisotopes ; Radionuclide Angiography* ; Stroke Volume ; Systole ; Ventricular Function, Left*

BACKGROUND: The angiotensin-converting enzyme(ACE) plays an important role in cardiovascular disease by production of angiotensin and degradation of bradykinin. Cloning of ACE gene revealed an insertion/deletion(I/D) polymorphism according to the presence/absence of a 287 base pair fragment in the 16th intron of ACE gene, and the ACE polymophism was associated with ACE activity. The genotype DD was identified as a risk factor for myocardial infarction in several studies. We analyzed the ACE I/D polymorphism in 62 patients with myocardial infarction and 67 normal subjects. METHODS: Genomic DNA from peripheral blood was amplified by polymerase chain reaction and characterized by three ACE genotypes; two insertion alleles(genotype II), two deletion alleles(genotype DD) and heterogenous alleles(genotype ID). ACE activity was determined by spectrophotometric method utilizing the synthetic substrate. RESULTS: There was no significant difference in ACE polymorphism between patients and normal subjects. But, the frequency of genotype DD was significantly increased in the low-risk group of patients compared with the high-risk group. The multi-vessel disease was more strongly associated with genotype DD, but there was no statistical significance. The ACE activity was strongly associated with ACE polymorphism with the activity being highest in genotype DD. There was no significant difference between patients and control subjects of the same genotype. CONCLUSION: There was no significant difference in ACE polymorphism between patients and normal subjects. The frequencies for genotype II, ID, DD were 0.328, 0.537, 0.134, respectively in normal subjects. There was high frequency of genotype II compared with Caucasians. A deletion polymorphism(genotype DD) may increase the risk for myocardial infarction in lowrisk group, and the serum ACE activity was correlated with three genotypes.
Angiotensins ; Base Pairing ; Bradykinin ; Cardiovascular Diseases ; Clone Cells ; Cloning, Organism ; DNA ; Genotype ; Humans ; Introns ; Myocardial Infarction* ; Polymerase Chain Reaction ; Risk Factors

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: In patients after acute myocardial infarction, signal-averaged electrocardiography is used as the one of the non-invasive methods for the prediction for ventricular arrhythmia, one of the causes ofn death in acute myocardial infarction. Signal-averaged electrocardiography has allowed the identification of low-amplitude, high-frequency signals(late potentials)in the terminal portion of the QRS complex. They are thougt to be occured in the portion of electrophysiologically unstable myocardium. The presence of late potentials identifies regions of delayed conducton in the elctrophysiologically unstable border zone of an acute infarction. These electrophysiologic change of myocardium is influenced by the patency of infarct-related artery. A patent artery is associated with electrical stability of myocardium, decreased in cidence of late potentials and improved survival. METHODS: 58 patients of acute myocardial infarction underwent signal-averaged electrocardiography, coronary angiography within 10 days after AMI, 20 of healthy persons underwent signal-averaged electrocardiography. RESULTS: In patent group, late potentials were recorded in 7 of 38 patients(18%) as compared with 13 of 20 patients(65%) of non-patent group. The statistically significant parameters of signal-averaged electrocardiography beteen patent and non-patent group were filtered total QRS duration(TQRS, 106.7+/-20.9msec), high frequency low amplitude signal (HLAS, 30.8+/-7.5 vs 41.3+/-16.5 msec)with HLAS being the most powerful varialble in the model. CONCLUSION: These results suggest that the patency of infarct-related artery is associated with electrophysiologic stability of myocardium and signal-averaged electrocardiography is one of the useful non-invasive method in risk stratification of acute myocrdial infarction.
Arrhythmias, Cardiac ; Arteries* ; Coronary Angiography ; Electrocardiography* ; Humans ; Infarction ; Myocardial Infarction* ; Myocardium

BACKGROUND: Angina with normal coronary angiogram has been called syndrome X or microvasclar angina. Pathophysiologic mechanisms for chest pain in this group of patients are not known exactly. This study was performed to compare the insulin level of the patients with syndrome X with that of the healthy asymptomatic volunteers. METHODS: The syndrome X group was consisted of 18 patients(11 men and 7 women). All patients had typical chest pain and positive exercise test with a completely normal coronary andgiogram. Patients with hypertension, diabetes mellitus, and there taking any drug known to affect the insulin secretion were excluded. The control group was consisted of 38 healthy subjects(25 men and 11 women) who were not taking any medications. We measured the plasma glucose insulin and C-peptide concentration during oral glucose tolerance test in both groups. RESULTS: Fasting plasma glucose was normal in all patients in both groups. There were no significant differences in plasma glucose level, during the oral grucose tolerance test. There were no significant differences between control and wyndrome X group in the fasting plasma insulin concentration(5.1+/-2.4 vs 5.9+/-2.7 microg/ml, p>0.05). However, the insulin levels at 60min(47.6+/-20.0 vs 84.0+/-68.0 microg/ml) and 120 min(31.4+/-18.2 vs 92.9+/-83.8 microg/ml)were significantly higher in the syndrome X group(p<0.05). THere were no significant differences in the C-peptide concentrations at fasting, 60 min and 120 min after oral glucose tolerance test between control and syndrome X group(p>0.05). CONCLUSION: As shown in above results, there were significant differences in insulin concentrations, but nor in C-peptide concentrations between control and syndrome X group. Thus it can be suggested that the increased dinsulin level in these patients is resulted from the altered insulin action to the target tissues, not from the pancreatic overproduction of insulin. We suggest that this hyperinsulinemia resulted from the insulin resistance play a possible role in the abnormality of microvascular circulation as a mechanism of Syndrome X.
Blood Glucose ; C-Peptide ; Chest Pain* ; Diabetes Mellitus ; Exercise Test ; Fasting ; Glucose Tolerance Test ; Humans ; Hyperinsulinism* ; Hypertension ; Insulin ; Insulin Resistance ; Male ; Plasma ; Thorax* ; Volunteers

Streptococcus anginosus is a member of Streptococcus milleri group, and is found in the oral mucosa, respiratory tract, and gastrointestinal tract as normal flora. It can develop into a disease in patients with deteriorating clinical condition or with clinical risk factors. A previously healthy 15-year-old boy was admitted due to fever, abdominal discomfort and vomiting which lasted for 7 days. He had a history of dental procedure 1 day before the development of fever. He was diagnosed with acute acalculous cholecystitis based on the clinical, laboratory, and imaging finding, and S. anginosus was isolated from the blood culture. The patient was successfully treated with antibiotic therapy.
Acalculous Cholecystitis ; Adolescent ; Bacteremia ; Cholecystitis ; Fever ; Gastrointestinal Tract ; Humans ; Mouth Mucosa ; Respiratory System ; Risk Factors ; Streptococcus ; Streptococcus anginosus ; Streptococcus milleri Group ; Vomiting

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