BACKGROUND: Recently the percutaneous transradial approach for coronary angiography, transluminal coronary angioplasty or coronary stention were reported but there was no report in Korea. So we tested the safety and efficacy of the transradial appreach for coronary angiography in Korean. METHODS: Eleven patients(male 9, female 2, mean age 59.3 yeal old)with chest pain underwent percutaneous transradial coronary angiography with 5 french multipurpose catheter. We evaluated clinical efficacy and observed complication of percutaneous transradial coronary angiography by physical examination and DOpple ultrasonography of puncture site of radial artery. RESULTS: Right coronary angiography and left ventriculography were performed successfully in all cases, but left coronary angiogrphy was failed in three cases. In another three cases, the patient complained of arm pain which was aggravated during manipulation of the catheter. After the procedure, it took 10.3 minutes to stop the bleeding at the puncture site, Clinically significant complications were not observed after the procedure. The patients were not restricted to bed at all since the completion of the procedure. CONCLUSION: In our limited dexperience, percutaneous transradial coronary angiography could be performend on the outpatient basis without significant complications.
Angioplasty ; Arm ; Catheters ; Chest Pain ; Coronary Angiography* ; Female ; Hemorrhage ; Humans ; Korea ; Outpatients ; Physical Examination ; Punctures ; Radial Artery ; Ultrasonography

Limb salvage operations for osteosarcoma of the extremity usually consist of wide excision and skeletal reconstruction. Most osteosarcoma patients are anemic prior to the surgery as majority of them undergo preoperative neo-adjuvant chemotherapy; thus, it is necessary to treat anemia before and after the surgery since limb salvage operation tends to accompany significant blood loss. Despite the fact that blood transfusion has bad influence on prognosis, complication, and postoperative outcome of cancer patients, it is still considered as a standard management to fix anemia for limb salvage operations. We would like to present a case report in which the authors succeeded in performing limb salvage operations on patients with distal femur osteosarcoma without transfusion.
Anemia ; Blood Transfusion* ; Drug Therapy ; Extremities ; Femur* ; Humans ; Limb Salvage* ; Osteosarcoma* ; Prognosis

BACKGROUND: Left ventricular hypertrophy is a major cardiovascular risk factor for sudden death, acute myocardial infarction and congestive heart failure. The left ventricle is generally thought to adapt to sustained arterial hypertension with increased total peripheral resistance by developing concentric hypertrophy. In recent years, the echocardiogrphy has been developed as a noninvasive method for evaluation of left ventricular geometry and left ventricular mass. However, left ventricular adaptation to hypertension has been shown to be more complex than expected. In fact, many patients with mild to moderate hypertension exhibit normal left ventricular mass and wall thickness, other hypertensive patients have eccentric ventricular hypertrophy that is not related to systolic dysfunction, but rather to increased cardiac output and preload and in some hypertensive patients absolute and relative wall thickness is increased with normal ventricular mass(concentric remodeling). There are differences in the hemodynamics, systolic function and diastolic function in each group. METHODS: From september 1992 to August 1994, in 144 patients with untreated essential hypertension and 50 age and gender matched normal adults studied by two-dimensional, M-mode and Doppler echocardiography. In the present study we used echocardiographically derived left ventricular mass and relative wall thickness to assess the patterns of ventricular geometric adaptation to systemic hypertension and their relations to systemic hemodynamics, left ventricular load and contractile performance. RESULTS: Hypertensive group was 144 cases(M:F=68:76), the mean age 56+/-13years. Normotensive group was 50 cases(M:F=22:28), the mean age 52+/-9years. Among hypertensive patients, left ventricular mass index and relative wall thickness were normal in 42 cases(29%), 24 cases(17%) had increased relative wall thickness with normal ventricular mass(concentric remodelin),48 cases(33%) had both increased relative wall thickness and ventricular mass(concentric hypertrophy), 30 cases(21%) had increased left ventricular mass with normal relative wall thickness(eccentric hypertrophy). Concentric hypertrophy and normal left ventricle group are more common in untreated hypertensive patients in Korea. Systemic hemodynamics showed tendency to paralleled ventricular geomety. In groups with concentric remodeling and hypertrophy, perpheral resistance was increased. Cardiac index was midly increased in eccentric hypertrophy. Diastolic dysfunction was prominent tn concentric hypertrophy. CONCLUSION: Each patterns of left ventricular geometry had different systemic hemodynamics, ventricular pressure overload and ventricular volume overload. Therefore, appropriate selection of antihypertensive agent for the patients with each patterns of hypertrophy reduce the left ventricular hypertrophy and may improve the prognosis.
Adult ; Cardiac Output ; Death, Sudden ; Echocardiography ; Echocardiography, Doppler ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular* ; Korea ; Myocardial Infarction ; Prognosis ; Risk Factors ; Vascular Resistance ; Ventricular Pressure

BACKGROUND: Syncope is both one of the most common and one of the most challenging problems seen in medical practice. In spite of intensive medical evaluation, the cause of syncope remains unknown in a significant number of patients. In recent years, head-up tilt test has been of increasing interest as a diagnostic aids in patients with unexplained syncope. This study investigated the clinical utility of this technique in te evaluation of patients with vasovagal syncope. METHODS: Seven patients with unexplained syncope were evaluated with a 60 degree or 80 degree head-up tilt test with or without intravenous infusion of isoproterenol(1-4ug/min) in an attempt to provoke bradycardia, hypotension or both. There were 4 males and 3 females with a mean age of 35+/-8 years. RESULTS: 1) During head-up tilt test, vasovagal responses were provoked in 5 of 7 patients(71.4%) with syncope of unknown origin. During the test, there was no complication associated with the test. 2) During tilt-induced vasovagal reponse, mean systolic blood pressure decreased to 84+/-12mmHg from supine control of 125+/-21mmHg(p<0.01) and mean diastolic blood pressure decreased to 50+/-17mmHG from supine control of 76+/-14mmHg(p<0.01). 3) Five patients with positive results of the tests were followed up for 12months and they had a good outcome free of recurrence. CONCLUSION: Head-up tilt test appeared safely applicable test in patients with suspected vasovagal syncope and good prognosis was expected in the patients.
Blood Pressure ; Bradycardia ; Female ; Follow-Up Studies* ; Humans ; Hypotension ; Infusions, Intravenous ; Male ; Prognosis ; Recurrence ; Syncope ; Syncope, Vasovagal*

BACKGROUND: Left ventricular hypertrophy is an independent risk factor for coronary artery disease, hypertension or other cardiovasular diseases, and normal health person due to cardiac arrhythmia or coronary microcirculatory insufficiency. According to development of echocardiography, left ventricular mass and the patterns of left ventricular hypertrophy can be measured. Therefore, we tried to classify the left ventricular hypertrophy in coronary artery disease and to differentiate cardiac function and severity of coronary artery disease in these groups. METHOD: From September 1993 to August 1995, in 44 cases(23 males, 21 females) without hypertension with normal coronary angiography and 84 cases(62 males, 22 females) without hypertension with coronary artery disease on coronary angiography were compared by two-dimensional, M-mode, and Doppler echocardiography. RESULTS: In normal control group, mean age was 51+/-11years, and in coronary artery disease group, mean age was 58+/-10years. Atherosclerotic risk factors showed no significant differences in each groups. LVH patterns in normal control group were 31 cases(70%) of normal left ventricle, 6 cases(14%) concentric remodelling, 2 cases(5%) concentric hypertrophy, and 5 cases(11%) eccentric hypertrophy. In coronary artery disease group, 30 cases(36%) were normal left ventricle, 17 cases(20%) concentric remodelling, 14 cases(17%) concentric hypertrophy, and 23 cases(27%) eccentric hypertrophy. CONCLUSIONS: In this study, concentric and eccentric hypertrophy were more common in coronary artery disease group than normal control group. And comparing to one vessel disease grroup, multi-vessel disease group had more common concentric and eccentric hypertrophy. This result were considered that left ventricular concentric hypertrophy may induce coronary heart disease because more oxygen demand required and fixed coronary circulation, and essentric hypertrophy was due to post-infarct left ventricular remodelling and wall thinning.
Arrhythmias, Cardiac ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Circulation ; Coronary Disease ; Coronary Vessels* ; Echocardiography* ; Echocardiography, Doppler ; Heart Ventricles ; Humans ; Hypertension ; Hypertrophy ; Hypertrophy, Left Ventricular* ; Male ; Oxygen ; Risk Factors

BACKGROUND: Total obstruction of the left main coronary artery is a common cause of sudden death but is rarely seen in patients who survive to undergo diagnostic evaluation or treatment. METHODS: During twenty six-year period, we encountered 5 patients with chronic total obstruction of the left main coronary artery out of about 4,000 patients who underwent coronary angiography. RESULTS: All patients have undergone coronary bypass surgery. These patients present with increasingly severe angina. A right dominat coronary anatomy is always found, usually with well-developed right-to-left collaterals. Left ventricular function was severely impaired in two patients out of five patients. CONCLUSIONS: The results of surgical revascularization in our patients and others described in the literature can support the safety and efficacy of this approach.
Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Humans ; Ventricular Function, Left

BACKGROUND: Established risk factors for coronary artery disease include smoking, hypertension, diabetes mellitus and hypercholesterolemia. However, these account for less than 50% of the actual incidence of coronary artery disease and the importance of other risk factors is being increasingly realized. It has been known that insulin resistance associated with hyperinsulinemia is a pivotal link to several risk factors of coronary artery disease, including hypertension, glucose intolerance, dyslipidemia and obesity. Recently both experimental and clinical studies have produced evidence suggesting that high plasma insulin level may promote the development of atherosclerotic vascular diseasa. Several prospective studies showed independently that high plasma insulin is associated with an increased risk of major coronary artery disease. In our study, plasma glucose, insulin and C-peptide level were determined with oral glucose tolerance test to assess the insulin resistance or hyperinsulinemia as a risk factory of coronary artery disease. METHOD: From September 1993 to April 1995, after excluding patients with hypertension, diabetes mellitus, hypercholesterolemia and obesity, 17 patients with significant coronary artery stenosis and 10 control subjects with normal coronary finding were selected among the 226 patients who undertook coronary angiography. In the 17 cases(M:F=15:2) of coronary artery disease group, the mean age was 54+/-10 years, and in the 10 cases(M:F=8:2) of control group, 51+/-9 years. All were matched for age, gender and body mass index. Blood pressure, lipid and lipoprotein were measured and smoking history was assessed. Glucose, insulin and C-peptide responses to oral glucose tolerance test were also determined. RESULT: 1) There was no significant difference in systolic and diastolic and diastolic blood pressure, total-cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ApoA and smoking history except ApoB between the subjects with coronary artery disease and normal control subjects. 2) In oral glucose tolerance test, the plasma glucose levels were not significantly different in the two groups. plasma insulin and C-peptide levels at 60 and 120 minutes were higher in the patient group than control, but the results lack statistical significance. The area under the insulin curve and C-peptide curve were larger in patient group than control, but the result lack statistical significance also. CONCLUSION: Although our study dose not prove the hypothesis that insulin resistance or hyperinsulinemia is statistically an independent risk factor for coronary artery disease, this study showed the tendency of insulinresistance to be correlated with development of coronary artery disease. As this study has limitations due to small sample size, further study is required to confirm the role of hyperinsulinemia using a larger sample size.
Apolipoproteins A ; Apolipoproteins B ; Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Peptide ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diabetes Mellitus ; Dyslipidemias ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hypercholesterolemia ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Lipoproteins ; Obesity ; Plasma ; Prospective Studies ; Risk Factors* ; Sample Size ; Smoke ; Smoking ; Triglycerides

BACKGROUND: Circadian rhythms have been described for acute myocardial infarction, sudden cardiac death, cerebrovascular disease, ischemic heart disease, and ventricular arrhythmia. Most of studies reported that the frequency of ventricular permature contractions(VPC's) shows a peak in day time. We tried to see that the circadian rhythm of VPC's in hypertension and ischemic heart disease(IHD) patients. And we will also studied the relationship between heart rate and frequencey of VPC's. METHOD: Twenty four hour holter monitoring was performed in hypertensive patients (N=23), ischemic heart disease patients(N=25), and normal control group(N=30). We tested the circadian pattern of VPC's and heart rates and the relationships of the frequency of VPC's and heart rates. RESULT: In hypertension group, a peak incidence of heart rate is between 5 and 8 P.M., in ischemic heart disease group, between 3 and 6 P.M.. In control group, the heart rate shows a peak beteen 1 and 3 P.M.. The frequency of VPC's in hypertension group shows the first peak between 4 and 10 P.M., and the second peak beteen 7 and 10 A.M.. In ischemic heart disease group, they show a peak between 2 and 8 P.M..In control group, there was no circadian variation for the frequency of VPC;s. Both in hypertension and IHD patients group, there was significant correlation between the frequency of VPC's and the heart rates. CONCLUSION: It seemed that VPC' were more frequently occurred in relation to the increase of heart rate in the afternoon, in hypertensive and ischemic heart disease patients.
Arrhythmias, Cardiac ; Circadian Rhythm ; Death, Sudden, Cardiac ; Electrocardiography, Ambulatory ; Heart ; Heart Rate ; Humans ; Hypertension* ; Incidence ; Myocardial Infarction ; Myocardial Ischemia* ; Ventricular Premature Complexes*

BACKGROUND AND OBJECTIVES: Insulin resistance is associated with hyperlipidemia. Recently, visceral fat adiposity is reported to be associated with insulin resistance and hyperlipidemia. We investigated insulin resistance and visceral fat adiposity in hyperlipidemic patients. MATERIALS AND METHOD: Hyperlipidemic group included 14 hyperlipidemic patients (total cholesterol > or = 220 mg/dl and triglyceride < or = 400 mg/dl) without hypertension, angina, impaired glucose tolerance and diabetes mellitus (DM). Control group included age, sex and body mass index (BMI) matched 25 healthy volunteers. We measured plasma lipid profiles and the insulin and glucose during the oral glucose tolerance test. We measured visceral fat area and abdominal subcutaneous fat area with computed tomography (CT). RESULTS: There were no differences of age, sex and BMI in both group. Total cholesterol, LDL cholesterol and triglyceride increased significantly in hyperlipidemic group. Fasting plasma glucose, insulin, area under curve (AUC) of the glucose and insulin and the Insulin / Glucose (IG) ratio increased significantly in hyperlipidemic group. Significant positive correlations were demonstrated between visceral fat area and the fasting plasma glucose, AUC of glucose and insulin at 120 minutes after glucose load. However, there was no difference in visceral fat area between both groups. After adjustment of visceral fat area, fasting plasma glucose, insulin, area under curve (AUC) of the glucose and insulin and the Insulin / Glucose (IG) ratio still remained increased significantly in hyperlipidemic group. CONCLUSION: We observed significantly increased insulin resistance in hyperlipidemic group. There was partial relationship between visceral fat area and the glucose and insulin profile. However, we did not find increased visceral fat area in hyperlipidemic group.
Adiposity ; Area Under Curve ; Blood Glucose ; Body Mass Index ; Cholesterol ; Cholesterol, LDL ; Diabetes Mellitus ; Fasting ; Glucose ; Glucose Tolerance Test ; Healthy Volunteers ; Humans ; Hyperlipidemias* ; Hypertension ; Insulin Resistance* ; Insulin* ; Intra-Abdominal Fat* ; Obesity* ; Plasma ; Subcutaneous Fat, Abdominal ; Triglycerides

OBJECTIVES: Hypertension provokes left ventricular diastolic dysfunction due to decreased elasticity of the ventricular myocardium at first. It has been proposed that the Doppler echocardiography might provide information concerning diastole because of its ability to measure the blood flow velocities across the mitral valve noninvasively. But Doppler mitral velocity may be "normalized" in hypertensive patients in different conditions. The purpose of this study is to evaluate diastolic function in hypertensive hearts using Doppler echocardiography of the pulmonary venous flow in conjunction with mitral flow velocity pattern. METHODS: We measured the mitral flow velocity curves and the pulmonary flow velocity curves in fifty hypertensive patients(mean age : 56.3+/-10.0, man : 19, woman : 31) nad forty healthy adults(mean age : 51.6+/-12.5, man : 14, woman : 26) from March 1995 to December 1995 by using the SONO 1000 of Hewlett Packerd. RESULTS: 1) The mitral flow velocity pattern in 50 hypertensive patients was characterized by the decrease in the peak early diastolic filling velocity(E : 0.59+/-0.12m/sec) and the ratio of E to peak filling velocity(A : 1.00+/-0.46m/sec). Isovolumetric relaxation time and deceleration time were 127.2+/-33.3msec, 258.9+/-40.9msec respectively. They were longer than normotensive patients(P < 0.05). 2) The pulmonary venous flow velocity pattern in hypertensive patients was characterized by the decreased peak diastolic forward velocity(D : 33.7+/-9.8cm/sec) and the ratio of peak systolic forward velocity(S) to D(S/D : 1.60+/-0.5)(P < 0.05). 3) There was no relation between the flow velocity integral parameters and the peak flow velocity parameters of pulmonary venous flow pattern in hypertensive patients. 4) The dofference in the pulmonary venous duration and the mitral A wave duration at atrial contraction (DA-DR) was 20.9+/-29.4 msec in hypertensive patients. DA-DR in normatensive patients was 24.3+/-32.9msec. DA-DR was not significant in hypertensive patients compared with that of the healthy subjects (P < 0.05) CONCLUSION: Analysis of pulmonary venous flow velocity pattern in conjunction with mitral flow velocity pattern in hypertensive patients provides more accurate assessment of left ventricular diastolic function.
Blood Flow Velocity ; Deceleration ; Diastole ; Echocardiography, Doppler ; Elasticity ; Female ; Heart* ; Humans ; Hypertension ; Mitral Valve ; Myocardium ; NAD ; Relaxation