BACKGROUND: Doppler echocardiography is a non-invasive technique that has been used to evaluate LV diastolic dysfunction. Impaired left ventricular diastolic filling is known to occur in patients with coronary artery disease. Compared with those in normal subjects, Doppler-derived transmitral blood flow velocities have been reported to be reduced during early diastolic filling and to be compensatory elevated subsequent to atrial systole in patinets with coronary artery disease. But stiffness of myocardium normalize the E/A ratio, and normal E/A ratio may reveal increased ventricular filling pressure. We tried to investigate left ventricular filling parameters by Doppler echocardiography in patients with early myocardial infarction, and to compare left ventricular diastolic function regarding infarct location on EKG, one or multivessel disease on coronary angiography, and treatment modality. METHODS: From September 1993 to August 1995, Pulsed wave Doppler echocardiography was performed in patients with early acute myocardial infarction(N=95) and control group(N=20) within 5 days after admission, and parameters of diastolic function was evaluated. RESULTS: Echocardiographic data showed significant differences in mean ejection fraction, mean left ventricular mass, and mean left ventricular mass index between two groups. There was no significant difference in E/A ratio, deceleration time, and isovolumetric relaxation time between two groups. Neither, there was significant difference in each diastolic parameter for infarct related wall on EKG. And there was no significant difference in deceleration time for one or multi vessel disease on coronary angiography, treatment modality(conservative treatment, thrombolytic therapy, or primary PTCA). CONCLUSION: In patients with early acute myocardial infarction, left ventricular diastolic dysfunction was absent. And there was no significant correlation between the presence of diastolic dysfunction and the location of infarct related wall on EKG, or one or multi vessel disease, or treatment modality.
Blood Flow Velocity ; Coronary Angiography ; Coronary Artery Disease ; Deceleration ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Humans ; Myocardial Infarction* ; Myocardium ; Relaxation ; Systole ; Thrombolytic Therapy

No abstract available.
Blepharoptosis*

Fetal teratomas rarely complicate pregnancy,having an incidance of only 20,000:1 to 40,000:1 of live births. Overthere, cervical teratomas are rare and accounts for only 5.5% of all neonatal teratomas. We have experienced a large cervical immature teratoma and present this case with a brief review of literatures.
Live Birth ; Teratoma*

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: 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

OBJECTIVE: Peripartum emergency cesarean hysterectomy of 28 cases at our hospital for 10years were reviewed that the clinical indication, history, and annual incidence change. METHODS: A retrospective descriptive analysis from January, 1988 to December, 1997 was carried out. RESULTS: There were 28 cases of emergency cesarean hysterectomy identified during this period among total 24, 689 deliveries. The annual incidence of emergency cesarean hysterectomy was significantly declined statistically(p<0.005). Cesarean hysterectomy was performed in 20 of 6, 671 cesarean section(0.30%) and in 8 of 18, 018 vaginal deliveries(0.04%), so more frequently after cesarean section than vaginal delivery. The cesarean hysterectomy rate was more frequent in multiparous women(0, 22%) than in nulliparous women(0, 02%). The most common indication of cesarean hysterectomy was 13 cases of uterine atony(46%), followed by 5 cases uterine rupture(18%), 5 cases of placenta previa with placenta accreta(18%), 3 cases of placenta previa(11%), 2 cases of uterine myoma(7%). No significant difference in length of operating time, amount of blood loss and operative complications were found between total abdominal hysterectomy and subtotal hysterectomy. The all patient who had cesarean hysterectomy recieved from 1200ml to 15840ml of blood transfusion with a mean of 3673ml. In aspect of fetal outcome, 3 cases of FDIU(Fetal death in utero) in uterine rupture and 1 case of stillbirth in preterm were found. The maternal complications were wound disruption, DIC, wound hematoma, ureter injury, vaginal stump bleeding, UTI(Urinary tract infection) and retroperitoneal bleeding, CONCLUSION: We conclude that the incidence of emergency cesarean hysterectomy declined with prediction of antenatal risk factor, preparing of sufficient fresh blood, prophylactic antibiotics, vigorous uterotonics and close observation after delivery.
Anti-Bacterial Agents ; Blood Transfusion ; Cesarean Section ; Dacarbazine ; Emergencies* ; Female ; Hematoma ; Hemorrhage ; Humans ; Hysterectomy* ; Incidence ; Peripartum Period* ; Placenta ; Placenta Previa ; Pregnancy ; Retrospective Studies ; Risk Factors ; Stillbirth ; Ureter ; Uterine Rupture ; Wounds and Injuries

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Cardiomyopathies* ; Catecholamines ; Child, Preschool ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Hypertension ; Myocarditis ; Neuroblastoma*

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

Objective : The aim of this study was to evaluate cross - reactivity between pollens in patients with strong skin reactivity to multiple pollens. METHODS: A pool of sera from 20 patients who showed strong skin responses( > or = 3+ ) to all three kinds of pollens ( tree, grass, and weed ) was used. Oak, ryegrass, mugwort, ragweed and hop Japanese pollens were chosen for the subject of study. The level and pattern of bound IgE to each pollen and cross - reactivity between pollens were investigated by ELISA and immunoblot experiments. RESULTS: In ELISA, the IgE of a pool of sera reacted to ryegrass and ragweed in 100%, to mugwort in 95%, to oak in 75%, and to hop Japanese in 65%, respectively. In inhibitory ELI - SA, more than 50% of bound IgE was mutually inhibited in oak vs ryegrass, oak vs mugwort, mugwort vs ryegrass and mugwort vs hop Japanese. In immunoblot, the IgE binding rate to major allergens of each pollen was 95% for hop Japanese, 75% for ragweed, 50% for ryegrass, 35% for mugwort, and 30% for oak, respectively. In inhibitory immunoblot, the mutually inhibited bound IgE could not be observed between major allergens of each pollen, but some minor allergens of oak pollen were mutually inhibited by ryegrass. CONCLUSION: Cross - reactivity between major allergens of oak, ryegrass, mugwort, ragweed and hop Japanese pollens was not observed at all, but some minor allergens of oak pollen cross-reacted with ryegrass and mugwort, and so did those of mugwort pollen with ryegrass and hop Japanese.
Allergens ; Ambrosia ; Artemisia ; Asian Continental Ancestry Group ; Enzyme-Linked Immunosorbent Assay ; Humans ; Humulus ; Immunoglobulin E ; Lolium ; Poaceae ; Pollen* ; Skin

BACKGROUND: IL - 5 has been recognized as a potent proeosinophilic cytokine and IL-10 has been reported as an important anti - inflammatory cytokine in allergic inflammation. But the clinical roles of these cytokines in allergic asthma are still unclear. Objectives : We studied the clinical implications of IL - 5 and IL - 10 secretions from stimulated peripheral blood mononuclear cells ( PBMC ) in Dermatophagoides farinae ( DF ) atopic asthmatics ( BA ). METHODS: Thirty - six DF sensitized BA and 9 non - atopic BA were enrolled for this study. Twenty - seven out of 36 subjects were challenged by inhalation of DF crude allergen. The isolated PBMCs were cultured for 6 days with DF antigen and the stimulatory index ( SI ) and secretions of IL - 5, IFN - y and IL - 10 from PBMC were measured. We analyzed these parameters with clinical parameters. RESULTS: SI (4.2 +/- 1.0 vs. 1.3 +/- 0.3, p<0.05) and secretions of IL - 5 ( 19.9 vs. 1.7 g/L, p< 0.001 ) and IL-10 ( 185.5 vs. 34.3 g/L, p(0.05 ) from the atopic BA were significantly higher than those of non-atopic BA, but the secretion of IFN - r was not different between the two groups ( 56.6 vs. 47.3 ug/L ). No significant difference in secretions of IL - 5, IL - 10, IFN - r and SI of PBMC was found between responder and non - responder of DF inhalation challenge test. Among responders to antigen challenge test ( n = 17 ), the production of IL - 5 correlated with the productions of IL - 10 (r = 0.773, p< 0.01 ) and methacholine PC20 ( r = 0.503, p< 0.05 ). Production of IL - 5 from the PBMC of atopic mild intermittent BA ( n = 10 ) was higher than that of atopic per'sistent BA ( n = 27 ) ( p< 0.01 ), but no difference in IL - 10, IFN - r and SI was found between the two groups. Conclusions : Allergen specific productions of IL - 5 and IL - 10 from the PBMC may be specific for atopic subjects and secretion of IL - 5 from the stimulated PBMC may contribute to the pathogenesis of atopic BA. The severity of BA may be more influenced by other factors.
Asthma ; Cytokines ; Dermatophagoides farinae ; Inflammation ; Inhalation ; Interleukin-10 ; Methacholine Chloride