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

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

Blue Rubber Bleb Nevus syndrome, or Bean's syndrome is a very rare disease characterized by an association of 1) hemangioma cutis in which the nevi feel like rubber blebs; 2) hemangiomas of the digestive organs; 3) iron-deficiency anemia due to hemorrhage from the digestive tract. Sometimes, the bleeding is so severe and massive that the patient needs blood transfusions and/or emergency operations. We present a 29-year-old man with Blue Rubber Bleb Nevus syndrome. This patient was admitted to out hospital due to recently aggrevated dizziness and intermittent rectal bleeding. Multiple bluish tumors were noted on the palm, sole and glans penis. Laboratory examination revealed severe iron-deficiency anemia. Barium studies revealed multiple polypoid masses in the stomach, small bowel and colorectum. On esophagogastroduodenoscopy and colonoscopy, three or four dozens of hemangiomas with variable size and shape were noted in the stomach, duodenum at or around the ampulla of Vater and colorectum. This patient was of particular interest because rectal bleeding occurred from rectal lesion which protruded out of anus and caused bleeding during defecation, and which showed as a 2.0 cm Yamada type III polypoid lesion. Endoscopic ultrasonography confirmed us that this lesion was confined to the mucosa and submucosa without extension into muscle layer. Endoscopic polypectomy of this lesion was performed because which considered as the main focus of current rectal bleeding. He was discharged without any complication and 4 months later, he was well without rectal bleeding and his hemoglobin level increased upto 13.5 g/dl. To our knowledge, this is the first case of Blue Rubber Bleb Nevus syndrome in Korea.
Adult ; Ampulla of Vater ; Anal Canal ; Anemia, Iron-Deficiency ; Barium ; Blister* ; Blood Transfusion ; Colonoscopy ; Defecation ; Dizziness ; Duodenum ; Emergencies ; Endoscopy, Digestive System ; Endosonography ; Gastrointestinal Tract ; Hemangioma ; Hemorrhage ; Humans ; Korea ; Male ; Mucous Membrane ; Nevus* ; Penis ; Rare Diseases ; Rubber* ; Stomach

BACKGROUND: Conventional echocardiography provides fundamental information about mitral valve morphology and function but is often subjective and has a relatively low specificity in evaluating valve calcific deposit, which is critical information for the preoperative decision. We hypothesized that mitral valvular calcification could be detected in standard two-dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis so that we could overcome the subjectivity and low specificity of conventional echocardiography. METHODS: We tested this hypothesis by performing standard 2.5MHz two-dimensional echoes on mitral valve and myocardium in 30 patients with mitral stenosis, scheduled to undergo mitral valve replacement. We compared gray level of each region of interest in mitral valve and myocardium in stop-frame images with the degree of calcifications identified by pathologic and radiographic examinations. RESULTS: Ratio of mean gray level of mitral valve to mean gray level of myocardium was the most reliable value in evaluating degree of calcification. Quantitatively, region of calcification displayed the ratio of significantly higher value than that of no calcification. In case of anterior mitral valve, the ratio of the evident calcified region was greater than 3.11, that of the region without calcification was less than 2.42 and that of microcalcification was betwwn 2.42 and 3.11. For posterior mitral valve, the ratio of the evident calcified region was greater than 3.50, that of the region without calcification was less than 2.19 and that of microcalcification was between 2.19 and 3.50. The sensitivity and specificity of this method for assessment of degree of calcification was 75% and 100% for anterior mitral valve and 9% and 87.5% for posterior mitral valve. CONCLUSION: Mitral valvular calcification could be detected quantitatively in standard two dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis.
Echocardiography ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Myocardium ; Sensitivity and Specificity

PURPOSE: To evaluate the effectiveness of a dexamethasone intravitreal implant (Ozurdex(R)) in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone. METHODS: We reviewed 9 eyes of 9 patients with diabetic macular edema treated with dexamethasone intravitreal implant. The patients were included in the study if presenting with refractory diabetic macular edema of more than 3 months despite combined treatment of intravitreal bevacizumab injection with posterior subtenon triamcinolone injection or intravitreal triamcinolone injection. We assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography at initial visit and 1, 3 and 4 months. RESULTS: The mean follow-up was 6.7 +/- 2.2 months. The baseline mean BCVA was 0.81 +/- 0.47 logarithm of the minimum angle of resolution (log MAR), which improved to 0.61 +/- 0.37 log MAR (p = 0.017), 0.57 +/- 0.38 log MAR (p = 0.011) and 0.62 +/- 0.36 log MAR (p = 0.027) at 1 month, 3 months and 4 months, respectively. The baseline mean CMT was 558.0 +/- 110.32 microm and decreased to 325 +/- 64.21 microm (p = 0.008) and 300.22 +/- 59.46 microm (p = 0.008) at 1 month and 3 months, respectively, then increased to 468.44 +/- 150.85 microm (p = 0.058) at 4 months after injection. CONCLUSIONS: Dexamethasone intravitreal implant showed short-term efficacy in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone and produced significant improvements in BCVA and CMT until 3 months after injection. The CMT then increased, but BCVA was sustained until the fourth month.
Dexamethasone* ; Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema* ; Tomography, Optical Coherence ; Triamcinolone ; Visual Acuity ; Bevacizumab

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: 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*

Conventional intraoral radiography continues to be the most widely used image modality for the diagnosis of dental caries. But, conventional intraoral radiography has several shortcomings, including the difficulty of exposing and processing intraoral film of consistently acceptable quality. In addition, radiographic retaking that was the result of processing errors, may result in increased discomfort and radiation dose to the patient. Recently, various digital radiographies substitute for conventional intraoral radiography to overcome these disadvantages. The advantages of digital radiography are numerous. One of advantages is the elimination of processing errors. In addition, the radiation dose for digital system is approximately 20% to 25% of that required for conventional intraoral radiography. Another potential advantage of digital imaging is the ability to perform image quality enhancements such as contrast and density modulation, which may increase diagnostic accuracy. The purpose of this study was to compare the diagnostic ability of artificial proximal defects to conventional intraoral radiography, direct digital image(CDX2000HQ(R)) and indirect digital image(Digora(R)). Artificial defects were made in proximal surfaces of 60 extracted human molars using #1/2, #1, #2 round bur. Five dentists assessed proximal defects on conventional intraoral radiography, direct digital image(CDX2000HQ(R)) and indirect digital image(Digora(R)). ROC(Receiver Operating Characteristic) analysis and Two-way ANOVA test were used for the evaluation of detectability, and following results were acquired. 1. The mean ROC area of conventional intraoral radiography, direct digital image(CDX2000HQ(R))and indirect digital image(Digora(R)) were 0.6766, 0.7538, 0.6791(Grade I), 0.7176, 0.7594, 0.7361(Grade II), and 0.7449, 0.7608, 0.7414(Grade III), respectively. 2. Diagnostic ability of direct digital image was higher than other image modalities. But, there was no statistically significant difference among other imaging modalities for Grade I, II, III lesion(p>0.05). In conclusion, when direct and indirect digital system are comparable with conventional intraoral radiography, these systems may be considered an alternative of conventional intraoral radiography for the diagnosis of proximal surface caries.
Dental Caries ; Dentists ; Humans ; Image Enhancement ; Imidazoles ; Molar ; Nitro Compounds ; Radiographic Image Enhancement

No abstract available.
Agranulocytosis* ; Granulocytes* ; Humans

To date several agents have been used to achieve hemostasis in patients with bleeding peptic ulcers using endoscopic sclerotherapy techniques. In this study, the efficacy of endoscopic local injections of hypertonie saline-epinephrine(HS-E) solution, consisting of 9 volume of 3% sodium chloride and 1 volume of 1: 1000 epinephrine, on the base of the ulcer around bleeding vessel was assessed. During the period between April 1989 and July l992, 127 patients were admitted to the study. Ninety-six of these patients underwent endoscopic treatmeat(endoscopic treatment group), while the other 31 cases received conservative treatment only(conservative treatment group). (continue...)
Epinephrine* ; Hemorrhage* ; Hemostasis ; Humans ; Peptic Ulcer* ; Sclerotherapy ; Sodium Chloride ; Ulcer