OBJECTIVE: Among risk factors associated with cerebral infarction, cardiac factors are well known to be very important. However there were only few studies related to correlation between cardiac risk factors and stroke recurrence. So we tried to evaluate cardiac disease as a risk factor of recurrent cerebral infarction. METHOD: Subjects were 118 patients (62 male, 56 female) with cerebral infarction and were divided into first attack group as a control and recurred group. We evaluated the results of transesophageal echocardiographic study and other major risk factors and the results were compared in two groups using X2 test. RESULTS: Control group was 75 patients (39 male, 36 female), and recurred group was 43 patients (23 male, 20 female) and the mean ages were 62.8 years and 66.7 years, respectively. General transesophageal echocardiographic abnormalities were shown in 63 cases (84%) in control group and 40 cases (93%) in recurred group. Among the abnormal transesophageal echocardiographic findings, atherosclerosis of aorta was significantly higher in recurred group (49%) compared to control group (25%) (p<0.05), but there were no significant difference in aortic valve calcification, mitral calcification etc. Among the major risk factors of cerebral infarction, hypertension, diabetes, hyperlipidemia, and alcohol intake showed tendency of high incidence in the recurred group. Patients with abnormal EKG findings concurrent with abnormal transesophageal echocardiographic findings showed in 33 cases (44%) in control group, and 24 cases (56%) in recurred group, but there's no statistical significance. CONCLUSION: Our results do not support the hypothesis that TEE would be able to diagnose the cardiac risk factor for recurred cerebral infarction. However, the prevalence of atherosclerosis of aorta was significantly higher in recurrent group, so further studies would be needed.
Aorta ; Aortic Valve ; Atherosclerosis ; Cerebral Infarction* ; Echocardiography ; Echocardiography, Transesophageal* ; Electrocardiography ; Heart Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Male ; Prevalence ; Recurrence ; Risk Factors* ; Stroke

OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of aerobic exercise program in cardiac patients. METHOD: Twenty patients participated in 6 weeks of aerobic exercise with telemetry monitoring as an outpatient rehabilitation program. For the comparison of physiologic changes, we used graded exercise test (GXT) by means of modified Bruce protocol before and in 6 weeks after aerobic exercise training. Exercise prescription for cardiac rehabilitation was composed of intensity, mode, frequency and duration. By use of EKG telemetry and monitoring of blood pressure and Borg RPE (ratings of perceived exertion) scale, we were monitored patients status during exercise. RESULTS: In six weeks after aerobic exercise training, the hemodynamic and metabolic responses were improved and statistically significant parameters were as follows: exercise time, maximal METs, resting heart rate, maximal heart rate, submaximal rate pressure product, maximal expired volume, maximal oxygen consumption rate and anaerobic threshold. CONCLUSION: We concluded that six week cardiac rehabilitation program is useful and safe to improve the aerobic capacity for cardiac patients.
Anaerobic Threshold ; Blood Pressure ; Electrocardiography ; Exercise Test ; Exercise* ; Heart Rate ; Hemodynamics ; Humans ; Outpatients ; Oxygen Consumption ; Prescriptions ; Rehabilitation ; Telemetry

Thirteen year old boy who had been stabbed in his left chest by the knife was transferred to our department from a general hospital, because of the massive bleeding from the intercostal tube drainage. Chest X-ray showed homogeneous density in the left lung field. He was confused and his vital signs were unstable. He was moved into a operating room as soon as possible. After resuscitation, his lacerated left ventricle wound was sutured through median sternotomy. The interventricular shunt was detected with intraoperative transesophageal echocardiography. The traumatic ventricular septal defect was closed via left ventricle using Dacron patch. His postoperative course was uneventful, and he was discharged with small residual shunt.
Drainage ; Echocardiography ; Echocardiography, Transesophageal ; Heart Septal Defects ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Hemorrhage ; Hospitals, General ; Humans ; Lung ; Male ; Operating Rooms ; Polyethylene Terephthalates ; Resuscitation ; Sternotomy ; Thoracic Injuries* ; Thorax* ; Vital Signs ; Wounds and Injuries

BACKGROUND: The correlation between levels of brain natriuretic peptide (BNP) and the effect of pulmonary resection on the right ventricle of the heart is not yet widely known. This study aims to assess the relationship between the change in hemodynamic values of the right ventricle and increased BNP levels as a compensatory mechanism for right heart failure following pulmonary resection and to evaluate the role of the BNP level as an index of right heart failure after pulmonary resection. MATERIAL AND METHOD: In 12 non small cell lung cancer patients that had received a lobectomy or pnemonectomy, the level of NT-proBNP was measured using the immunochemical method (Elecsys 1010(R), Roche, Germany) which was compared with hemodynamic variables determined through the use of a Swan-Ganz catheter prior to and following the surgery. Echocardiography was performed prior to and following the surgery, to measure changes in right ventricular and left ventricular pressures. For statistical analysis, the Wilcoxon rank sum test and linear regression analysis were conducted using SPSSWIN (version 11.5). RESULT: The level of postoperative NT-proBNP (pg/mL) significantly increased for 6 hours, then for 1 day, 2 days, 3 days and 7 days after the surgery (p=0.003, 0.002, 0.002, 0.006, 0.004). Of the hemodynamic variables measured using the Swan-Ganz catheter, the mean pulmonary artery pressure after the surgery when compared with the pressure prior to surgery significantly increased at 0 hours, 6 hours, then 1 day, 2 days, and 3 days after the surgery (p=0.002, 0.002, 0.006, 0.007, 0.008). The right ventricular pressure significantly increased at 0 hours, 6 hours, then 1 day, and 3 days after the surgery (p=0.006, 0.009, 0.044, 0.032). The pulmonary vascular resistance index [pulmonary vascular resistance index=(mean pulmonary artery pressure-mean pulmonary capillary wedge pressure)/cardiac output index] significantly increased at 6 hours, then 2 days after the surgery (p=0.008, 0.028). When a regression analysis was conducted for changes in the mean pulmonary artery pressure and NT-proBNP levels after the surgery, significance was evident after 6 hours (r=0.602, p=0.038) and there was no significance thereafter. Echocardiography displayed no significant changes after the surgery. CONCLUSION: There was a significant correlation between changes in the mean pulmonary artery pressure and the NT-proBNP level 6 hours after a pulmonary resection. Therefore, it can be concluded that changes in NT-proBNP level after a pulmonary resection can serve as an index that reflects early hemodynamic changes in the right ventricle after a pulmonary resection.
Brain* ; Capillaries ; Catheters ; Echocardiography ; Heart ; Heart Failure ; Heart Ventricles ; Hemodynamics* ; Humans ; Linear Models ; Natriuretic Peptide, Brain* ; Pulmonary Artery ; Small Cell Lung Carcinoma ; Vascular Resistance ; Ventricular Pressure

BACKGROUND: Exercise intolerance is a common symptom of heart failure and has a detrimental impact on the quality of life. Skeletal muscle atrophy has been considered an important contributor to exercise intolerance; however, most studies have been conducted in patients with advanced systolic heart failure. METHODS: We studied 39 ambulatory heart failure patients (age, 77.9+/-6.5; male, 17 [43.6%]) and 39 age and gender-matched, community-dwelling, elderly subjects. Clinical, laboratory, and echocardiographic evaluations were performed. Dual-energy X-ray absorptiometry was performed to assess the body composition. Exercise capacity was measured by a six-minute walk test. Comprehensive geriatric assessments were also performed to evaluate comorbidity, medication, physical function, cognitive function, and nutritional status. RESULTS: Skeletal muscle mass of heart failure patients showed no differences when compared with that of age- and gender-matched control subjects in any part of the body or in the whole body. Although diastolic heart failure patients showed lower levels of skeletal muscle mass than systolic heart failure patients, no significant difference was identified in either systolic or diastolic heart failure patients compared with respective age- and gender-matched control groups. The six-minute walk distances showed no difference between the groups (257.2+/-117.8 m in the diastolic heart failure group versus 302.7+/-109.4 m in the systolic heart failure group, p=0.226). CONCLUSION: Although skeletal muscle mass has been known to be an independent factor associated with exercise capacity in advanced heart failure patients, skeletal muscle mass was not decreased in ambulatory, elderly heart failure patients when comparing age- and gender-matched control subjects.
Absorptiometry, Photon ; Aged ; Atrophy ; Body Composition ; Comorbidity ; Geriatric Assessment ; Heart ; Heart Failure ; Heart Failure, Diastolic ; Heart Failure, Systolic ; Humans ; Male ; Muscle, Skeletal ; Quality of Life

Multiple endocrine neoplasia (MEN) is a combination of endocrine tumor associations and consists of 3 types: 1, 2A and 2B. Herein, we report a case of insulinoma which is combined with pheochromocytoma discovered at the left adrenal gland which was treated by surgical resection. We think there is a possibility of a new type of multiple endocrine neoplasia (MEN).
Adrenal Glands ; Insulinoma* ; Multiple Endocrine Neoplasia ; Pheochromocytoma*

BACKGROUND: It is very important to determine the surgical anatomy of the aortic root when performing spreading aortic root preserving heart surgery. This study focuses on the surgical aspect of the aortic root anatomy by performing dissection of Korean cadavers. MATERIAL AND METHOD: The subjects were 62 cadavers. We measured the intercommissural distances, heights of the sinuses and the circumference of the sinotubular junction and the aortic annulus. RESULT: The mean age of death was 61.3 years. The intercommissural distance for the right coronary sinus was 0.73+/-2.23 mm, that for the non coronary sinus was 19.34+/-2.03 mm, and that for the left coronary sinus was 18.58+/-2.15 mm. The height of sinus was 20.59+/-2.48 mm for the right coronary sinus, 18.61+/-2.26 mm for the non coronary sinus and 17.95+/-19 mm for the left coronary sinus. The circumference of the sinotubular junction was 70.73+/-5.94 mm and that of the aortic annulus was 77.94+/-5.63 mm. There is no correlation between age and STJ, aortic annulus and the ratio of STJ of aortic annulus respectively (p=0.920, p=0.111, p=0.073). The tilting angle of the sinotubular junction and aortic annulus is from 2.03 degrees to 7.77 degrees (mean=4.90 degrees). CONCLUSION: The intercommissural distance and the height of the sinus were largest in the right coronary sinus, and the position of the sinotubular junction to the aortic annulus is obliquely tilted levo-posteriorly.
Aortic Valve ; Cadaver ; Coronary Sinus ; Sinus of Valsalva ; Thoracic Surgery

BACKGROUND: Extubation failure was associated with poor prognosis and high hospital mortality. Cuff leak test (CLT) has been proposed as a relatively simple method for detecting laryngeal obstruction that predispose toward postextubation stridor (PES) and reintubation. We examined the risk factors of extubation failure and evaluated the usefulness and limitation of CLT for predicting PES and reintubation. METHODS: Thirty-four consecutive patients intubated more than 24 hours were examined. The subjects were evaluated daily for extubation readiness, and CLT was performed prior to extubation. Several parameters in the extubation success and failure group were compared. The accuracy and limitation of CLT were evaluated after choosing the thresholds values of the cuff leak volume (CLV) and percentage (CLP). RESULTS: Of the 34 patients studied, 6 (17.6%) developed extubation failure and 3 (8.8%) were accompanied by PES. The patients who had extubation failure were more likely to have a longer duration of intubation and more severe illness. The patients who developed PES had a smaller cuff leak than the others: according to the CLV (22.5+/-23.8 vs 233.3+/-147.1ml, p=0.020) or CLP (6.2+/-7.3 vs 44.3+/-24.7%, p=0.013). The best cut off values for the CLV and CLP were 50ml and 14.7%, respectively. The sensitivity, negative predictive value, and specificity of CLT were relatively high, but the positive predictive value was low. CONCLUSION: The likelihood of developing extubation failure increases with increasing severity of illness and duration of intubation. A low CLV or CLP (<50ml or 14.7%) is useful in identifying patients at risk of PES, but the CLT is not an absolute predictor and should not be used an indicator for delaying extubation.
Hospital Mortality ; Humans ; Intubation ; Prognosis ; Respiratory Sounds* ; Risk Factors*

BACKGROUND: A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. METHODS: Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia (PaO2/FIO2 ratio Anoxia* ; Bronchoalveolar Lavage* ; Bronchoscopes ; Continuous Positive Airway Pressure* ; Gases ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Masks ; Mouth ; Oxygen ; Respiratory Insufficiency ; Ventilators, Mechanical ; Vital Signs

BACKGROUND: A bronchoalveolar lavage(BAL) is useful in diagnosing the etiology of bilateral pulmonary infiltrations, but may worsen the oxygenation and clinical status in severely hypoxemic patients. This study assessed the safety and efficacy of the continuous positive airway pressure(CPAP) using a conventional mechanical ventilator via a face mask as a tool for maintaining the oxygenation level during BAL. METHODS: Seven consecutive patients with the bilateral pulmonary infiltrates and severe hypoxemia (PaO2/FIO2 ratio Anoxia* ; Bronchoalveolar Lavage* ; Bronchoscopes ; Continuous Positive Airway Pressure* ; Gases ; Humans ; Hydrogen-Ion Concentration ; Intubation ; Masks ; Mouth ; Oxygen ; Respiratory Insufficiency ; Ventilators, Mechanical ; Vital Signs