It would seem logical that a left to right shunt may be localized to that chamber in which an increase in oxygen content beyond the normal variation is first seen, while this is generally true, there are certain limitations to such direct diagnostic interpretation. The interpretation of an observed difference in oxygen content is influenced by the result of extremely poor mixing or of a change in respiratory, circulatory or metabolic steady states. This is one of the major challenges to proper interpretation. The purpose of this study was to analyze the blood oxygen content in various chambers of the right side of the heart in patients without shunt and to study the difference in oxygen content between the various chambers. The right heart catheterization was performed in 19 cardiac patients without shunt in Cardiac Laboratory in Hospital. 1. The blood oxygen content was 12.36+/-2.23 volume per cent (mean+/-standard error) in superior vena vava, 12.59+/-2.23 volume per cent in inferior vena cava, 12.59+/-2.23 volume per cent in mid-right atrium, 12.92+/-1.90 volume per cent in mid-right ventricle and 12.26+/-2.13 volume per cent in main pulmonary artery. 2. The mean difference of oxygen content was 0.16 volume per cent between superior vena cava and right atrium, 0.08 volume per cent between right atrium and right ventricle, and 0.06 volume per cent between right ventricle and main pulmonary artery.

The study was conducted to determine the lateral tibio-articular angle of ankle joint in 100 korean adults(160 cases) ranging from second to eight decades of age. The authors have defined as the lateral tibio-articular angle of ankle joint, that is the sharp angle between the lateral tibial axis which is the lateral longitudinal line through each midpoints of the upper and lower one third of the tibia, and the line to connect the anterior and posterior tips of the tibial articular surface of ankle joint. 1. It was 79.3°±3.4°in all cases. 2. It was 79.2°±3.6°in male and 79.6°±2.7°in female. It was reduced in male approximately 0.4°compared with female. 3. It was 79.1°±3.1°in the left side and 79.5°±3.6°in the right side. It was reduced approximately 0.4°in the left side compared with the right side. 4. It was reduced approximately 0.9°in the left side compared with both sides of the same person.
Adult ; Ankle Joint ; Ankle ; Female ; Humans ; Male ; Statistics as Topic ; Tibia

Recently the syndrome of mitral valve prolapse with associated auscultatory and other clinical findings has generated considerable interest. Although this syndrome was originally described as benign, more recent observations have demonstrated that the patients are subject to sudden death, life threatening arrhythmias, bacterial endocarditis or hemodynamically significant mitral regurgitation. It is therefore important to identify such patients so that appropriate antibiotic prophylaxis and antiarrhythmic therapy may be instituted. Since earlier reports of this syndrome by Barlow et al. in 1963, various names or descriptions have been applied to the condition based upon pathologic findings, on cinical investigators has stressed different aspects of the entity. Now it is well known that the syndrome is no longer a benign condition. We have recently had the opportunity to study 15 cases of mitral valve prolapse, which was confirmed by left ventricular cineangiography. Among them 9 cases had associated other cardiac anomalies, most frequently secundum type of atrial septal defect. Among 15 cases 8 were female and the ages ranged from 20 to 52. Selective cine-coronary arteriography was also performed in 2 cases who complained of severe chest pain. We discussed generally the clinical features including hemodynamic and angiocardiographic findings, and pertinent literature published until recently were reviewed.
Female ; Humans

Electrocardiography has been long an important tool in cardiac diagnosis and, with advances in electrocardiography, the accuracy of the electrocardiographic diagnosis has been greatly increased. Though the most accurate methods for quantitative diagnosis of mitral valvular disease are cardiac catheterization and ventriculography, these procedures are time consuming, expensive, and not without risk, thus, it would be helpful if routine catheterization of the heart could be avoided in patients who are potential condidates for mitral valvulotomy. This could be done if reliable electrocardiographic criteria could be found for estimating the amount of obstrcution and leak at the mitral valve. As mitral valvular dysfunction progress, changes (hypertrophy and/or dilation) in the left atrium and both ventricles are inevitable. Many authors attempted to characterize the electrocardiographic findings of such changes according to the specific lesion of the mitral valve. In addition to atrial fibrillation, characteristic P wave changes and their diagnostic significance have been reported (Macruz et al., 1958; Arevalo et al., 1963: Morris et al., 1964). The diagnostic importance of QRS voltage difference in precordial leads has been stressed in the differential diagnosis of specific lesions of mitral valvular disease (Janton et al., 1954: Bateman and January, 1955: Wierum and Glenn, 1957: Bentivoglio et al., 1958: Imperial et al., 1960). Semle and Pruitt(1960) reported that a mean QRS electrical axis of +91degrees or more degrees was the most frequent positive single index of increased total pulmonary resistance in mitral stenosis, and Fowler et al. (1955) stated that precordial lead V1 was very helpful in evaluating the degree of pulmonary hypertension. In Korea there are only a few reports on the electrocardiographic changes in mitral valvular disease and the correlation of electrocardiographic findings and hemodynamics (Oh et al., 1961: Kim, 1970: Kim, 1971). It would be evident that the various electrocardiographic findings noted in western races can't be applied to Koreans. The main objectives of this study are: 1. To determine the electrocardiographic characteristics of pure mitral valvular disease and the differentiation between the specific lesions of pure mitral stenosis, pure mitral insufficiency and combined lesions of mitral stenosis and insufficiency. 2. To know whether the characteristic electrocardiographic changes of mitral stenosis are directly related to the narrowed valve area or to the hemodynamic abnormalities secondary to obstruction. SUBJECTS AND METHODS: 139 cases of isolated mitral valvular disease were reviewed: of these 93 were cases of pure mitral stenosis, 18 were pure mitral insufficiency, and 28 were combined mitral stenosis and insufficiency. Of the total patients, 68 were male and 71 were female. The ages ranged from 10 to 54 years with an average of 35.6 years. Diagnosis was based on cardiac catheterization and supplemented by cienangiocardiography. The conventional 12 lead electrocardiogram was taken at normal sensitivity and at a paper speed of 25mm/sec. The mitral valve area was estimated according to the Gorlin's formula and cardiac output was determined by the direct Fick's principle. The electrocardiograms were analyzed with respect to: 1. Rhythm (atrial fibrillation and sinus rhythm) 2. Presence or absence of P-mitrale 3. Terminal P force in lead V1 (by the method of Morris et. al., 1964) 4. Mean QRS electrical axis in frontal plane 5. QRS voltage in percordial leads(V1S, V5R, V6R & V1S+V(5-6)R) 6. R/S ratio in lead V1 7. Conduction disturbance of right bundle branch block In patients with pure mitral stenosis the electrocardiographic findings of atrial fibrillation P-mitrale, terminal P force in lead V1 were correlated with the hemodynamic data of mean pulmonary artery pressure, mean pulmonary arterial wedge pressure and mitral valve area. An attempt was made to ascertain whether or not a quantitative correlation could be found. A patient showing electrocardiographic pattern of right bundle branch block was excluded in the evaluation of QRS voltage in lead V1 and mean QRS electrical axis in frontal plane. RESULTS AND SUMMARY: 1. P wave abnormality, which was noted in most (131/139) cases, is apparently a characteristic and most frequent electrocardiographic finding in mitral valvular disease. Of the P weve abnormalities the development of atrial fibrillation and P-mitrale were thought to be related to the duration of the illness rather than to the types of lesion or hemodynamic abnormalities secondary to valvular dysfunction. However, the terminal P force in lead V1 was thought to be related to the mean pulmonary arterial wedge pressure rather than to narrowing of the valve. 2. 15 patients showed the electrocardiographic pattern of right bundle branch block. In patients with mitral stenosis this electrocardiographic pattern was noted at almost all levels of mean pulmonary artery pressure, mean pulmonary arterial wedge pressure, mitral gradient and mitral valve area. 3. Mean QRS electrical axis and QRS voltage in precordial leads; There was no case which deviated leftward more than +30degrees even among cases with a predominant or pure mitral insufficiency. Although the difference of mean value in mean QRS electrical axis and QRS voltage in precordial leads according to the types of the lesion was significant, this difference was generally not helpful in the differential diagnosis in individual patients because of much overlapping among cases. 4. There was no definite electrocardiographic criteria to differentiate clearly the types of mitral valvular disease. However, the following aspects of electrocardiogram may be useful in differential diagnosis. a. Difference of QRS voltage in precordial leads: The volage of V1S and V1S+V(5-6)R in all patients with pure mitral insufficiency was over 1mm and 11mm respectively. That of V1S+V(5-6)R in all patients with pure mitral stenosis was below 39mm. b. R/S ratio in lead V1: There was no case showing "R wave only" in lead V1 among patients with pure or predominant mitral insufficiency. c. Mean QRS electrical axis in frontal plane: The mean QRS electrical axis of all patients with pure mitral stenosis deviated rightward more than +60degrees in all except one case. None of the patients with pure mitral insufficiency deviated rightward more than +110degrees. 5. Relationship between hemodynamics and electrocardiography in paitents with mitral stenosis: Among the hemodynamic abnormalities, mean pulmonary artery pressure showed a close relationship with the following aspects of the electrocardiogram. a. R/S ratio in lead V1:The mean value of mean pulmonary artery pressure (45.9+/-3.8mmHg) in groups showing R/S>1 was significantly elevated as compared with that (34.8+/-1.5mmHg) of groups showing R/Sdegrees1. b. Mean QRS electrical axis in frontal plane: There was a weak positive correlation (r=+0.53) between mean pulmonary artery prersure and QRS electrical axis in the frontal plane. The QRS axis of all patients with a mean pulmonary artery pressure of 41mmHg or more was +91degrees or more except for one case. c. Terminal P force in lead V1: The difference of mean value in mean pulmonary artery pressure according to the size of terminal P force in lead V1 was significant in all cases.
Atrial Fibrillation ; Axis, Cervical Vertebra ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Catheterization ; Catheters ; Continental Population Groups ; Diagnosis ; Diagnosis, Differential ; Electrocardiography* ; Female ; Heart ; Heart Atria ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Korea ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Artery ; Pulmonary Wedge Pressure

BACKGROUND: Some research viewed that effective dietary therapy was enough to control proper blood glucose level, but in the most patient, dietary therapy was not practiced and the most difficult part of managing their diabetes. The purpose of this research study was to investigate dietary practice adherence and perceived barriers among the elderly diabetes. METHODS: The survey was mailed to 852 persons with diabetes member via diabetic educator of 156 hospitals or clinics and 24 health centers. Questionnaire had background information of patients, meal regularity, food intake as a dietary practice adherence, barriers of 36 items which have 3 areas such as motive/attitude, knowledge, authority/resource. We asked the person with diabetes to rate barrier to dietary practice adherence. 432 questionnaire were returned the response. we selected 69 persons who were over 65 year old. RESULTS: 1) meal regularity was more satisfactory than food intake. 2) deficit of meal regularity were evening snack and resonable spacing between evening meal and evening snack. 3) deficit of food intake was serving of milk. 4) main barrier to dietary practice adherence was that of knowledge. CONCLUSION: For practice effectively dietary therapy to elderly diabetes, individual consultation or small group education must be pursued and more easily educational skills should be required.
Aged* ; Blood Glucose ; Eating ; Education ; Humans ; Meals ; Milk ; Postal Service ; Surveys and Questionnaires ; Snacks

No abstract available.
Androgen-Insensitivity Syndrome* ; Male

Aortic regurgitation is a common valvular heart disease, usually the result of rheumatic fever, or syphilis, and rarely of congenital origin. It is frequently associated with other valvular heart disease, especially mitral valve disease. It can be diagnosed by the presence of pulse pressure widening, a Corrigan pulse, and an early decreascendo diastolic murmur at the left sternal border between the second and third intercostal spaces. After the clinical application of cineaortography in the diagnosis of valvular disease, Segal et al (1964) first reported rheumatic aortic regurgitation without an audible murmur in patients having mitral valve disease. The importance of discovering aortic reguritation in patients with predominent mitral disease has begun to be appreciated recently, especially as commisurotomies for the relief of mitral stenosis are performed more frequently. Nowadays eventhough the severity of aortic regurgitation is often not evident preoperatively, aortic regurgitation can become very evident when mitral stenosis is relieved. This study was comprised of seventeen patients with silent aortic regurgitation which was confirmed by cineaortography at Severance Hospital from January, 1970 to August, 1976. 1. Of the seventeen patients, 12 patients were associated with mitral stenosis, 4 with mitral steno-insufficiency, and 1 with mitral insufficiency. 2. Silent aortic regurgitation was suggested from the accompanying clinical features such as chest pain, apical heaving, and left ventficular hypertrophy pattern on both roentgenogram of the chest and electrocardiogram. 3. The severity of the aortic regurgitation was mild to moderate; 7 of the 17 patients being grade I, and 10 patients being grade II on cineaortogram.
Aortic Valve Insufficiency* ; Blood Pressure ; Chest Pain ; Diagnosis ; Electrocardiography ; Heart Murmurs ; Heart Valve Diseases ; Humans ; Hypertrophy ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Rheumatic Fever ; Syphilis ; Thorax

Isolated pulmonary stenosis, a relatively common congenital anomaly that accounts for about 10 percent of all congenital heart disease, is characterized by stenosis of pulmonary valve itself, infundibulum or both of them. Since cardiac catherterization was applied to man by Cournand and Ranges, pulmonary stenosis had been easily diagnosed and many clinical studies had been investigated. It has a wide clinical spectrum depending on the degree of stenosis. The electrocardiogram, phonocardiogram and chest X-ray have proved useful in estimating the severity of hemodynamic facotrs in individual cases. This series comprises 47 cases in whom the clinical diagnosis of isolated pulmonary stenosis was confirmed by right heart catheterization with cardiac cineangiography at Severance Hospital, Yonsei University. An attempt was made to correlate the electrocardiographic, phonocardiographic, chest X-ray findings, and types of stenosis with the hemodynamic data in these cases. 1. Of 47 patients, 33 were male and 14 female. Their ages ranged from 2 to 42 years: the mean age was 19.1 years. 2. The incidence was 5.9 percent of all 797 catheterized congenital heart disease cases. The pulmonary valvular stenosis was 30 (68.3%), infundibular 7 (14.6%) and combined 10 (21.6%) cases. 3. The correlation between electrocardiogram and hemodynamic data were as follows. i) The regression equation between right ventricular sysytolic pressure (RVSP) and height of R wave in V1 lead (RV1) was RVSP=3.32 RV1+48.2: its correlation coefficient was 0.818 and it was very significant (p=0.000). ii) The higher the RVSP, the more the frontal axis of QRS complex shifted to the right side (r=0.55. p=0.001). iii) The RVSP of the groups with positive ECG findings such as p-pulmonale, right ventricular hypertrophy or right ventricular strain were much higher than the RVSP of the groups without such findings (p=0.032.0.000, 0.000). iv) The group with RV1 higher than 20 mm showed much more elevated mean of RVSP than the group with lower RV1 (p=0.000). v) The groups with the above mentioned positive ECG findings showed good correlation with the severity of RVSP which was arbitrarily classified as 49 or less, 50~100, and 100 mmHg or more (chi-square=8.96, 26.69, 19.06; p=0.011, 0.000, 0.000). 4. The group with late occurrence of the maximum intensity of the ejection systolic murmur showed higher mean of RVSP than the group with early peak of the murmur (p=0.014). 5. The means of RVSP of the groups with chest X-ray findings such as decreased pulmonary vascularity, were much higher than the means of RVSP of the groups without such findings (p=0.000, 0.005, 0.015). The groups with above mentioned positive chest X-ray findings showed good corelations with the severity of RVSP which was classified as above limits (chi-square=7.55, 10.94, 13.36; p=0.022, 0.004, 0.001). 6. Combined pulmonary valvular and infundibular stenosis showed more severe systolic pressure gradient and higher mean of RVSP than the isolated types (p=0.000).
Axis, Cervical Vertebra ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Electrocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics* ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Pulmonary Valve ; Pulmonary Valve Stenosis* ; Systolic Murmurs ; Thorax

Aflatoxin B1 (AFB1), a fungal toxin produced by Aspergillus flavus, is known to be a possible hepatocarcinogen. But the molecular biologic changes which may occur following exposure to AFB1 are not known and thus the carcinogenesis is not yet understood. This study was performed to examine the expressions of c-myc, c-fos and TGF-alpha genes and to investigate the possible role of those molecular biologic changes in hepatic regeneration and in the development of hepatocellular carcinoma (HCC). Sprague-Dawley rats were divided into 3 groups: Carbon tetrachloride (CCl4) only was administered to group I, AFB1 only was administered to group II and a combination of AFB1 and CCl4 was administered to group III. The animals were sacrificed at 0.5, 1, 2, 6, 12, 24, 48, and 72 hours after treatment. In addition to the examination of the hematoxylin-eosin stained sections, hepatic regeneration and apoptosis were analyzed quantitatively by bromodeoxyuridine (BrdU)-anti-BrdU immunohistochemistry and TUNEL assay utilizing apoptosis kit, respectively. The hepatic expressions of c-myc, c-fos and transforming growth factor-alpha (TGF-alpha) were examined by immunohistochemistry and studied by Western blot. The number of BrdU labelled cells and the degree of necrosis/apoptosis were comparable among the different groups. Livers of the group II rats showed nearly normal histology without regeneration and necrosis/apoptosis. In groups I and III, the number of BrdU- labelled cells showed an increase at 48 hours after treatment, and the increment was significantly higher in group I than in group III. Most BrdU-labelled cells were mature hepatocytes in group I, whereas in group III they appeared to be less mature. In group I, apoptosis showed an increase at around 24 hours, but appeared in group III as early as 12 hours after treatment and persisted through 48 hours. The expression of c-myc and c-fos were also different between the experimental groups. The expression intensity of c-myc in group I was highest at 1 hour and decreased thereafter. In groups II and III, the expressions were much more intense than in group I, except at 1 hour, and the increased intensity persisted throughout the experiment. Group II in particular showed a peak intensity at 30 minutes and at 6 hours after treatment. In group I, c-fos was strongly expressed only at 24 hours, but in group III, there was progressively increased expression with peak intensity at 24 hours. TGF-alpha was expressed in similar intensities in all groups throughout the experiment. These results suggest that AFB1 may evoke an intense and protracted expression of c-myc, provocating the CCl4-induced necrosis of hepatocytes, and a prolonged expression of c-fos, including persistent signals for regeneration which in turn may activate the replication of immature cells. These findings will aid further investigation of molecular biologic and histologic characteristics of the hepatotoxic and hepatocarcinogenic mechanism of AFB1 in rats. And these results in rats, together with clinico-epidemiologic and molecular biologic investigations in humans and other animals, suggest that AFB1 may supply hepatocarcinogenic background in early exposure time in AFB1-contaminated areas of China and Korea.
Aflatoxin B1/pharmacology* ; Animal ; Carbon Tetrachloride ; Carcinogens/pharmacology* ; Gene Expression/drug effects* ; Genes, Immediate-Early/drug effects* ; Liver Diseases/metabolism* ; Liver Diseases/genetics* ; Liver Diseases/chemically induced ; Male ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor alpha/metabolism*

The ventricular septal defect with aortic insufficiency is a relatively uncommon congenital heart disease. Once the prolapse of aortic cusp complicates the ventricular septal defect, the prolapse of the aortic cusp is a progressive, rather than static lesion. With the curent possibility of surgical correction in cases of ventricular septal defect and other abnormalities, the differential diagnosis assumes marked importance. vTwo cases of ventricular septal defect with aortic insufficiency are presented with a review of pertinent literature. These young female patients had long standing palpitation and dyspnea on exertion since childhood. The physical examination showed with pulse pressure, bounding carotid pulsation and a systolic ejection-type murmur and a decrescendo diastolic murmur at the upper left sternal border, which simulated "machinery" type murmur of patent ductus arteriosus. The ventricular septal defect with aortic insufficiency was demonstrated by cardiac catheterization and cineangiocardiography.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis, Differential ; Ductus Arteriosus, Patent ; Dyspnea ; Female ; Heart Defects, Congenital ; Heart Murmurs ; Heart Septal Defects, Ventricular* ; Humans ; Physical Examination ; Prolapse