Cerbral embolism in the patient with rheumatic heart disease is a serious complication and has poor prognosis. In view of the abundance of rheumatic heart disease in Korea, a retrospective clinical study was done on 49 cases of cerebral embolism with rheumatic heart disease admitted to Severance Hospital from 1970 through 1977. The resultls were as follows; 1. The age distribution of the 49 patients ranged from 20 to 70 years and the mean age was 48.7 years. Twenty-five patients, more than half of the total number, were in their 5th and 6th decades, and the peak of the incidence was in the 6th decade. Male to female ratio was 1:1.3. 2. Mitral stenosis was by far the most predominant valvular lesion representing 33 of the 49 cases, and 25 of the 33 patients had "pure" mitral stenosis. Mitral valve involvement represented 43 of the 49 cases. 3. Seventeen of the total 49 cases were in regular sinus rhythm whereas 32 of the 49 were in atrial fibrillation at the time of admission. 4. Twenty-two of the 49 patients expired during the hospitalization whereas only six made complete recovery and the other 21 made variable degrees of recovery. The anticoagulant treatment did not appear to make any significant difference in the mortality probably due to inadequacy of timing, completeness and followup.
Age Distribution ; Atrial Fibrillation ; Embolism ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Intracranial Embolism* ; Korea ; Male ; Mitral Valve ; Mitral Valve Stenosis ; Mortality ; Prognosis ; Retrospective Studies ; Rheumatic Heart Disease*

To determine factors involved in left ventricular aneurysm formation after transmural anterior myocardial infarction, 74 patients with a first myocardial infarction who underwent cardiac catheterization within 6 weeks of infarction were evaluated.Patients were divided into four groups depending on the status of the left anterioe descending artery(LAD) and the presence Group I(n=15);aneurysm with occluded LAD, Group II(n=16);no aneusrysm and occluded LAD, Group III(n=18);aneusrysm and patent LAD, and Group IV(n=25);no aneusrsm with patent LAD. Neither age, sex nor risk factors for coronary disease correlated with aneusrysm formation,but the duration of chest pain in patients with previous angina was significantly longer in group II(no aneusrysm with occluded LAD) compared with other groups(P<0.01). Single vessel disease was more commom in Group I and III(aneusrysm) compared with II and IV(no aneusrysm)(P<0.06). Collateral blood supply was more frequently observed in Group I and II(occluded LAD) compared with Group III and IV(patent LAD)(P<0.01) and was slightly less in Group I(aneusrysm) compared with Group II(no aneusrym)(P<0.07). Delta area decreasing rate of the left ventricle was significantly lower in Group I and III(aneusrysm)compared with Group II and IV(no aneusrysm)(P<0.01). Single vessel disease in assocition with poor collateral circulation tends to be a determinant of left ventricular aneusrysm formation after anterior myocardial infarction.
Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Collateral Circulation ; Coronary Disease ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction* ; Risk Factors

A study of effect of local hypothermia upon the spinal cord was performed in cats. With a cuff, a cooler, to which was attached connecting tubes to a refrigerator, the experimental technique was deviced to cool the spinal cord locally at midthoracic level. Cold liquid, saline at a temperature of +/-1.1 degrees C, was circulated in closed system through the tubing into the cuff which was snugly rested on the dorsal surface of the spinal cord as a heat exchanger. The temperatures were measured with thermocouples at various sites in the spinal cord before, during, and after the cooling every two minutes upto twenty minutes. In the cord underneath the cuff, the mean precooling temperature of 35.4 degrees C in normal control group was lowered to 11.0 degrees C during the first two minutes of cooling. After this in initial rapid drop in temperature, there was a further gradual reduction of 4.5 degrees C upto 20 minutes cooling to be 6.5 degrees C. The lowest mean temperatures recorded throughout cooling were 4.3 degrees C at dorsal surface and 6.9 degrees C at center of the cord. And the temperature lowering was nearly not noted beyond the cord 1 cm apart from an edge of cuff in rostral and caudal directions. For comparison, the temperature in the cord that had not been injured was also measured. The rate of cooling in the cord underneath the cuff seemed to be faster than in the control group of animal in which the cord was not injured. Another design of this experiment was an evaluation of the protective effect of local hypothermia with respect to cord edema and injury associated cord hemorrhage. Immediately after intravenous administrations of fluorescin the spinal cords were contused with impaction injury. These injured cords were removed ar different time intervals after trauma, and spread or distribution of fluorescin in frozen sectioned specimens was observed under ultraviolet illumination with fluorescence microscope. In all cooling groups, pathological pictures were reduced in its degree and extent more than those in the control group, and that, earlier the cooling after the injury to the cord, better the result was outcome. It would be well to say that local hypothermia might be within the margin of safety and beneficial in the management of spinal cord injury in this experiment.
Administration, Intravenous ; Animals ; Cats ; Edema ; Fluorescence ; Hemorrhage ; Hot Temperature ; Hypothermia* ; Lighting ; Spinal Cord Injuries ; Spinal Cord*

BACKGROUND: Since the nonsurgical treatment of mitral stenosis using a single balloon has been introduced by Inoue et al. in 1984. percutaneous mitral valvuloplasty has became an accepted therapeutic modality for selected patients with mitral stenosis. Zeibag et al. demonstrated the double balloon technique showed a better outcome than the single balloon in obtainning the optimal mitral valve area. On the other hand, there are several reports that single balloon technique was comparable with the double balloon technique. Therefore, there are still controversies in efficacy, benefit and complications between balloon techniques. METHOD: To compare the efficacy and complications of percutaneous mitral valvuloplasty with the double balloon or the Inoue balloon technique, 40 patients were studied consecutively by random method in selecting the balloon technique. RESULTS: In all cases, percutaneous mitral valvulopasty was performed successfully. Optimal outcome defined as mitral valve area larger than 1.5cm2 was obtained in 12 cases out of 16(75%) in double balloon group and 15 out of 24(63%) in Inoue balloon group(p=NS). Mitral valve area was significantly increased after valvulopasty in both technique but there was no different between both groups(Mean+/-SD ; 0.9+/-0.3 to 1.7+/-0.2 vs 0.9+/-0.2 to 1.9+/-0.2cm2). There were also hemodynamic improvement significantly in mean mitral gradient(MG). pulmonary artery pressure (PAP) and left atrial pressure(LAP) after PMV but there were no difference between groups (18+/-8 to 7+/-2 vs 21+/-13 to 9+/-4 mmHg for MG. 29+/-12 to 22+/-9 vs 28+/-9 to 18+/-5mmHg for PAP and 22+/-8 to 11+/-5 vs 21+/-6 to 11+/-4 for LAP respectively). Mitral requrgitation greater than grade 2 occurred in 2 cases of the double balloon group and one case of the Inoue balloon group(p=NS). New development of atrial shunt was found in 3 cases in both groups. CONCLUSIONS: The double and Inoue balloon techniques were quite comparable in immediate outcome and complications.
Hand ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Prospective Studies* ; Pulmonary Artery

Balloon angioplasty of stenosis involving a bifurcation of coronary arteries carries a significant risk of iatrogenic permanent occlusion of one of the adjacent branches. In order to prevent this complication, kissing balloon technique, inhitially, used for aortoplasty in Leriche synrome, was introduced into coronary angioplasty. Alternatively Oesterle described the single-guide, two-wire technique which is less traumatic with nearly equal outcomes. Among 200 coronary angioplasty cases done in our laboratory, 3 cases of unstable angina pectoris with stenosis involving major bifurcation sites were encountered. In 2 cases with stenosis involving left anterior descending artery and diagonal branch, kissing balloon technique was performed. Single-guide, two-wire technique was performed in remaining 1 case with stenosis of posterior descending and posterior lateral branchs. The outcome were successful without major complications.
Angina, Unstable ; Angioplasty* ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Vessels

PURPOSE: We performed this study to evaluate the usefulness and the limitation of magnetic resonance angiography in imaging portal vein and hepatic vein. MATERIALS AND METHODS: Magnetic resonance portography was performed in five normal subjects and seven patients with hepatomas, two patients with Budd-Chiari syndromes, one patient with liver cirrhosis and one patient with hepatic metastasis from stomach cancer. Magnetic resonance angiography was done with a 1.5-T Scanner. Breath-hold two-dimensional time-of flight images with spoiled gradient echo technique were acquired. Scan parameters were 34/8/40degrees(TR ms/TE ms/flip angle). The portal vein and the hepatic vein were selectively imaged by applying two presaturation bands. These images were then postprocessed by a maximum intensity projection algorithm. MRA findings were compared with ultrasonography in all cases of the hepatic disease, and conventional angiography (SMA portography) in four cases. RESULTS: In normal subjects, the splenic vein, intrahepatic and extrahepatic portions of the portal vein, and the hepatic veins were well visualized. In the patients with hepatic diseases, the varices (4 cases), the splenorenal shunts (2 cases), and the recanalized umbilical vein (1 case) were demonstrated. There were portal vein thrombosis in the cases of hepatomas and hepatic metastasis. In the cases of Budd-Chiari syndrome, the hepatic veins were not visualized and there were inferior vena cava obstructions with multiple collateral vessels. CONCLUSION: Compared with ultrasonography, MRP may be useful in evaluation of varices, splenorenal shunts, and other collaterals, though less accurate than conventional angiography. MRP can be useful as a noninvasive screening alternative in the evaluation of portal vein and hepatic veins.
Angiography ; Budd-Chiari Syndrome ; Carcinoma, Hepatocellular ; Hepatic Veins ; Humans ; Liver Cirrhosis ; Magnetic Resonance Angiography ; Mass Screening ; Neoplasm Metastasis ; Portal Vein ; Portography* ; Splenic Vein ; Splenorenal Shunt, Surgical ; Stomach Neoplasms ; Ultrasonography ; Umbilical Veins ; Varicose Veins ; Vena Cava, Inferior ; Venous Thrombosis

We evaluated the hypolipidemic effect and adverse reaction of Lovastatin, HMG-CoA reductase inhibitor 20 to 40mg once-daily in the evening, in 20 patients with primary hypercholesterolemia for 12 weeks and the following results were obtained. 1) Lovastatin significantly reduced the total cholesterol(from 264.8+/-12.9mg/dl to 195.3+/-31.3mg/dl) by 26.3%, TG(from 191.1+/-41.5mg/dl to 156.2+/-52.9mg/dl) by 18.3%, LDL-C(from 177.0+/-12.4mg/dl to 121.3+/-19.6mg/dl) by 31.5% and increased th HDL-C (from 39.8+/-4.2mg/dl to 41.6+/-5.0mg/dl) by 4.5% at the end of 12th week. 2) The adverse reaction during the period of study were limited to diarrhea and nausea in one patient, dryness of skin and itching in one patient, and no patients was withdrawn form therapy. In this study, Lovastatin was well toterated and effective agent for the treatment of hypercholesterolemia without serious side effects.
Diarrhea ; Humans ; Hypercholesterolemia* ; Lovastatin ; Nausea ; Oxidoreductases ; Pruritus ; Skin

Anomalous origin of coronary artery is a relatively rare disordes which is often associated with hypertension and valvular geart desease and in some instances lead to sudden death.Among 1,100 patients who underwent diagnosis coronary angiography at Yonsei Uiversity Medical Center, severance hospital, we found 2 patients with anomalous aortic origin of coronary arteries.In one patient, single coronary artery originated from ascending aorta 1.5cm above the left aortic sinus and in another patient, the origin of the orifice of the right coronary artery separately from the left aortic sinus.
Aorta ; Coronary Angiography ; Coronary Vessels* ; Diagnosis ; Humans ; Hypertension ; Sinus of Valsalva

To evaluate the antihypertensive effects of serotonin antagonist, ketanserin, a daily dosage of 10~40mg (18.9+/-6.8 mean+/-SE) was administered to 22 patients with essential hypertension and aged 55??1 years (64+/-7.7 mean+/-SE) for 12 weeks. After 12 weeks of ketanserin treatment mean blood pressure decreased from 177.9+/-11.9 to 15.7+/-15.3mmHg in systole and from 104.2+/-7.4 to 88.4+/-7.9mmHg in diastole (P<0.001). There was no significant change in heart rates with ketanserin treatment. The antihypertensive treatment with ketanserin was effective in 18 patients(81.8%) and ineffective in 4 patients (18.2%). Adverse reactions such as drowsiness (8.7%), edama (4.3%) and weakness (4.3%) were noted, but all were mild and transient. This results suggest that ketanserin is an effective and safe antihypersive agent in the treatment of essential hyperension.
Aging* ; Blood Pressure ; Diastole ; Heart Rate ; Humans ; Hypertension* ; Ketanserin* ; Serotonin ; Sleep Stages ; Systole

Percutaneous mitral ballon vavuloplasty(PMV) using the double-ballon technique was performal in a 48 year old female patient with recurrent mitral stenosis 16 years after surgical open mitral commissurotomy. PMV resulted in an increase in mitral valve area by Gorlin's method from 0.9 to 2.2 cm2, a decrease in mean mitral diastolic pressure gradient from 30 to 17 mmHg, and an increase in cardiac output from 4.7 to 5.5 L/min. There was no evidene of significant left to right shunt through the atrial septal punture site PMV. After PMV minimal grade 1 mitral regurgutation developed. Mitral ballon valvuloplasty can be performed effectively and safely in selected patients with restenosis after surgical commissurotomy.
Blood Pressure ; Cardiac Output ; Female ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Stenosis