BACKGROUND: Thromboembolism is the major complication in patients with the insertion of cardiac prosthetic valves. The purpose of this study is evaluate the risk factors about the formation of left atrial thrombi after cardiac valve replacement. METHOD: Transesophageal(TEE) and transthoracic echocardiography(TTE) were done to evaluate postoperative cardiac condition in 98 patients with cardiac prosthetic valves from Jan. 1991 to Oct 1991. Several clinical and echocardiographic parameters were analyzied to evaluate the relationship with the formation of left atrial thrombi. RESULT: In univariate analysis, important factors related to the formation of left atrial thrombi are type of operation (p=0.027), postoperative left ventricular function(p=0.003), preoperative(p=0.037) and postoperative systolic ventricular size(p=0.024). However, in multivariate analysis postoperative left ventricular size(p=0.017), presence of previous thrombi(p=0.014), preoperative left atrial size(p=0.014) and postoperative left atrial size(p=0.014) are significant factors. CONCLUSION: Patients with high risk and low risk for the formation of left atrial thrombi after valve replacement can be identified by readily available clinical and echocardiographic variables.
Echocardiography ; Heart Valves ; Humans ; Multivariate Analysis ; Risk Factors* ; Thromboembolism

BACKGROUND: Although a number of indices of diastolic function based on transmitral flow have been proposed, no single factor seems to be adequate for seperating patients with normal from with abnormal diastolic functions. Pulsed Doppler echocardiography of pulmonary venous flow(PVF) is another non-invasive method to evaluate left ventricular diastolic performance. The purpose of this study is to evaluate the normal PVF pattern by TEE. METHOD: We performed pulsed-wave Doppler studies of the PVF and of the mitral flow by transesophageal-(TEE) and transthoracic echocardiography(TTE) in a healthy young adults. RESULTS: In TEE, all sublects showed four phases of the PVE pattern ; two antewgrade systolic phase(early and late : SE and SL), one antewgrade diastolic phase(D) and one retrograde diastolic phase(A). In TTE, there were three phases of the PVF pattern ; two antewgrade phase(systolic, diastolic) and one retrograde diastolic phase but we couldn't find out early systolic phase flow. Peak velocity of each phase of PVF was as follows:SE was 48.9+/-14.1cm/sec, SL was 56.3+/-16.1cm/sec, D was 52.6+/-14.9cm/sec. The timing of SL flow was correlated significantly with that of peak aortic flow(r=0.42, p=<0.01), while the timing of D flow and that of A flow were correlated significntly with timing of mitral E peak and A peak, respectively(r=0.84, p<0.01 ; r=0.80, p<0.01). CONCLUSIONS: In the young normal subject, PVF showed four phase of flow pattern and could be easily obtained by TEE. Furthermore it may be used for evaluation of left ventricular function.
Echocardiography, Doppler, Pulsed ; Echocardiography, Transesophageal* ; Humans ; Ventricular Function, Left ; Young Adult*

BACKGROUND: Patients with sinus rhythm, the left atrial appendage(LAA) appeared as a vigorously contracting structure and the blood flow patterns of LAA showed biphasic configuration. However, patients with AF rhythm the blood flow showed irregular or no configuration in doppler echocardiographic study. The purpose of this study is to evaluate relationship between the blood flow patterns of LAA with the presence of spontaneous contrast(SC) and thrombi in LAA. METHODS: We performed TEE and TTE simultaneously to 58 consecutive patients who had native mitral valve disease or mitral prosthesis. Spontaneous contrast(SC) and the presence and location of LAA thrombi were evaluated during TEE and left atrial dimension(LAD) & ejection fraction(EF) were evaluated during TTE. We divided the whole subjects into three groups according to the blood flow patterns ; regular pattern(Group 1), irregular pattern(Group 2), no flow pattern(Group 3). RESULTS: 1) Blood flow within the left atrial appendage is divided with three groups among of them, atrial fibrillation have two blood flow patterns. 2) Peak prositive & negative flow velocity within LAA in AF rhythm groups were slower than normal sinus rhythm group.(p<0.01) 3) Left atrial dimension in group 3 is significantly larger than others groups.(p<0.01) 4) Spontaneous contrast(SC) with LAA could be detected in 2(6.8%) of the 29 patients of group 1, 6(31.5%) of the 19 patients of group 2, 10(100%) of the 10 patients of group 3. Incidence of SC within LAA in group 3 is significantly higher than others groups. 5) LAA thrombi could be detected in 1(3.4%) of the 29 patients of group 1, 1(5.2%) of the 19 patients of group 2, 3(30%) of the 10 patients of group 3. Incidence of LAA thrombi is significangly higher than other groups. CONCLUSIONS: We can suggest that blood flow within LAA is divided into three groups according to the blood flow patterns, and spontaneous contrast and thrombi in LAA were closely related with the blood flow pattern.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Humans ; Incidence ; Mitral Valve ; Prostheses and Implants

We report a case of nonsyphilitic isolated coronary ostial stenosis of the left main coronary artery observed by transesophageal echocardiography(TEE) in a 52-year-old woman with angina. The lesion was suspected during coronary angiography and it was not visualized by transthoracic echocradiography. Coronary ostial stenosis, which is potentially lethal as left main coronary artery disease, occurs rarely in the absence of other coronary artery disease. The diagnosis of ostial stenosis has been usually made by the use of coronary angiography, however, it may be difficult to diagnose at angiography if angiographic catheter is positioned across the stenotic lesion, and the unexpected serious complication during coronary angiography in such a patient may happen. The new ultrasonic imaging technique of TEE provides more detailed images of proximal coronary anatomy and coronary blood flow.
Angiography ; Catheters ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Female ; Humans ; Middle Aged ; Ultrasonography

OBJECTIVES: It has been constantly reported that mismatch negativity (MMN) is impaired in patients with schizophrenia. However, the mechanism which relates impaired MMN and schizophrenia is not clear yet. The aim of this study is to investigate the association between MMN and clinical variables including functional status in patients with schizophrenia. METHODS: The present study assessed MMN using passive auditory oddball task in 26 patients with schizophrenia and 48 healthy controls. Repeated measures Analysis of Variance with age as a covariate was carried out for comparing peak amplitude and latency of MMN at 8 central line electrodes (FPz, Fz, FCz, Cz, CPz, Pz, POz, Oz) across groups. Pearson's correlation was performed to reveal the relationship between MMN and clinical variables including neurocognitive test results and the Global Assessment of Functioning score. RESULTS: MMN amplitude was significantly reduced in patients with schizophrenia compared with healthy controls. Pearson's correlation showed that subsets of short form of Korean Wechsler Adult Intelligence Scale scores and GAF scores were associated with MMN amplitude in patients with schizophrenia. CONCLUSION: These findings suggest that MMN amplitude is associated with current functional status including cognitive function in patients with schizophrenia.
Adult ; Analysis of Variance ; Electrodes ; Humans ; Intelligence ; Schizophrenia*

The number of Kupffer cells was evaluated in hepatocellular carcinomas, including 18 primary lesions, 3 tumor emboli within the portal vein radicles and 4 metastatic lesions and in non-neoplastic liver adjacent to the primary lesions, to persue the origin of Kupffer cells dwelling in hepatocellular carcinoma. Hepatocellular carcinomas of the sinusoidal(trabecular) type were carefully selected, and excluded were those carcinomas which showed inflammation or other changes evoking inflammation. The immunohistochemical stains for CD 68 and lysozyme were done to identify Kupffer cells and to draw the mean Kupffer cell number per high power microscopic field of each lesion. Kupffer cell was most numerous in primary lesions followed by tumor emboli and still fewer in metastatic lesions. The Kupffer cell number in the primary lesions of hepatocellular carcinoma was in turn smaller than that of the adjacent non-neoplastic liver. The results suggest that, during the early neoplastic transformation, sinusoids of the non-neoplastic liver could creep into the carcinomatous tissue accompanying Kupffer cells.
Carcinoma, Hepatocellular ; Neoplasm Metastasis

PURPOSE: Carnitine plays a key role in the oxidation of fatty acids by facilitating their transport. As very low birth weight(VLBW) infants receiving total parenteral nutrition(TPN) with limited oral intake are likely to be carnitine-deficient state, they require exogenous supplementation of carnitine, however, effects of it remains controversial. To demonstrate effects of parenteral camitine supplementation on fat metabolism, weight gain and clinical outcome. We analyzed plasma levels of biochemical markers, changes of weight, and incidence of complications in 23 VLBW infants receiving TPN. METHOD: We randomly assigned 23 VLBW infants(<32 wks of gestational age) receiving TPN to carnitine-supplemented(100mg/kg per day) group(n=10) and control(n=13). Plasma total (TC), free(FC), and acyl carnitine(AC) levels and serum cholesterol, triglyceride and free fatty acid levels were measured before and 2 weeks after carnitine supplementation. RESULT: Decrements in TC for 2 weeks were significantly lower in carnitine group(41.6umol/l->32.3umol/l) than control group(46.3umol/l->25.2umol/l)(p<0.05). Changes of FC and AC were similar in both groups. Levels of cholesterol and triglyreride were similar in both groups. Days of regaining birth weight were faster in carnitine group than control group(15.3+/-3.4 vs 20. 8+/-11.1 days)(p<0.05). Rate of weight gain for two weeks were significantly faster than carnitine group than control group(p<0.05). No significant differences in clinical outcome were found. CONCLUSIONS: Carnitine supplementation in VLBW infants receiving TPN has an supportive nutritional regimen in that it reduces decrement in carnitine level and facilitate weight gain.
Biomarkers ; Birth Weight ; Carnitine* ; Cholesterol ; Fatty Acids ; Humans ; Incidence ; Infant* ; Infant, Very Low Birth Weight* ; Metabolism ; Parenteral Nutrition, Total ; Parturition ; Plasma ; Triglycerides ; Weight Gain

We report a case of non-cirrhotic portal hypertension in a 73 year-old woman, who had 19-year history of idiopathic myelofibrosis. There were esophageal varix, splenomegaly, and ascites. The biopsied liver showed irregular sinusoidal/ perisinusoidal fibrosis and occasional central-to-central fibrous connection. In areas with extensive fibrosis, coarse collagen fibers filled the sinusoidal spaces and compressed hepatocytes. However, nodular regeneration was absent. Double immunohistochemical stain for smooth muscle actin and proliferation cell nuclear antigen (PCNA) revealed diffusely activated stellate cells, some of which showed nuclear PCNA staining. There was also extramedullary hematopoiesis with bizarre megakaryocytes. The portal vein and its branches were patent. Idiopathic myelofibrosis is a rare cause of non-cirrhotic portal hypertension: the portal hypertension was considered to be the result of sinusoidal/perisinusoidal fibrosis in this case.
Actins ; Aged ; Ascites ; Collagen ; Esophageal and Gastric Varices ; Female ; Fibrosis ; Hematopoiesis, Extramedullary ; Hepatocytes ; Humans ; Hypertension, Portal* ; Liver ; Megakaryocytes ; Muscle, Smooth ; Portal Vein ; Primary Myelofibrosis* ; Proliferating Cell Nuclear Antigen ; Regeneration ; Splenomegaly

BACKGROUND: The prompt and accurate diagnosis of acute aortic dissection is decisive for the prognosis of the patient, since an effective surgical and medical therapy can improve the high rate of mortality due to this pathology. Among the various diagnostic methods, transesophageal echocardiography can provide a rapid and accurate method of diagnosing and evaluating dissecting aortic aneurysm and permits prompt initiation of appropriate treatment. Thus we performed transesophageal echocardiography in patients supected to dissecting aortic aneurysm, as a preliminary examination, and now we reported the result. METHODS: We have studied 4 case of dissecting aortic aneurysms among the patient received examination of cardiovascular system by transesophageal echocardiography, since January 1991 at Keimyung University hospital. In these 4 cases, 3 cases had CT scan, 2 cases had MRI scan, and all cases had transthoracic echocardiography simultaneously as a adjuvant diagnostic method. RESULTS: All 4 cases could be promptly and accuratoly diagnosed and typed by transesophageal echocardiography. As a consequence, patients could receive the early medical treatment and good clinical results. CONCLUSION: Transesophageal echocardiography is fast, inexpensive and accurate method in diagnosis of dissecting aortic aneurysm. So we recommend transesophageal echocardiography, as a preliminary examination in case of suspecting dissecting aortic aneurysm.
Aortic Aneurysm* ; Cardiovascular System ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Humans ; Magnetic Resonance Imaging ; Mortality ; Pathology ; Prognosis ; Tomography, X-Ray Computed

BACKGROUND: In vitro study, normal cardiac prosthetic valve has functional regurgitation due to structural characteristics of prosthetic valve. To evaluate functional regurgitant characteristics of prosthetic valves, we examined patients who had clinically normal mitral prosthesis. METHODS: Transesophageal two-dimensional and color doppler echocardiography were performed to 25 patients who had the clinically normal mitral prosthesis. RESULTS: Seven patients had the mitral bioprosthesis and 18 patients had the mitral mechanical prosthesis. Regurgitation was found in 4 patients(57%) with bioprosthetic valve, and the pattern of regurgitation was central in three patients and unilateral in one patient. But regurgitation was detected in 17 patients(94%) with mechanical prosthesis, and the pattern of regurgitation was bilateral in twelve patients, unilateral in four patients and central in one patient(p=0.0035). The length of regurgitant jets were 22.00+/-6.73(mm) in bioprosthetic valve and 28.65+/-7.33(mm) in mechanical valve. The regurgitant jets were detected in systolic period in most of patients. But in 4 patients who had tachycardia during TEE, regurgitation was detected in systolic and early diastolic period. CONCLUSION: Regurgitation was found in clinically normal cardiac prosthetic valves by TEE. These findings may be useful to differentiate between normal and abnormal cardiac prosthesis.
Bioprosthesis ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal* ; Humans ; Prostheses and Implants* ; Tachycardia