BACKGROUND: The two most commonly used drugs as a stressor during wtress echocardiography are dipyridamole and dobutamine. The purpose of this study was to compare diagnostic accuracies of dipyridamole and dobutamine stress echocardiography for fixed coronary artery disease and evaluate complications related to the two agents in the same patients. METHODS: 30(M : 5=19 : 11, age=56+/-8.8yr) consecutive patients without history of previous myocardial infarction underwent coronary angiography, dipyridamole and dobutamine stress echocardiography in random order. Dipyridamole was infused up to 0.84mg/Kg for 10 minutes during clinical, ECG and echocardiographic montioring. Dobutamine was infused in dose increments from 5 to 40microg/Kg/min under the same condition. Positive criteria for myocardial ischemia by echocardiography was now regional wall mation abnormatity or worsening of regional wall motion after stress. Significant coronary disease was defined as more than 70% stenosis by coronary angiography. RESULTS: The sensitivity and specificity of both stress echocardiography were same, 82% and 92% respectively. In a single vessel disease the sensitivity of dipyridamole echocardiography was 75% and dobutamine echocardiography was 83% without statistical difference. The correlation of ischemic free time during both stress test was 0.375. During dipyridamole infusion no test was prematurely terminated because of side effects, but 3 patients(10%) developed severe hypertension and ventricular arrytricular arrythmia during dobutamine infusion and test was terminated. CONCLUSION: Thus, by this prospective direct comparison of both stress test, dipyridamole and dobutamine stress echocardiography have similar diagnostic accuracies for the detection of coronary artery disease. But during dobutamine infusion, careful monitoring for hemodynamic changes arrythmia is required for possible serious complications.
Arrhythmias, Cardiac ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Dipyridamole* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Electrocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension ; Myocardial Infarction ; Myocardial Ischemia ; Prospective Studies ; Sensitivity and Specificity

We, at Department of Orthopedic Surgery, College of Medicine, Pusan National University, applied epiphyseal distraction as a method of limb lengthening, using unilateral one-plane pin fixator(ORTHOFIX) and bilateral multi-plane ring fixator(SEQUOIA) to three children with limb length discrepancies and angulation deformity due to injury of epiphyseal plate, and obtained following results. l. At first case, on whose distal femoral physis, bone bridge occupied about 20% of total epiphyseal plate and distributed mainly on the lateral side. At 10 days of distraction, epiphysiolysis occurred from the lateral side at first and angulation deformity was corrected. Epiphysiolysis on the medial side of physis appeared apparently after 60mm distraction. Bone lengthening of 4.2cm and correction of 25 valgus deformity were achieved after 72mm distraction for about 10 weeks. The percentage of increase in the initial length achieved was 11.67% and healing index was 27.86. 7 months later, loss of lengthening of 2.7cm was observed and it was considered that this was due to relatively short corticalization phase. 2. At second case, on whose distal tibial physis, bone bridge occupied about 40% of total epiphyseal plate and distributed on the medial side. At 10 days of distraction, epiphysiolysis occurred on the medial side of the epiphyseal plate, but not on the lateral side and instead of further lengthening, valgus deformity of the ankle appeared. It was thought that asymmetric distraction was attributed to the difference between the force applied on the medial side and that applied on the lateral side of the epiphyseal plate by unilateral one-plane pin fixation. 3. At third case, on whose distal tibial physis, bone bridge occupied about 75% of total epiphyseal plate. No epiphysiolysis occurred. there was a difficulty in observation of epiphysiolysis because ring fixator was overlapped with the epiphyseal plate on radiographs.
Ankle ; Bone Lengthening ; Busan ; Child ; Congenital Abnormalities ; Epiphyses, Slipped ; Extremities ; Growth Plate ; Humans ; Methods ; Orthopedics

Among 334 thoracolumbar spinal injury patients who were admitted to this hospital from June 1972 to June, 1982, 66 patients with fracture and fracture dislocation of thoraco-lumbar spine which were defined as unstable clinically and radiologically were treated with surgical measures. The ratio between male and female was 7.3:1, the majority was found in third and fourth decade (46 cases, 69%), and the most common cause of injury was falling from a height (38 cases, 58%). The most common site of the injury was lumbar spine (29 cases, 44%) and the most common mechanism of injury was flexion-rotation (29 cases, 44%). Our surgical measures were Harrington rod instrumentation with either anterior or posterior fusion (25 cases, 38%), posterior wiring and fusion (14 cases, 21%), anterior decompression and anterior fusion (14 cases, 21%), posterior fusion (4 cases, 6%), anterior fusion and posterior fusion (3 cases, 5%) and etc. The average correction of displacement was 65% and the average correction of kyphotic deformity was 50%. The most remarkable correction was found at the cases of Harrington rod instrumentation (71%, 74%). Neurological deficit had already developed in 43 cases(65%) prior to operation, and the recovery was observed in 18 cases(42%). Most excellent recovery of neural deficit was found also at the cases of Harrington rod instrumentation (11 cases, 52%). We have analysed the results of these treatment and obtained following conclusions. 1. For the unstable fracture and fracture-dislocation of thoraco-lumbar spine with or without neural involvement, immediate surgical treatments were valuable to expect restoration of anatomical reduction and promotion of every possible recovery of neural function with spinal stability and fewest complication. 2. Fixation with Harrington rod instrumentation appears to provide better reduction and stability with neural improvement than other methods, and therefore early undertaking of rehabilitation activities is possible. 3. For the patients who are seriously compromised or require anterior decompression, immediate posterior reduction and fixation with Harrington rod instrumentation followed anterior decompression and anterior fusion of the involved segments at the eariest feasible time, we feel, is the treatment of choice.
Accidental Falls ; Clinical Study ; Congenital Abnormalities ; Decompression ; Dislocations ; Female ; Humans ; Male ; Mortuary Practice ; Rehabilitation ; Spinal Injuries ; Spine

There was increasing tendency to stabilize unstable cervical spine injuries surgically with the benefit of good stability of the spine, easy nursing care, early mobilization and therefore early rehabilitation. A clinical study was performed on 47 patients with fractures and dislocations of the cervical spine treated at the department of orthopedic surgery, Inje Medical College, Paik Hospital from Jan. 1975 to Dec. 1981. Following is the summery of the our findings. 1. The prevalent age distribution was between 3rd and 6th decade and the ratio between males and females was 10:1. The most common cause of injuries was automobile accident (70%). 2. The most common site of the injuries was C5-6 (34%) and the most frequent mechanism of injury was flexion-rotation type (47%). 3. In overall patients, neurologic damage was found at first examination in 73% and among these, complete paralysis below the injured level in 26%, incomplete paralysis in 11% and nerve root injury in 35%. 4. Among 47 patients, conervative treatment was performed on 9 patients, anterior spinal fusion on 8 patients, anterior spinal fusion with Halo application on 4 patients, posterior wiring with posterior spinal fusion on 16 patients and posterior wiring with anterior spinal fusion on 8 patients. 5. In the several methods of treatment, the posterior wiring with anterior spinal fusion revealed the best results, the correction rate of displacement was 92%, the correction rate of angular deformity 98% and neural recovery rate 72%. 6. The posterior wiring with posterior spinal fusion revealed good results in correction of displacement and angular deformity but required rigid external support for a long time. The anterior spinal fusion revealed poor results in correction of displacement(67%) and angular deformity(38%) and required rigid external support for a long time and had increasing tendency of kyphotic angle after operation. 7. In the treatment of unstable cervical spine injury, we thoughy that early posterior reduction with posterior wiring and followed anterior spinal fusion was ideal for accurate reduction, rigid stability and early mobilization with simple external support.
Age Distribution ; Automobiles ; Clinical Study ; Congenital Abnormalities ; Dislocations ; Early Ambulation ; Female ; Humans ; Male ; Nursing Care ; Orthopedics ; Paralysis ; Rehabilitation ; Spinal Fusion ; Spine

BACKGROUND: To investigate the effects of nitroglycerin(NTG) and dipyridamoie(DIP) on the perfusion of ischemic myocardium during total occlusion of one coronary vessel and with 3 graded partial occlusion of its collateral supplying vessel, myocardial contrast echocardiography(MC-Echo) was performed on seven pentobarbital anesthetized open chest dogs. METHODS: After a left thoracotomy was done, the left anterior descending coronary artery(LAD) was dissected for ligation to produce total LAD occlusion and left circumflex coronary artery(LCX) was separated to place an electromagnetic flow probe and, distally, screw occluder to restrict LCX flow by 50% and 90% of the preocclusion value. MC-Echo images were made by bolus injections of a 5ml of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix) and normal saline(2 : 3 by volume) into the aortic root, and then the echocontrast defect area(EDA) with planimeter, peak echocontrast intensity(PEI) and the echocontrast washout halftime(WHT) with videodensitometer were measured. A 100microg of NTG was administered by bolus injection in the aortic root and was followed by 5mg of DIP after the hemodynamic effect of the NTG has been abolished. MC-Echo images were obtained after each infusion of NTG and DIP, first 60 minutes after total LAD occlusion with intact LCX flow, next with a 50% restriction of LCX flow, and third with a 90% restriction of LCX flow. RESULTS: 1) During total LAD occlusion with intact LCX flow : The EDA measured 60 minutes postocclusiom(PO) of LAD(14.2%) was smaller than that 3 minutes PO(20.5%, p<0.01). After NTG, systolic and diastolic blood pressure(BP) was decreased(p<0.01, p<0.05, respectively) and heart rate(HR) was not changed. The mean EDA(15.1%) was not changed, but an increase in EDA occurred in cases of which the diastolic BP fell by more than 20mmHg, and/or the systolic BP was less than 80mmHG after NTG, After DIP, BP and HR were unchanged. The PEI was increased and WHT was shortened in the nonischemic area, reflecting an increase in myocardial perfusion to a normal zone. However, the EDA(17.0%) was increased(p<0.05). The increase in EDA was more prominent in cases with good collaterals. This finding indicates that DIP cases coronary steal from the ischemic myocardium to the normal myocardium through the collaterals. 2) During total LAD occlusion with a 50% restriction of LCX flow : BP and HR were not altered. EDA, PEI and WHT were the same as those taken during intact LCX flow. After NTG, BP was decreased(p<0.01), but HR were not different from baseline values, After DIP, BP and HR remaince unchanged and EDA(16.2%) was increased(p<0.05). PEI was decreased(p<0.05) and WHT was delayed(p=0.054), indicating that DIP impaired any further increase of perfusion in ischemic myocardium. 3) During total LAD occlusion with a 90% restriction of LCX flow : Systolic and diastolic BP were decreased(p<0.05), but HR was unchanged. EDA(20.2%) was increased as compared to those during intact LCX flow(p<0.01). NTG decreased the EDA(17.6%, p<0.05) despite decrease in BP(p<0.01), while DIP did not alter the hemodynamics or EDA(20.7%). The PEI and WHT after infusion of both NTG and DIP were not different from baseline values. CONCLUSION: 1) Dipyridamole causes coronary steal from ischemic myocardium when the flow of collateral supplying vessel is intact or restricted by 50%, but not during 90% restriction of flow, suggesting the degree of stenosis of collateral supplying vessels is a determinant of coronary steal. 2) The beneficial effect of nitroglycerin to ischemic myocardium was largely determined by the extent of collateral flow and its effect on hemodynamics.
Animals ; Constriction, Pathologic ; Coronary Occlusion* ; Coronary Vessels ; Dipyridamole* ; Dogs* ; Echocardiography ; Heart ; Hemodynamics ; Ligation ; Magnets ; Meglumine ; Myocardial Ischemia ; Myocardium ; Nitroglycerin* ; Pentobarbital ; Perfusion* ; Sodium ; Thoracotomy ; Thorax*

A oral inotropic agent, denopamine(TA-064, (-)-alpha-(3,4-dimethoxyphenethyl aminomethyl)-4-hydroxybenzylalcohol), was shown to have strong positive inotropic effect in experimental animals. To determine effects of denopamine on the left ventricular9LV) function and clinical features in patients with severe chronic heart failure who were treated with conventional regimens, denopamine(5mg 3 times per day for 4 weeks) was administered orally to 28 patients with chronic heart failure(22 dilated cariomyopathy, 6 ischemic heart disease) and systolic time interval, 2-D and Doppler echocardiognaphy were performed to evaluate LV function. Denopamine had no effect on LV dimension, volume and fractional shortening, and produced modest increase of ejection fraction and cardiac index, and modest decrease of PEP/LVET and cardiothoracic ratio in the cheat X-ray(PA view). The stroke volume was significantly increased (32.8+/-10.0 to 36.4+/-11.1 ml, p<0.05). Systolic BP was decreased (131.3+/-32.7 to 123.2+/-20.8 mmHg, p<0.05) with little change in diastolic BP and heart rate. Subjective symptoms and NYHA functional class were improved (71.4%, 67.9%, respectively). No adverse effect and ECG abnormality were noted. In conclusion, the addition of denopamine to conventional therapy improved clinical symptoms and caused modest increase of LV contractile function in patients with severe chronic heart failure without significant untoward effects. Therefore, the addinion of denopamine to conventional therapy may be an effective and safe method for the treatment of chronic congestive heart failure.
Animals ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Stroke Volume ; Systole ; Ventricular Function, Left*

This study aimed to examine factors and the correlations of burnout and job satisfaction in hospital dietitians. Burnout was classified into three sub-concepts: emotional exhaustion, depersonalization, and reduced personal accomplishment. Job satisfaction was also classified into three sub-concepts, including relationships, self-realization, and advancement opportunities. A survey was conducted with dietitians working in general hospitals of over 400 beds, in the Seoul metropolitan area. The factors that significantly influenced emotional exhaustion were health, work hours, number of intern dietitians, self-esteem, level of responsibility, while the factors that influenced depersonalization were relationships with coworkers, and role ambiguity. Personal accomplishment was influenced by age, the number of staff dietitians, the general number of managed workers, and self-esteem. In terms of job satisfaction, relationship was affected by age and relationships with supervisors, while self-realization was influenced by work hours, health, the number of patient meals, and role ambiguity. Age, job regularity, business management, role ambiguity, and relationships with supervisors also affected advancement opportunities. Emotional exhaustion, depersonalization, and reduced personal accomplishments, which represented burnout, had negative relationships with satisfaction with relationships, self-realization and advancement opportunities. Dietitians with low job satisfaction were likely to experience burnout. These results suggest that burnout and job satisfaction are influenced by internal and external factors that are individual or organizational problems encountered by hospital dietitians. Therefore, managers as well as dietitians need to understand these factors and overcome them through communication and mutual support.
Commerce ; Depersonalization ; Hospitals, General ; Humans ; Job Satisfaction ; Meals

No abstract available.
Citrullinemia*

To evaluate the influencing factors on pulmonary venous flow(PVF) pattern, we studied the relationship between PVF and left ventricular ejection fracton(EF), mitral annulus motion(MAM) and transmitral flow using pulsed doppler echocardiography in patients with dilated cardiomyopathy(DCMP), acute myocardioal infarction(AMI), left ventricular hypertrophy(LVH) and atrial fibrillation(AE). Ther results were as follows : 1) In the normal controls(13 cases), two forward flow during ventricular systole(VS) and diastole(VD) and one retrograde flow during atrial systole(AS) were observed. The peak velocity of VS, VD and AS flow was 45.9cm/s, 42.8cm/s and -18.3cm/sec, respectively. The peak VS/VD ratio was 1.1. 2) In patients with DCMP(11 cases), (a) compared to the noraml subjects, the peak velocity of VS flow and VS/VD ratio were were significantly reduced(p<0.005 and p<0.001, respectively) and were positively correlated with ejection fraction(r=0.8 and r=0.7, respectively) (b) in 2 DCMP cases with severe mitral regurgitation, systolic retrograde flow was observed in the pulmonary vein instead of forward VS flow. 3) In 12 AMI cases and 7 LVH cases with normal or slightly diminished left ventricular systolic function but with abnormal diastolic function. (a) the peak velocity of VS flow and peak VS/VD ratio were significantly increased(r<0.005 and p<0.01, respectively). (b) the peak velocity of VD flow is positively correlated with transmitral E/A ratio(r=0.8) and the peak VS/VD ratio was positively correlated with transmitral pressure half time(r=0.8). (c) the peak velocity of retrograde AS flow was significantly increased(p<0.001). (d) there was no correlation between doppler parameters of PVF and left ventricular ejection fraction. 4) In patients with atrial fibrillation(10 cases), VS flow was markedly diminished or absent and only VD flow was observed. Also, retrograde AS flow was not observed. These findings suggest that the pattern of PVF is influnced by LVEF, MAM, transmitral inflow and atrial contraction. However, main contributary factors in determining the pattern of PVF in each disease are diverse according to its main pathophysiology.
Deoxycytidine Monophosphate ; Echocardiography, Doppler, Pulsed ; Heart Diseases* ; Heart* ; Humans ; Mitral Valve Insufficiency ; Pulmonary Veins ; Stroke Volume

BACKGROUND: Left ventricular thrombus is a common complication after acute myocardial infarction. Methods and RESULTS: To Study the incidence of left ventricular thrombosis (LVT) after acute myocardial infarction, we performed serial two-dimensional echocardiography (2D-Echo) in 35 consecutive patients with acute myocardial infarction prospectively ; 10 patients had inferior wall myocardial infarction, 25 patients had anterior wall myocardial infarction. 2D-Echo was obtained within 3 days of acute myocardial infarction, at 4-10 days after symptom onset, and 2-4 weeks after symptom onset serially in each case. 19 out of 35 patients received thrombolytic therapy with urokinase. Left ventricular thrombi were identified in 9(25.7%) of the 35 study patients. The location of myocardial infarction was anterior and apical in all cases with left ventricular thrombi. The shape of thrombi was mural in 6 cases and protruding in 3 cases. The incidence of left ventricular thrombi in patients who received urokinase was not significantly different from that in patients who didn't(31.9% vs 18.8%,p=0.22). Wall motion score was significantly higher in patients who developed left ventricular thrombi than in patients who had no left ventricular thrombus(8.2+/-1.9 vs 5.8+/-2.6, p<0.005). All thrombi appeared within 10 days after myocardial infarction. CONCLUSIONS: Thus left ventricular thrombi develops within 10 days following myocardial infarction with large anterior and apical location. The thrombolysis therapy has no effect in the incidence of left ventricular thrombi in this study. But because of confounding effect of thrombolysis and location of myocardial infarction and extent of myocardial infarction, further investigation is needed.
Anterior Wall Myocardial Infarction ; Echocardiography ; Humans ; Incidence* ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator