The antihypertensive effects of diltiazem was observed in 30 cases of essential hypertension, and following results were obtained. 1) Mean decrease in systolic and diastolic blood pressure by oral diltiazem was 42.0+/-2.5mmHg and 17.8+/-1.7mmHg. The results of antihypertensive therapy revealed good control in 50% fair control in 30% poor in 17% and failure in 3% of the cases. In 80% of the cases, good or fair control of Hypertension which means drop of diastolic pressure to the level of less than 100mmhg was observed. 2) Mean drop in heart rate was 21+/-2 beats/min. 3) Daily dose was 90-180mg. 4) The side effect of oral Diltiazem was mild headache and dizziness, respectively one case.
Blood Pressure ; Diltiazem* ; Dizziness ; Headache ; Heart Rate ; Hypertension

Coenzyme Q is concentrated in Golgi apparatus membranes and mitochondria, but not in other membranes. Although it is difficult to prove the metabolic action of coenzyme Q administered exogenously in clinical cases, the effect of this substance can be evaluated by criteria based on clinical findings. In an attempt to evaluate the effect of coenzyme Q for the treatment of 67 patients(male 26 cases, female 41 cases) of congestive heart failure, we administered Coenzyme Q1030mg daily for 4 to 8 weeks. Most of them were valvular heart disease(74.6%) and hypertension (14.9%). Clinical effects were evaluated at least 4 weeks later by the criteria using a scoring method of severity of congestive heart failure which was devised by Ishiyama, etc. In summary, a definite effect was found in 13 cases(19%) and a mild effect was observed in 46 cases(69%). During treatment there were no significant side effects, and also no significant changes in heart rate and blood pressure.
Blood Pressure ; Estrogens, Conjugated (USP)* ; Female ; Golgi Apparatus ; Heart ; Heart Failure* ; Heart Rate ; Humans ; Hypertension ; Membranes ; Mitochondria ; Research Design ; Ubiquinone

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

Clinical EPS was performed in 16 normal adults without evidence of conduction disease on the surface standard 12 lead electrocardiogram in order to provide normal electrophysiological values of the sinus node function and AV conduction. EPS was also performed in 15 patients with sick sinus syndrome and 10 patients with AV conduction disturbance to evaluate the clinical usefulness of EPS in detecting sinus node dysfunction and AV conduction disturbance. The results were as follows. 1) The results of sinus node function test in the normal group were m-SNRT 853+/-198msec(range 800-1,560msec), c-SNRT 230+/-66msec(range 120-370msec), and %m -SNRT/SCL 127+/-11%(range 114-149%). 2) In 15 patients with SSS, the M-SNRT were ranged from 1,270 to 12,330msec and 10 patients(66%) had significantly increased m-SNRT exceeding 1,560msec. The c-SNRT were ranged from 230 to 10,730msec and 13 patients(83%) had significantly increased c-SNRT exceeding 370msec. The % m-SNRT/SCL were ranged from 136 to 770% and 12 patients(80%) had significantly increased % m-SNRT/SCL exceeding 150%. 3) The SACT in normal group were 84+/-14msec(range 70-105msec) measured by continuous atrial pacing method and 80+/-19 msec(range 60-115msec) measured by atrial extrastimulation method. 4) In SSS, the SACT measured by continuous atrial pacing method was ranged from 80 to 1,050msec and 11/12 patients(92%) had significantly increased SACT exceeding 112 msec. The SACT measured by atrial extrastimulation method was ranged from 90 to 310msec and 7/8 patients(88%) had significantly increased SACT exceeding 118 msec. 5) C-SNRT, % m-SNRT/SCL, and SACT were more useful in detecting sinus node dysfunction than m-SNRT. 6) The AV conduction intervals in normal group were PA interval 17+/-6(range 5-25msec), AH interval 96+/-18 msec(range 70-135msec), and HV interval 46+/-7msec(range 35-55msec). 7) Rapid atrial pacing induced Wenckebach type second degree AV block proximal to H at pacing rate of 90 to 190/min in 14/16 normal adults. 2 patients maintained intact AV conduction upto maximum pacing rate of 200/min. 8) His bundle electrogram showed the site of AV block in 9 of 10 patients with AV conduction disturbances. The sites of AV block were AV nodal area 1 case, intraHis bundle 4 cases, and infraHis bundle 4 cases. 9) EPS provided a good supportive information that was useful in selecting pacemaker therapy in a patient with chronic bifascicular block who revealed prolonged HV interval and infraHis bundle block at a pacing rate of 70min. 10) The refractory periods of AV conduction system in normal group were AERP 274+/-54msec (range 170-410msec), AVN-FRp 467+/-74msec(range 285-600msec), AVN-ERP 341+76msec(range 190-460), and V-ERP 280+/-25msec(range 240-320msec).
Adult ; Atrioventricular Block ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Humans ; Sick Sinus Syndrome ; Sinoatrial Node*

The authors obtained the following results through comparative investigation between experiences from authors clinical study of ureterolithotomy by posterior vertical incision devised by Gil-Vernet and Yoon`s clinical study of ureterolithotomy by posterior vertical incision and his lumbar incision. 1. Operation time was average 62 min. and blood loss was average about 50cc. So operation time and blood loss were similar to Yoon`s result but more or less reduced as compared with lumbar incision. 2. Postoperative urine leakage and ambulation time were 1 day and 2 day that were more or less reduced as compared with Yoon`s result. 3. Ipsilateral lower abdominal wall protrusion was noted postoperatively. We think, this is from subcostal nerve injury. 4. Postoperatively sensation change on subcostal nerve, ilohypogastric nerve and ilioinguinal nerve innervation sites were noted in half of all, but disappeared in several weeks. Considering above results, while posterior vertical incision has merits such as minimal operative invasion and early postoperative ambulation time, but it often notes inevitable nerve damage. So, we think better results would be gained by careful attention to nerve and vascular distribution.
Abdominal Wall ; Sensation ; Walking

BACKGROUND AND OBJECTIVES: The Oriental herbal materials known as aconitine have long been used in oriental traditional medicine for their analgesic and antiinflammatory effects. Aconitine and its related alkaloids are known cardiotoxins with no therapeutic role in modern western medicine. We have studied the cardiovascular side effects of intoxication that took place in otherwise healthy individuals after ingestion of herbal decoctions containing aconite alkaloids. MATERIALS AND METHOD: During a six-year interval from 1990 to 1996, 9 cases of accidental herb-induced aconitine intoxication were managed in Kyung Hee university medical center. Hospital records were reviewed in detail. RESULTS: All patients developed symptoms of aconitine toxicity within 4 hours of herb ingestion. The frequency of the order in cardinal symptoms of acute aconitine poisoning was nausea or vomiting, irritability, chest discomfort, dizziness, etc. Nine patients developed arrhythmias, including multifocal APC with aberrancy, multifocal VPC, ventricular tachycardia, etc. Administration of isotonic saline, dopamine, atropine and lidocaine with supportive cares brought clinical recovery and disappearance of arrhythmias in most cases within several hours. However, one case of acute aconitine poisoning had been dead of cardiac arrest due to ventricular fibrillation. CONCLUSION: Aconitine and its related alkaloids can cause toxic effects and even fatal poisoning. These cases point to the need for strict surveillance of herbal substances with low safety margins.
Academic Medical Centers ; Aconitine* ; Aconitum ; Alkaloids ; Arrhythmias, Cardiac ; Atropine ; Cardiotoxins ; Dizziness ; Dopamine ; Eating ; Heart Arrest ; Hospital Records ; Humans ; Lidocaine ; Medicine, East Asian Traditional ; Nausea ; Poisoning* ; Tachycardia, Ventricular ; Thorax ; Ventricular Fibrillation ; Vomiting

The antihypertensive effect of Indapamide(Fludex(R)) was studied in 31 patients of essential hypertension and following results were obtained. 1) Daily dosage was 1mg b.i.d. and total duration of medication was weeks. 2) Mean systolic and diastolic blood pressure declined by 23mmHg(14%) and 18mmHg(17%) respectively. 3) Good or fair controls were achieved in 78% of patients. 4) There was no significant change in heart rate during and after treatment. 5) There were no significant changes in fasting blood sugar, serum creatinine, K+, uric acid, ca++, transaminase and cholesterol levels before and after treatment. 6) In 5 patients transient side effects were observed which resolved spontaneously. In view of these results Indapamide appears to be effective agent for the treatment of mild to moderate hypertension and dose not cause significant change in blood chemistry.
Blood Glucose ; Blood Pressure ; Chemistry ; Cholesterol ; Creatinine ; Fasting ; Heart Rate ; Humans ; Hypertension ; Indapamide ; Uric Acid

The force-interval relationship of cardiac muscle has been known as not only a fundamental manifestation of beat-to-beat kinetics of intracellular activator calcium which control contractile response but also a potential clinical tool for evaluating cardiac contracile function. In this study were evaluated the force-interval relationship of intact canine left ventricle through mechanical restitution curves by plotting contrctile responses to varying steady state, extrasystolic and postextrasystolic intervals, and compared the force-interval relationships of intact canine left and right ventricles quantitatively. Effects of localized myocardial ischemia on the left ventricular force-interval relationship and relaxtion function were also evaluated 30 minutes after ligating proximal left anterior descending coronary artery through observing contractile and relaxtion responses to various intervals. 1) Mechanical restitution curve of left ventricle showed that left ventricular dp/dt max responses rose stiffly until plateau level with increasing postextrasystolic intervals, then declined with further increment of postextrasystolic intervals. 2) Mechanical restitution curve of left ventricle shifted leftward and upward with shortening of steady state and extrasystolic intervals, which suggest intracellular calcium kinetics during electrical diastole may operate as a mechanism of the force-interval relationship. 3) Steady state contractile responses remained unchanged but maximal contractile responses increased significantly or contractile reserve in intact left ventricle. 4) Normalized force-interval relationships of left and right ventricle were similar quantitatively, which suggest the force-interval relationship is independent of structural factors in intact canine heart. 5) Occlusion of coronary artery lowered absolute values of left ventricular dp/dt max responses to varying postextrasystolic intervals, but didn't show significant changes of normalized dp/dt max responses, which suggest force-interval relationship be also present in spite of localized myocardial ischemia. 6) Responses of normalized left ventricular dp/dt min to varying postextrasystolic intervals were similar to those of normalized dp/dt max but reduced after coronary artery occlusion in the range above 100% dp/dt max response, which may be used for the detection and evaluation of deranged myocardial relaxation in the left ventricle with localized myocardial ischemia.
Calcium ; Coronary Vessels ; Diastole ; Heart ; Heart Ventricles ; Kinetics ; Myocardial Ischemia ; Myocardium ; Relaxation ; Ventricular Function, Left*

In an attempt to define quantitatively the relation between left atrial size and atrial fibrillation, echocardiography was used to study 58 patients with mitral stenosis and sinus rhythm, 22 patients with mitral stenosis and newly appeared atrial fibrillation, 62 patients with mitral stenosis and atrial fibrillation, 14 patients with sinus rhythm who undergone mitral valve replacement, 18 patients with atrial fibrillation who undergone mitral valve replacement,17 patients with idiopathic atrial fibrillation and 22 control persons. In all groups of mitral stenosis, atrial fibrillation was rare when left atrial dimension was below 40mm but common when this dimension exceeded 40 mm. When left atrial dimension exceeded 50 mm, sinus rhythm was rare even in patients who undergone mitral replacement operation. These data suggest that left atrial size is an important factor in the development of atrial fibrillation. To reduce the risk of systemic embolism complicating atrial fibrillation and to reduce the need of long term anticoagulant therapy postoperatively, the left atrial dimension should be followed closely for the patients with mitral stenosis.
Atrial Fibrillation* ; Echocardiography* ; Embolism ; Heart Atria* ; Humans ; Mitral Valve ; Mitral Valve Stenosis

Nine patients of mean age 47.8 years, with suspected sinus node dysfunction, underwent extensive electrophysiological studies. Sinus bradycardia(6the electrophysiological study, AH and HV intervals were prolonged in 2/9 and 1/9 patients, respectively. Maximal sinus node recovery times were prolonged in 7/9 patients, ranging from 1,330 msec to 12,330msec. Sinoatrial conduction times measured by atrial premature stimulation technique were prolonged in 5/7 patients, ranging from 137msec to 310 msec. And sinoatrial conduction time measured by continuous pacing technique also revealed prolonged value in 4/6 patients ranging from 140 msec to 195 msec. The effective refractory periods, of atrium were prolonged in 6/8 patients (320 msec to 470 msec). The effective and functional refractory periods of AV node were prolonged in 3/8 patients (440 csec to 490 msec) and 4/8 patients (530 msec to 560 msec), respectively. Retrograde VA conduction could be observed in 3/7 patients and ventricular effective refractory periods were normal in 7/7 patients. Atrial flutter was induced in 1/9 patients by electric stimulation during electrophysiological study. Above data suggest that the electrophysiological study is very useful in assessing the sinus node function and other electrophysiological properties in sick sinus syndrome patients and also suggest that the data could be utilized in choosing the proper mode of artificial pacemaker for each patient.
Atrial Flutter ; Atrioventricular Node ; Electric Stimulation ; Humans ; Pacemaker, Artificial ; Sick Sinus Syndrome* ; Sinoatrial Node