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

BACKGROUND: Propafenone is a new class IC antiarrhythmic drug that has been found to be effective in both supraventricular and ventricular tachyarrhythmias. We studied the electrophysiologic and long-term effects of oral propafenone in the patients with paroxysmal supraventricular tachycardia(PSVT). METHODS: The electrophysiologic study was done in 15 patients with PSVT to assess the short-term efficacy of propafenone 450mg daily. For 10 patients with short-term efficacy, follow up study was done to assess the long-term efficacy of propafenone 450mg daily. RESULTS: The electrophysiologic mechanisms of PSVT were AV nodal reentry in 6 patients and AV reentry in 9 patients. During the electrophysiologic study, propafenone prolonged AH, HV and PR intervals significantly(p<0.05), but did not change the corrected SNRT, SACT, and the ERP of atrium, ventricle, AV node and accessory pathway(AP) significantly. The anterograde and retrograde 1:1 conduction capacity of AV node and AP seemed to decrease. Complete block of anterograde conduction over the AP was noted in 2 of 3 patients with manifest WPW syndrome and complete block of retrograde conduction was noted over the AV node in 1 patient with AV nodal reentry and over the AP in 1 patient with AV reentry. Propafenone was effective in 3 of 6 patients with AVNRT and 7 of 9 patients with AVRT. During long term administration for 3 to 11 months in 10 patients with short-term efficacy of propafenone, 7 patients did not report any episode of symptomatic tachycardia and 3 patients reported less frequent palpitation. There were no side effects during short-and long-term follow up except 2 patients with mild indigestion. CONCLUSIONS: Propafenone seems to be a safe, well tolerated and effective drug for short and long-term therapy of patients with PSVT, especially of orthodromic AV reentry.
Atrioventricular Node ; Dyspepsia ; Follow-Up Studies ; Humans ; Propafenone* ; Tachycardia ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

BACKGROUND: Normally major forward pulmonary venous flow(PVF) into left atrium occurs during systole and early diastole. This is followed by the reversal of the PVF with atrial contraction during late diastole. Chronic increase of left atrial pressure and volume, and decrease of the left atrial compliance might alter the PVF pattern in patients with mitral stenosis. Moreover, the cardiac rhythm could be changed from sinus rhythm(SR) to atrial fibrillation(AF) with the progression of the disease. To elucidate the effect of these changes on PVF, we performed transesophageal echocardiographic(TEE) Doppler examination in 20 patients of mitral stenosis who were going to be taken Percutaneous mitral commissurotomy(PMC). METHOD: We measured the velocities of the PVF by TEE pulsed Doppler examination, and compared it with the hemodynamic parameters measured by cardiac catheterization in 20 patients of mitral stenosis who underwent the PMC. The SR was found in 12 patients and the rest showed established AF. RESULTS: 1) Doppler variables measured by TEE. 2) Hemodynamic parameters measured by cardiac catheterization. 3) In patients with SR, S-PV, S-VTI and S-FVTI showed negative correlation with mean LAP(r=-0.66, -0.67, -0.71, respectively, p<0.05). However in AF group, there is no correlation between Doppler variables and mean LAP. CONCLUSION: In mitral stenosis with SR, systolic PVF decreases with the increase of mean left atrial pressure and finally, diastolic PVE becomes predominant with the development of AF.
Atrial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Compliance ; Diastole ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Atria ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Systole

BACKGROUND: The main cause of atherosclerotic peripheral vascular disease is known to be atherosclerotic processing. In patients with atherosclerotic peripheral vascular disease, other atherosclerotic diseases are frequently combined, especially coronary artery disease. There were some suggestions that the risk factors of the atherosclerotic peripheral vascular disease be different from the those of the coronary artery disease. The aim of this study was to evaluate the independent risk factors for the atheroslerotic peripheral vascular disease(PVD) without influence of coronary artery disease(CAD). METHODS: The study population was male patients with atherosclerotic peripheral vascular disease(n=66) documented by peripheral angiogram form February 1991 to Octobor 1993, and during their abmission all patients with suspected atherosclerotic peripheral vascular diaease underwent both peripheral angiogram and coronary angiogram. Careful history taking and physical examination and lipid battery sampling after at least 14 hours of fasting were also performed. RESULTS: 60% of patients with peripheral vascular disease also had coronary artery disease. There was no significant difference in total cholesterol, HDL cholesterol, LDL cholestrerol, triglyceride between patients with peripheral vascular disease and age-matched control. The prevalence of hypertension was higher in patients with peripheral vascular disease but with no statistical significance. Smoking(p<0.0001) and diabetes(p<0.05) were strongly associated with peripheral vascular disease. When patients without coronary artery disease were compared to control from the viewpoint of risk factors again, the results were the same, that is, smoking and diabetes were also associated with periperal vascular diseaes. CONCLUSION: The prevalence of associated coronary artery disease was relatively high in patients with atherosclerotic peripheral vascular disease. And smoking and diabetes seem to be important risk factors of atherosclerotic peripheral vascular disease.
Cholesterol, HDL ; Cholesterol, LDL ; Coronary Artery Disease ; Coronary Vessels ; Diabetes Mellitus ; Fasting ; Humans ; Hypertension ; Male ; Peripheral Vascular Diseases ; Physical Examination ; Prevalence ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

A patient, 59 years old male, with paroxysmal AV reentrant tachycardia utilizing a concealed left lateral accessory pathway with long VA conduction time is presented. During tachycardia P waves were negative in leads I, aVL, and V6 and positive in leads aVR and V1. The R-P/P-R ratio was 1.6. Radiofrequency catheter ablation was successful to interrupt the VA conduction through the accessory pathway.
Catheter Ablation ; Humans ; Male ; Middle Aged ; Tachycardia*

To evaluate the disturbed left ventricular diastolic filling by pulsed Doppler echocardiography in patients with ischemic heart disease who have normal systolic function, 117 subjects (50 angina patients with, 39 myocardial infarction patients with, 28 control subjects without significant coronary arterial narrowing) underwent echocardiographic examination one day before coronary arteriography. Beside analyzing trasmitral flow velocity curve, reconstruction and quantitative analysis of left ventricular filling rate and filling volume curves were made from Doppler trasmitral flow velocity curve, 2-Dimensional mitral annulus diameter and M-Mode mitral valve motion. From reconstructed left ventricular filling rate, filling fraction during early rapid filling or half diastolic rate, ratio of early to atrial peak filling rate, filling fraction during early rapid filling or half diastolic period and diastolic time interval(esp. T1/2 from peak early filling rate to its half valve)were measured. Angina and myocardial infarction group had significantly lower normalized peak early filling rate(4.9+/-0.6, 4.8+/-1.2 vs 6.0+/-1.1 DFV/sec, P<0.005), ratio of early to atrial peak filling rate(103.6+/-29. 4120.6+/-3.5 VS 175.5+/-55.0%, P<0.005), filling fraction during early diastolic period(46.2+/-5.0, 44.4+/-12.6 VS 54.3+/-6.8%, P<0.005) and filling fraction during half diastolic period(56.3+/-5.8, 55.4+/-14.1 VS 66.6+/-7.7%, P<0.005) than those of control group. Angina and myocardial infarction group had significantly higher normalized peak atrial filling rate(4.9+/-1.4, 5.0+/-2.0 VS 3.5+/-0.9 DFV/sec, P<0.005), prologed normalized T1/2 (12.5+/-3.0, 12.0+/-4.0 VS 9.8+/-2.2%, P<0.005) and delayed isovolumic relaxation time(81.7+/-7.8, 95.0+/-13.6 VS 74.3+/-6.9msec, P<0.005) than those of control group. Affecting factors to pseudonormalize left ventricular filling rate and filling volume curves in myocardial infarction group were mitral regurgitation, left ventricular aneurysm and severe impairment of systolic function. In 13 angina group patients who had undergone coronary angioplasty, no difference were found in any noninvasive diastolic filling parameters before and immediately(24 hours and 5 days) after the procedure. Thus, abnormal patterns of left ventricular filling occur in patients with ischemic heart disease and near normal global systolic function. The decreased peak early filling rate and early filling fraction occuring during rapid filling and the increased peak atrial filling rate occuring in late diastolic suggest that the patients with ischemic heart disease have impaired early diastolic filling. These diastolic filling abnormalities are unimproved 24 hour and 5 days after succesful coronary angioplasty. These diastolic filling parameters from left ventricular filling rate and filling volume curves provide useful noninvastive hemodynamic indices for assessment of left ventricular diastolic filling in patients with ischemic heart disease.
Aneurysm ; Angiography ; Angioplasty ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Myocardial Infarction ; Myocardial Ischemia* ; Relaxation

BACKGROUND: Atrial fibrillation is the most common sustained arrhythmia especially in the elderly. Despite the beneficial effect of anticoagulation to prevent disastrous complication of throm-boembolism, anticoagulation is not widely used in patients with atrial fibrillation. The purpose of this study was to identify the prevalence and clinical characteristics of atrial fibrillation and investigate the current status of anticoagulation in the elderly. METHODS: Through electrocardiographic analysis of 6,138 elderly (> or =65yr) patients from tan. to Dec. 1997, 386 patients with atrial fibrillation was found. Among the 386 patients, 274 patients with available medical records were enrolled for review of clinical findings (associated diseases, risk factor of throm-boembolism, medications) retrospectively. RESULTS: Mean age of population with atrial fibrillation was 72+/-6yr. The prevalence of atrial fibrillation was 6.2% and increased with age (65-69yr: 5.4%, 70-74yr: 6.4%, 75-79yr: 7.5%, 80yr-:9.0%). Atrial fibrillation with valvular hear disease was 27% of patients. Common associated diseases with nonvalvular atrial fibrillation were hypertension (48%), diabetes mellitus (18%), coronary artery disease (25%), congestive heart failure (21%), history of stroke or transient ischemic attack (27%). Anti-coagulation was used in 59% of valvular atrial fibrillation patients without contraindications (prosthetic valve: 100%, native valve: 42%), 24% of nonval-vular atrila fibrillation. Antiplatelet therapy with aspirin was 15%, 30% respectively, Aspirin was used in only 20% of atrial fibrillation patients with contraindication of anticoagulation. CONCLUSION: Atrial fibrillation is prevalent in the elderly. Anticoagulation and antiplatelet therapy in atrial fibrillation appears to be less than optimal.
Aged* ; Arrhythmias, Cardiac ; Aspirin ; Atrial Fibrillation* ; Coronary Artery Disease ; Diabetes Mellitus ; Electrocardiography ; Heart Failure ; Humans ; Hypertension ; Ischemic Attack, Transient ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Stroke ; Triacetoneamine-N-Oxyl

Otitis media (OM) is one of the most common pediatric infectious diseases. The burden of OM is known in many countries, but data for Korea has not been collected. The primary objective of this study was to evaluate the disease burden of OM in both children and adults. The Health Insurance Review and Assessment database study was analyzed to estimate the clinical and economic burden of OM and acute OM (AOM) for 2004. OM was defined as all cases coded H65, H66, or H67 and AOM cases coded H65, H65.0, H65.1, H65.9, H66, H66.4 or H66.9. For AOM, repeated visits within 30 days were considered to be one episode. Age specific incidence, and direct and indirect costs were estimated. A survey on pediatricians and otolaryngologists who most frequently diagnosed OM was carried out. The objective was to evaluate the accuracy of the claims made for OM and to examine the diagnosis and treatments of OM. A total of 5,964,587 claims for OM and 2,924,532 AOM episodes were reported. The incidence of outpatients presenting AOM was 60.9/1,000. The incidence of AOM was highest in children aged 1 year (736.9/1,000). The overall hospitalization rate due to AOM was 2.8/10,000, with a peak of 29.4/10,000 (1 year). The total cost incurred by AOM in Korea was estimated to be around 606.3 billion Korean won (KRW; 1,000 KRW is approximately US$1.00). The total cost of admissions was approximately 22.9 billion KRW, and the average cost of admission per person was about 1,690,000 KRW in a year. The cost of outpatient visits was 583.4 billion KRW, and 199,000 KRW per person. According to a survey of pediatricians and otolaryngologists on the accuracy of the OM diagnostic code, treatment, and prescription habits, the first-line diagnosis of AOM seemed to be fairly accurate. OM, including AOM, causes a considerable clinical and economic burden in Korea.
Adult ; Aged ; Child ; Communicable Diseases ; Hospitalization ; Humans ; Incidence ; Insurance, Health ; Korea ; Otitis ; Otitis Media ; Outpatients ; Prescriptions

To evaluate effect of coronary collateral circulation on left ventricular function in patients with acute myocardial infarction, global ejection fraction(EF), left ventricular end distolic pressure(LVEDP), peak creatine kinase(CK) level and regional wall motion were analysed and compared in 30 patients with acute myocardial infarction according to grade of coronary collateral circulation. Patients with total or near total(above 95% of diameter) occlsion of left anterior descending coronary artery without significant lesion in right coronary artery or left circumflex artery were selected and divided into 3 groups according to the degree of collateral circulation on coronary angiography, to be compared by the index of ejection fraction, peak creatine kinase level, left ventricular and diastolic pressure and regional wall motion. The result are as following : 1) There were no statistically significant differences in ejection fraction, peak creatine kinase level, left ventricualr and diastolic pressure among the groups. 2) Regional wall motion of infarct related area of G2+3 group(adequate collateral) were better than that of G0(no collateral) group(p<0.05). Therefore, adequate coronary collateral circulation in acute myocardial infarction is thought to have beneficial effect on left ventricular function especially in regional wall motion of infarct related area.
Arteries ; Blood Pressure ; Collateral Circulation* ; Coronary Angiography ; Coronary Vessels ; Creatine ; Creatine Kinase ; Humans ; Myocardial Infarction* ; Ventricular Function, Left*

BACKGROUND: Atherosclerosis is the most important disease that may cause ischemic syndrome in many organs including heart. It is supposed that apoptosis of vascular smooth muscle cells(VSMCs) is closely related to the progression and rupture of atheromatous plaque. Recent studies have documented evidence for elevated level of nitric oxide(NO) within advanced human atheroma and evidence of regression of atheroma by NO. So this study is designed to evaluate whether exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs and which proapoptotic gene(s) is involved in this type of apoptosis. METHODS: Rat VSMCs were cultured and used for experiment at passage 5 through 7. For NO donor, sodium nitroprusside (SNP) and S-nitroso-N-acetylpenicillamine(SNAP) of 0.5, 1, 2, 4mM were exposed to subconfluent VSMCs. The cells were harvested at 6, 12, 24, 48, 72hours after exposure of NO donors. Apoptosis was to be identified by 4, 6-diamidino-2-phenylindole dihydrochloride(DAPI) staining of nuclei and in-situ nick end labeling(TUNEL). The amount of fragmented DNA was analyzed semiquantitatively by diphenylamine(DPA) assay. Immunocytochemical(ICC) staining and western bolt analyses were designed to detect apoptosisrelated gene products, such as Bax-a, Fas and Bcl-2. RESULTS: 1) Decreased mitotic activity was shown after 12 hours exposure of exogenous NO donors, and condensation and margination of chromatin was identified agter 24 hours exposure, by DAPI staining. 2) Percent DNA fragmentation assessed by DPA method was 0,2,9,48,45% at 0,6,12,24,48 hours after exposure of 2mM of NO donors respectively. 3) The expression of Bax-a and Bcl-2 proteins was demonstrated in apoptotic cells by ICC staining. 4) The expression of Bax-a protein in cells under 24 hours exposure of NO donors was elevated by more than 18% of control level on densitometric analysis of western blot. The level of Bcl-2 was suppressed by 26% of control. So, Bax-a/Bcl-2 ratio in cells under exposure of NO donors was elevated to 2.0 from 1.2 of control level. CONCLUSIONS: Exogenous NO from NO donors can induce apoptosis of cultured rat VSMCs, and it is considered that bax-a and bcl-2 genes are involved in this type of apoptosis.
Animals ; Apoptosis* ; Atherosclerosis ; Blotting, Western ; Chromatin ; DNA ; DNA Fragmentation ; Genes, bcl-2 ; Heart ; Humans ; Muscle, Smooth, Vascular* ; Nitric Oxide ; Nitroprusside ; Plaque, Atherosclerotic ; Rats* ; Rupture ; Tissue Donors