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

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: 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

Carcinoid tumors have been described in almost every organ and may affect virtually every body system. Cardiac involvement manifesting as right-sided valvular disease is characteristic of the carcinoid heart disease. Myocardial metastasis is an unusual manifestation of carcinoid heart disease and it was manifested as a mass lesion in the previous reports. We observed a myocardial metastasis of carcinoid tumor manifesting as diffusely infiltrative pattern.
Carcinoid Heart Disease* ; Carcinoid Tumor* ; Neoplasm Metastasis

PURPOSE: To investigate the anatomic and histologic changes of testis as a result of long-term estrogen exposure on male MATERIALS AND METHODS: Fourteen testes were harvested from 14 consecutive male-to-female transsexuals who had sex reassignment operation in Dong-A University Hospital from March 1991 to March 1997. Age at inception of estrogen therapy was 16 years to 24 years. The duration of estrogen therapy was 2-12 years (mean 7.4 years). The dose and method of estrogen treatment regimen was variable, but about 20 mg (intravenous) monthly during first year. Sperm analysis, volume of testis and histologic change of testis were compared to the duration of estrogen therapy. RESULTS: The mean volume of semen was 1.8 ml(0.5~3 ml), and oligozoospermia, azoospermia or asthenospermia were observed in 12 cases (85.7%) by means of sperm analysis. The mean volume of testis was 17.3 ml(15~23ml). In light microscopic examination of the testis, near-normal histologic finding was noted in 3 cases(21.4%), spermatocytic arrest in 8 cases(57.2%) and geminal cell aplasia in 3 cases (21.4%). CONCLUSION: As the duration of estrogen therapy was longer, there was a tendency that volume of semen, sperm count and motility were reduced and the histologic change of seminiferous tubules was severe. It was considered that the negative feedback of estrogen on hypothalamic-pituitary-gonadal axis, the down regulation of estrogen receptors and the direct effect of estrogen might produce the adverse effect on male reproductive system by testicular change with maturation arrest, germ cell aplasia, end-stage testis and peritubular fibrosis and reduced fertility after long-term estrogen exposure.
Axis ; Azoospermia ; Down-Regulation ; Estrogens* ; Fertility ; Fibrosis ; Germ Cells ; Humans ; Male ; Oligospermia ; Receptors, Estrogen ; Semen ; Seminiferous Tubules ; Sperm Count ; Spermatozoa ; Testis* ; Transsexualism

In situ follicular lymphoma is a newly defined entity among the lymphoid neoplasms and is defined as architecturally normal-appearing lymph nodes and other lymphoid tissues that have one or more follicles that demonstrate bcl-2 overexpressing centrocytes and centroblasts, with or without a monomorphic cytologic appearance suggestive of follicular lymphoma. Here we present a case of in situ follicular lymphoma diagnosed during the follow-up after a complete response to the treatment of lymphocyte-rich classical Hodgkin's lymphoma. In our case, because only a few germinal centers contained bcl-2 overexpressing cells, we missed the diagnosis of in situ follicular lymphoma in the initial histological examination. We could establish the diagnosis only after performing bcl-2 immunostaining in the sequential biopsy. Therefore, we recommend that careful histological examination along with bcl-2 immunostaining is needed in patients with suspicious clinical findings.
Biopsy ; Follow-Up Studies ; Germinal Center ; Hodgkin Disease ; Humans ; Lymph Nodes ; Lymphoid Tissue ; Lymphoma ; Lymphoma, Follicular ; Precancerous Conditions

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: 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