A2 D time, a time interval from aortic second heart sound to the D point of mitral valve echogram, was reported as a valuable index of the left ventricular relaxation in its early diastole. It was suggested, however, that A2D time is influenced by variable factors rather than single factor. This study was performed to evaluate the influences of several on the A2D time and to extend our understandings in A2D time. For this purpose, A2D time was measured in 4 groups whose hemodynamic states were different, i.e.31 normal subjects (group A), 32 patients with essential hypertension without decompensation (group B), 10 normotensive patients with clinically full blown congestive heart failure (group C), and 11 patients with hypertensive heart failure (group D), and the mean values of each group were compared between the groups. Concordantly systolic hemodynamic parameters were observed and the relationship of A2D time and each of these parameters were observed. A2D time was consistently influenced by the level of left ventricle impedance and it is well correlated with parameters representing left ventricular systolic performances. In hypertensive subiects, A2D time was increased before the deterioration of the left ventricular systolic function but shortened after clinical heart failure. These findings suggest that A2D time may be of value in longitudinal follow-up of the left ventricular function in the hypertensive patients even before the development of clinical heart failure.
Diastole ; Electric Impedance ; Heart Failure ; Heart Sounds ; Heart Ventricles* ; Hemodynamics ; Humans ; Hypertension ; Mitral Valve ; Relaxation ; Ventricular Function, Left

The development of the cardiac ganglion was studied by electron microscopy in human fetuses ranging from 30mm to 270mm crown rump length. At 40mm fetus, the cardiac ganglia were observed in the adventitia of both the aorta and pulmonary artery, superior aspect of the left and right atrium, and interatrial septum. The cardiac ganglia were comprised of clusters of undifferentiated cells, neuroblasts, and unmyelinated nerve fibers. The ganglia were small and uncapsulated until 70mm fetus. At 70mm fetus, the cardic ganglia consisted of neuroblasts, satellite cells, and unmyelinated nerve fibers. Each ganglion was ensheathed in a connective tissue capsule. The cytoplasm of neuroblast contained Nissl bodies, mitochondria, coated vesicles, extensive Golgicomplex, and rough endoplasmic reticulum. Synaptic contacts between the cholinergic preganglionic axon and dendrites of postganglionic neuron were first observed. At 100mm fetus, the cardiac ganglia consisted of small clusters of ganglion cells and dendrites, together with supporting elements and blood vessels. During next prenatal stage from 170mm fetus, the ganglion cells were large and each contained a large nucleus with one or more nucleoli. The cytoplasm of ganglion cells contained much rough endoplasmic reticulum and extensive Golgi complex. Cholinergic preganglionic axons were numerous and interposed between the satellite cells. Adrenergic axons were rarely observed. A great number of synaptic junctions between the cholinergic preganglionic axon terminals and the dendrites of postganglinic neuron were found, and a few axosomatic synapses were also observed. Adrenergic nerve terminals did not seem to be involved in the synaptic transmission. The cardiac ganglion cells of the human fetal heart were innervated only by cholinergic nerve.
Adventitia ; Aorta ; Axons ; Blood Vessels ; Coated Vesicles ; Connective Tissue ; Crown-Rump Length ; Cytoplasm ; Dendrites ; Endoplasmic Reticulum, Rough ; Fetal Heart ; Fetus* ; Ganglia ; Ganglion Cysts* ; Golgi Apparatus ; Heart Atria ; Humans* ; Microscopy, Electron ; Mitochondria ; Nerve Fibers, Unmyelinated ; Neurons ; Nissl Bodies ; Presynaptic Terminals ; Pulmonary Artery ; Synapses ; Synaptic Transmission

No abstract available.
Hernia*

PURPOSE: The purpose of this study was to evaluate the long term outcome and the factors contributing to treatment outcome for chronic functional constipation in children. METHODS: Sixty three children were enrolled who had chronic functional constipation and could be followed by telephone contact. They were treated at the Bucheon Soonchunhyang Hospital for more than 1 month and observed from March 2001 to June 2005. We analyzed the clinical features, symptoms and signs, as well as the course and results of treatment. RESULTS: The male to female ratio was 35 (55.6%) : 28 (44.4%). The mean age at the onset of symptoms and diagnosis was 21.1+/-23.5 (1.9~84.0) months and 47.1+/-34.2 (6.9~138.0) months, respectively. The mean defecation frequency before treatment was 3.2+/-2.3 (0.5~10.0) times per week. The symptoms associated with constipation were as follows: soiling 34 (54.0%) which was more common in males than females, large stools in 30 (47.6%), decreased bowel movements less than three times a week in 20 (31.7%), straining during defecation in 19 (30.2%) and retentive posturing 19 (30.2%). The mean duration of follow-up was 34.2+/-14.6 (3.6~60.0) months and 44 (69.8%) patients had their symptoms resolve ("success") and 19 (30.2%) were not resloved ("fail") from the constipation. The time for recovery from soiling, straining during defecation and retentive posturing after treatment was 4.3+/-2.4 (1.0~36.0), 5.0+/-1.4 (0.8~36.0) and 5.0+/-3.1 (1.0~36.0) months, respectively. A relapse of the constipation occurred in 15 (23.8%) patients, 9 (60%) boys and 6 (40%) girls. The time to relapse after cessation of treatment was 2.9+/-1.9 (1.0~6.0) months and the only risk factor associated with relapse was the initial duration of treatment. CONCLUSION: Most of the patients had resolution of symptoms within five months after treatment; relapse occurred within three months after the interruption of treatment. The duration of treatment was important for recovery and for the prevention of relapse in the constipated children. Thus a long term maintenance of therapy and follow-up is necessary for chronic functional constipation in children.
Child* ; Constipation* ; Defecation ; Diagnosis ; Female ; Follow-Up Studies* ; Gyeonggi-do ; Humans ; Male ; Recurrence ; Risk Factors ; Soil ; Telephone ; Treatment Outcome ; Withholding Treatment

The hypotensive effect of tripamide(Normonal(R)) were evaluated in 31 cases of essential hypertension. Fifteen to thirty mg of tripamide per day were administered continuously for 8 weeks. The results were as follows; 1) The systolic blood pressure was significantly lowered from 175+/-15 mmHg(Mean+/-SD) before treatment to 144+/-17 mmHg after treatment(p<0.01), and the diastolic blood pressure was significantly lowered from 106+/-11 mmHg before treatment to 90+/-12 mmHg after treatment(p<0.01). 2) The systolic blood pressure was lowered 20 mmHg or more in 25 out of 31 cases(80.7%), and the diastolic blood pressure was decreased 10 mmHg or more in 25 out of 31 cases(80.7%) at the end of 8 weeks treatement. 3) There was no significantl differences in the level of SGOT, serum cholesterol, serum electrolytes(Na+, K+, Cl-), BUN, creatinine and urinc acid before and after treatment with tripamide. 4) In most cases the subjective symptoms disappeared or became easier after tripamide treatment. 5) Profound weakness was developed in 2 cases during tripamide administration.
Aspartate Aminotransferases ; Blood Pressure ; Cholesterol ; Creatinine ; Hypertension*

This study was made to evaluate the effect of oral atenolol, a cardioselective beta-adrenergic blocking agent without intrinsic sympathomimetic activity, on left ventricular function in patient with essential hypertension. Atenolol, 100mg/day, was given to 11 hypertensive patients for 4 weeks, and its effects on arterial pressure, pulse rate, left ventricular dimensions and ejection phase indices of myocardial performance were examined by echocardiography. Echocardiographic studies were performed before treatment and after 4 weeks of atenolol therapy. Arterial pressure fell form 145/90 mmHg to 138/84mmHg after 4 weeks. Pulse rate fell significantly from 69/min to 58/min(p<0.05). Left ventricular end-diastolic and end-systolic dimensions and mean rate of circumferential fiber shortening(mVcf) did not change significantly. Ejection fraction increased significantly from 0.66 to 0.72(p=0.01). This results indicate that atenolol in the resting state has no depressant effect on left ventricular function in patients with essential hypertension.
Arterial Pressure ; Atenolol* ; Echocardiography ; Heart Rate ; Humans ; Hypertension* ; Ventricular Function, Left*

Fistula between the right renal artery and the infereior vena cava is a rare disorder, of which only 7 cases were reported in so far as the authors have reviewed. A 34-year-old man, who had got a stab wound on the abdomen and undergone an abdominal surgery 12 years ago during his military service, visited the hospital because of occipital headache and known hypertension for 5 years. On examination, his blood pressure was 200/140mmhg, and a thrill and loud continuous vascular bruits over the paraumbilical and right loin region were noted. his blood pressure was refractory to usual antihypertensive regimens. The chest X-ray film showed cardiac enlargement and pulmonary congestion. With the aids of abdominal ultrasonogram, static and dynamic renal scanning with (99m)T-DTPA, excretory urogram, aortogram and selective right renal angiogram, he was diagnosed as right renal artery inferior vena cava fistula. After fistulectomy and repair of walls of both vessels, his blood pressure was successfully controlled with drugs.
Abdomen ; Adult ; Arteriovenous Fistula* ; Blood Pressure ; Estrogens, Conjugated (USP) ; Fistula ; Headache ; Humans ; Hypertension ; Hypertension, Renovascular ; Military Personnel ; Renal Artery* ; Thorax ; Ultrasonography ; Vena Cava, Inferior* ; Wounds, Stab ; X-Ray Film

BACKGROUND: In order to elucidate toxic mechanism of the oxygen radicals on cultured rat myocardial cells, cytotoxic effect of oxygen radicals was evaluated by MTT assay. In addition protective effect of glutathione(GSH) on oxidant-induced cardiotoxicity was investigated on these cultures. METHODS: Myocardial cells derived from neonatal rats were cultured for 12 hours in the medium containing various concentrations of glucose oxidase(GO). Cell viability was measured by MTT assay and morphological changes of the myocardial cells were observed by light microscope. RESULTS: GO-mediated oxygen radicals remarkably decreased cell viability of cultured myocardial cells in a dose-and time-dependent manner. And also, GSH blicked GO-induced cardiotoxicity in these cultures. CONCLUSION: These results suggest that the oxygen radicals are tixic and the selective antioxidants such as GSH are effective in blocking against the oxidant-induced cardiotoxicity in cultures of the myocardial cells of neonatsl rats.
Animals ; Antioxidants ; Cell Survival ; Glucose ; Glutathione* ; Rats ; Reactive Oxygen Species

Rupture of intracranial vessel during general anesthesia dramatically jeopardise patient's state and may lead to death. A sudden cardiovascular change during intubation and extubation in general anesthesia is dangerous, especially in patient with coronary and intracranial vascular disease. Myocardial infarction, congestive heart failure or intracranial hemorrhage can occur in such condition, but these occur rarely. We discovered the rupture of the hidden intracranial arteriovenous malformation in 13 years old female patient after tonsillectomy. We discuss about prognosis, prophylaxis and management of the intracranial arteriovenous malformation rupture during general anesthesia.
Adolescent ; Anesthesia, General* ; Arteriovenous Malformations ; Cerebrovascular Disorders ; Female ; Heart Failure ; Humans ; Intracranial Arteriovenous Malformations* ; Intracranial Hemorrhages ; Intubation ; Myocardial Infarction ; Prognosis ; Rupture* ; Tonsillectomy

42 patients with mitral stenosis(MS), diagnosed by M-mode, 2-D sector scan and pulsed Doppler echocardiography, were evaluated. Among them 28 patients were complicated with atrial fibrillation and one foruth was normal sinus rhythm. Pulsed Doppler echocardiographic left ventricular inflow velocity patterns(PELVIVP) were compaired with the EF slop of anterior mitral valve leaflet. The results were as follows; The normal PELVIVP showed a biphasic pattern during diastole. PEVIVP in MS were classified into 5 types and measured EF slop of anterior mitral valve leaflet in each type. Type I was characterized by a biphasic flow pattern showing a relative increase in the atrial contraction wave compared with the rapid filling wave and the prolonged deceleration time. EF slop was 24.7+/-6.1mm/sec. Type II was turbulent scaphoid pattern during diastole. EF slop was 14.5+/-4.4mm/sec. Type IIIa was monophasic with gradual descending slop during diastole. EF slop was 16.9+/-4.0mm/sec. Type IIIb was also turblent monophasic with gradual ascending slop during diastole. EF slop was 8.1+/-2.3mm/sec. Type IV was diastolic turblent and was characterized by dome shaped pattern. EF slop was 7.9+/-1.9mm/sec. There was a significant correlation between the 3 groups(I, II and IIIa, IIIb and IV) of LVIVP in MS and EF slop(P<0.005). This result indicated that type I of the flow pattern was well observed in mild MS, type II and IIIa in moderate MS, and type IIIb and IV in severe MS. Pulsed Doppler flow pattern in MS was alterable in the atrial fibrillation.
Atrial Fibrillation ; Deceleration ; Diastole ; Echocardiography* ; Echocardiography, Doppler, Pulsed ; Humans ; Mitral Valve ; Mitral Valve Stenosis*