In the real-time two-dimensional Doppler flow mapping(2DD) system, Doppler signals are processed using auto-correlation technique, so that the direction, velocity and turbulence of the intracardiac blood flow are displayed by coloration on the B mode image of the heart in real time. Aortic regurgitant flow is imaged as a mosaic jet spurting out from the aortic valve orifice to cardiac chamber. Dynamic features in the direction and extent of regurgitant flow and the site of regurgitation on the aortic valve orifice are readily obtained. Feasibility of the 2DD system in the assesment of aortic regurgitation was examined in 30 cases documented by angiography. In 30 cases, there were 20 cases with aortic regurgitation(AR) aged 16 to 57 years(mean 34) and 10 cases without AR aged 17 to 39 years(mean 30). The underlying disorders of AR were rheumatic in 15 cases, bicuspid aortic valve in 1, ventricular septal defect in 1, aortitis in 1, Marfan's syndrome in 1 and unknown in 1. The results are as follows : 1) In 19 out of 20 cases with AR the 2DD showed regurgitant jet spurting out from valve orifice(sensitivity=95%). One case missed by the 2DD had 1+AR. None of the 10 cases who had no AR manifested the evidence of AR on the 2DD(specificity=100%). 2) There was an excellent positive correlation between the maximal jet length of regurgitant flow on the 2DD and angiographic severity of regurgitation(r=0.998, p<0.001). The maximal jet length was less than 3cm for cases with 1+, 3-4.9cm for 2+, 5-5.9cm for 3+, and 6cm or more for 4+AR. 3) In 19 out of 20 cases with AR, the 2DD identifed the anatomic valvular site of regurgitation(sensitivity=95%, specificity=100%). 4) The regurgitant aortic valvular area was measured as 0.6cm2 or less in all of 12 cases with 2+ or less AR, while 0.9cm2 or more in 6 out of 7 cases with 3+or more AR. Thus, a less or greater than 0.8cm2 regurgitant aortic valvular area provides to discriminate between mild(< or = 2+) and severe(> or = 3+) AR. 5) In all 8 cases with fluttering of anterior mitral leaflet and 8 out of 9 cases with fluttering of interventricular septum, a regurgitant jet impinged on them. The results of this investigation indicate that the 2DD system is a very useful and unique noninvasive technique in the detection, estimation of severity and spatial orientation of AR.
Angiography ; Aortic Valve ; Aortic Valve Insufficiency* ; Aortitis ; Bicuspid ; Equidae ; Heart ; Heart Septal Defects, Ventricular ; Marfan Syndrome

No abstract available.
Diagnosis*

Aquagenic urticaria is a rare form of physical urticaria in which wheal is produced by contact with water. A 21-year-old woman was referred to our department because of itching wheal after contact with water for 1 month. Match-head-sized wheal surrounded by bean sized erythema was provoked with water on her face regardless of its tempera ture, osmolarity and quality. Passive transfer test was negative. Result of pro vocation test with normal saline and NaHCO solution, which was reported to be therapeutically effective, was similar to those with pure water.
Erythema ; Female ; Humans ; Intradermal Tests ; Occupations ; Osmolar Concentration ; Pruritus ; Urticaria* ; Water ; Young Adult

A 25-year-old woman developed generalized urticaria and an anaphylactic syndrome of sudden onset while she was being treated for her decubitus ulcer with chlorhexidine antiseptic solution. Prick test with 0.5% chlorhexidine produced a wheal in a few minutes. A passive intradermal transfer test (PK test) to her mother was positive. These enabled us diagnose her as having an immunologic contact urticaria to chlorhexidine.
Adult ; Chlorhexidine* ; Female ; Humans ; Mothers ; Pressure Ulcer ; Urticaria*

The characteristics of echocardiographic dilated cardiomyopathy according to its etiologic factors were studied from June, 1984 to September, 1986 in Pusan national University Hosptial. The cases included in the study were 144 patients, 90 cases of male and 54 cases of female respectively ranging the age from 17 years old to 79 years old. Patients with valvular heart disease were excluded in this study. The results were as follows: 1) Primary dilated cardiomyopathy was 40.3%, and secondary dilated cardiomyopathy was 59.7% of the study group. In secondary dilated cardiomyopathy, its etiologic factors were hypertension 17.4%, ischemic heart disease 27.8%, thyrotoxicosis 5.6%, chronic renal failure 4.8%, pregnancy 3.4% and alcohol drinking 0.7%. 2) Atrial fibrillation was noted in 32.6% of primary, 36.0% of hypertensive, 30.0% of ischemic and 62.5% of toxic cardiomyopathy. Conduction disturbance was noted in 57.1% of uremic cardiomopathy, it was far more frequent comparing with other cases of cardiomyopathy ranging 20-30%. 3) The frequency of end-diastolic internal dimension of left ventricle over 6.0cm was 58.6% in primary, 68.0% in hypertensive, 75.0% in ischemic, 71.4% in uremic and 40.0% in postpartum cardiomyopathy. 4) The frequency of ejection fraction of left ventricle below 40% was 17.2% in primary, 8.0% in hypertensive, and 28.2% in ischemic cardiomyopathy. 5) The paradoxical motion of anteroseptal wall of left ventricle was observed in 6.9% of primary, 4.0% of hypertensive, and 17.5% of ischemic cardiomyopathy. The ratio of anteroseptal wall motion to posterior wall motion below 0.4 was 15.6% in primary, 20.0% in hypertensive, and 25.0% in ischemic cardiomyopathy. 6) The frequency and grade of mitral regurgitation became increased with the dilatation of left ventricle. 7) The follow-up of cardiothoracic ratio was helpful significantly in the prediction of prognosis.
Adolescent ; Aged ; Alcohol Drinking ; Atrial Fibrillation ; Busan ; Cardiomyopathies ; Cardiomyopathy, Dilated* ; Dilatation ; Echocardiography* ; Female ; Follow-Up Studies ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Hypertension ; Kidney Failure, Chronic ; Male ; Mitral Valve Insufficiency ; Myocardial Ischemia ; Postpartum Period ; Pregnancy ; Prognosis ; Thyrotoxicosis

BACKGROUND: Electroconvulsive therapy (ECT) that works by electrically inducing grand mal seizure is an effective therapy for patients with major psychosis and affective disorders. But ECT may produce intense stimulation of the central nervous system resulting in hypertension and tachycardia. Such an acute hyperdynamic state may be undesirable because of possible cardiovascular complications. We compared the ability of different bolus doses of esmolol to blunt the hemodynamic effects of ECT. METHODS: Twenty ASA physical status 1~2 patients were enrolled in a crossover design study to determine the effects of two standard esmolol bolus doses (0.5 mg/kg and 1.0 mg/kg) on the hemodynamic response and seizure duration during ECT. In each patients receiving esmolol or placebo, arterial pressure, heart rate, seizure duration and peripheral oxygen saturation (SpO2) were recorded. RESULTS: The seizure duration with placebo was 43 +/- 9 sec, esmolol 0.5 mg/kg bolus dose was 39 +/- 14 sec and esmolol 1.0 mg/kg bolus dose was 39 +/- 12 sec, but it was not significant. Compared with esmolol 0.5 mg/kg bolus dose, esmolol 1.0 mg/kg bolus dose decreased blood pressure and heart rate during ECT more effectively. CONCLUSIONS: Esmolol 1.0 mg/kg bolus dose was considered to be the better dose in blunting the hyperdynamic response during ECT without shortening of seizure duration.
Arterial Pressure ; Blood Pressure* ; Central Nervous System ; Cross-Over Studies ; Electroconvulsive Therapy* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Mood Disorders ; Oxygen ; Psychotic Disorders ; Seizures ; Tachycardia

No abstract available.

Flap survival is critical to the success in reconstructive surgery, there have been many investigations to increase the blood supply to the flaps such as surgical delay and pharmacologic delay. Prostaglandin(PG) is released from various tissues including blood vessel in response to physical stimulus. Among the Prostaglandins, PGE1 has been proven to be a vasodilatation property and many authors have demonstrated its effect to increase blood supply after random cutaneous flap surgery. Clinically, however, muscle flap or musculocutaneous flap is more significantly used in reconstructive surgery and hemodynamic effects of PGE1 of this type of flap are still not documented. The authors designed the random muscle flap to study the hemodynamic effects of PGE1 of the muscle flap. Superior based rectus muscle flap was elevated from rats and the superior epigastric artery, its major vascular pedicle, was ligated to create the random-type muscle flap. Twenty two rats were divided into two experimental groups and each group had 11 rats; Group I: No drugs Group II: PGE1 injection group for 7 postoperative days intraperitoneally The average muscle flap survival rate of group I was 46+/-3.0 precent and it had a higher survival rate than the control group(23+/-4.3%). The muscle flap survival rates showed significant differences between the two groups (p< 0.005) This study shows that the administration of the PGE1, in clinical usage of the rare random muscle flap with a pedicle injury or musculocutaneous flap with the risk of distal cutaneous flap necrosis, such as TRAM flap, which might be much safer and popular.
Alprostadil ; Animals ; Blood Vessels ; Epigastric Arteries ; Hemodynamics ; Myocutaneous Flap ; Necrosis ; Prostaglandins ; Rats* ; Rectus Abdominis* ; Survival Rate ; Vasodilation

PURPOSE: This study was undertaken to determine whether the clinical presentation of patients with central precocius puberty(CPP) varies according to the etiology, whether this permits the differentiation between idiopathic and organic forms and to examine whether LH determination in a single timed blood sample after GnRH administration is sufficient to diagnose CPP. METHODS: This study included 33 girls with signs of breast development, of whom 23 were diagnosed as definite central precocious puberty. Sixteen patients had idiopathic CPP; the remaining 7 patients had organic CPP. Ten patients were classified as non-CPP. Potential clinical and laboratory predictors of CNS abnormalities were assessed and GnRH stimulation test was done. RESULTS: The age of onset in patients with organic CPP was 4.11+/-2.08 years, whereas the age in patients with idiopathic CPP was 7.25+/-1.34 years. This parameter is the only one showing statistical significance. We compared sensitivities and specificities at 0, 15, 30, 60, 90 and 120 min which yielded sensitivities of 8.7%, 87.0%, 91.3%, 87.0%, 73.9%, 60.9%. CONCLUSION: It is impossible to exclude a central nervous system lesion in patient with central precocious puberty without performing central nervous system imaging. However, this study indicates earlier the onset of disease, higher the possibility of presence of CNS lesion. According to the mean GnRH stimulated LH levels and sensitivity at each times, a single blood sample obtained for LH determined after GnRH administration at 30 min can be used to diagnose the central precocious puberty.
Age of Onset ; Breast ; Central Nervous System* ; Female ; Gonadotropin-Releasing Hormone* ; Humans ; Luteinizing Hormone ; Puberty, Precocious*

No abstract available.
Hydronephrosis*