The idiopathic mitral valve prolapse(IMVP) syndrome presents with nonspecific cardiovascular symptoms which need to evaluate those clinical meaning. These symptoms should not necessarily be interpreted as suggesting arrhythmias, conduction abnormalities or myocardial ischemia unless the symptoms and the the electrocardiographic changes documented to occur simultaneously. And it will be that ambulatory electrocardiographic monitoring is a a very sensitive method to detect the transient arrhythmias, conduction abnormalities of ischemic changes in patients with IMVP. Author undertook a study to systemically evaluate the electrocardiographic findings in symptomatic patients with IMVP by means of 24 hour ambulatory Holter electrocardiographic monitoring for the evaluation of the clincal meaning of those symptoms. The following results were obtained; 1) Twenty five subjects, 15 male and 10 female, with IMVP were studied. The subjects ranged in age from 10 to 50 decades. 2) The presenting complaints were palpitation in 20, atypical chest pain in 17, dizziness and syncope in 9, and lyspnea and fatigue in 7 of 25 studied subjects. 3) There were no correlations the presence of complaints with the routine 12 lead electrocardiographic findings, echocardiographic findings, and phonocardiographic findings. 4) The relationship of symptoms recorded in patient diary to Holter monioring electrocardiographic findings is summarized. (1) 20 patients recorded episodes of palpitation. Seven of these patients was associated with sinus tachycardia, 2 with paroxysmal atrial tachycardia, 3 with atrial fibrillation, 2 with atrial premature contractions, 5 with ventricular premature contractions, and 1 with no changes, (2) 17 patients recorded episodes of atypical chest pain. Three of these patients was associated with sinus bradycardia, 2 with sinus tachycardia, 1 with paroxysmal atrial tachycardia, 2 with atrial finbrillation, 2 with ventricular premature contractions, 3 with nonspecific ST segment change, 1 with first degree AV block, and 3 with no changes. (3) 8 patients recorded episodes of dizziness. Three of these patients was associated sinus bradycardia, 2 with paroxysmal atrial tachycardia, 1 with paroxysmal ventricular tachycardia, 1 with ventricular premature contractions, and 1 with no changes. (4) 1 patient recorded episodes of syncope associated with second degree AV block and sinus bradycardia. (5) 3 Patients recorded episodes of dyspnea. One of these patients was associated with sinus bradycardia, 1 with ventricular premature contractions and one with no changes. 5) The prolonged QTc interval revealed in 7 of 25 studied subjects. One of these had frequent ventricular contractions followed by paroxysmal ventricular tachycardia. 6) Ectopic beats associated with bradyarrhythmias tend to decrease in frequency and associated with tachyarrhythmias to increase in frequency in patients with atrial premature contractions during exercise, and with ventricular premature contractions during sleeping, respectively. 7) Bradyarrhythmia accounted for the majority of arrhythmias recorded in 15 of 25 symptomatic IMVP patients. It is concluded that Holter monitoring is of considerable value in assessing the clinical meaning of the nonspecific complaints in patinets with IMVP.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrioventricular Block ; Bradycardia ; Chest Pain ; Dizziness ; Dyspnea ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory* ; Fatigue ; Female ; Humans ; Male ; Mitral Valve Prolapse* ; Mitral Valve* ; Myocardial Ischemia ; Syncope ; Tachycardia ; Tachycardia, Sinus ; Tachycardia, Ventricular

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*

A 15-year-old female patient had malignant atrophic papulosis(Degos' disease) that affected the skin and probably intestinal tract. She had multiple erythematous papules with porcelain-white atrophic centers on the trunk and extremities. Also she suffered from intermittent nausea, vomiting and abdominal pain. She received appendectomy for abdominal pain 2 months ago. Histopathologic studies showed atrophic epidermis and necrobiotic dermis. There were endothelial thickening, fibrinoid necrosis of bload vessels, perivascular lymphocytic infiltation in the lower dermis. She was treatd with acetyl salicylic acid and dipyridamole, but there was no improvement.
Abdominal Pain ; Adolescent ; Appendectomy ; Dermis ; Dipyridamole ; Epidermis ; Extremities ; Female ; Humans ; Malignant Atrophic Papulosis* ; Nausea ; Necrosis ; Salicylic Acid ; Skin ; Vomiting

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: This study was performed in order to investigate the changes of Na+ transport system in the red blood cells of patients with essential hypertension. METHODS: Na(+)-Li(+) countertransport and Na(+)-K(+) pump activity were measured in 30 cases of essential hypertension and 20 healthy normal controls. And these measurements were analyzed in terms of some important clinical parameters in the patients, i.e., body mass index(BMI), status of hypertension and plasma lipids. RESULTS: Na(+) and K(+) contents of red cells in hypertensive patients were 16.9+/-1.4 and 77.8+/-2.1mmol/L cells, respectively, and no significant difference was found compared with respective value of normal control(14.2+/-0.9 and 82.2+/-2.8mmol/L cells). Na(+)-Li(+) countertransport in the patients group was significantly ancreased compared with control group(62.5+/-4.5 and 46.8+/-3.0umol/L cells.hr), and Na(+)-K(+) pump activity was also showed a significant depression(8.72+/-0.80 and 12.79+/-0.52umol Pi/mg.hr). In the analysis regarding the relationship between Na(+) transport system and some important clinical parameters of the patients with essential hypertension, Na(+)-Li(+) countertransport was related to BMI, and the level of triglyceride. On the other hand, Na(+)-K(+) pump activity was related to the WHO stage and the levels of total cholesterol and triglyceride. But level of blood pressure did not show a significant correlation with either are of the two Na(+) transport system. CONCLUSION: These resluts suggest that Na(+)-Li(+) countertransport and Na(+)-K(+) pump activity in patients with essential hypertension were significantly altered compared with heathy normal controls, and these Na(+) transport system were also influenced by BMI, WHO stage, and the levels of cholesterol and triglyceride. And the individual variation in Na(+) transport system were also suggested by the findings being overlapped between hypertensive patients and controls.
Blood Pressure ; Cholesterol ; Erythrocytes* ; Hand ; Humans ; Hypertension* ; Plasma ; Triglycerides

In 1941, Jaffe and coworkers studied a lesion with histologic appearance of fibrous stroma, pigmented deposition and histiocytic infiltration as well as giant cell, for which they named pigmented villonodular synovitis, bursitis and tenosynovitis. Thereafter many authors have discussed etiology, clinical and radiological features, pathology and treatment regarding the disease. Almost all, this disease is monoarticular and knee joint is most common site. We experienced a case of localized pigmented villonodular synovitis involving an shoulder joint which was treated by local excision and obtained good result.
Bursitis ; Giant Cells ; Knee Joint ; Pathology ; Shoulder Joint ; Shoulder ; Synovitis, Pigmented Villonodular ; Tenosynovitis

The clinical study was performed to 28 patients with the pericardiac effusion who were admitted in Busan university Hospital and Paik Hospital, In-Je Medical College, Busan, korea during March 1976 and July 1981. The results were as following; 1) 12 cases(42.9%) of total 28 pericardiac effusion occured in 3rd decade, 8(28.5%) in 2nd decade and 5 cases(17.9%) in 4th decade. Sex distribution showed male to female 2.5:1. 2) With etiological distribution there were 15 cases(53.6%) tuberculous, 5(17.9%) nonspecific, 3(10.7%) malignant, 2(7.1%) pyogenic, 2 traumatic and 1(3.6%) rheumatic. 3) On admission 28 cases(100%) complained of dyspnea, 24(85.7%) distant heart sound, 20(71.4%) each engorged jugular vein and edema, 18(64.3%) each cough and abdominal fullness, 17(60.7%) each sputum and chest discomfort and pain, 12(42.9%) fever, 11(39.1%) orthopnea, 10(35.7%) chilling, 7(25%) oliguria, 4(14.6%) palpitation and 3(17.2%) headache. Increased cardiac dullness was observed in 26 cases(71.4%), hepatomegaly 18(64.3%), pulmonary rales 17(60.7%), ascites 13(46.1%), fever 12(42.9%), pericardiac friction rub 10(35.7%), splenomegaly 7(25%), paradoxical pulse 6(21.4%) and jaundice 2(7.1%). 4) On amission SGOT and SGPT level was increased each in 15(53.6%) and 13(46.7%), TTT and CCF abnormal in 10(35.7%), and 8(28.5%), serum NPN, BUN, creatinine increased in each 10(35.7%), 11(39.1%), 8(28.5%), WBC increased in 6(21.4%), RBC decreased in 8(28.5%) and ESR increased in 16(57.1%). 5) Characteristics of pericardiac effusion showed hemorrhagic 17(60.7%), serosangeous 6(21.4%), sangeous 3(17.2%) and pyogenic 2 cases(7.1%). 6) The ECG on admission revealed low voltage in 25(89.1%), depressed ST segment in 13(46.1%) and inverted T wave in 12(42.9%). 7) Chest X-ray showing cardiomegaly 28(100%), pleural effusion in 20(71.4%), and pulmonary congestion in 16(57.1%). 8) The m mode and 2-D Echocardiogram showed echo free space in 28 cases and after pericardiocentesis the space was reduced or disappeared. 9) 19 cases of 28(67.5%) were improved clinically, while 5 cases(17.9%) were not improved and 4 cases(14.6%) died.
Alanine Transaminase ; Ascites ; Aspartate Aminotransferases ; Busan ; Cardiomegaly ; Cough ; Creatinine ; Dyspnea ; Edema ; Electrocardiography ; Estrogens, Conjugated (USP) ; Female ; Fever ; Friction ; Headache ; Heart Sounds ; Hepatomegaly ; Humans ; Jaundice ; Jugular Veins ; Korea ; Male ; Oliguria ; Pericardiocentesis ; Pleural Effusion ; Respiratory Sounds ; Sex Distribution ; Splenomegaly ; Sputum ; Thorax

The index on myocardial contractility of pure mitral regurgitation(MR) after mitral valve replacement is believed to be useful in determining proper operation time before irreversible myocardial damage by volume overload. Thus the authors examined pre and post-operative echocardiographic results of 20 cases of pure MR patients who had been admitted to Pusan National University hospital and compared the usefulness of each index. Pre and post-operative echocardiographic results were as follows respectively ; 1) Left ventricular internal dimension in diastole(LVIDd) were 6.49+/-0.19cm and 5.51+/-0.17cm. 2) Left ventricular internal dimension in systole(LVIDs) were 4.26+/-0.12 and 3.79+/-0.18cm. 3) Ejection fraction were 71.28+/-1.57% and 59.24+/-3.05%. 4) Fractional shortening(FS) were 34.09+/-1.18% and 27.21+/-1.84%. 5) Mean Vcf were 1.53+/-0.08cm/sec and 1.18+/-0.09cm/sec. 6) Left ventricular end-diastolic volume index(EDVI) were 196.35+/-18.33cc/m2 and 98.46+/-9.96cc/m2. 7) Left ventricular end-systolic volume index(ESVI) were 55.28+/-5.12cc/m2 and 41.88+/-6.07cc/m2. 8) Left ventricular end-systolic wall stress/ESVI(ESS/ESVI) were 2.3+/-0.21 and 3.91+/-0.83. ESS/ESVI showed significantly(p<0.05) elevated postoperative change, LVIDd, LVIDs, EF, FS, EDVI, ESVI revealed significantly(p<0.05) reduced postoperative change whereas Mean Vcf had no postoperative change. After examining correlation between preoperative and postoperative results of each index, it is believed that LVIDd, LVIDs, and ESS/ESVI were useful prognostic indices but were unrelated to postoperative ejection phase indices such as EF, FS, and MEan Vcf. Especially in case of LVIDd>6cm, LVIDs>4cm, and ESS/ESVI<2, the prognosis was poor due to myocardial damage by mitral regurgitation.
Busan ; Echocardiography ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Prognosis ; Stroke Volume

To recognize the hemodynamic change in the constrictive pericarditis, we have reviewed the Doppler echocardiography, cardiac catheterization, and pathology of 6 patients who were admitted to Pusan National University Hospital due to right-side heart failure, diagnosed as constrictive pericarditis and were undertaken pericardiectomy. Doppler echocardiographic findings showed that acceleration and deceleration of early diastolic rapid filling were increased, followed by shortening of duration but there was a tendency to decrease in velocity-time integral of early diastolic rapid filling compared to that of atrial contraction filling in the left ventricle. On the contrary, there was decrease in acceleration of rapid filling in right ventricle, but other indices were comparable to that of left ventricle. The integral of D wave increased relatively compared to that of S wave in superior vena canal flow. Also, there was decrease in peak flow velocity, acceleration and velocity-time integral of aortic and pulmonary arterial flow velocity. One patient who had increased fraction of integral of early diastolic rapid filling compared to that of atrial contraction filling in right ventricle showed that he had higher central venous pressure and D wave was dominant in superior vena caval flow. In conclusion, Doppler flow patterns showed characteristic diastolic filling inpairment and systolic dysfunction in constrictive pericarditis, so that Doppler echocardiography is believed to be a useful method of noninvasive diagnosis and follow-up of hemodynamic change in constrictive pericarditis.
Acceleration ; Busan ; Cardiac Catheterization ; Cardiac Catheters ; Central Venous Pressure ; Deceleration ; Diagnosis ; Echocardiography ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Pathology ; Pericardiectomy ; Pericarditis, Constrictive*