Clinical characteristics and coronary angiographic findings were analyzed in 24 patients with angiographically documented coronary artery spasm, which developed spontaneously in 11 cases and was provoked by intravenous ergonovine meleate in 13 cases. The commonest clinical presentation was chest pain at rest in 21 out of 24 cases, and nine patients with resting angina had also exertional chest pain. Ten patients complained of chest pain which developed especially at night and in the early morning. Cumulative doses of ergonovine meleate whoch were required to provoked spasm were 0.05mg in 3, 0.15mg in 8 and 0.35mg in 2 cases. Transient hypertension occured in one case as a complication of ergonovine provocation test. In 20 cases coronary artery spasm developed at the portion of normal or insignificantly narrowed coronary arteries, at the severely stenotic portion in 3 cases and at the normal portion different fropm severe tight lesion in one case. Electrocardiographic findings at the time of coronary spasm were ST segment elevation in 11 among 18 cases, ST segment depression in 2 cases and no change in 3 cases. Twenty two patients complained of chest pain of the same characteristics which they had previously experienced, but there was no chest pain in 2 patients. Right coronary artery was the most prevalent site of coronary artery spasm, and percutaneous transluminal coronary angioplasties were performes successfully in 4 cases with significantly tight lesions. In conclusion coronary artery spasm is thought to play a significant role in the conversion of stable to unstable angina and the development of silent myocardial ischemia as well as variant angina.
Angina, Unstable ; Angioplasty ; Chest Pain ; Coronary Artery Disease* ; Coronary Vessels* ; Depression ; Electrocardiography ; Ergonovine ; Humans ; Hypertension ; Myocardial Ischemia ; Spasm*

Early diastolic left ventricular relaxation was determined in 20 patients by combined echopressure measurement. 7 normal control cases and 13 cases with valvular regurgitation were studied with reference to incremental delta elastance. The hemodynamic and echocardiographic data were analysed during the phase of decreasing left ventricular elastance (that is, when pressure is decreasing while volume is increasing). Starting from a fixed level of wall stress (40 kdyne/cm2), we determined Incremental Delta Elastance(ratio big up tri, Delta p/big up tri, Delta V) by a constant increase in LV volume(eg. 10 ml/M2 or 20 ml/M2). We named Incremental Delta Elastance at 10 ml/M2 and 20 ml/M2 of LV volume increase as d-E 10 and d-E 20 respectively. In valvular regurgitation, incremental delta elastances were statistically different from those of normal subjects(p<0.01). d-E10 was -1.67+/-0.69(versus -3.38+/-1.75 in normal subjects) mmHgm2/ml and d-E20 was -0.98+/-0.39(versus -1.69+/-0.84 in normal subjects) mmHgm2/ml. d-E 10 and d-E20 were compared with ejection phase indices(ejection fraction, meanVcf) in whole group(n=20). There was significant correlation between d-E and ejection fraction(d-E10 : r=-0.47, d-E20:r=-0.50) p<0.05. There was significant correlation between d-E and meanVcf(d-E10: r=0.53, d-E20: r=-0.57) p<0.05. d-E10 and d-E20 were compared with volume indices(end-diastolic volume index and end-systolic volume index) but no significant correlation was found. Because we evaluated that inotropic state or afterload would influence incremental delta elastance, further study, especially with reference to endsystolic volume index may be needed. The absolute values between d-E10 and d-E20 were different but they were simliar in property. We concluded that incremental delta elastance(d-E10 or d-E20) could be used as a useful index of early diastolic relaxation in chronic valvular regurgitation.
Echocardiography ; Hemodynamics ; Humans ; Relaxation*

Authors analysed systolic pressure-volume-stress relations by combined echo-pressure-cineangiographic measurement in 10 normal subjects(Group I) and 37 patients with chronic valvular heart diseases. Patients with chronic valvular heart diseases were divided into 3 groups : Group II ; mitral stenosis(n=9), Group III ; mitral stenosis with aortic regurgitation(n=19). The aims of this study are to find useful left ventricular(LV) contractility indices and evaluate left ventricular contractility at various volume loading states. Studied LV contractility indices were maximal elastance of isovolumic contraction(Eiso), endsystolic pressure-volume ratio(Ees) and slope of regression line in late systolic stress-volume loop(A). Eiso was estimated using an isovolumic contraction model of Sunagawa and A was analysed in a single ejecting beat. Endsystolic volume index(ESVI), end diastolic volume index(EDVI), stress at peak pressure(Speak), cardiac index, Vmax, mean Vcf and ejection fraction were determined also. The obtained results were as follows. 1) Significant correlations were found in whole group(n=47) between Eiso and Ees(r=0.88, P<0.005), Elso and cardiac index(r=0.83, P<0.005), Ees and CI(r=<0.76, p<0.005). Further, these correlation coefficiencies were not different between any two groups of Group I, Group II, Group III, Grouop IV and whole group (p<0.05); that is Eiso or Ees had a constant significance at various loading state. 2) Significant correlation between A and cardiac index was noted in Group I+II+III(n=28, r=0.48, p<0.01), but this correlation coefficiency was significantly different from that of Group IV(n=19, r=0.08); p<0.05. 3) In Group II(patients with mitral stenosis), cardiac index* and EDVI* and stress at peak pressure** were decreased significantly(*:p<0.05, **:p<0.005). But Eiso, Ees, A and all the other idices were not decreased. These findings suggested that left ventricular contractility is not reduced in mitral stenosis. 4) In Group IV(patients with amitral regurgitation with or without aortic regurgitation), **EDVI and ESVI** were increased while Eiso**, Ees, Vmax*, mean Vcf* and cardiac index** were decreased significantly. But ejection fraction and A were not decrease. These findings suggested that ejection fraction and A may not be decreased at volume overload, despite of impaired left ventricular contractility. In summary; Eiso or Ees was evaluated as an useful contractility index which appeared not to be influenced by various volume loading state, while eiection fraction and A to be influenced. Patients with mitral stenosis as a group have reduced cardiac performance which is not due to impairment of left ventricular contractility(muscle function) but to reduced preload.
Constriction, Pathologic ; Heart Valve Diseases* ; Humans ; Mitral Valve Stenosis

Fractures of the body of the talus are extremely rare, constituting only about 0.1 percent of all fractures (Coltart 1952). Consequently, the prognostic problems have so far been elucidated only on the basis of few reports in the literature. The authors experienced an unusual type of the shearing fracture of the talar body with total disocation that the talar body was lying upside down in the ankle joint. Satisfactory results were obtained after follow up period of 20 months and some are reporting this case with bibliographic reviews.
Ankle Joint ; Deception ; Follow-Up Studies ; Talus

No abstract available.
Child* ; Cholecystectomy, Laparoscopic* ; Humans

No abstract available.
Trophoblasts*

Serum levels of HDL-cholesterol, triglyceride and total cholesterol were measured in 107 normal Koreans and in 327 patients; 66 patients with hypertension, 34 patients with coronary heart disease, 45 patients with cerebral thrombosis, 18 patients with nephrotic syndrome, and 164 patients with diabetes mellitus. Patterns of serum lipoprotein fractions were also investigated by agarose gel electrophoresis in 41 normal Koreans and in 72 patients; 14 patients with hypertension, 10 patients with coronary heart disease, 19 patients with cerebral thrombosis, 7 patients with nephrotic syndrome, and 22 patients with diaebetes mellitus. The results are summarized as follows; 1. Mean values of serum HDL-cholesterol, triglyceride and cholesterol in normal Koreans were 52.2+/-12.4mg/100ml, 110.6+/-31.6mg/100ml and 175.3+/-21.4mg/100ml respectively. No significant difference in mean value of serum HDL-cholesterol was observed between Korean males and females. 2. In Korean females serum, HDL-cholesterol level showed peak values in the fifth decade, but no significant difference with aging was observed in Korean males. 3. Serum HDL-cholesterol levels were significantly decreased in patients with hypertension, coronary heart disease, cerebral thrombosis, and in male diabetic patients with complication. 4. Serum triglyceride levels were significantly increased in all the disease groups, and serum cholesterol levels were significantly increased in all the disease groups except cerebral thrombosis. 5. Mean values of alpha-lipoprotein, pre-beta-lipoprotein and beta-lipoprotein fraction ratios in normal Koreans were 28.9+/-7.5%, 14.9+/-4.9% and 56.2+/-8.1% respectively. 6. Seum alpha-lipoprotein fraction ratio was significantly decreased in relatively advanced hypertensive patients. Pre-beta-lipoprotein fraction ratio tends to be increased in patients with hypertension, cerebral thrombosis, nephrotic syndrome and in diabetic patients with complications, and beta-lipoprotein fraction ratio tends to be increased in patients with hypertension, coronary heart disease and nephrotic syndrome, but those were not statistically significant.
Aging ; Cardiovascular Diseases* ; Cholesterol ; Coronary Disease ; Diabetes Mellitus ; Electrophoresis, Agar Gel ; Female ; Humans ; Hypertension ; Intracranial Thrombosis ; Lipoproteins ; Male ; Nephrotic Syndrome ; Triglycerides

Echocardiographic right ventricular systolic time invervals were measured in 69 cases of congenital and acquired valvular heart disease, who have neither arrhythmia nor conduction disturbances. The results were as follows: 1) Right ventricular preejection periord(RVPEP) relates with main pulmonary arterial systolic pressure (MPA(s)), main pulmonary arterial diastolic pressure (MPA(d)), main pulmonary arterial mean pressure (MPA(m)), pulmonary vascular resistance (Rp), and the ratio of pulmonary systemic vascular resistance (Rp/Rs) (r=0.746, 0.738, 0.755, 0.721, 0.687). 2) Rifht ventricular ejection time relates with MPA (s), MPA (d), MPA (m), Rp, and Rp/Rs (r=-0.580, -0.541, -0.544, -0.577, -0.420). 3) The ratio of right ventricular preejection period-right ventricular ejection time (RVPEP/RVET) relates with MPA (s), MPA (d), MPA (m), Rp and Rp/Rs (r=0.789, 0.784, 0.781, 0.778, 0.695). 4) Pulmonary hypertension and increased pulmonary vascular resistance can be predicted, when RVPEP/RVET is over 0.3. 5) By serial preoperative and postoperative measurements, pulmonary hypertension and increased pulmonary vascular resistance were relieved in the cases of mitral stenosis. But in the cases of congenital heart diseas there were no significant change in RVPEP/RVET ratio.
Adult* ; Arrhythmias, Cardiac ; Blood Pressure ; Echocardiography* ; Heart ; Heart Valve Diseases ; Humans ; Hypertension, Pulmonary ; Mitral Valve Stenosis ; Systole* ; Vascular Resistance

Tuberculosis of the spine is still prevalent in many parts of the world and still remains as an important orthopaedic problem in Korea. Moreover, spinal tuberculosis is the most common and dangerous form of skeletal tuberculosis. With the availability of very effective antituberculous drugs two divergent controversy in the management of tuberculosis of the spine have been reported. A large group of surgeons has advocated the radical excision of the tuberculous focus and replacement of the defect with autogenous bone grafts under cover of chemo-therapy, and another practise is typified by regimen of Friedman, Konstam, Kaplan, and Stevenson and Manning, who treated a large number of patients with spinal tuberculosis using antiuberculous drugs alone. Even now, because of the shortage of hospital beds and ancillary help, private poor economy and patients general condition, some group of patient with tuberclous spine have been treated conservatively using effective antituberculous drugs. In this study authors clinically analysed the 75 patients who had conservative treatment with triple drug therapy for 18 months at the department of Orthopaedics, Catholic Medical College and Center during the past 10 years, and the results were as follows: 1. There were two prevalent age groups. One is the first decade (30.6%) and the other is the third decade(30.7%). The age prevalence in children was 6 to 10 years of age. 2. The lesions were common in the lumbar spine(56.0%) and the most commonly involved vertebra was L3. The average initial number of involved vertebral body was 1.9 vertebrae and it was changed to 2.3 vertebrae at the end of treatment(18 months). 3. Active pulmonary foci was associated in 17.4%(6.7% of tuberculous pleurisy included). 4. Out of 75 cases twenty-six(34.7%) had new involvement at the adjacent vertebra within 18 months after treatment. 5. The radiographic activity was assessed as active in all cases initially, but at 18 months after treatment 83% of the cases were in quiescent condition, and this percentage was increased to 78.7% at 36 months. 6. Spontaneous fusion rate of involved vertebral bodies was 24% at 18 months and 36% at 36 months after treatment, respectively. 7. Radiologically observed deep seated abscess shadow disappeared slowly over 3 to 20 months, but this disappearance was observed mainly within 8 months after treatment. 8. Mean increment of the kyphosis was average 7.5 degree (9.3° in children and 6.6° in adults) at the end of the treatment(18 months), and average 8.6 degree(10.9° in children and 7.3° in adults) at 36 months, by. internal gibbus angle. 9. Almost in all the adult patients, kyphosis developed during the active phase of the disease, while in children kyphosis progressed even after the healing of the disease. Children who had multiple vertebral involvement at the dorsal area had a tendency to develop more severe kyphosis. 10. Decrement of the kyphosis angle which located at the lumbar area after the end of the treatment was considered to be an effect of narmal lordotic curvature. 11. Generally representation of the changes seen in children was almost osteolytic change without sequestrum in comparison to adults who had more sequestrum formation. 12. In 95% of cases a favourable results were obtained.
Abscess ; Adult ; Child ; Drug Therapy ; Humans ; Korea ; Kyphosis ; Prevalence ; Spine ; Surgeons ; Transplants ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Spinal

No abstract available.
Neurilemmoma*