No abstract available.

Ticlopidine, a platelet aggregation inhibitor, is widely used in the secondary prevention of stroke and previous manifestation of peripheral arterial occlusive disease, Ticlopidine is also used to prevent myocardial infarction and post-stenting occlusion after intracoronary stent implantation. The exact mechanism of action of ticlopidine is unclear, but likely involves the inhibition of platelet activity by the suppression of adenosine diphosphate-induced patelet aggregation. The most common adverse effects are gastrointestinal problems, skin reactions, and hematologist changes. The adverse hepatic effects are not frequent(4% in different series).

We experienced a case of ticlopidine-induced cholastatic jaundice, and report with review of literatures.

The pacemaker syndrome is a complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequence of ventricular pacing in the absence of other cause.

The following illustrates a case of pacemaker syndrome proven by cardiac catheterization. A 64-year-old female patient who had been previously managed with single chamber pacemaker(VVI mode) due to sick sinus syndrome, suffered from chest discomfort, headache, dizziness, lightheadedness.

We thought that she suffered from pacemaker syndrome and changed single chamber pacing to dual chamber pacing. At that time we performed cardiac catheterization perioperatively.

Pulmonary capillary wedge pressure, amin pulmonary arterial pressure, right atrial pressure and right ventricular pressure were normalized after the change and she didn't feel any symptoms.

It is known that the morphologic expression or progression of hypertrophy in hyertrophic cardiomyopathy(HCMP) occurs mostly during childhood, when the body growth is considerable, but nearly not occurs in adult life. Apical hypertrophic cardiomyopathy is an uncommon variant of HCMP which is characteristic apical hypertrophy of the left ventricle showing characteristic ace of spade diastolic configuratioin of the left ventriculogram. It has not yet been clarified when the progression or development of hypertrophy occurs in apical HCMP. The possibliity of the morphologic changes in apical HCMP has been poposed in previous study, but not proved yet.

We experienced a case of apical HCMP in 62-year-old female, which evolved during 6 years from mild, diffuse left ventricular hypertrophy to more progressed diffuse hypertrophy associated with marked hypertrophy of the apex of left ventricle showing ventriculopraphic picture of apical HCMP. The present case shows the morphologic change in HCMP with progression of hypertrophy during adult life.

We describe an unusual 30-year-old female patient with a history of refractory hypertension and hypokalemia. She was diagnosed as primary aldosteronoism with bilateral adrenal hyperplasia 8 years age and blood pressure has been controlled with spironolactone 200mg/day, nifedipine 40mg/day, Cardura 4mg/day and oral potassium supplement till these days.

Recently refractory high blood pressure was developed and about 5×4×4.5cm sized left a-drenal mass was observed by abdominal CT. The hypertension and hypokalemia was controlled by left adrenalectomy.

Aortic dissection is caused by a circumferential or transverse tear of the intima by a discrepancy between the strength of the aortic wall and the intraluminal pressure.

Arterial hypertension seems clearly to be a factor in the genesis of aortic dissection.

An elevated blood pressure or evidence of its existence can be found in 70-80 percent of patients. Other factors predisposing to aortic dissection are congenital disorder of connective tissue, vasculitis, etc. But trauma or physical strain is unusual cause of classic dissection.

Diagnosis is confirmed by computed tomography, aortography or echocardiography.

A 62-year-old man without a history of hypertension, emphysema or congestive heart failure visited our hospital because of hoarseness which developed suddenly during the physical strain. A contrast material-enhanced computed tomographic (CT) scan was performed at an other hospital due to hoarseness, mild fever and general weakness. Then he visited to our ENT department and performed laryngeal CT due to hoarseness. The CT shows somewhat mass-like soft tissue, so he was transferred to our internal medical department.

The chest CT scan and simple chest PA was done and we found a dissecting aneurysm.

This case developed by Physical strain and diagnosed by hoarseness is unusual and rare.

Femoral pseudoaneurysm is important complication after diagnostic femoral catheterizationor more complex procedure.

With the increasing use of larger-size percutaneous instruments and periprocedual anticoagulant or antiplatelet agent the incidence of postcatheterization femorl artery injuries ncluding pseudoaneuiysm has increased in the past few years.

Duplex ultrasonography and addition of color- flow Doppler provides an accurate, noninvasive. risk-free diagnosis and faster detection of intraaneurysrnal blood flow and the track betweenthe injured artery and the pseudoaneurysm.

Though early surgical repair of the arterial defect is usually recommended because of severeand life-threatening complication such as rupture, fhrornboembolism, compression neuropathyetc, Ultrasono-Guided Compression Repair(UGCR) is to be first-line treatment for its advantagesuch as high success rate, low morbidity and cost-effectiveness.

The authors report 2 cases of femoral psoudoaneurysrns treated using UGCR with nlanualcompression with C-clamp at the same time as a nonsurgical treatment.

Hypothyroidism may accompany pericardial may accompany pericardial effusion occasionally, in the patient who complains of any symptom of hypothyroidism and dose not receive treatment. We have experienced two cases of hypothyroidism presenting with the symptoms of dyspnea and chest tightness. The cuase of dyspnea and chest tightness was pericardial effusion and congestive heart failure. So we report two cases of primary hypothyroidism presenting with pericardial effusion and review the literature.

To determine the effect of aging on left ventricular filling mitral valve flow was evaluatedwith conventional pulsed Doppler echocardiography in 100 normal subjects, aged 20 to 76 years, who had no evidence of cardiovascular disease. The subjects were classified into the5 groups, according to the age, with 20 subjects in each groups : 20-29 years(group I), 30-39 years(group II), 40-49 years(group III), 50-59 years(group IV) and 60-76 years(group V).

The results were as follows :

1) The LVEDD(Left Ventricular End Diastolic Diameter) and left ventricular mass indexwere significantly increased with aging(r=0.50, r=0.60) and the ejection fraction showed nosignificant differences among these groups.

2) With aging, the peak early velocity(Peak E) was decreased(r=-0.36) and the peak atrialvelocity(Peak A) was increased(r=0.43). The E/A ratio and atrial diastolic velocity were decreased significantly with aging and showed a negative correlation with aging(r=-0.70).

3) The deceleration time of early diastolic flow was increased with aging(r=0.29) but without significance.

4) The isovolumetric relaxation time was significantly increased with aging(r=0.75).

In conclusion, as myocardial stiffness increases with aging, nonuniformity of myocardialrelaxation is frequently associated in older age group. Thus, a certain echocardiographic parameter shows abnormal value with normal aging process : the IVRT and DT are prolonged, Peak E is decreased and E/A ratio increased. For correct evaluation of the left ventricular diastolicfunction, age should be considere, along with the other factors such as loading conditionsof the heant heart rate and the contractile status of the heart.

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• Analysis of the Influence of Doppler Incidence Angle in the Evaluation of Cardiac Diastolic Function
  Yon-Min Kim
  Journal of Radiological Science and Technology.2024; 47(6): 549.     CrossRef

Patient with noninsulin dependent diabetes mellitus(NIDDM) have a major risk factor of the coronary herat disease which is important cause of death in NIDDM patients. In addition, they have relatively high levels of plasma cholesterol.

In order to assess the hypolipidemic effect and adverse effect of lovastatin, we studied in 30 NIDDM with mild to moderate elevations of serum cholesterol.

Lovastatin, HMG-CoA reductase inhibitor(20mg once daily in the evening) was given for 12 wks, during which blood glucose concentration remained controlled.

The following results were obtained:

1) Lovastatin reduced totol cholesterol by 26.4%, low-density lipoprotein(LDL) by 26.9%, and triglyceride(TG) by 26.7%.

2) During the study period, one patient complained nausea and vomiting, the other patient complained itching. No abnormalities in serum values were noted.

In conclusion, lovastatin was effective agent in NIDDM with hypercholeste rolemia without siginificant side effect.

In order to observe the clinical characteristics of the primary dilated cardiomyopathy. I reviewed 39 patients examined in the Cardiology Department of the Ewha Womans University Hospital from January. 1986 to in June. 1990.

The findings were as follows ;

1) Among whom 27 patients were male and 17 were female with a male to female ratio of 2.3:1.

2) An age distribution was diverse from 17 years to 79 years old with a mean age 58.2±15.6 year. The peak age incidence was the 6th decade.

3) The most frequent chief complaints were exertional dyspnea(82.1%) and orthopnea(20.5%).

4) The duration of symptoms was relatively short. mainly less than 1 month. suggesting an abrupt onset of symptoms.

5) Among various arrhythmias. atrial fibrillation was most common(30.8%) and premature ventricular contraction(23.1%) and premature atrial contraction(10.3%) were frequently found.

6) By M-Mode echocardiography. left ventricular enddiastolic dimension(LVEDD) was 65.7±9.3mm. left ventricular endsystolic dimension(LVEDS) was 57.8±8.1mm and ejection fraction was 31.1±5.9%.

7) After treatment, most of the patients(82.0%) were improved to New York Heart Association Function Class II. Before treatment. 71.7% of the patients were belongs to New York Heart Association Functional Class III and IV.

It is well known that the diastolic dysfunction of the left ventricle plays an important ole in the pathophysiology of heart failure in the various cardiac diseas. And many hypertensive patinents manifest diastolic dysfunction of the left ventricle in its early stage. Thus, early detection of left ventricular diastolic dysfunction has clinical importance in management and prognosis of hypertensive heart disease.

For the evaluation of the left ventricular diastolic function in the hypertensive patients, 30 normotensive control subject and 30 untreated essential hypertensive patients were studied by pulsed Doppler echocardiography at the left ventricular inflow, and then E/A velocity ratio [E/A (v)], early diastolic deceleration time(EDDT), and late diastolic time(LDT) were measured after confirming normal ejection fraction by M-mode echocardiography. The hypertensive patients were subgrouped according to the level of the diastolic pressure(Group A : mild, Group B: moderate, Group C: severe) and the each parameters of different groups were compared with those of the normal control group.

The result were as follows :

1) In the 30 noraml control group. ejection fraction was 69.4±4.6% and in the 30 hypertensive patients group, it was 66.7±5.3%. There was no significant differences between the normal control and the hypertensive patients group.

2) In the normal control group, E/A (v) was 1.54±0.32, EDDT was 147±13.4msec, LDT was 159±14.8 msec, and in all hypertensive patients group, mean E/A (v) was 0.80±0.38, mean EDDT was 165±19.4 msec, mean LDT was 149±14.9 msec. E/A (v) was significantly decreased(P<0.005) and EDDT was prolonged(P<0.025), compared with those of the normal control group, but there was no significant difference in LDT.

3) In Group A, E/A (v) was significantly decreased(0.98±0.36, P<0.005), compared with those of the normal control group, but there was no significant difference in EDDT(155±18.5 msec).

4) In Group B, E/A (v) was markedly decreased(0.76±0.45, P<0.005), and EDDT was significantly prolonged(170±24.8 msec, P<0.025), compared with those of the normal control group.

5) In Group C, E/A (v) was significantly decreased(0.66±0.32, P<0.005), and EDDT was prolonged(171±21.3 msec, P<0.01), compared with those of the normal control group.

Above results suggest that diastolic dysfunction of the left ventricle can precede the systolic dysfunction and clinical deterioration even in the mild hypertensive patients, and pulsed Doppler echocardiographic diastolic indices such as E/A (v) and EDDT play an important role in the early detection of the left ventricular diastolic dysfunction in the hypertensive patients.

The expectorant effect of Ambroxol was observed in 13 cases of respiratory diseases (5 cases with bronchial asthma, 2 cases with acute bronchitis, 2 cases with lung ca, 2 cases with pneumonia, 1 case with chronic bronchitis and 1 cases with pulmonary tuberculosis) between Nov. '83 and Mar. '84. The folliwing results were obtained; 1) Clinical improvement of % of cases after treatment with Ambroxol was 78% of cough, 62% of frequency of sputum expectoration, 59% of amount of sputum vloume, 80% of expectoration and 75% of color of sputum. 2) Clinical improvement of pulmonary function test was as follows;(1) Improvement of less than 10% of FVC was 9 cases(69.2%) improvement between 10% and 20% of FVC was 3 cases(23.1%), and improvement of more than 20% of FVC was 1 case(7.7%). (2) Improvement of less than 10% of FEV₁/FVC was 11 cases(84.6%), improvement between 10% and 20% of FEV₁/FVC was 2 cases(15.4%)3) No remarkable side effects was observed.

Myxoma of the left atrium is known to mimic the clinical and hemodynamic features of mitral valvular disease. The tumor was diagnosed by using the Echophonocardiography, CAT-scanning, and hemodynamic studies including left heart catheterization and angiography. The diagnosis was confirmed at operation. An electrocardiographic timing signal permitted correlation of heart sounds and pressure waves with movement of the tumor between the left atrium and the left ventricle. In early systole, the tumor suddenly moved from left ventricle to the left atrium, and a notch in the rising left ventricular pressure, a prominant c-wave, and loud, late element of the first heart sound were noted. In early diastole, the tumor moved rapidly through the mitral valve, causing an abrupt diminution in the left atrial volume, thus-causing rapid y-descent despite severe obstruction of the mitral valve. An early diastolic sound, thought to be an opening snap, appeared to be related to the checking of the tumor in the left ventricle.(Tumor plop). The unusual left atrial pressure pulse permits accurate preoperative diagnosis in left atrial myxoma. In this respect we evaluated the accuracy of the preoperative noninvasive studies for the diagnosis of intra-cardiac myxoma.

The antidiarrheal effects of Lidamidine was observed in 30 cases of acute and chronic diarrhea between Mar. '85 and May '85. The following results were obtained. 1) Overall evaluation of therapy was rated by physician and patient at the end of the study revealed excellant control in 50%, good control in 30%, fair control in 15% and poor in 5% of the cases and in placebe 10 of 10 cases all revealed no effect. 2) Vital signs were stable and all laboratory findings including CBC, urinalysis, liver function test revealed no significant change during the treatment. 3) Mean daily dose were 32.3±29.4mg. 4) There was no side effect of Lidamidine Hydrochloride. 5) Mean duration of treatment were 4.5±1.5 days.

Serum calcium, magnesium and plasma renin activity were studied in the groups of 20 controls and 20 hypertensives. All patients were admitted to Ewha Womans University Hospital between March 1984 and August 1984. The following results were obtained : 1) The plasma renin activity in normal controls were 1.40±1.48mg/ml/hr, and 1.59±1.97 ng/ml/hr in hypertensives. Most of the hypertensives were normal renin hypetension. 2) The serum calcium in normal controls were 8.85±0.84mg/dl and 9.14±0.49mg/dl in hypertensives and had no correlationship between plasma renin activity and serum ca-lcium in controls, byt had positive correlationship in hypertensives (P<0.025). 4) The serum magnesium in normal controls were 2.85±0.82mg/dl and 2.63±0.34mg/dl in hypertensives and had no correlationship to mean blood pressure. 5) There were no correlationship between plasma renin activity and serum magnesium in both controls and hypertensives.

A case of lead poisoning is presented and recent litures are reviewed. A 47-year old male had been admitted to Ewha Womans University Hospital in March 1983 with chief complaints of abdominal colic & distention, nausea and tingling sensation of lower extremities after ingestion of herb pills(HAE GU SIN). Laboratory examinations are as follows; anemia with hypocromic, microcytic, basophilic stippling of erythrocytes in peripheral blood and bone marrow. Blood level of lead was 34.6mcg/dl, urine level of lead was 128.4mcg/L, coproporphyrine and ▵-ALA in 24hours urine were 270.8mcg/L, 19.9mg/L respectively. After treatment with BAL for 1 day, blood level of lead was 30.4mcg/dl, urine level of lead was 2988.6mcg/L, coproporphyrine and ▵-ALA in 24hours urine were increased to 667.2mcg/L, 5.5mg/L respectively and quantitative analysis of herb pills revealed 10% of containing lead.

A clinical observation was done on 144 cases of coronary heart disease admitted to Ewha Womans University Hospital from January, 1973 to December, 1997. The following results have been obtained. 1. The 144 cases were composed with 46.4% of atherosclerotic heart disease, 29.2% of myocardial infarction, 18.8% of coronary insuffiency and 5.6% of angina pectoris. 2. The ration of male to female was 1:1.14. The most patients were in the age group between the 6th and 7th decades(60.4%). 3. The major symptoms of coronary heart disease were precordial pain(54.2%) and dyspnea(45.1%). The pain was radiated in 24.3% 4. The most common preceding disease was hypertension(39.3%) followed by diabetes mellitus(11.5%). 5. There were leukocytosis in 66.6%, increased SGOT in 39.3%, increased LDH in 71.5% and increased cholesterol in 49.5% 6. The common associatd electrocardiographic abnormalities were left ventricular hypertrophy(28%), sinus tachycardia(16.9%), premature ventricular beat(11.6%). first degree AV block (8.4%) and premature atrial beats(6.1%). 7. The ratio of anterior to posterior wall infarction was 4:1. 8. The common findings of chest PA were cardiomegaly(38.5%), Atherosclerotic changes of aorta(15.2%) and pulmonary congestion(2.4%). 9. The mortality rate was 6.2%(10 cases). Among them, myocardial infarcition was 5 cases. atherosclerotic hart disease was 4 cases and coronary insufficiency was 1 case.