Association of Blood Pressure and Heart Rate Response to Graded Exercise Test with Left Atrial Volume Index and Pulse Wave Velocity

BACKGROUND: Exaggerated blood pressure (BP) response to exercise can be an independent risk factor for cardiovascular mortality and morbidity. The purpose of this study was to define the factor that effect on early systolic BP response to exercise. METHODS: We examined echocardiographic data, BP, heart rate from graded exercise test and brachial ankle pulse wave velocity (PWV) of 205 patients (137 men and 68 women; mean age 58 +/- 11 years; range, 19 to 83 years). Graded exercise test was conducted in BRUCE protocol. We define delta systolic blood pressure (SBP) as systolic BRUCE stage "n" BP minus baseline BP. RESULTS: Resting BP (127 +/- 16 mm Hg) was elevated to 171 +/- 26 mm Hg after peak graded exercise test. Resting heart rate (80 +/- 15 bpm) was increased to 146 +/- 27 bpm after peak graded exercise test. Stepwise regression test between baseline SBP, delta SBP, maximal SBP and left atrial volume index (LAVI) was done. Supine SBP, delta SBP, maximal SBP was not associated with LAVI (p > 0.5). But increased LAVI was significantly associated with delta SBP1 in woman (R2 = 0.192, p = 0.002). PWV was significantly associated with base line (R2 = 0.311, p < 0.01) and maximal SBP (R2 = 0.051, p < 0.01). However, PWV was not associated with delta SBP. CONCLUSIONS: LAVI and PWV were not associated with early SBP response to exercise. But in women, elevation of early SBP during exercise is associated with LAVI.

Clinical Impact of Time Delay on 1-Year Mortality in Patients with ST-Segment Elevation Myocardial Infarction / 대한내과학회지

BACKGROUND/AIMS: The delay between the onset of myocardial infarction symptoms and primary percutaneous coronary intervention (PCI) is an important prognostic factor in patients with ST-segment elevation acute myocardial infarction (STEMI). We reviewed this delay in patients with STEMI and analyzed clinical outcomes. METHODS: The study enrolled 3,399 patients (age, 61.4 +/- 12.8 years; 25.6% women) with STEMI who underwent primary PCI within 12 hours of symptom onset between October 2005 and February 2008 from the Korea Acute Myocardial Infarction Registry. The patients were divided into two groups according to the symptom-to-balloon time: group I ( 3 hours, n = 2444). The in-hospital mortality rates and 1-year mortality and major adverse cardiac event (MACE) rates were compared between the two groups. RESULTS: The mean time interval from the onset of symptoms to arrival at the emergency room (ER) was 188.0 +/- 133.6 minutes (median, 152 minutes). The mean time interval from the ER to reperfusion (door-to-balloon time) was 97.8 +/- 67.9 minutes (median, 80 minutes). The mean time interval from the onset of symptoms to reperfusion (symptom-to-balloon time) was 285.8 +/- 146.2 minutes (median 250 minutes). The in-hospital mortality rate was significantly lower in group I as compared with group II (3.6% versus 5.2%, p = 0.044). The 1-year mortality rate was also significantly lower in group I (4.7% versus 7.2%, p = 0.012), while the 1-year MACE rate was not significantly different between groups (17.9% versus 20.4%, p = 0.179). CONCLUSIONS: This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI in Korea and this time delay is associated with increased 1-year mortality.

Unilateral Sensorineural Hearing Loss in Cerebral Venous Thrombosis

A 24-year-old woman presented with headache and left-sided tinnitus. Evaluations demonstrated left sensorineural hearing loss and cerebral venous thrombosis (CVT) with normal intracranial pressure. Unilateral hearing loss has rarely been reported in patients with CVT. It is thought that the unilateral hearing loss in this case was caused by impaired drainage of the cochlear veins into the lateral sinus.

Unilateral Single Vaginal Ectopic Ureter with Ipsilateral Hypoplastic Kidney: A Case Report / 대한비뇨기과학회지

To date, the unilateral single vaginal ectopic ureter has been regarded as the rarest form of ureteral ectopia because 80 per cent of all ectopic ureters are associated with a duplicated system and most of the ectopic ureters occur in male patients. This malformation may take the form of but is not limited to any ombination of abnormal development of the mesonephric and paramesonephric ducts. We report a case of unilateral single vaginal ectopic ureter with ipsilateral hypoplastic kidney in a 9 year-old female patient who has been suffered from diaper dermatitis due to persistent urinary incontinence since birth.

Giant Hydronephrosis with Contralateral Congenital Renal Agenesis: A Case Report / 대한비뇨기과학회지

We report a case of giant hydronephrosis due to congenital ureteropelvic junction obstruction in a 7-month-old female infant with contralateral renal agenesis. Congenital renal agenesis is an uncommon congenital condition that results from a failure of induction of the metanephric blastema by the ureteral bud and fifteen per cent of cases show anomalies of the contralateral kidney. An excretory urogram and abdominal CT scan of the patient revealed nonvisualization of left kidney, and a retrograde pyelogram showed markedly dilated extrarenal pelvis crossing over the mid-line because of narrowing of ureteropelvic junction. However, the other combined anomalies were not identified. A successful dismembered pyeloplasty was performed after temporary urinary diversion with percutaneous nephrostomy for 4 weeks.

Effectiveness of Bladder Preservation Treatment For Patients with Superfcially Invasive Bladder Tumor(T2/T3a) / 대한비뇨기과학회지

Radical cystectomy and/or radiotherapy represent the standard treatment for invasive bladder carcinoma. However these approaches are less than ideal since a substantial number of patients have progressive disease and die of metastatic cancer. Then recent treatment modality is trending toward chemotherapy. Therefore, we performed the aggressive transurethral resection of the bladder tumor (TURBt) followed by the combined chemotherapy of methotrexate, vinblastine, doxorubicin and cisplatin(RI-VAC) for conservative treatment of muscle invasive transitional cell carcinoma of the bladder. From July 1990 to March 1995, 41 patients with stage T2 to T4 were entered into the study. Of that patients, 26 completed 4 to 8 cycles of M-VAC and were followed, while 15 were excluded from the study because of incomplete chemotherapy or inadequate follow-up. Median follow-up was 30 months(4-56 months). Median age of the patients was 66 years(range 48 to 85 years). All patients had Karnofsky performance status(KPS) score between 70 and l00. There were 3 patients with clinical stage T2, 8 with T3a, 7 with T3b, 8 with T4. G-CSF(Granulocyte-Colony Stimulating Factor) was used for 19 patients with M-VAC induced leukopenia, thereby allowing the chemotherapy to be complete on schedule. Responses to therapy were evaluated according to standard accepted phase II response criteria. Overall clinical response (complete and partia1) was noted in 15 patients(58%), and no response in 11(42%). Of the patients with T2 and T3a, 9(82%) showed complete and partial response, and of them with T3b and T4, 6(40%) showed complete and partial response. Of 26 patients 21(81%) are alive now. These data suggest that survival was no better than expected following radical cystectomy or radiotherapy in short term follow-up, so far, however systemic M-VAC chemotherapy in combination with radical TURBt is probably expected to provide a high response rate and a better survival with the particular advantage of preserving normal bladder function in patients with superficially invasive bladder tumor(T2/T3a).

The Relevance between the Post-operative Voiding Symptoms and the Rate of Resected Weight to the Prostatic Volume / 대한비뇨기과학회지

TURP is one of the common operations in the urologic field, and it has been well shown as a golden standard treatment modality for the patients with the BPH. Nevertheless, there was no available objective index to determine effective amount of the prostate resection. Therefore, we reviewed and evaluated the charts of 119 BPH patients more than 15 in modified Boyarsky symptom score evaluation, and who have undergone TURP from 1992 to June 1994. In addition, we excluded the cases associated with the other disease, such as neurogenic bladder, urethral stricture, or prostatic carcinoma. The volume of prostate was calculated by using of TRUS and ellipsoid formula. The maximal flow rate(MFR) was evaluated mostly on 5th post-operative volume of the day. We defined the resection rate(R.R) as the rate of the resected weight to the volume of the prostate. The results were as follows. 1. The mean resection rate of the prostate was 42.1%. 2. The average of the post-operative MFR was 20.52ml/sec. 3. The relevance between the RR and the post-operative MFR was not shown herein. 4. Distribution of the patients by the postoperative modified Boyarsky symptom score was different according to the resection rate. Statistically significant difference of the postoperative modified Boyarsky symptom score was shown between the greater than 30% resection group 1ess than 30% resection group(P=<0.05) 5. The post-operative modified Boyarsky symptom score could be predicted by the equation induced through the regression analysis. Symptom score = 5.28 - (0.04'RR) Our results suggest that resection rate of 30% is the marginal rate for the desirable voiding improvement, and, if it is practicable, the resection of more than 30% is favorable for all patients with BPH.

Spontaneous Rupture of Renal Angiomyolipoma Causing Hemorrhagic Shock / 대한비뇨기과학회지

We report a case of massive retroperitoneal hemorrhage from a spontaneous rupture of a renal angiomyolipoma in a 35 year-old man, that appeared unilateral and solitary tumor without stigma of tuberous sclerosis. He experienced a sudden onset severe pain on the right flank, but had no history of specific associated diseases or factors such as trauma or stone. The patient presented with a clinical picture of shock because of massive hemorrhage in despite of the emergency care and was treated by right total nephrectomy. Herein we review briefly the clinical presentation, diagnosis and management of renal angiomyolipoma.

Morphological Studies on the Rabbits Ciliary Epithelium by Bunazosin

Bunazosin is a alpha-1 blocker that is more selective and effective than other alpha-1 receptor blockers. Bunazosin has been shown to lower intraocular pressure but it's mechanism is uncertain. The purpose of this study is to know the morphological changes in the ciliary epithelium by bunazosin. 0.1% Bunazosin was instilled on the eye of the rabbits and the eyes were enucleated on 1, 2, 6 and 24 hours after instillation to find out the tissue response under the electronmicroscopy. As a result, widening of the cell membranes and swelling of the mitochondria were observed in the pigmented and non-pigmented epithelium and these changes were recovered with time and seem to be the morphological changes of bunazosin against aqueous formation in the ciliary body.

Electronmicroscopic Study of the Effect of Hexamethonium on Serous Choriretinopathy in Rabbits

Stress has been regrarded as one of the causes of central serous chorioretinopathy. We studied the effect of Hexamethonium (ganglionic blocking agent) on experimentaI serous chorioretinopathy following epinephrine injection in rabbits. In group 1, we injected the 0.1 % epinephrine into the rabbits through IV route for 10 days and in group 2, we addited Hexamethonium subcutaneously prior to injection of the epinephrine same term of gorup 1. We could find slight histological changes in gorup 2 as com paired with group 1, which produced serous chorioretinopathy, under the electronmicroscopic study so we would expect the preventive effect of Hexamethonium on the stress-induced serous chorioretinopathy.

Electronmicroscopic Study of the Effect of Hexamethonium on Serous Choriretinopathy in Rabbits

Stress has been regrarded as one of the causes of central serous chorioretinopathy. We studied the effect of Hexamethonium (ganglionic blocking agent) on experimentaI serous chorioretinopathy following epinephrine injection in rabbits. In group 1, we injected the 0.1 % epinephrine into the rabbits through IV route for 10 days and in group 2, we addited Hexamethonium subcutaneously prior to injection of the epinephrine same term of gorup 1. We could find slight histological changes in gorup 2 as com paired with group 1, which produced serous chorioretinopathy, under the electronmicroscopic study so we would expect the preventive effect of Hexamethonium on the stress-induced serous chorioretinopathy.