Evaluation of Left Ventricular Diastolic Function Using New Doppler Time Index

BACKGROUND: There is a clinical need for a simpler measurement of global cardiac function incorporating elements of both systole and diastole. Doppler time index is theoretically regarded as a sensitive index of global left ventricular perfomance and defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET). This study was designed to determine the clinical usefulness of the Doppler time index in patients with left ventricular diastolic dysfunction as well as systolic dysfunction. METHODS: The study population consisted of 23 patients with hypertension as a diastolic dysfunction group, 16 patients with low ejection fraction as a systolic dysfunction group and 31 subjects with normal LV function. The ejection fraction (EF) was measured using M-mode echocardiography. Doppler profiles such as IVCT, IVRT and ET were obtained from Doppler echocardiography. The Doppler time index [ (IVCT+RT)/ET] was calculated from each Doppler velocity profiles. RESULTS: IVRT, IVRT/ET and (IVCT+VRT)/ET were significantly increased in the diastolic dysfunction group (120.5+/-19.5 msec, 0.45+/-0.1, 0.64+/-0.2, respectively:p<0.001, p<0.001, p<0.001, respectively) compared with normal subjects (66.1+/-17.4 msec, 0.25+/-0.0, 0.41+/-0.1). IVCT and IVRT were significantly increased and ET was significantly shortened in systolic dysfunction group (75.4+/-25.7, 144.0+/-39.5 msec, 242.7+/-46.5 msec respectively:p<0.001, p<0.05, p<0.05, respectively) compared with diastolic dysfunction group (50.4+/-23.0 msec, 120.5+/-19.5 msec, 276.8+/-44.6 msec, respectively). IVCT/ET, IVRT/ET and (IVCT+IVRT)/ET also were increased in patients with systolic dysfunction group (0.32+/-0.1, 0.61+/-0.2, 0.93+/-0.2 respectively:p<0.01, p<0.01, p<0.001, res-pectively) compared with diastolic dysfunction group (0.19+/-0.1, 0.45+/-0.1, 0.64+/-0.2). Ejection fraction calculated by M-mode parameters was significantly correlated with (IVCT+IVRT)/ET (correlation coefficient - 0.605, p<0.001). CONCLUSION: The Doppler time index was significantly difficient from normal subjects in patients with isolated LV diastolic dysfunction as well as in those with systolic dysfunction. Thus, this index can be used as a sensitive indicator of myocardial performance.

Effect of Vitamin C on Airway Hyperresponsiveness in Heavy Smokers / 결핵

BACKGROUND: Vitamin C has been reported to have a role in the decrease of airway hyperresponsiveness in animal models. This data is based on some metabolic actions of vitamin C, such as promotion of histamine degradation, producing mote PGE2 than PGE2 alpha in cyclooxygenase pathway, decrease of smooth muscle contraction, and acting as reducing agent of oxidant. It has been also known that heavy smokers have lower blood levels of vitamin C than nonsmokers and this deficiency in heavy smokers have been explained by several mechanisms, such as increased oxidation by oxidants and free radicals, increased biosynthesis of catecholamine and serotorim released by nicotine, and inadequate dietary intake. In this study, We attempted to assess effect of vitamin C on bronchial hyperresponsiveness in heavy smokers who have bronchial hyerresponsiveness and role of vitamin C on bronchial hyperresponsiveness. METHOD: To assess acute effect of vitamin C on airway hyperresponsiveness, blood sample for vitamin C level and spirometry, methacholine challenge test were done in 17 smokers and 8 nonsmokers, and one hour after oral administration of vitamin C 3 g, blood sample for vitamin C level and spirometry, metliacholine challenge test were repeated. To assess chronic effect of vitamin C on airway hyperreeponsiveness after daily administration of vitamin C 1 g for one week in 17 smokers, blood sample for vitamin C level and spirometry, methacholirie challenge test were done. To assess role of vitamin C, after oral administration of vitamin C 3 g plus indomethacin 100 mg in 12 of 15 smokers who were reactive to methacholine challenge test, spirometry and methacholine challenge test were done and after oral intake of indomethacin 100 mg in 12 smokers who were reactive to methacholine challenge test, spirometry and metbachoine challenge test were repeated. RESULT: There were no significant differences in whole blood vitamin C levels between smokers(1.17+/-0.22mg/dL) and nonsinokers(1.14+/-0.19 mg/dL) (p>0.05). Fifteen of the 17 smokers(88.2%) were reactive to metbacholine chaflenge test amd 10 of the 15 smokers who were reactive to methacholine challenge test were less than 8 mg/dL in PC20FEV1, and 7 of the 8 nonsmokers(87.5%) were nonreactive to methacltoline challenge test There were significant decrease in bronchial responsiveness after oral administration of xitamin C 3 g in 13 of the 15 smokers who were reactive to methachoine challenge test. This significant decrease persisted with maintenance daily administration of 1 g for one week. PC20FEV1 were not correlated to vitamin C levels in smokers. After oral administration of indomethacin 100 mg, significant reduction of bronchial responsiveness that occured after oral administration of xdtamin C 3 g in smokers were attenuated. CONCLUISON: Although there were no significant differences in whole blood vitamin C levels between smokers and nonsmokers, heavy smokers have significant increase in bronchial responsiveness than nonsmokers. This bronchial hyperresponsiveness of heavy smokers can be attenuated by vitamin C supplement Disappearance of vitamin C effect by indcrnethaein supplement may suggest that vitamin C exert its effect via alteration of arachidonic acid metabolism.

A Case of Tongue Tuberculosis with Pulmonary Tuberculosis / 대한내과학회지

Up to 1937, 357 cases of tongue tuberculosis had been reported. However, Since potent antituberculosis drugs had been introduced, the incidence of oral tuberculosis lesions has been dramatically decreased. This might be related to the marked vascularity of the tongue which enables a high concentration of the drug to be reached to the lesion. Both the primary and secondary types of tuberculosis can be revealed in the oral cavity. In the primary type, the causative organisms are directly inoculated in the oral mucosa of a person who has never been tuberculosis earlier and who has not acquired an immunity to the disease, In the secondary type, tuberculosis of the oral cavity is coexistent with pulmonary disease. We report a case of tongue tuberculosis with pulmonary tuberculosis, with a review of literature.