Effects of Ramipril on Vascular Response in Patients with Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Angiotensin-converting enzyme (ACE) inhibitors have been shown to improve the endothelial dysfunction and prevent the development of atherosclerosis in animal models. We performed this study to investigate the effects of the ACE inhibitor, ramipril, on carotid atherosclerosis and endothelial dysfunction of the brachial artery in patients with coronary artery disease (CAD). SUBJECTS AND METHODS: We studied 69 subjects with a mean age of 59yrs, and divided them into two groups according to ramipril use (39 patients with ramipril and 30 without). Using a double-blind, randomized, prospective design, we measured the flow-mediated vasodilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the carotid artery, prior to, and 1, 3 and 6 months following coronary angiograms in CAD patients. RESULTS: The FMD was significantly increased in the ramipril group from 4.6+/-2.2% baseline to 5.3+/-2.5% at the 1 month follow-up (p<0.05), but at the 3 and 6 month follow-ups no significant changes were found. There were no significant differences in the FMD between the two groups at any of the follow-up periods, and no changes in the IMT were found in relation to time for either group. CONCLUSION: Ramipril improved the endothelial dysfunction in patients with CAD for the first month; however this effect did not persist 3 or 6 months after taking ramipril. Ramipril had no effect on the atherosclerotic vascular changes to the IMT of carotid arteries.

The Relationship of Left Atrial Volume and Left Ventricular Diastolic Dysfunction

BACKGROUND AND OBJECTIVES: Mitral flow Doppler has been used to evaluate left ventricle (LV) diastolic function by mitral E/A flow ratio, isovolumic relaxation time (IVRT) and deceleration time (DT) of E wave. Such variables can be affected by various factors. The increase in left atrium (LA) afterload and preload is accompanied by increased LA size. So, we investigated the relationship of LA volume and LV diastolic dysfunction. MATERIALS AND METHOD: From January 2000 to July 2000, 39 patients were included in this study. They were classified into normal (M:F=5:6, mean age 54.0+/-11.4 years), impaired relaxation (M:F=5:4, mean age 70.0+/-5.5 years), pseudonormal (M:F=5:3, mean age 68.3+/-13.2 years) and restrictive physiology (M:F=10:1, mean age 65.5+/-12.7 years) according to mitral inflow variables. The LA volume of each groups was measured by Simpson method, M-mode method and arealength method. RESULTS: 1) The LA volumes measured by Simpson method, M-mode method and area-length method were correlated (p<0.001, r=0.925 in Simpson compared with arealength method). 2) The LA volume by Simpson method were found 54.4+/-16.4 cm3 in normal, 57.3+/-9.2 cm3 in impaired relaxation, 81.4+/-28.8 cm3 in pseudonormal and 119.8+/-64.5 cm3 in restrictive physiology. 3) The LA volume were significantly increased in pseudonormal group compared with normal (p<0.05). CONCLUSION: The LA volume is a useful and easy diagnostic stool for evaluating of LV diastolic function.

The Change of Cardiac Function and Morphology after Mitral Valve Repair Surgery in Mitral Valve Prolapse with Mitral Regurgitation

BACKGROUND AND OBJECTIVES: Although it is well known that mitral valve repair provides a better postoperative outcome than valve replacement for mitral valve prolapse with mitral regurgitation, there haven't been much studied the nature of remnant regurgitation and the change of heart function and structure by remnant regurgitation after mitral valve repair surgery. We tried to research for it. METHODS AND RESULTS: Retrospective analysis of echocardiographic data and medical records was done in patients who underwent repair surgery for mitral valve prolapse with significant mitral regurgitation at the Keimyung University Dong-san Medical Center from February 1996 to February 2000. Patients who underwent echocardiography before and after the surgery were selected for the analysis. Of patients who underwent mitral valve repair surgery for mitral valve prolapse with mitral regurgitation during that period, 30 patients (male 15, female 15) were included in this study. The average age of them was 44.30+/-14.30 year old. After surgery, heart chamber size was decreased significantly in all patients (e. g. LVDd 6.25+/-1.06 cm vs. 5.14+/-0.62 cm, LV mass 272.46+/-107.36 gm vs. 197.30+/-75.16 gm). Remnant mitral regurgitation after repair surgery was found in 22 patients (73.3%). Remnant mitral regurgitation above trivial flow was found in 10 patients. Such case as involving ant. leaflet was found in 5 patients (16.7%), as involving post. leaflet, in 2 patients (6.7%), as involving both leaflet, in 3 patients (10%) among 10 ones. Eccentric flow among remnant regurgitation, was observed in 2 patients who underwent repair surgery for ant. leaflet, 1 patient who underwent repair surgery for both leaflet. CONCLUSION: Mitral valve repair surgery reduce the left ventricular chamber size and left ventricular mass. Postoperatively, patients who involve ant. leaflet were much remnant regurgitation above trivial flow more than others.

A Retrospective Study on the Potentially Fatal Asthma / 대한내과학회지

OBJECTIVES: A number of investigators have examined the possible pathophysiological mechanisms in patients who died from asthma, but the reasons for the increased incidence of death in patients with asthma are largely unknown. To elucidate the risk factors and possible causes of fatal asthma, we reviewed the clinical data of patients with potentially fatal asthma(PFA). METHODS: We retrospectively studied the clinical and laboratory profiles of 35 PFA patients(43 episodes) who had been admitted at the Kyungpook University Hospital and Taegu Fatima Hospital in recent 5 years(1989. 7-1994. 6). Our criteria of PFA were defined as either respiratory arrest or an arterial carbon dioxide tension(PaCO2) greater than 50 mmHg or an altered state of consciousness, due to acute asthma. RESULTS: 1) Twenty four patients with PFA were female and 11 male. At the time of PFA episode, age distribution was between 16-65 year (42% between 36-49). 2) Seasonal distribution was 13 episodes between March and May, 13 June and August, 6 September and November, 11 December and February. 3) Previous hospitalization history due to asthmatic attack was noted in 81 percent, and 75 percent were relatively compliant to their therapy. 5) At visiting emergency room, 81 percent satisfied the criteria of PFA, whereas 19 percent during hospitalizatoin. 77 percent required mechanical ventilation, and 52 percent of them within 30 minutes after visiting. 6) Initial arterial blood gas analysis at emergency room showed marked hypercapnia(75 +/- 29 mmHg), hypoxemia(50 +/- mmHg) and acidosis(pH 7.14 +/- 0.15). Serum potassium levels were within normal ranges in 75 percent. 7) All, except one, showed no significant cardiac arrthymias. 8) Possible precipitating factors leading to PFA were respiratory tract infection in 31 episodes, ingestion of NSAIDs in 2, emotional upsets in 2, irritant air pollutions in 2, withdrawal of anti-asthma drugs in 1, and unknown causes in 5. 9) Nine of 16 patients were atopic, and majority of them showed positive reaction to Dermatophagoides antigen. CONCLUSIONS: These results may suggest that PFA is mainly due to airway obstruction, and upper respiratory infection is an important precipitating factor leading to PFA. It is necessary to establish an appropriate plan for preventing PFA and related deaths.

A Case of Double Pylorus / 대한소화기내시경학회지

The double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb. Some investigators postulate that the doubling of the pyloric channel is a congenital phenornenon, but others believe that it is an acquired lesion. A 72 year-old-man was admitted to this hospital because of epigastric pain for 1 month. Upper G-I series revealed thickened rnucosal folds of pylorus and duodenal bulb and dilated, deformed duodenal bulb filled with barium materials. Endoscopic findings also showed two ovoid large openings of the pyloric channel divided by smooth thickened septum and multiple gastroduodenal ulcers. We thought that this case was an acquired lesion. The relevant literatures on the subject were reviewed.