Usefulness of stress echocardiography in the diagnosis of coronary artery disease

No abstract available.

MVP Chemotherpy and Hyperfractionated Radiotherapy for Stage III Unresectable Non-Small Cell Lung Cancer: Randomized for maintenance Chemotherapy vs. Observation: Preliminary Report / 대한치료방사선과학회지

To evaluate the effect of MVP chemotherapy and hyperfractionated radiotherapy in Stage III unresectable non small cell lung cancer (NSCLC), authors have conducted a prospective randomized study since January 1991. Stage IIIa or IIIb unresectable NSCLC patients were treated with hyperfractionated radiotherapy (120 cGy/fx BID) up to 6500 cGY following 3 cycles of induction MVP (Mitomycin C 6 mg/m2, vinblastine 6 mg/m2, Cisplatin 60 mg/m2) and randomized for either oservation or 3 cycles of maintenance MVP chemotherapy. Until August 1991, 18 patients were registered to this study. 4 cases were stage IIIa and 14 were stage IIIb. Among 18 cases 2 were lost after 2 cycles of chemotherapy, and 16 were analyzed for this preliminary report. The response rate of induction chemotherapy was 62.5%; partial response, 50% and minimal response, 12.5%. Residual tumor of the one partial responder was completely disappeared after radiotherapy. Among 6 cases who were progressed during induction chemotherapy, 4 of them were also progressed after radiotherapy. All patients were tolerated BID radiotherapy without definite increase of acute complications, compared with conventional radiotherapy group. But at the time of this report, one patient expired in two month after the completion of the radiotherapy because of treatment related complication. Although the longer follow up is needed, authors are encouraged with higher response rate and acceptable toxicity of this treatment. Authors believe that this study is worthwhile to continue.

Assessment of Mitral Stenosis by Doppler Echocardiography: Influence of Regurgitation on Doppler Pressure Half-Time

Mitral pressure half-time(PHT) is widely used as an independent measure of mitral valve area(MVA) in patients with mitral stenosis. However, few data exist regarding the effect of mitral regurgitation and aortic regurgitation on the validity of this method. Two hundreds and three patients with mitral stenosis were studied by Doppler echocardiography and 2 dimensional echocardiography(2 DE) to assess whether mitral regurgitation and aortic regurgitation affected the calculation. Ninety patients had mitral stenosis only, 45 patients were combined with mitral regurgtation, 54 patients were combined with aortic regurgitation and 14 patients were combined with both mitral and aortic regurgitation group. Doppler PHT and 2DE estimates of MVA correlated well in total patients(r=0.903) and mitral stenosis only group(r=0.924). Good correlations were maintained in patient subgroups combined with mitral or aortic regurgitation(r=0.867 and 0.911, respectively) and both mitral and aortic regurgitation(r=0.843). Thus, measurement by Doppler PHT may reflect accurately the MVA as determined by 2DE regardless of presence of mitral and/or aortic regurgitation.

Assessment of Mitral Stenosis by Doppler Echocardiography: Influence of Atrial Fibrillation of Doppler Pressure Half-Time

Atrial fibrillation in mitral stenosis(MS) may be cause of error in calculation of mitral valve area(MVA) by Doppler derived pressure half-time(PHT) method. This is due to changes of peak velocity and diastolic slope in mitral inflow Doppler spectrum in cases of assoociated with atrial fibrillation. However, few data exist regarding the effect of atrial fibrillation on the validity of this method. Two hundreds and three patients with mitral stenosis were studied by Doppler echocardiography and two-dimensional echocardiography(2DE) to assess whether atrial fibrillation affected the calcullation of MVA. Total patients was divided into four groups according to the accompanied mitral or aortic regurgitation. Ninety patients had mitral stenosis only(group 1), 45 patients had mitral stenosis only(group 2), 54 patients were combined with aortic regurgitation(group 3) and 14 patients were combined with both mitral and aortic regurgitation(group 4). And then, each group was divided into sinus rhythm subgroup and atrial fibrillation subgroup respectively. In total patients, Doppler echocardiographic indices(pressure half-time, mean pressure gradient, peak pressure gradient and peak velocity) were correlated significantly with 2DE-MVA in both patients with sinus rhythm and patients, with atrial fibrillation(P0.005). In group 4 patients, pressure half-time was significantly correlated in patients with atrial fibrillation(P<0.005). Therefore, Doppler echocardiography can estimates mitral valve area in patients with mitral stenosis associated with mitral and aortic regurgitation regardless of presence of the atrial fibrillation.

Clinical Studies on the Etiology and Clinical Course of Pericardial Effusions

To assess the etiology and clinical course of moderate and severe pericardial effusions, we reviewed 118 consecutive patients seen in the cardiology department of the Kyunghee Medical Center from January, 1984 to July, 1988. 1) The common etiologies of pericardial effusions were tuberculosis(25.4%), malignancy(18.8%), uremia(16.2%), heart failure(14.4%), idiopathic(7.7%) and collagen vascular disease(5.1%). The lung cacer(77.2%) and breast cancer(9.1%) comprised most of the etiology of malignant pericardial effusion. The adenocarcinoma was the most common histologic entity of lung cancer. 2) Collapses of right atrium, right ventricle or both were seen in 17 case(14.4%), and the causes of collapses were malignancy(35.5%), idiopathic(11.8%) and uremia(11.8%). 3) The causes of constrictive pericarditis were : tuberculosis(42.9%), idiopathic(28.6%), malignancy(14.3%) and uremia(14.3%). 4) The percentages of improved cases were determined in 55 patients by echocardiography twice, 30th day after treatment and the last follow up day. It revealed 84%/96% in tuberculosis, 85.7%/0% in malignancy, 66.7%/83.3% in uremia, 83.3%/83.3% in heart failure, 100%/100% in both myxedema and myocardial infarction, and 33.3%/33.3% in collagen vascular disease at both follow up day. We conclude that the most common etiology of the pericardial effusions is still tuberculosis in Korea and the most common etiology of cardiac tamponade is malignancy, even though the suspected patients without echocardiography have been excluded can be a limitation of this study. The pericardial effusions by tuberculosis, uremia or heart failure responded well to the adequate treatment and response in malignancy or collagen vascular disease was not good.

Computerized Quantitative Analysis of Left Ventricular Wall Motion by 2-Dimensional Echocardiography

We present the methods of analysis of left ventricular wall motion by 2-dimensional echocardiography using computerized system. Quantiative analysis of left ventricular wall motion abnormalities depents on the used reference method, because the heart shifts and rotates within thorax during the cardiac cycle. To access left ventricular wall motion abnormalities, we studied 60 subjects(normal; 30 subjects, abnormal; 30 subjects)with 5 different floating reference methods correcting for traslation and/or rotation in two echocardiographic views. (apical 4-chamber view and apical 2-chamber view) In the first the endocardial tracings of enddiastole and endsystole in 30 normal subjects were stored in VAX-11-780 main computer and the data of these 30 normal subjects were plotted to obtain a 95% confidence interval for measured normal fractional change every five degree according to 5 reference methods. In the second, 30 patients with abnormal left ventricular wall motion analyzed and the results were compared with a 95% confidence interval. We assessed that left ventricular wall motion by visual and computerized quantitative anlysis were in close relationship according to optimal reference method. We suggested that computerized quantitative analysis of left ventricular wall motion by 2-dimensional echocardiography was clinically useful method and translation of the midpoint of mitral anulus with rotation according to center of mass was the most specific and sensitive new method of evaluating left ventricular wall motion abnormalities.