A Clinical Study on the Hypotensive Effect of Lisinopril

In order to evaluate the hypotensive effect of the lisinopril, a long acting angiotensin converting enzyme inhibitor, 10 to 30mg of lisinopril were administered in 35 hypertensive Korean adults during six weeks after a week observation for washout with stepwise increments of the dose according to the response of the patients blood pressure in every two weeks. The results were ; 1) The supine blood pressures were decreased from 163.7+/-16.6/99.8+/-9.3mmHg to 140.7+/-15.5/87.4+/-9.9mmHg at the end of six weeks' drug therapy(p<0.001). The standing blood pressures were also decreased conferrably and to the some lower levels. 2) In 14 patients to whom the drug was administered longer period(12 to 28 weeks) the blood pressure lowering effects were maintained at the level of that of 6th week. 3) Hematologic examination and blood chemistry revealed no discernible abnormal findings before and after the treatment. 4) In those patients who showed no adequate blood pressure control with other classes of antihypertensive drugs the lisinopril was effective in lowering their blood pressures by adding small doses. 5) During the period of the study a few probably drug-related symptoms developed but not troublesome except dry cough and dry mouth shich forced to stop administering the drug after completion of six weeks' period in one patients. From above results we concluded that lisnopril is effective and safe for the treatment of hypertension in Korean adults.

A Case Report of Pacemaker Runaway

Pacemaker Runaway is a rare, but potentially lethal complication after pacemaker implantation. Pacemaker runaway was one of the common manifestations of malfunctioning pacemaker at the time of fixed rate pacemaker, but has been less common after the demand type pacemaker had replaced the fixed rate model. The early recognition of runaway pacemaker is very important because runaway pacemaker can cause bradyarrhythmia, ventricular tachycardia-fibrillation and asystole resulting in syncope or death. We report a clinical experience of runaway pacemaker in 68 year-old woman, who received permanent pacemaker implantation(fixed rate 72/min, VVI, Micropulse 22U, Edwards system) due to sick sinus syndrome eight years ago. She complained of sudden chest tightness and dyspnea 10 days prior to admission. On physical examination, increased jugular venous pressure, rapid heart beats, basal rales on both lung fields and three finger-breath tender hepatomegaly. Electrocardiogram showed a rapid pacemaker rhythm of 140 beats per minute. So, the malfunctioning pacemaker was removed and replaced with a new programmable demand type pacemaker(VVI, OPTIMA-MP, Telectronics) in the same pocket under the diagnosis of pacemaker runaway. Her subject symptoms were relieved and electrocardiogram showed a regular pacemaker rhythm of 71 BPM. She was discharged ten days after pacemaker replacement.

AV Conduction Disturbances Associated with Acute Myocardial Infarction

To evaluate the incidence and clinical course of AV conduction disturbances associated with acute myocardial infarction(MI) and coronary angiographic characteristics in acute inferior MI with AV blocks. We reviewed the medical records and serial ECG's in 89 patients with acute MI treated in CCU of Chonnam National University Hospital from january, 1987 through August, 1990. The subjects were 44 anterior MI's, 43 inferior MI's, and 2 anterior and inferior MI's. AV conduction disturbances were observed in 25.8% of all the patients with acute MI's, 48.8% of 43 inferior MI's and 4.5% of 44 anterior MI's. High degree AV block was observed in 20.0% of all the subjects, 39.3% of inferior MI patients, and none of anterior MI patients. The most severe AV blocks observed in each patients were 7(30.4%) first-degree, 5(21.7%) second-degree, and 11(47.8%) third-degree AV block. The initial AV conduction disturbances developed within 6 hours after onset of symptoms in 9(47.4%) and after 24-hours in 9(47.4%). Seven(30.4%) of 23 patients with AV block showed a transient progression in the degree of AV block, 5(29.4%) of 17 patients with first-or second-degree AV block progressed to third-degree AV block thereby constituting 45.5% of 11 third-degree AV blocks. Nine patients with early AV block less tended to progress in the degree of AV block than the patients with late AV block (1/9 vs 4.9). In early AV block the duration of high-degree AV block was shorter than late AV block(2.5 days vs 6.1 days). The duration of third-degree AV block was less than 2-hurs in 36.4~24 hours in 27.3%, and more than 24 hours in 36.4%. All third-degree AV blocks(90.9%) but one with the longest duration of 13 days returned to 1 : 1 AV conduction within 7 days. There was no significant difference in coronary angiographic findings including the incidence of stenotic lesion in proximal LAD and first septal perforator, number of involved vessel(s), and severity of RCA lesion between the patients with AV block and the patients without AV block in inferior MI.

Herpetic Esophagitis in a Renal Transplant Patient / 대한소화기내시경학회지

Herpetic esophagitis is a rare diaease and is usually deecribed in autopsied reports. Most of the cases are reported in an immunocompromised host. We report a patient with herpetic esophagitis, following renal transplantation and longstanding steroid therapy due to rejectioh phenomenon. The patient complained of dysphagia and odynophagia. Endoscopic finding revealed multiple scattered or confluent erosions and hemorrhagie tendency, diffusely scattered linear or confluent shallow ulcer covered by a whitish exudate on a elevated margin. Microscopic finding revealed uicerated squamous epithelium of ballooning degeneration, ground glass nuclei, multinuclear giant cell and intranuclear inclusion body. The patient responded dramatically to intravenous acyclovir and leading to syniptomatic and endoscopic improvement.

A Case of Recurrent Pacemaker Twiddler's Syndrome

Pacemaker twiddler's syndrome is reported as a very rare complication of permanent pacemaker implantation. There was a recent report suggesting that the incidence of pacemaker twiddler's syndrome increase recently presumably as a result of the implantation of thinner and smaller pacemaker system than before. We experienced a case of pacemaker twiddler's syndrome complicated 3 times with the conventional method of implantation or replacement during 14 months after the first implantation(Optims MP 158C and Pacing lead 400, Telectronic)on June 13th 1987. This case was an 18 year-old high school girl who had suffered frequent syncope for 2 years and extertionl dyspnea for 5 years due to congenital complete heart block, of which block site was proved to be AV nodal by His bundle electrogram. Pacemaker twiddler's syndrome developed 3 times;firstly 6 weeks after the first implantation in the right subclavicular fossa, secondly 10 weeks after the replacement of the twisted pacing lead, thirdly 10 months after the change of implantation site to the left subcalvicular fossa with the replacement of the twisted and fractured lead. Finally, the pacemaker generator was anchored to the clavicular periostium and pectoralis fascia at several points by using Dacron pouch.