The Correlation between Coronary Artery Disease and Carotid Atherosclerosis

BACKGROUND: In patients with coronary artery disease (CAD), atherosclerotic changes of carotid arteries (CA) often coexist with CAD itself. If the degree of carotid atherosclerosis can be estimated, it would be very helpful in the management of patients with CAD. METHODS: CA intima-media thickness (IMT) was evaluate by ultrasonography at 12segments (both proximal, middle, distal common CA, bifurcation, internal and external CA-of the extracranial CA) on the 182 subjects whom underwent coronary angiograms. The subjects were divided into 4 groups according to the severity of CAD; control (C, n=23), single vessel disease (1, n=64), two vessel disease (II, n=44), three vessel disease (III, n=51). RESULTS: The means (+/-SD) of maximal IMT, chosen from the 12 segments, of each group were 1.4+/-0.7mm (C), 2.1+/-1.4mm (I), 2.2+/-1.2mm (II), and 2.9+/-1.7mm (II). The 4 groups showed significant differences between each other. The only conparison to yield unsignificant differences was between group I and group II (p=0.02 for C and I, p=0.001 for C and II, p<0.001 for C and III, p=0.01 for I and III, p=0.04 for II and III). When multivariate analysis was used to assess which major risk factors for CAD (age, male sex, smoking, hypertension, diabetes, cholesterol, triglycerides and CAD groups affected CA IMT), group III and increasing age were the most significant variables (p=0.0001 and 0.0035, respectively). CONCLUSIONS:It is necessary to evaluate the status of the extracranial carotid arterial system with ultrasonography in patients with three vessel CAD even if neurologically symptomless. It becomes especially evident in elderly patients.

Evaluation of in-Hospital Cardiopulmonary Resuscitation

BACKGROUND: Cardiopulmonary resuscitation (CPR) has been practised since the introduction of external cardiac massage in 1960. Observed results of in-hospital CPR in many published studies vary greatly. Data on survival has called attention to patient-related factors, lack of medical personnel training and delay in initiation of CPR. We evaluated the results of CPR attempted in a single institute in Korea. SUBJECTS: Our subjects were patients in whom CPR was instituted in our hospital with activation of the emergency call system between August 1, 1995 and December 31, 1997 (n=308, M=181, F=127, mean age=47.8+/-26.4 years). RESULTS: One hundred and ninety-eight among the 308 cases of in-hospital CPR were reviewed, excluding preventive CPR cases and CPR performed on subjects designated DNAR (Do not attempt resuscitation). Mechanism of arrest were respiraory arrest in 84 cases (42.4%), ventricular tachycardia/fibrillation in 59 (29.8%), asytole in 52 (26.3%), and electromechanical dissocaition in 3 (1.5%) in order of declining frequency. Overall survival rate at discharge was 12.6%. Among different age groups, the rates were:21.6% in the pediatric group (age or = 70). Survival outcomes associated with mechanism of arrest were:11.9% for respiratory arrest, 15.3% for ventricular tachycardia/fibrillation and 9.6% for asystole. No significant difference in survival was found between mechanisms of arrest. Successful outcome after CPR was significantly associated with CPR duration, showing higher wurvival rates with CPR performed for less than 15 minutes than over 15 minutes (p<0.001). CONCLUSION: Among in-hospital CPR cases, only 12.6% survive to discharge. We suggest that guidelines for performing and evaluating in-hospital CPR should be set up to improve the survival rate.

Influences of the Apolipoprotein E Polymorphism on the Development of Coronary Artery Disease and on Serum Lipids in the Korean Males

BACKGROUND: Apo E lipoprotein is polymorphic and exists in three common isoforms (E2, E3 and E4), which are the gene products of three apo E alleles, e2, e3 and e4. Apo E lipoprotein plays an important role in the regulation of the lipid metabolism through its ability to bind to receptors. Depending on the genotypes apo E polymorphism is either protective or increases risk for atherosclerosis and coronary artery disease. The purpose of this study is to evaluate 1) the association between apo E allele and the development of coronary artery disease, 2) the association between apo E alleles and dyslipidemia in Korean males. METHODS: We studied 241 patients with angiographically verified coronary artery disease and 257 male subjects without evidence of coronary artery disease. Apo E genotyping was determined with the INNO-LiPA Apo E kit (Innogenetics, Belgium), which is based on reverse hybridization. RESULTS: There was a higher frequency of the apo e4 allele in subjects with coronary artery disease than in normal controls. The frequencies of apo E genotype were not significantly associated with apo e2 were associated with higher levels of triglyceride and lower LDL, and the subjects with apo e4 had lower levels of HDL cholesterol. CONCLUSION: ApoE polymorphism is a genetic marker for risk of the development of coronary artery disease and an important determinant of dyslipidemia.

The Effect of Beta-blocker Assessed by Repeat Head-up Tilt Test in Adults with Vasovagal Syncope or Presyncope

BACKGROUND: Oral beta-blocker is initially used to prevent the symptons in patients with vasovagal syncope or presyncope. But, beta-blocker treatment may actually cause worsening of symptoms in some patients. The purpose of the present study was to evaluate the efficacy of oral beta-blocker in preventing symptoms during repeat head-up tilt test in patients who had a positive response in initial head-up tilt test. METHOD: Patients. Among the 150 patients with unexplained syncope or presyncope who underwent head-up tilt from October 1994 to January 1996, forty-three patients, who were taking beta-blocker and underwent repeat head-up tilted test, were included in this study. Initial head-up tilt test. Each patients was tilted to the 70 degree upright position for 30 minutes. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 (micro)g/min and then increased by 1 (micro)g/min every three minutes to al maximum of 5 (micro)g/min while maintaining 70 degree upright position. Repeat head-up tilt test. The test was repeated while each patients was taking atinolol. The repeat test was continued until reaching at the stage where each patient had a positive response in initial test. RESULTS: 1) In initial head-up tilt test, most (91%) of a positive response occured during isoproterenol provocation. 2) In repeat head-up tilt test on atenolol, thirty-four patients(79%) had a negative response. But nine patients(21%) still had a positive response. 3) Nonresponsive group showed younger age and shorter time period to a positive response in initial head-up tilt test than responsive group. CONCLUSION: It may be useful to assess the effectiveness of beta-blocker by repeat head-up tilt before deciding long term treatment, especially younger age group.

Correlation between Apolipoprotein E Polymorphism and Plasma Lipid Levels in the Korean Males

BACKGROUND: Apo E lipoprotein is made up of 299 amino acid and is classified into three major isoforms(E2, E3 and E4). Aop E lipoprotein plays an important role in the regulation of the lipid metabolism. The purpose of this study is to evaluate the variations of plasma lipids depending on the apo E genotype in the Korean males. METHODS: We studied 257 male subjects without evidence of coronary artery disease. Apo E genotyping was determined with the INNO-line probe assay apo E test, which is based on reverse hybridization. RESULTS: Apo E genotype frequencies for 257 subjects were as follows, 73.9% for epsilon3/3, 16% for epsilon4/3, 8.2% for epsilon3/2, 1.2% for epsilon2/2, and 0.8 for epsilon4/4. We found significant differences in apo E allele frequencies of our subjects campared with those of western populations. Compared to the subjects with apo epsilon3, the subjects with apo epsilon2 was associated with higher levels of triglyceride, and the subjects with apo epsilon4 had lower levels of HDL cholesterol. CONCLUSION: The frequencies of apeE genotype varies depending on the ethnic origin. ApoE polymorphism plays an important role in determining individual differences in plasma lipids.

Usefulness of Head-up Tilt Test in Adults with Syncope or Presyncope of Unexplained Origin

BACKGROUND: Vasovagal syncope is a common cause of syncope. In some cases, syncopal episode is recurrent, resulting in physical injury. Head-up tilt test with or without isoproterenol provocation has been a tool to diagnose vasovagal syncope. But the protocol of head-up tilt test has not been settled. In this study, we evaluate the usefulness of a head-up tilt test with isoproterenol provocation in patients with syncope or presyncope of unexplained origin. METHODS: Head-up tilt test was performed with patients in the fasting state in the morning. After supine heart rate and blood prewwure were obtained, each patient was tilted to the 70 degree upright position for 30 minutes using a motorized tilt table with a footboard. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 microg/min and then increased by 1 microg/min every three minutes to a maximum of 5 microg/min while maintaining 70 degree upright position. The end points of test were positive response, intolerance of isoproterenol, heart rate>150 beats/min, and completion of the protocol. When an end point reached, the patient was rapidly returned to the horizontal position. RESULTS: 1) Of 122 patients with syncope or presyncope, 113 patients(93%) had prodromal symptoms. 2) 23 patients(19%) had physical injury during episode. 3) 93 patients(76%) experienced episodes while they were standing or sitting. 4) A total of 83 patients(68%) had a positve response during head-up tilt test ; 7 patients(8%) of these 83 patients had a positive response during the baseline tilt. But, 76 patients(92%) required isoproternol provocation to elicit this response. 5) The pattern of positive response showed vasodepressive pattern in 55 patients(67%), mixed pattern in 26 patients(31%), and cardioinhibitory pattern in 2 patients(2%). 6) No significant side effect of isoproterenol was noted. 7) There were no significant differences between positive response group and negative response group in terms of clinical characteristics and hemodynamic findings during head-up tilt test. CONCLUSION: A head-up tilt test with isoproterenol provocation could be an useful tool for diagnosing vasovagal syncope or presyncope in adults.

A Case of Precocious Pseudopuberty due to Granulosa Cell Tumor in an Infant

No abstract available.

A Clinical Study on he Intestinal Tuberculosis in Children

No abstract available.