Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group

BACKGROUND/AIMS: The detection of white coat hypertension (WCH), treated normalized hypertension, and masked hypertension (MH) is important to improve the effectiveness of hypertension management. However, whether global cardiovascular risk (GCR) profile has any effect on the discordance between ambulatory blood pressure (ABP) and clinic blood pressure (CBP) is unknown. METHODS: Data from 1,916 subjects, taken from the Korean Multicenter Registry for ABP monitoring, were grouped according to diagnostic and therapeutic thresholds for CBP and ABP (140/90 and 135/85 mmHg, respectively). GCR was assessed using European Society of Hypertension 2007 guidelines. RESULTS: The mean subject age was 54.1 ± 14.9 years, and 48.9% of patients were female. The discordancy rate between ABP and CBP in the untreated and treated patients was 32.5% and 26.5%, respectively (p = 0.02). The prevalence of WCH or treated normalized hypertension and MH was 14.4% and 16.0%, respectively. Discordance between ABP and CBP was lower in the very high added-risk group compared to the moderate added-risk group (odds ratio [OR], 0.649; 95% confidence interval [CI], 0.487 to 0.863; p = 0.003). The prevalence of WCH or treated normalized hypertension was also lower in the very high added-risk group (OR, 0.451; 95% CI, 0.311 to 0.655). CONCLUSIONS: Discordance between ABP and CBP was observed more frequently in untreated subjects than in treated subjects, and less frequently in the very high added-risk group, which was due mainly to the lower prevalence of WCH or treated normalized hypertension.

Recurrent Infective Endocarditis Associated With Pyogenic Spondylodiskitis

Infective endocarditis is a life-threatening condition caused by microbial infection of the heart's endocardial surface. This condition can also be associated with bacterial infections of other organs. We experienced an unusual case of recurrent infective endocarditis associated with pyogenic spondylodiskitis. A 70-year-old man presented with persistent fever and lower back pain visited our hospital. The patient had a past history of recurrent infective endocarditis. He was diagnosed with infective endocarditis again based on clinical symptoms and echocardiographic findings. Magnetic resonance imaging was used to evaluate lower back pain, which showed acute spondylodiskitis on L3 and L4 vertebrae. The patient completely recovered following four weeks of antibiotic therapy.

Type 2 Myocardial Infarction Following Generalized Tonic-Clonic Seizure

Myocardial infarction is diagnosed when blood levels of biomarkers are increased in the clinical setting of acute myocardial ischemia. Among the biomarkers, troponin I is the preferred biomarker indicative of myocardial necrosis. It is tissue specific for the heart. Myocardial infarction is rarely reported following seizure. We report a case of elevated troponin I in a patient after an episode of generalized tonic-clonic seizure. The diagnosis was type 2 myocardial infarction.

Development of acute myocardial infarction in a young female patient with essential thrombocythemia treated with anagrelide: a case report

Essential thrombocythemia (ET) is a chronic myeloproliferative disorder with a prolonged clinical course. Since this disorder is considered to be at increased risk of thromboembolism, therapy is mainly focused on the decreased risk of thrombohemorrhagic events by use of cytotoxic agents. Anagrelide is a phosphodiesterase III inhibitor which is utilized in the treatment of ET for the reduction of platelets. However, patients treated with anagrelide might experience cardiovascular adverse effects including myocardial infarction (MI), although these events are rare. Herein, we report a case of a 30-year-old female with well controlled ET by anagrelide, who eventually developed an acute non-ST elevation myocardial infarction (MI). There has no found any cardiovascular risk factors in this ET patient, strongly suggesting that anagrelide might be the cause of MI. Therefore, cardiovascular function should be monitored in those patients prescribed with anagrelide.

A Case of Coronary Artery-Left Ventricular Microfistulae Demonstrated by Transthoracic Doppler Echocardiography

The coronary artery-left ventricular microfistula is an extremely rare congenital anomaly. Little is known about their epidemiologic and clinical features. Moreover, to our knowledge, only two cases of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography have been reported in the literature. Recently we experienced a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography, who was a 63 year old woman and visited for evaluation of chest pain. Herein, along with a review of the pertinent literature regarding this disorder, we report a case of coronary artery-left ventricular microfistulae demonstrated by transthoracic doppler echocardiography.

A Case of Aortic Root Abscess Causing Fatal Myocardial Infarction

Despite the major advances in diagnostic technology and improvements in antimicrobial selection and monitoring accompanied by parallel advances in surgical techniques, the morbidity and mortality of infective endocarditis(IE) still remain high. Because of this high mortality rate, it is worthy of investigating the clinical features of IE and it's complications thoroughly. The main causes of mortality in IE are congestive heart failure and septic embolization. In 9% of active IE, acute myocardial infarction(AMI) developed. AMI caused by coronary artery obliteration by occlusion or embolization is a rare but recognized complication of aortic valve endocarditis with annular abscess. We reported a case of aortic valve endocarditis with aortic root abscess which was complicated by AMI and death.

Diagnostic Accuracy and Evaluation of Myocardial Viability by Cardiac Magnetic Resonance Imaging in Acute Myocardial Infarction: A Comparison with Thallium-201 Myocardial SPECT

PURPOSE: To assess the usefulness of cardiac MR imaging (MRI) in the diagnosis of acute myocardial infarction and in the assessment of myocardial viability in comparision with Tl-201 SPECT. MATERIALS AND METHODS: We retrospectively studied 17 patients who complained of chest pain and dyspnea with cardiac MRI . The patients were evaluated for the presence or absence of high signal intensity on T2-weighted image (T2WI), abnormal wall motion on 2D - FIESTA, perfusion defect on Gd-DTPA enhanced T1WI, and delayed myocardial enhancement on 15-minutes delay Gd-DTPA enhanced T1WI. The results were correlated with the images on Tl-201 SPECT, taken at rest and stress, through which reversibility of perfusion defect was assessed. RESULTS: Both cardiac MRI and Tl-201 SPECT proved to be useful methods for diagnosing acute myocardial infarction. In order of decreasing correspondence, T2WI, Tl-201 SPECT, delayed enhancement study, and wall motion images all showed significant statistical correlation with the clinical diagnosis of myocardial infarction. Perfusion MRI, on the other hand, showed no significant statistical difference was found between Tl-201 SPECT and cardiac MRI. The results on T2WI showed high accordance with those on Tl-201 SPECT, while delayed myocardial enhancement and wall motion studies showed no agreement with Tl-201 SPECT. CONCLUSION: Cardiac MRI is useful method for diagnosis of acute myocardiac infarction. With respect to the assessment of myocardial viability, the results obtained on cardiac MRI showed high agreement with those on Tl-201 SPECT. However, further study is necessary at this point for standardization and establishment of the methods for assessing myocardial viability on cardiac MRI.

Characteristics of QT Interval Dispersion During Exercise-induced Changes of Heart Rate

BACKGROUND: QT interval dispersion (QTD) reflects the regional inhomogeneity of ventricular repolarization, and heart rate variability reflects the autonomic tone of the heart. The relation between QTD and heart rate is not clarified yet. The object of this study was to examine the influence of heart rate on QTD using exercise treadmill test in healthy subjects. METHODS: The influence of heart rate on QTD was studied in 42 young healthy pilots by evaluating the changes in QTD induced by hyperventilation and exercise. QTpeak interval dis-persion (QTp D) was defined as the difference between maximum and minimum QTpeak interval measured on 12 lead ECG at single cardiac beat. Paired t test was used between QTp D at rest, QTp D after hyperventilation and QTp D after exercise to determine the effect of heart rate on QTp D. RESULTS: The QTp D after hyperventilation (37+/-11 msec) was greater compared to QTp D at rest (35 +/-14 msec), but there was no difference (P>0.05). The QTp D after exercise was 31 +/-11 msec at stage 1, 28 +/-13 msec at statge 2 and 31 +/-12 msec at stage 3. and there was the significant difference in QTp D at statge 2 compared to QTp D at rest (P<0.05). CONCLUSION: The QTp D significantly decreased at stage 2 after graded exercise in healthy men. This finding suggests that anti-arrhythmogenic effect associated with decreased QTp D during physiologic exercise is present in apparently healthy men.

Association of Chlamydia Pneumoniae Strain TWAR Antibody and Angiographically Demonstrated Coronary Artery Disease

BACKGROUND: A recent case-control study from Finland reported a strong relationship between high antibody titers to Chlamydia pneumoniae , strain TWAR, and both chronic heart disease and acute myocardial infarction. Other studies also suggested an association between C. pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not been yet regarded as an established theory. The objective of this study was to investigate the relationship between C. pneumoniae immnoglobulin G antibody titers and angiographically diagnosed coronary artery disease. METHOD: Coronary angiography was performed. Controls (n=89) were coronary angiographically normal cases and coronary artery disease (n=115) was diagnosed if coronary artery luminal diameter is obstructed more than 50% in more than one coronary artery. Micro-IF assay was used to measure C. pneumoniae TWAR antibodies. The sera were titrated in two-fold dilutions starting from 1 in 8, and a titre of 1 in 8 or more was judjed positive. RESULTS: The estimated risk of coronary artery disease, adjusted for age and gender, was greater among subjects with high (> or =1:128) antibody titers than with low (ENGLISH=Ptimes-i or =1:128) antibody titers.

Association of Chlamydia Pneumoniae Strain TWAR Antibody and Angiographically Demonstrated Coronary Artery Disease

BACKGROUND: A recent case-control study from Finland reported a strong relationship between high antibody titers to Chlamydia pneumoniae , strain TWAR, and both chronic heart disease and acute myocardial infarction. Other studies also suggested an association between C. pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not been yet regarded as an established theory. The objective of this study was to investigate the relationship between C. pneumoniae immnoglobulin G antibody titers and angiographically diagnosed coronary artery disease. METHOD: Coronary angiography was performed. Controls (n=89) were coronary angiographically normal cases and coronary artery disease (n=115) was diagnosed if coronary artery luminal diameter is obstructed more than 50% in more than one coronary artery. Micro-IF assay was used to measure C. pneumoniae TWAR antibodies. The sera were titrated in two-fold dilutions starting from 1 in 8, and a titre of 1 in 8 or more was judjed positive. RESULTS: The estimated risk of coronary artery disease, adjusted for age and gender, was greater among subjects with high (> or =1:128) antibody titers than with low (ENGLISH=Ptimes-i or =1:128) antibody titers.

Left Ventricular Geometry in Essential Hypertensive Patients Versus Hemodialysis Patients

BACKGROUND: In end stage renal disease, left ventricular hypertrophy developed frequently due to volume and pressure overload and other unclarified precipitating factors which could not be seen in essential hypertension. It is now well established that left ventricular hypertrophy and patterns of left ventricular geometry can influence the prognosis in essential hypertension. The aim of present study was to investigate the characteristics and prognostic significance of left ventricular hypertrophy and geornetrir patterns in hemodialysis patients and to compare them with essential hypertension group. METHOD: One hundred and forty essential hyertensive patients and forty eight hemodialysis patients were enrolled and their left ventricular geometric patterns(normal, roncentric remodeling, concentric hypertrophy, eccentric hypertrophy) were compared. RESULTS: 1) Mean age was higher in essential hypertension group(57.3+/-13.5 years versus 48.8+/-11,2 years) but the left ventricular mass index was higher in hemodialysis group(126.0+/-35.3g/m versus 142.6+/-44.4g/m, p=0.01). 2) Among left ventricular geometric patterns in hemodiaysis patients, only the prevalence of concentric hypertrophy was higher statistically compared with essential hypertensive patients(p= 0.014). 3) In essential hypertension group, age(B=0.18, p=0.016), systolic blood pressure(B=0.40, p<0.01) and total peripheral resistance(B=- 0.45, p<0.01) were correlated with left ventricular mass index. On the other hand, mean blood pressure(B=0.38, p<0.01), heart rate(B=- 0.39, p=0.012) and total peripheral resistance(B= - 0.70, p<0.01) were correlated with left ventricular mass index in hemodialysis group. 4) The hemodynamic characteristics of left ventricular hypertrophy were similar in both groups. Cardiac index was lowest and total peripheral resistance was highest in concentric remodeling. Left ventricular mass index, left ventricular septal and posterior wall thickness were highest in concentric hypertrophy and left ventricular internal dimension was highest in eccentric hypertrophy. 5) Comparing the difference between pre- and post-dialysis, only norrnal pattern slightly showed decreased left ventricular internal dimension in diastole, increased relative wall thickness and increased fractional shortening. CONCLUSION: It is considered that the characterization of geometric patterns of left ventricular hypertrophy and investigation of its precipitating factors in essential hypertensive patients and hemodialysis patients mll be helpful to improve their mortality and morbidity.

A case of arteriovenous type cardiac hemangioma

Cardiac hemangiomas are rare primary tumors of the heart and constitute only 2.8% of primary cardiac tumors. They are classified into capillary, cavernous, epitheloid and arteriovenous type and the last one is the most uncommon type. We experienced a case of cardiac hemangioma which was diagnosed as arteriovenous type for the first time in Korea in the literature. The patient was a 54-year-old woman who presented with palpitation and anterior chest pain. The diagnosis was based upon coronary angiography which showed two tumor blushings located in the interatrial and interventricular septum with venous drainage to the coronary sinus and right atrium. Associated atrial fibrillation with rapid ventricular response was controlled with digitalis.

Vocal Cord Paralysis in Patent Ductus Arteriosus and Primary Pulmonary Hypertension

Nowadays left vocal cord paralysis is a rare presenting sign of cardiovascular diseaes, associated with pulmonary hypertension. This condition is known as Cardiovocal syndrome. The mechanism of this condition is thought to be due to compression of the recurrent laryngeal nerve by a dilated, tense pulmonary artery against its adjacent structure. Two patients complaining hoarseness were proven to have cardiovascular diseases. The one had patent ductus arteriosus and the other had primary pulmonary hypertension. A causal relation between cardiovascular problem and the vocal cord paralysis is proposed. We describen two cases of Cardiovocal syndrome with a review of the literature.

Chest X-ray Findings and Acid-base Disturbances in the Early Phase of Leptospirosis / 대한내과학회지

BACKGROUND: Clinical syndrome of leptospirosis in Korea which accompanied by hemoptysis, pulmonary hemorrhage, respiratory failure was quite different from that of typical Weil's disease. The death rate in the early stage of disease has relationship with chest X-ray findings and acid-base disturbances resulted from hypoxia and asphyxia. We've come to consider chest X-ray findings and arterial blood gas findings as factors influencing the prognosis of the disease. METHODS: Forty one cases of leptospirosis diagnosed by acute febrille illness symptoms and serologic tests were graded for chest X-ray findings and grouped according to acid-base abnormalities. Retrospectively, we attempted to correlate the acid-base disturbances and chest X-ray findings with morbidity and mortality of the disease. RESULTS: The result were as follows. 1) Abnormal chest X-ray findings were observed in 30 cases(73%). Mortalities according to the chest X-ray findings were 0(0%), 2(17%), 3(0%), 4(0%), 5(33%), 6(50%) and chest X-ray findings influenced the mortality with statistical significance(p<0.05). 2) Acid-base abnormalities were observed in 39 cases(95%) and the types were divided to six groups . Respiratory alkalosis was the most common acid-base disturbance(44%). Five cases were died. Two of five were respiratory alkalosis, two cases were mixed respiratory metabolic acidosis and another case was mixed respiratory-metabolic alkalosis. As shown, acid-base abnormality influenced the mortality and mixed acid-base disturbances were showed high mortality with statistical significance (p<0.05). 3) Total mortality was 12%(five of forty-one). The chest X-ray score, morbidity, pH, pCO2, pO2, and HCO3 were 5.0 +/- 0.8, 3.4 +/- 1,3, 7.16 +/- 0.17, 32.5 +/- 1.1, 43.3 +/- 13.4 and 17.6 +/- 3.1 in died group, 2.4 +/- 0.4, 12.7 +/- 1.0, 7.46 +/- 0.01, 48.8 +/- 13.4, 65.4 +/- 3.7 and 23.4 +/- 0.9 in recovery group, respectively. There was difference between two groups with statistical significance. CONCLUSION: In this study, we concluded that chest X-ray findings and acid-base abnormalities influenced the mortality of leptospirosis. The factors above mentioned make us consider chest X-ray and blood gas analysis are essential to the patient hospitalized for the suspicion of leptospirosis. Especially, these factors pointed out the patient having chest X-ray abnormalities and mixed acid-base disturbances needed intensive care in the early stage of leptospirosis.

Evaluation of Correlation between Automatic Ocillometric Sphygmomanometer and Standard Korotkoff Auscultatory Sphygmomanometer

BACKGROUND: Early diagnosis and treatment of hypertension is imperative to prevent the complications associated with this condition. The development of accurate and convenient methods of blood pressure measurement, therefore, is indispensible. At present, the JNC V has acknowledged the use of automatic sphygmomanometer that can be used without the help of someone else. We compared automatic oscillometric sphygmomanometers manufactured by Sein Electronics, korea(SE-7000 and SE-5000) with the standard Korotkoff auscultatory mercuy sphygmomanometer meter. The correlation between these two methods were calculated to determine whether these products could actually be used in clinical practice. This study was undertaken to ensure the clinical evaluation of these two products and standardization of an antomatic sphygmomanometer in korea before it is actually used. METHODS: The study included eighty-three patients, ranging in age from 14 to 81 years, who were admitted to Hanyang University Hospital in October, 1995. The blood pressure measured by the automatic oscillometric sphygmomanometer(SE-7000) in the right arm and was compared with that measured by the standard mercury sphygmomanometer(baumanometer) in the left arm. Also the blood pressure measured by the automatic oscillometric sphygmomanometer(SE-5000) at the wrist was compared by the baumanometer in the same side arm. The correlation between these methods were determined by the paired Student`s t-test and by the simple liner regression method. RESULTS: The p value of systolic blood pressure between two methods(SE-7000 and baumanometer) in the both arms was 0.896 and correlation coefficient was 0.8286. The p value of diastolic blood pressure between this two methods was 0.352 and correleation coefficient was 0.7455. The p value of systolic blood pressure between two methods(SE-5000 and baumanomter) by the arm and the wrist was 0.00018 and correlation coefficient was 0.8588, the p value of diastolic blood pressure between this two methods was 0.000048 and correlation coefficient was 0.5944. CONCLUSION: The blood pressure measured by the SE-5000 at the wrist was statistically different from that measured with the baumanometer in the arm. Further studies are necessary to use this product in clinical practice. However, the systolic and diastolic blood pressures measured with the SE-7000 in the arm were relatively similar to those measured by the baumanometer enabling this products to be effectively used in clinical practice.

The Influence of Nonselective Beta-Adrenergic Blockade (carteolol) and ACE Inhibitor (captopril) in Plasma Potassium on Maintenance hemodialysis / 대한내과학회지

OBJECTIVES: The degree of hyperkalemia and effects of potassium removal by hemodialysis on the plasma potassium concentration to see the influence of nonselective beta-adrenergic blockade(carteolol) and ACE inhibitor(captopril) on patients in maintenance hemodialysis were evaluated. METHODS: This study was done on 16 patients with end-stage renal disease undergoing maintenance hemodialysis. These patients were classified two groups; group 1-patients with carteolol or captopril(9 patients) and group 2-patients without medication(7 patients). Measurement of plasma potassium and arterial blood gas analyses were performed at pre-dialysis and during hemodialysis(4 hours). To analysis the distribution of potassium kinetics during hemodialysis, dialysis potassium clearance rate was introduced in this study. RESULTS: 1) Among 16 patients studied, the mean age was 43 years old and the ratio of male to female was 2: 1 and the mean duration of hemodialysis was 17.9 months. The underlying cause of end-stage renal disease was chronic glomerulonephritis in the most patients. 2) The mean predialysis plasma potassium concentration of all patients, group 1 on medication, and group 2 without medication was 5.13 +/- 1.04mEq/L, 5.67 +/- 1.01mEq/L and 4.410.55mEq/L, with high significance(p<0.001) between groups 1 and 2. 3) The mean postdialysis plasma potassium concentration of group 1 on medication and group 2 without medication was 348 +/- 0.40mEq/L and 3.39 +/- 0.56mEq/L with insignificance between groups 1 and 2. 4) The pre- and post-dialysis concentration of plasma sodium, pH and bicarbonate between group 1 and group 2 was similar except glucose. 5) Despite the fall in absolute plasma concentration in group 1 more than twice than in group 2, the difference in dialysis potassium clearance rate measured at 1 hour of hemodialysis in group 1 compared to that of group 2 was only 12M. CONCLUSION: These data are consistent with at least a two-compartment distribution of plasma potassium rather than single pool in addition to frequent hyperkalemia on maintenance hemodialysis on nonselective beta-adrenergic blocker or ACE inhibitor contributed to partial impairment of extrarenal transcellular shifts of potassium during inter- and intra-dialytic phase.

The Clinical Characteristics of Acute Pyelonephritis Associated with Acute Renal Failure as an Initial Presentation / 대한내과학회지

BACKGROUND: Acute renal failure (ARF) due to acute pyelonephritis (APN) in patients in the absence of obstructive uropathy, diabetes, or chronic renal failure was reported rarely (12 cases in the last 25 yrs in Clin Inf Dis, 1992; 243-6 by SR Jones)2). Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure, and when clinicians weigh the possible consequences of bacteriuria, renal failure is not considered to be a reasonable possibility. METHODS: We observed 6 patients of acute pyelonephritis associated with acute renal failure as an initial manifestation on admission in the past 6 months. The analysis of clinical features of these 6 patients (APN+) compared to 7 patients of APN without ARF (APN-) revealed following data. RESULTS: All were female in both groups. The mean age was 331.7 years in APN+ and 48+6 years in APN-, respectively (p, ns). All in both APN- and APN+ were caused by E. coli. But, none in both groups except 1 in APN- had bacteremia. The previous history of UTI was present in 5 in APN-, but none in APN+. Duration of clinical symptoms before admission (8.4+/-0.5 vs. 4.4+/-1.0 days, P<0.05) and admission days (24.2+/-1.8 vs. 11.1+/-1.5 days, p=0.000) were significantly longer in APN+. On admission, HUN and serum creatinine was 45+/-2.7mg/dL and 3.5+/-0.2mg/dL in APN+, respectively. No one in APN+ required dialysis, and subsequently recovered renal function with prompt antibiotic therapy resulting in no significant difference compared to that of APN on discharge (serum creatinine, 1.0+/-0.1 vs. 0.9+/-0.1mg/dL). No differences in leukocytosis and serum electrolyte levels on admission were present. However, significant anemia was noted in APN+ (hemoglobin, 9.0+/-0.7 vs. 11.9+/-0.2gm/dL). The days of fever and leukocytosis before disappearance were not different in both groups, but those of flank pain (12.8+/-1.5 vs. 5.7+/-0.7 days, P=0.001) and pyuria (16+/-1.9 vs. 6.4+/-0.6 days, P=0.000) significantly longer in APN+. Upon ultrasonography, all in APN+ showed enhanced echogenicity, but I in APN . (P=P value, NS=not significant) CONCLUSION: Upon these data, we concluded that ARF associated with APN as an initial manifestation was accompanied by several distinct clinical characteristics, which could be used for the early recognition of its unusual occurrence and subsequent appropriate management including antibiotics leading to a favorable outcome.

Pyogenic Thalamic Brain Abscess: A Case Report

The authors investigated a case of surgically verified solitary left thalamic abscess in a 37-year-old man presented with raised intracranial pressure and congenital heart disease(ventricular septal defect). He had experienced headache, vomiting and right hemiparesis, which progressed to somnolence and confusion. Brain computed tomography(CT) and magnetic resonance image(MRI) demonstrated a left thalamic ring-enhanced lesion. The purulent material was drained and subtotal excision was done with a transcallosal transventricular craniotomy. Concomitant systemic antibiotics therapy was a dministered.

Left Ventricular Geometric Patterns of Dippers and Non-Dippers in Essential Hypertension

BACKGROUND: One of the unique feature of ambulatory blood pressure monitoring is its ability to describe the variations of BP throughout the day and night. Left ventricular hypertrophy and other measures of target organ damage in hypertension are more closely related to the average 24-h BP than to clinic BP. In addition to the mean levels of BP, the characteristics of the 24-h BP profile might be a further determinant of organ in essential hypertension. METHODS: Data were obtrained from 105 patients with essential hypertension and 44 normal subjects. Echocardiography and 24 hour ambulatory blood pressure monitoring were performed in all subjects. At first, relative wall thickness(RWT) and left ventrcular mass index were calculated from normal subject and normal values(RWT<0.44, LV mass index,120gm/m2) were applied to hypertensive patients which were classified to dipper and non-dipper according to the result of ambulatory monitoring. RESULTS: 1) There were 49 dippers and 56 non-dipper in hypertensive patients subjects. 2) Among the dippers, left ventricular mass index and relative wall thickness were normal in 51%, whereas 8.2% had increased relative wall thickness with normal ventricular mass(concentric remodeling), 32.7% had increased mass with normal relative wall thickness(eccentric hypertrophy) and 8.2% had typical hypertensive concentric hypertrophy. 3) Among the non-dippers, left ventriculat mass index and relative wall thicksness were normal in 40%, whereas 41.8% had eccentric hypertophy, 16.4% had concentric hypertrophy, only 1.8% had concentric remodeling. 4) The incidence of concentric hypertophy was significantly increased in non-dipper subjects(15.2%) than dippers(8.2%), especially in non-dipper female patients. 5) The incidence of concentric remodeling was increased in dipper(8.2%), especially in dipper female patients. 6) There were no difference between left ventricular geometies in duration of hypertension, ejecton fracton, fractional shortening, and cardiac index. 7) There were no difference between dipper and non-dipper subjects in total peripheral resistance except dipper female patients(1,484+/-535 dynes.s.cm5). CONCLUSION: Patterns of left ventricular hypertophy and geometric remodeling in essential hypertension may not be influenced by the duration of hypertension, but by gender, blood pressure level, diurnal rhythm and total peripheral resistance.

Transthoracic Fine Needle Aspiration Biopsy in Localized Pulmonary Lesions: Diagnostic Accuracy and Complications / 결핵

INTRODUCTION: Transthoracic fine needle aspiration biopsy(TNAB) has shown to be a resonably safe, simple, and accurate procedure in diagnosis of intrathoracic lung lesions. We reviewed the results of 1,005 TNAB of chest lesions performed on 930 patients with 20 or 22-gauze needles over a period of 10 years. METHODS: From November 1983 to June 1995, 1,005 cases in 930 patients with an undiagnosed lung lesion underwent TNAB at the Hanyang University Hospital: 66% were men and 34% were women. Most of the patients were 40~60 years old and the youngest patient was 3 years of age. RESULT: 540 patients had various malignant chest lesions and 322 patients had benign pulmonary lesions. The diagnostic accuracy of TNAB was 96.1 percent in malignant diseases with one false positive result and 90.1% in benign diseases. A definitive diagnosis was not obtained in the remaining 68 patients. The most common diagnoses among 519 malignancy chest lesions with TNAB were the following: squamous cell lung carcinoma, 31.7%; adenocarcinoma, 24.7%; small cell lung carcinoma, 16.7%; metastatic cancer, 14.2%; large cell lung carcinoma, 6.2% and so on. Complications included pneumothorax in 12.3% necessitating chest tube drainage in 0.6%. Minor hemoptysis occurred in 3.6%. There was no death directly attributable to the procedure. CONCLUSION: We concluded that TNAB permits a direct approach to all kinds of localized lung lesions with a high degree of accuracy and without major complications.