Jung Don Seo

Effect of red ginseng on blood pressure in patients with essential hypertension and white coat hypertension.

The objective of this study is to evaluate the changes of diurnal blood pressure pattern after 8 weeks of red ginseng medication (4.5 g/day) by 24 hour ambulatory blood pressure monitoring. In 26 subjects with essential hypertension, 24 hour mean systolic blood pressure decreased significantly (p = 0.03) while diastolic blood pressure only showed a tendency of decline (p = 0.17). The decrease in pressures were observed at daytime (8 A.M.-6 P.M.) and dawn (5 A.M.-7 A.M.). In 8 subjects with white coat hypertension, no significant blood pressure change was observed. We suggest that red ginseng might be useful as a relatively safe medication adjuvant to current antihypertensive medications.

Takayasu arteritis in Korea: Clinical and angiographic features

SummaryClinical and angiographic features of Takayasu arteritis were investigated in 129 Korean patients. This disease affects females more frequently than males, in a ratio of 6.6 to 1. Of the total number of patients, 51 were in the third decade, 27 in the fourth decade, and 23 in the second decade. Common clinical symptoms were headache (60%), exertional dyspnea (42%), dizziness (36%), and malaise or weakness (34%). Takayasu arteritis affected the abdominal aorta (46%) and descending thoracic aorta (37%) more frequently than the ascending aorta (1%) and aortic arch (2%) According to Uenos classification based on aortographic findings, the 129 patients were divided into type I (37), type II (25), and type III (67). Among the 48 patients who had coronary angiography, 11 (23%) showed coronary arterial involvement. Because the clinical features are determined by the extent and severity of the specific artery involved in the occlusive phase of the disease, total aortography including coronary angiography is very important in the initial evaluation of Takayasu arteritis.

Limited performance of quantitative assessment of myocardial function by thallium-201 gated myocardial single-photon emission tomography

Abstract.We investigated the reproducibility between thallium-201 and technetium-99m methoxyisobutylisonitrile (MIBI) gated single-photon emission tomography (SPET) for the assessment of indices of myocardial function such as end-diastolic and end-systolic volume (EDV, ESV), ejection fraction (EF) and wall motion. Rest 201Tl (111 MBq) gated SPET was sequentially performed twice in 20 patients. Rest 201Tl gated SPET and rest 99mTc-MIBI (370 MBq) gated SPET were performed 24 h apart in 40 patients. Wall motion was graded using the surface display of the Cedars quantitative gated SPET (QGS) software. EDV, ESV and EF were also measured using the QGS software. The reproducibility of functional assessment on rest 201Tl gated SPET was compared with that on 99mTc-MIBI gated SPET, and also with that between 201Tl gated SPET and 99mTc-MIBI gated SPET performed on the next day. The two standard deviation (2 SD) values for EDV, ESV and EF on the Bland-Altman plot were 29 ml, 19 ml and 12%, respectively, on repeated 201Tl gated SPET, compared with 14 ml, 11 ml and 5.3% on repeated 99mTc-MIBI gated SPET. The correlations were good (r=0.96, 0.97 and 0.87) between the two measurements of EDV, ESV and EF on repeated rest studies with 201Tl and 99mTc-MIBI gated SPET. However, Bland-Altman analysis revealed that the 2 SD values between the two measurements were 31 ml, 23 ml and 12%. We were able to score the wall motion in all cases using the 3D surface display of the QGS on 201Tl gated SPET. The kappa value of the wall motion grade on the repeated 201Tl study was 0.35, while that of the wall motion grade on the repeated 99mTc-MIBI study was 0.76. The kappa value was 0.49 for grading of wall motion on repeated rest studies with 201Tl and 99mTc-MIBI. In conclusion, QGS helped determine EDV, ESV, EF and wall motion on 201Tl gated SPET. Because the EDV, ESV and EF were less reproducible on repeated 201Tl gated SPET or on 201Tl gated SPET and 99mTc-MIBI gated SPET on the next day than on repeated 99mTc-MIBI gated SPET, functional measurement on 201Tl gated SPET did not seem to be interchangeable with that on 99mTc-MIBI gated SPET.

Temperature-guided radiofrequency cathether ablation of slow pathway in atrioventricular nodal reentrant tachycardia☆

During the last several years, catheter ablation techniques with radiofrequency current have developed dramatically and have become the method of choice for curative therapy of atrioventricular (AV) nodal reentrant tachycardia. Initial reports have achieved AV nodal fast-pathway ablation with excellent results, but AV nodal slow-pathway ablation is currently the alternative to fast-pathway ablation because of an excellent success rate of 90 % to 100 % and the lower risk of AV block. 13 The ablative effect of radiofrequency energy is based on direct electric (resistive) heating and passive (conductive) heating of the tissue adjacent to the ablating electrode. 4 Assuming that only temperature is the basis for the ablative effects of radiofrequency energy, the temperature of the electrode-tissue interface is more reliable and a better predictor of radiofrequency lesion volume than other variables such as power output, duration of energy delivery, contact pressure of ablation electrode, size of electrode tip, and cavity blood flow. 57 Very few published studies were performed carefully to investigate the effects of temperature-guided radiofrequency catheter ablation on the treatment of AV nodal reentrant tachycardia. This investigation was performed to evaluate the efficacy and safety of temperature-guided radiofrequency catheter ablation of slow pathway for the treatment of AV nodal reentrant tachycardia. The study population consisted of 34 consecutive patients with symptomatic AV nodal reentrant tachycardia for 12 _+ 10 years (range 1 to 40 years). The 10 men and 24 women had a mean age of 44 _+ 16 years (range 14 to 72 years). Structural heart disease was present in four patients: mitral valve prolapse in 2, mitral stenosis in 1, and aortic valve regurgitation in 1. Electrophysiologic study and catheter ablation were performed with quadripolar

The Coexistence of Calcitonin Gene-Related Peptide and Substance P in Pericellular Arborization and Satellite Cell of Goat Trigeminal and Nodose Ganglia

Pericellular arborization is reported to be the self‐regulating structure in sensory ganglia. Although the calcitonin gene‐related peptide (CGRP) or substance P (SP) immunoreactive pericellular arborization appeared in the sensory ganglia, there was no available information that CGRP and SP colocalize in this structure. As the attempts to resolve the question described above, the present study was undertaken to identify the coexistence of CGRP and SP in pericellular arborizations of the goat nodose and trigeminal ganglia by double immunohistochemistry. As the results show, CGRP immunoreactivity was present in every pericellular arborization containing SP immunoreactivity in trigeminal ganglia, however, pericellular network containing CGRP or SP immunoreactivity was not present in nodose ganglia. Unexpectedly, a few small satellite elements were observed to contain intense CGRP and SP immunoreactivity at the periphery of CGRP and SP immunoreactive neurones in nodose ganglia. Therefore, these results suggest that CGRP and SP coexsit in pericellular arborizations, and that satellite cell as well as pericellular arborization may be involved in intraganglionic regulation of goat sensory ganglia.

The Distribution of Calcitonin Gene-Related Peptide in Gastric Vagal Circuit of Rats

In the present study, we performed the retrograde tracing method using the neurotropic pseudorabies virus bartha strain (PRV‐Ba) and immunohistochemistry against CGRP, to identify whether CGRP exists in the gastric monosynaptic vagal circuit between dorsal motor nucleus of vagus nerve (DMV) and nucleus tractus solitarius (NTS).

Successful Management of Mechanical Complications Following Acute Myocardial Infarction -A Case Report-

Rupture of the heart as a complication of myocardial infarction is one of the most common causes of in-hospital mortality. Rupture of the free wall of the ventricle or interventricular septum has a poor prognosis when treated conservatively. So, rupture of the heart after infarction requires prompt diagnosis and early surgical repair despite the high overall incidence of early operative mortality before hemodynamic deterioration and multiorgan failures develop. Rupture of the left ventricle results in pseudoaneurysm if the overlying pericardium adhers to the surface of the heart. Pseudoaneurysms which rarely develop after infarction, tend to rupture. Their presence alone is an indicator for operation because of the very poor prognosis following rupture. We experienced successful management of 2 rare complications after acute myocardial infarction: ventricular septal defect and pseudoaneurysm. The first patient was a 49-year-old man who had an apical septal defect. His electrocardiogram showed Q wave in leads V2–V6, II, III, and aVF but a coronary angiogram showed normal findings. He was successfully treated by patch closure of the septal defect. The second patient was a 65-year-old female who had false aneurysm of the left ventricle. She had neither chest pain nor abnormality on the electrocardiogram. A coronary angiogram showed complete occlusion of the distal circumflex artery. Under cardiopulmonary bypass, the neck of the aneurysmal sac was successfully closed with a prolene suture.

Infective endocarditis in a patient with Williams' syndrome--case report.

An 18-year-old male was admitted to Seoul National University Hospital for the evaluation of fever and chill on February 3, 1988. On physical examination, his face showed a characteristic “elfin” facial appearance. His face was characterized by abnormalities of dental development, a broad overhanging upper lip, high arched palate and gum hypertrophy. He also showed mental retardation. Cardiac catheterization with selective cineangiocardiography demonstrated a supravalvular aortic narrowing, grade 2 aortic insufficiency, and moderately dilated proximal coronary arteries with normal distribution without an intraluminal narrowing. There was a systolic pressure gradient (55mmHg) between the aortic root and ascending aorta distal to a stenotic segment. MRI showed a supravalvular aortic stenosis. Vegetation was not found on echocardiograpghy. Unidentified G(−) rods were isolated in 3 out of 9 bottles in blood culture test. He was treated with Na-penicillin and gentamicin for 28 days.

Cardiac Amyloidosis Diagnosed by Endomyocardial Biopsy

A 56-year-old male patient who had a history of syncopal attack was diagnosed as having cardiac amyloidosis. His ECG finding showed a pattern of inferior and anteroseptal wall infarction with Wenckebach AV block. Echocardiographic examination revealed that the LV posterior wall and interventricular septum were markedly thickened with granular sparkling. We demonstrated the amyloid deposit in the myocardium by endomyocardial biopsy. Pathology showed a green white birefringence by polarizing illumination and amyloid fibril in electron microscopic study.

Noninvasive evaluation of left ventricular diastolic function in patients with angina pectoris--pulsed Doppler echocardiographic technique.

To assess the disturbed left ventricular diastolic filling by pulsed Doppler echocardiography in patients with angina pectoris who have normal systolic function, 55 subjects (33 angina patients with, 22 control subjects without significant (⩾75%) coronary artery narrowing) underwent pulsed Doppler echocardiography examination one day before coronary arteriography. From analysis of the transmitral flow velocity curve, diastolic time intervals, peak early and late atrial flow velocities, the ratio of early to atrial peak flow velocity, and deceleration slope after peak early flow velocity were measured. The angina group had a significantly higher peak atrial flow velocity (50.1 ± 10.0 cm/sec vs. 43.7 ± 9.0, p<0.05) and a lower ratio of early to atrial peak flow velocity (0.91 ± 0.24 vs. 1.17 ± 0.30, p<0.005), but peak early flow velocity, deceleration slope, and diastolic time intervals were similar in both groups. Therefore, the pulsed Doppler technique using the transmitral flow velocity curve is thought to be useful in the noninvasive evaluation of diastolic function even in patients with angina pectoris who have normal systolic function and no left ventricular hypertrophy.