Relationship between Heart Rate Turbulence and Heart Rate Variability in Korean Adults with Structurally Normal Heart

BACKGROUND AND OBJECTIVES: Heart rate variability (HRV) illustrates the autonomic integration of the heart. Depressed HRV has been proven to be associated with an increased risk of cardiac death, whereas heart rate turbulence (HRT) is believed to reflect baroreflex sensitivity and it was recently introduced as another noninvasive tool for risk stratification. The aim of this study was to determine the relationship between the HRT and HRV parameters in Korean adults with a structurally normal heart. SUBJECTS AND METHODS: We studied 61 adults (males: 31) who showed ventricular premature complexes on 24 hour Holter recording and who were found to have normal hearts on full noninvasive investigation. We calculated the mean heart rate (RR interval), the number of VPBs, the time- and frequency-domain HRV parameters and two HRT parameters: turbulence onset (To) and turbulence slope (Ts). RESULTS: Ts showed a strong correlation with the HRV parameters (LF/HF ratio: r=0.35, p=0.006; VLF: r=0.32, p=0.013; LF: r=0.27, p=0.035; SDNN: r=0.28, p=0.029; SDANN: r=0.32, p=0.012), but To showed no significant correlation with the HRV parameters. CONCLUSION: The HRT parameters, and especially Ts, correlate strongly with the HRV parameters; therefore, Ts should be considered as a parameter that reflects the overall cardiac autonomic tone.

A Clinical Investigation of Community-Acquired Pneumonia in Mokpo Area / 결핵

BACKGROUND: Community-acquired pneumonia(CAP) remains a leading cause of morbidity and mortality worldwide. Recently, the evolution of drug-resistant microorganisms has become a serious problem in CAP management. Specific antimicrobial therapy is the cornerstone of CAP management. However, obtaining an accurate etiologic diagnosis clinically is not easy and empirical antimicrobial treatment is usually administered prior to the correct microbiologic diagnosis. In this study, the clinical usefulness of empirical CAP treatment was investigated. METHODS: A total 35 cases were studied prospectively over a 16-month period in Mokpo Catholic Hospital from Dec. 1995 to Mar. 1997. The microbiologic diagnosis was made by sputum, blood culture, a specific serum antibody test and an immunologic study. RESULTS: The causative organisms were isolated in 10 (30%) out of 33 cases: 8 cases and 1 case on the sputum culture and blood culture respectively, and 1 case by an indirect hemagglutinin test. 12 cases had underlying diseases: pulmonary tuberculosis 4, alcoholism 4, diabetes mellitus 3, and liver cirrhosis 1. Antimicrobial treatment was given empirically and all cases recovered. CONCLUSION: A definite microbiologic diagnosis before commencing the appropriate treatment in CAP is not straightforward. Empirical therapy according to a clinical assessment is important and helpful. However, every effort to make the correct etiologic diagnosis should be taken.

A Case of Malignant Lymphoma in Patient with Ulcerative Colitis / 대한소화기내시경학회지

Ulcerative colitis has been recognized as a premalignant condition because a considerable proportion of patients with colitis eventually develop colorectal carcinoma at the site of the inflammatory disease. Malignant lymphoma occurring in cases of long-standing ulcerative colitis is rare. Cancer risk is positively correlated with duration and anatomic extent of colitis, but do not appear to be increased by early age at onset of disease. Patients with chronic ulcerative colitis should have periodic rectal and colonoscopic biopsies, and those with moderate to marked dysplasia require colectomy because of the increased risk of colon carcinoma. We report a case of malignant lymphoma in patient with ulcerative colitis.

A comparative study on initial pleural fluid findings of tuberculous pleurisy between patients with and those without pleural thickening / 대한내과학회지

BACKGROUND: Indicator that can predict pleural thickening in pleural tuberculosis has not been known clearly. By the previous study, patients with pleural thickening > or =10 mm had significantly lower glucose and pH values and higher lysozyme and TNF-alpha values than those with pleural thickening or =10 mm and 12 patient (54.5%) had pleural thickening > or =3 mm. Initial pleural fluid protein, LDH, pH, glucose and IFN-gamma, Interleukin-1alpha (IL-1alpha) were studied. RESULTS: Pleural fluid levels of protein, LDH, glucose, and IFN-gamma were not statistically significant different not only between the group of pleural thickening > or =3 mm and the group of pleural thickening or =10 mm and the group of pleural thickening or =3 mm (85.9+/- 37.1 U/mL) was significantly higher than without thickening (44.8+/-32.0 U/mL) (p or =10 mm (106.9+/-8.6 U/mL) was significantly higher than without thickening (58.5+/-8.6 U/mL)(p< 0.001). CONCLUSION: Although patient number of our study was smaller than the previous study, IFN-gamma level in initial pleural fluid of pleural tuberculosis may be considered as the predictive factor of pleural thickening.

The Effect of Propofol for Sedation during Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

BACKGROUND AND AIMS: This research was conducted in order to study the clinical usefulness and stability of the propofol used for sedation during upper gastrointestinal endoscopy. METHODS: The objective of this research was to study one hundred patients, who were chosen based upon their preference to be examined through diagnostic upper gastrointestinal endoscopy accompanied with propofol from July 1998 to August 1998, and who showed normality in the pulmonary function test and ECG. The elements observed were hemodynamic variations, injection dosage, injection time, recovery time and side effects. RESULTS: All patatints had no recollection of the procedure during gastrointestinal endoscopy. It was found that the older the patients were, the less amount of propofol sleep was indued. Systolic blood pressure, diastolic blood pressure and the mean arterial blood pressure were lowered noticeably after sleep, compared with those before the injection of propofol, while the heart rate hardly changed. CONCLUSIONS: Profopol is believed to be a useful sedative for upper gastrointestinal endoscopy. As blood pressre can be lowered however, a cautious attitude should be considered when injecting propofol in the elderly or in patients who have cardiovascular disease.