Resolution of left atrial appendage thrombus in mitral stenosis after warfarin therapy.
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Adult↗
Biomedical subjects
J S Hung
Publications and source records attributed to J S Hung.
Creatine kinase MB elevation in paralytic shellfish poisoning.
An outbreak of paralytic shellfish poisoning occurred in southern Taiwan, affecting 116 persons who had consumed purple clams. Two victims died within four hours. Gonyautoxins were identified as causative toxins. During the outbreak, five patients with paralytic shellfish poisoning were seen in our hospital. All recovered following supportive treatments. Serum creatine kinase concentration was elevated in three of the five patients. The levels of the enzyme did not seem to correlate with the severity of poisoning. The most significant finding was the previously unreported observation of elevation of the creatine kinase MB level. In all four patients who had creatine kinase MB value determined, it was elevated.
Adult↗
Erythrocyte Li-Na countertransport in hypertension: lack of atrial natriuretic peptide effect.
The rate of erythrocyte Li-Na countertransport and cellular Na+ and K+ contents have been determined in normotensive (NT) and hypertensive (HT, essential hypertension) subjects in the presence and absence of atrial natriuretic peptide (ANP). The rate of Li-Na countertransport was significantly higher in erythrocytes of HT subjects, while the Na+ and K+ contents were not different between the NT and HT groups. We found that ANP (10(-9) and 10(-7) M) had no effect on either the rate of Li-Na countertransport or the cellular Na+ and K+ contents. Since ANP does not influence erythrocyte Na pump and Na-K-Cl cotransport, our results suggest that the Na transport systems of human erythrocytes do not respond to ANP and this lack of response in Li-Na countertransport is independent of the status of hypertension. These findings are consistent with the view that the rate of Li-Na countertransport of erythrocytes may serve as a useful genetic marker for essential hypertension in Chinese. However, the erythrocyte transport systems cannot provide further differentiation utilizing ANP response for essential hypertension.
Adult↗
[In vitro effect of topical fluoride gels on the surface of composite resins].
This study was designed to compare the surface change in 6 brands of composite resins immersed in 4 topical fluoride gels of various pH. The result was evaluated by visual change in light reflectance and SEM. The findings were as follows: 1) five 4-minute immersions in acidic fluoride gels increased surface roughness and decreased the light reflectance of Prisma-Fil, Prisma APH, Brillant D and P-30, 2) Silux-Plus and Heliomolar were not affected by acidic fluoride gels, and 3) the surface texture of all resin samples was not changed when immersed in neutral fluoride gels. The findings suggested that a) neutral fluoride gels should be recommended for patients who have extensive composite restorations and require fluoride treatment, and b) when resin restoration is indicated, microfilled composite resin should be considered for patients who plan to use acidic fluoride gels.
Composite Resins↗
Atrial natriuretic peptide and vasopressin during percutaneous transvenous mitral valvuloplasty and relation to renin-angiotensin-aldosterone system and renal function.
To study the relation between plasma atrial natriuretic peptide (ANP) and cardiac pressure, and to assess the pathophysiologic significance of ANP in water and electrolyte metabolism, the changes in plasma levels of ANP and arginine vasopressin (AVP) were examined in 11 patients with mitral stenosis who underwent percutaneous transvenous mitral valvuloplasty, and compared with the changes in the renin-angiotensin-aldosterone system and renal function. Immediately after valvuloplasty, plasma ANP levels decreased significantly with a concomitant decrease in mean pressures in the left atrium, the pulmonary artery and the right atrium. Plasma ANP levels decreased to the normal range in 4 of the 6 patients with normal sinus rhythm, while all 5 patients with atrial fibrillation had higher levels despite a similar degree of decrease in atrial pressure. There were significant positive correlations between plasma ANP levels and the mean left atrial pressure (r = 0.61, p less than 0.01), the mean pulmonary arterial pressure (r = 0.49, p less than 0.01) and the mean right atrial pressure (r = 0.54, p less than 0.01). The mean plasma AVP levels, on the other hand, showed a transient increase after valvuloplasty from 0.5 +/- 0.1 to 1.2 +/- 0.4 pg/ml (p less than 0.05). The mean plasma renin activity (1.3 +/- 0.3 vs 2.7 +/- 0.8 ng/ml/hr, p less than 0.05) and plasma aldosterone concentration (8.6 +/- 2.3 vs 17.2 +/- 5.2 ng/dl, p less than 0.05) also increased significantly 30 minutes after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Cardiac myxoma--clinical experience in 24 patients.
We reviewed our clinical experience in 24 patients with cardiac myxoma. There were 8 males and 16 females, their ages ranged from 14 to 73 (mean, 48) years. Prior to echocardiographic examination, cardiac myxoma was suspected clinically in only 2 cases. The remaining patients were initially diagnosed as having mitral valvar disease (9 cases), infective endocarditis (3 cases), congestive cardiomyopathy (4 cases), pericardial effusion (1 case), systemic embolism of unknown cause (1 case), cerebrovascular accident (2 cases), ventricular septal defect (1 case) and Ebstein's malformation (1 case). The tumor was in the left atrium in 16, in the right atrium in 2, in the biatrium in 1, while one was in the right ventricle and peripheral arterial occlusion had been produced by myxoma without demonstrable cardiac tumors in the other two. Twenty-two patients underwent open heart surgery for excision of myxoma and there was no surgical mortality. Abdominal embolectomy was carried out in 2 patients; one of these 2 patients survived and 1 died. Follow-up for a mean period of 32 months (range 2 to 99 months) was possible in in 18 patients with no evidence of recurrence. We conclude that cardiac myxoma may mimic many cardiovascular diseases, so a high index of suspicion is important for its diagnosis. Echocardiography is the most useful diagnostic screening tool.
Adolescent↗
Perforated aneurysm of the anterior mitral valve. A Doppler and two-dimensional echocardiographic report.
Antemortem diagnosis of a perforated MV aneurysm by Doppler echocardiography, as well as two-dimensional echocardiography (2-DE), has not been reported. Herein we present such a case.
Adult↗
Figure-eight kinking of the aorta (pseudocoarctation) coexistent with coarctation.
An asymptomatic young man presented with a cardiac murmur and hypertension only in the right arm. Angiograms showed kinking of the aortic arch with a figure-eight appearance consistent with pseudocoarctation. Before the kinked segment, also demonstrated were a stenotic lesion in the aortic arch proximal to the left carotid artery and profound collateral circulations in the right thorax. These findings strongly suggested a rare combination of pseudocoarctation and true coarctation. His hypertension was corrected following surgery with a bypass graft between the ascending aorta and the abdominal aorta.
Adult↗
The impact of dietary sodium, potassium and calcium on blood pressure.
A blood pressure survey was conducted in 3,886 male Taiwanese workers of a single Fukien ethnic group. Their mean age was 34 years. Hypertension defined as a systolic blood pressure of greater than or equal to 140 and/or diastolic blood pressure of greater than or equal to 90 mmHg was present in 370 subjects (9.5%). The high ethnic homogeneity in the study population allowed for an examination on the relationship between diet and blood pressure. A case control study was conducted in 161 subjects with elevated blood pressure and 154 subjects with normal blood pressure, randomly selected in each group, to assess the effects of dietary sodium, potassium and calcium on blood pressure. A 24-hour dietary recall was collected independently by a nutritionist. Using regression analysis, a significant (p less than 0.01) positive association of sodium intake and blood pressure was noted independent of age, body mass index and alcohol intake. The risk of elevated blood pressure was 2.5 times greater in men with a daily sodium intake of greater than 15g compared with those whose daily sodium intake was less than 15g. A negative association of calcium and potassium with blood pressure was noted in a group who ingested potassium greater than 2g and calcium greater than 0.5g daily. However, a statistical significance was achieved for calcium (p less than 0.01) but not for potassium (p = 0.15). These results indicate that dietary sodium and calcium are related to blood pressure and hypertension status within a unique and culturally homogeneous male group of Fukien ethnicity.
Adult↗
Hemodynamic and clinical efficacies of catheter balloon percutaneous transvenous mitral commissurotomy: experience of 100 patients with rheumatic mitral stenosis.
From January 1987 to December 1988, 100 patients with symptomatic severe rheumatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PTMC). The patients included 32 males and 68 females, aged 19-71 years (mean of 41). Mild mitral regurgitation (grade 1 or 2) was present in 23 patients and a history of thromboembolism in 12. One patient had had mitral restenosis after surgical open mitral commissurotomy 9 years earlier. The mitral valve was successfully dilated in 97 patients. PTMC resulted in immediate improvements in hemodynamic measurements. The left atrial pressure decreased from 24.5 +/- 5.3 to 14.8 +/- 5.2 mmHg (p less than 0.001), the mean mitral transvalvular gradient from 13.8 +/- 4.8 to 5.0 +/- 2.8 mmHg (p less than 0.001), and the mean pulmonary artery pressure from 38.8 +/- 12.0 to 30.6 +/- 10.3 mmHg (p less than 0.001). The mitral valve area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). The cardiac output increased from 4.5 +/- 1.2 to 4.84 +/- 1.2 L/min (p less than 0.05). The right atrial pressure did not change significantly after PTMC (6.5 +/- 3.8 vs 6.4 +/- 4.0 mmHg). The mitral valve area measured by 2-D echocardiograms increased from 1.04 +/- 0.48 to 1.88 +/- 0.66 cm2 after PTMC (p less than 0.001). All 97 patients were followed for 6-24 months (median of 13) after the PTMC. After an initial recovery period of 1-2 weeks, all patients reported improvements in symptoms and in New York Heart Association (NYHA) functional class by at least one class. A comparison between treadmill exercise test durations before, and 3 months after PTMC, showed an increase from 9.1 +/- 4.3 to 15.4 +/- 3.8 minutes (n = 60; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Long-term hemodynamic results of percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with pliable, non-calcified valves.
Percutaneous transvenous mitral commissurotomy (PTMC) for severe, symptomatic mitral stenosis was successfully performed in 47 of 50 patients with pliable, non-calcified valves. The procedure resulted in immediate hemodynamic and sustained clinical improvements in all patients. Repeat cardiac catheterization was performed in 22 patients at a mean follow-up period of 15 months (range 12 to 29). The patients were similar to the other 25 patients in regard to gender, age, clinical and hemodynamic characteristics. There were 4 males and 18 females with a mean age of 37 years (range 20 to 61). Immediately after PTMC, there were significant increases in the mitral valve area (1.0 +/- 0.2 to 2.4 +/- .9cm2, p less than 0.001) and cardiac index (3.1 +/- 0.7 to 3.3 +/- 0.7 l/min/m2, p less than 0.05) and significant (p less than 0.001) decreases in the left atrial pressure (25.7 +/- 6.4 to 13.2 +/- 3.9 mmHg), the mitral valve gradient (15.7 +/- 5.7 to 3.9 +/- 1.4 mmHg), mean pulmonary arterial pressure (41.5 +/- 10.7 to 29.2 +/- 10.9 mmHg) and the pulmonary vascular resistance (4.2 +/ 3.4 to 3.5 +/- 2.9 Wood unit). At follow-up study, the mitral valve area (2.2 +/- 0.7 cm2) and the left atrial pressure (12.6 +/- 3.7 mmHg) remained unchanged. There were further decreases in the mean pulmonary arterial pressure (22.4 +/- 5.9 mmHg, p less than 0.05) and the pulmonary vascular resistance (2.0 +/- 1.5 Wood unit, p less than 0.05). There were significant (p less than 0.05) increases in the mitral valve gradient (6.6 +/- 2.5 mmHg) and the cardiac output (3.6 +/- 0.7 l/min/m2).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Successful percutaneous transvenous catheter balloon mitral commissurotomy after warfarin therapy and resolution of left atrial thrombus.
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Adult↗
Rapid fall in elevated plasma atrial natriuretic peptide levels after successful catheter balloon valvuloplasty of mitral stenosis.
To determine whether an acute fall in atrial pressure decreases the secretion of atrial natriuretic peptide in man, changes in the plasma levels of this peptide were studied after catheter balloon valvuloplasty of the mitral valve. Ten patients with severe mitral stenosis were included in the study. The valvuloplasty resulted in an immediate reduction in left atrial pressure and an increase in the mitral valve area. Decreases in right atrial pressure were inconsistent and less significant. Plasma atrial natriuretic peptide levels, which were elevated before the valvuloplasty, decreased significantly in all 10 patients at 15 minutes after the valvuloplasty and reached lower plateaus at 30, 45, and 60 minutes after the procedure. In the seven patients studied for a longer period, both plasma atrial natriuretic peptide levels and the left atrial pressure remained reduced 24 hours after the valvuloplasty. Plasma atrial natriuretic peptide levels before and 30 to 60 minutes after the valvuloplasty were positively correlated to simultaneously determined left and right atrial pressures. These results indicate that atrial stretch caused by increased atrial pressure is an important stimulus for atrial natriuretic peptide release in man. "De-stretching" of the myocytes of the atria results in rapid inhibition of atrial natriuretic peptide secretion.
Adult↗
Echocardiographic findings of mobile atrial hepatocellular carcinoma. Report of five cases.
Hepatoma with cardiac metastasis is difficult to diagnose antemortem. Herein we describe five cases of hepatoma with intracardiac metastasis detected with two-dimensional echocardiography (2DE). The clinical presentations include cardiac murmur, syncope, and chest pain. The 2DE demonstrated a right atrial (RA) mass in each case and the presence of tumor echoes in the inferior vena cava connecting with the RA mass in four. In three cases the cardiac tumor was removed, whereas the other two patients agreed only to liver biopsy, which confirmed the diagnosis. This paper emphasizes the practical utility of 2DE for early detection of intracardiac hepatoma and also describes the clinicopathologic correlation of such a disease entity.
Adult↗
Diltiazem as monotherapy in treatment of mild to moderate essential hypertension.
The effectiveness and safety of diltiazem monotherapy was evaluated in 29 patients with mild to moderate essential hypertension (diastolic pressure between 95 and 115 mmHg). There were 16 men and 13 women, ages ranged from 29 to 58 years (mean 43). After a 2-week placebo period, each patient was given a 60 mg diltiazem tablet three times a day for 8 weeks. Blood pressure and heart rate were determined at weekly clinic visits. Three patients were withdrawn from the study because of a skin rash, palpitation and a frequent loose stool, respectively. In the remaining 26 patients, the mean systolic and diastolic blood pressures were reduced significantly in 2 weeks of therapy and thereafter. At the end of the 8-week treatment the mean supine blood pressure decreased from 158/103 at baseline to 139/94 mmHg, the mean sitting blood pressure from 156/104 to 136/93 mmHg, and the mean standing blood pressure from 151/104 to 134/96 mmHg. The heart rate did not change significantly before or during diltiazem treatment. In 16 (61.5%) of the 26 patients, diltiazem consistently reduced the diastolic blood pressure more than 5 mmHg throughout 2 to 8 weeks of treatment. The left ventricular mass and ejection fraction assessed with M-mode echocardiograms were normal before diltiazem treatment, and remained unchanged 8 weeks after the treatment. By using treadmill exercise tests, there was a significant increase in exercise duration and a significant reduction in the peak heart rate at 8 weeks after the treatment. The peak systolic blood pressure did not change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Atrial natriuretic peptide during supraventricular tachycardia and relation to hemodynamic changes and renal function.
Changes in plasma levels of atrial natriuretic peptide (ANP) and arginine vasopressin were studied in 5 patients during and after a 30-minute period of induced supraventricular tachycardia (SVT). Immediately after the induction of SVT, plasma ANP levels began to increase, peaked at 32 minutes (+734% increase on average) and then gradually decreased. The mean plasma arginine vasopressin levels decreased during SVT, but the differences were not significant. When plasma ANP levels during SVT were compared with the simultaneously measured hemodynamic variables, a significant positive correlation (r = 0.73, p less than 0.001) was observed between plasma ANP levels and pulmonary capillary wedge pressure. Induced SVT was associated with increased urinary sodium and potassium excretion, increased urine flow and increased free water clearance. Concomitantly, glomerular filtration rate significantly increased (+77%) with an increase in filtration fraction. Although no significant change was observed in plasma renin activity, plasma aldosterone concentrations decreased during and after SVT. These results suggest that increased left atrial pressure stimulates ANP release during SVT and that increased glomerular filtration rate and decreased aldosterone secretion by ANP, in addition to the inhibition of water reabsorption by decreased arginine vasopressin, may be responsible for natriuresis and diuresis associated with SVT.
Adult↗
Doppler echocardiographic flow characteristics of isolated patent ductus arteriosus: better delineation by Doppler color flow mapping.
Eighteen infants and children with isolated ductus arteriosus and various hemodynamic states were examined with the Doppler color flow mapping technique to study the flow patterns of the patent ductus and its adjacent structures. Direct visualization of the ductus was achieved in all patients. All ductal flow was shunting left to right from the descending aorta to the pulmonary artery even in the presence of significant elevation of pulmonary artery pressure. However, transient bidirectional shunting was observed in two patients on serial studies. Disturbed systolic and diastolic flows were demonstrated within the ductus in each case. The blood flows in the main pulmonary artery consisted of three distinguishable areas: 1) a characteristic high velocity turbulent retrograde ductal jet throughout the entire cardiac cycle, located in the anterolateral aspect of the main pulmonary artery; 2) nonspecific low velocity retrograde late systolic and early diastolic flow, located in the posteromedial aspect of the main pulmonary artery; and 3) low velocity forward systolic and diastolic flow, occupying the remaining area of the pulmonary artery. The blood flows in the descending aorta near the ductal orifice consisted of disturbed systolic and diastolic flows in a reversed direction. By providing detailed real time blood flow information with simultaneous imaging of the ductus, Doppler color flow mapping greatly facilitates the detection of a small ductal shunt. This technique also allows detection of a bidirectional or right to left ductal shunt.
Aorta↗
Effect of beta-adrenergic blockade on plasma levels of atrial natriuretic peptide during exercise in humans.
Effect of beta-adrenergic blockade on plasma levels of atrial natriuretic peptide (ANP) during treadmill exercise was studied in 9 healthy volunteers. Plasma ANP levels increased during exercise. The mean plasma ANP concentration on 12-min exercise (32.5 +/- 3.7 pg/ml, mean +/- SEM) was significantly higher than the control (16.7 +/- 1.0 pg/ml). After exercise, the levels decreased and the mean plasma ANP concentrations in the recovery period were higher in subjects in the sitting position than in subjects who kept standing. Prior administration of a long-acting propranolol, 160 mg daily for 3 consecutive days, augmented ANP release during exercise. The mean plasma ANP concentrations on 9- and 12-min exercise (34.5 +/- 3.1 and 64.9 +/- 15.0 pg/ml, respectively) were significantly higher than those in the corresponding exercise stage without propranolol. Plasma ANP levels in the recovery period also increased after the administration of propranolol and the subjects in the sitting position again had higher plasma levels than those in the standing position. These results suggest that increased central blood volume during exercise elevates atrial pressure to stimulate ANP secretion, and that greater atrial distension and pressure due to reduced ventricular contractility by beta-adrenergic blockade facilitates ANP release to a greater extent.
Adrenergic beta-Antagonists↗