• The Journal of Korean Medicine
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• v.28 no.1 s.69
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• pp.105-116
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• 2007

Objectives : Mahuang (Ephedra sinica), well known as an herbal medicine in the East and West, contains a relatively high percentage of ephedrine known as sympathomimetic alkaloid. We investigated the effects of Mahuang on sympathetic nervous system with heart rate variety (HRV). Time and frequency domain analysis of HRV is a noninvasive technique capable of providing information on autonomic modulation of the sinus node. Methods : We investigated 57 healthy volunteers consisting of 37 subjects in the Mahuang group and 20 subjects in the placebo group. Study form was a randomized, placebo-controlled, double-blind clinical trial. The 37 subjects in the Mahuang group took 3 Mahuang capsules (1 capsule equivalent to 2g herb Mahuang) twice a day at 10 a.m. and 2 p.,., while the 20 subjects in the placebo group took 3 placebo-capsules filled with glutinous rice powder at the same times. Mahuang medicine and placebo medicine were made into opaque capsules. We measured HRV at 3 p.m. 1 or 2 days before medication and at 3 p.m. after medication. Results : Mean-RR and SDNN of the Mahuang group significantly decreased compared with that of the placebo group, but the heart rate of the Mahuang group significantly increased compared with the placebo. HRV-Index, RMSSD and SDSD of the Mahuang group significantly decreased compared with that of the placebo group, but PNN50 of the Mahuang group significantly increased compared with placebo. Ln(TP), Ln(VLF), Ln(LF) and Ln(HF) of the Mahuang group significantly decreased compared with those of the placebo group. There were no significant differences in normalized LF, normalized HF and LF/HF ratio between the Mahuang and placebo groups. Conclusion : The results suggest that Mahuang in healthy adults tends to reduce the autonomic nervous system within the normal range.

• Journal of Veterinary Clinics
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• v.30 no.2
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• pp.115-118
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• 2013

An 8-year-old spayed female domestic shorthair cat was presented with a chief complaint of chronic nasal discharge and dyspnea. Physical examination revealed pyohemorrhagic nasal discharge, inspiratory dyspnea and stertor, and an enlarged right mandibular lymph node. Abnormalities of blood works and serum chemistry included mildly increased hematocrit, and globulin concentration. Serologic tests for FeLV and FIV, and a panel of polymerase chain reaction tests for Chlamydophila felis, Feline Calicivirus, Herpesvirus, Bordetella, Mycoplasma felis, and H1N1 influenza was all negative. Only radiographic finding showed increasing soft tissue density in the right nasal cavity and computed tomography disclosed soft tissue/fluid opacification in the right nasal cavity, paranasal sinus, and pharyinx along with slight deviation to the right of the osseous nasal septum. Focal lysis of ventral nasal septum was also suspected in CT scan. Cytological evaluation of fine needle aspirate smears of the enlarged mandibular lymph nodes revealed numerous fungal yeasts having variably thick capsule both extracellularly and intracellularly with low numbers of macrophages. Some yeasts showed narrow based budding, which was a consistent finding with Cryptococcus organisms. Serum protein electrophoresis was a polyclonal consistent with chronic infection and serum was submitted for a fungal serology panel test. In serologic tests Cryptococcus antigen titer was 1 : 32,768. In vitro culture was unsuccessful. Treatment was initiated with administration of fluconazole, clindamycin, and tocopherol. Clinical signs resolved within 3 days after the initial treatment. The cat was discharged and scheduled for periodic evaluation and continued therapy, but was lost to follow-up thereafter.

• The Korean Journal of Pharmacology
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• v.20 no.1 s.34
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• pp.55-65
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• 1984

Comparative effects of $PGF_{2{\alpha}}$ and ouabain on the isolated rat(Sprague-Dowley) atria were studied. The isolated rat atria were prepared for isometric myography in the isolated organ bath containing Feigen's solution perfused with 95% $O_2$ and 5% $CO_2$, and the pH of the medium was maintained at 7.4. The cumulative concentration-response relationship revealed the positive inotropic effects of both drugs with the higher potency of $PGF_{2{\alpha}}$ and the higher efficacy of ouabain. $PGF_{2{\alpha}}$ showed a positive chronotropic effect, but ouabain showed a tendency of increasing the contraction rate. In low-Ca(1.4 mM) medium, the positive inotropic and chronotropic effect of $PGF_{2{\alpha}}$(by $3{\times}10^{-8}M$) were preponderant $(p<0.05{\sim}p<0.005)$ over those of ouabain(by $3{\times}10^{-3}M$). $Ca^{++}$-addition(cumulative, to 2.8, 4.2, 5.6, and 7.0 mM) into the medium evoked the more sensitive response in the $PGF_{2{\alpha}}$ group than in the ouabain group. In low-K(2.8 mM) medium, the $PGF_{2{\alpha}}a(3{\times}10^{-8}M)$ group and the ouabain$(3{\times}10^{-3}M)$ group showed similar tensions(DT and RT) and contraction rates. And both group showed significantly(p<0.05p<0.01) higher tensions and contraction rates than those of the control group. By the cumulative addition of the $K^+$(to 4.2, 5.6, 7.0 and 8.4 mM), only the DT of the $PGF_{2{\alpha}}$ group was sustained at signifcantly$(p<0.05{\sim}p<0.01)$ higher level than the DT of the control group. The $K^+$-addition inhibited the positive inotropic effect of ouabain significantly (p<0.05). The cumulative addition of lidocaine in high concentrations $(1{\times}10^{-5}\;to\;1{\times}10^{-3}M)$ evoked no significant influence on the intropic activities of $PGF_{2{\alpha}}$ and ouabain, but significant ${\beta}$-blockade with propranolol could not inhibit the positive intropic and chronotropic effect of $PGF_{2{\alpha}}$. In conclusion, it is presumed that $PGF_{2{\alpha}}$ may have some more active mechanism of accelerating the influx of $Ca^{++}$ across the cell membrane of the isolated rat atria as compared with ouabain, and the action site may be located at the cell membrane. As a supposition which needs further investigations, it is presumed that $PGF_{2{\alpha}}$ may have its specific membrane receptors on the atrial muscle or sinus node cells.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.529-537
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• 2005

Background: Historically the Fontan operation in patients with single ventricle and heterotaxy syndrome has been associated with high mortality because of systemic or pulmonary anomalous venous drainage, incompetent common atrioventricular valve, right ventricle type univentricular heart, and arrhythmia. Material and Method: A retrospective review of 62 patients $(age:\;54.79\pm33.97\;months)$ with heterotaxy syndrome who underwent a extracadiac Fontan operation between 1996 and 2005 was performed. Twenty one patients had left atrial isomerism, and 41 had right isomerism. The Fontan procedure was staged in all but 2 patients, and a fenestration was less placed in left isomerism. Result: Left isomerism was associated more with interrupted inferior vena cava and pulmonary arteriovenous fistula, and right isomerism was associated more with anomalous pulmonary venous drainage, common atrioventricular valve and morphologic right ventricle. There were 3 hospital deaths$(4.8\%)$ and 3 late deaths $(5.2\%)$ with a follow-up duration of $48.8\pm31.0$ months. Eight-year survivals were $90.5\pm6.4\%$ in left isomerism and $88.6\pm5.4\%$ in right isomerism (p=0.94). At 8 years, freedom from reoperation was $73.9\pm11.3\%$ in left isomerism, and $82.3\pm6.7\%$ in right isomerism (p=0.87). Atrioventricular valve regurgitation progressed after Fontan operation in heterotaxy syndrome, and reoperation for pulmonary arteriovenous fistula and permanent pacemaker implantation for sinus node dysfunction were required more in left isomerism. Conclusion: The extracardiac Fontan operation can now be performed in patients with heterotaxy syndrome with excellent survival. However, morbidity in terms of postoperative atrioventricular valve regurgitation, arrhythmia, and pulmonary arteriovenous fistula remains significant.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.811-816
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• 2007

Background: We analyzed our experience of arrhythmia surgery in patients with congenital heart disease. Material and Method: A retrospective review was performed on 43 consecutive patients with congenital heart disease, who underwent arrhythmia surgery between June 1998 and June 2006. Result: The median age at surgery was 52 years ($4{\sim}75$ years). The most frequent cardiac anomaly was an atrial septal defect (23/43, 53.5%). The types of arrhythmias were atrial flutter-fibrillation, intermittent non-sustainable ventricular tachycardia and others in 37, 2 and 4, respectively. Arrhythmia surgery consisted of a bi-atrial maze operation in 18 patients (modified cox maze III procedure in 5 patients, and a right side maze plus pulmonary vein cryo-isolation in 13), right side maze operation in 18 patients, cavo-tricuspid isthmus cryoablation for benign atrial flutter in 4 patients, right ventricular endocardial cryoablation in 2 patients and extranodal cryoablation for atrioventricular node re-entry tachycardia in 1 patient. The median follow-up was 23.8 months ($1{\sim}95.2$ months). There was no early mortality, and one late non-cardiac related death. The overall rates of restored sinus rhythm before discharge and $3{\sim}6$ months after surgery were 79% and 81%, respectively (bi-atrial maze group: 72% and 83%, right-side maze group: 77%, 77%). Conclusion: Arrhythmias associated with congenital heart disease can be safely treated surgically with an excellent intermediate-term outcome.

• Clinical and Experimental Pediatrics
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• v.45 no.12
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• pp.1528-1533
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• 2002

Purpose : Isolated noncompaction of the ventricular myocardium(INVM) is one of the unclassified cardiomyopathies that is characterized by numerous, excessively prominent trabeculations, and deep intertrabecular recesses. We performed this study to evaluate the clinical features of INVM in children. Methods : The medical records of 10 patients with INVM were reviewed. We analyzed the clinical manifestations, hemodynamics, pattern of inheritance, and long-term prognosis of INVM in children. Results : Age at diagnosis was $45{\pm}53months$(1 day-14 years) with follow-up lasting as long as 78 months. Most INVM was asymptomatic on diagnosis. Associated cardiac anomalies were noted in six patients(ventricualr or atrial septal defect, patent ductus arteriosus with mitral valve prolapse, or mitral valve cleft). Depressed or flat changes of T wave in lead II, III and aVF were observed on electrocardiography. Various arrhythmia including WPW syndrome with paroxysmal supraventricular tachycardia, third-degree atrioventricular block, and familial sick sinus node dysfuction were observed. The degree of trabeculation in INVM was significantly prominent from level of mitral valve to apex compared to age-matched control. Familial recurrences were noted in two patients. The systolic function of the left ventricle was decreased in 20% of patients during the follow-up period, but systemic embolism or ventricular tachycardia was not observed. Conclusion : INVM is not a rare disorder. The cardiac function may be deteriorated in children as well as adults during long-term follow up. Thus early diagnosis and long-term follow-up must be done. So, the nation-wide multicenter clinical study would be mandatory to evaluate the incidence, long-term prognosis, and establishment of objective diagnostic criteria of INVM.