BACKGROUND AND OBJECTIVES: It has been well known that the Braunwald classification is an appropriate clinical parameter in the prediction of the outcome in patients with unstable angina. However, the ability of the classification to predict prognosis of unstable angina according to treatment strategy is not established. We evaluated the relation between severity of angina on admission and outcome of primary unstable angina with early invasive strategy. MATERIALS AND METHOD: 148 patients (M 85, F 63, age 61+/-10) with suspected unstable angina were divided into three subgroups on the basis of the Braunwald classification on admission. The patients were followed up to 6 months prospectively if the final diagnosis was primary unstable angina. Early invasive strategy was used for the treatment of unstable angina. Major cardiac events were assessed during hospitalization and 6 months follow-up period according to the Braunwald classification. RESULTS: Unstable angina was diagnosed in 95 patients (64%). Among these patients, 89 patients with primary unstable angina were followed up to 6 months. Clinical characteristics including number of patients, mean age, sex ratio, risk factors, coronary angiographic findings and revascularization rate during hospitalization were not different in three subgroups of these patients. Among these patients, early coronary revascularizations was performed in 67 patients (75%) and 2 (2%) deaths/myocardial infarctions occurred during hospitalization. During the follow-up period, 1 (1%) myocardial infarction/death and 12 (13%) revascularizations occurred. Cardiac event rate (death, myocardial infarction or revascularization) was not different during hospitalization and 6 months follow-up period among subgroups of severity class. CONCLUSION: Clinical outcome should be reevaluated after early coronary intervention to predict cardiac event in patients with unstable angina.
Angina, Unstable* ; Classification ; Diagnosis ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Myocardial Infarction ; Prognosis ; Prospective Studies ; Risk Factors ; Sex Ratio

BACKGROUND: The analysis of ACE gene expression in vital to study the role of angiotensin conveting enzyme(ACE) in the pathogenesis of cardiovascular disease. Traditionally, levels of individual mRNA expression have been analyzed by semiquantitative Northern blotting, which requires a large quantity of tissue. Therefore, gene expression of a little biopsy specimen from the human heart or atherectomy specimen from the blood vessel cannot be measured easily. Reverse transcription-polymerase chain reaction(RT-PCR) is very effective, sensitive and rapid method of detecting the method of quantitative RT-PCR(QRT-PCR) using recombinant RNA template as internal standard to measure the expression of ACE. METHOD: Recombinant RNA(rcRNA) was designed to yield PCR product which differs in size by about 200bp from that of the target RNA. Initially, spacer gene, which was composed of ACE sense primer, antisense primer, T7 promotor and poly(dT) tail with glutathione transferase(GSTM) gene of 180bp in the middle, was constructed. Then, standard rcRNA was obtained by in vitro transcription. Target RNA was mixed with rcRNA and amplified by PCR, togather with P-dCTP. PCR products were analyzed by gel electrophoresis. For quantitation, either gel was cut and radioactivity was counted or gel was dried and exposed to X-ray film and density was measured using image densitometer. We carried out semiquantitative RT-PCR to study the modulation of ACE expression in vascular smooth muscle cell(VSMC) by dexamethasone and basis FGF(bFGF). RESULT: The size difference of PCR products from the standard RNA and the extracted target RNA was matched as designed. By using QRT-PCR, there was 1.7*10(8) ACE mRNA molecules in 1 ng of rat lung total RNA. bFGF and dexamethasone upregulated ACE mRNA expression in cultured VSMC. CONCLUSION: These results suggest that RT-PCR using rcRNA as internal standard is a very useful method for quantitation or semiquantitation of ACE mRNA from a small amount of tissue or cultured cells. Expression of ACE in VSMC can be modulated by various stimuli such as basic FGF and dexamethasone. QRT-PCR could be widely used in the studies of expression of specific human genes.
Angiotensins* ; Animals ; Atherectomy ; Biopsy ; Blood Vessels ; Blotting, Northern ; Cardiovascular Diseases ; Cells, Cultured ; Dexamethasone ; Electrophoresis ; Gene Expression ; Glutathione ; Heart ; Humans ; Lung ; Muscle, Smooth, Vascular ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Radioactivity ; Rats ; RNA ; RNA, Messenger* ; X-Ray Film

PURPOSE: To compare the dose distributions between three-dimensional (3D) and four-dimensional (4D) radiation treatment plans calculated by Ray-tracing or the Monte Carlo algorithm, and to highlight the difference of dose calculation between two algorithms for lung heterogeneity correction in lung cancers. MATERIALS AND METHODS: Prospectively gated 4D CTs in seven patients were obtained with a Brilliance CT64-Channel scanner along with a respiratory bellows gating device. After 4D treatment planning with the Ray Tracing algorithm in Multiplan 3.5.1, a CyberKnife stereotactic radiotherapy planning system, 3D Ray Tracing, 3D and 4D Monte Carlo dose calculations were performed under the same beam conditions (same number, directions, monitor units of beams). The 3D plan was performed in a primary CT image setting corresponding to middle phase expiration (50%). Relative dose coverage, D95 of gross tumor volume and planning target volume, maximum doses of tumor, and the spinal cord were compared for each plan, taking into consideration the tumor location. RESULTS: According to the Monte Carlo calculations, mean tumor volume coverage of the 4D plans was 4.4% higher than the 3D plans when tumors were located in the lower lobes of the lung, but were 4.6% lower when tumors were located in the upper lobes of the lung. Similarly, the D95 of 4D plans was 4.8% higher than 3D plans when tumors were located in the lower lobes of lung, but was 1.7% lower when tumors were located in the upper lobes of lung. This tendency was also observed at the maximum dose of the spinal cord. Lastly, a 30% reduction in the PTV volume coverage was observed for the Monte Carlo calculation compared with the Ray-tracing calculation. CONCLUSION: 3D and 4D robotic radiotherapy treatment plans for lung cancers were compared according to a dosimetric viewpoint for a tumor and the spinal cord. The difference of tumor dose distributions between 3D and 4D treatment plans was only significant when large tumor movement and deformation was suspected. Therefore, 4D treatment planning is only necessary for large tumor motion and deformation. However, a Monte Carlo calculation is always necessary, independent of tumor motion in the lung.
Four-Dimensional Computed Tomography ; Humans ; Lung ; Lung Neoplasms ; Organothiophosphorus Compounds ; Population Characteristics ; Prospective Studies ; Spinal Cord ; Tumor Burden

BACKGROUND: Vasovagal syncope is a common cause of syncope. In some cases, syncopal episode is recurrent, resulting in physical injury. Head-up tilt test with or without isoproterenol provocation has been a tool to diagnose vasovagal syncope. But the protocol of head-up tilt test has not been settled. In this study, we evaluate the usefulness of a head-up tilt test with isoproterenol provocation in patients with syncope or presyncope of unexplained origin. METHODS: Head-up tilt test was performed with patients in the fasting state in the morning. After supine heart rate and blood prewwure were obtained, each patient was tilted to the 70 degree upright position for 30 minutes using a motorized tilt table with a footboard. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 microg/min and then increased by 1 microg/min every three minutes to a maximum of 5 microg/min while maintaining 70 degree upright position. The end points of test were positive response, intolerance of isoproterenol, heart rate>150 beats/min, and completion of the protocol. When an end point reached, the patient was rapidly returned to the horizontal position. RESULTS: 1) Of 122 patients with syncope or presyncope, 113 patients(93%) had prodromal symptoms. 2) 23 patients(19%) had physical injury during episode. 3) 93 patients(76%) experienced episodes while they were standing or sitting. 4) A total of 83 patients(68%) had a positve response during head-up tilt test ; 7 patients(8%) of these 83 patients had a positive response during the baseline tilt. But, 76 patients(92%) required isoproternol provocation to elicit this response. 5) The pattern of positive response showed vasodepressive pattern in 55 patients(67%), mixed pattern in 26 patients(31%), and cardioinhibitory pattern in 2 patients(2%). 6) No significant side effect of isoproterenol was noted. 7) There were no significant differences between positive response group and negative response group in terms of clinical characteristics and hemodynamic findings during head-up tilt test. CONCLUSION: A head-up tilt test with isoproterenol provocation could be an useful tool for diagnosing vasovagal syncope or presyncope in adults.
Adult* ; Fasting ; Heart ; Heart Rate ; Hemodynamics ; Humans ; Isoproterenol ; Prodromal Symptoms ; Syncope* ; Syncope, Vasovagal

To identify the long-term survival rate and prognostic factors of AMI in Korea, total 404 patients who presented between Jan 1984 and mar 1989 at Seoul National University Hospotal were followed for and average of 24.9+/-18.2 months(range 1 to 69 months). 50 patients(12.4%) died during the in-hospital period and 25 patients(6.2%) died after discharge. Among the survivors reinfarction developled in 11 patients(3.3%). Overall survival rates were 0.87, 0.85, 0.83, 0.81, 0.79, 0.77 and event-free survival rates were 0.87, 0.84, 0.83, 0.79, 0.77, 0.72 at 1, 6, 12, 24, 36, 48 months respectively. During the in-hospital period sex, age, peak creatine kinase level, Killip class, Q wave in ECG, heart failure, and AV block in anterior infarction were of prognostic value. After discharge age, exercise duration on pre-discharge treadmill test, cardiac index, ejection fraction, and presence of heart failure were significant prognostic factors. Pre-discharge coronary angiographies were performed in 217 cases. There was no statistically significant difference in survival rate between multiple vessel disease and single vessel disease. But the more the number of involved vessels was, the higher the incidence of reinfarction was. In the group with jeopardy score less than 8, event-free survival rate was signigicantly higher. Overall survival rate was higher and reinfarction rate was lower in the group, but both were not statistically significant. On discriminant analysis of in-hospital prognostic factors, Killip class, heart failure and age were independent prognostic factors, but other factors had no additional prognostic value.
Atrioventricular Block ; Coronary Angiography ; Creatine Kinase ; Disease-Free Survival ; Electrocardiography ; Exercise Test ; Heart Failure ; Humans ; Incidence ; Infarction ; Korea ; Myocardial Infarction* ; Seoul ; Survival Rate* ; Survivors

BACKGROUND: Oral beta-blocker is initially used to prevent the symptons in patients with vasovagal syncope or presyncope. But, beta-blocker treatment may actually cause worsening of symptoms in some patients. The purpose of the present study was to evaluate the efficacy of oral beta-blocker in preventing symptoms during repeat head-up tilt test in patients who had a positive response in initial head-up tilt test. METHOD: Patients. Among the 150 patients with unexplained syncope or presyncope who underwent head-up tilt from October 1994 to January 1996, forty-three patients, who were taking beta-blocker and underwent repeat head-up tilted test, were included in this study. Initial head-up tilt test. Each patients was tilted to the 70 degree upright position for 30 minutes. If the test was negative in the baseline tilt, intravenous isoproterenol was started at 1 (micro)g/min and then increased by 1 (micro)g/min every three minutes to al maximum of 5 (micro)g/min while maintaining 70 degree upright position. Repeat head-up tilt test. The test was repeated while each patients was taking atinolol. The repeat test was continued until reaching at the stage where each patient had a positive response in initial test. RESULTS: 1) In initial head-up tilt test, most (91%) of a positive response occured during isoproterenol provocation. 2) In repeat head-up tilt test on atenolol, thirty-four patients(79%) had a negative response. But nine patients(21%) still had a positive response. 3) Nonresponsive group showed younger age and shorter time period to a positive response in initial head-up tilt test than responsive group. CONCLUSION: It may be useful to assess the effectiveness of beta-blocker by repeat head-up tilt before deciding long term treatment, especially younger age group.
Adult* ; Atenolol ; Humans ; Isoproterenol ; Syncope* ; Syncope, Vasovagal*

In rodents, the circumvallate papilla (CVP), with its underlying minor salivary gland, the von Ebners' gland (VEG), is located on the dorsal surface of the posterior tongue. Detailed morphological processes to form the proper structure of CVP and VEG have not been properly elucidated. In particular, the specific localization patterns of taste buds in CVP and the branching formation of VEG have not yet been elucidated. To understand the developmental mechanisms underlying CVP and VEG formation, detailed histological observations of CVP and VEG were examined using a three-dimensional computer-aided reconstruction method with serial histological sections and pan-Cytokeratins immunostainings. In addition, to define the developmental processes in CVP and VEG formation, we examined nerve innervations and cell proliferation using microinjections of AM1-43 and immunostainings with various markers, including phosphoinositide 3-kinase, Ki-67, PGP9.5, and Ulex europaeus agglutinin 1 (UEA1). Results revealed specific morphogenesis of CVP and VEG with nerve innervations patterns, evaluated by the coincided localization patterns of AM1-43 and UEA1. Based on these morphological and immunohistochemical results, we suggest that nerve innervations and cell proliferations play important roles in the positioning of taste buds in CVP and branching morphogenesis of VEG in tongue development.
Animals ; Cell Proliferation ; Mice ; Microinjections ; Morphogenesis ; Rodentia ; Salivary Glands, Minor ; Taste Buds ; Tongue ; Ulex ; von Ebner Glands

Pancreatic abscess is a highly lethal infectious complication of acute pancreatitis despite a wide variety of operative approaches and percutaneous drainage for the treatment. Surgical drainage has its limitation because of high postoperative mortality, recurrence, operative hemorrhage and/or gastrointestinal fistula. Percutaneous drainage has been used only as a temporizing measure prior to operation in critically ill patient or as additional modality for a postoperative recurrent abscess. Endoscopic drainage can be indicated as a primary therapy for the well-localized paraintestinal pancreatic abscess bulging into the duodenal or gastric lumen, as it has been proven successful in patients with pancreatic pseudocyst compressing duodenum or stomach. However, the report is rare. We report a case of pancreatic abscess successfully treated with endoscopic drainage without any complications.
Abscess* ; Critical Illness ; Drainage* ; Duodenum ; Fistula ; Hemorrhage ; Humans ; Mortality ; Pancreatic Pseudocyst ; Pancreatitis ; Recurrence ; Stents* ; Stomach

BACKGROUND: Since the 1980s, early ambulation and cardiac rehabilitation have been emphasized in clincal practice after myocardial infarction. This is based on the belief that cardiac rehabilitation can reduce cardiovascular mortality, improve functional capacity and reduce the risk of further coronary events. In this study, we investigate the effect of aerobic exercise-based cardiac rehabilitation on functiona capacity and cardiopulmonary response in patiets with myocardial infarction. METHODS: 19 patients were divided into two group(9 patients for training group and 10 patients for control group) at 4-6 weeks after acute myocardial infarction. Training group performed aerobic exercise for 8 weeks(3 sessions per week, mean 53mins per session) at 40-60% of heart rate(HR) reserve, while control group did not. Before and after 8 weeks, all patients performed symptom-limited exercise test using modified Bruce protocol. Also, breath by breath respiratory gas analysis was carried out throughout exercise test. RESULTS: For body composition, body weight(-2.7%, p<0.001), body mass index(-2.5%, p<0.001) and %body fat(-2.6%, p<0.05) were decrease significantly in training group after 8 week cardiac rehabilitation. Resting HR(-13%, p<0.05) was reduced significantly in training group, but no significant change occured in resting blood pressure between the two groups. Maximal oxygen uptake(18%, p<0.01) and anaerobic threshold(21%, p<0.05) were increased significantly in training group after 8 week cardiac rehabilitation as compared with the control group. There was no significant change in maximal O(2)pulse between the two groups. Submaximal rate-pressure product(-17%, p<0.05) and submaximal rate of perceived exertion (-2.6, p<0.001) were decreased significantly in training group after 8 week cardiac rehabilitation as compared with the control group. CONCLUSIONS: Our findings indicate that cardiac rehabilitation results in the significant improvement of functional capacity and cardiopulmonary response in patients with myocardial infarction. Cardiac rehabilitation for patients with myocardial infarction can contribute early return and readaptation to normal life, because myocardial oxygen consumption(or rate-pressure product) is decreased at the same exercise level after exercise training.
Blood Pressure ; Body Composition ; Early Ambulation ; Exercise ; Exercise Test ; Heart ; Humans ; Mortality ; Myocardial Infarction* ; Oxygen ; Rehabilitation*

Silicone fluid(polydimethylsiloxane) is widely used in breast augmentation and other cosmetic procedures because of little incidence of complications and low mortality rate. However, local reaction following silicone injections can be occurred sometimes leading to serious complications. Especially, illicit silicone injections have resulted in severe reactions within the pulmonary area, and some have resulted in acute respiratory distress syndrome subsequently. We experienced a case of acute respiratory distress syndrome induced by subcutaneous injections of silicone at vaginal wall. The patients was 39-year-old, previously healthy woman who had complained of dyspnea related to silicone injection at vaginal wall. Chest X-ray and chest CT scan show diffuse air consolidation with ground glass opacities and perfusion lung scan revealed likelihood of pulmonary embolism as showing multiple perfusion defects. We report a case of acute respiratory distress syndrome after silicone injection with review of literature.
Adult ; Breast ; Dyspnea ; Female ; Glass ; Humans ; Incidence ; Injections, Subcutaneous ; Lung ; Mortality ; Perfusion ; Pulmonary Embolism* ; Respiratory Distress Syndrome, Adult* ; Silicones* ; Thorax ; Tomography, X-Ray Computed