Hypertension is a serious health problem due to high frequency and concomitant other diseases including cardiovascular and renal dysfunction. Olmesartan cilexetil is a new antihypertensive drug associated with angiotensin II receptor antagonist. This study was conducted to evaluate the mutagenicity of olmesartan cilexetil by bacterial reverse mutation test using Salmonella typhimurium (TA100, TA1535, TA98, and TA1537) and Escherichia coli (WP2 uvrA). At the concentrations of 0, 62, 185, 556, 1667, and 5000 microg/plate, olmesartan cilexetil was negative in both Salmonella typhimurium and Escherichia coli regardless of presence or absence of metabolic activation system (S9 mix). These results demonstrate that olmesartan cilexetil does not induce bacterial reverse mutation.
Biotransformation ; Escherichia coli ; Hypertension ; Imidazoles ; Receptors, Angiotensin ; Salmonella typhimurium ; Tetrazoles

Immunoglobulin G4 (IgG4)-related disease (IgG4RD) is a relatively recently recognized entity that is histopathologically characterized by an extensive infiltration of lymphocytes and IgG4-positive plasma cells with dense fibrosis. IgG4RD is now known to affect any organ system, and a few cases of gastrointestinal lesions have also been reported. However, solitary IgG4RD of the stomach is still very rare. Furthermore, as it can mimic malignant conditions, it is important to recognize this disease to avoid unnecessary surgery. Herein, we present a case of IgG4RD presenting as an isolated subepithelial mass in the stomach.
Fibrosis ; Granuloma, Plasma Cell* ; Immunoglobulins* ; Lymphocytes ; Plasma Cells ; Stomach* ; Unnecessary Procedures

No abstract available.
Atrial Fibrillation* ; Mitral Valve Stenosis*

BACKGROUND AND OBJECTIVES: The purpose of this study was to investigate the relationship between chronic atrial fibrillation (AF) and reduced pulmonary function. SUBJECTS AND METHODS: Eighty-six chronic AF patients who were enrolled from annual health examination programs were studied using echocardiography and pulmonary function tests (PFT). Echocardiography and PFT matched for age, gender, and year performed were selected by the control group who had normal sinus rhythms. Patients with ejection fractions <50%, valvular heart disease, or ischemic heart disease were excluded. RESULTS: In the chronic AF patients, the forced expiratory volume at one second (FEV1), FEV1%, and FEV1/forced vital capacity (FVC) were significantly reduced, and the right ventricular systolic pressure was significantly increased. Episodes of heart failure were more frequently associated with the chronic AF patients than the controls. In particular, the FEV1% had the most meaningful relationship to chronic AF after an adjustment for cardiovascular risk factors {p=0.003, Exp (B)=0.978, 95% confidence interval (CI):0.963-0.993}. CONCLUSION: Reduced FEV1%, which represents the severity of airway obstruction, was associated with chronic AF, and the greater the pulmonary function impairment, the greater the co-existence with AF and congestive heart failure in those with preserved left ventricular systolic function.
Airway Obstruction ; Atrial Fibrillation ; Blood Pressure ; Echocardiography ; Forced Expiratory Volume ; Heart Failure ; Heart Valve Diseases ; Humans ; Myocardial Ischemia ; Pulmonary Disease, Chronic Obstructive ; Respiratory Function Tests ; Risk Factors ; Vital Capacity

BACKGROUND AND OBJECTIVES: The QT interval (QTi) and QT dispersion (QTd), which represent the myocardial electrical heterogeneity of repolarization, were studied to recognize the differences between normal controls (n=32) and stable angina patients (n=78). SUBJECTS AND METHODS: During the treadmill exercise test, standard 12 lead Electrocardiogram (ECG) was obtained at every stage, with the QTi and QTd measured. The corrected QT interval (cQTi) and QT dispersion (cQTd) were calculated using Bazett's formula, with the Delta QT interval (DeltaQTi) measured on leads V5 and aVF. RESULTS: During exercise, the QTi had a reverse relationship with the heart rate in both groups, but was decreased by a lesser extent in the patient group. The QTd also had a tendency to decrease according to increasing heart rate in both groups and was significantly greater in the patient group. The corrected QTi increased during exercise in both groups, and reached maximum during the pre-peak stage, but was minimized during a 1 minute recovery stage in the patient group. The corrected QTd reached a maximum during the peak exercise stage in both groups, but the values between the two groups were significantly different. Both the QTi and cQTi had tendencies to increase according to the number of vessels with stenosis. The DeltaQTi tended to reflect a regional ischemia in a single vessel disease. CONCLUSION: The QTi, QTd, cQTi and cQTd were increased in the stable angina patients compared with the normal controls, and augmented during the exercise test.
Angina, Stable* ; Constriction, Pathologic ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Ischemia ; Population Characteristics

BACKGROUND AND OBJECTIVES: The newly developed 2-dimensional ultrasound speckle tracking imaging (2D-STI) has enabled researchers to assess the changes of left ventricular (LV) rotation and torsion. The aims of the present study are to establish normal values and to examine the effect of advancing age on left ventricular torsion. SUBJECTS AND METHODS: We enrolled 182 healthy persons in this study. After examined the standard clinical echocardiographic parameters, we obtained the degree of the LV rotation at the basal and apical levels of the short axis view with using a customized software program EchoPAC, GE. RESULTS: Among the 182 healthy subjects, 109 healthy subjects were finally included (49 males and 60 females) due to the failure of obtaining reliable rotational patterns (feasibility: 59.8%). The basal and apical peak LV rotations during systole were 8.14+/-3.55 degrees and 8.48+/-3.70 degrees, respectively. The basal peak LV rotation and peak LV torsion had a tendency to increase with aging (r=0.277, p=0.004 and r=0.253, p=0.008, respectively). All the values of the basal LV rotation during systole tended to increase with aging. The apical LV rotation had no relationship with aging throughout the entire cardiac cycle. CONCLUSION: 2D-STI was a feasible methodology to measure the LV rotation. The peak LV torsion during systole shows statistically significant augmentation with advancing age, and this is mainly due to the increased basal LV rotation.
Age Factors ; Aging ; Axis, Cervical Vertebra ; Echocardiography, Doppler ; Heart Ventricles ; Humans ; Male ; Reference Values ; Systole ; Track and Field

BACKGROUND/AIMS: Increased left atrial (LA) size has been proposed as a predictor of poor cardiovascular outcome in the elderly. In the present study, we evaluated the relationship between LA size and stroke in subjects of all ages who presented with preserved left ventricular systolic function (LVSF) and sinus rhythm (SR), and investigated the relationships between LA size and other echocardiographic parameters of diastolic function. METHODS: A total of 472 subjects were enrolled in the study (161 men, 311 women) and divided into the stroke group (n=75) and control group (n=397). A conventional echocardiographic study was then performed. Subjects with valvular heart disease, atrial fibrillation, or coronary heart disease were excluded. RESULTS: The mean subject age was 65.2+/-5.1 years in the stroke group and 65.6+/-5.9 years in the control group. Mitral inflow pattern and E & A velocity showed no significant relationship with stroke (p=NS, p=NS, respectively). Left ventricular mass index and LA dimension were significantly related to stroke (p=0.003, p=0.023, respectively), and hypertension showed a marginal relationship with stroke (p=0.050). Age was not related to stroke in the present study (p=NS). CONCLUSIONS: The LA dimension is significantly related to the incidence of stroke. Therefore, strategies for prevention of stroke in patients with preserved LVSF and SR should be considered in cases of LA enlargement.
Adult ; Aged ; Echocardiography, Doppler, Pulsed ; Female ; Heart Atria/*ultrasonography ; Heart Rate/*physiology ; Heart Ventricles/physiopathology/ultrasonography ; Humans ; Incidence ; Korea/epidemiology ; Male ; Middle Aged ; Myocardial Contraction/*physiology ; Retrospective Studies ; Risk Factors ; Stroke/*epidemiology/etiology ; Stroke Volume/*physiology ; Systole ; Ventricular Function, Left/*physiology

BACKGROUND/AIMS: Pericardial effusion (PE), which is more than a moderate amount, is usually accompanied with various underlying illnesses. However, there have been few reports on the long-term follow-up results of these cases, and even in the studies where the etiologies were well presented. METHODS: 64 consecutive patients (mean age: 66.3 years, 23 males) with more than a moderate amount of PE, as confirmed by echocardiography, were analyzed for pericardial fluid and this was diagnosed according to ESC Executive Summary. The mean follow-up duration was 1.95+/-1.78 years and the final survival was assessed in November, 2006. RESULTS: The etiologies were composed of malignancy-related PE (MRPE: 29.7%), tuberculosis pericarditis (40.6%), idiopathic pericarditis (18.8%), hypothyroidism (7.8%), and miscellaneous (3.1%). Mortality occurred in 21 cases (32.8%), of which 15 cases were attributed to MRPE. In all patients, the mean survival duration was 372+/-247.9 days after diagnosis, and the mean survival duration was 253+/-221.5 days after pericardiocentesis. Cardiac tamponade, constrictive pericarditis and recurrent pericarditis were presented in 15 cases (23.4%), 9 cases (14.1%) and 2 cases (3.1%) respectively. The chemistry findings of PE were of no use to differentiate the etiologies. CONCLUSION: Pericardial effusion of more than a moderate amount often manifested urgent symptoms such as cardiac tamponade and intractable dyspnea, and these conditions require therapeutic pericardiocentesis more frequently than diagnostic tests. The prognosis is usually subordinate to the progression of the underlying illness, and especially in case of MRPE. The occurrence of constrictive pericarditis should be monitored carefully.
Cardiac Tamponade ; Diagnostic Tests, Routine ; Dyspnea ; Echocardiography ; Follow-Up Studies ; Humans ; Hypothyroidism ; Pericardial Effusion ; Pericardiocentesis ; Pericarditis ; Pericarditis, Constrictive ; Prognosis ; Tuberculosis

BACKGROUND AND METHOD: Pharmacological coronary vasodilation induced by dipyridamole is often used in association with thallium-201 scintigraphy to evaluate the presence and prognostic significance of coronary artery disease(CAD). Although dipyridamole has traditionally been used for this purpose, it causes frequent side effect, which at times can be life-threatening. Moreover, dipyridamole dose not elicit maximal coronary vasodilation in a substantial number of patients receiving the usual i.v. dose. Adenosine is an endogenously produced compound that has significant effects as a coronary vasodilator and rapid onset action and extremely short half-life(<10 seconds). The safety and diagnostic accuracy of intravenous adenosine Tc-99m MIBI imaging were evaluated in 248 patients who were referred for evaluation of CAD; 51 of the patients underwent coronary angiography and 25 of those exercise Tc-99 MIBI imaging. Adenosine was infused intravenously at a dose of 0.14 mg/kg/body weight per minute for 6 min and MIBI was injected at 3 min. RESULTS: Adenosine induced a significant decrease in systolic(p<0.05) and diastolic(p<0.001) blood pressures as well as a significant increase in heart rate(p<0.001) and rate-pressure product(p<0.01). The PR interval was slightly prolonged(p-NS). The overall sensitivity, specificity and predictive accuracy for CAD detection was 85%, 82%, and 83%, respectively. The diagnostic accuracy for individual CAD was low in left circumflex CAD. The agreement of segmental perfusion on adenosine and exercise Tc-99 MIBI imaging was 92% (Kappa index-0.83, p<0.001). Side effects occurred in 84% of 248 patients. Flushing (47%), dyspnea(45%), chest pain(28%) and headache(28%) were common. ST depression> or =1.0mm occurred in 8% and lst-, 2nd- and 3rd-degree atrioventricular block in 7%, 4%, and 1%, respectively. Side effects were mostly mild and transient except in 3 patients in whom premature termination of adenosine infusion and treatment were necessary. Aminophylline was used in only two patients. CONCLUSION: Thus, these facts suggest that pharmacological coronary vasodilation with adenosine in conjuction with Tc-99m MIBI myocardial scintigraphy appears to be a feasible, safe and valuable test for the diagnosis of coronary artery disease, particulary in patients unable to exercise.
Adenosine* ; Aminophylline ; Atrioventricular Block ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Dipyridamole ; Flushing ; Heart ; Humans ; Myocardial Perfusion Imaging ; Perfusion Imaging* ; Perfusion* ; Radionuclide Imaging ; Sensitivity and Specificity ; Thorax ; Vasodilation

PURPOSE: This study was designed to optimize the flip angle (FA) and scan timing of the hepatobiliary phase (HBP) using the 3D T1-weighted, gradient-echo (GRE) imaging with controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) technique on gadoxetic acid-enhanced 3T liver MR imaging. MATERIALS AND METHODS: Sixty-two patients who underwent gadoxetic acid-enhanced 3T liver MR imaging were included in this study. Four 3D T1-weighted GRE imaging studies using the CAIPIRINHA technique and FAs of 9° and 13° were acquired during HBP at 15 and 20 min after intravenous injection of gadoxetic acid. Two abdominal radiologists, who were blinded to the FA and the timing of image acquisition, assessed the sharpness of liver edge, hepatic vessel clarity, lesion conspicuity, artifact severity, and overall image quality using a five-point scale. Quantitative analysis was performed by another radiologist to estimate the relative liver enhancement (RLE) and the signal-to-noise ratio (SNR). Statistical analyses were performed using the Wilcoxon signed rank test and one-way analysis of variance. RESULTS: The scores of the HBP with an FA of 13° during the same delayed time were significantly higher than those of the HBP with an FA of 9° in all the assessment items (P < 0.01). In terms of the delay time, images at the same FA obtained with a 20-min-HBP showed better quality than those obtained with a 15-min-HBP. There was no significant difference in qualitative scores between the 20-min-HBP and the 15-min-HBP images in the non-liver cirrhosis (LC) group except for the hepatic vessel clarity score with 9° FA. In the quantitative analysis, a statistically significant difference was found in the degree of RLE in the four HBP images (P = 0.012). However, in the subgroup analysis, no significant difference in RLE was found in the four HBP images in either the LC or the non-LC groups. The SNR did not differ significantly in the four HBP images. In the subgroup analysis, 20-min-HBP imaging with a 13° FA showed the highest SNR value in the LC-group, whereas 15-min-HBP imaging with a 13° FA showed the best value of SNR in the non-LC group. CONCLUSION: The use of a moderately high FA improves the image quality and lesion conspicuity on 3D, T1-weighted GRE imaging using the CAIPIRINHA technique on gadoxetic acid, 3T liver MR imaging. In patients with normal liver function, the 15-min-HBP with a 13° FA represents a feasible option without a significant decrease in image quality.
Acceleration ; Artifacts ; Breath Holding ; Contrast Media ; Fibrosis ; Gadolinium DTPA ; Humans ; Injections, Intravenous ; Liver ; Magnetic Resonance Imaging ; Signal-To-Noise Ratio