BACKGROUND: Quantitative myocardial perfusion scintigraphy with thallium-201 has provided an increase in accuracy of coronary artery disease detection. Myocardial uptake and clearance data based on thallium-201 kinetics in normal subjects is using in quantitative interpretation of myocardial perfusion scan. Exercise and pharmacologic stress make different hemodynamic effects and different myocardial uptake and clearance of thallium-201. Effect of background subtraction on thallium-201 myocardial perfusion scintigraphy may also be different due to different thallium-201 biokinetics in each type of stress used. This study was aimed to evaluate the effects of the background subtraction on myocardial thallium-201 biokinetics according to the type of stress used. METHODS: Fifteen healthy volunteers underwent planar thallium-201 myocardial perfusion imaging with peak treadmill exercise and intravenous infusion of dipyridamole, adenosine, or dobutamine. Each subject underwent another planar thallium-201 myocardial perfusion imaging at 4 hour later, as a redistribution imaging. Count densities from ROIs(regions of interest) drawn over left ventricle, lung, and liver were compared between before- and after background subtraction. RESULTS: Before background subtraction, absolute myocardial thallium-201 uptake was greater after pharmacologic testing than exercise testing in both stress and redistribution imaging. Myocardial thallium-201 clearance was lower during pharmacologic stress than exercise. After background subtraction, myocardial thallium-201 uptake was higher during exercise than pharmacologic testing. The percentage change in clearance was higher with exercise testing, while the percentage change in uptake was higher with pharmacologic testing. CONCLUSION: Thallium-201 uptake and clearance in heart and adjacent structure were different between adenosine, dipyridamole, dobutamine, and exercise testing. Background subtraction results in different myocardial uptake and clearance data due to different extracardiac uptake subtracted in each stress method. The diagnostic criteria for quantitative analysis of myocardial perfusion imaging must be specified for types of myocardial stress and processes used for background subtraction.
Adenosine* ; Coronary Artery Disease ; Dipyridamole* ; Dobutamine* ; Exercise Test ; Healthy Volunteers ; Heart ; Heart Ventricles ; Hemodynamics ; Infusions, Intravenous ; Kinetics* ; Liver ; Lung ; Myocardial Perfusion Imaging ; Myocardium* ; Perfusion ; Perfusion Imaging

Inflammation is a series of host defense processes in response to microbial infection and tissue injury. Inflammatory processes frequently cause extracellular acidification in the inflamed region through increased glycolysis and lactate secretion. Therefore, the immune cells infiltrating the inflamed region encounter an acidic microenvironment. Extracellular acidosis can modulate the innate immune response of macrophages; however, its role for inflammasome signaling still remains elusive. In the present study, we demonstrated that macrophages exposed to an acidic microenvironment exhibited enhanced caspase-1 processing and IL-1β secretion compared with those under physiological pH. Moreover, exposure to an acidic pH increased the ability of macrophages to assemble the NLR family pyrin domain containing 3 (NLRP3) inflammasome in response to an NLRP3 agonist.This acidosis-mediated augmentation of NLRP3 inflammasome activation occurred in bone marrow-derived macrophages but not in bone marrow-derived neutrophils. Notably, exposure to an acidic environment caused a reduction in the intracellular pH of macrophages but not neutrophils. Concordantly, macrophages, but not neutrophils, exhibited NLRP3 agonist-mediated translocation of chloride intracellular channel protein 1 (CLIC1) into their plasma membranes under an acidic microenvironment. Collectively, our results demonstrate that extracellular acidosis during inflammation can increase the sensitivity of NLRP3 inflammasome formation and activation in a CLIC1-dependent manner. Thus, CLIC1 may be a potential therapeutic target for NLRP3 inflammasome-mediated pathological conditions.

BACKGROUND: Tc-99m tetrofosmin is a recently developed myocardial perfusion agent that has shown promising characteristics, displaying rapid accumulation in and slow clearance from the myocardium with rapid clearance from background organs. Adenosine is relatively safe, direct and potent coronary vasodilator and has been used as a stress agent in myocardial perfusion scintigraphy. We have performed tetrofosmin single photon emisson computed tomography(SPECT) in patients suspected of coronary artery disease. This study was aimed to assess the safety profile and diagnostic accuracy of adenosine Tc-99m tetrofosmin SPECT. METHOD: One hundred forth six patients underwent Tc-99m tetrofosmin SPECT with intravenous adenosine. Four hours after resting Tc-99m tetrofosmin SPECT imaging, adenosine was infused intravenously at a dose of 0.14 mg/kg of body weight per minute for 6 min and Tc-99m tetrofosmin was injected at 3 min after start of infusion. Blood pressure, heart rate and side effects was recorded during and after four minites of adenosine infusion. Forty seven of patients underwent coronary angiography within 2 weeks. RESULTS: Adenosine induced a significant and mild decrease in systolic and diastolic blood pressure at 2 min after start of adenosine infusion and a significant and mild increase in heart were observed in 70% of 146 patients. Chest discomfort(30%), mild dyspea(25%), chest pain(19%), and headach(12%) were common. No serious side effects were observed despite of continuation chest pain and restlessness, respectively. The diagnostic sensitivity for detection of CAD(>/=50% and >/=70% coronary stenosis by coronary angiography) by adenosine Tc-99m tetrofosmin SPECT were sensitivity 92%, 97%, and specificity) were 76%, 79% for LAD, 67%, 67% for LCX, and 73%, 82% for RCA, respectively. Specificities were 92%, 89% for LAD, 100%, 100% for LCX, 92%, and 87% for RCA. CONCLUSION: Adenosine Tc-99m tetrofosmin SPECT appears to be a feasible, safe, highly sensitive and specific test for the diagnosis of coronary artery disease.
Adenosine* ; Blood Pressure ; Body Weight ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis ; Heart ; Heart Rate ; Humans ; Myocardium ; Perfusion ; Perfusion Imaging ; Psychomotor Agitation ; Thorax ; Tomography, Emission-Computed, Single-Photon*

Hypoxia-induced cell damage is known to be mediated by increase in intracellular calcium. In the present study, the effect of calcium channel blockers on the hypoxia-induced cell damage was investigated in iat pheochromocytoma cells line, PC12 cells. The cultured cells were exposed to hypoxia under 95% N2 plus 5% C02 gas phase and incubated in the media devoid of fetal bovine seruril The cell demage was assessed by measuring the release of lactate dehydrogenase (LDH) from the cells into the incubation media. Exposure of the cells to hypoxia for 2 hours caused a 28% of the total LDH to be released from cells -into media. The pretreatment of the cells with 1 mM each of diltiazem, nifedipine, and verapamil depressed the LDH release to the extent of 52%, 42%, and 30% inhibition, respectively. The inhibitory effects of diltiazem and verapamil were more marked at 1 mM than at 10 mM. The influx of 45 Ca2+ into the cells was rapidly increased within 2 minutes after exposure of the cells to hypoxia. Diltiazem at 1 mM almost completely inhibited Ca2+ influx, while nifedipine and verapamil exhibited only, 30% inhibition of Ca2- influx. The results lend support to the notion that mcreased intracellular calcium triggers a series of cascade reactions leadmg to cell death. It is suggested that the inhibitory effects of various calcium antagonists on hypoxia-induced cell damage differ from each other in their potency.
Animals ; Anoxia* ; Calcium Channel Blockers ; Calcium* ; Cell Death ; Cells, Cultured ; Diltiazem ; L-Lactate Dehydrogenase ; Nifedipine ; PC12 Cells* ; Pheochromocytoma ; Verapamil

Anisakiasis of the gastrointestinal tract is caused by the ingestion of raw fish or uncooked foods infested with Anisakis larvae belonging to the subfamily Anisakidae. With the increasing popularity of Japanese cuisine such as sashimi in Korea, the incidence of anisakiasis is expected to increase. The entire gastrointestinal tract from the esophagus to the rectum can be involved. Colonic anisakiasis is rare in comparison with gastric involvement. We report the anisakiasis concurrently invading the stomach, ileocecal valve and transverse colon treated by endoscopy with a brief review of the relevant literature.
Anisakiasis* ; Anisakis ; Asian Continental Ancestry Group ; Colon ; Colon, Transverse* ; Eating ; Endoscopy ; Esophagus ; Gastrointestinal Tract ; Humans ; Ileocecal Valve* ; Incidence ; Korea ; Larva ; Rectum ; Stomach*

BACKGROUND AND OBJECTIVES: This study was designed to investigate the relationship between myocardial perfusion defect in single photon emission tomography(SPECT) and the difference in left ventricular functional parameters obtained after stress and at rest. MATERIALS AND METHODS: Eighty five patients known to have coronary artery disease (CAD) or suspected to have CAD underwent gated Tc-99m sestamibi SPECT using one or separate day rest/stress protocol. We compared post-stress left ventricular ejection fraction (LVEF-s) with that at rest (LVEF-r) in gated myocardial SPECT. We considered myocardial stunning was developed when LVEF was >5% lower than that at rest. METHODS: Forty one (48%) patients demonstrated reversible or irreversible perfusion defects in gated perfusion SPECT (group 1). Forty four (52%) patients demonstrated normal perfusion status (group 2). In group 1, LVEF-s was significantly lower than that at rest([mean+/-SD] 46+/-15.5 vs 48+/-16.0 respectively, p<0.05). In group 2, There was no significant difference among LVEF-s and LVEF-r(60+/-7.6 vs 61+/-7.9, p=NS). In group 1, no difference was observed between LVEF-s and LVEF-r by stress modes. In 13 (32%) of 41 patients with perfusion defects, LVEF-s was >5% lower than LVEF-r. CONCLUSION: The LVEF obtained after stress with gated SPECT may not reflect true resting values. We recommend gated myocardial perfusion SPECT should be performed also at rest especially in patients with myocardial perfusion defects.
Adenosine* ; Coronary Artery Disease ; Humans ; Myocardial Stunning ; Perfusion* ; Stroke Volume ; Tomography, Emission-Computed, Single-Photon* ; Ventricular Function, Left*

The endoscopic mucosal resection(EMR) is proposed by some Japanese investigators as a curative therapy of early gastric cancer(EGC) because of its minimal invasiveness and excellent results. To evaluate the possible role of EMR as a curative treatment modality of EGC, we retrospectively analyzed l9 casea with EGC initially treated by EMR in Seoul National University Hospital from December 1993 and January 1996. 1) The histologic diagnosis prior to EMR was adenocarcinoma in 12 cases(63%) and adenomatous polyp in 7 cases(38%), which were confirmed as adenocarcinoma after EMR. 2) The histologic curative resection was done in 7 cases(37%). Two cases of them showed recurrence of the gastric cancer and were treated by radical surgery. The other five cases have been closely observed by regular endoscopic examination without recurrence for the maximal period of 1~3 months. 3) Histoiogically inadequate resection(positive cancer cell in resection margin, submucosal cancer infiltration, or no cancer tissue in resected specimen) was done in 12 cases(73%). But two surgically resected cimens of them have no residual cancer cells, and there was no cancer cells in the follow-up biopsy of the other two patients. There 4 cases were seemed to he examples of buring effect of EMR 4) After excluding five depressed lesions greater than 1 cm is long diameter, nine lesions were curatively treated by EMR. So successful EMR rate for strictly indicated lesions wsa 64% 5) There was no signifieant complication related to the procedure. We thnnk that endoscopic mucosal resection has a potential role as a curative treatment modality in a highly selected patient with darly gastric cancer
Adenocarcinoma ; Adenomatous Polyps ; Asian Continental Ancestry Group ; Biopsy ; Diagnosis ; Follow-Up Studies ; Humans ; Neoplasm, Residual ; Recurrence ; Research Personnel ; Retrospective Studies ; Seoul ; Stomach Neoplasms*

BACKGROUND/AIMS: Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirins. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea. METHODS: From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed. RESULTS: Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirins. H. pylori infection was found as the only risk factor for the recurrence of PUD. CONCLUSIONS: For the old patients who are taking drugs, such as NSAIDs and aspirins, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Endoscopy, Gastrointestinal ; Female ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Male ; Middle Aged ; Peptic Ulcer/drug therapy/*etiology ; Proton Pump Inhibitors/therapeutic use ; Questionnaires ; Recurrence ; Risk Factors ; Sex Factors ; Smoking ; Stomach Ulcer/etiology

Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by increased subepithelial collagen deposition associated with an inflammatory infiltrate in the lamina propria. Its etiology is still unclear, although a variety of associated diseases such as rheumatic syndromes, scleroderma, and thyroid diseases have been reported. We report a case of collagenous colitis following the prolonged use of NSAIDs. A 72-year-old woman who has taken NSAIDs for many years due to some dermatologic problems was admitted to the hospital because of chronic watery diarrhea and colicky abdominal pain of 3 months duration. There was no abnormal physical finding except cachectic appearance due to weight loss of 10kg during 3 months. Stool examination for ova and parasites and fat was negative, and stool culture for bacterial pathogens was negative. In complete blood count, there were relative eosinophila and mild anemia. Total serum protein and albumin was low, and thyroid function, RA factor, FANA were all normal. Results of upper and lower gastrointestinal contrast radiographs were normal. Sigmoidoscopy revealed normal colonic mucosa but she had a thick subepithelial collagenous deposit and chronic inflammation in lamina propria on colonic biopsy. Based on the above findings, she was diagnosed as collagenous colitis. Diarrhea improved after withdrawing NSAIDs and the treatment with oral prednisolone. In the post-treatment biopsy, the thickness of the collagen hand was diminished. Collagenous colitis is now recognized as one of the common causes of chronic diarrhea of obscure origin and NSAIDs may play an etiological role in some patient with collagenous colitis.
Abdominal Pain ; Aged ; Anemia ; Anti-Inflammatory Agents, Non-Steroidal ; Biopsy ; Blood Cell Count ; Colitis, Collagenous* ; Collagen* ; Colon ; Diarrhea ; Female ; Hand ; Humans ; Inflammation ; Mucous Membrane ; Ovum ; Parasites ; Prednisolone ; Sigmoidoscopy ; Thyroid Diseases ; Thyroid Gland ; Weight Loss

BACKGROUND AND OBJECTIVES: A left ventricular mass (LVM) can be used as a prognostic factor in patients with cardiovascular disease, and echocardiographic LVM measurements are most commonly used. We have measured LVM using quantitativel gated myocardial perfusion SPECT (QGS), and compared these results with LVM measured by echocardiography. SUBJECTS AND METHODS: One hundred and sixteen subjects (M/F=66/50, mean age: 58 yrs) underwent both rest QGS with Tc-99m MIBI and echocardiography. On visual interpretation, thirty-six subjects (31%) showed perfusion defects. The myocardial volume was obtained using the AutoQUANT program, and the LVM (LVMSPECT) was calculated by multiplying the volume by the specific gravity of the myocardium. We also measured the echocardiographic LVM (LVMEcho) by the Devereux formula, within one month of the LVMSPECT. RESULTS: The LVMSPECT and LVMEcho were well correlated (r=0.717, p<0.001), but a significant difference was noted between the two values. The mean difference between the LVMSPECT and LVMEcho was 24 g. The LVMEcho was smaller than the LVMSPECT in those subjects with a small LVMEcho, and greater than the LVMSPECT in the subjects with a large LVMEcho. The difference between the LVMEcho and LVMSPECT (LVMEcho-LVMSPECT) was positively correlated with the LVMEcho (r=0.893, p<0.001). CONCLUSION: The LVMs measured by gated myocardial perfusion SPECT and echocardiography were well correlated. But they were significantly different, especially in subjects with large LVMs.
Cardiovascular Diseases ; Echocardiography* ; Humans ; Hypertrophy, Left Ventricular ; Myocardium ; Perfusion* ; Specific Gravity ; Tomography, Emission-Computed, Single-Photon*