BACKGROUND AND OBJECTIVES: We investigated in patients with coronary vasospastic angina whether the exercise ECG test results are influenced by the different modes of exercise load and compared the clinical characteristics including coronary risk factors between patients with positive and negative exercise tests. MATERIALS AND METHODS: This study comprised 34 patients with documented coronary artery spasm without significant stenosis (coronary artery luminal diameter narrowing <70%) and treadmill exercise test. Treadmill exercise ECG test was performed based on Bruce's protocol (graded exercise test, GET) and sudden rapid exercise protocol (non-graded exercise test, NGET) in the morning of the same day. RESULTS: 1) Of 29 patients who underwent both GET and NGET, 19 patients manifested positive result by NGET, whereas only 11 patients did by GET (66 vs. 38%, P=0.04). All patients with positive GET had positive NGET and 8 of 18 patients with negative GET had positive NGET. 2) Of 34 patients who underwent GET, there was no significant difference in frequency of hypertension, diabetes, current smoking, presence of effort chest pain by history, mixed disease (fixed stenosis >50%, <70% of luminal diameter) or total cholesterol level between patients with positive and negative results. In 18 typical variant angina patients by clinical history, 8 of 10 patients with high disease activity (5 times or more attack per week) manifested positive result by GET or NGET, whereas 4 of 8 patients with low disease activity (80 vs. 50%, P=NS). CONCLUSION: In patients with coronary vasospastic angina, sudden rapid exercise could induce more frequently coronary artery spasm than multistage exercise. The result of an exercise test may not be correlated with coronary risk factors, coronary anatomy, effort chest pain, and the disease activity.
Arteries ; Chest Pain ; Cholesterol ; Constriction, Pathologic ; Coronary Vessels ; Electrocardiography ; Exercise Test* ; Humans ; Hypertension ; Phenobarbital ; Risk Factors ; Smoke ; Smoking ; Spasm

We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.
Analgesia, Epidural ; Anesthesia, General ; Catheterization ; Catheters ; Cauda Equina ; Humans ; Leg ; Magnetic Resonance Spectroscopy ; Paralysis ; Polyradiculopathy ; Spinal Cord ; Spinal Cord Injuries ; Spine

A large-scale pandemic by human influenza virus H1N1 in 2009 caused severe health, social, and economic impacts. In this study, a photocatalyst technology based on TiO2, was evaluated for inactivation of a human influenza virus H1N1 isolated from a patient. The virus titer was reduced by 103.16-fold within 24 h and more than 104.31-fold inactivation within 48 h and 72 h. These results suggest that the tested photocatalyst technology based on TiO2 can be used for reduction of influenza A virus adherence to other surfaces with Hizen-s inside diverse buildings, enabling effective control of its indirect contact infection. The photocatalyst is expected also to reduce level of the aerosol transmission of the virus.
Humans ; Influenza A virus ; Influenza, Human ; Pandemics ; Viral Load ; Viruses

Rhododendron brachycarpum has been known as a panacea in Korean folk medicine, and is used to treat various diseases including hypertension. Excessive ingestion can cause intoxication by grayanotoxin. We experienced a 59 year-old man suffering of grayanotoxin intoxication following excessive ingestion of Rhododendron brachycarpum. The patient presented dizziness, weakness, and chest discomfort with cold sweats. Electrocardiography showed marked sinus bradycardia with atrio-ventricular dissociation. With intravenous saline and atropine, the patient recovered. This case calls attention to the potential cardiotoxicity of Korean folk medicine Rhododendron brachycarpum.
Atropine ; Bradycardia* ; Dizziness ; Eating* ; Electrocardiography ; Humans ; Hypertension ; Medicine, Traditional ; Middle Aged ; Rhododendron* ; Sweat ; Thorax

PURPOSE: Clinical study to evaluate the efficacy and the safety of various surgical treatments in snoring and obstructive sleep apnea. METHODS AND MATERIALS: We performed surgical treatments such as radiofrequency ablation, uvulopalatopharyngoplasty(UPPP) with tonsillectomy, uvulopalatopharyngoplasty with advancement genioplasty, orthognathic surgery(maxillomandibluar advancement), distraction osteogenesis device insertion. Diagnosis was performed with clinical examination, polysomnography, lateral cephalometric and computed tomography. 62(M : F = 45 :17 , mean age 41.5, mean follow-up 4 weeks) patients underwent radiofrequency ablation and 7(M : F = 5 : 2, mean age 38.9, mean follow-up 19months)patients experienced uvulopalatopharyngoplasty with tonsillectomy. Uvulopalatophayngoplasty with advancement genioplasty was performed for 3 (M : F = 2: 1, mean age 30.2 , mean follow-up 14 months)patients. The last 3(M : F = 2 : 1, mean age 21.5 , mean follow-up 24 months)patients was treated with orthognathic surgery including distraction device insertion. The results was evaluated by questionnaires, polysomnography, investigation of complications. RESULTS: Of the patients treated with radiofrequency ablation, 95% reported improvement of their symptom. 100% improvement was reported in patients treated with UPPP with tonsillectomy and UPPP with advancement genioplasty. The two of three patients who underwent orthognathic surgery showed the satisfactory of treatments. Dryness of mouth was the most common complication during short period in radiofrequency ablation and UPPP with tonsillectomy. Relapse complication was not found in any surgical treatments. CONCLUSION: Treatment for snoring and OSA is determined by severity degree of the physiologic derangements, predominant type of apnea and obstructive site. Accuracy diagnosis should be performed prior to treatment for satisfactory treatment result. This study demonstrates feasibility, safety and efficacy of surgical treatments in snoring and OSA.
Apnea ; Follow-Up Studies ; Genioplasty ; Humans ; Mouth ; Orthognathic Surgery ; Osteogenesis, Distraction ; Polysomnography ; Questionnaires ; Recurrence ; Sleep Apnea, Obstructive ; Snoring ; Tonsillectomy

BACKGROUND AND OBJECTIVES: The present study investigated differences in the effects of macrophages between neointimal formation after balloon (BI) and that after stent injury (SI) in hypercholesterolemic rabbits. We also studied the relationship between advanced glycation end products (AGE), the receptor for AGE (RAGE), and S100A8/A9 in the inflammatory reaction mediated by macrophages. MATERIALS AND METHODS: Male New Zealand White rabbits fed with a 1% cholesterol diet for 2 weeks underwent balloon dilatation to one iliac artery, and stenting to the contralateral artery. Arteries were harvested at 7, 14, and 28 days after injury. RESULTS: Sizes and cell numbers of neointima were higher in SI than in BI (p<0.05), but those from media showed no difference between SI and BI (p>0.05). Sizes and cell numbers of neointima in BI and SI increased significantly till 14 days (p<0.05). Macrophage numbers increased in neointima of BI at 14 days (p=0.011), but not at 28 days (p>0.05). Macrophage numbers increased until 28 days in the media of BI (p=0.003). Macrophage numbers increased at 14 days in the neointima of SI (p=0.001), but decreased at 28 days (p=0.014). Macrophage numbers were not changed in the media of SI. Cell numbers and area were significantly correlated with macrophage numbers in the neointima and media of BI, and in the neointima of SI (p<0.05). RAGE expression was strong in cells adjacent to lumen at 7 and 14 days, and in cells of neointima and media adjacent to internal elastic lamina at 28 days. Expression of RAGE was increased in both macrophage and smooth muscle cells. Macrophages were the predominant cells observed with AGE accumulation. S100A8/A9 was not found. CONCLUSION: There seems to be a difference in effect of macrophages on the formation of neointima after injury between BI and SI. The effects of macrophages appears to be more significant in the neointima of BI. Mechanical arterial injury induces the formation of AGE and overexpression of RAGE in macrophages.
Arteries ; Cell Count ; Cholesterol ; Coronary Restenosis ; Diet ; Dilatation ; Glycosylation End Products, Advanced ; Humans ; Hypercholesterolemia ; Iliac Artery ; Macrophages* ; Male ; Myocytes, Smooth Muscle ; Neointima ; Rabbits* ; Rage ; Stents*

Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant disease characterized by early manifestation of colorectal cancer (CRC), occurrence of multiple colorectal tumors and high frequencies of extracolonic malignancies. Evaluation of clinical findings in concert with a well-documented and extended pedigree and genetic studies of colorectal cancer can identify person who are at high risk and who thereby might benefit from targeted early detection and primary prevention programs. Here we report 4 cases of HNPCC including 2 cases with synchronous gastric cancers.
Colorectal Neoplasms ; Humans ; Pedigree ; Primary Prevention ; Stomach Neoplasms* ; Stomach*

Glucocorticoid-induced TNF receptor (GITR) was a new member of the TNF/nerve growth factor receptor (TNFR/ NGFR) family and induced in murine T cells by dexamathasone. Recombinant soluble GITR (sGITR) induced an inflammation in peritoneal membrane and changes in spleen after i.p. injection of 3 mg/kg in C57BL/6 mice. Spleen was enlarged and percentage of neutrophils and monocytes were increased. The area of red pulp in spleen was increased, while that of white pulp was decreased after GITR injection. The thickening of membrane and neutrophil infiltration was observed in peritoneal membrane with increased myeloperoxidase activity. At later time, neutrophil infiltration moved to inside the tissue with tissue damage. GITR ligand and GITR were expressed constitutively on the surface of spleen cells and cells from peritoneal fluid. In contrast, no significant change in the spleen and in peritoneal membrane was observed in mice treated with LPS. GITR may play a role in body's inflammatory processes.
Animals ; Carrier Proteins/metabolism ; Flow Cytometry ; Inflammation/*chemically induced/pathology ; Injections ; Male ; Mice ; Mice, Inbred C57BL ; Receptors, Nerve Growth Factor/*metabolism ; Receptors, Tumor Necrosis Factor/*metabolism ; Solubility ; Spleen/metabolism/pathology ; Support, Non-U.S. Gov't

BACKGROUND AND OBJECTIVES: It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD). METHODS: Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants. RESULTS: The mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF ( < 55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36–0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39–0.97, p=0.037) for all-cause mortality. CONCLUSIONS LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.

BACKGROUND AND OBJECTIVES: It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD). METHODS: Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants. RESULTS: The mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF ( < 55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36–0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39–0.97, p=0.037) for all-cause mortality. CONCLUSIONS: LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.
Atrial Fibrillation ; Coronary Disease ; Echocardiography ; Follow-Up Studies ; Humans ; Incidence ; Ischemic Attack, Transient ; Mortality ; Myocardial Infarction ; Prospective Studies ; Risk Factors ; Stroke ; Stroke Volume ; Ventricular Function, Left