Anterograde and retrograde conduction properties of dual AV nodal pathways were analyzed in 15 patients having no accessory pathway and showing dual AV nodal pathways during extrastimulation. Four patients in whom the supraventricular tachycardia of common type (common type SVT) was induced during electrophysiological study were classified into group A. The remained 11 patients in whom the common type SVT was not induced were classified into group B. There was a history of paroxysmal supraventricular tachycardia(PSVT) in all of group A but none of group B. Among the properties of dual AV nodal pathways, effective refractory period (ERP) of anterograde fast pathway (FP) and retrograde FP were not different in both group. Maximal AH interval of anterograde slow pathway (SP) was significantly shorter in group A than in group B (P<0.01). In group A, all patients had intact ventriculoatrial (VA) conduction, but in group B, 5 patients had no VA conduction. The paced atrial cycle length producing Wenckebach block (WBCL) and the paced ventricular cycle length producing retrograde VA block (VABCL) were significantly shorter in group A the in group B (p<0.05). There were two patients showing retrograde dual AV nodal pathways. The common type SVT was not induced in both of them probably due to long ERP of retrograde FP. In conclusion, in patients with anterograde dual AV nodal pathways, the occurrence of common type SVT is highly related to anterograde slow pathway refractoriness (WBCL) and retrograde fast patway refactoriness (VABCL).
Humans ; Tachycardia, Atrioventricular Nodal Reentry* ; Tachycardia, Supraventricular

Two cases of familial asymmetric septal hypertrophy diagnosed by myocardial biopsy and clinical studies are reported with literature reviewed. Myocardial biopsy was done at right ventricular septal wall, and pedigree of family members was observed clinically and examined by noninvasive methods including chest X-ray and echocardiography.
Biopsy ; Cardiomyopathy, Hypertrophic* ; Echocardiography ; Humans ; Pedigree ; Thorax

A 30-year-old primigravida with gestational age of 25 weeks and 4 days was admitted for emergency cesarean section. She was diagnosed as pre-eclampsia with fetal distress. We anesthetized the patient through the combined spinal-epidural anesthetic technique, and there was no specific event throughout the surgical procedures and in post anesthetic care unit. Subsequently, she complained of unilateral hearing difficulty in the ward and an otolaryngology consultation was obtained. She was diagnosed with left sudden sensorineural hearing loss in full frequency range after an acoustic examination. She received intravenous and local steroid treatments for 4 weeks. She showed 32 dB on pure tone audiometry after 5 months. However, we could not continue follow-up testing on the patient because she stopped visiting the hospital since the last examination. We reported a case of uncommon unilateral sudden sensorineural hearing loss after a combined spinal-epidural anesthesia for emergency cesarean section.
Acoustics ; Adult ; Anesthesia* ; Audiometry ; Cesarean Section* ; Emergencies* ; Female ; Fetal Distress ; Follow-Up Studies ; Gestational Age ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural* ; Humans ; Otolaryngology ; Pre-Eclampsia ; Pregnancy

BACKGROUND: An increase in oxidative stress has been suggested to play major roles in the complications of diabetes. The bulk of the experimental data favors enhanced free radicals in diabetes and antioxidant defense mechanisms may be reduced in diabetes. Melatonin, the major secretory product of the pineal gland has been shown to be a potent and specific hydroxyl radical scavenger. The purpose of our study was to determine the antioxidative effeet of melatonin in streptozotocin-induced diabetic rats. METHODS: Sprague-Dawley rats weighing 200-240 g were divided into 3 groups: normal controls(n-7), diabetic contmls(n-9), melatonin-treated diabetic animals(n-9). Diabetes was induced by intraperitoneal injection of streptozotoein(55 mg/kg body weight) and melatonin(6 mg/kg body weight) was orally administered for 20 days. At day 20 after streptozotocin administration, blood was collected for the assay of glucose, albumin and cholesterol. Erythrocyte membrane lipid peroxidation was determined by malonyldialdehyde(MDA) reactivity. RESULTS: 1) The MDA resctivity of erytbrocyte membrane in melatonin-treated diabetic animals (meanstandard deviation: 5.52+-1.52nmol/ml packed cells) were lower(p<0.05) than that in diabetic controls(7.68+-1.16nmol/mL packed cells). But, there was no significant difference between melatonin-treated diabetic animals and normal contls(4.93+-1.19 nmol/mL packed cells). 2) There were no significant differences of blood glucose and body weight between diabetic controls and melatonin-treated diabetic animals. CONCLUSION: These results show the antioxidative effect of melatonin in streptozotocin-induced diabetic rats. Further clinical and long-term experimental studies are needed to assess the effect of melatonin on development and progression of diabetic complications.
Animals ; Blood Glucose ; Body Weight ; Cholesterol ; Defense Mechanisms ; Diabetes Complications ; Erythrocyte Membrane ; Free Radicals ; Glucose ; Hydroxyl Radical ; Injections, Intraperitoneal ; Lipid Peroxidation ; Melatonin* ; Membranes ; Oxidative Stress ; Pineal Gland ; Rats* ; Rats, Sprague-Dawley ; Streptozocin

It is known that radiation can induce various kind of mutations, cancers and congenital malformations. Day 9 rats embryos were cultured by whole embryo culture method and irradiated 0.1, 0.5, 2 and 5 Gy at day 10 to study the effect of radiation on the development of rat embryos. Haversting after 48 hours culture, the morphological changes and apoptosis were investigated. In addition, we assessed the expression patterns of p53, WAF1, Bcl -2, Bcl -x and Bax. Compared to the control group, no remarkable morphological changes were observed in the low dosage group (0.1 and 0.5 Gy). But at high dosage group (2 and 5 Gy), growth was retarded and the heart beats were weak. The crown rump length, the number of somites, and branchial arch were decreased and the rotation of embryo and development of otic pit and lens pit, and upper limb bud was delayed significantly. Especially in the 5 Gy group the most of external morphology were difficult to discriminate. In histological observations, high dosage group showed marked increase in the number of apoptotic bodies in the optic cup, trigeminal ganglion, pharyngeal arches, heart and small intestine. In western blot analysis, Bcl -x and Bax were not expressed in all groups. Expression level of Bcl -2 was constant regardless of the amount of radiation. Expression level of p53 and WAF1 increased significantly in accordance with the increasing amount of radiation. Especially, WAF1 was expressed 7.2, 6.3, 9.9 and 11.3 folds more than the control groups when embryos were exposed to 0.1, 0.5, 2 and 5 Gy, respectively. Considering WAF1 arrests cell cycle, we concluded that cell cycle was affected most sensitively to radiation injury. From these results, radiation showed growth retardation, decrease in protein synthesis, increase in apoptosis and expression of related genetic materials. These results may be used as a standard to test the effect of drugs for reducing and protecting agents against deterious effect of radiation in developing embryo and fetus.
Animals ; Apoptosis ; Blotting, Western ; Branchial Region ; Cell Cycle ; Crown-Rump Length ; Embryonic Structures* ; Fetus ; Heart ; Intestine, Small ; Radiation Injuries ; Rats ; Somites ; Trigeminal Ganglion ; Upper Extremity

In order to understand the effect of retinoic acid (RA) on the craniofacial pattern formation during embryogenesis, we injected RA intraperitoneally into the pregnant female rat on day 11 post coitum (p.c.) and then embryos of day 13 to day 17 p.c. were isolated consequently. The overall morphology and the differential gene expression patterns were analyzed by the microscopic and (DD) RT-PCR methods, respectively. For the morphological study, the retardation of craniofacial region, the shortage of crown rump length and limbs were analyzed in the RA-treated embryos. In the RA-treated embryos of day 17, it was observed that the palatogenesis was completely finished just like in the normal embryos. However, the cleft plate was observed in 36 out of 52 total samples with the distance of cleft palate being 0.80+/-0.36 mm in average. The temporal expression pattern of Hox genes through RT-PCR revealed that the expression of Hoxa7 reached its peak on day 13 then slowly declined in the normal embryos. Whereas in the RA-treated embryos, the expression peak was observed on day 15, then declined subsequently. With the Hoxc8 gene, its expression was low in all stages until the day 16 of normal embryogenesis. On the other hand, Hoxc8 gene expression was detected slightly early on day 15 in the RA-treated embryos. In the study of Bcl-2 family genes, uniformly strong expression of anti-apoptotic and pro-apoptotic genes was observed from day 13 to day 17 of normal embryos, whereas anti-apoptotic gene expressions were decreased after day 16 in the RAtreated embryos. Additionally, a dramatic decline of pro-apoptotic gene expression was observed from day 13 to day 15 of the RA-treated embryos. Therefore, we believe that RA is a potential factor that is actively involved in the cleft palate formation. Moreover, it is profoundly linked with the regulation of Hox and Bcl-2 family gene expression pattern that leads to the embryonic malformation.
Animals ; Cleft Palate ; Crown-Rump Length ; Embryonic Development* ; Embryonic Structures ; Extremities ; Female ; Gene Expression ; Genes, Homeobox ; Hand ; Humans ; Palate* ; Pregnancy ; Rats* ; Tretinoin*

PURPOSE: To report the short-term effects of intravitreal bevacizumab alone, low-dose bevacizumab combined with low-dose triamcinolone injection, and intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA, USA) injection in patients with macular edema following central retinal vein occlusion (CRVO). METHODS: The medical records of 70 patients (70 eyes) with macular edema secondary to CRVO were reviewed retrospectively. Of these, 25 eyes (IVB group) were injected with intravitreal bevacizumab, 23 eyes (intravitreal low-dose bevacizumab and triamcinolone injection [IVB+IVTA] group) were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL), and 20 eyes (intravitreal dexamethasone implant [IVD] group) were injected with an intravitreal dexamethasone implant. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) of treated eyes were measured before injection and at 1 month and 3 months after injection. RESULTS: Groups were similar in age and gender distribution. At 1 month, the CMT of all groups was significantly lower, and the BCVA of all groups had increased significantly in patients with CRVO; there were no significant differences among the three groups (p = 0.246, p = 0.974). At 3 months, the CMT and BCVA had improved significantly only in the IVD and IVB+IVTA groups; the short-term effect was comparable to the IVD group. IOP showed no significant change at 3 months after injection for all groups. CONCLUSIONS: Considering various clinical variables in the treatment of macular edema associated with CRVO, intravitreal injection of bevacizumab, low-dose bevacizumab combined with triamcinolone, and dexamethasone implants may be used selectively.
Bevacizumab ; Dexamethasone ; Humans ; Intraocular Pressure ; Intravitreal Injections ; Macular Edema ; Medical Records ; Retinal Vein Occlusion ; Retinal Vein ; Retrospective Studies ; Triamcinolone ; Visual Acuity

PURPOSE: An optimal timing for diagnosis and management of papillary thyroid microcarcinoma (PTMC) has become the subject for much controversy. The aim of the present study is to analyze people's preference in Korea for timing of diagnosis and management of PTMC using an online questionnaire. METHODS: The questionnaire consists of 3 questions about preference for the diagnosis and management of PTMC and 3 additional questions about respondents' personal information. An online survey was conducted from March 3 to June 3 in 2015 using Google Survey (http://goo.gl/forms/b81yEjqNUA). RESULTS: A total 2,308 persons (1,246 males, 1,053 females) answered the questionnaire. Respondents' ages varied widely from teenagers to 70-year-olds. If there was a suspicious thyroid nodule from PTMC measuring less than 1 cm in diameter, 95.7% of respondents want to know a cytological diagnosis for it. If a thyroid nodule turned out to be a PTMC, 59.5% of respondents wanted it removed immediately. For surgical management of PTMC, 53.0% of respondents were worried more about recurrences than complications. In subgroup analyses, respondents younger than 40 years old more often want immediate surgery than others: 66.7% vs. 32.7% (P < 0.05). Respondents who underwent thyroid cancer surgery (n = 91) were worried more about recurrences than others: 69.2% vs. 52.4% (P < 0.05). CONCLUSION: Almost all respondents in the present study wanted diagnosis of suspicious thyroid nodules immediately. However, there were opposing opinions about the preferred timing for surgical treatment and surgical extents. A patient's right to know their disease status and decision on treatments should be emphasized all the more.
Adolescent ; Aged ; Diagnosis* ; Humans ; Korea* ; Male ; Patient Rights ; Recurrence ; Surveys and Questionnaires ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule

Amputation neuroma can cause very serious, intractable pain. Many treatment modalities are suggested for painful neuroma. Pharmacologic treatment shows a limited effect on eliminating the pain, and surgical treatment has a high recurrence rate. We applied pulsed radiofrequency treatment at the neuroma stalk under ultrasonography guidance. The long-term outcome was very successful, prompting us to report this case.
Amputation ; Catheter Ablation* ; Neuroma* ; Pain, Intractable ; Pulsed Radiofrequency Treatment ; Recurrence ; Ultrasonography*

BACKGROUND AND OBJECTIVES: Implantable cardioverter–defibrillators (ICDs) are indicated in patients with Brugada syndrome (BS), early repolarization syndrome (ERS), or idiopathic ventricular fibrillation (IVF) who are at high risk for sudden cardiac death. The optimal ICD programming for reducing inappropriate shocks in these patients remains to be determined. We investigated the difference in the mean cycle length of tachyarrhythmias that activated either appropriate or inappropriate ICD shocks in these three patient groups to determine the optimal ventricular fibrillation (VF) zone for minimizing inappropriate ICD shocks. SUBJECTS AND METHODS: We selected 41 patients (35 men) (mean age±standard deviation=42.6±13.0 year) who received ICD shocks between April 1996 and April 2014 to treat BS (n=24), ERS (n=9), or IVF (n=8). Clinical and ICD interrogation data were retrospectively collected and analyzed for all events with ICD shocks. RESULTS: Of the 244 episodes, 180 (73.8%) shocks were appropriate and 64 (26.2%) were inappropriate. The mean cycle lengths of the tachyarrhythmias that activated appropriate and inappropriate shocks were 178.9±28.7 ms and 284.8±24.4 ms, respectively (p<0.001). The cutoff value with the highest sensitivity and specificity for discriminating between appropriate and inappropriate shocks was 235 ms (sensitivity, 98.4%; specificity, 95.6%). When we programmed a single VF zone of ≤270 ms, inappropriate ICD shocks were reduced by 70.5% and appropriate shocks were missed in 1.7% of these patients. CONCLUSION: Programming of a single VF zone of ≤270 ms in patients with BS, ERS, or IVF could reduce inappropriate ICD shocks, with a low risk of missing appropriate shocks.
Brugada Syndrome* ; Death, Sudden, Cardiac ; Defibrillators* ; Humans ; Retrospective Studies ; Sensitivity and Specificity ; Shock* ; Tachycardia* ; Ventricular Fibrillation*