BACKGROUND: The effective ventricular function during ejection and filling is likely to depend on the coordinated action of the longitudinally and circumferentially orientated myocardial fibers and the function of these longitudinal fibers has not been extensively studied. METHODS: The role of longitudinally and circumferentially orientated fibers in left ventricular wall motion was evaluated by M-mode echocardiograms of the mitral ring(whose motion reflect long axis change) and the standard minor axis(left ventricular posterior wall), simultaneous recordings of phonocardiograms and electrocardiograms on the paper (speed 100mm/sec), in 24 healty individuals, 17 patients with mitral stenosis, 11 patients with open mitral commissurotomy and 17 mitral valve replaced patients. RESULTS: In the controls long axis shortening significantly preceded minor axis shortening (phase difference between two axes : 20+/-3 msec, mean+/-SEM) during early systole, indicating left ventricle become more spherical. This phase difference was also observed in the patients with mitral stenosis and in those with open mitral commissurotomy. In patients with mitral valve replacement(MVR) whose papillary muscles had been sectioned, the onset of long axis shortening was more delayed during early systole than that of short axis(-33+/-6msec) and the end of shortening was also prolonged to early diastole more than that of normal controls (54+/-3 msec vs 90+/-8 msec, mean+/-SEM, p<0.01 by t-test). CONCLUSION: We observed the time relations between long and short axis motion in normal controls. It can be concluded that the reversed time relation in patients with MVR is one of the important factors which may effect negatively on ventricular function and long-term prognosis, thus the surgical procedures to preserve papillary annular continuity should be considered in patients with mitral valvular disease. And the controlled, prospective, clinical trials with homogenous groups of patients are needed to evaluate the potential benefits of papillary annular continuity in preserving atrio-ventricular interaction in patients undergoing mitral valvular surgery.
Axis, Cervical Vertebra* ; Diastole ; Echocardiography ; Electrocardiography ; Heart Valve Diseases* ; Heart Ventricles ; Humans ; Mitral Valve ; Mitral Valve Stenosis ; Papillary Muscles ; Prognosis ; Systole ; Ventricular Function

BACKGROUND AND OBJECTIVES: Platelet-activating factor (PAF) in middle ear effusion is thought to induce hearing loss. The purpose of this study is to determine the effects of PAF placed on round window membrane (RWM) on hearing and cochlear hair cells in guinea pigs, and we also wanted to investigate the role of nitric oxide (NO) in the mechanism of PAF-induced hearing loss by comparing its immunoreactivity to iNOS between the control group and PAF application group. MATERIALS AND METHOD: Guinea pigs were divided into 2 groups: PBS, PAF. The PBS group received phosphate buffered saline (PBS) and the PAF groups received 10, 20, and 40 mug/ml of PAF soaked in gelfoam placed on the RWM. The following three tests were performed on each animal group: hearing was tested with an auditory brainstem response (ABR) test through 24 hours. At the end of 24 hours, cochlear hair cells were examined by scanning electron microscopy (SEM) and immunohistochemistry was carried out on the cochlea to test the expression of inducible nitric oxide (iNOS). RESULTS: The PAF group developed significant elevation of ABR threshold and cochlear hair cell damage in SEM compared with the PBS control group. Strong expression of iNOS on cochlea was observed in the PAF group and lighter expression was seen in PBS group. CONCLUSION: This study demonstrated that PAF placed on the RWM induced hearing loss, and cochlear hair cell damage, and strong iNOS expression in the cochlea. These findings suggest that the PAF-induced hearing loss caused by cochlear hair cell damage may have been mediated by NO. PAF-antagonists and NOS inhibitor may have future therapeutic implications in preventing sensorineural hearing loss associated with chronic otitis media.
Animals ; Cochlea ; Ear, Inner* ; Evoked Potentials, Auditory, Brain Stem ; Gelatin Sponge, Absorbable ; Guinea Pigs* ; Guinea* ; Hair ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Immunohistochemistry ; Membranes ; Microscopy, Electron, Scanning ; Nitric Oxide ; Otitis Media ; Otitis Media with Effusion ; Platelet Activating Factor

BACKGROUND: Inaccuracies associated with target-controlled infusion (TCI) delivery systems are attributable to both software and hardware issues, as well as pharmacokinetic variability. However, little is known about the inaccuracy of the syringe pump operating in TCI mode. This study aimed to evaluate the accuracy of the TCI pump based on international standards.METHODS: A test apparatus for accuracy evaluation of a syringe pump (PION TCI®, Bionet Co. Ltd.) was designed to apply the gravimetric method. Pump accuracy was evaluated in terms of deviation defined by the following equation: infusion rate deviation (%) = (Rate(mea) − Rate(est)) / Rate(est) × 100, where Rate(mea) is the infusion rate (ml/h) as measured by the gravimetric system, and Rate(est) is the infusion rate (ml/h) as estimated by the pump. An infusion rate representing TCI mode was determined from previous clinical trial data which evaluated the predictive performance of the pharmacokinetic model. The PION TCI pump used in that clinical trial was used to evaluate accuracy of the syringe pump. The distribution of infusion rates obtained from the clinical trial was calculated, and the median value of the distribution was determined as the representative value.RESULTS: The representative infusion rate representing TCI mode was 31 ml/h, at which the infusion rate deviation was 4.5 ± 1.6%.CONCLUSIONS: The inaccuracy of the syringe pump contributing to TCI system inaccuracy is insignificant.
Mesons ; Methods ; Syringes

Purpose: Mechanical and functional ankle instability or combinations of both can contribute to chronic ankle instability (CAI). Therefore, the purpose of this study was to compare the difference in (1) static and (2) dynamic balance function between patients with CAI and the controls; (3) to investigate association between balance function and CAI; and (4) to examine whether balance assessments are valuable for diagnosing CAI. Methods: This study was conducted on 40 patients with CAI and 40 ankle healthy individuals. All participants evaluated the Cumberland Ankle Instability Tool questionnaire. Additionally, joint laxity and center of pressure (COP) during static postural control, anterior landing, and lateral landing were measured using an electronic pedobarography. Results: CAI patients showed a larger COP area than controls when performing static postural control (p=0.023) and lateral landing (p=0.002). As a result of the receiver operation characteristic curve analysis, COP distance, area, and speed during static postural control and COP area during lateral landing showed low accuracy, indicating that they are valuable evaluations for the diagnosis of CAI. Conclusion Patients with CAI had poor static and dynamic postural control ability. The static posture control and the lateral landing test had diagnostic significance to evaluate the objective function of CAI.

Irritable bowel syndrome (IBS) is a gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause. As the clinical manifestations are very diverse and associated with nonspecific symptoms, research seeking to identify organic causes to rule out IBS and to enable differential diagnosis is required. A 24-year-old man was referred to our hospital for specialized management of IBS. He had a 7-month history of intermittent epigastric and lower abdominal pain. On the basis of clinical examination, he was diagnosed with IBS and administered medication at a primary clinic. However, his symptoms did not improve after treatment. We performed capsule endoscopy at our hospital and identified a parasite (Ancylostoma duodenale) in the proximal jejunum. We therefore report a case of parasitic infection found by additional examination while evaluating symptoms associated with a previous diagnosis of refractory IBS.
Abdominal Pain ; Ancylostoma ; Ancylostomatoidea ; Capsule Endoscopy ; Diagnosis* ; Diagnosis, Differential ; Humans ; Irritable Bowel Syndrome* ; Jejunum ; Parasites* ; Young Adult

We report an isolated anterior dislocation of the radial head in a 23-year-old man after a fall on the outstretched arm. At the time of the injury, the patient's elbow was in a position of mild flexion and pronation which was suddenly further pronated as he fell down. The radial head was incarcerated by the lateral portion of brachialis muscle, and annular ligament was interposed between capitellum and radial head. Open reduction was performed. During 12 months follow-up, reduction of radial head was well maintained without a limitation of range of motion.
Adult* ; Arm ; Dislocations* ; Elbow ; Follow-Up Studies ; Head* ; Humans ; Ligaments ; Pronation ; Range of Motion, Articular ; Young Adult

Infectious bursal disease virus (IBDV) causes a highly contagious and immunosuppressive disease of chicken. Agar gel immunodiffusion using IBDV antigen extracted from bursa of Fabricius of infected chicken has been used officially for diagnosis of IBDV in Korea. In this study, in order to replace the IBDV whole virus antigen with non-infectious antigen, recombinant VP2 protein (rVP2) of IBDV was produced using recombinant baculovirus expression system. Purified baculovirus-expressed rVP2 was used as an antigen in an agar gel immunodiffusion (AGID). rVP2 antigen precipitated specifically IBDV antibodies. AGID using rVP2 antigen detected anti-IBDV antibodies from 6 dpi to 28 dpi (termination of the experiment) when specific pathogen free chickens were experimentally infected with IBDV 52/70 strain. This was consistent with result by AGID using IBDV antigen, virus neutralization test (VNT) and a commercial ELISA kit (except for one serum). The sensitivity of rVP2 was the same with that of IBDV antigen when field sera (n=324) were tested by AGID. However, AGID using rVP2 antigen detected maternal antibodies from broiler chickens (n=20) on a broiler farm up to 15 days old, although the detection rate of the AGID was relatively low compared to a commercial ELISA kit. Our results indicate that IBDV whole virus antigen from IBDV infected chickens would be replaced with recombinant VP2 protein as an antigen for AGID.
Agar ; Animals ; Antibodies ; Baculoviridae ; Bursa of Fabricius ; Chickens ; Enzyme-Linked Immunosorbent Assay ; Immunodiffusion ; Infectious bursal disease virus ; Korea ; Neutralization Tests ; Specific Pathogen-Free Organisms ; Sprains and Strains ; Staphylococcal Protein A ; Viruses

Infectious bursal disease virus (IBDV) is responsible for a highly contagious disease of poultry causing severe immunosuppression in chickens. A double antibody sandwich ELISA (DAS-ELISA) was developed to detect IBDV from clinical samples. Two kinds of anti-IBDV antibodies, monoclonal antibody R63 and chicken anti-IBDV sera, were used for DAS-ELISA. Detection limit of IBDV by DAS-ELISA was approximately 10(2.7) EID(50)/ml. The DAS-ELISA detected IBDV from most (13/14) of vaccine products including mild, intermediate and intermediate-plus types. The DAS-ELISA also detected IBDV from all (19/19) of field Korean isolates including very virulent and intermediate-plus phenotypes. Our results indicate that the DAS-ELISA would provide useful diagnostic tool to detect IBDV from clinical samples as well as rapid quantitative detection of IBDV.
Antibodies, Monoclonal ; Chickens ; Enzyme-Linked Immunosorbent Assay ; Immunosuppression ; Infectious bursal disease virus ; Limit of Detection ; Phenotype ; Poultry ; Viruses

Endometriosis is a long term, disabling condition and a relatively common disease, affecting 5~15% of the adult female population. Endometriosis of the urinary tract, which occurs mostly bladder or ureter, is rare and accounts for 1 or 2% of cases. However, they may cause hydronephrosis and other serious complications on the involved site. We experienced one case of vesical endometriosis and two cases of ureteral endometriosis, and report these cases with a brief review of the concerned literatures.
Adult ; Endometriosis ; Female ; Humans ; Hydronephrosis ; Ureter ; Urinary Bladder ; Urinary Tract

PURPOSE: This study examined 2-year outcome of consecutive therapy using entecavir (ETV) followed by telbivudine (LdT) in subjects with undetectable hepatitis B virus (HBV) DNA level and normal alanine aminotransferase level after the initial 6 months of ETV treatment. MATERIALS AND METHODS: Sixty subjects were randomized to continue with ETV or switch to LdT. Significant difference in baseline characteristics was not found between the two groups. Persistent HBV DNA level of 20–60 IU/mL in three consecutive samples collected three months apart or singly measured HBV DNA level of >60 IU/mL was defined as virological rebound. RESULTS: During 96 weeks of follow-up, all subjects of the ETV-only group (n=30) resulted in undetectable HBV DNA level. On the other hand, 83.3% (n=25) of the LdT-switched group showed treatment success. Virological rebound time varied from week 24 to 84 after switching to LdT. HBV DNA level was 180 to 2940 IU/mL at rebound time. All subjects with virological rebound (n=5) showed drug-resistant mutation: three had mutation rtM204I, and two had mutation rtM204V. Consecutive treatment using ETV followed by LdT showed virological rebound in 16.7% of subjects during 96 weeks of follow-up. HBV DNA negativity during initial ETV therapy could not be achieved in patients who switched to LdT. CONCLUSION: Consecutive treatment using ETV followed by lamivudine was ineffective for treating chronic hepatitis B. LdT was found as a more potent antiviral agent than lamivudine. However, this conclusion requires larger-scale, long-term prospective reviews of the treatment effects of ETV-LdT switch therapy.
Alanine Transaminase ; DNA ; DNA, Viral* ; Follow-Up Studies ; Hand ; Hepatitis B virus ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Lamivudine ; Prospective Studies