PURPOSE: To evaluate the growth pattern depicted by MR imaging and used to differentiate between uterine cervcal and endometrial carcinoma where the mass involves both the uterine corpus and cervix. MATERIALS AND METHODS: The tumor growth pattern observed on MR images obtained between November 1989 and January in 1999 in 37 of 784 cervical carcinomas and 9 of 47 endometrial carcinomas in which the tumor involved both the uterine corpus and cervix was analysed. The histologic type was squamous (n=29), adenocarcinomatous (n=6) or adenosquamous (n=2) in cervical carcinoma, and carcinomatous (n=8) or adenosquamous (n=1) in endometrial carcinoma. A 1.5-T (Magnetom Vision, Siemens, Germany) and a 2.0-T unit (Spectro-20000, Goldstar, Korea) were used to obtain T1-and T2-weighted axial, T2-weighted sagittal and Gdenhanced images. Tumor involvement of the uterine cervix was classified as either partial(Cp) or total(Ct), and partial involvement(Cp) was subclassified as Cp-n, Cp-x, or Cp-b according to involvement of the endocervix, exocervix or both. Tumors of the uterine corpus were classified as involving the mucosa(U-mu), myometrium(U-my) or serosa(U-se). RESULTS: In 37 cases of cervical carcinoma, all three involving the endocervix(Cp-n) invaded the endometrium(U-mu), three involving both the endo- and exocervix(Cp-b) invaded the endometrium(U-mu, 1 case), myometrium(U-my, 1 case), or serosa(U-se, 1 case), and 31 involving the full-thickness of the uterine cervix(Ct) invaded the endometrium (U-mu, 6 cases) or serosa(U-se, 25 cases). In nine cases of endometrial carcinoma, three involving the endometrium(U-mu) and five involving the myometrium(U-my) invaded the endocervix(Cp-n), and one involving the serosa(U-se) invaded the full-thickness of the uterine cervix(Ct). CONCLUSION: Cervical carcinoma tended to involve the entire cervix and the full thickness of the uterine corpus, but endometrial carcinoma tended to involve the endometrium or myometrium of the uterine corpus and endocervix.
Animals ; Cervix Uteri* ; Endometrial Neoplasms* ; Endometrium ; Female ; Magnetic Resonance Imaging* ; Mice ; Myometrium ; Uterine Neoplasms

PURPOSE: Cyclooxygenase (COX)-2 and matrix metalloproteinase (MMP)-9 play a key role in the pathogenesis of in-stent restenosis. We investigated the effect of a short-term therapy of celecoxib, a COX-2 inhibitor, with or without doxycycline, an MMP inhibitor, after coronary stenting on inflammatory biomarkers and neointimal hyperplasia. MATERIALS AND METHODS: A total of 75 patients (86 lesions) treated with bare metal stents were randomized into three groups: 1) combination therapy (200 mg celecoxib and 20 mg doxycycline, both twice daily), 2) celecoxib (200 mg twice daily) only, and 3) non-therapy control. Celecoxib and doxycycline were administered for 3 weeks after coronary stenting. The primary endpoint was neointimal volume obstruction by intravascular ultrasound (IVUS) at 6 months. The secondary endpoints included clinical outcomes, angiographic data, and changes in blood levels of inflammatory biomarkers. RESULTS: Follow-up IVUS revealed no significant difference in the neointimal volume obstruction among the three treatment groups. There was no difference in cardiac deaths, myocardial infarctions, target lesion revascularization or stent thrombosis among the groups. Blood levels of high-sensitivity C-reactive protein, soluble CD40 ligand, and MMP-9 varied widely 48 hours and 3 weeks after coronary stenting, however, they did not show any significant difference among the groups. CONCLUSION: Our study failed to demonstrate any beneficial effects of the short-term therapy with celecoxib and doxycycline or with celecoxib alone in the suppression of inflammatory biomarkers or in the inhibition of neointimal hyperplasia. Large scale randomized trials are necessary to define the role of anti-inflammatory therapy in the inhibition of neointimal hyperplasia.
Aged ; Angioplasty, Balloon, Coronary ; Anti-Bacterial Agents/therapeutic use ; Biological Markers/metabolism ; Coronary Artery Disease/immunology/metabolism/*therapy ; Cyclooxygenase 2 Inhibitors/therapeutic use ; Doxycycline/*therapeutic use ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Male ; Metals ; Middle Aged ; Neointima/*drug therapy/*immunology/metabolism ; Pyrazoles/*therapeutic use ; Stents/*adverse effects ; Sulfonamides/*therapeutic use

BACKGROUND AND OBJECTIVES: There is a seasonal variation in the incidence of diabetes mellitus and cardiovascular disease. Insulin resistance is important in the development of both non-insulin dependent diabetes mellitus (Type II DM) and cardiovascular disease. Hyperinsulinemia, induced by an insulin resistant state, causes the development of a chronic inflammatory response in vascular structures, which is one of the main causes of cardiovascular disease. There have been several studies on seasonal variation in insulin resistance. Therefore, seasonal variation in insulin resistance were investigated to discover if any relationship existed. SUBJECTS AND METHODS: Korean people examined at a health care center were included. The subjects were divided into four groups, according to the season, and a homeostasis model assessment index (HOMA) calculated, as an indicator of insulin resistance, and compared between the groups. RESULTS: Using the homeostasis model assessment, the highest insulin resistance was observed during winter. Also, the body mass index and waist-hip ratio were highest during winter. CONCLUSION: Compensating for other metabolic factors (age, gender, body mass index, waist-hip ratio and season), insulin resistance was still found to be higher during winter. Seasonal variation in insulin resistance can be associated with the incidence of DM or cardiovascular disease. Therefore, a prospective study will be needed.
Body Mass Index ; Cardiovascular Diseases ; Delivery of Health Care ; Diabetes Mellitus ; Homeostasis ; Hyperinsulinism ; Incidence ; Insulin Resistance* ; Insulin* ; Seasons* ; Waist-Hip Ratio

BACKGROUND AND OBJECTIVES: There is growing evidence that inflammation plays an important role in atherosclerosis and in the elevation of cardiac troponin I (cTnI) after coronary intervention. The aim of this study was to evaluate the relationship between inflammatory markers and the elevation of cTnI after coronary intervention in patients with stable angina. SUBJECTS AND METHODS: Twenty-three patients who underwent successful percutaneous transluminal coronary angioplasty with stent were examined as the subjects. Serial blood samples were obtained for High Sensitivity C-reactive protein (hs-CRP), which served as markers of systemic inflammation, and cTnI. The difference of cTnI before and 24 hours after coronary intervention was defined as the gradient of cTnI. RESULTS: The mean gradient of cTnI was 1.77+/-3.4 ng/mL. The concentrations of baseline and post-procedural hs-CRP were 1.57+/-1.3 mg/L and 6.31+/-3.8 mg/L, respectively (p=0.001). There were no significant differences in the gradient of cTnI with hypertention, diabetes, smoking, and hypercholesterolemia. The variable that significantly correlated with the gradient of cTnI was the baseline hs-CRP (R2=0.374, p=0.048). CONCLUSION: Systemic inflammation correlated with periprocedural elevation of cTnI in stable angina patients. These results suggest that inflammation plays a pivotal role in the predictive value of myocardial injury after coronary intervention.
Angina Pectoris ; Angina, Stable* ; Angioplasty, Balloon, Coronary* ; Atherosclerosis ; C-Reactive Protein ; Humans ; Hypercholesterolemia ; Inflammation* ; Smoke ; Smoking ; Stents* ; Troponin I* ; Troponin*

Background and Objectives: We evaluated the effect of diabetes on the relationship between body mass index (BMI) and clinical outcomes in patients following percutaneous coronary intervention (PCI) with drug-eluting stent implantation. Methods: A total of 6,688 patients who underwent PCI were selected from five different registries led by Korean Multicenter Angioplasty Team. They were categorized according to their BMI into the following groups: underweight (<18.5 kg/m 2 ), normal weight (18.5–24.9 kg/m 2 ), overweight to obese (≥25.0 kg/m 2 ). Major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of death, nonfatal myocardial infarction, stroke, and target-vessel revascularization, were compared according to the BMI categories (underweight, normal and overweight to obese group) and diabetic status. All subjects completed 1-year follow-up. Results: Among the 6,688 patients, 2,561 (38%) had diabetes. The underweight group compared to normal weight group had higher 1-year MACCE rate in both non-diabetic (adjusted hazard ratio [HR], 2.24; 95% confidence interval [CI], 1.04–4.84; p=0.039) and diabetic patients (adjusted HR, 2.86; 95% CI, 1.61–5.07; p<0.001). The overweight to obese group had a lower MACCE rate than the normal weight group in diabetic patients (adjusted HR, 0.67 [0.49–0.93]) but not in non-diabetic patients (adjusted HR, 1.06 [0.77–1.46]), with a significant interaction (p-interaction=0.025). Conclusions Between the underweight and normal weight groups, the association between the BMI and clinical outcomes was consistent regardless of the presence of diabetes.However, better outcomes in overweight to obese over normal weight were observed only in diabetic patients. These results suggest that the association between BMI and clinical outcomes may differ according to the diabetic status.

BACKGROUND AND OBJECTIVES: Recent studies have implicated inflammation as playing an important role in the occurrence, persistence and recurrence of atrial fibrillation and that C-reactive protein is a useful marker of the inflammation. The purpose of this study is to evaluate the association between serum CRP levels and the risk of atrial fibrillation. SUBJECTS AND METHODS: This study was performed on 9,487 subjects (5,263 men and 4,224 women; mean age: 58.8+/-6.6 years) who underwent medical check-ups at the Health Promotion Center in Kanbuk Samsung Hospital. 9,438 normal control subjects and 49 atrial fibrillation patients were included in the study. The CRP was measured using a highly sensitive Behring Nephelometer II. RESULTS: When comparing the two groups, there were significant differences in age, gender and the presence of hypertension and cerebrovascular accident, and these are the previously known risk factors for atrial fibrillation. After adjustment was made for the clinical significant variables of atrial fibrillation, multiple regression analysis revealed that the hsCRP levels were not associated with the risk for atrial fibrillation (p=0.52). CONCLUSION: The inflammatory markers (CRP, WBC count) were not predictive of a higher risk for atrial fibrillation in the Korean population.
Adult* ; Atrial Fibrillation* ; C-Reactive Protein* ; Female ; Health Promotion ; Humans ; Hypertension ; Inflammation ; Male ; Recurrence ; Risk Factors ; Stroke

PURPOSE: Transcatheter aortic valve implantation (TAVI) has become an attractive therapeutic strategy for severe aortic stenosis (AS) in elderly patients due to its minimally-invasive nature. Therefore, early results of its clinical outcomes in elderly Korean patients were evaluated. MATERIALS AND METHODS: We compared early clinical outcomes of TAVI, surgical aortic valve replacement (SAVR), and optimal medical therapy (OMT) in patients aged > or =80 years with symptomatic severe AS. Treatment groups were allocated as follows: TAVI (n=10), SAVR (n=14), and OMT (n=42). RESULTS: Baseline clinical characteristics including predicted operative mortality were similar among the three groups. However, patients with New York Heart Association functional class III or IV symptoms and smaller aortic valve area were treated with TAVI or SAVR rather than OMT. In-hospital combined safety endpoints (all-cause mortality, major stroke, peri-procedural myocardial infarction, life-threatening bleeding, major vascular complication, and acute kidney injury) after TAVI or SAVR were significantly lower in the TAVI group than in the SAVR group (10.0% vs. 71.4%, respectively, p=0.005), along with an acceptable rate of symptom improvement and device success. During the follow-up period, the TAVI group showed the lowest rate of 3-month major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, myocardial infarction, major stroke, and re-hospitalization (TAVI 0.0% vs. SAVR 50.0% vs. OMT 42.9%, p=0.017). CONCLUSION: Treatment with TAVI was associated with lower event rates compared to SAVR or OMT. Therefore, TAVI may be considered as the first therapeutic strategy in selected patients aged > or =80 years with symptomatic severe AS.
Age Factors ; Aged, 80 and over ; Aortic Valve/*surgery ; Aortic Valve Stenosis/diagnosis/*surgery ; Female ; Humans ; Male ; Prognosis ; Risk Factors ; Treatment Outcome

Kawasaki disease (KD) is an acute pediatric vasculitis that affects genetically susceptible infants and children. To identify coding variants that influence susceptibility to KD, we conducted whole exome sequencing of 159 patients with KD and 902 controls, and performed a replication study in an independent 586 cases and 732 controls. We identified five rare coding variants in five genes (FCRLA, PTGER4, IL17F, CARD11, and SIGLEC10) associated with KD (odds ratio [OR], 1.18–4.41; p = 0.0027–0.031). We also performed association analysis in 26 KD patients with coronary artery aneurysms (CAAs; diameter > 5 mm) and 124 patients without CAAs (diameter < 3 mm), and identified another five rare coding variants in five genes (FGFR4, IL31RA, FNDC1, MMP8, and FOXN1), which may be associated with CAA (OR, 3.89–37.3; p = 0.0058–0.0261). These results provide insights into new candidate genes and genetic variants potentially involved in the development of KD and CAA.