Laryngeal involvement in systemic lupus erythematosus (SLE) is rare. It can range from mild ulcerations, vocal cord paralysis, and edema to necrotizing vasculitis with airway obstruction. The causes of vocal cord paralysis included vasculitis of the vasa nervorum, neuritis, thromboembolic effect on recurrent laryngeal nerves, and compression of the left recurrent laryngeal nerve by an enlarged left pulmonary artery. Few cases on the association of vocal cord palsy and pulmonary hypertension in SLE patient have been reported. We report a case of left vocal cord palsy and pulmonary hypertension in a patient with SLE who experienced improvement of vocal cord palsy and dyspnea after steroid pulse therapy.
Airway Obstruction ; Dyspnea ; Edema ; Humans ; Hypertension, Pulmonary* ; Lupus Erythematosus, Systemic* ; Neuritis ; Pulmonary Artery ; Recurrent Laryngeal Nerve ; Ulcer ; Vasa Nervorum ; Vasculitis ; Vocal Cord Paralysis* ; Vocal Cords*

BACKGROUND: The autonomic nervous control of the cardiovascular system has been thought to have a diurnal variation in its activity. This variation could be an important underlying mechanism for the circardian distribution of cardiac events such as angina pectoris attack, transient myocardial ischemia, and some arrhythmia. The vagal cardiac function is commonly impaired in patients with coronary artery disease. Recently, an assessment of parasympathetic and sympathetic activities is now possible using neart rate spectral analysis. The spectral density of R-R interval variability contains two major components, high frequency (HF) power spectral density (<0.25Hz) and low frequency (LF) power spectral density (<0.15Hz), which have magnitudes that are quantitative markers of cardiac vagal activity and sympathetic activity with vagal modulation, respectively. METHODS: We analyzed the spectral components of R-R interval variability from 24 hour ambulatory holter monitoring in 20 controls and 20 patients with angina pectoris. The patients had no clinical evidence of hypertension, acute myocardial infarction, heart failure, arrhythmia or diabetes mellitus. Recording continued for 24 hours while the subject undertook his normal work and leisure activities. For power spectral analysis, 1024 hours beats was sampled at early morning, afternoon, evening and during sleeping. RESULTS: The spectral component of R-R interval variability was unaffected by the time of day during the waking period, althought a significant decrease in LFCCV and HFCCV was observed during sleeping in controls(p<0.001). In comparison of two groups, patients with angina pectoris showed markedly diminished HFCCV values during waking period except during sleeping period. The R-R interval and LF/HFCCV and LF/HFCCV ratio at transient ischemic attack in patients with angina pectoris. CONCLUSION: Autonomic cardiac control during the waking period shows little variation with the time of day in both groups. We observed that vagal cardiac function was reduced in patients with coronary artery disease by heart rate spectral analysis. It is suggested that ischemic changes in patients with coronary artery disease underlying reduced vagal cardiac function is associated with increased sympathetic activity.
Angina Pectoris* ; Arrhythmias, Cardiac ; Cardiovascular System ; Coronary Artery Disease ; Diabetes Mellitus ; Electrocardiography, Ambulatory ; Heart Failure ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Ischemic Attack, Transient ; Leisure Activities ; Myocardial Infarction ; Myocardial Ischemia

Functional paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system that causes symptoms and signs of episodic catecholamine release. It has not been reported in Korea. We experienced a case of a 17 years old man with a history of diaphoresis and paroxysmal hypertension refractory to therapy since 14 years old. Urinary execretion of catecholamine and its metabolites were elevated. Computed tomography(CT) scan revealed high density mass located on the posterior mediastinum in the area of the right fifth intercostal space. At thoracotomy, a 3X3X4cm sized lesion was resected and confirmed as a paraganglioma.
Adolescent ; Humans ; Hypertension* ; Korea ; Mediastinum* ; Paraganglioma* ; Pheochromocytoma ; Thoracotomy

PURPOSE: The appropriate management of traumatic truncal arterial injury is often difficult to determine, particularly if the injury is associated with severe additional truncal lesions. The timing of repair is controversial when patients arrive alive at the hospital. Also, there is an argument about surgery versus stent-graft repair. This study's objective was to evaluate the appropriate method and the timing for treatment in cases of truncal abdominal injury associated with other abdominal lesions. Methods: The medical records at Ajou University Medical Center were reviewed for an 8-year period from January 1, 2001, to December 31, 2008. Twelve consecutive patients, who were diagnosed as having had a traumatic truncal arterial injury, were enrolled in our study. Patients who were dead before arriving at the hospital or were not associated with abdominal organ injury, were excluded. All patients involved were managed by using the ATLS (Advanced Trauma Life Support) guideline. Data on injury site, the timing and treatment method of repair, the overall complications, and the survival rate were collected and analyzed. RESULTS: Every case showed a severe injury of more than 15 point on the ISS (injury severity score) scale. The male-to-female ratio was 9:3, and patients were 41 years old on the average. Sites of associated organ injury were the lung, spleen, bowel, liver, pelvic bone, kidney, heart, vertebra, pancreas, and diaphragm ordered from high frequency to lower frequency. There were 11 cases of surgery, and one case of conservative treatment. Two of the patients died after surgery for truncal organ injury: one from excessive bleeding after surgery and the other from multiple organ failure. Arterial injuries were diagnosed by using computed tomography in every case and 9 patients were treated by using an angiographic stent-graft repair. There were 3 patients whose vessels were normal on admission. Several weeks later, they were diagnosed as having a truncal arterial injury. CONCLUSION: In stable rupture of the truncal artery, initial conservative management is safe and allows management of the major associated lesions. Stent grafting of the truncal artery is a valuable therapeutic alternative to surgical repair, especially in patients considered to be a high risk for a conventional horacotomy.
Abdominal Injuries ; Academic Medical Centers ; Arteries ; Diaphragm ; Heart ; Hemorrhage ; Humans ; Kidney ; Liver ; Lung ; Medical Records ; Multiple Organ Failure ; Pancreas ; Pelvic Bones ; Rupture ; Spine ; Spleen ; Stents ; Survival Rate ; Transplants

The present work is the first joint epidermiological study of contact dermatitis carried out by the Korean Contact Dermatitis Research Group which was organized in 15i8p. For the past 2 years total 937 patients with contact dermatitie and suspected contact dermatitis have been routinely patch tested with Hollister-Stier standard battery (28 different antigens) by using Finn Chamber at 10 different General Hospitals which were located around Seoul area. The MOHL index was quite different from the western data, which was characterized with less male, rare leg ulcer and less occupational cases. However, housewife hand eczema cases were more common. The most common senaitiaers were ammoniated mercury, nickel sulfate, potassium dichromate, cinnamic alcohol, neomycin sulfate, paraphenylendiamine, balsam of Peru and thimerosal in order of frequency.
Dermatitis, Contact* ; Eczema ; Epidemiology ; Hand ; Hospitals, General ; Humans ; Joints ; Leg Ulcer ; Male ; Neomycin ; Nickel ; Patch Tests ; Peru ; Potassium Dichromate ; Seoul ; Thimerosal

PURPOSE: The aim of this study was to compare the distribution and risk from hand positions applied at the center of the chest (CoC) versus the inter-nipple line (INL) during external chest compression by novice rescuers. METHODS: This simulation study included 105 participants. The participants were given photographs of the unexposed male chest and asked to mark a cross at the center of the chest and at the midpoint of the inter-nipple line. The range of contact with the chest was estimated by measuring the participants' palm width. The median and distribution of the two points were then compared and analyzed to determine whether the range in contact with the chest involved the xiphoid process. RESULTS: The level of the INL was approximately 0.8 cm higher at the sternum than the CoC (p<0.001), while the standard deviation of the CoC [1.8(0.6-3.8)] was higher than that of the INL [1.2(0.4-2.4)] (p<0.001). There were more cases in which the palm range involved the xiphoid process in the CoC group [15(14.3%)] than the INL group [1(0.9%)] (p<0.001). CONCLUSION: For male adult patients, chest compression at the level of the INL by novice rescuers is safer and more intensive than compression at the level of the CoC.
Adult ; Cardiopulmonary Resuscitation ; Hand ; Heart Massage ; Humans ; Male ; Nipples ; Sternum ; Thorax* ; Xiphoid Bone

PURPOSE: To investigate the effects of transglutaminase in the environment of extracellular matrix on perichondrocyte in alginate culture. MATERIALS AND METHODS: Perichondrocyte cells were isolated from articular cartilage of New Zealand white rabbits by enzymatic digestion and maintained in monolayer culture. After 7 days, the cells were trypsinized and cultured in an alginate bead system. Four groups of the alginate beads were prepared as follow: containing 1 mg/ml of transglutaminase, 10 microgram/ml of fibronectin, mixture of 1mg/ml of TGase and 10 microgram/ml of fibronectin and only perichondrocytes as a control group. Cell proliferation was measure by [Methyl-3H] Thymidine uptake, and proteoglycan synthesis was measure by [35S] Sulfate uptake. The gene expression of integrin-alpha5, integrin-beta1 and type II collagen was analyzed by reverse transcription-polymerase chain reaction. Safranin-O staining was utilized for histological assessment of proteoglycan in extracellular matrix. One-way ANOVA was used to analyze the results statistically. RESULTS: Mixture of transglutaminase and fibronectin exhibited high synthesis rates of proteoglycan and active cell proliferation compared with other groups. The gene expression of type II collagen did not show significant difference between groups. The gene expression of integrin-alpha5 was down-regulated in all groups with time. The gene expression of integrin-beta1 was not down-regulated with time only in mixture of transglutaminase and fibronectin. Histological staining of the secretions by Safranin-O staining was in agreement with the data of proteoglycan synthesis, and Safranin-O staining showed that more cell-to-cell aggregates is developed in the mixture of transglutaminase and fibronectin. CONCLUSION: Mixture of transglutaminase and fibronectin can stimulate chondrocyte proliferation and proteoglycan synthesis, and integrin seems to modulate such interactions.
Cartilage, Articular ; Cell Proliferation ; Chondrocytes ; Collagen Type II ; Digestion ; Extracellular Matrix ; Fibronectins ; Gene Expression ; Proteoglycans ; Rabbits ; Thymidine ; Trypsin

We examined whether apigenin affects the gene expression, secretion and activity of matrix metalloproteinase-3 (MMP-3) in primary cultured rabbit articular chondrocytes, as well as in vivo production of MMP-3 in the knee joint of rat to evaluate the potential chondroprotective effects of apigenin. Rabbit articular chondrocytes were cultured in a monolayer, and reverse transcription - polymerase chain reaction (RT-PCR) was used to measure interleukin-1β (IL-1β)-induced expression of MMP-3, MMP-1, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), and ADAMTS-5. In rabbit articular chondrocytes, the effects of apigenin on IL-1β-induced secretion and proteolytic activity of MMP-3 were investigated using western blot analysis and casein zymography, respectively. The effect of apigenin on MMP-3 protein production was also examined in vivo. In rabbit articular chondrocytes, apigenin inhibited the gene expression of MMP-3, MMP-1, MMP-13, ADAMTS-4, and ADAMTS-5. Furthermore, apigenin inhibited the secretion and proteolytic activity of MMP-3 in vitro, and inhibited production of MMP-3 protein in vivo. These results suggest that apigenin can regulate the gene expression, secretion, and activity of MMP-3, by directly acting on articular chondrocytes.
Animals ; Apigenin* ; Blotting, Western ; Caseins ; Chondrocytes* ; Gene Expression ; Knee Joint* ; Knee* ; Osteoarthritis ; Polymerase Chain Reaction ; Rats* ; Reverse Transcription ; Thrombospondins

The throat swabs obtained from 1,098 adults and 432 children patients with respiratory diseases were examined for Mycoplasma pneumoniae infection detected by culture and polymerase chain reaction (PCR). Antimicrobial susceptibilities of the resulting 60 M. pneumoniae isolates were evaluated by testing minimum inhibitory concentrations (MICs) of erythromycin, minocycline, tetracycline, josamycin, sparfloxacin, ofloxacin, and ciprofloxacin by a broth micro-dilution method. In a preliminary screening, the detection rate of M. pneumoniae by PCR was 29.2% (277/948) for the adults and 28.3% (90/318) for the children. In the second survey, the isolation rate of M. pneumoniae by culture was 29.3% (44/150) for the adults, and 14.0% (16/114) for the children. The PCR detection rate was 36.7% (55/150) for the adults and 23.7% (27/114) for the children. The MIC90s of the M. pneumoniae isolates were 0.015 mg/ml for erythromycin, lower than 0.03 mg/ml for josamycin, 0.06 mg/ml for sparfloxacin and minocycline, 0.12 mg/ml for tetracycline, 0.5 mg/ml for ofloxacin and CFC-222, and 1.0 mg/ml for ciprofloxacin. The isolates were susceptible to erythromycin, josamycin, sparfloxacin, minocycline, tetracycline, and ofloxacin, but the 63.3% of them was resistant to ciprofloxacin. These results indicate that the PCR method has a significant potential as a rapid and sensitive method for early detection of M. pneumoniae infection in clinical specimens as compared with the culture method, but the PCR method could not provide any information concerning the biological chracteristics of M. pneumoniae strains. Erythromycin, josamycin, sparfloxacin, minocycline, and tetracycline could be recommended as the antimicrobial agents of choice in Korea.
Adult ; Anti-Infective Agents ; Child ; Ciprofloxacin ; Erythromycin ; Humans ; Josamycin ; Korea ; Mass Screening ; Microbial Sensitivity Tests ; Minocycline ; Mycoplasma pneumoniae* ; Mycoplasma* ; Ofloxacin ; Pharynx ; Pneumonia* ; Pneumonia, Mycoplasma* ; Polymerase Chain Reaction ; Tetracycline

The frequency distribution of cardiovascular disease are changing recently due to the development of living environment. Unfortunately there are few epidemiological studies of cardiovascular diseases in general population, we tried to estimate the recent trend of cardiovascular diseases studying hospitalized patients in nationwide 13 large hospitals during a year of 1985. The hypertensive disease (24.1%) was the most common cardiovascular disease and the next were cerebrovascular disease (15.8%), arrhythmias (12.2%), ischemic heart disease (9.7%), congenital heart disease (9.1%), and rheumatic heart disease (5.4%) in order. This results showed that hypertensive disease and cerebrovascular disease are still the major cardiovascular disease and ischemic heart disease and arrhythmias are increased. But chronic rheumatic heart disease is declined compared with previous studies in hospitalized patients.
Adolescent ; Adult ; Aged ; Cardiovascular Diseases/*epidemiology ; Coronary Disease/*epidemiology ; Female ; Humans ; Korea ; Male ; Middle Aged ; Rheumatic Heart Disease/*epidemiology