The lesions of central nervous system in tuberous sclerosis often calcify, especially those present in the perivascular region, allowing the computed tomography to make early and definite diagnosis, even when patients intelligence was normal, seizures were absent, or clinical findings were not specific, We report three cases of tuberous sclerosis, which showed pathognomic subependymal paraventricular calcification in brain CT.
Brain* ; Central Nervous System ; Diagnosis ; Humans ; Intelligence ; Seizures ; Tuberous Sclerosis*

Almost all advanced glomerular diseases have glomerular sclerotic changes to varying degrees whatever causes their primary glomerular disease are. Pathogenesis of these sclerosis has been thought of as the hyperfiltration in the primary glomerulosclerosis due to development of glomerular hypertension in each insulted glomeruli. This background gave the theoretical bases for antihypertensive therapies for supporting chronic renal insufficient patients. Angiotensin converting enzyme (ACE) inhibitor, one of the antihypertensive drugs, has received attention recently for its effectiveness. The aims of this study determined the effects and mechanism of the ACE inhibitor, enalapril, on the glomerulosclerosis in FGS/NgaKist mice, which was an animal model of chronic renal failure by generating spontaneously heavy proteinuria and progressive glomerulosclerosis. Five-week-old FGS/NgaKist mice (n=38) were assigned to four groups. Group 1a (n=6) and group 2a (n=8) fed with a vehicle, were sacrificed at the end of 10 weeks and 15 weeks, respectively. Group 1b (n=12) and 2b (n=12) received enalapril (100 mg/L) in drinking water for 5 weeks and 10 weeks from 6th week of age respectively, and were sacrified on the same day as the control groups. Doses of enanapril were maintained to 2 mg/kg/day by measuring the amount of water consumption. In enalapril groups 1b and 2b, systemic blood pressure (74.7 14.0 mm Hg, 74.3 15.9 mmHg) were significantly lower than control group 2a (116.1 4.6 mmHg, P<0.001). Similarly, degree of proteinuria lowered in enalapril group 2b versus control group 2a (0% and 50.0%, P<0.001). Glomerulosclerosis percentage significantly decreased (P<0.001) (group 1b and 2b; 1.9 6.5, 5.6 7.0 vs control 1a and 2a; 32.8 15.5, 31.4 13.8). Glomerulosclerosis score also decreased (P<0.001) (group 1b and 2b; 0.02 0.08 vs control 1a and 2a; 0.48 0.12, 0.30 0.14). The immunofluorescent staining of enalapril groups showed negative for mesangial deposition of IgG, IgA, IgM, and C3 which were positive in control groups. Immunohistochemical staining with TGF-beta1 was negative in enalapril groups and sclerotic glomeruli both enalapril groups and control groups. These results support that the ACE inhibitor has a renoprotective effect on glomerulosclerosis not only by decreasing the blood pressure but also by suppressing the immune deposits on glomeruli.
Angiotensins* ; Animals ; Antihypertensive Agents ; Blood Pressure ; Drinking ; Drinking Water ; Enalapril ; Humans ; Hypertension ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Kidney Failure, Chronic ; Mice ; Models, Animal ; Peptidyl-Dipeptidase A* ; Proteinuria ; Sclerosis* ; Transforming Growth Factor beta1

Glucocorticoids are usually given according to a standard dosing protocol regardless of individual difference. We evaluated the pharmacokinetic characteristics of methylprednisolone and the degree of interpatient variation in stable Korean renal transplant recipients during the period of 15-21 days after transplantation. This study included 23 renal transplant recipients, 13 males and 10 females, who received kidneys from living donors with stable graft function and without episode of acute rejection. On the study day at 8 A.M., 16.3mg of ethylprednisolone sodium succinate (i.v.) was administered to each patient instead of usual dose (20mg) of prednisolone (p.o.) after sampling of 7cc of baseline blood and additional blood samples were drawn after starting infusion. Plasma was separated and analyzed for methylprednisolone level using high performance liquid chromatography (HPLC) assay, and parameters for pharmacokinetics were calculated. There was significant interpatient variation in the pharmacokinetics of methylprednisolone in our patients group. There was no significant difference in the pharmacokinetic parameters between patients with and without side effects of steroid. Korean renal transplant recipients had higher volume of distribution than black renal transplant recipients; lower clearance than white renal transplant recipients; longer t1/2 than both black and white renal transplant recipients. Even if the number of patients included in this study was too small to reach conclusion, the differences in the pharmacokinetics of glucocorticoids do not seem to be a significant risk factor for side effects of steroid after transplantation. It may be necessary to individualize the dose of a glucocorticoid to achieve an optimal effect and also we need to establish a new steroid regimen protocol for Korean renal transplant recipients.
Chromatography, Liquid ; Female ; Glucocorticoids ; Humans ; Individuality ; Kidney ; Kidney Transplantation ; Living Donors ; Male ; Methylprednisolone* ; Pharmacokinetics ; Plasma ; Prednisolone ; Risk Factors ; Sodium ; Succinic Acid ; Transplantation* ; Transplants

BACKGROUND AND OBJECTIVES: Most reports about coronary angiographic findings in acute myocardial infarction were done after thrombolytic therapy or several days after onset of symptom. The aim of this study is to evaluate coronary angiographic findings in patients with AMI within 24 hours after onset of symptoms and without thrombolytic therapy. Also we evaluated the correlation between the risk factors and severity of coronary artery disease. MATERIALS AND METHODS: We studied 70 patients with acute myocardial infarction admitted to Kyungpook National University Hospital (KNUH) from November 1997 to January 1999, and evaluated the clincial and coronary angiographic findings. We analyzed risk factors of coronary artery disease: age, total cholesterol, tiglyceride, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, hypertension, smoking, diabetes and family history of CAD. Coronary angiography was done immediately after the arrival at emergency room (door-to- angiography time). Exclusion criteria were delayed arrival (more than 24 hours after symptom onset), previous history of anticoagulation or medication of antiplatelet agents. RESULTS: 1) Among 70 patients (M/F: 53/17), 59 patients had Q wave myocardial infarction (QMI) (84%), 11 patients had non-Q wave-MI (NQMI) (16%). 2) The mean age was 61+/-12.2 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to angiography was 6.2+/-4.7 hours. 4) Twenty eight patients (40%) had one-vessel disease, 25 (36%) had two-vessel disease and 17 (24%) had three-vessel disease. 5) The location of infarct related arteries were as follows: LAD in 33 (47%), LCX in 13 (19%) and RCA in 24 (34%). 6) The mean diameter stenosis of infarct related artery (IRA) was 95+/-10.9%. According to the American College of Cardiology/American Heart Association (ACC/AHA) classification of IRA, type B lesion occurred most commonly in 56 patients (80%). 7) Thrombus was observed in 44 patients (63%) with QMI versus 3 patients (27%) with NQMI (p=0.006). 8) Calcifications of the wall of coronary arteries were observed in 28 patients (40%) and correlated with ages of patients. 9) History of cigarette smoking was present in 73%, hypertension in 31% and hypercholesterolemia in 15% of patients. The mean number of risk factor for each patient was 1.3. 10) Multivessel disease was significantly more frequent in patients who had two more risk factors. 11) The frequency of cigarette smoking was greater and the level of plasma triglyceride were higher in patients under 50 years of age. 12) One patient died during coronary angiography and another 2 patients died at 5 and 8 days after coronary angiography due to cardigenic shock. CONCLUSION: In immediate coronary angiographic findings in patients with AMI, multivessel disease and thrombus, and severe stenosis of IRA were observed more frequently than other studies after thrombolytic therapy or after several days of delay. Multivessel disease was significantly more frequent in the patients who had two or more risk factors of atherosclerosis.
Angiography ; Arteries ; Atherosclerosis ; Chest Pain ; Cholesterol ; Classification ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Emergency Service, Hospital ; Gyeongsangbuk-do ; Heart ; Humans ; Hypercholesterolemia ; Hypertension ; Lipoproteins ; Myocardial Infarction* ; Plasma ; Platelet Aggregation Inhibitors ; Risk Factors ; Shock ; Smoke ; Smoking ; Thrombolytic Therapy ; Thrombosis ; Triglycerides

BACKGROUND AND OBJECTIVES: The intracoronary stent may be useful in the preventing of abrupt closure and coronary restenosis after coronary angioplasty, and recently primary stenting has been one of therapeutic modalities. We assessed the clinical and angiographic results of primary NIR stenting in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: Between November 1997 to January 1999, 55 stentings with NIR stents were done in 51 patients with acute myocardial infarction. Angiographic follow-up was available at 7+/-2.3 days in 35 patients. RESULTS: 1) Among 51 patients (M/F: 37/14), 44 patients had Q-wave MI (86%), 7 patients had non-Q-wave MI (14%). 2) The mean age was 61+/-12.4 years (range: 26 to 82 years). 3) The mean time from the onset of chest pain to the arrival at emergency room was 4.6 +/- 4.2 hours. The mean door-to-balloon time was 93+/-46 minutes 4) Treated vessels were as follows: 28 in LAD, 17 in RCA, 10 in LCX. 5) The indications for stent implantation were suboptimal angiographic results after PTCA in 38 lesions (69%), dissection in 9 lesions (16%), abrupt vessel closure in 1 lesion and elective in 7 lesions (13%). 6) Single stent implantation was done in 47 patients. Overlapping stents were done in 4 patients. 7) A procedure related complication occurred in one patient, peri-stent dissection without flow limitation. 8) Full expansion of the stent failed in three lesions with coronary calcifications and the residual stenosis was 35, 40, 50% in each case. In these cases, in-stent thrombus was not demonstrated in follow up angiography. 9) The minimal lumen diameter increased from 0.11+/-0.39 to 2.96+/-0.40 mm. 10) Angiographic follow-up on 38 stents in 35 patients demonstrated in-stent thrombus in 3 stents, in-stent restenosis in 1 stent. But in-stent flow limitations were not found in these 4 cases and TIMI III flow were maintained. Patients with Q-wave MI and coronary thrombus on initial angiography were more prone to subacute thrombosis. CONCLUSION: The NIR stent could be used successfully in primary coronary stenting in acute myocardial infarction. The present study shows relatively low risk of subacute stent thrombosis. The rate of restenosis needs to be confirmed by long term study.
Angiography ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Restenosis ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Stents* ; Thrombosis

BACKGROUND: Considering that both humoral and cell mediated immunities play an important role for human tuberculosis infection, enzyme-linked immunosorbent assay(ELISA) measurement of immunoglobulin G (IgG) antibody to mycobacterial antigens can be used for the serologic diagnosis of tuberculous pleural effusion. METHOD: We measured absorbance values of IgG antibodies to purified-protein-derivative (PPD) and lipoarabinomannan-B (LAM-B) in the pleural fluid (PF) and the serum in 40 tuberculous (TPE) and 19 nontuberculous pleural effusions (NTPE). RESULTS: 1) The IgG antibodies to PPD and LAM-B were significantly (P<0.0005) higher in the PF and the serum of TPE compared to NTPE. 2) The IgG antibodies to PPD and LAM-B in the serum were higher than that in PF. 3) Significant correlations were found between pleural and serum IgG antibodies to PPD and LAM-B. 4) With a cutoff value for IgG antibody to PPD in the PF of 0.091, sensitivity was 55.0% and specificity 94.7% in the diagnosis of TPE. 5) With a cutoff value for IgG antibody to LAM-B in the PF of 0.337, sensitivity was 50.0% and specificity 94.7% in the diagnosis of TPE. 6) The seropositive rates in TPE were not related to PPD skin test status, the amount of PF and coexisting active pulmonary tuberculosis. CONCLUSION: The assay of IgG antibodies to PPD and LAM-B might be useful for the diagnosis of TPE. Our study suggests the mechanism of passive transfer of IgG antibodies to PPD and LAM-B from the serum to the PF through pleural tissue.
Antibodies* ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Humans ; Immunoglobulin G ; Pleural Effusion* ; Sensitivity and Specificity ; Skin Tests ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: To review the outcomes of surgical treatment for superficial peroneal nerve entrapment. MATERIALS AND METHODS: Ultrasonogram was used for diagnosis and surgical treatment. Seven superficial peroneal nerve entrapment were surgically treated with follow up of average 16 months (range, 6~29 months). Three patients were male and four patients were female with mean age 36.7 years (range, 19~51 years). Four cases developed after repetitive ankle sprain and three cases had no etiology. RESULTS: Operation was performed mini-open and subcutaneous fasciotomy under local anesthesia. The results were excellent in two cases, good in four cases, fair in one case. CONCLUSION: Ultrasonogram was useful for diagnosis and surgical treatment of superficial peroneal nerve entrapment syndrome.
Anesthesia, Local ; Animals ; Ankle ; Female ; Follow-Up Studies ; Humans ; Male ; Peroneal Nerve ; Sprains and Strains

BACKGROUND: The combination of local anesthetics and opioids in the spinal anesthesia has a synergic analgesic effect. Therefore, we compared intraoperative conditions and clinical effects of low dose (5 mg) bupivacaine added with fentanyl versus a conventional dose(10 mg) of bupivacaine in spinal anesthesia for a transurethral resection of the prostate (TURP). METHODS: Forty five ASA class 1 and 2 patients scheduled for a TURP were randomly divided into three groups. Group B (n = 15) received bupivacaine 10 mg, group BF (n = 15) received bupivacaine 5 mg added with fentanyl 20microgram, and group BFE received bupivacaine 5 mg added with fentanyl 20microgram and 0.2 mg epinephrine. Blood pressure and heart rate were recorded every 5 minutes before and after spinal anesthesia. Sensory blockade was measured by a pin-prick test and motor blockade was evaluated by the Bromage motor scale. Side effects including pruritus, nausea, vomiting, respiratory depression, and intraoperative pain were observed. RESULTS: The duration of sensory and motor blockade in group BF was significantly shorter than in group B and group BFE (P<0.05). Without statistical significance, hypotension (6.7%) and bradycardia (13.3%) were observed in group B and pruritus (26.7%) and nausea (13.3%) occurred in all patients who received fentanyl. CONCLUSIONS: The addition of fentanyl 20microgram to low dose bupivacaine 5 mg resulted in short lasting motor and sensory block, compared with conventional dose bupivacaine 10 mg. Therefore, we concluded that the clinical application of this method could provide adequate analgesia with early discharge and no serious side effects for TURP patients.
Analgesia ; Analgesics, Opioid ; Anesthesia, Spinal* ; Anesthetics, Local ; Blood Pressure ; Bradycardia ; Bupivacaine* ; Epinephrine ; Fentanyl* ; Heart Rate ; Humans ; Hypotension ; Nausea ; Prostate* ; Pruritus ; Respiratory Insufficiency ; Transurethral Resection of Prostate ; Vomiting

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

BACKGROUND: The ability of the body to maintain its temperature is evidently decreased in patients with thermal injury. The aim of this study is was to evaluate the effect of inhaled sevoflurane and intravenous propofol with remifentanil on core body temperature in burn patients. METHODS: Sixty patients scheduled for burn surgery were divided into 4 groups. Within the major burn patients, intravenous propofol and remifentanil group (group I) followed by a continuous infusion of propofol and remifentanil. In inhaled sevoflurane group (group II), propofol 2mg/kg was given intravenously over 10 seconds as a single bolus and was maintained with nitrous oxide and oxygen and 2-2.5% sevoflurane. In minor burn patients, the intravenous propofol and remifentanil group (group III) and inhaled sevoflurane group (group IV) were treated in the same manner. After induction of anesthesia, esophageal stethoscope was placed to monitor the core temperature every five minutes in all patients. RESULTS: During operation, the core temperature of major burn patients was about 0.7-1.0 degreesC greater than that of minor burn patients. Until 95 minutes after induction of anesthesia, this difference showed statistical significant. However, there was no statistical significance after 100 minutes (P < 0.05). There were no statistically significant differences between group I and group II and group III and group IV for burn patients as well. CONCLUSIONS: Compared to minor burn patients, the core temperature of major burn patients was greater, and anesthetics type and administration route during operation had no effect on the core temperature in these patients.
Anesthesia ; Anesthetics ; Body Temperature ; Burns ; Humans ; Methyl Ethers ; Nitrous Oxide ; Organothiophosphorus Compounds ; Oxygen ; Piperidines ; Propofol ; Stethoscopes