We report a cace of 69-year-old man who developed massive pulmonary hemorrhage and subsuquent adult respiratory distress syndrome following intravenous urokinase for acute myocardial infarction. Pulmonary hemorrhage is a rare but a potentially life-threatening complication after thrombolytic therapy and should be considered in the differential diagnosis of pulmonary infiltrates of falling hemoglobin after thrombolytic therapy for acute myocardial infarction with no obvious site of bleeding.
Adult* ; Aged ; Diagnosis, Differential ; Hemorrhage* ; Humans ; Myocardial Infarction* ; Respiratory Distress Syndrome, Adult* ; Thrombolytic Therapy* ; Urokinase-Type Plasminogen Activator

No abstract available.
Chondrogenesis* ; Ear*

No abstract available.
Allopurinol* ; Animals ; Liver* ; Rats* ; Reperfusion Injury* ; Verapamil*

Objective: To observe the effect of amlodipine on bone marrow endothelial progenitor cell (EPC) mobilization, neo-vascularization and cardiac function in diabetic rats after myocardial infarction (MI) with the possible mechanisms.
Methods: A total of 60 male SD rats were divided into 2 groups. Normal group, n=20. Diabetic group, n=40, the rats were fed with high fat diet (HFD) for 4 weeks and then received streptozotocin followed by left anterior descending coronary artery ligation to establish MI model, those rats were further divided into 2 sub-groups:Control group, the rats received sodium carboxymethylcellulose 1 ml/day with HFD and Treatment group, the rats received amlodipine 2 mg/kg/day with HFD, n=20 in each sub-group, all animals were treated for 4 weeks. The EPC level in peripheral blood CD45-/low+/CD133+/KDR+ at before and 1, 3, 5, 7, 14, 28 days after operation were examined by lfow cytometry, plasma vascular endothelial growth factor (VEGF) level was measured by ELISA, capillary density in MI area was determined by CD31 staining, EPC related protein expressions were detected by western blot analysis and the cardiac function was evaluated by echocardiography.
Results: EPC in CD45-/low+/CD133+/KDR+in Treatment group at 7 days after operation was increased than Control group at 5 days after operation (112 ± 30/106) vs (55 ± 10/106), plasma VEGF in Treatment group was higher than Control group (5.63 ± 1.33) ng/L vs (3.68 ± 0.98) ng/L; Treatment group presented increased expressions of protein kinase B, endothelial nitric oxide synthase (eNOS) and matrix metallopeptidase-9, increased capillary density in MI area, higher LVEF and left ventricular fractional shorting, all P<0.05-0.01.
Conclusion: Amlodipine improves EPC mobilization, neo-vascularization and cardiac function in diabetic-MI rats, it may be related to VEGF/eNOS cascade activation.

Primary chondrosarcoma of the extraskeletal soft tissue is extremely rare. Extraskeletal chondrosarcoma was first described as entity in 1953 by Stout and Verner, who were able to collect a series of seven cases. Because of the rarity of this lesion in extremities, neither the clinical course nor the preferred method of treatment has been clearly established. Authors report a case of extraskeletal chondrosarcoma which occurred on the right forearm of a thirty-nine-year-old man. The lesion was completely excised with free resection margins. There was no recurrence or metastasis for four years follow up.
Chondrosarcoma ; Extremities ; Follow-Up Studies ; Forearm ; Methods ; Neoplasm Metastasis ; Recurrence

Opioids are effective analgesics, but they are often difficult to use properly, due mainly to adverse events, such as constipation, respiratory depression, addiction, tolerance, and opioid induced hyperalgesia. In the past, the problem of opioids around the world was usually caused by drugs traded illegally, so there was no need for medical and social attention in Korea. On the other hand, with the dramatic increase in the therapeutic use of opioids, which commenced more than a decade ago, problems caused by legally prescribed drugs have emerged, and now a more serious opioid crisis is being experienced than in the days of illegal drugs. A growing number of patients are chronically prescribed opioids, and a growing number of health care providers and hospitals suffer from problems related to chronic prescription. Currently, in Korea, it is the time to pay serious attention to achieve the safe and effective use of prescribed opioids. This paper consists of the following parts. 1) A summary of the issues related to chronic pain, opioids, and problems associated with the use of opioids. 2) Some case examples the authors' experienced. 3) Simple guidelines on the use of opioids in the treatment of chronic non-cancer pain are proposed based on the author's experience and existing literature. These guidelines are by no means comprehensive, and hopefully in the future, related experts will join forces to develop better guidelines.
Analgesics ; Analgesics, Opioid ; Chronic Pain ; Constipation ; Hand ; Health Personnel ; Humans ; Hyperalgesia ; Korea ; Prescriptions ; Respiratory Insufficiency

Endocrine adrenal tumors are uncommon but clinically significant because they can be managed successfully by surgical therapy. During pregnancy, adrenal tumors can be a cause of death for both mother and baby, unless they diagnoses antenatally and managed properly. To investigate clinical characteristics of endocrine adrenal tumors, we analyzed 26 cases of adrenal tumor diagnosed and managed in Chung Ang Gil Hospital including cases associated with pregnancy and also a rare case of paraganglioma in liver. 1) There were 7 cases of Cushing's syndrome among which two cases were due to Cushing's disease and five cases were due to adrenal adenoma. Six cases were managed successfully by appropriate surgery. Another one case was associated with pregnancy but the patient expired due to sudden development of pulmonary edema and hypotension during preoperative preparation.2) Among 9 cases of primary aldosteronism, 8 cases were aldosterone-producing adenoma(APA) and 1 case was idiopathic hyperaldosteronism(IHA). In differential diagnosis between APA and IHA, diagnostic accuracy of postural study and adrenal CT was 86%, 78% respectively. In each one case of APA and IHA, adrenal venous aldosterone sampling was used for the differential diagnosis. Six cases of APA were managed by appropriate surgery. One patient with APA who refuses surgery and one patient with IHA were placed on spironolactone with good response.3) Among 10 cases of pheochromocytoma, seven cases were from adrenal gland and three cases were paragangliomas including one case originating from liver and two cases from abdominal ganglia. One patient with pheochromocytoma was diagnosed in 1st trimester of pregnancy and she was successfully treated by surgery.We observed 26 cases of endocrine adrenal tumors which were successfully managed except one case. We think that it is important to pay attention to adrenal tumor for early diagnosis particulary when associated with pregnancy. Paraganglioma in liver, although very rare, should be included in the differential diagnosis of space occupying lesion in liver.
Adenoma ; Adrenal Glands ; Aldosterone ; Cause of Death ; Cushing Syndrome ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Ganglia ; Humans ; Hyperaldosteronism ; Hypotension ; Liver ; Mothers ; Paraganglioma ; Pheochromocytoma ; Pregnancy ; Pulmonary Edema ; Spironolactone

The report of aspiration cytologic findings of epithelial-myoepithelial carcinoma(EMC) in the salivary gland is extremely rare. We present a case of fine needle aspiration cytology(FNAC) from EMC in the right submandibular gland of a 46 years old male patient. Neck CT scan revealed a confined lesion in the submandibular gland without enlargement of the regional lymph node. FNAC from the tumor showed several three-dimensional cellular clusters with admixed normal acinar cells. They frequently formed branching tubular structures composed of two type of cells; darker cells having eosinophilic scanty cytoplasm with round dense nuclei and clear cells having abudant pale cytoplasm with vesicular nuclei at the periphery of clusters. The tumor cells of both types did not show pleomorphism or mitoses. The resected submandibular gland showed an ill-defined whitish firm tumor, measuring 2 X1.5X2cm. The histology revealed an infiltrative tumor showing characteristic two cell types in a duct-like arrangement surrounded by thin basement menbrane. An inner layer of darker cells and outer layer of clear cells were postive for cytokeratin in the former and S-100 protein in the latter on the immunohistochemical stain.
Acinar Cells ; Biopsy, Fine-Needle ; Cytoplasm ; Eosinophils ; Humans ; Keratins ; Lymph Nodes ; Male ; Middle Aged ; Mitosis ; Neck ; S100 Proteins ; Salivary Glands* ; Submandibular Gland ; Tomography, X-Ray Computed

The present study was attempted to examine the effect of pituitary adenylate cyclase-activating polypeptide (PACAP) on catecholamine (CA) secretion evoked by cholinergic stimulation, membrane depolarization and calcium mobilization from the isolated perfused rat adrenal gland. The perfusion of PACAP (10 nM) into an adrenal vein for 60 min produced a great inhibition in CA secretion evoked by ACh (5.32 X 10(-3) M), high K+ (5.6 X 10(-2) M), DMPP (10(-4) M for 2 min), McN-A-343 (10(-4) M for 2 min), cyclopiazonic acid (10(-5) M for 4 min) and Bay-K-8644 (10(-5) M for 4 min). Also, in the presence of neuropeptide (NPY), which is known to be co-localized with norepinephrine in peripheral sympathetic nerves, CA secretory responses evoked by ACh, high potassium, DMPP, McN-A-343, Bay-K-8644 and cyclopiazonic acid were also significantly depressed. However, in adrenal glands preloaded with PACAP (10 nM) under the presence of VIP antagonist ((Lys1, Pro2.5, Arg3.4, Tyr6)-VIP (3 micrometer)) for 20 min, CA secretory responses evoked by ACh, high potassium, DMPP, McN-A-343, Bay-K-8644 and cyclopiazonic acid were not altered greatly in comparison to the case of PACAP-treatment only. Taken together, these results suggest that PACAP causes the marked inhibition of CA secretion evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors as well as by membrane depolarization, indicating that this effect may be mediated by inhibiting influx of extracellular calcium and release in intracellular calcium in the rat adrenomedullary chromaffin cells.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; 3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethyl-5-nitro-4-(2-(trifluoromethyl)phenyl)-, Methyl ester ; Adrenal Glands* ; Animals ; Calcium ; Chromaffin Cells ; Dimethylphenylpiperazinium Iodide ; Membranes* ; Neuropeptides ; Norepinephrine ; Perfusion ; Pituitary Adenylate Cyclase-Activating Polypeptide ; Potassium ; Rats* ; Veins

BACKGROUND: Recently, a lower incidence of late potentials has been reported in patients with acute myocardial infarction after successful thrombolysis when compared with conventionally treated patients. In another recent study, however, no significant effect of thrombolytic therapy on any abnormal signal average electrocardiography was found at 13 days after acute myocardial infarction. The present study was designed to determine the prognostic significance of the signal average electrocardiography and to evaluate the possible value of this technique as a noninvasive tool for monitoring of coronary occlusion and reperfusion. METHODS: Signal averaging was performed by using a signal average electrocardiography with bidirectional filterings before coronary artery occlusion, at 5 minutes after coronary occlusion and on reperfusion in 20 cats. Three of them died due to malignant ventricular arrhythmia during reperfusion. In all cats, approximately 250 beats were averaged. All data were analysed at filter frequency 25 to 250Hz, 40 to 250Hz and 80 to 250Hz. The following quantitative high resolutional electrocardiographic variables were calculated by computer : 1) filtered total QRS duration, 2) duration of HFLA(high frequency low amplitude) signals under 40uV, 3) RMS voltage of terminal 40ms, 4) mean Voltage of terminal 40ms, 5) average noise voltage. RESULTS: At the filter frequency of 40 to 250Hz and 80 to 250Hz, the filtered QRS duration and duration of HFLA signals 40uV were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean voltage(terminal 40ms) were significantly prolonged at 5 minutes after coronary artery occlusion than before coronary occlusion(p<0.01, p<0.01 respectively). At the filter frequency of 80 to 250Hz, the filtered QRS duration and at the filter frequency of 25-250Hz, the duration of HFLA signals at 40uV were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.05 respectively). At the filter frequency of 40 to 250Hz and 80 to 250Hz, the RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) were significantly shortened during reperfusion than at 5 minutes after coronary artery occlusion(p<0.01, p<0.01 respectively). There was no significant change of the filtered QRS duration, duration of HFLA signals 40uV,RMS voltage(terminal 40ms) and mean Voltage(terminal 40ms) after reperfusion compared with those of control at the filter frequency of 25 to 250Hz, 40 to 250Hz and 80 to 250Hz respectively. CONCLUSION: These results suggest that the signal average electrocardiography could be a valuable tool for monitoring the state of coronary artery occlusion and reperfusion.
Animals ; Arrhythmias, Cardiac ; Cats* ; Coronary Occlusion ; Coronary Vessels* ; Electrocardiography* ; Humans ; Incidence ; Myocardial Infarction ; Noise ; Reperfusion* ; Thrombolytic Therapy