BACKGROUND: Systemic arterial hypotension is relatively common following initiation of cardiopulmonary bypass (CPB). Decreased blood viscosity is induced by acute normovolemic hemodilution (ANH) and by the use of crystalloid oxygenator prime. The purpose of this paper is to study the effect of ANH on mean arterial pressure, perfusion flow index and PaO2/FiO2 upon initiation of CPB, and on homologous blood usage during CPB in coronary artery bypass grafting (CABG) surgery. METHODS: We reviewed 30 patients constituting an ANH group, and 30 patients in a control group who had undergone CABG surgery within the past 2 years. In the ANH group, 1 or 2 units of fresh autologous whole blood were sequestrated following induction of anesthesia. We compared mean arterial pressure, perfusion flow index, PaO2/FiO2, and hematocrit on the initiation of CPB, and homologous blood usage during and post CPB periods between the groups. RESULTS: Upon initiation of CPB, hematocrit in the ANH group was significantly less than in the control group, but there was no significant difference in mean arterial pressure, perfusion flow index or PaO2/FiO2 between the groups. The use of homologous blood during CPB in the ANH group was not significantly higher than in the control group. CONCLUSIONS: Acute intraoperative normovolemic hemodilution in CABG surgery was safely performed without significant hypotension and increased homologous blood usage during CPB.
Anesthesia ; Arterial Pressure ; Blood Viscosity ; Cardiopulmonary Bypass* ; Coronary Artery Bypass* ; Coronary Vessels* ; Hematocrit ; Hemodilution* ; Humans ; Hypotension ; Oxygen ; Oxygenators ; Perfusion

3-Deazaadenosine (DZA), one of the potent inhibitors of S-adenosylhomocysteine hydrolase, is known to possess several biological properties including an induction of apoptosis. To evaluate a possibility that DZA may be utilized for the treatment of human leukemia, we studied molecular events of cell death induced by DZA in human leukemia HL-60 and U-937 cells. DZA induced a specific cleavage of poly ADP-ribose polymerase (PARP) and an activation of the cysteine protease caspase-3/CPP32 which is known to cleave PARP. DZA-mediated nuclear DNA-fragmentation was completely blocked in the presence of a universal inhibitor of caspases (z-VAD-fmk) or the specific inhibitor of caspase-3 (z-DEVD-fmk) unlike of cycloheximide (CHX). DNA fragmentation was preceded by the lowering of c-myc mRNA in the DZA treated cells. In addition, DZA-induced apoptosis was blocked by pretreatment with adenosine transporter inhibitors such as nitrobenzylthioinosine (NBTI) and dipyridamole (DPD). Taken together, these results demonstrate that DZA-induced apoptosis initiated through an active transport of DZA into human leukemia cells, is dependent on the caspase-3-like activity without de novo synthesis of proteins and possibly involves c-myc down-regulation.
Adenosine/metabolism ; *Apoptosis ; Biological Transport, Active ; Carrier Proteins/metabolism ; Caspases/*metabolism ; Down-Regulation ; Enzyme Activation ; Genes, myc ; HL-60 Cells ; Human ; Leukemia, Promyelocytic, Acute/*drug therapy ; Thioinosine/*analogs & derivatives/pharmacology ; Transcription Factors/genetics ; Tubercidin/*pharmacology ; U937 Cells

For the treatment of coarction of aorta, surgical intervention has been known as a standard therapy.During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient beween ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation (2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angioplasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angioplasty for coarctation of aorta is the first case reported in Korea.
Adolescent ; Adult* ; Aneurysm ; Angioplasty ; Angioplasty, Balloon* ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Blood Pressure ; Child ; Dilatation ; Emergency Service, Hospital ; Femoral Artery ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Infant ; Korea ; Subclavian Artery ; Upper Extremity ; Young Adult

BACKGROUND: Early reperfusion therapy with thrombolytic agents or primary PTCA is most important to salvage ischemic myocardium in acute myocardial infarction(AMI). Timely reperfusion of jeopardized myocardium clearly improves hemodynamics, decreases infarct size and improves survival. The extent of protection appears to be directly related to the rapidity of reperfusion after onset of coronary occlusion. Although the intravenous thrombolysis is a feasible therapy in the patients with evolving AMI, the benifit of thrombolytic therapy decreases because of the time delay after onset of symptom. This study was perfomed to analyze the factors time delay between onset of symptom and the thrombolytic therapy with retrospective and prospective questionaire in the patients with AMI. METHOD: Eighty one patients with AMI were included in this study who came to the emergency room(ER) of Chungnam National University Hospital(CNUH) from Feburary 1995 to October 1996. Delay between door and thrombolytic therapy was defined as hospital time delay. RESULTS: Thrombolytic therapy(rt-PA or urokinase iv) was done in 60 patients(74.1%) and mean prehopital time delay was significantly decreased in the patients with thrombolytic therpapy when compared with those without thormbolytic threapy(462+/-90 vs 1375+/-473 minutes, p=0.005). There were no singificant factors for prehospital time delay such as age, sex, redsidence, ER near residence, transfer time to ER near residence, family status, family history of AMI, severity of chest pain, presence of risk factors of cardiovascular disease(CVD), previous CVD, degree of education, history of other disease and routine check, transfer methods. The only 8 patients(9.8%) knew about AMI and 7 patients among these patient came to ER earlier and received thrombolytic therapy. From 57 referred patients, 40 patients(70.2%) received reperfusion therapy and only 30 patients(52.6%) had recored EKG in the referred hospital. In the analysis of hospital delay from patient's arrival to the thrombolytic therapy, the arrival time at weekdays and weekend had no differences, but hospital delay were significantly prolonged when patients arrived at ER in the night. CONCLUSION: Since prehospital time delay is a most important factor of time delay for the effective thrombolytic therapy in AMI, the pubic education program and effective transport system are needed. And routine record of EKG in patient with chest pain in the local hospital is very helpful to start effective thromolytic therapy at ER. The well designed prospective study with more patinets in our local region is essential to get more accurate information about transport system and to improve survival rate in patients with AMI.
Chest Pain ; Chungcheongnam-do ; Coronary Occlusion ; Education ; Electrocardiography ; Emergencies ; Fibrinolytic Agents ; Hemodynamics ; Humans ; Myocardial Infarction* ; Myocardium ; Prospective Studies ; Reperfusion ; Retrospective Studies ; Risk Factors ; Survival Rate ; Thrombolytic Therapy* ; Urokinase-Type Plasminogen Activator

Cyclopentenone prostaglandins (PGs) have antiproliferative activity on various tumor cell growth in vitro. Particularly, 9-deoxy-(9,12)-13,14-dihydro PGD2( delta12-PGJ2) was reported for its antineoplastic and apoptotic effects on various cancer cells, but its mechanism inducing apoptosis is still not clear. In this study, we have characterized apoptosis induced by delta12-PGJ2in HeLa cells. Treatment of delta12-PGJ2induced apoptosis as indicated by DNA fragmentation, chromatin condensation, and formation of apoptotic body. We also observed release of cytochrome c from mitochondria and activation of caspase cascade including caspase-3, -8, and -9. And the pan-caspase inhibitor z-Val-Ala-Asp (OMe) fluoromethyl-ketone (z-VAD-fmk) and Q-Val-Asp (OMe)-CH2-OPH (Q-VD (OMe)-OPH) prevented cell death induced by delta12-PGJ2 showing participation of caspases in this process. However, protein expression level of Bcl-2 family was not altered by delta12-PGJ2, seems to have no effect on HeLa cell apoptosis. And ZB4, an antagonistic Fas-antibody, exerted no effect on the activation of caspase 8 indicating that Fas receptor-ligand interaction was not involved in this pathway. Treatment of delta12-PGJ2 also leads to suppression of nuclear factor kappaB (NF-kappaB) as indicated by nuclear translocation of p65/RelA and c-Rel and its DNA binding ability analyzed by EMSA. Taken together, our results suggest that delta12-PGJ2-induced apoptosis in HeLa cell utilized caspase cascade without Fas receptor-ligand interaction and accompanied with NF-kappaB inactivation.
Antigens, CD95/metabolism ; Apoptosis/*physiology ; Caspases/metabolism ; Cytochromes c/*metabolism ; Hela Cells ; Human ; NF-kappa B/metabolism ; Prostaglandin D2/*analogs & derivatives/*metabolism ; Proto-Oncogene Proteins c-bcl-2/metabolism

PURPOSE: Respiratory syncytial virus (RSV) which is the most common cause of bronchiolitis in infants is an important triggering factor of asthma exacerbation in children. This virus stimulates chemokine such as regulated on activation normal T-cell expressed and secreted (RANTES) production by human airway epithelial cells in vitro. Corticosteroids are effective medications for prevention of asthma exacerbation. We examined whether the inhibitory effect of corticosteroid on RANTES production in human bronchial epithelial cells (BEAS-2B) infected with RSV varies according to the kinds of corticosteroids and the timing of corticosteroid treatment in vitro. METHODS: In the pretreatment group, BEAS-2B cells were pretreated with budesonide (BUD), fluticasone propionate (FP), or methylprednisolone (MP), and then the cells were infected with RSV. The supernatants of the cell culture were collected after virus infection. In the posttreatment group, BEAS-2B cells were infected with RSV, and then treated with corticosteroid, and the supernatants of the cell culture were collected. RANTES levels in each of the collected supernatant were determined. RESULTS: In the pretreatment group, the strength of each corticosteroid's inhibitory effect on RANTES product was not significantly different. In the posttreatment group, the strength of the inhibitory effect on the production of RANTES was in the order of BUD> MP=FP. BUD have more inhibitory effect on RANTES production at posttreatment group. CONCLUSION: The inhibitory effect of corticosteroid on the production of RANTES in BEAS-2B cells infected with RSV varied widely according to the kinds of corticosteroids and the timing of the corticosteroid treatment.
Adrenal Cortex Hormones* ; Asthma ; Bronchiolitis ; Budesonide ; Cell Culture Techniques ; Chemokine CCL5* ; Child ; Diethylpropion ; Epithelial Cells* ; Humans* ; Infant ; Methylprednisolone ; Respiratory Syncytial Viruses* ; T-Lymphocytes ; Fluticasone

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) has been known as a method of local treatment for early gastric cancer (EGC) or gastric adenoma. The purpose of this study was to identify the factors affecting complete resection rate (CRR) of EMR and to identify histological discrepancy between endoscopic biopsy and the resected specimen obtained by EMR. METHODS: Forty four gastric adenomas and twenty seven EGCs in 63 patients were treated by EMR from January, 1999 until August, 2002. We analysed the factors affecting CRR on the basis of location, macroscopic type, size, piecemeal resection, and EMR methods. RESULTS: The CRR in antrum was 72%. The CRR of the method using endoscopic resection with hypertonic saline-epinephrine solution, injection, precutting and snaring (ER-HSE) was 78%. The CRR according to en bloc resection was 77%. Sixty six percents of histological coincidence was noted between the endoscopic biopsy and the resected specimen of gastric adenoma. CONCLUSIONS: In this study, the CRR of the ER-HSE method and the lesion located in antrum is higher than that other groups. Gastric adenoma should be removed by EMR because of histologic discrepancy between the endoscopic biopsy and the resected specimen.
Adenoma* ; Biopsy* ; Humans ; SNARE Proteins ; Stomach Neoplasms*

Mitral ring motion and indices of left ventricular diastolic filling were measured by M-mode and Doppler echocardiography in apical 4 chamber view in 11 dilated cardiomyopathy patients and 9 normal subjects without clinical evidence of heart disease. The mean age of patients was 52 years and average heart rate was 76 beats/min. The parameters of mitral annulus motion include earley relaxation amplitude(ER), late atrial contraction amplitude(AC) and A2-peak excursion(A2-PE). Transmitral flow velocity parameters include peak flow velocity of early diastolic flow velocity(PFVE), peak flow velocity of late atrial contraction(PFVA), the ratio between early and late peak flow velocity(PFVE/PFVA), Acceleration rate of early diastolic peak flow(AR), deceleration rate of early diastolic peak flow(DR), time velocity integral of early diastolic flow velocity(TVIE), time velocity integral of late atrial contraction flow velocity(TVIA) and ratio between early diastolic and late atrial flow velocity integral(TVIE/TVIA). In patients with dilated cardiomyopathy, ER(4.5+/-2.3mm) and AC(2.3+/-1.6mm) were significantly decreased than normal(10.7+/-2.6mm, 6.6+/-1.6mm, p<0.01, p<0.01, respectively), whereas ER/AC(1.7+/-0.7) was not significantly different than normal subjects(1.6+/-0.5). A2-PE(100+/-80 msec) was significantly delayed in dilated cardiomyopathy patients than normal subjects(35+/-25 msec, p<0.01). In analysis of transmitral flow velocities, PFVE, PFVA and PFVE/PFVA, etc were not significantly different compared to normal subjects in patients with dilated cardiomyopathy. Mitral ring motion amplitude was decreased and A2-peak excursion time interval(A2-PE) was delayed in patients with dilated cardiomyopathy, but transmitral flow velocities were not significantly different from normal subjects in patients with dilated cardiomyopathy. These results reflect the facts that early diastolic relaxation amplitude is decreased by the change of compliance of LV and late atrial contractin amplitude is decreased by decrease of atrial contractility and increased stiffness of LA and LV. Despite of decreased mitral ring motion, transmitral flow velocity is not significantly different compared to normal subjects in patients with dilated cardiomyopathy. From these evidences, not only transmitral flow velocity affected by multiple factors but also mitral ring motion affected by LA and LV function are considered in assessment of LV diastolic dysfuction.
Acceleration ; Blood Flow Velocity* ; Cardiomyopathy, Dilated* ; Compliance ; Deceleration ; Echocardiography, Doppler ; Heart Diseases ; Heart Rate ; Humans ; Relaxation

3-Deazaadenosine (DZA), a cellular methylation blocker was reported to induce the caspase-3-like activities-dependent apoptosis in U-937 cells. In this study, we analyzed the activation pathway of the caspase cascade involved in the DZA-induced apoptosis using specific inhibitors of caspases. In the U-937 cells treated with DZA, cytochrome c release from mitochondria and subsequent activation of caspase-9, -8 and -3 were observed before the induction of apoptosis. zDEVD-Fmk, a specific inhibitor of caspase-3, and zLEHD-Fmk, a specific inhibitor of caspase-9, prevented the activation of caspase-8 but neither caspase-3 nor caspase-9, indicating that caspase-8 is downstream of both caspase-3 and caspase-9, which are activated by independent pathways. zVAD-Fmk, a universal inhibitor of caspases, kept the caspase-3 from being activated but not caspase-9. Moreover, ZB4, an antagonistic Fas-antibody, exerted no effect on the activation of caspase-8 and induction of apoptosis by DZA. In addition, zVAD-Fmk and mitochondrial permeability transition pore (MPTP) inhibitors such as cyclosporin A (CsA) and bongkrekic acid (BA) did not block the release of cytochrome c from mitochondria. Taken together, these results suggest that in the DZA-induced apoptosis, caspase-8 may serve as an executioner caspase and be activated downstream of both caspase-3 and caspase-9, independently of Fas receptor-ligand interaction. And caspase-3 seems to be activated by other caspses including IETDase-like enzyme and caspse-9 seems to be activated by cytochrome c released from mitochondria without the involvement of caspases and CsA- and BA- inhibitory MPTP.
Amino Acid Chloromethyl Ketones/pharmacology ; Apoptosis/*drug effects ; Bongkrekic Acid/pharmacology ; Caspases/*metabolism ; Cell Line ; Cyclosporine/pharmacology ; Cytochrome c/drug effects/metabolism ; Enzyme Activation ; Human ; Leukocytes, Mononuclear/cytology ; Ligands ; Membrane Glycoproteins/metabolism ; Tubercidin/*pharmacology ; U937 Cells

3-Deazaadenosine (DZA), a cellular methylation blocker was reported to induce the caspase-3-like activities-dependent apoptosis in U-937 cells. In this study, we analyzed the activation pathway of the caspase cascade involved in the DZA-induced apoptosis using specific inhibitors of caspases. In the U-937 cells treated with DZA, cytochrome c release from mitochondria and subsequent activation of caspase-9, -8 and -3 were observed before the induction of apoptosis. zDEVD-Fmk, a specific inhibitor of caspase-3, and zLEHD-Fmk, a specific inhibitor of caspase-9, prevented the activation of caspase-8 but neither caspase-3 nor caspase-9, indicating that caspase-8 is downstream of both caspase-3 and caspase-9, which are activated by independent pathways. zVAD-Fmk, a universal inhibitor of caspases, kept the caspase-3 from being activated but not caspase-9. Moreover, ZB4, an antagonistic Fas-antibody, exerted no effect on the activation of caspase-8 and induction of apoptosis by DZA. In addition, zVAD-Fmk and mitochondrial permeability transition pore (MPTP) inhibitors such as cyclosporin A (CsA) and bongkrekic acid (BA) did not block the release of cytochrome c from mitochondria. Taken together, these results suggest that in the DZA-induced apoptosis, caspase-8 may serve as an executioner caspase and be activated downstream of both caspase-3 and caspase-9, independently of Fas receptor-ligand interaction. And caspase-3 seems to be activated by other caspses including IETDase-like enzyme and caspse-9 seems to be activated by cytochrome c released from mitochondria without the involvement of caspases and CsA- and BA- inhibitory MPTP.
Amino Acid Chloromethyl Ketones/pharmacology ; Apoptosis/*drug effects ; Bongkrekic Acid/pharmacology ; Caspases/*metabolism ; Cell Line ; Cyclosporine/pharmacology ; Cytochrome c/drug effects/metabolism ; Enzyme Activation ; Human ; Leukocytes, Mononuclear/cytology ; Ligands ; Membrane Glycoproteins/metabolism ; Tubercidin/*pharmacology ; U937 Cells