Seventeen years old man was diagnosed as left calf varicous vein and deep vein thrombosis on the same area. Three years later the patient visited for the exasperated swelling but had no sufficient warfarin therapy. At the age of 24, the patient had abrupt onset of left hemiplegia. Risk factor was monitored and patent foramen ovale and protein S deficiency were diagnosed. Simultaneously pulmonary embolism was detected and inferior vena cava filter was inserted. Nine months later from stroke, the patient had several times neurolysis on left lower extremity for spasticity. But after three days from last neurolysis we detected aggravation of lower extremity and left upper extremity swelling. He continued anticoagulation therapy. We reported a young patient with cerebral infarction by the mechanism of paradoxical embolism and upper extremity deep vein thrombosis in the lack of anticoagulation medication.
Cerebral Infarction ; Embolism, Paradoxical ; Foramen Ovale, Patent ; Hemiplegia ; Humans ; Intracranial Embolism* ; Lower Extremity ; Muscle Spasticity ; Protein S Deficiency ; Pulmonary Embolism ; Risk Factors ; Stroke ; Upper Extremity ; Upper Extremity Deep Vein Thrombosis ; Veins ; Vena Cava Filters ; Venous Thrombosis ; Warfarin

We evaluated the clinical and laboratory characteristics of five children with Kawasaki disease who had showed arthritis after responding to intravenous immunoglobulin(IVIG) treatment. Age distribution was between 13 months and six years of age(mean 3.2+/-1.6 years). There were two males and three females. Arthritis occurred when acute symptoms were subsiding, with the average onset on day 5.8+/-1.8 after final IVIG treatment. Arthritis was pauciarticular in three, and polyarticular in two. Regarding laboratory findings, one child was positive in rhematoid factor and changed to negative after two months. Three patients were examined for HLA B27 and all showed negative results. High dose aspirin(two cases), anti-inflammatory drug(ibprofen, three cases), and corticosteroids(methyprednisolon pulse therapy, one case) were used for this type of arthritis. Symptoms and signs of arthritis in all patients were improved by these therapies. There was no relapse or complications within six months. Arthritis after responding to IVIG therapy was rarely observed in children with Kawasaki disease. This type of arthritis responded well to anti-inflammatory drugs including corticosteroids, and showed no relapses.
Adrenal Cortex Hormones ; Age Distribution ; Arthritis* ; Child ; Female ; Humans ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Male ; Mucocutaneous Lymph Node Syndrome* ; Recurrence

Coronary artery dissection after blunt chest trauma is very rare conditon, and this can result in a serious acute myocardial infarction. We report a case of a 54-year old male who was presented with an anterior myocardial infarction after traffic accident, with steering wheel injury. His coronary angiography revealed a discrete eccentric 85% stenosis of proximal left anterior descending coronary artery with dissection and intravascular ultrasound showed a dissecting flap from the distal left main coronary artery to proximal left anterior descending coronary artery. He was successfully treated by percutaneous transluminal coronary angioplasty with stent.
Accidents, Traffic ; Angioplasty, Balloon, Coronary ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels* ; Humans ; Male ; Middle Aged ; Myocardial Infarction* ; Stents ; Thorax* ; Ultrasonography

The presence of severe pulmonary arterial hypertension (PAH) in patients with atrial septal defect (ASD) is still thought to preclude shunt closure, although there are several reports of good clinical outcomes after vasodilator therapy. We report the case of a young woman with ASD and severe PAH who was able to successfully undergo percutaneous shunt closure following 1 year use of the oral endothelin receptor antagonist, bosentan.
Female ; Heart Septal Defects, Atrial* ; Humans ; Hypertension, Pulmonary* ; Receptors, Endothelin* ; Sulfonamides

PURPOSE: To evaluate whether Extracorporeal Shock Wave Therapy (ESWT) is an effective treatment without side effects for chronically painful calcifying tendinitis. MATERIALS AND METHODS: Study subjects were 72 patients (17 males and 55 females) aged 37-64 years, with a mean of 48, showing chronic, symptomatic, calcifying tendinitis of the shoulder refractory to other conventional conservative therapies. Calcifications were type I or type II according to the classification of Gartner, and with a minimum diameter of 10 mm. Patients with type 3 calcific tendinitis were excluded, because this type has a strong tendency to spontaneous resolution. Extracorporeal shock wave therapy comprised one or two treatments, each consisting of 800 shocks, with a frequency of 120 impulse per minute and the energy density of 0.14 mJ/mm2. We assessed the presence and size of calcified deposits at 1, 3, 6 and 12 months by conventional radiography. All patients also underwent clinical examination, and the Constant (and Murley) score and pain were calculated. The intensity of pain was measured with the visual analogue scale (VAS) from 0 to 10 points, where 0 represents the absence of pain and 10 unbearable pain. RESULTS: One month after the treatment, complete resorption of the calcium deposits was observed in 19 patients (26%), partial resorption was observed in 26 patients (36%), and no modification in the calcium deposits was observed in 27 patients (38%). At six months the complete disappearance of the calcium deposits was noted in 42 patients (68%), but in the 10 patients (14%), calcium deposit appeared unchanged. This result is remained unvaried after 6 month follow-up. Using the Constant and Murley score, this study showed a significant decrease in pain and a significant increase in shoulder function (p<0.001). At six months, 76% of the patients presented satisfactory functional result. About 15% reported a subjective and objective recovery, and only 6 patients (8%), classified as poor result but in our series no differences were found between results at 6 month and 12 month follow-up. At 12 month follow-up there were differences in the Constant score between treated shoulder and contralateral side, respectively 77.6 (59-91) and 87.2 (74-96), but not significant. There were no side effects. CONCLUSION: ESWT is an effective treatment without side effects and an alternative therapy for chronically painful calcifying tendinitis of the shoulder refractory to conventional therapies.
Calcium ; Classification ; Follow-Up Studies ; Humans ; Male ; Radiography ; Shock* ; Shoulder* ; Tendinopathy*

BACKGROUND/OBJECTIVES: One of the mechanisms considered to be prevalent in the development of Alzheimer's disease (AD) is hyper-stimulation of microglia. Black chokeberry (Aronia melanocapa L.) is widely used to treat diabetes and atherosclerosis, and is known to exert anti-oxidant and anti-inflammatory effects; however, its neuroprotective effects have not been elucidated thus far. MATERIALS/METHODS: We undertook to assess the anti-inflammatory effect of the ethanolic extract of black chokeberry friut (BCE) in BV2 cells, and evaluate its neuroprotective effect in the lipopolysaccharide (LPS)-induced mouse model of AD. RESULTS: Following stimulation of BV2 cells by LPS, exposure to BCE significantly reduced the generation of nitric oxide as well as mRNA levels of numerous inflammatory factors such as inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX-2), interleukin 1 beta (IL-1β), and tumor necrosis factor alpha (TNF-α). In addition, AD was induced in a mouse model by intraperitoneal injection of LPS (250 µg/kg), subsequent to which we investigated the neuroprotective effects of BCE (50 mg/kg) on brain damage. We observed that BCE significantly reduced tissue damage in the hippocampus by downregulating iNOS, COX-2, and TNF-α levels. We further identified the quinic acids in BCE using liquid chromatography-mass spectrometry (LCMS). Furthermore, we confirmed the neuroprotective effect of BCE and quinic acid on amyloid beta-induced cell death in rat hippocampal primary neurons. CONCLUSIONS: Our findings suggest that black chokeberry has protective effects against the development of AD.
Alzheimer Disease ; Amyloid ; Animals ; Atherosclerosis ; Brain ; Cell Death ; Cyclooxygenase 2 ; Ethanol ; Hippocampus ; Inflammation ; Injections, Intraperitoneal ; Interleukin-1beta ; Mice ; Mice, Inbred ICR ; Microglia ; Neurons ; Neuroprotective Agents ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Phytochemicals ; Quinic Acid ; Rats ; RNA, Messenger ; Spectrum Analysis ; Tumor Necrosis Factor-alpha

Transient left ventricular apical ballooning syndrome is also known as takotsubo cardiomyopathy, and this is characterized by transient wall-motion abnormalities involving the left ventricular apex without significant stenosis on the coronary angiogram. We report here on a new variant of transient left ventricular ballooning in which only the mid-ventricle was affected. The patient initially presented with dyspnea and she had wall-motion abnormalities involving the mid-ventricle with hypercontractility of the apical and basal segments in the absence of a significant coronary artery stenosis. Emotional or physical stress or other preceding triggering factors might play a key role in this cardiomyopathy, but the precise etiology remains unknown. So far, the cases of this syndrome have been reported only among the North America Caucasian population and the Japanese population.
Asian Continental Ancestry Group ; Cardiomyopathies ; Constriction, Pathologic ; Coronary Stenosis ; Dyspnea ; Humans ; North America ; Takotsubo Cardiomyopathy

Basaloid squamous cell carcinoma occurs in various organs including the upper respiratory tract, the base of the tongue, pharynx, larynx, breast, uterine cervix and anus. It is a rare tumor, but it must be distinguished from other malignancies because of its aggressive clinical behavior. Many cases present in the advanced stage at the time of diagnosis. We present here a case of esophageal basaloid squamous cancer that was diagnosed in 75-year-old male patient who had dysphagia and throat pain, and this was accompanied by squamous cell cancer of the tongue base, as was determined by laryngoscopic and esophagogastroscopic examination.
Aged ; Anal Canal ; Breast ; Carcinoma, Squamous Cell* ; Cervix Uteri ; Deglutition Disorders ; Diagnosis ; Esophagus ; Female ; Head and Neck Neoplasms ; Humans ; Larynx ; Male ; Neoplasms, Squamous Cell ; Pharynx ; Respiratory System ; Tongue*

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) serves as an extracellular signal triggering apoptosis in tumor cells. To characterize the molecular events involved in TRAIL-induced apoptotic signaling, we investigated the role of extracellular signal-regulated kinase 1/2(ERK1/2) in the apoptosis using HeLa cells. Here we show that TRAIL pronounced ERK1/2 activation through a tyrosine kinase-dependent mechanism, subsequently elevated anti-apoptotic Bcl-2 protein levels. Pretreatment with Genistein, an inhibitor of tyrosine kinase, significantly attenuated ERK1/2 activation and enhanced cell death. Moreover, inhibition of ERK1/2 with PD98059 promoted apoptotic cell death through the down-regulation of ERK1/2 activity and Bcl-2 protein levels. Taken together, our results suggest that the activation of ERK1/2 via tyrosine kinase pathway plays a protective role as the mechanism of cellular defense through the up-regulation of Bcl-2 protein levels in TRAIL-induced apoptosis.
Apoptosis* ; Cell Death ; Down-Regulation ; Genistein ; HeLa Cells* ; Humans ; Necrosis ; Phosphotransferases ; Protein-Tyrosine Kinases* ; Tyrosine* ; Up-Regulation

BACKGROUND: Coronary artery spasm plays an important role in the pathogenesis of variant angina. However the precise mechanism (s) and the clinical characteristics of variant angina remain to be elucidated. We investigated the clinical characteristics and diagnostic features of variant angina. METHODS: The clinical characteristics and coronary angiographic findings were analyzed in 178 patients with angiographically documented coronary artery spasm, which developed spontaneously or was provoked by the admistration of intravenous ergonovine maleate. All patients were followed for at least 1 year or more or until their death. RESULTS: One hundred and eleven patients complained of chest pain which developed especially at night and in the early morning. One hundred and thirty three patients (74.7%) were smokers. The electrocardiographic findings at the time of admission showed no changes in 147 cases (82.6%), testes showed ST segment elevation in 22 cases (12.4%), ST segment depression in 2 cases (1.1%), T wave inversion in 7cases (3.9%). The treadmill test was performed in 135 cases, ST segment elevation was noted in 6 patients (4.4%) and ST segment depression in 18 patients (13.3%). All of the other results were within normal range. The ergonovine provovative tests for coronary spasms were safe and effective. The right coronary artery was the most prevalent site of coronary artery spasm. Drug treatment was applied initially to all patients, but only 115 patients (64.5%) received the follow-up. Of these three died from cardiac arrest. The rate of cardiac death was low (1.7%) in patient, which made it difficult to know the risk factors for the cardiac deaths. Two (1.1%) had cardiac arrest. They didn`t take any medication. Patients with variant angina usually responded well to nitrates and calcium antagonists. Thus nitrates and calcium antagonists are useful in preventing attacks and abolished attacks of variant angina. CONCLUSION: In this study, 13.2% of coronary artery disease was variant angina. The effectiveness of drug therapy and the prognosis of the patients was quite good in the group. But when chest pain happens, the adequate use of nitrate agents is needed because of cardia arrest or cardiac death in 2.8% of the patients.
Calcium ; Cardia ; Chest Pain ; Coronary Artery Disease ; Coronary Vessels ; Death ; Depression ; Drug Therapy ; Electrocardiography ; Ergonovine ; Exercise Test ; Follow-Up Studies ; Heart Arrest ; Humans ; Nitrates ; Prognosis ; Reference Values ; Risk Factors ; Spasm ; Testis