Percutaneous transluminal coronary angioplasty(PTCA) is rarely performed on patients with coronary arterial stenosis that resulted from Kawasaki disease. We experienced a 3 year 10-month-old male with a history of Kawasaki disease who developed a few numbers of fusiform aneurysm on the right and left coronary artery. We examined and followed up the patient for 21 months using eletrocardiography, echocardiography, scintigraphy, and coronary angiography. The angiography was performed at 4 months initially and repeated 21 months after the onset because of a perfusion defect at scintigraphy. A significant stenotic lesion was found on the right coronary artery. Twenty-one months after the onset, the stenotic lesion was successfully dilated after percutaneous transluminal coronary angioplasty and luminal patency was maintained for over 1 year. We report this case and a review of literatures.
Aneurysm ; Angiography ; Angioplasty, Balloon, Coronary* ; Child* ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Vessels ; Echocardiography ; Humans ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome* ; Perfusion ; Phenobarbital ; Radionuclide Imaging

BACKGROUND: The amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful biomarker for the diagnosis of acute congestive heart failure. A point-of-care test (POCT) could rapidly detect the presence of NT-proBNP during emergencies. We evaluated the analytical performance of the new Samsung LABGEO PA CHF Test (Samsung Electronics, Korea). METHODS: Based on the guidelines of the Clinical and Laboratory Standards Institute (CLSI), we compared the precision, linearity, and method with those of the E170 (Roche Diagnostics, Switzerland). Matrix comparison between the NT-proBNP values in whole blood and plasma was also performed, and the reference interval was determined using residual samples from healthy adults selected based on the evaluation criteria. RESULTS: The Samsung LABGEO PA CHF Test provided results in approximately 18 min. The coefficient of variation (CV) of within-laboratory precision was below 6.8%. A desirable linearity was observed in the range of 0–10,000 pg/mL, with R²=0.99. The correlation with E170 was also excellent (N=108, r=0.96). NT-proBNP values in the whole blood were correlated with those in the plasma (N=36, r=0.99). The reference interval for the circulating NT-proBNP concentration was determined in 118 plasma samples from healthy subjects (26-75 yr of age). The 97.5th percentile was found to be 58.3 pg/mL. CONCLUSIONS: The Samsung LABGEO PA CHF Test demonstrated a good analytical performance. It could be a powerful tool as a POCT for clinical practice, particularly during emergencies.
Adult ; Diagnosis ; Emergencies ; Healthy Volunteers ; Heart Failure ; Humans ; Methods ; Plasma ; Point-of-Care Systems* ; Point-of-Care Testing

BACKGROUND AND OBJECTIVES: Nitric oxide is a labile neurotransmitter causing vasodilation by relaxing vascular smooth muscle. Endogenous nitric oxide is an important modulator of airway function, but its role in the regulation of airway microvascular leak remains unclear. The purpose of this study was to investigate modulatory action of nitric oxide on capsaicin-induced neurogenic plasma extravasation. MATERIALS AND METHODS: Neurogenic inflammation in rat nasal mucosa was induced by intranasal application of the capsaicin, 50 mM, 50 microliter. Rats were administered i.v. Nw-nitro-L-arginine (L-NNA, 1 to 10 mg/kg), as well as concurrent pretreatment with L-arginine (50 mg/kg). The amount of plasma extravasation was measured by measuring amount of extravasated Evans blue using spectrophotometer and by counting percent area density of Monastral blue-labeled blood vessels. RESULTS: In L-NNA(50 mg/kg) pretreated group, the amount of extravasated Evans blue and percent area density of Monastral blue-labeled blood vessels decreased in a dose-dependent manner (p < 0.01). This inhibition was reversed significantly by adding L-arginine. CONCLUSION: It is suggested that endogenous nitric oxide may have as modulatory role in neurogenic plasma extravasation.
Animals ; Arginine ; Blood Vessels ; Capsaicin ; Evans Blue ; Muscle, Smooth, Vascular ; Nasal Mucosa* ; Neurogenic Inflammation ; Neurotransmitter Agents ; Nitric Oxide* ; Plasma* ; Rats* ; Vasodilation

Ectopic thyroid is an uncommon embryological aberration characterized by the presence of thyroid tissue in a site other than in its usual pretracheal region. It occurs along the path of descent of the developing thyroid primodium from the foramen cecum. It most commonly presents as a lingual thyroid, and is the only thyroid in 70% of all cases. It is extremely rare for two ectopic foci of thyroid tissue to present simultaneously. The authors report a recent case of dual ectopic thyroid present in the lingual and infrahyoid area with no thyroid tissue in the pretracheal area in a 15 year-old girl. The presence of dual ectopic thyroid tissue was confirmed by CT and scintigram with 99 mTc. The patient had originally been scheduled for surgery under the impression of a thyroglossal duct cyst, but the pre-operative neck CT and thyroid scans revealed the presence of a dual ectopic thyroid, thus preventing unnecessary surgery. Therefore, ultrasound scans or a neck CT's and thyroid scans should be performed routinely to confirm the presence of thyroid in the normal position and avoid unnecessary surgeries.
Adolescent ; Cecum ; Female ; Humans ; Lingual Thyroid ; Neck ; Thyroglossal Cyst ; Thyroid Dysgenesis* ; Thyroid Gland ; Ultrasonography ; Unnecessary Procedures

PURPOSE: The present study investigated clinical features of popliteal artery aneurysm (PAA) and evaluated clinical factors which cause poor outcomes of surgical management. METHODS: From January 2004 to January 2011, 17 patients underwent surgical treatment at Asan Medical Center. Patient medical records and radiographic findings were retrospectively reviewed. RESULTS: Twenty one PAAs were treated in 17 patients, consisting 15 men (88.2%) and 2 women (11.8%) and were diagnosed at a median age of 59 years (range: 24-88). The mean PAA diameter was 2.73+/-1.88 cm (range: 1.1-7.1 cm). Ten patients (58.8%) had bilateral PAAs. Four patients (19.0%) had abdominal aortic aneurysms, and 9 patients (42.9%) had other peripheral artery aneurysms. Acute limb ischemia was the initial presentation symptom in 9 patients (42.9%), and chronic limb ischemia was present in 9 patients (42.9%). One patient (4.8%) was asymptomatic. All patients received interposition or bypass surgery. The graft patency and limb salvage rate were 81.0% and 90.5%, respectively. Two of 3 cases (66.7%) of no distal run-off developed graft obstruction, while only 2 of 18 cases (11.1%) of patent distal run-off showed graft obstruction. However, no statistical significance was observed between graft obstruction and lack of distal run-off (P=0.080). The risk factor for amputation was no distal run-off (P=0.014). CONCLUSION: The patency of distal branches was a contributing factor for improving the outcome of surgical management.
Amputation ; Aneurysm ; Aortic Aneurysm, Abdominal ; Arteries ; Extremities ; Female ; Humans ; Ischemia ; Limb Salvage ; Male ; Medical Records ; Popliteal Artery ; Retrospective Studies ; Risk Factors ; Transplants

OBJECTIVES: Caffeic acids are known to have anti-oxidant, anti-inflammatory, immunomodulatory, and tissue reparative effects. The purposes of this study were to determine the effect of caffeic acid on transforming growth factor (TGF) beta1-induced myofibroblast differentiation and collagen production, and to determine whether caffeic acid is involved in the antioxidant effect in nasal polyp-derived fibroblasts (NPDFs). METHODS: NPDFs were pretreated with caffeic acid (1-10 microM) for 2 hours and stimulated with TGF-beta1 (5 ng/mL) for 24 hours. The expression of alpha-smooth muscle actin (SMA), collagen types I and III, and Nox4 mRNA was determined by a reverse transcription-polymerase chain reaction, and the expression of alpha-SMA protein was determined by actin ned by immunofluorescence microscopy. The amount of total soluble collagen production was analyzed by the Sircol collagen dye-binding assay. The reactive oxygen species (ROS) generated by NPDFs were determined using 2',7'-dichlorfluorescein-diacetate. siNox4 was used to determine the effect of Nox4. RESULTS: The expression of alpha-SMA and production of collagen were significantly increased following TGF-beta1 treatment. In contrast, the level of expression of alpha-SMA and the level of production of collagen were decreased by pretreatment with caffeic acid. The activation of Nox4 and the subsequent production of ROS were also reduced by pretreatment with caffeic acid. The expression of alpha-SMA was prevented by inhibition of ROS generation with siNox4. CONCLUSION: Caffeic acid may inhibit TGF-beta1-induced differentiation of fibroblasts into myofibroblasts and collagen production by regulating ROS.
Actins ; Antioxidants ; Caffeic Acids ; Collagen* ; Fibroblasts* ; Microscopy, Fluorescence ; Myofibroblasts ; Nasal Polyps ; Reactive Oxygen Species ; RNA, Messenger ; Transforming Growth Factor beta1 ; Transforming Growth Factors

BACKGROUND AND OBJECTIVES: Phototherapy has a profound immuno- suppressive effect and is widely used for the treatment of immune- mediated skin diseases. The purpose of this study was to investigate the effectiveness of intranasal phototherapy in treating patients with perennial allergic rhinitis. MATERIALS AND METHODS: We conducted a study on 19 patients with perennial allergic rhinitis from January 2008 to July 2008. Each intranasal cavity was illuminated three times in the first week and then once a week the following five weeks. Symptom scores and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were assessed. RESULTS: Phototherapy was well tolerated by the patients and resulted in a significant improvement of clinical symptoms for rhinorrhea, nasal obstruction, nasal itching, sneezing and total nasal score. In addition, significant improvements were achieved for itching of eyes, itching of the palate and total non-nasal symptom score except tearing and redness of eyes. After six weeks, the overall RQLQ scores significantly improved by 51% from the baseline in the treatment. CONCLUSION: These Results suggest that phototherapy is an effective modality for treating clinical symptoms of perennial allergic rhinitis and represents an alternative treatment for perennial allergic rhinitis.
Eye ; Humans ; Nasal Obstruction ; Palate ; Phototherapy ; Pruritus ; Quality of Life ; Rhinitis ; Rhinitis, Allergic, Perennial ; Skin Diseases ; Sneezing ; Tears ; Surveys and Questionnaires

Meckel's diverticulum is the most common congenital anomaly of gastrointestinal tract in children. The incidence of complicated Meckel's diverticulum is about 4%. The major complications of Meckel's diverticulum are bleeding, intussusception, obstruction and perforation. The aim of this study was to investigate the clinical manifestations and the role of laparoscopic surgery in complicated Meckel's diverticulum in children. We retrospectively reviewed the medical records of 19 patients with complicated Meckel's diverticulum who underwent operation at Asan Medical Center between Jan. 1990 and Apr. 2007. Male to female ratio was 11:8, and median age was 1 year (1 day-13 years). The most frequent symptom was hematochezia (68%), followed by irritability or abdominal pain (16%), vomiting (11%), and abdominal distension (5%). Two operative procedures were performed; small bowel resection with anastomosis (68%) and diverticulectomy (32%). The operation proven complications of the Meckel's diverticulum were bleeding (68%), intussusception (16%), perforation (11%) and obstruction (5%). Ectopic tissues found by postoperative pathologic examination were gastric (84%) and pancreatic (11%). Hospital stay after laparoscopic operation for bleeding Meckel's was 5 days (median) and average first postoperative feeding was 1.5 days. On the contrary, hospital stay for open surgery was 7 days and first feed was 3 days. In summary, the most common compliation of Meckel's diverticulum in children was bleeding and ectopic gastric tissues were present in 84%. Laparoscopic procedure seemed to be useful for diagnosis as well as for definitive treatment.
Abdominal Pain ; Child* ; Choristoma ; Chungcheongnam-do ; Diagnosis ; Female ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Incidence ; Intussusception ; Laparoscopy ; Length of Stay ; Male ; Meckel Diverticulum* ; Medical Records ; Retrospective Studies ; Surgical Procedures, Operative ; Vomiting

OBJECTIVES: The aims of this study were 1) to evaluate the effect of isolated uvulopalatopharyngoplasty (UPPP) on subjective obstructive sleep apnea (OSA) symptoms in adult patients regardless of the response to surgery, and ultimately 2) to investigate the differences in changes in subjective OSA symptoms between successful and unsuccessful surgery groups. METHODS: Twenty consecutive adult patients who underwent isolated UPPP were enrolled. Pre- and postoperative subjective OSA symptoms (snoring, witnessed apnea, daytime sleepiness, morning headache, daytime fatigue, restless sleep, difficulty with morning arousal) and polysomnographic data were evaluated in all subjects. Changes in subjective OSA symptoms before and after surgery were investigated in the successful (n=11) and unsuccessful (n=9) groups. Surgical success was defined as a reduction of at least 50% in the preoperative apnea-hypopnea index (AHI) and a postoperative AHI less than 20 per hour. RESULTS: After isolated UPPP, all subjective OSA symptoms changed significantly in the patients, especially in the successful group. In the unsuccessful group, snoring, witnessed apnea and daytime fatigue changed significantly, while other symptoms did not change significantly after surgery. CONCLUSION: Isolated UPPP may improve subjective OSA symptoms in adult patients whom surgery was successful or unsuccessful. However, after isolated UPPP, the improvements in subjective OSA symptoms in the unsuccessful group may be different from those in the successful group.
Adult ; Apnea ; Fatigue ; Headache ; Humans ; Polysomnography ; Sleep Apnea, Obstructive ; Snoring ; Wit and Humor as Topic

Placenta growth factor (PIGF) was originally described as a placenta produced homodimeric protein that shares substantial structural similarity with vascular endothelial growth factor (VEGF). It is becoming increasingly evident that PIGF may directly or indirectly modulate several key vascular events in various tissues. These include angiogenesis or vasculogenesis, vascular maturation and stabilization, vascular permeability, and endothelial cell survival. Inflammatory reaction in the nasal mucosa increases mucosal vascular permeability, resulting in edematous nasal mucosa with polypoid change. In this respect, PIGF may play a role in the formation of nasal polyp. In the present study we evaluated the expression of PIGF mRNA and protein in human inferior turbinate mucosa and nasal polyp. The expression and localization of PlGF mRNA and protein were investigated in the inferior turbinate mucosa and nasal polyps using reverse transcription-polymerase chain reaction (RT-PCR), Western blotting and immunohistochemistry. These results showed that the mRNA transcripts and protein for PlGF are expressed in human turbinate mucosa and nasal polyps. Semiquantitative RT-PCR revealed that PIGF mRNA in nasal polyps increased in its expression level than that in nasal turbinate mucosa. Likewise, immunoblot analysis demonstrated a higher expression of PIGF protein in nasal polyp tissues, compared with that of the nasal turbinate mucosa. However, immunohistochemical findings revealed that PlGF is localized in the endothelial lining of blood vessels in the inferior turbinate mucosa, whereas it is expressed in the epithelial cells of nasal polyps. These results indicate that PlGF mRNA and protein are expressed in normal turbinate mucosa and nasal polyp. Further, based on the fact showing that the expression site of PIGF is different in both tissues, the action mechanism of PIGF may be different in human nasal mucosa and nasal polyp. That is, the PIGF may play a role in the physiological function of normal nasal mucosa, possibly the maintenance of blood vessel and in the pathogenesis of nasal polyp formation.
Blood Vessels ; Blotting, Western ; Capillary Permeability ; Endothelial Cells ; Epithelial Cells ; Humans ; Immunohistochemistry ; Mucous Membrane ; Nasal Mucosa* ; Nasal Polyps* ; Placenta* ; RNA, Messenger* ; Turbinates ; Vascular Endothelial Growth Factor A