The rupture of ventricular septum complicating acute myocardial infarction requires prompt recognition for the correct management of the patient. The diagnosis of this condition had required right heart catheterization. We performed two-dimensional and Doppler echocardiography in patients with systolic murmur after acute myocardioal infarction. Ventricular septal defect was found at lower interventricular septum by mapping technique of pulsed wave Doppler system and obtained high velocity Doppler tracting by continuous wave Doppler echocardiography. Doppler echocardiography could be useful noninvasive method for detection of ventricular septal rupture after acute myocardial infarction.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Echocardiography, Doppler ; Heart Septal Defects, Ventricular* ; Humans ; Infarction ; Myocardial Infarction* ; Rupture ; Systolic Murmurs ; Ventricular Septal Rupture ; Ventricular Septum

OBJECTIVES: This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. METHODS: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. RESULTS: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for beta-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. CONCLUSIONS: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.
Adrenergic beta-Antagonists/therapeutic use ; Age Factors ; Aged ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases/complications/drug therapy/*epidemiology ; Diabetes Complications ; Diabetes Mellitus/diagnosis ; Female ; Humans ; Hypercholesterolemia/complications/diagnosis ; Hypertension/complications/diagnosis ; Male ; Middle Aged ; Percutaneous Coronary Intervention/*statistics & numerical data/trends ; Prevalence ; Registries/statistics & numerical data ; Risk Factors ; Smoking ; Time Factors

Compliance of epileptic patients is one of the most important factors for adequate therapy. Recently, it had been shown that the variability of three serial measurement of the serum levels of antiepileptic drug(AED) may be used as an indication of the degree of compliance. Coefficient variation(CV) of serum drug levels calculated by only one AED had been used to determine the compliance in epileptic patients who took multiple AEDs. We attempted to evaluate the CV of AEDs and then find the objective clue of compliance and the compatible therapeutic planing according to CV. Ninety seven epileptic patients of outpatients department of the Gyengsang National University Hospital were entered to this study. All patients were taking medication at least for 6 months without any changes of drug regimen. Patient's information was acquired by reviewing the chart and interview with questionnaire. With these informations, we determined the compliance of the patients. Antiepileptic serum levels were measured three times at intervals of at least two to four weeks apart, and their CV was calculated. We compared the CV between the compliant and non-compliant group in each AED(phenytoin, carbamazepine , valproic acid) and three drugs in the compliant group. The mean CVs of phenytoin, carbamazepine and valproic acid in the compliant group were 18.3+/-13.0, 15.2+/-10.2 and 23.8+/-8.9, respectively(mean+/-SD). The mean of CV in the compliant and the non-compliant group were 17.9+/-10.9 and 38.8+/-27.2, respectively. The CVs of the compliant group were significantly lower than those of the non-compliant group(p<0.05). However, CVs had no significant difference between three antiepileptic drugs. This study showed that CVs of AEDs were not different between each AEDs, even though they possess different pharmacokinetic properties. Therefore, the CV of one AED can be used in determining the compliance of the epileptics who are taking multiple AEDs.
Anticonvulsants ; Carbamazepine* ; Compliance ; Humans ; Outpatients ; Phenytoin* ; Surveys and Questionnaires ; Valproic Acid*

PURPOSE: The mechanisms, which alter urinary bladder muscle function during infectious cystitis, are poorly understood. The objective of this study was to identify potential resident targets for endotoxin lipopolysaccharide(LPS) within normal bladder smooth muscle and test the hypothesis that LPS induces an inflammatory response within the bladder muscle and that this is associated with a decrease in muscle contractility. MATERIALS AND METHODS: Male rats were studied 24 hours after a single bolus i.p. injection of LPS(15mg/kg). Whole-mount preparations of the bladder muscle were immunohistochemically stained for neutrophils(myeloperoxidase), macrophages(ED2), activated leukocytes(LFA-1) and mast cells(FITC-Avidin). Contractile activity was assessed from muscle strips of the bladder in response to bethanechol(0.3-300microM). Voiding frequency and urine volume for 24 hours were measured using metabolic cage. Cystometry was performed to measure the intravesical bladder pressure. RESULTS: Using the resident macrophage marker ED2, dense network of macrophages were observed within the bladder muscle of control and LPS treated rats. Few neutrophils(myeloperoxidase-positive cells, 2.3 +/- 0.38 cells, x200) were detected in whole-mounts of bladder muscle of control rats, while LPS pretreatment resulted in a significant increase in the number of neutrophils which demonstrate inflammatory response(10.8 +/- 1.70 cells, x200, p<0.001). LFA-1 immunohistochemistry demonstrated an increased presence of LFA-1 positive cells in bladder muscle of LPS treated rats, which had a morphology similar to both neutrophils and resident macrophages. The expression of LFA-1 is known as a marker of cells that are in an activated state. LPS pretreatment resulted in a significant reduction in bladder muscle contractions in response to bethanechol(i.e. control = 0.049 +/- 0.010 vs. LPS= 0.029 +/- 0.003 gr/mm2/sec, 100microM, p<0.05). Voiding frequency of LPS treated rats was significantly increased compared to that of control rats. In LPS treated rats, voiding phase representing bladder contractility in cystometry was observed. CONCLUSIONS: These data demonstrate that a single intraperitoneal injection of LPS initiates an inflammatory response within the bladder muscle that is associated with a decrease in the functional activity of the bladder. We hypothesize that secretions from the resident macrophages and extravasated leukocytes within the muscle cause the observed suppression in bladder muscle activity in vitro.
Animals ; Cystitis ; Humans ; Immunohistochemistry ; Inflammation* ; Injections, Intraperitoneal ; Leukocytes ; Lymphocyte Function-Associated Antigen-1 ; Macrophages ; Male ; Muscle Contraction ; Muscle, Smooth ; Neutrophils ; Rats* ; Urinary Bladder*

Interpositionally grafted arteries and veins were expanded with a 20cc tissue expanders in 50 Sprague-Dawley rats. The grafts were done on both hind legs, one side was expanded and the remaining side was used as control. The average gain in length of expanded grafted arteries and veins was over 4 and 6 times that of the controls respectively. The differences in the patency rates between expanded and control grafts were not statistically significant. Histologic examination revealed that there were no changes in the areas of the media and lengths of the inner elastic laminae of the expanded arterial grafts. In both expanded and control vein grafts, marked intimal thickening was noticed, although these changes were not statistically significant. Expansion of grafted vessels can be safely carried out without loss of vessel patency. Tissue expander, grafted vessels
Animal ; Femoral Artery/*anatomy and histology/transplantation ; Male ; Rats ; Rats, Inbred Strains ; *Tissue Expanders ; Vascular Patency ; Veins/*anatomy and histology/transplantation

Interpositionally grafted arteries and veins were expanded with a 20cc tissue expanders in 50 Sprague-Dawley rats. The grafts were done on both hind legs, one side was expanded and the remaining side was used as control. The average gain in length of expanded grafted arteries and veins was over 4 and 6 times that of the controls respectively. The differences in the patency rates between expanded and control grafts were not statistically significant. Histologic examination revealed that there were no changes in the areas of the media and lengths of the inner elastic laminae of the expanded arterial grafts. In both expanded and control vein grafts, marked intimal thickening was noticed, although these changes were not statistically significant. Expansion of grafted vessels can be safely carried out without loss of vessel patency. Tissue expander, grafted vessels
Animal ; Femoral Artery/*anatomy and histology/transplantation ; Male ; Rats ; Rats, Inbred Strains ; *Tissue Expanders ; Vascular Patency ; Veins/*anatomy and histology/transplantation

Central diabetes insipidus (CDI) is a clinical syndrome that result from a failure of the neurohypophyseal axis to produce or release a sufficient quantity of arginine vasopressin (AVP) to permit normal function of the urinary concentrating mechanism. Polyuria and polydipsia are the symptoms associated with CDI. The most common cause of CDI is idiopathic variety and head trauma, neurohypophyseal surgery, primary or metastatic brain tumors acount for most of the remaining cases. CDI in Langerhans cell histiocytosis (LCH) is thought to be to infiltration of the hypothalamus-neurohypophyseal system. We report a patient with CDI and LCH underwent water depriviation test, MR imaging of the pituitary-hypothalamic region, and VATS associated open lung biopsy.
Arginine Vasopressin ; Axis, Cervical Vertebra ; Biopsy ; Brain Neoplasms ; Craniocerebral Trauma ; Diabetes Insipidus* ; Diabetes Insipidus, Neurogenic ; Histiocytosis* ; Histiocytosis, Langerhans-Cell ; Humans ; Lung ; Magnetic Resonance Imaging ; Polydipsia ; Polyuria ; Thoracic Surgery, Video-Assisted

Etretinate(Ro 10-9359), an aromatic analogue of vitamin A acid, has been known to be effective in the treatment of psoriasis, Darier's disease, pityriasis rubra pilaris, ichthyosis, and palmoplantar keratoderma when administered orally. In this experiment, we compared the therapeutic and side effects between a group with high dose therapy(initially 75mg of etretinate a day) and an another group with low dose therapy(initially 40mg of etretinate a day). We also observed whether the pretreatment followed by combined treatment with vitamin E could potentiate the therapeutic effect as well as reduce the side effects of oral etretinate. This experiment comprised 102 moderate to severe psoriatic patients. The following results were obtained from this experiment. 1. Fifty-six among 92 patients(61%) who were treated with etretinate for more than 4 weeks showed good to excellent therapeutic effect. 2 The high dose therapy was more effective, but showed more side effects than low dose therapy. 3 Vitamin E did not potentiate the effect of etretinate. In low dose therapy, the pretreatment followed by combined treatment with vitamin E showed a tendency to reduce the side effects of etretinate.
Acitretin* ; Darier Disease ; Etretinate* ; Humans ; Ichthyosis ; Keratoderma, Palmoplantar ; Pityriasis Rubra Pilaris ; Psoriasis* ; Tretinoin ; Vitamin E* ; Vitamins*

OBJECTIVE: The freezing response in rats has been used widely as an index of fear in threatening or stressful situations. Considering its importance in basic studies of affective disorders and in drug testing, it is necessary to develop a reliable, automated system for measuring the freezing response accurately. METHODS: We developed the Vision-Based Analysis for Freezing (V-BAFF) system to analyze the freezing response in rats, based on several image-processing modules and motion classification schemes generated from our own experience. We compared the performance of V-BAFF with that of experienced human observers. RESULTS: The level of freezing measured with V-BAFF was highly correlated with that measured by human observers. CONCLUSION: We demonstrated that V-BAFF could yield a bias-free, accurate, and efficient measurement of freezing in rats.
Animals ; Freezing ; Humans ; Mood Disorders ; Rats

INTRODUCTIONThe purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.

MATERIALS AND METHODSWe undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.

RESULTSOur results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.

CONCLUSIONWe conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.

Adolescent ; Adult ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; surgery ; Magnetic Resonance Imaging ; Male ; Physical Examination ; methods ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder Dislocation ; complications ; diagnosis ; surgery ; Shoulder Joint ; surgery ; Young Adult