BACKGROUND: The anterior spinal artery infarction constitutes a classical syndrome of vascular myelopathy. The causes of the anterior spinal artery syndrome are various, but most episode probably occur as the result of atherosclerosis or dissection of the aorta and its branches. However, few cases reported developed with spinal structural abnormalities. CASE: A 65-year-old man presented with sudden paraparesis. There was no evidence of hypertension, diabetes and smoking. Motor weakness was more prominent on the left side and progressed. Loss of pain and temperature senses were shown at the level of 71 with preservation of touch, joint perception and vibration senses. The DTR's of legs were depressed and extensor toe signs were presented. A C-spine MRI showed high signal intensity on 72 weighted image and low signal on 71 weighted image(C6-71) with cervical spinal stenosis at the C4-C7 spinal level and mild cervical disc protrusion (C6-C7, C7-T1). After three months later, follow up cervical MRI showed somewhat decreased size of high signal intensity on 72 weighted image and more prominent low signal on 71 image. DISCUSSION: In our case, we could not find any usual cause of anterior spinal artery infarction. However only cervical spinal stenosis associated with mild cervical disc protrusion was present. In stenotic cervical canal, the anterior spinal artery can be more vulnerable to extrinsic compression and the infarction may early develop with insignificant trigger event, such as disc protrusion. We concluded that the ischemic change of anterior two thirds of cervical spinal cord might develop due to the compression of the anterior spinal artery by cervical stenosis and mild cervical intervertebral disc protrusion.
Aged ; Anterior Spinal Artery Syndrome* ; Aorta ; Arteries ; Atherosclerosis ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Hypertension ; Infarction ; Intervertebral Disc ; Joints ; Leg ; Magnetic Resonance Imaging ; Paraparesis ; Smoke ; Smoking ; Spinal Cord ; Spinal Cord Diseases ; Spinal Stenosis* ; Toes ; Vibration

No abstract available.
Blood Platelets* ; Hypertension, Pulmonary* ; Lung Diseases, Obstructive* ; Platelet Activation*

OBJECTIVES: Maintaining the constant exposure to hydrophobic organic compouds in acute toxicity tests is one of the most difficult issues in the evaluation of their toxicity and corresponding risks. Passive dosing is an emerging tool to keep constant aqueous concentration because of the overwhelming mass loaded in the dosing phase. The primary objectives of this study were to develop the constant exposure condition for an acute mortality test and to compare the performance of the passive dosing method with the conventional spiking with co-solvent. METHODS: A custom cut polydimethylsiloxane (PDMS) tubing loaded with benzyl butyl phthalate (BBP) was placed in each well of a 24-well plate containing assay medium. The rate of the release of BBP from PDMS was evaluated by measuring the change in the concentration of BBP in the assay medium. The efficiency of maintaining constant exposure condition was also evaluated using a simple two-compartment mass transport model employing a film-diffusion theory. An acute mortality test using 10 C. elegans in each well was conducted for the evaluation of the validity of passive dosing and the comparative evaluation of the passive dosing method and the conventional spiking method. RESULTS: Free concentration in the assay medium reached 95% steady state value within 2.2 hours without test organisms, indicating that this passive dosing method is useful for an acute toxicity test in 24 hours. The measured concentration after the mortality test agreed well with the estimated values from partitioning between PDMS and the assay medium. However, the difference between the nominal and the free concentration became larger as the spiked concentration approached water solubility, indicating the instability of the conventional spiking with a co-solvent. CONCLUSIONS: The results in this study support that passive dosing provides a stable exposure condition for an acute toxicity test. Thus, it is likely that more reliable toxicity assessment can be made for hydrophobic chemicals using passive dosing.
Benzophenones ; Biological Availability ; Boronic Acids ; Caenorhabditis ; Caenorhabditis elegans ; Dibutyl Phthalate ; Dimethylpolysiloxanes ; Phthalic Acids ; Solubility ; Toxicity Tests, Acute

We evaluated the antihypertensive effect of amlodipine, a calcium channel bloker, in 35 cases of essential hypertention. After 12 weeks' administration(5~10mg q.d.), the following results were obtained : 1) The systoloic and diastolic blood pressure were decreased significantly(170.3+/-12.2mmHg vs 143.7+/-13.0mmHg p<0.01 and 104.7+/-5.9mmHg vs 87.8+/-6.5mmHg, p<0.01, respectively) but the heart rate was independant of amlodipine administration. 2) The systolic blood pressure was lowered by 20mmHg or more in 26(76.5%) of 34 patients and the diastolic pressure was lowered by 10mmHg or more in 26(76.5%) of 34 patients at 12 weeks after amlodipine administration. 3) The adverse effects of amlodipine were dizziness in 5, edema in 5, indigestion in 3, constipation in 2, headache, flushing, insomnia in 1 patient respectively and only one of them discontinued amlodipine administration due to severs facial flushing and skin eruption.
Amlodipine* ; Blood Pressure ; Calcium Channels ; Constipation ; Dizziness ; Dyspepsia ; Edema ; Flushing ; Headache ; Heart Rate ; Humans ; Skin ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Although considerable efforts have been made to improve the graft patency in coronary artery bypass surgery, the role of biomechanical factors remains underrecognized. The aim of this study is to investigate the influences of geometric configurations of the bypass graft on hemodynamic characteristics in relation to anastomosis. MATERIALS AND METHODS: The Numerical analysis focuses on understanding the flow patterns for different values of inlet and distal diameters and graft angles. The Blood flow field is treated as a two-dimensional incompressible laminar flow. A finite volume method is adopted for discretization of the governing equations. The Carreau model is employed as a constitutive equation for blood. In an attempt to obtain the optimal aorto-coronary bypass conditions, the blood flow characteristics are analyzed using in vitro models of the end-to-side anastomotic angles of 45degrees, 60degrees and 90degrees. To find the optimal graft configurations, the mass flow rates at the outlets of the four models are compared quantitatively. RESULTS: This study finds that Model 3, whose bypass diameter is the same as the inlet diameter of the stenosed coronary artery, delivers the largest amount of blood and the least pressure drop along the arteries. CONCLUSION: Biomechanical factors are speculated to contribute to the graft patency in coronary artery bypass grafting.
Bays ; Computer Simulation ; Coronary Artery Bypass ; Coronary Vessels ; Hemodynamics ; Transplants

The coexistence of mesenchymal tumor and carcinoma in the esophagus is extremely rare. We report a case of squamous cell carcinoma located at the mucosal surface over leiomyoma of the esophagus. A 76-year-old man with complaints of 3 months onset of odynophagia was diagnosed preoperatively as squamous cell carcinoma over submucosal tumor with calcification. Esophagectomy and esophagogastrostomy were performed through the right thoracotomy and upper median laparotomy. The patient is doing well without evidence of recurrence in the 25 months after resection. We discuss the pathogenesis and possible relations between the two tumors.
Aged ; Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Esophagectomy ; Esophagus ; Humans ; Laparotomy ; Leiomyoma* ; Recurrence ; Thoracotomy

Clinically, the infarction of posterior spinal arteries is rarely recognized due to rich anastomosis. As a result, there have been few clinical reports of posterior spinal artery infarction. A 38-year-old man experienced severe transitory neck and occipital pain after his friend had struck him on the cervical area. A few days later, he developed dysmetria, dysdiadochokinesia, and decreased vibration and position senses on the right side of his body. Routine laboratory find-ings, an echocardiogram, a work-up for connective tissue diseases, and CSF studies were all found to be normal. A MRI showed increased signals in the right posterior and posterolateral part of the lower medulla and some portion of the first cervical cord on T2- and proton-weighted images without significant enhancements. A cerebral angiogram showed a long narrow thread-like segment in the distal portion of the right vertebral artery, which was indicative of a dissection. The right posterior inferior cerebellar artery was not visualized.
Adult ; Arteries* ; Cerebellar Ataxia ; Connective Tissue Diseases ; Friends ; Humans ; Infarction* ; Lateral Medullary Syndrome ; Magnetic Resonance Imaging ; Neck ; Proprioception ; Spinal Cord ; Vertebral Artery ; Vibration

Inflammation appears to have a major role in the development of atherosclerosis. Cyclooxygenase-2 (COX-2) is involved in the inflammatory response via the generation of prostanoids that, in turn, are involved in the production of matrix metalloproteinases (MMPs). This study aimed to investigate atherosclerosis in human aortas for in situ tissue distribution of COX-2, MMPs including MMP-9 and membrane type 1 MMP (MT1-MMP), and tissue inhibitor of metalloproteinase-2 (TIMP-2). Immunohistochemical studies were performed on atherosclerotic lesions of aortas from patients with aortic aneurysms (n = 4) and dissections (n = 3) by using antibodies to COX-2, MMP-9, MT1-MMP, and TIMP-2. Control tissues were obtained from traumatically dissected aortas (n = 2). All specimens from diseased aortas had atherosclerotic lesions ranging from fatty streak to atheromatous plaques. In control, there was no expression of COX-2, MMP-9, and MT1-MMP in all aortic layers. Immunoreactivity for COX-2 was predominantly noted in macrophages and smooth muscle cells (SMCs) of the intima including atherosclerotic plaque itself and the medial layer of the plaque base, as well as in SMCs and endothelial lining of the vasa vasorum in the adventitia. Immunoreactivity for MMP-9 and MT1-MMP was found in the same distribution as that of COX-2. Additionally, the expression of TIMP-2 increased in relation to MMP-9 expression. This study demonstrates that COX-2 is coexpressed with MMP-9 and MT1-MMP, not only by macrophages and SMCs in atherosclerotic lesions, but also in endothelial lining of the vasa vasorum of human aortas. Thus, vascular inflammatory reactions may influence extracellular matrix remodeling by coactivation of MMPs in the development of atherosclerosis and, in turn, the progression of disease.
Animal ; Aorta/enzymology* ; Aortic Diseases/pathology ; Aortic Diseases/enzymology* ; Arteriosclerosis/pathology ; Arteriosclerosis/enzymology* ; Female ; Guinea Pigs ; Human ; Immunochemistry ; Isoenzymes/metabolism* ; Male ; Matrix Metalloproteinases/metabolism* ; Middle Age ; Prostaglandin-Endoperoxide Synthase/metabolism*

Advanced glycation endproducts (AGEs) have been reported to play a role in neointimal formation and increase the rate of in-stent restenosis (ISR) in the diabetic coronary artery disease patients treated with stents, but the potential pathogenic mechanisms of AGEs in vascular smooth muscle cell proliferation remain unclear. We sought to determine the AGEs related pathobiological mechanism of diabetic vasculopathy. Rat aortic smooth muscle cell (RAoSMC) culture was done with different concentrations of AGEs and proliferation was assessed. Immunohistochemistry for receptor of AGEs (RAGE) was performed with human carotid atheroma. Western blotting was performed to assess the activation of MAP kinase system in the cultured RAoSMC. AGEs increased RAoSMC proliferation and were associated with increased phosphorylation of ERK and p38 kinase by time and dose dependent manner. The MAP kinase activity was decreased by RNA interference for RAGE. AGEs stimulation increased reactive oxygen species (ROS) generation in cultured RAoSMC. From this study it is concluded that AGEs played a key role in RAoSMC proliferation via MAP kinase dependent pathways. Activation of vascular smooth muscle cell (VSMC) proliferation by MAP kinase system and increased formation of ROS may be the possible mechanisms of AGEs induced diabetic vasculopathy.
Animals ; Carotid Artery Diseases/metabolism/pathology ; Cell Proliferation/drug effects ; Cells, Cultured ; Diabetic Angiopathies/*etiology/metabolism/pathology ; Extracellular Signal-Regulated MAP Kinases/metabolism ; Glycosylation End Products, Advanced/adverse ; Humans ; MAP Kinase Signaling System/drug effects/*physiology ; Phosphorylation/drug effects ; RNA, Small Interfering/pharmacology ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species/metabolism ; Receptors, Immunologic/antagonists & inhibitors/metabolism

Herpes simplex esophagitis usually occurs in immunocompromised or severely debilitated patients. Odynophagia and dysphagia are major symptoms and the prognosis of immunocompromised patients is variable. We present the case of a cadeveric donor renal transplantation recipient who developed herpes simplex esophagitis shortly after anti-rejection therapy. A 43-years-old female had cadaveric renal transplantation and following treatment with cyclosporine, prednisolone, mycophenolate mofetile. Twelve months later, renal insufficieny and proteinuria were developed. Allograft kidney biopsy showed some evidence of acute rejection. She was treated with 3 successive days of intravenous methylpredinisolone (500 mg/d) therapy and continued tapering of steroids. Two weeks later, she had oral cavity ulceration, odynophagia, dysphagia, epigastric pain, and nausea. Esophagoscopy reveals multiple confluent ulceration in the whole part of esophagus and biopsies showed the epithelial cell were enlarged with prominent nuclei. Immunohistochemically, the epithelial cell were positive with a monoclonal antibody to herpes simplex virus type 1. Treatment was started on intravenous ayclovir and changed to oral agent for 10 days. After treatment, her symptoms and repeat endoscopic findings were improved.
Allografts ; Biopsy ; Cadaver* ; Cyclosporine ; Deglutition Disorders ; Epithelial Cells ; Esophagitis* ; Esophagoscopy ; Esophagus ; Female ; Herpes Simplex* ; Herpesvirus 1, Human ; Humans ; Immunocompromised Host ; Immunosuppression ; Kidney ; Kidney Transplantation* ; Mouth ; Nausea ; Prednisolone ; Prognosis ; Proteinuria ; Steroids ; Tissue Donors ; Ulcer