A 36-year-old woman was presented with extensive anterior wall myocardial infarction. We tried to perform direct coronary angiography for the purpose of primary stenting. However, coronary angiogram revealed normal coronary arteries without intracoronary thrombi. We continued further evaluations to find out the cause of normal coronary myocardial infarction. The findings of severe hypertensive retinopathy and concentric left ventricular hypertrophy suggested that she had secondary hypertension. The detailed history, laboratory and radiological findings revealed the pheochromocytoma. The tumor was successfully removed by operation.
Adult ; Anterior Wall Myocardial Infarction ; Coronary Angiography ; Coronary Vessels ; Female ; Humans ; Hypertension ; Hypertensive Retinopathy ; Hypertrophy, Left Ventricular ; Myocardial Infarction* ; Pheochromocytoma* ; Stents

BACKGROUNG AND OBJECTIVES: Diabetes mellitus is a significant risk factor for adverse outcome after PTCA, which is associated with an increased late mortality and target lesion revascularization (TLR) rates. The beneficial role of coronary stenting on the clinical and angiographic outcomes of diabetic patients is not clearly defined. The aim of this study was to evaluate the early and mid-term outcomes in diabetic patients undergoing elective stenting of native coronary lesions compared with those in non-diabetic patients. MATERIALS AND METHODS: Between July 1997 and June 1998, coronary stenting was performed on 46 lesions in 38 diabetic patients and 126 lesions in 117 non-diabetic patients. Follow-up angiography at mean day of 189+/-45 was performed in 58.7% (91 patients) and analysed by quantitative coronary angiography (QCA). RESULTS: There was a higher incidence of multi-vessel disease in diabetic patients than non-diabetic patients but not statistically significant (71.1% vs 51.3%, p=0.106). There were no differences in major procedural complications and in-hospital events (myocardial infarction, angina and death) in diabetics and non-diabetics. During the follow-up, the incidence of target lesion revascularizton (TLR) and cardiac event free survival did not differ between two groups. CONCLUSION: Coronary stenting in diabetics resulted in a low rate of immediate procedural com-plications and early major adverse cardiac event (MACE), similar to non-diabetics. There were no differences in the mid-term clinical and angiographic outcomes in diabetics and non-diabetics.
Angiography ; Coronary Angiography ; Diabetes Mellitus ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Infarction ; Mortality ; Risk Factors ; Stents*

No abstract available.
Myxoma*

Hormone replacement therapy combined with progestogens induces changes in effect of estrogen on serum lipid levels and it has been known that the changes depend on a type and dosage of progestogen. It is also known that progestational agent induces positive ch-ange in bone mineral density. To study the effects of progestogen on lipoprotein and bone metabolism, we administ- ered conjugated equine estrogen 0.625 mg alone to 50 postmenopausal women, in combinat- ion with medroxy- progesterone acetate 5 mg to 40 postmenopausal women. The data demonstrated a beneficial effect in lipoprotein profiles in both groups. Total cholesterol in two groups decreased from the baseline values, LDL-cholesterol decreased significantly by 4.8 % in group I and 16.2 % in group II(p < 0.05), HDL-cholesterol increa- sed significantly by 11.3 % in group I and 14.7 % in group II(p < 0.05), triglyceride incre- ased slightly in both groups. Bone mineral density of femur was maintained and BMD of vertebrae increased by 1.1 % in group I and 2.0 % in group II, but it is not statistically significant. The differences of changes between two groups were not statistically significa- nt. Our results suggest that medroxyprogesterone acetate have no adverse effect on HDL -cholesterol and have no additive effect on bone mineral density in hormone replacement therapy.
Bone Density* ; Cholesterol ; Estrogens* ; Female ; Femur ; Hormone Replacement Therapy ; Humans ; Lipoproteins ; Medroxyprogesterone Acetate ; Metabolism ; Progesterone ; Progestins ; Spine ; Triglycerides

BACKGROUND: There is considerable controversy about the exact molecular mechanisms of excitatory amino acid receptors in epileptogenesis. METHODS: We used in situ hybridization to examine the hybridization density (HD) of n-methyl- D-aspartic acid receptor type 1 (NMDAR-1) and alpha-amino-3-hydroxy -5-methyl-4-isoxazole-propionate (AMPA) receptor type 2 (GluR-2) mRNA, in the hippocampus obtained from the kainic acid (KA)-induced status epilep-ticus (SE) model. Some Sprague-Dawley rats were injected with KA (10 mg/Kg; I.p.), and others with MK-801 (4 mg/kg) 20 minutes prior to KA. The rats were allowed to have 4-hour SE and were killed at 8 hours or 4 weeks after KA or MK-801/KA injection. HD of NMDAR-1 and GluR-2 mRNA in subfields of the hippocampus was measured by an image analysis system. RESULTS: A typical neuropathological finding of hippocampal sclerosis and spontaneous repetitive seizures (SRS) were observed in the KA injected rats, but not in the MK-801 pretreated rats, killed at 4 weeks. Compared with controls, the rats killed at 8 hours after KA showed increased CA1, CA2, and CA3 NMDAR-1 HD, and stratum granulosum (SG) GluR-2 HD. The increase of NMDAR-1, not GluR-2, HD was blocked effectively by MK-801. The increase of SG GluR-2 HD remained until 4 weeks after the KA injection. CONCLUSIONS: Not only the NMDAR-1activa-tionbut also the GluR-2 activation is an important factor in delaying hippocampal neuronal loss and epileptogenesis. (J Korean Neurol Assoc 19(1):36~44, 2001
alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid ; Animals ; D-Aspartic Acid ; Dizocilpine Maleate ; Epilepsy, Temporal Lobe ; Gene Expression* ; Glutamic Acid* ; Hippocampus ; In Situ Hybridization ; Kainic Acid ; N-Methylaspartate ; Neurons ; Rats ; Rats, Sprague-Dawley ; Receptors, Glutamate* ; RNA, Messenger ; Sclerosis ; Seizures ; Temporal Lobe*

The induction of interleukin-6 (IL-6) using combined proinflammatory agents (LPS/IFN-gamma or TNF-alpha/IFN-gamma) was studied in relation to p38 mitogen-activated protein kinase (MAPK) and NF-kappaB transcriptional factor in primary neonatal cardiomyocytes. When added to cultures of cardiomyocytes, the combined agents (LPS/IFN-gamma or TNF-alpha/IFN-gamma) had stimulatory effect on the production of IL-6 and the elevation was significantly reduced by SB203580, a specific p38 MAPK inhibitor. SB203580 inhibited protein production and gene expression of IL-6 in a concentration-dependent manner. In this study, IFN-gamma enhancement of TNF-alpha-induced NF-kappaB binding affinity as well as p38 MAP kinase activation was observed. However, a specific inhibitor of p38 MAPK, SB203580, had no effect on TNF-alpha/IFN-gamma or LPS/IFN-gamma-induced NF-kappaB activation. This study strongly suggests that these pathways about TNF-alpha/IFN-gamma or LPS/IFN-gamma-activated IL-6 release can be primarily dissociated in primary neonatal cardiomyocytes.
Gene Expression ; Interleukin-6* ; Myocytes, Cardiac* ; NF-kappa B ; p38 Mitogen-Activated Protein Kinases ; Protein Kinases*

Most hepatocellular carcinomas arise in orthotopic liver tissue as a result of chronic hepatitis B or C infection or cirrhosis secondary to other chronic liver disease. There have been reports of ectopic liver tissue located in an extrahepatic organ such as the gallbladder, spleen, hepatoduodenal ligament and subdiaphragm. However, the incidence of hepatocellular carcinoma originating from ectopic liver is very low. There have been 22 cases of ectopic HCCs (hepatocellular carcinoma) reported in the literature, and ruptured HCC has not yet been reported in the literature. As for the pathogenesis, the development of an ectopic HCC may be result of a compromised vascular supply or biliary drainage. We report here on a case of ruptured ectopic hepatocellular carcinoma arising in the left subdiaphragm in a 76-year-old man who was treated with surgical resection. The patient was followed up for 1 year after surgery and he remained free of recurrence. Therefore, the unique localization and growth pattern of ruptured ectopic HCC may give the physician and patient the chance to achieve a curative resection.
Aged ; Carcinoma, Hepatocellular ; Drainage ; Fibrosis ; Gallbladder ; Hepatitis B, Chronic ; Humans ; Incidence ; Ligaments ; Liver ; Liver Diseases ; Recurrence ; Spleen

BACKGROUND: Negative public attitude toward epilepsy is a common phenomenon all over the world and one of the major factors causing social discrimination against people with epilepsy. In general, those with epilepsy have considerable limitations in their interaction with and adaptation to their surroundings, and some of them find social attitudes more devastating than the disorder itself. METHODS: In order to indicate folk medicines known as an epilepsy treatment among Korean rural residents and to deduce the background of the negative attitudes from analysis of the estimated effect of the folk medicine, a survey was conducted in a Korean rural area. RESULTS: Of 713 persons contacted in the survey, 22% of respondents replied that they knew at least one folk medicine as an epilepsy treatment. About 55% of the folk medicines were superstitious or incantational one such as eating the organs of animals or humans, or soup boiled with the branches of a tree struck by lightening, or with a rope used in a suicidal hanging. From the results, we can deduce the fact that the understanding of epilepsy by the Korean respondents base on the supernatural or superstitious thinking that seem to be attributed to our own unique culture. CONCLUSION: In order to ameliorate prejudices against epilepsy and allow epileptic persons to interact with and adapt to their surrounding properly, not only continuous and repetitive educational efforts but also the sympathy of professional and lay societies regarding epilepsy would be needed.
Animals ; Surveys and Questionnaires ; Eating ; Epilepsy* ; Humans ; Medicine, Traditional* ; Prejudice ; Social Discrimination ; Superstitions ; Thinking ; Trees

STUDY DESIGN: A retrospective study. OBJECTIVES: To describe the surgical procedure and assess the results of an unilateral transpedicular screw and contralateral translaminar facet screw fixation in degenerative lumbar stenosis. SUMMARY OF LITERATURE REVIEW: A drawback of conventional lumbar fusion is the extensive soft-tissue destruction that is essential when inserting a screw and preparing the fusion bed. The development of a procedure that minimizes the tissue trauma without compromising the effectiveness of the conventional posterior lumbar interbody fusion (PLIF) should be pursued in lumbar spinal stenosis. MATERIALS AND METHODS: From August 2004 to November 2005, PLIF was performed on 25 consecutive patients who had lumbar spinal stenosis. Among them, 10 patients underwent with unilateral transpedicular screw and contralateral translaminar facet screw fixation (Group 1), and 15 patients underwent traditional bilateral transpedicular screw fixation (Group 2). The clinical and radiological results in the two groups were compared. RESULTS: The mean follow-up was 17.6 and 20.5 months in Groups 1 and 2, respectively. Group 1 had less blood loss, fewer transfusion requirements (P.0.05) in the surgical procedure, and less postoperative back pain (P.0.05). There was no significant difference between the two groups in the clinical results such as the VAS score for back pain and the Kirkadly-Willis criteria at the last follow-up, and the radiological results such as the changes in the disc height and interbody fusion. CONCLUSION: The PLIF with unilateral transpedicular screw and contralateral translaminar facet screw fixation in lumbar spinal stenosis has advantages over conventional PLIF of less soft tissue injury, and produces good clinical results.
Back Pain ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Retrospective Studies ; Soft Tissue Injuries ; Spinal Stenosis*

BACKGROUND: Neointimal hyperplasia, as the most important mechanism of restenosis after intracoronary artery stenting, its severity is closely correlated with the degree of local inflammatory reaction initiated by vasular injury during stenting procedure. So, we proceeded this study to determine whether inflammatory markers such as CD11b/CD18 (Mac-1) adehsion molecules of neutrophils, sICAM-1 (soluble intercellular adhesion molecule-1), ESR, and CRP increase or not in the peripheral circulation after coronary artery stenting, and whether there is any association between these findings and the degree of later restenosis. METHOD: 32 patients (chronic stable angina 4, unstable angina 17, acute myocardial infarction 11) underwent single vessel coronary artery stenting were enrolled in our study. Blood samples were obtained from peripheral vein just before coronary artery stenting and 48 hours thereafter. The degrees of CD11b/CD18 expression on the surface of neutrophils were analyzed by flow cytometry with monoclonal antibodies, and sICAM-1 by ELISA method. At each times, ESR and CRP were also measured. Follow-up coronary artery angiography was performed with QCA analysis at least 6 months later. We compared the each 48 hours values with the baseline (just before procedure) values. Percentage increments (as a ratio 48 hours values to baseline) of CD11b/CD18 expression, sICAM-1, ESR, and CRP levels were also compared with the results of follow-up QCA analysis. RESULTS: Restenosis (diameter stenosis > or = 50%) occurred in 6 patients (19%) at follow up angiography. 48 hours values of CD11b/CD18 expression, sICAM-1, ESR, and CRP were significantly elevated from the baseline values (each p values, CD11b : < 0.0001, CD18 : 0.01, sICAM-1 : < 0.0001, ESR : 0.005, and CRP : 0.001). The percentage increments of CD11b/CD18 expression were more elevated in restenosis group than nonrestenosis group (CD11b : 341+/-215%/74+/-95%, CD18 : 84+/-60%/17+/-37%, each p < 0.001, 0.001). There was some positive correlation between the percentage increments in the expression of CD11b and the late loss index at the follow up angiography (r=.43, p<0.05). CONCLUSIONS: Through this study, we found that the activation of neutrophils was occurred, and that sICAM-1 level was increased after coronary artery stenting in the peripheral blood. There was some correlations between the degree of CD11b expression on the surface of neutrophils and the severity of late lumen loss of inserted stents. The measurements of increased neutrophil adhesion molecules of CD11b/CD18 levels at 48hrs after coronary stenting may have a value as the predictor of subsequent late restenosis.
Angina, Stable ; Angina, Unstable ; Angiography ; Antibodies, Monoclonal ; Arteries ; Constriction, Pathologic ; Coronary Vessels* ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Follow-Up Studies ; Humans ; Hyperplasia ; Myocardial Infarction ; Neutrophils* ; Stents* ; Veins