OBJECTIVES: This study evaluates the change of the left atrial appendage function before and after electrical cardioversion to understand the mechanism involved in systemic thromboembolism of atrial fibrillation. BACKGROUND: Systemic thromboembolism associated with electrical cardioversion of atrial fibrillation is thought to originate from the left atrium or left atrial appendage, or both.However, the mechanism involved is poorly understood. METHOD: We studied left atrial appendage function funcction with transesophageal echocardiography in 15 patients with atrial fibrillation before and after successful electrical cardioversion. We measured left atrial appendage emptying and filling velocities and left atrial appendage areas. Also we analysed the characteristic Dopper flow pattern of LAA. RESULT: Left atrial appendage emptying velocities before cardioversion were greater in patients without(32.0+/-13.2cm/sec) than in those with(21.4+/-7.6cm/sec) spontaneous echo contrast(SEC). Furthermore emptying velocities after cardioversion were significantly reduced group with (21.4+/-7.6 vs 12.2+/-9.6, p<0.05) and the groupwithout(32.0+/-13.2 vs 18.1+/-10.2, p<0.05)SEC. CONCLUSION: After electrical cardioversion for atrial fibrillation left atrial appendage function is impaired. These observations suggest that stunned left atrial appendage after cardioversion may predispose to thrombus formation, which may play a role in the mechanism involved in the occurrence of thromboembolism after cardioversion.
Atrial Appendage* ; Atrial Fibrillation* ; Echocardiography, Transesophageal* ; Electric Countershock* ; Heart Atria ; Humans ; Thromboembolism ; Thrombosis

It has been known that the interconnection between the gervous, endocrine and immune system are largely mediated through regulatory soluble factors such as neruopeptides, cytokines and hormones. Capsaicin, the pungent principle of hot peppers, is a neurotoxin that affects primary sensory neurons of the C and A-b type and depletes primary sensory neurons (polymodal nociceptors) of neuropeptides like tachykinin. In this study capsaicin was used to explore the possible role of the neruons on the expression of cellular and humoral immune responses and TNF-a prodcution. Mice were pretreated with s.c. injections in the neck region with a single dose of 100 u,g of capsaicin per mouse before immunization. ...continue...
Anaphylaxis* ; Animals ; Capsaicin* ; Carcinogenesis* ; Cytokines ; Immune System ; Immunity, Humoral ; Immunization ; Mice* ; Neck ; Neuropeptides ; Sensory Receptor Cells ; Tachykinins

There had been total 20 patients with early onset(4 months~2 years) primary nephrotic syndrome in the Department of Pediatrics, Seoul National University Children's Hospital, during the period from March 1987 to February 1993. We analysed clinical courses, response to treatment, pathological findings and prognosis of the patients And the results were as follows; 1) The initial responders to steroid treatment were 10(50%), of whom 3 became late nonresponders. Of the 10 initial nonresponders, 8 revealed continuing nonresponsiveness. 2) Incidence of hypertension was significantly higher in the intial nonresponders than in the initial responders. 3) Renal biopsies were performed in 9 initial nonresponders and 2 late nonresponders. And the results were 6 with minimal change lesion, 4 with focal segmental glomerulosclerosis and 1 with mesangiocapillary glomerulonephritis. 4) Six continuing or late nonresponders received methylprednisolone pulse therapy or cyclophosphamide. And partial remission was induced in 4 of them. 5) The overall 3 year maintenance rate of normal renal function was 81%(100% in the initial responders and 64% in the initial nonresponders). In conclusion, the initial steroid responsiveness and prognosis were poorer in patients with early onset nephrotic syndrome than in patients with usual childhood nephrotic syndrome.
Biopsy ; Cyclophosphamide ; Glomerulonephritis, Membranoproliferative ; Glomerulosclerosis, Focal Segmental ; Humans ; Hypertension ; Incidence ; Methylprednisolone ; Nephrotic Syndrome* ; Pediatrics ; Prognosis ; Seoul

Syphilitic involvement of the stomach often takes the appearance of neoplastic conditions. We describe the radiological findings of syphilitic gastritis. A 36-year-old man was diagnosed with gastric cancer by upper GI and CT, but syphilitic gastritis was confirmed by endoscopy and upper GI series performed after penicillin therapy, We report a case of syphilitic gastritis presented as advanced stomach cancer by clinical, endoscopic and radiological study.
Adult ; Endoscopy ; Gastritis* ; Humans ; Penicillins ; Stomach ; Stomach Neoplasms

Human Adjuvant Disease(HAD) is a connective tissue disease occuring after cosmetic surgery with a foreign substance. It was first reported by Miyoshi in 1964. There have been specific connective disorders such as systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis and mixed connective tissue disease. Scleroderma is the single most commonly reported disease. A 55-year-old woman was seen for evaluation of dypnea. Four years previously, she underwent cosmetic surgery with silicone injected directly into eyelid, forehead, both hand and monspubis. The patient presented the classic feature of systemic sclerosis and pericardial effusion. Following pericardiocentesis, she felt somewhat better and became less dyspneic. Seventeen days later, however, she progressively deteriorated and died in spite of intensive medical therapy and supportive care.
Arthritis, Rheumatoid ; Connective Tissue Diseases ; Eyelids ; Female ; Forehead ; Hand ; Humans ; Lupus Erythematosus, Systemic ; Middle Aged ; Mixed Connective Tissue Disease ; Pericardial Effusion ; Pericardiocentesis ; Scleroderma, Diffuse ; Scleroderma, Systemic ; Sclerosis* ; Silicone Gels* ; Surgery, Plastic*

Hemangioblastomas comprise 1 to 2% of all intracranial neoplasm, and 8 to 12% of tumors within the posterior fossa. They are composed of admixtures of three different cell types; endothelial cells, pericytes and stromal cells. Although most hemangioblastomas arise sporadically, they are associated with von Hippel-Lindau disease in about 20% cases. We have experienced a case of multiple hemangioblastomas occuiing in the cerebellum, medulla oblongata and cervical spinal cord simultaneously in a 55-year-old male. He had complained of headache, dizziness, generalized weakness and gait disturbance for 2 weeks. The patient had neither specific family history nor increased hematocrit. MRI showed a nonenhancing cystic lesion with an enhancing mural nodule in the right cerebellar hemisphere and two separate enhancing nodules in the medulla oblongata and dorsal cervical spinal cord at the 5-6th. Grossly, the excised mass of the cerebellum, 2.5 x 2 x 1.8cm, was solid to partly cystic, and that of spinal cord, lcm in diameter, was mostly solid. Microscopically, the tumor was composed of thin-walled blood vessels in variable size and interspersed stromal cells. The stromal cells revealed dimorphic cytoplasm that were either homogeneous and eosinophilic, or clear and vacuolated. Immunohistochemically, the endothelial cells reacted positively for glial fibrfllaty acidic protein(GFAP) and vimentin. The stromal cells reacted diffusely positively for vimentin, focally positively for GFAP and S-100 protein near the periphery of the tumor, focally positivel for neuro specipic enolase(NSE), and negatively for lysozyme, desmin and chromogranin. Ultrastructurally, the stromal cells contained numerous microfilaments and lipid droplets.

Hemangioblastomas comprise 1 to 2% of all intracranial neoplasm, and 8 to 12% of tumors within the posterior fossa. They are composed of admixtures of three different cell types; endothelial cells, pericytes and stromal cells. Although most hemangioblastomas arise sporadically, they are associated with von Hippel-Lindau disease in about 20% cases. We have experienced a case of multiple hemangioblastomas occuiing in the cerebellum, medulla oblongata and cervical spinal cord simultaneously in a 55-year-old male. He had complained of headache, dizziness, generalized weakness and gait disturbance for 2 weeks. The patient had neither specific family history nor increased hematocrit. MRI showed a nonenhancing cystic lesion with an enhancing mural nodule in the right cerebellar hemisphere and two separate enhancing nodules in the medulla oblongata and dorsal cervical spinal cord at the 5-6th. Grossly, the excised mass of the cerebellum, 2.5 x 2 x 1.8cm, was solid to partly cystic, and that of spinal cord, lcm in diameter, was mostly solid. Microscopically, the tumor was composed of thin-walled blood vessels in variable size and interspersed stromal cells. The stromal cells revealed dimorphic cytoplasm that were either homogeneous and eosinophilic, or clear and vacuolated. Immunohistochemically, the endothelial cells reacted positively for glial fibrfllaty acidic protein(GFAP) and vimentin. The stromal cells reacted diffusely positively for vimentin, focally positively for GFAP and S-100 protein near the periphery of the tumor, focally positivel for neuro specipic enolase(NSE), and negatively for lysozyme, desmin and chromogranin. Ultrastructurally, the stromal cells contained numerous microfilaments and lipid droplets.

PURPOSE: To verify the value of CT in the diagnosis of cirrhosis, CRL ratio was measured in 225 Koreans who had and evidence of cirrhosis both clinically and radiologically. MATERIALS AND METHODS: The mean value of CRL ratio was 0.68+/-0.21 which was significant difterent from the published value of normal person(0.45+/-0.07). The difference of CRL ratio between men and women and that among different age groups were found to be not statistically signficant. RESULTS: CRL ratio of virus- related group(N:149) was 0.64+/-0.18, whereas that of virus-nonrelated group (N=76) was 0.76+/-0.23. There was a statistically significant difference of CRL ratio between virus-related group and virus-nonrelated group. CRL ratio of hepatoma-related group(N:113) was 0.71+/-0.22 whereas that of heparoma-nonrelated group(N:112) was 0.66+/-0.19. There was no statistically significant difference of CRL ratio between hepatoma-related group and hepatoma-nonrelated group. CONCLUSION: Measurement of CRL ratio by CT is a useful method in assessing cirrhosis of the liver.
Diagnosis ; Female ; Fibrosis ; Humans ; Liver Cirrhosis* ; Liver* ; Male

BACKGROUND: Bupivacaine is a potent, and commonly used, long acting local anesthetic. If accidentally injected into the systemic circulation, bupivacaine can cause lethal dysrhythmias and circulatory collapse. Attempts to treat bupivacaine induced cardiac toxicity have been varied and controversial, and they have not been very successful. The aim of this study was to investigate the electrophysiologic effects of bupivacaine in Purkinje fibers. METHODS: Effects of bupivacaine on the membrane potential were studied in 12 isolated canine Purkinje fibers. Purkinje fibers from ventricle were dissected and mounted in a tissue chamber perfused with Tyrode's solution. Transmembrane potentials recorded through glass microelectrodes filled with 3M KCI in the beating or quiescent Purkinje fibers during infusions of bupivacaine at concentratons of 3*10/-7M,10/-6M, 3*10/-6M,10/-5M, and 3*10/-5M. RESULTS: Bupivacaine reduced action potential druation in a dose-dependent manner. Bupivacaine produced a decrease in intracelullar sodium ion activity in driven(1Hz) and quiescent canine Purkinje fibers. Bupivacaine-induced hyperpolarizaton of diastolic membrane potential in quiescent Purkinje fibers was dose dependent, and the hyperpolarization by bupivacaine was attenuated by depolarization induced by high potassium extracellular concentration in part. CONCLUSIONS: These results suggest that bupivacaine decreases the fast inward sodium current, and inhibits pacemaker current in canine Purkinje fibers.
Action Potentials ; Bupivacaine* ; Glass ; Membrane Potentials* ; Membranes* ; Microelectrodes ; Potassium ; Purkinje Fibers ; Shock ; Sodium ; Sodium Channels

We report a case of Becker's nevus associated with ipsilateral breast hypoplasia in a 13-year-old female. Three years esrlier, she noticed a palrn-size hyperpigmented area on her left chest. The lesion showed a well defined geographic border. No hypertrichosis was seen. Hypoplasia was apparent on the left breast. A histopathologic finding showed a slightly hyperpigmented epidermis and some rectangular rete ridges with flat bases.
Adolescent ; Breast* ; Epidermis ; Female ; Humans ; Hypertrichosis ; Nevus* ; Thorax