Between December 1993 and March 1996, 75 patients had undergone subannular procedures in mitral valve reconstruction. Their mean age was 45 years and they consisted of 28 males and 47 females. The cause of mitral disease in 75 patients were classified as follow : 29 cases were degenerative, 40 cases were rheumatic, 3 cases were congenital, 2 cases were infectious and 1 case was ischemic. Average number of mitral anatomical lesion per patient was 3.1 and we used average 1.5 procedures on subannular structure in mitral valve per patient. Subannular procedures were chordae shortening 21, chordae transfer 22, new chordae formation 20, papillary muscle splitting 33, shortening of papillary muscle 2. Intraoperative transesophageal echocardiography was carried out for providing an immediate and accurate assessment of the adequacy of the reconstruction. There was no operative death. Patients have been followed up from 2 to 29months, mean 12.5. There were two failures that necessitated reoperation. The mean functional class(NYHA) was 3.19 preoperative and improved to 1.12. postoperatively. After mitral valve repair, the patients were improved hemodynamic, echocardiographic data. In conclusion, subannular procedure in mitral valve repair when feasible is stable and safe with a low prevalence of reoperation.
Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Valve Diseases ; Hemodynamics ; Humans ; Male ; Mitral Valve* ; Papillary Muscles ; Prevalence ; Reoperation

Primary cardiac tumors in infancy and childhood are rare, with fibromas being the second most common tumor after rhabdomyomas. Although cardiac fibromas are characteristically benign intramural tumors, they may exhibit exhibit expansile growth resulting in obstruction, valvular dysfunction, as well as other problems so early diagnosis and successful surgical excision are important. We report a case of cardiac fibroma in a 2 month-old male infant. He presented with generalized cyanosis from birth. Echocardiography showed oval round large mass filing the right atrium and ventricle which infiltrated into the lateral wall of the ventricle. Partial excision of the tumor was done after another echocardiogram showed a pericardial effusion and restriction of blood flow to the right ventricle due to the tumor. The resected tumor was ovoid, gray-tan, slightly firm and measuring 5x3x2.5 cm. Histologically, the tumor was composed of spindle-shaped fibroblasts and hyalinized fibrous tissue interdigitating with the surrounding myocardium.
Infant ; Child ; Male ; Female ; Humans

In the past two decades, open reduction and internal fixation has been the preferred treatment of posterior pelvic ring disruption with instability. Despite of rigid fixation, it can induce bleeding, wound infection, wound necrosis and prolong operation time in the patient with combined injuries. To compensate for these disadvantages, we have implemented closed reduction and percutaneous iliosacral fixation under fluoroscopy in reducible posterior pelvic ring disruption. In spite of anatomical risk during screw insertion, the percutaneous iliosacral screw technique after closed reduction of the posterior pelvic ring disruption minimally violates the soft tissue envelope and reduces both the operative blood loss and infection rate. We are reporting the early results of our 6 patients treated between Aug. 1995 to Aug. 1996. The operation time was shorter than open reduction and internal fixation. There was no significant bleeding, wound infection and nerve injury by screws.
Fluoroscopy ; Hemorrhage ; Humans ; Necrosis ; Wound Infection ; Wounds and Injuries

BACKGROUND/AIMS: Ischemic colitis is a vascular condition of inadequate blood flow in the colon which leads to colonic inflammation and can cause significant morbidity and mortality. Oxidative stress is an early initiating event in ischemia and reperfusion injury. Heme oxygenase (HO) is considered to be an antioxidant enzyme that catabolizes heme to carbon monoxide, free iron and biliverdin. The aim of this study was to evaluate the expression patterns of HO-1, inducible form of HO, in ischemic colitis. METHODS: We analyzed the twelve cases of clinically and pathologically diagnosed ischemic colitis without surgical intervention compared with normal colon (n=10) and psedomembranous colitis (n=5). Immunohistochemical stainings for HO-1 were performed in paraffin-embedded tissues. RESULTS: The age of the patients ranged from 56 to 84 years (mean: 67 years) in ischemic colitis. Eight patients (66.7%) were female. The most common presenting symptom was bloody stool (66.7%) and rectosigmoid area (91.7%) of the large intestine was the most common ischemic site. Expression of HO-1 in ischemic colitis was high in contrast to normal colonic mucosa or psedomembranous colitis. CONCLUSIONS: Ischemic colitis usually involves the rectosigmoid area in elderly female patients with a history of bloody stool. High expression of HO-1 in ischemic colitis may be responsible for a protective mechanism to ischemia or heme injury.
Aged ; Aged, 80 and over ; Colitis, Ischemic/*enzymology ; Colon/*enzymology ; Female ; Heme Oxygenase (Decyclizing)/*metabolism ; Humans ; Immunohistochemistry ; Intestinal Mucosa/*enzymology ; Male ; Middle Aged

Fibroblast growth factor-4 (FGF-4) has various functions, affecting many signaling pathways, and leading to cellular proliferation and differentiation and to the regulation of cell migration, invasion, and angiogenesis. However, there are few reports of the relationship between TS cells and FGF-4 even if FGF-4 is located in inner cell mass of embryo and Fibroblast growth factor receptor (FGFR) is located in TS cells. Therefore the physiologic effects of FGF-4 on TS cells were investigated for identifying the effects of FGF-4 on TS ell differentiation. FGF-4 was involved in early stage development of the trophoblast via upregulation of eomesodermin mRNA expression. In addition, FGF-4 suppressed the differentiation of TS cells through activation of extracellular-signal regulated kinase (Erk) and suppression of focal adhesion kinase (FAK) activation, which in TS cells is an important indicator of early trophoblast cell differentiation, migration and invasion. FGF-4 was involved in angiogenesis in the trophoblast through the activation of p38 and the induction of Dlx-3 mRNA expression in TS cells. In addition, TS cells cultured with FGF-4 for 4 days in a thrombinfibrinogen gel culture system, a specific culture system for endothelial cells, showed a healthy appearance, while TS cells cultured without FGF-4 were severely damaged. Taken together, these data suggest that FGF-4 is closely involved in differentiation of TS cells for development of placenta.
Cell Differentiation ; Cell Movement ; Cell Proliferation ; Embryonic Structures ; Endothelial Cells ; Fibroblasts ; Focal Adhesion Protein-Tyrosine Kinases ; Phosphotransferases ; Placenta ; Receptors, Fibroblast Growth Factor ; RNA, Messenger ; Trophoblasts* ; Up-Regulation

BACKGROUND: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small vessel disease caused by mutations in the Notch3 gene. Lacunes may reflect occlusive type microangiopathy. However, cerebral microbleeds (CMBs) may reflect bleeding-prone microangiopathy. In the present study, we aimed to determine whether hypertension influence the distribution and severity of lacunes and CMBs in patients with CADASIL. METHODS: The study population comprised 85 patients who underwent brain MRI, including T1-weighted image, susceptibility weighted image (SWI), and fluid attenuated inversion recovery (FLAIR) image. The patients were divided into two groups depending on the presence or absence of hypertension. In the first, demographic factors, and MRI findings were compared between CADASIL patients with and without hypertension. In the second, we undertook a region by region comparison of number of patients with lacunes or CMBs. RESULTS: The hypertensive group showed a higher incidence of CMBs in lobar area (p<0.001) and basal ganglia (p=0.014). CMBs tend to be observed more frequently in the thalamus (p=0.058), brainstem (p=0.057), and cerebellum (p=0.052) in the hypertensive group. However, hypertensive group demonstrated a higher incidence of lacunes just in lobar area (p=0.040). CONCLUSIONS: Our findings suggest that CMBs may be a more sensitive neuroimaging marker of hypertensive arteriopathy in patients with CADASIL.
Basal Ganglia ; Brain ; Brain Stem ; CADASIL* ; Cerebellum ; Demography ; Humans ; Hypertension* ; Incidence ; Leukoencephalopathies ; Magnetic Resonance Imaging ; Neuroimaging ; Thalamus

BACKGROUND: Rhus verniciflua Stokes (RV) has traditionally been used in Korea as an indigenous food (Rhus chicken soup) and as an herbal medicinal plant. While the anticancer, antimicrobial, and anti-inflammatory properties of RV have been actively studied in the medical field, its antioxidant effects in the skin that resist the reactive oxygen species in keratinocytes and fibroblasts is less understood. OBJECTIVE: We designed to evaluate the effects of R. verniciflua Stokes extract (RVE) on the photo-aged skin by an in vitro experiment using human fibroblasts and an in vivo experiment using a photo-aged murine model. METHODS: For the in vitro experiments, human fibroblasts irradiated with ultraviolet (UV) B were treated with RVE or vehicle, and the growth levels and the expression level of type 1 procollagen were compared. For the in vivo experiment, photo-aged mice irradiated with UVB and UVA were administered drinking water with or without RVE, and histological changes and the expression level of type 1 procollagen and matrix metalloprotease (MMP)-13 were compared. RESULTS: In vitro experiments using fibroblasts irradiated with UVB showed that RVE promoted growth and significantly increased the expression of type 1 procollagen as compared to the control group. In the photo-aged mice, RVE increased collagen content in the dermis and promoted the synthesis of type 1 procollagen without any visible decrease in MMP-13 as compared to control group. CONCLUSION: In addition to the previously reported antioxidant effects of RVE, oral intake of RVE effectively inhibited photo-aging in hairless mice by enhancing collagen synthesis.
Aging ; Animals ; Antioxidants ; Chickens ; Collagen ; Dermis ; Drinking Water ; Fibroblasts ; Humans ; In Vitro Techniques ; Keratinocytes ; Korea ; Mice* ; Mice, Hairless ; Plants, Medicinal ; Procollagen ; Reactive Oxygen Species ; Rhus* ; Skin*

Myxoma, a rare primary tumor occurring in cardiac chamber, has been shown to cause various neurologic complications such as embolic infarction, neoplastic aneurysm and metastasis. Recently we experienced a patient with cardiac myxoma who presented with behavioral changes. Brain MRI showed lesions suggestive of metastasls and embolic infarctions. Aneurysm was also documented in cerebral angiogram. The case illustrates diverse spectrum of neurologic complications of cardiac myxoma.
Aneurysm ; Brain ; Humans ; Infarction ; Magnetic Resonance Imaging ; Myxoma* ; Neoplasm Metastasis

BACKGROUND: Dizziness is one of the most common neurological symptoms for visiting the emergency department. Acute vertigo and severe imbalance may be the only presenting features of cerebellar stroke that could masquerade as a peripheral vestibular lesion. Magnetic resonance images (MRI) proved to be very sensitive in detecting acute stroke involving brainstem or cerebellum. In this retrospective study, we investigated the diagnostic yield of emergency brain MRI among the patients who visited emergency department with acute dizziness. METHODS: We reviewed the medical records of consecutive patients with acute dizziness who were seen in emergency department of Cheju National University Hospital between May 2005 and Oct 2006. We collected following the information from medical records. (1) Age, sex, and blood pressure at emergency department (2) Type, duration, accompanying symptoms of dizziness and positive finding from neurological and neuro-otological examination (3) Vascular risk factors (4) Results of MRIs. RESULTS: During the study period, 360 patients visited emergency department due to isolated acute dizziness. Emergent MRIs were performed in 84 (23.3%) patients. Although about 90% of them were older than 50 years and 60% of them had at least one or more vascular risk factors, central causes of dizziness were found in only five patients including four acute cerebellar infarctions and a cerebellar hemorrhage. Diagnostic yield of emergent MRI was only 6%. CONCLUSIONS: In this study, emergency brain MRIs showed limited diagnostic yield among patients who visited emergency department with acute isolated dizziness.
Blood Pressure ; Brain Stem ; Brain* ; Cerebellum ; Dizziness* ; Emergencies* ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Infarction ; Jeju-do ; Magnetic Resonance Imaging* ; Medical Records ; Retrospective Studies ; Risk Factors ; Stroke ; Vertigo

BACKGROUND: A major pathway for protein degradation in eukaryocytes is ubiquitin-dependent. A novel species of plant and mammalian E2 homologous to yeast UBC4/UBC5 is involved in polyubiquitination and degradation of off and many other proteins as well. METHODS: By sequencing the Expressed Sequence Taqs(ESTs) of human dermal papilla cDNA library, we isolated a clone, named K183 which showed high homology to the yeast UBC4/UBC5. We designated this gene as UBC-dp. RESULTS: K183 clone is 1,222 nucleotides long, and has a coding region of 622 nucleotides and a 3' noncoding region of 538 nucleotides. The presumed open reading frame starting at the 5' terminus of UBC-dp encodes 207 amino acids. The amino acid sequence deduced from the open reading frame of UBC-dp shares 81%, 80% and 80% identities with that of HSUBCH5. yeast UBC4 and yeast UBC5, respectively. The transcripts were ubiquitously expressed in a variety of human tissues. The levels of transcript were relatively high in those tissues such as skeletal muscle, heart, testis and ovary. CONCLUSIONS: Homology search result suggests that K183 clone is human homolog of the UBC4 and UBC5 which are involved in p53 degradation so its function related with p53 should be studied.
Amino Acid Sequence ; Amino Acids ; Clinical Coding ; Clone Cells* ; Cloning, Organism* ; Female ; Gene Library ; Heart ; Humans ; Muscle, Skeletal ; Nucleotides ; Open Reading Frames ; Ovary ; Plants ; Polyubiquitin ; Proteolysis ; Testis ; Ubiquitin* ; Yeasts