BACKGROUND: The previous reports have demonstrated that coronary artery flow profiles might change in patients with aortic valve disease. Our objective was to assess phasic coronary artery flow and velocity characteristics and coronary flow reserve in patients with severe aortic vale disease. METHOD: We studied six patients (4 men and 2 women, mean age 61.3+/-6.3 years) with aortic regurgitation and seven patients (3 men and 4 women, mean age 66.3+/-10.3 years) with aortic stenosis. Coronary flow velocity was measured at the proximal portion of left anterior descending artery with 0.014-inch Doppler tipped guide wire and intracoronary injection of adenosine. Nineteen patients (11 men and 8 women, mean age 52+/-9.8 years) with normal coronary artery were served as normal control. Result: The velocity-time integral of systolic coronary flow (SPVi) was significantly higher in patient with severe aortic regurgitation than control (21.1+/-5 vs 9.4+/-3.1, p<0.05, respectively) and ratio of diastlic to systolic the velocity-time integrals (DSiR) was significantly lower in patient with severe aortic regurgitation than control subject (1.5+/-0.5 vs 3.7+/- 0.8 p<0.05, respectively). Patients with severe aortic stenosis had significantly higher velocity-time integral of diastolic coronary flow (DPVi) than control subject (17+/-9.7 vs 8.8+/-3.0 p<0.05, respectively) and slighly higher DSiR than control subject (4.0+/- 2.5 vs 3.7+/-0.8 p<0.05, respectively). Coronary flow reserve was significantly decreased in patient with aortic valve disease compared with control subject (2.1+/-0.8 vs 3.2+/-0.4 p<0.05, respectively). CONCLUSION: Coronary flow reserve decreased significantly in patients with AR and with AS compared with normal control. Coronary blood flow profiles in patients with AR was characterized by systolic flow predominance and reduced diastolic flow whereas patients with AS was a tendency toward decreased systolic flow and increased diastolic flow.
Adenosine ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Arteries ; Coronary Vessels* ; Female ; Humans ; Male

We already achieved the goal of the elimination of leprosy that was recommended by WHO. But the amazing change of our country's situation of the economical & social conditions makes the need of the migrant worker. Especially, the portion of migrant workers form India, Nepal, Indonesia, Philippines, Bangladesh, & Vietnam, the countries of relatively high prevalence rate of Hansen's disease are increasing among them recently. It means the attention about the influx of Hansen's disease form the foreign countries. We perform the survey for Hansen's disease of the migrant worker. Total 603 workers were surveyed. We found only 4 persons, that had the high titer(above 500) of the result of PGL-1 ELISA, and only 3 persons, that had some findings, the suggestive finding of Hansen's disease, of cutaneous & neurological symptoms. In spite of the special study, we did not conform the diagnosis of Hansen's disease among them. During this survey, we did not find the conformed patients of Hansen's disease. But we think that we will be concerned about the influx of Hansen's disease from foreign countries, because of the recently significance change of the epidemiological situations of Hansen's disease in Korea.
Bangladesh ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; India ; Indonesia ; Korea ; Leprosy* ; Nepal ; Philippines ; Prevalence ; Social Conditions ; Transients and Migrants* ; Vietnam

Diabetes is a metabolic disease, leading to high blood glucose levels, and oral complications were as follows : cheilosis and a tendency toward drying cracking : burning sensations : decrease in salivary flow : alterations in the flora of the oral cavity with greater predominance of Candida albicans : and increased periodontal disease. The increase susceptibility of diabetics to infection has been well known. The cellular and humoral immune systems also require accessory cells, such as macrophages and antigen-presenting cells, for an optimal response to occur. Male rats weighing about 150-200 gm were induced to diabetes by streptozotocin, and were serially sacrificed on the 1st, 2nd, 3rd day and 1st, 2nd, 6th week of experiment. And then histologic examination on the cervical lymph node & S-100 protein positive dendritic cell were carried out under th light microscope. The results of this study were as follow : 1. In control group, cevical lymph node consists of a capsule, cortex, paracortex, medullary sinus and medullary cord. The germinal centers appear in the cortex. The medullary cord was composed of closely packed lymphocytes, and the medullary sinus was full of lymph. In the features of immunohistochemical stain, S-100 protein positive cells were seen in the germinal center. 2. In the 1 day experimental group, the germinal centers were more smaller than that of control group and most of them disappeared. The medullary cord was composed of loosely packed lymphocytes. In the features of immunohistochemical stain. S-100 positive protein cells were decreased and somewhere negative. 3. In the 3 day experimental group, it is similar to 1 day finding but the germinal center had clear margin than that of 1 day experimental group. In the features of immunohistochemical stain, the number of S-100 protein positive cell was decreased and somewhere negative. 4. In the 1 week experimental group, the germinal center was more clear than that of 3 day experimental group and T lymphocytes were scattered in the paracortex. In the medullary cord, density of lymphocyte was more increased. In the immunohistochemical stain, S-100 protein positive dendritic cells were increased in the margin of germinal center and somewhere negative. 5. In the 2 week experimental group, the germinal centers were more recovered. In the medullary cord, density of lymphocyte was increased. In the immunohistochemical stain, S-100 protein positive dendritic cell were increased in the germinal center. 6. In the 6 week experimental group, histologic pattern of cortex and paracortex was similar to control group finding, in the immunohistochemical stain, somewhere the number of S-100 protein positive dendritic cell was similar to control group. From above results, in the streptozotocin induced diabetic rat, as the germinal center of cervical lymph node were decreased and antigen-presenting cell, dendritic cell was affected, the function of cervical lymph node, which was responsible for maxillofacial immune system, was decreased.
Animals ; Antigen-Presenting Cells ; Blood Glucose ; Burns ; Candida albicans ; Dendritic Cells* ; Germinal Center ; Humans ; Immune System ; Lymph Nodes* ; Lymphocytes ; Macrophages ; Male ; Metabolic Diseases ; Mouth ; Periodontal Diseases ; Rats* ; S100 Proteins ; Sensation ; Streptozocin* ; T-Lymphocytes

BACKGROUND: Previous studies indicated that a recently approved synthetic HMG-CoA reductase inhibitor, atorvastatin, reduces LDL cholesterol and triglyceride. To assess the efficacy on the level of serum LDL cholesterol and other lipoprotein fractions and its safety, we investigated 59 patients for lipid and side effect profile. METHOD: In patients with hypercholesterolemia, who showed 12-hours fasting serum LDL cholesterol>145 mg/dl and <250 mg/dl and triglyceride levels<400 mg/dl were enrolled to diet therapy for 4 weeks. After 4 weeks of diet therapy, serum lipid profile were reevaluated and patients with LDL cholesterol > or =130 mg/dl were assigned to receive 10 mg dose of atorvastatin once daily for 4weeks. After 4 weeks of drug therapy, serum lipid profile were rechecked, if showed LDL cholesterol level> or =130 mg/dl, assigned to receive 20 mg dose of atorvastatin once daily until 8 weeks. RESULTS: Of the 59 patients were assigned to receive atorvastatin therapy, 52 patients completed the study. Among lipid profiles, total cholesterol, triglyceride, LDL-cholesterol and apolipoprotein B levels showed significant reduction with mean reduction rate of 28%, 13%, 38%, 32% respectively after 4 weeks and 31%, 13%, 41% and 34% respectively after 8 weeks. HDL-Cholesterol and lipoprotein (a) level did not show significant change after 8 weeks of therapy. Nine patients had mild adverse events, such as elevated ALT, epigastric pain, insomnia, thumb pain. postural hypotension, palpitation and constipation. Only three patients of fifty-nine withdrew from the study due to adverse events related to drug treatment. CONCLUSION: The atorvastatin was highly effective and generally well tolerated with an acceptable safety profile in patients with primary hypercholestelemia.
Apolipoproteins ; Cholesterol ; Cholesterol, LDL ; Constipation ; Diet Therapy ; Drug Therapy ; Fasting ; Humans ; Hypercholesterolemia* ; Hypotension, Orthostatic ; Lipoprotein(a) ; Lipoproteins ; Oxidoreductases ; Sleep Initiation and Maintenance Disorders ; Thumb ; Triglycerides ; Atorvastatin Calcium

Orthodontic tooth movement requires remodelling of periodontal tissues, especially alveolar bone. Fluoride is known to be a potent inhibitor of osteoclastic bone resorption. The purpose of this study was to examine the effects of a consumption of fluoride on osteoclast numbers appearing on the pressure side of alveolar bones at experimental tooth movement. 40 male rats were exposed to 0, 10, 25 mg/kg/day of sodium fluoride(NaF) in their drinking water for up to 60 days. Orthodontic appliance were activated to mesially tip maxillary first molar with 50-70g. The rats were sacrificed at 1, 2, 4 days after initial activation. The number of osteoclast was counted in a 450 x 700 micrometer2 area interradicular septum on the pressure side of the maxillary first molar. The results were as follows, 1. There was significantly different osteoclast number between control group and 25 mg/kg/day group at all measured time. (p<0.05) 2. There was significantly different active bone-resorption area between control group and 25 mg/kg/day group except at 96 hours post activation. (p<0.05) 3. There was slight reduction of active bone-resorption area in control group from 48 hours to 96 hours but in both 10 mg/kg/day group and 25 mg/kg/day group a slight increase was observed from 48 hours to 96 hours.
Animals ; Bone Resorption* ; Drinking Water ; Fluorides* ; Humans ; Male ; Molar* ; Orthodontic Appliances ; Osteoclasts* ; Rats* ; Sodium ; Tooth Movement

STUDY DESIGN: Case report OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.
Adhesives ; Diagnosis ; Diskectomy ; Electromyography ; Fistula ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Nylons ; Pain, Intractable ; Tears

OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD).SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.

Golf is low demanded activity and becoming more popular. But it often occur problems in back, shoulder, elbow and wrist. Golf injuries in professional golfer are related overuse and frequency, while in amateur are related wrong swing technique. Also muscle activities in swing are different between professional and amateur. We report partial tear of pronator teres in middle aged amateur golfer with literatures.
Elbow ; Golf ; Humans ; Middle Aged ; Muscles ; Shoulder ; Wrist

Multiple coronary arteries to communicating with the left ventricular fistulae is a very rare congenital anomaly in adults. This anomaly involves three major coronary arteries that have a direct communication between these arteries and the left ventricle. Hemodynamically, it induces myocardial ischemia due to coronary steal syndrome and diastolic volume overload from a left-to-left shunt. A 70-year-old woman with essential hypertension was admitted to our clinic to evaluate complaints of exertional dyspnea. Clinical examination revealed a diastolic murmur at the apex. A coronary angiogram showed a common fistular channel connecting the right coronary artery, the left circumflex coronary artery, and the first large diagonal branch of the left anterior descending coronary artery with the left ventricular chamber. The patient's symptoms were relieved by the administration of calcium channel blocker and angiotensin II receptor blocker. We report a very rare case of three major coronary arteries communicating to the left ventricular fistulae via a common channel.
Adult ; Aged ; Arteries ; Calcium Channels ; Coronary Vessel Anomalies ; Coronary Vessels* ; Dyspnea ; Female ; Fistula* ; Heart Murmurs ; Heart Ventricles ; Humans ; Hypertension ; Myocardial Ischemia ; Receptors, Angiotensin

BACKGROUND AND OBJECTIVES: It is well known that anti-platlet agents decrease the rate of subacute thrombosis after intracoronary stenting significantly. The aim of this study is to assess the antithrombotic effect and safety of 2-month combined regimen of cilostazol and aspirin on intracoronary stenting. METHODS: The study population consisted of 78 lesions of 57 patients (age: 58.1+/-10.3, male 47, female 10) with ischemic heart disease who were underwent successful intracoronary stenting. They were received cilostazol(200mg/day) and aspirin(100mg/day) two days before intracoronary stenting and continued for 8 weeks, and then aspirin was medicated continuously during the study. The laboratory and clinical findings were evaluated before cilostazol administration, 4 weeks, 8 weeks and 6 months after intervention. The excercise treadmill test was done at 6 months after intervention. RESULTS: Subacute thrombosis occurred in 2 patients(3.5%). Target lesion revascularization(TLR) was done in 4 patients(7.3%). Clinical restenosis (symptomatic or positive stress test, subacute thrombosis and TLR) occurred in 15 patients(26.3%). There was no granulocytopenia, or severe liver dysfunction. HDL-cholesterol was increased significantly at 2 months(36.6+/-7.4 mg/dl versus 41.6+/-9.3 mg/dl. p<0.01) and 6 months(36.6+/-7.4 mg/dl versus 42.4+/-10.6 mg/dl. p<0.01) follow up. CONCLUSION: Two-month combined regimen of cilostazol and aspirin was effective and safe after intracoronary stenting. Subacute thrombosis and clinical restenosis rate were comparable with pervious reports. Further large randomized trials are needed for the evaluation of favorable effect of cilostazol on lipid metabolism.
Agranulocytosis ; Aspirin* ; Exercise Test ; Female ; Follow-Up Studies ; Humans ; Lipid Metabolism ; Liver Diseases ; Male ; Myocardial Ischemia ; Stents* ; Thrombosis