No abstract available.
Heterotaxy Syndrome*

We investigated a prospective study to compare the effects of single or combined use of three commonly used anti-platelet agents; aspirin, ticlopidine and trapidil, on the platelet aggregation. Total 78 patients admitted to the neurology ward of Yonsei University Hospital with acute ischemic stroke were randomly divided into 7 groups .The blood was drawn from these patients before and a week after the prescription of anti-platelet agents pertinent to each group. Platelet aggregation was measured by using a platelet aggregometer (Chrono-Log Lumi Aggregometer Model 400) after addition o f adenosine diphosphite (ADP), collagen, epinephrine, ant platelet activating factor (PAF) on the platelet rich plasma. The results showed that 1) trapidil most effectively inhibited platelet aggregation by PAF, 2) aspirin and/or ticlopidine were superior to trapidil for the inhibitory effect on platelet aggregation by ADP. Collagen and epinephrine. 3) all three drug combination therapy successfully inhibited platelet aggregation by ADP. Collagen, epinephrine and PAF. Therefore. This in-vitro study suggests that combined use of anti-platelet agents having different mechanisms may provide more effective anti-platelet act;ons in acute ischemic stroke patients.
Adenosine ; Adenosine Diphosphate ; Ants ; Aspirin ; Blood Platelets ; Collagen ; Epinephrine ; Humans ; Neurology ; Platelet Activating Factor ; Platelet Aggregation ; Platelet-Rich Plasma ; Prescriptions ; Prospective Studies ; Stroke ; Ticlopidine ; Trapidil

BACKGROUND AND OBJECTIVE: Eosinophil is a major inflammatory cell in allergic diseases and parasitic infestations. Various cytokines such as GM-CSF, IL-3 and IL-5 are known to activate eosinophils and prolong their survival. Among them, IL-5 is the most potent stimulator of eosinophil survival. Recently, it was reported that increased expression of Bcl-2 is related to prolonged survival of IL-5 stimulated eosinophil. Theophylline is a useful drug in bronchial asthma, due not only to bronchial dilation but also to its anti-inflammatory effects. It has been suggested that anti inflammatory action of theophylline derives from the reduction of inflammatory cells in the airways which is mechated by stimulat on of apoptosis of inflammatory cells. In this study, we investigated, by measuring Bcl-2 expression of IL-5 stimulated eosinophil, the effect of theophylline on apoptosis as one of the anti-inflammatory action. MATERIAL AND METHOD: Peripheral eosinophils were isolated from atopic patients by using Perco- 11 discontinuous gradient and purified by negative selection technique using MACS. Eosinophil viability and apoptosis were measured by FACscan. Expression of Bcl-2 protein in eosinophils was detected by Western blot and ELISA. RESULTS: IL-5 increased the percentage of viable eosinophils and reduced the apoptosis of eosinophils in a dose dependent manner. The increased survival of IL-5 stimulated eosinophils was reduced by theophylline via activation of apoptosis. Bcl-2 was increased when eosinophils were cultured with IL-5 only, but when theophylline was cocultured, reduced Bcl-2 was seen with Western blot and ELISA. CONCLUSION: IL-5 increases the survival of eosinophil through the enhanced expression of Bcl- 2. Theophylline has counter action against IL-5 via inhibition of Bcl-2 induced by IL-5. Inhibiting the prolongation of eosinophil survival caused by IL-5 might be one possible mechanism of antiinflammatory effects of theophylline.
Apoptosis ; Asthma ; Blotting, Western ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Eosinophils* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Interleukin-3 ; Interleukin-5 ; Theophylline*

PURPOSE: We evaluated the diagnostic performance of a noninvasive bladder cancer test, the urinary bladder cancer (UBC) antigen test, on voided urine samples from patients with active transitional cell carcinomas, on follow-up and controls. MATERIALS AND METHODS: We measured the UBC antigen in the urine from 136 patients with active transitional cell carcinomas of the bladder (group 1), 56 patients with no evidence of tumor recurrence, confirmed by cystoscopy at follow-up (group 2), 60 patients with urinary tract infections (group 3), 52 patients with other genitourinary tract malignancies (group 4) and 74 healthy subjects, free from urological diseases (group 5). RESULTS: The mean UBC antigen concentrations were 75.79, 28.95, 52.90, 16.90 and 7.56micro gram/L, in groups 1 to 5, respectively. Group 2, 4 and 5 showed statistically significant differences in the UBC concentrations compared to group 1 (p=0.03, <0.001 and <0.001, respectively). Sensitivity and specificity were 61.8 and 68.2%, at a threshold value of 9.7micro gram/L, from group 1, compared to groups 2 to 5. As for the tumor grade in group 1, there were significant differences between grade I and II (p<0.001) or between grade I and III (p<0.001), but there were no significant differences according to the T stage. CONCLUSIONS: The UBC test might have a role as a potential tumor marker for the diagnosis of transitional cell carcinomas of the bladder adjunct to cystoscopy.
Carcinoma, Transitional Cell* ; Cystoscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Keratins ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections ; Urologic Diseases

PURPOSE: We evaluated the diagnostic performance of a noninvasive bladder cancer test, the urinary bladder cancer (UBC) antigen test, on voided urine samples from patients with active transitional cell carcinomas, on follow-up and controls. MATERIALS AND METHODS: We measured the UBC antigen in the urine from 136 patients with active transitional cell carcinomas of the bladder (group 1), 56 patients with no evidence of tumor recurrence, confirmed by cystoscopy at follow-up (group 2), 60 patients with urinary tract infections (group 3), 52 patients with other genitourinary tract malignancies (group 4) and 74 healthy subjects, free from urological diseases (group 5). RESULTS: The mean UBC antigen concentrations were 75.79, 28.95, 52.90, 16.90 and 7.56micro gram/L, in groups 1 to 5, respectively. Group 2, 4 and 5 showed statistically significant differences in the UBC concentrations compared to group 1 (p=0.03, <0.001 and <0.001, respectively). Sensitivity and specificity were 61.8 and 68.2%, at a threshold value of 9.7micro gram/L, from group 1, compared to groups 2 to 5. As for the tumor grade in group 1, there were significant differences between grade I and II (p<0.001) or between grade I and III (p<0.001), but there were no significant differences according to the T stage. CONCLUSIONS: The UBC test might have a role as a potential tumor marker for the diagnosis of transitional cell carcinomas of the bladder adjunct to cystoscopy.
Carcinoma, Transitional Cell* ; Cystoscopy ; Diagnosis ; Follow-Up Studies ; Humans ; Keratins ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections ; Urologic Diseases

Background: The PLASMIC score is a convenient tool for predicting ADAMTS13 activity of ＜10%.Lactate dehydrogenase (LDH) is widely used as a marker of haemolysis in thrombotic thrombocytopenic purpura (TTP) monitoring, and could be used as a replacement marker for lysis. We aimed to validate the PLASMIC score in a multi-centre Asia Pacific region, and to explore whether LDH could be used as a replacement marker for lysis. Methods: Records of patients with thrombotic microangiopathy (TMA) were reviewed. Patients’ ADAMTS13 activity levels were obtained, along with clinical/laboratory findings relevant to the PLASMIC score. Both PLASMIC scores and PLASMIC-LDH scores, in which LDH replaced traditional lysis markers, were calculated. We generated a receiver operator characteristics (ROC) curve and compared the area under the curve values (AUC) to determine the predictive ability of each score. Results: 46 patients fulfilled the inclusion criteria, of which 34 had ADAMTS13 activity levels of ＜10%. When the patients were divided into intermediate-to-high risk (scores 5‒7) and low risk (scores 0‒4), the PLASMIC score showed a sensitivity of 97.1% and specificity of 58.3%, with a positive predictive value (PPV) of 86.8% and negative predictive value (NPV) of 87.5%. The PLASMIC-LDH score had a sensitivity of 97.1% and specificity of 33.3%, with a PPV of 80.5% and NPV of 80.0%. Conclusion Our study validated the utility of the PLASMIC score, and demonstrated PLASMIC-LDH as a reasonable alternative in the absence of traditional lysis markers, to help identify high-risk patients for treatment via plasma exchange.

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.
Acute Disease ; Aged ; Drug Therapy, Combination ; Female ; Hemorrhage ; Heparin/*therapeutic use ; Heparin, Low-Molecular-Weight/*therapeutic use ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/epidemiology/mortality/*therapy ; Myocardial Revascularization ; Odds Ratio ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors/metabolism ; Prognosis ; Registries

BACKGROUND AND OBJECTIVES: It is thought that patients with diabetes mellitus (DM) have a poor prognosis after an acute myocardial infarction (AMI), but the effect of diabetes on the outcomes of hypertensive patients with AMIs has not been elucidated in the Korean population. The aim of this study was to investigate the effects of diabetes on long-term clinical outcomes following AMIs in patients with hypertension. SUBJECTS AND METHODS: Using data from the Korea Acute Myocardial Infarction Registry (November 2005 to December 2006), 2,233 hypertensive patients with AMIs were grouped as follows based on the presence of DM: group I, diabetic hypertension (n=892, 544 men, mean age=66.2+/-10.9 years); and group II, non-diabetic hypertension (n=1341, 938 men, mean age=63.9+/-12.8 years). The primary study outcomes included in-hospital death and major adverse cardiac events (MACE; cardiac death, myocardial infarction (MI), repeat percutaneous coronary intervention, and coronary artery bypass surgery) at the 1 year follow-up. RESULTS: Hypertensive patients with DM were older and more likely to be women. The diabetic group had lower blood pressure (p<0.001), a lower left ventricular ejection fraction (p<0.001), a more severe degree of heart failure (p<0.001), a longer duration of coronary care unit admission (p<0.001), and a higher incidence of hyperlipidemia (p=0.007). The N-terminal pro-brain natriuretic peptide level (4602.5+/-8710.6 pg/mL vs. 2320.8+/-5837.9 pg/mL, p<0.001) was higher and the creatinine clearance (62.4+/-29.9 mL/min vs. 73.0+/-40.8 mL/min, p<0.001) was lower in the diabetic group than the non-diabetic group. Coronary angiographic findings revealed more frequent involvement of the left main stem (p=0.002) and multiple vessels (p<0.001) in the diabetic group. The rate of in-hospital death was higher in the diabetic group (p<0.001). During follow-up, the rates of composite MACE at 1 month, 6 months, and 12 months were higher in the diabetic group (p<0.001). CONCLUSION: In hypertensive patients with AMI, DM was associated with worse clinical and angiographic features, with a higher risk of development of severe heart failure, and an increased risk of MACE on long-term clinical follow-up.
Blood Pressure ; Coronary Artery Bypass ; Coronary Care Units ; Creatinine ; Death ; Diabetes Mellitus ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Korea ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Stroke Volume