BACKGROUND: It is well known that ischemic preconditioning protects the heart against infarction or arrhythmias from a subsequent ischemic injury. Two phases of the effect of preconditioning has been explored, early protection and second window of protection at 24 hours. The late protection was seen in some animal model, but the precise mechanism is controversal. This study was designed to evaluate the late cardioprotective effect and role of HSP70 in ischemic preconditioning of cat heart. METHODS: Two groups of cats were studied. Control animals were subjected to an episode of 40-min coronary artery occlusion followed by 30-min reperfusion. Experimental animals were subjected to ischemic preconditioning before the 40-min ishcemia/reperfusion. The preconditioning protocol was comprised of three 5-min episodes of ischemia interspersed by 10-min episodes of reperfusion. After sustained ischemia and reperfusion, left ventricular risk area and infart area were measured by injection of Evans blue bye and triphenyltetrazolium staining, and myocardial HSP70 mRNA was examined in risk(left ventricular anterior wall) and nonrisk(left ventricular posterior wall) area using northern blot hybridization. HSP70 mRNA expression was quantified as a percent of GAPDH. The late cardioprotective effects of ischemic preconditioning were determined by infarct size (% area at risk). RESULTS: Infarct size was markedly limited by ischemic preconditioning when compared with the control group (18.5+/-6.9% vs 38.5+/-11.1%; p<0.001). HSP70 mRNA expression in risk area was much higher in preconditioning group than control group(78+/-12% vs 41+/-11%; p<0.01). But, there was no significant difference of HSP70 mRNA expression in the posterior wall between control and ischemic preconditioning group. CONCLUSIONS: These data suggest that ischemic preconditioning have delayed myocardial protective effect from ischemia. The increase in myocardial HSP70 mRNA may be one of the contributing factors to the delayed cardioprotective effects of ischemic preconditioning in cats.
Animals ; Arrhythmias, Cardiac ; Blotting, Northern ; Cats* ; Coronary Vessels ; Evans Blue ; Heart* ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins ; Infarction ; Ischemia ; Ischemic Preconditioning* ; Models, Animal ; Reperfusion ; RNA, Messenger

We present a case of an acute psoas muscle hematoma following percutaneous endoscopic lumbar discectomy. A 60-year-old female who presented with far lateral lumbar disc herniation underwent endoscopic discectomy on the right side at the L4-5 level. On the second postoperative day, the patient complained of severe right flank and leg pain and her blood pressure decreased. A computed tomography scan showed a large acute psoas muscle hematoma at right L4-5 level. The patient was transfused with packed red blood cells and placed at absolute bed rest. After observing the patient in intensive care, the severe flank and leg pain subsided, but the mild back pain persisted. Although percutaneous endoscopic lumbar discectomy is an effective minimally invasive surgical technique for the treatment of lumbar disc herniation, this case highlights the inherent risks of acute lumbar segmental vessel injury.
Back Pain ; Bed Rest ; Blood Pressure ; Diskectomy ; Erythrocytes ; Female ; Glycosaminoglycans ; Hematoma ; Humans ; Critical Care ; Leg ; Middle Aged ; Psoas Muscles

OBJECTIVE: Although endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because of anatomic limitations, a rigid endoscope cannot reach all lesions effectively. The purpose of this study was to determine the feasibility of endoscopic transforaminal suprapedicular approach to high grade inferior-migrated lumbar disc herniations. METHODS: Between May 2006 and March 2008, a suprapedicular approach was performed in 53 patients with high grade inferior-migrated lumbar disc herniations using a rigid endoscope and a semi-rigid flexible curved probe. One-to-four hours after surgery, the presence of remnant discs was checked with MRI. The outcomes were evaluated with the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) one week after surgery. RESULTS: The L2-3 level was involved in 2 patients and the L3-4 level was involved in 14 patients, while the L4-5 level was involved in 39 patients. There were single piece-type in 34 cases and a multiple piece-type in 19 cases. Satisfactory results were obtained in all cases. The mean preoperative VAS for leg pain was 9.32+/-0.43 points (range, 7-10 points), whereas the mean ODI was 79.82+/-4.53 points (range, 68-92 points). At the last follow-up examination, the mean postoperative VAS for leg pain was 1.78+/-0.71 points and the mean postoperative ODI improved to 15.27+/-3.82 points. CONCLUSION: A high grade inferior migrated lumbar disc is difficult to remove sufficiently by posterolateral endoscopic lumbar dscectomy using a rigid endoscope. However, a satisfactory result can be obtained by applying a transforaminal suprapedicular approach with a flexible semi-rigid curved probe.
Endoscopes ; Follow-Up Studies ; Humans ; Leg

As a result of surgical orthodontic treatment of mandibular prognathism, changes take place in the skeletal and soft orofacial components. Although some investigators had stated that permanent reduction of airway space was observed agter mandibular setback surgery, it was not clear thath this permanent reduction was sustained during long-term follow-up. The purpose of this study was to assess the changes in oropharyngeal airway space and soft tissue orofacial compoment following the mandibular setback surgery and during the follow-up period. The correlation between the changes of the oropharyngeal airway space and the changes of other soft tissue orofacial component was also assessed. The findings of this study were as follows ; 1. The ofoharyngeal airway space area fecreased following mandibular setback surgery for mandibular prognathism and continued to decrease during the follow-up period(p<0.05). 2. The pharyngeal depth at Xi point level and the 2nd cervical vertebra point level decreased agter the surgery and remained during the follow-up period(p<0.05). The decrease of these pharyngeal depth was correlated with the decrease of oropharyngeal airway space area(p<0.01). 3. The decrease of pharyngeal depth at the 3rd and 4th cervical vertebra point level was not significant after the surgery and during the follow-up period. 4. The hyoid bone moved downwasd after the surgery(p<0.05), but returned to its original position during the follow-up period. 5. The length & height of tongue and the position of epiglottis base did not change significantly(p<0.05). 6. The soft palate was displaced posteriorly after the surgery and remained to its changed position during the follow-up period(p<0.05) due to posterior displacement of tongue. The changes of soft palate were significantly correlated with the decrease of oropharyngeal airway space area(p<0.01). 7. The narrowing of oropharyngeal airway space was due to the posterior displacement of tongue above the level of epiglottis tip. The posterior displacement of tongue following mandibiular setback osteotomy remained during the follow-up period.
Epiglottis ; Follow-Up Studies ; Humans ; Hyoid Bone ; Oropharynx ; Osteotomy* ; Palate, Soft ; Prognathism ; Research Personnel ; Spine ; Tongue

PURPOSE: This study was designed to analyze the short-term clinical and functional outcomes of perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. METHODS: The data were prospectively collected and consisted of the clinical data, the functional status before and after surgery, the operation record, and the postoperative course. The functional status was evaluated by using Wexner's constipation score (0-30), Wexner's incontinence score (0-20), anorectal manometry, and pudendal nerve terminal motor latency. Follow-up was performed at 3-6 months after the operation by using both a standardized questionnaire completed in the outpatient clinic or telephone interview (n=23) and an anorectal physiology test (n=7). RESULTS: During a one-year period, 23 patients (male=10) underwent perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse. The median duration of the operations was 88 minutes. The median length of postoperative hospital stay was 6 days. There was one urinary tract infection and no mortalities. The constipation score was significantly decreased after the operation (9.8 vs 3.8; P<0.001), and constipation was improved in 90 percent (19/21) of the cases. The incontinence score was significantly decreased after surgery (mean preop.=11.6, postop.=3.7; P<0.001) and incontinence was improved in 17 of 21 patients with impaired continence (81 percent). Anal sphincter function was not improved but rectal reservoir capacity was significantly decreased after surgery (rectal urgent volume (45.7 cc vs 37.1 cc; P=0.045), maximal tolerable volume (120 cc vs 85.7; P=0.011). Most patients (83 percent) felt that the operation had improved their symptoms. The major reasons for dissatisfaction after surgery were frequent defecation, fecal soiling, persistent or aggravated fecal incontinence, and recurrence. One patient had a complete recurrence (4.3 percent), and another patient had a mucosal prolapse which was treated. CONCLUSIONS: Perineal rectosigmoidectomy with levatoroplasty for complete rectal prolapse is a safe technique with acceptable short-term functional results; however, it is not recommended for rectal prolapse patients with diarrhea-predominant irritable bowel syndrome.
Ambulatory Care Facilities ; Anal Canal ; Constipation ; Defecation ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Interviews as Topic ; Irritable Bowel Syndrome ; Length of Stay ; Manometry ; Mortality ; Physiology ; Prolapse ; Prospective Studies ; Pudendal Nerve ; Surveys and Questionnaires ; Rectal Prolapse* ; Recurrence ; Soil ; Urinary Tract Infections

PURPOSE: To evaluate the diagnostic efficacy of three-dimensional(3D) short-range MR angiography(MRA) andmultiplanar reconstruction(MPR) imaging in hemifacial spasm(HS). MATERIALS AND METHODS: Two hundreds patientswith HS were studied using a 1.5T MRI system with a 3D time-of-flight(TOF) MRA sequence. To reconstructshort-range MRA, 6-10 source images near the 7-8th cranial nerve complex were processed using a maximum-intensityprojection technique. In addition, an MPR technique was used to investigate neurovascular compression. We observedthe relationship between the root-exit zone(REZ) of the 7th cranial nerve and compressive vessel, and identifiedthe compressive vessels on symptomatic sides. To investigate neurovascular contact, asymptomatic contralateralsides were also evaluated. RESULTS: MRI showed that in 197 of 200 patients there was vascular compression orcontact with the facial nerve REZ on symptomatic sides. One of the three remaining patients was suffering fromacoustic neurinoma on the symptomatic side, while in two patients there were no definite abnormal findings. Compressive vessels were demonstrated in all 197 patients; 80 cases involved the anterior inferior cerebellarartery(AICA), 74 the posterior cerebellar artery(PICA), 13 the vertebral artery(VA), 16 the VA and AICA, eight theVA and PICA, and six the AICA and PICA. In all 197 patients, compressive vessels were reconstructed on one 3Dshort-range MRA image without discontinuation from vertebral or basilar arteries. 3D MPR studies providedadditional information such as the direction of compression and course of the compressive vessel. In 31 patientsthere was neurovascular contact on the contralateral side at the 7-8th cranial nerve complex. CONCLUSION: Inpatients with HS, 3D short-range MRA and MPR images are excellent and very helpful for the investigation ofneurovascular compression and the identification of compressive vessels.
Angiography* ; Basilar Artery ; Cranial Nerves ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Inpatients ; Magnetic Resonance Imaging ; Neurilemmoma ; Pica

Immunohistochemical changes of epidermal growth factor receptor (EGFR) and nerve growth factor receptor (NGFR) were investigated in the rat mandibular molar and incisors after submandibular sialadenectomy. In the sham operated rat, any EGFR immunoreactivity was not observed in the teeth but NGFR immunoreactivities were observed exclusively in the periodontal ligament and ameloblasts of incisor. In the sialadenectomized rat, EGFR immunoreac-tivities were observed in the odontoblasts of the mandibular first molar, periodontal ligament cells, ameloblasts of incisor and some cells of bone marrow. NGFR immunoreactivities were more intense and widely distributed in alveolar bone, periodontal ligaments and odontoblasts of the sialadenectomized rat than in the sham operated rat. Both of EGFR and NGFR immunoreactivities gradually increased in their intensities in a time-dependent manner after submandibular sialadenectomy. The results show that expression of EGFR and NGFR in the mandibular molar and incisor is enhanced by submandibular sialadenectomy. Therefore, it is suggested that EGF and NGF derived from submandibular gland may affect to the mandibular molar and incisors by direct and/or indirect mechanism.
Ameloblasts ; Animals ; Bone Marrow ; Epidermal Growth Factor* ; Immunohistochemistry ; Incisor* ; Molar* ; Nerve Growth Factor ; Odontoblasts ; Periodontal Ligament ; Rats* ; Receptor, Epidermal Growth Factor* ; Submandibular Gland ; Tooth

BACKGROUND: P wave dispersion(PWD) is defined as the difference between the maximum and minimal P wave duration in any of the 12 leads of the surface ECG. The prolongation of atrial conduction time and the inhomogeneous propagation of sinus impulse are known electrophysiologic features in patients with paroxysmal atrial fibrillation(PAF). The purpose of this study was to determine the role of P wave dispersion for the prediction of PAF and to evaluate the effectiveness of prophylactic antiarrhythmic therapy. MATERIALS AND METHODS: The study population included 20 patients with a history of idiopathic PAF and 20 age and sex matched healthy control subjects. We measured the maximum P wave duration(P maximum) and P wave dispersion from 12 lead ECG. RESULTS: P maximum and P dispersion in idiopathic PAF were significantly higher than normal control group(97.2+/-12, 48.5+/-9msec vs, 76.5+/-11, 21+/-8msec, respectively p<0.001, <0.001). After 12-month follow up period P maximum and P dispersion were significantly reduced than those of initial state(77.2+/-13, 26.4+/-9msec vs. 97.2+/-12, 48.5+/-9msec, respectively p<0.001,<0.001). CONCLUSION: P dispersion and P maximum were significantly different between patients with idiopathic PAF and healthy control group. Those are easily accessible, non-invasive simple electrocadiographic markers that could be used for the prediction and prognostic factors of idiopathic PAF.
Atrial Fibrillation* ; Electrocardiography ; Follow-Up Studies ; Humans

Bronchial asthma can be triggered by microbial agents in the oropharynx. This study was designed to identify the differences in microbiota of oropharynx of bronchial asthmatic patients in contrast to normal controls. In order to resolve the qualitative and quantitative diversity of the 16S rRNA gene present in the oropharynx microbiota of 4 patients and 4 controls, we compared microbial communities using Sanger sequencing and 376 sequences of 16S rRNA gene were analyzed. Of the total microbial diversity detected in the oropharynx in asthmatic patients 45.6% comprised members of the Firmicutes. In contrast, Proteobacteria (44.0%) dominated the oropharyngeal microbiota in the normal control group. Members of the Bacteroidetes, Fusobacteria, Actinobacteria, TM7, Cyanobacteria and unclassified bacteria were present in both groups. In conclusion, the difference in the microbiota of the oropharynx between patients and normal individuals could trigger symptomatic attacks in bronchial asthma.
Actinobacteria ; Asthma* ; Bacteria ; Bacteroidetes ; Cyanobacteria ; Fusobacteria ; Genes, rRNA ; Humans ; Metagenome ; Microbiota* ; Oropharynx ; Proteobacteria

Multple features of occlusion have been combined by epodemiologists in attemps to objectively to determine malocclusion severity and treatment priorty. Jenny et al were developed DAI(Dental Aesthetic Index), which is an orthodontic index based on socially defined aesthetic stamdards. This stydy aimed to evaluate association between 10 occlusal componets of DAI and individual measures of skeletal morphology by use of univariate and multivariate analysis. In addition the relationship between a Dental Aeathetic Index score and skeletal mophology was evaluated. The data for this study were obtained from cephalometric radiographs and dental casts of 182 korean patients(79 men, 103 women) with permanent dentition who had been acccepted for the orthodontic treatment at Department of Orthodontics, Chonbuk National University. The results are as follows : 1. Several occusal components of DAI(missing, crowding and spacing in the incisal segment, diastema, largest anterior irregularity on upper and lower arch) were not associated with individual measures of craniofacial morphology. 2. Sagittal occlusal components of DAI were associated with anteroposterior skeletal measures. 3. The relation between vertical occlusal components of DAI and vertical skeletal measures was low magnitude. 4. A Dental Aesthetic Index, which is based on several aspects of occlusion, did not identify craniofacial morphology. We can conclude that combination of certain occlusal components of the DAI may be related with specific skeletal morphology: but, this concept could not be accepted generally.
Crowding ; Dentition, Permanent ; Diastema ; Humans ; Jeollabuk-do ; Male ; Malocclusion ; Multivariate Analysis ; Orthodontics