Over the physiologic range of heart rate, the duration of electrical systole(QT) is shorter than that of electromechanical systole(QS2), which reflects direct physiologic link between electrical repolarization and mechanical events of the cardiac cycle. The present study designed to test usefulness of systolic time intervals and QT-QS2(QT minus QS2) value as complication predictors, which may predict prognostic status of myocardial infarction. The studied subjects were consisted of 33 healthy adults as control(22 men, 11 women) and 35 patients with myocardial infarction. And studied patients were divided into 3 groups; group I of 14 patients with or without complication in acute stage, group II of 11 uncomplicated patients under recovery of chronic status, group III of 10 complicated patients under recovery or chronic status. The observation periods were 3 to 13 days in group I, 5 to 96 weeks in group II and III after their onset. The results were follows; 1) The normal ranges were defined as mean+/-2 standard deviations of the measured values of control, that of QTc were shorter than 431ms of man and 458ms of woman, that of QS2 I were longer than 503ms of man and 514ms of woman, that of PEP/LVET ratio was less than 0.40, that of QT-QS2 value was less than 0 ms respectively. 2) QTc of all patient groups were significantly prolonged compared with that of control, and that of group III was significantly longer than that of group II(481+/-25 vs 432+/-32, p<0.005). 3) The changes of QS2 I were not significant in all patient groups compared with QS2 I of control. 4) QT-QS2 value showed QT>QS2 in group I and III. and QTQS2 had positive predictive value of 82% for predicting probability of previous complicated status. We concluded that QT-QS2 value, including PEP/LVET ratio and QTc, could be used as complication predictors. But it is necessary to examine these indicators prospectively to confirm its clinical applicability.
Adult ; Female ; Heart Rate ; Humans ; Male ; Myocardial Infarction* ; Reference Values ; Sensitivity and Specificity ; Systole*

Paralytic shellfish poisoning results from consumption of mollusks that have fed on dinoflagellates capable of producing neurotoxins such as saxitoxin. The saxitoxin is concentrated in the shellfish and acts by decreasing sodium-channel permeability, thereby blocking neuronal transmission in skeletal muscles. Symptoms including paresthesia, perioral numbness, perioral tingling, nausea, vomiting, extremity numbness, extremity tingling, dizziness, ataxia, dysphagia, and weakness have been reported. In serious cases, respiratory hold may occur up to 6~24 hours after ingestion. Generally, the treatment for paralytic shellfish poisoning is supportive care, but mechanical ventilation is needed in serious cases acompanied by respiratory hold. We experienced two cases of paralytic shellfish poisoning. Respiratory hold was presented in one case and only mild paresthesia in the other case. After supportive management, including mechanical ventilation in former case, both patients were discharged without sequalae.
Ataxia ; Deglutition Disorders ; Dinoflagellida ; Dizziness ; Eating ; Extremities ; Humans ; Hypesthesia ; Mollusca ; Muscle, Skeletal ; Nausea ; Neurons ; Neurotoxins ; Paresthesia ; Permeability ; Respiration, Artificial ; Saxitoxin* ; Shellfish ; Shellfish Poisoning* ; Vomiting

Recent molecular studies indicate two different genetic pathways leading to the development of glioblastoma; final progression of astrocytoma and de novo formation. To define the mutual relationships of cytogenetic changes in the pathogenesis of glioblastoma, molecular histopathologic alterations of p53 and epidermal growth factor receptor (EGFR) were evaluated by single stranded conformational polymorphion, reverse transcriptase-polymerase chain reaction and immunohistochemical stains in 15 primary and 21 secondary glioblastomas. Mutations in p53 gene and positive immunoreactivity to p53 protein (DO1) were more prevalent in secondary glioblastomas than in primary glioblastomas. A correlation between p53 mutations and p53 immunopositivities in glioblastomas was observed in 83.3% of the cases. All cases with positive p53 immunoreactivities showed p53 mutations; however, 13.9% of glioblastomas with p53 immuno-positivities lacked the relevant mutations. EGFR amplifications were detected in 73.3% of primary glioblastomas and 9.5% of secondary glioblastomas (p<0.001). The concurrence of p53 mutation and EGFR amplification was revealed in only 2 out of 15 primary glioblastomas and none among the secondary glioblastomas. Immunoreactivities for EGFR were noted in 66.7% of primary glioblastomas and in 9.5% of secondary glioblastomas (p<0.001). A correlation between EGFR amplification and EGFR immunopositivity in glioblastomas was observed in 91.7% of the cases. These data indicate that EGFR amplification and p53 mutations are two independent genetic events in the development of glioblastomas.
Adolescence ; Adult ; Brain Neoplasms/*genetics/metabolism ; Female ; *Genes, p53 ; Glioblastoma/*genetics/metabolism ; Human ; Immunohistochemistry ; Loss of Heterozygosity ; Male ; Middle Age ; *Mutation ; Protein p53/analysis ; Receptor, Epidermal Growth Factor/analysis/*genetics ; Reverse Transcriptase Polymerase Chain Reaction

To investigate the histopathological characteristics of inverted papillomas of the urinary bladder, including the possibility of malignant transformation, we studied the indicators of cellular proliferation activity in 7 inverted papillomas of the bladder including two cases of malignant inverted papilloma of the bladder. PCNA expression rates in two cases of malignant inverted papilloma were higher than in benign inverted papillomas. Mean numbers of AgNORs per nucleus in malignant inverted papillomas were much more than in benign inverted papillomas. The c-erbB-2 oncoprotein was expressed only in malignant inverted papillomas. These results suggest that PCNA expression rate, mean number of AgNORs per nucleus and c-erB-2 oncoprotein expression may be merited as good indicators to detect the inverted papilloma with more proliferative and aggressive lesions, and with the potential of malignant transformation.
Adult ; Bladder Diseases/pathology ; Bladder Neoplasms/chemistry/*pathology ; Cell Division/physiology ; Cell Transformation, Neoplastic/pathology ; Female ; Human ; Male ; Middle Age ; Nitrosourea Compounds/analysis ; Nucleolus Organizer Region/chemistry ; Papilloma, Inverted/chemistry/*pathology ; Receptor, erbB-2/analysis ; Silver Staining

PURPOSE: Successful treatment of bladder cancer greatly depend upon the regular surveillance for early detection of persistent or recurrent cancer. We assessed the efficacy of urinary NMP22 test in screening and post-trearment follow-up for bladder cancer. MATERIALS AND METHODS: Urinary NMP22 test kit, which is based on an enzyme-linked immunosorbent assays, were used to measure the values of urinary NMP22 in 30 patients of transitional cell carcinoma of the bladder, 32 healthy volunteers, 12 patients of urinary tract infection and 13 patients of other urinary malignancy. RESULTS: Median values of urinary NMP22 in patients with bladder cancer were significantly greater than in healthy volunteers(p<0.05). With a cutoff value of 15units/ml, urinary NMP22 test had a 90.0% of sensitivity and a 90.6% of specificity in predicting bladder cancer. There was significant postoperative decrease of urinary NMP22 values in all patients with bladder cancer(p<0.05). CONCLUSIONS: These results suggest that urinary NMP22 test is useful for screening and postoperative surveillance of patients with transitional cell carcinoma of urinary bladder. Further comparative studies of urinary NMP22 test with the results of postoperative cystoscopy or cold cup biopsies are requested to enhance the practical utility of urinary NMP22 test.
Biopsy ; Carcinoma, Transitional Cell ; Cystoscopy ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies* ; Healthy Volunteers ; Humans ; Mass Screening* ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Tract Infections

We report a case of spontaneous renal rupture in a 63 year-old woman as a complication of diabetes mellitus. She experienced a sudden onset of severe pain and bulging mass on the left flank. She had been suffered from diabetes mellitus for 30 years without any specific treatment, and she had no history of specific associated diseases or factors such as trauma, stone, tumor, hydronephrosis or vascular lesion of the kidney. Grossly this ruptured kidney showed a characteristic necrosis and infarcted lesions extended from papilla to cortex of the upper pole kidney and surrounding tissues of the kidney showed interstitial fibrosis, tubular atrophy and mononuclear cell infiltration. Microscopically the atherosclerotic medium-sized blood vessels and small vessels around the infarcted lesion also showed hyaline sclerosis. This pathologically defined spontaneous renal rupture is thought to be caused by focal renal infarction due to atherosclerosis or fat emboli-associated renovascular occlusion in diabetic patient. This report emphasizes the importance of diabetic nephropathy as a new cause of the spontaneous renal rupture in patients of diabetes mellitus.
Atherosclerosis ; Atrophy ; Blood Vessels ; Diabetes Mellitus* ; Diabetic Nephropathies ; Female ; Fibrosis ; Humans ; Hyalin ; Hydronephrosis ; Infarction ; Kidney* ; Middle Aged ; Necrosis ; Rupture ; Rupture, Spontaneous* ; Sclerosis

BACKGROUND: The X gene is the smallest coding region of the hepatitis B virus (HBV) genome. Several studies reported that X gene-encoded protein may be related to viral replication, and possibly used as a new marker indicative of HBV infection. However, its practical application as a diagnostic reagent remains limited. In this study, we developed anti-X monoclonal antibodies using recombinant hepatitis B virus X (HBx) proteins and investigated the humoral immune responses against HBx in sera of HBV-infected patients by enzyme-linked immunosorbent assay (ELISA). METHODS: Sera of 47 HBV-associated patients and 12 normal controls were studied. Using recombinant HBx expressed in Escherichia coli, seven clones of monoclonal anti-HBx antibodies were developed. The binding site and activity of each monoclonal antibody were determined by ELISA and Western blot analysis, and antibodies that gave the best signals in both assays were selected for the detection of HBx antigen. An ELISA to detect anti-X was also constructed by using recombinant HBx proteins. RESULTS: Clinical samples from patients with liver cirrhosis and hepatocellular carcinoma (HCC) were more than 60% positive for anti-HBx antibody. The positive rate of X antigen in patients with liver cirrhosis and HCC was 27% and 33%, respectively. None of acute hepatitis patients and chronic asymptomatic carriers were positive for HBx antigen or anti-X antibody. The present ELISA system detected circulating HBx with a dynamic range from 5 to 1000 ng per milliliter and the specificity of the assay was also acceptable. The analysis of binding site and activity of monoclonal antibodies performed by ELISA were in agreement with Western blotting results. CONCLUSIONS: ELISA using recombinant HBx and monoclonal antibodies showed good sensitivity and corresponded well with immunoblotting results. For the clinical application of this assay, however, further study is needed on the relationship between HBx and the progression of the disease.
Antibodies ; Antibodies, Monoclonal* ; Binding Sites ; Blotting, Western ; Carcinoma, Hepatocellular ; Clinical Coding ; Clone Cells ; Enzyme-Linked Immunosorbent Assay* ; Escherichia coli ; Genome ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunity, Humoral ; Immunoblotting ; Liver Cirrhosis ; Sensitivity and Specificity

Giant hydronephrosis is a clinical entity in which errors of diagnosis are frequent due to the silent development of this pathologic state. We present a case which has been considered worthy of detailed report for various reasons. First, it was a 22 liter hydronephrosis which is, so far as can be discovered from available Korean literature, the largest that has been removed surgically. Secondly, despite of huge hydronephrosis, the patient experienced delivery.
Diagnosis ; Humans ; Hydronephrosis*

We report a case in which traumatic epistaxis with a carotid cavernous fistula was successfully treated by using radiologic intervention. Since the inner facial bone is an anatomically weak structure and has numerous bleeding sites, traumatic epistaxis is profuse and can not be controlled well by using traditional treatments such as gauze, merocel(R), and foley balloon packing. Uncontrolled epistaxis may cause unstable vital signs and threaten the patient. In the case of failure through traditional treatments, angiographic embolization can be used as a treatment of choice because angiographic embolization can be done at a high success rate with few complications. Stroke, facial palsy, visual loss, and facial pain are the most common complications. In our case, we had tried traditional treatments first, but there was no marked improvement. After the angiographic embolization had been conducted, epistaxis was successfully controlled. The patient 's vital signs were stabilized, and he was admitted to the ICU.
Epistaxis* ; Facial Bones ; Facial Pain ; Facial Paralysis ; Fistula ; Hemorrhage ; Humans ; Stroke ; Vital Signs

No abstract available.
Kidney* ; Plasmacytoma*