The purpose of this study is to investigate the morphologic changes of the sinusoidal endothelial cells and the associated structures of the cirrhotic rat liver induced by repeat intraperitoneal injections of N-diethylnitrosamine (DEN) (100 mg/kg/week). One day to 6 weeks later, rat livers were observed under the light, transmission and scanning electron microscopy, and immunostained with laminin antibody. Two weeks after DEN treatment, the fibrillar material in Disse's space was noted, and then a basement membrane-like structure was found at 4 weeks after treatment. Laminin was detected in perisinusoidal areas after 4 weeks. Laminin was strongly positive on the fibrous septum and in the sinusoidal wall of cirrhotic nodules after 6 weeks of treatment. The diameters and numbers of sinusoidal endothelial fenestrations did not change significantly until 2 weeks. They decreased within 4 weeks, and then the sinusoidal endothelium was poorly fenestrated at 6 weeks after DEN treatment. These results suggest that as fibrosis develops in cirrhosis, the deposit of extracellular matrix such as laminin within Disse's space is a major contributing factor in the structural alteration of sinusoidal endothelial cells, and the capillarization of the sinusoidal endothelial cells may be a contributor to impairment of the hepatic function in cirrhosis.
Rats ; Animals

We have experienced a case of deflation failure of Inoue balloon in the left atrium during mitral balloon valvuloplasty in a 44 year old male patient with tight mitral stenosis, who died just after emergency open heart surgery for removal of undeflated Inoue balloon and mitral valve replacement because of associated acute hemorrhagic myocardial infarction.
Adult ; Balloon Valvuloplasty ; Emergencies ; Heart Atria ; Humans ; Male ; Mitral Valve ; Mitral Valve Stenosis ; Myocardial Infarction ; Thoracic Surgery

Two cases of exercise-induced atrial fibrillation were diagnosed in 68 years old female and 47 years old male. They complained palpitation during exercise, and emotional upset for the last 5 years. There was no evidence of organic heart disease except mild hypertension in female patient. The atrial fibrillation was induced repeatedly by treadmill exercise test and intravenous infusion of isoproterenol. The beta blocker(atenolol 50mg po dialy) prevented the induction of atrial fibrillation during treadmill exercise. We report two cases of exercise-induced atrial fibrillation which is very rare and might be related to catecholamine.
Aged ; Atrial Fibrillation* ; Exercise Test ; Female ; Heart Diseases ; Humans ; Hypertension ; Infusions, Intravenous ; Isoproterenol ; Male ; Middle Aged

BACKGROUND/AIMS: Entecavir is a synthetic nucleoside analogue, cyclopentyl guanine nucleoside, which has a potent antiviral effect and the least viral breakthrough in hepatitis B virus (HBV) replication. Entecavir has been available in Korea since 2007 but there are few reports on its effects. The aim of this study was to evaluate the virological response (VR) and biochemical response (BR) to entecavir in HBV patients at 3, 6 and 9 months after treatment with entecavir. MATERIALS AND METHODS: Thirty-three chronic hepatitis B patients who took entecavir for at least 9 months were enrolled. We investigated VR and BR by retrospectively reviewing medical records. Patients who satisfied the following criteria were chosen: 1) initial alanine aminotransferase (ALT) levels = 1.5upper limit of normal (ULN) and 2) initial HBV DNA levels = 5 log10 copies/ml. We measured ALT levels every 3 months until month 9. HBV DNA was measured every 2 or 3 months by polymerase chain reaction (PCR) method. RESULTS: Most patients taking entecavir showed good BR (ALT < 40 IU/L). The BR rates were 61%, 73% and 67% at months 3, 6 and 9, respectively. VR (HBV DNA < 5 log(10) copies/ml or 2 log lower than initial HBV DNA) rates were 82%, 91% and 91% at months 3, 6 and 9, respectively. Undetectable HBV DNA (HBV DNA < 4 log(10) copies/ml) rates were 49%, 73% and 85% at months 3, 6 and 9, respectively. Two patients presented with virological breakthrough without adverse effects until month 9. CONCLUSIONS: Entecavir showed good BR and VR from month 3 and these effects continued through the 9-month observation period. This suggests that entecavir is also a good choice for the first line treatment of chronic hepatitis B (CHB). Further studies are needed to determine the long-term efficacy and drug resistance of entecavir in Korean CHB patients.
Alanine Transaminase ; DNA ; Drug Resistance ; Guanine ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Korea ; Medical Records ; Polymerase Chain Reaction ; Retrospective Studies

BACKGROUND: The interest of patients with chest pain and normal coronary arteries has been increased since 1960. From the year 1973, the syndrome representing these characteristics has been classified as syndrome X. Treadmill test and exercise TI-201 SPECT are important in the diagnosis of syndrome X. This study was designed to evaluate the clinical value of exercise TI-201 SPECT and the difference of clinical characteristics between exercise TI-201 SPECT positive(Group A) and negative (Group B) in patients with chest pain and normal coronary angiogram. METHODS: Twenty seven patients with chest pain and normal coronary angiogram underwent echocardiogram and exercise TI-201 SPECT. Patients received 2 mCi of thallium intravenously during exercise, redistribution images were performed 4 hour later and second dose of 1 mCi of thallium was injected at rest immediately thereafter. These three sets of image(stress, redistribution and reinjection) were analyzed. RESULTS: 1) 12 of 16 patients in Group A, none of 11 patients were positive on exercise treadmill test(p<0.005). 2) The incidence of systemic hypertension in Group A was significant greater than Group B(p<0.05). 3) The left ventricular end diastolic pressure was significantly higher in Group A than in Group B (p<0.05). CONCLUSION: The exercise TI-201 SPECT is a useful method to evaluate the patients with chest pain and normal coronary angiogram and the reversible perfusion defects on the exercise TI-201 SPECT might be related to systemic hypertension and elevated left ventricular end diastolic pressure.
Blood Pressure ; Chest Pain* ; Coronary Vessels ; Diagnosis ; Exercise Test ; Humans ; Hypertension ; Incidence ; Perfusion ; Thallium ; Thorax* ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Liver Transplantation* ; Liver*

A retrospective analysis of 36 cases of petrous pyramid fractures was studied clinically and radiographically during last 5 years. Of 503 patients with skull fractures admitted to the Inha University hospital, of which 7.1% involved the petrous pyramid. The most common mode of injury was a motor vehicle accident and the most common age group was the first decade. The anatomic location of fractures in the petrous pyramid were evaluated by high resolution computed tomography and it disclosed 20 longitudinal and 16 transverse fractures. The principal symptoms and signs, occurring alone or in combination, were a otologic problem, facial paralysis and CSF liquorrhea. The otologic problems were noted in almost every case. The facial palsy and CSF liquorrhea were present in 16 cases(36%) and 9 cases(25%), respectively. The anatomic type of fractures well corresponded to the principal symptoms and signs and the prognosis, the development rate of principal symptoms and signs of the transverse fracture was more higher and the prognosis of that was worse than the longitudinal fracture.
Facial Paralysis ; Humans ; Motor Vehicles ; Petrous Bone* ; Prognosis ; Retrospective Studies ; Skull Fractures

Carcinoid tumors of the intestinal tract are uncommon neoplasms thought to arise from argentaffin cells in the base of the intestinal crypts. Carcinoid tumors of other sites have since been reported with increasing frequency. We experienced one case of rectal carcinoid tumor and the other case of stomach carcinoid turnor. A 52-year-old male patient was admitted to the hospital because of right upper abdominal discomfort. On the CT scan, multiple low density masses were noticed. Sigmoidoscopy revealed the whitish yellow ulcerofungating mass which had vague margin. And a 31-year-old male patient was admitted to the haspital because of hematemesis. On the gastrofiberscopic examination, an ovoid shallow ulcer crater which had elevated margin, smooth tapered fold and vissible vessel was noticed on the anterior wall side of the high body. The biopsy specimen in both these cases showed carcinoid cells. 24h urine 5-HIAA of these cases was negative. Awareness of carcinoid tumor in differential diagnosis of hepatic metastasis and of gastric ulcer is necessary.
Adult ; Biopsy ; Carcinoid Tumor* ; Diagnosis, Differential ; Enterochromaffin Cells ; Hematemesis ; Humans ; Hydroxyindoleacetic Acid ; Male ; Middle Aged ; Neoplasm Metastasis ; Rectum* ; Sigmoidoscopy ; Stomach Ulcer ; Stomach* ; Tomography, X-Ray Computed ; Ulcer

PURPOSE: To evaluate the radiologic and clinical results of treatment of the Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual incision approach and dual plating. MATERIALS AND METHODS: Twelve cases in eleven patients of Shatzker type 6 tibia plateau fracture which has been treated using the lateral and posteromedial dual incision approach and dual plating were analyzed with an average follow-up of 16 months. Times to union, alignment and reduction loss on radiograph and postoperative clinical outcome with checking the range of motion of the knee joint, Knee Society Score and UCLA activity scale were analyzed and evaluated. RESULTS: In all cases, bony union was obtained in an average fifteen weeks after the operation, and there was no reduction loss. The arc of motion of the knee joint at the latest follow-up was 132 degrees on average. Average of Knee Society Score was 85 and UCLA activity scale was decreased from 9.6 points preoperatively to 5.7 points postoperatively. CONCLUSION: The treatment of Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual approach and dual plating have shown clinically preferable results of excellent recovery of joint motion and good knee society score by early range of motion exercise after firm fixation. However, it was high energy injury, so the sports activity of patients was significantly decreased.
Follow-Up Studies ; Humans ; Joints ; Knee ; Knee Joint ; Range of Motion, Articular ; Sports ; Tibia

BACKGROUND: The estimation of coronary flow velocity(CFV) is essential for assessing the impaired coronary flow reserve in patients whith angina pectoris and normal coronary arteries. But, intracoronary blood flow velocity measurement remains invasive,requiring cardiac catheterization and can not be repeated without risk during serial follow-up study. Transesophageal Doppler echocardiography(TEE) is a new noninvasive method of assessing CFV in the proximal portion of left anterior descending coronary artery. This study was performed to clarify the value of TEE in evaluating CFV, to compare the coronary flow patterns among various cardiac diseases, to estimate the coronary flow dynamics according to change of blood pressure, and to evaluate the parameters influencing CFV. METHODS: We studied 95 subjects, 51 men and 44 women, mean age 46. Normotensive subjects were 29, hypertensive patients 41, aortic stenosis 5, aortic regurgitation 4, mitral stenosis 8, and others 8. After transthoracic echocardiography(H-P Sonos 1000,2.5 MHz), transesophageal echocardiography was performed using a 5-Hz(omniplane)transesophageal probe connected to a H-P Sonos 1000 to assess CFV in the proximal portion of left anterior descending coronary artery. Doppler evaluation of left anterior descending coronary blood flow velocity was obtained in restiong conditions and after sublingual administraion of nitroglycerim(0.6mg), Blook pressure and heart rate were monitored thoughout the entire procedure. RESULTS: 1) The detection rate of CFV by TEE was 89.5%. 2) The morphology of CFV in proximal left anterior descending coronary artery was biphasic(greater diastolic and smaller systolic). 3) The baseline CFV in hypertensive patients was greater than in normotensive subjects(p<0.05) but there was no difference between two groups in diastolic/systolic CFV ratio. 4) The diastolic CFV and diastolic/systolic CFV ratio in patients with aortic stenosis were greater than in normotensive subjects(p<0.05). 5) The CFV was significantly decreased after administration of nitroglycerin(p<0.05) and the decrement of CFV correlated closely with the decrement of systolic(r=0.65, p<0.05) and diastolic blood pressure(r=0.57, p<0.05). 6) Major parameters influencing CFV were systolic blood pressure and heart rate. CONCLUSION: The CFV is influenced by various parameters and the TEE may be a useful, noninvasive tool to investigate the coronary flow dynamics.
Angina Pectoris ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Blood Flow Velocity ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Vessels ; Echocardiography, Doppler* ; Echocardiography, Transesophageal ; Female ; Follow-Up Studies ; Heart Diseases ; Heart Rate ; Humans ; Male ; Mitral Valve Stenosis