Bilateral putaminal hemorrhages rarely occur simultaneously in hypertensive patients. The association of intracerebral hemorrhage with cerebral edema (CE) has been rarely reported in diabetic patients. We present a patient with bilateral putaminal hemorrhage (BPH) and CE during the course of hyperglycemic hyperosmolar syndrome (HHS). A 40-year-old man with a history of diabetes mellitus and chronic alcoholism was admitted with acute impaired mentality. His blood pressure was within the normal range on admission. Laboratory results revealed hyperglycemia and severe metabolic acidosis without ketonuria. After aggressive treatment, plasma sugar fell to 217 mg/dl, but brain CT showed BPH and diffuse CE. Our case demonstrated that HHS should be considered as a cause of BPH with CE. Initial brain imaging study may be recommended for patients with diabetic coma.
Adult ; Brain/pathology ; Brain Edema/*etiology ; Case Report ; Human ; Hyperglycemic Hyperosmolar Nonketotic Coma/*complications ; Male ; Putaminal Hemorrhage/*etiology ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). SUBJECTS AND METHODS: A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. RESULTS: Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). CONCLUSION: Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.
Cohort Studies ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Death ; Follow-Up Studies ; Homocysteine* ; Humans ; Male ; Myocardial Infarction ; Prognosis ; Propensity Score* ; Risk Factors

BACKGROUND: Doppler variable of mitral inflow have been used to assess left ventricular siastolic function indirectly. Pulmonary venous flow(PVF) variables could supplement mitral inflow in the estimation of left ventricular diastolic function. The purpose of this study are to assess the feasibility of PVF measurement by using transthoracic pulsed wave Doppler echocardiogram and to estimate the LV end-diastolic pressure with PVF parameters. METHODS: Fifty six patients underwent transthoracic pulsed wave Doppler echocardiagraphy (HP Sonos 1500) within 2 hours before left heart catheterization for the measurement of left ventricular pressure. RESULTS: 1) Measurement of transthoracic PVF was feasible in 50 patients(89.3%). 2) The difference between the duration of pulmonary venous reversal flow and mitral A wave(D difference, delta D) was strongly correlated with left ventricular end diastolic pressure(r=0.73, p<0.01). PVF reversal duration exceeding that of mitral A wave predicted left ventricular end diastolic pressure > or =12mmHg(sensitivity 90.6%, specificity 50.0%). CONCLUSION: PVF could be assessed with transthoracic Doppler ultrasound with good feasibility. PVF may be an important parameter in the evaluation of left ventricular diastolic function. PVF reveral duration exceeding that of mitral A wave would be a marker of elevated left ventricular end diastolic pressure(> or =12mmHg). Plumonary venous flow . Transmitral inflow . Left ventricular end diastolic pressure. Transthorasic doppler echocardiography.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography, Doppler* ; Humans ; Sensitivity and Specificity ; Ultrasonography ; Ventricular Pressure

Advanced glycation endproducts (AGEs) have been reported to play a role in neointimal formation and increase the rate of in-stent restenosis (ISR) in the diabetic coronary artery disease patients treated with stents, but the potential pathogenic mechanisms of AGEs in vascular smooth muscle cell proliferation remain unclear. We sought to determine the AGEs related pathobiological mechanism of diabetic vasculopathy. Rat aortic smooth muscle cell (RAoSMC) culture was done with different concentrations of AGEs and proliferation was assessed. Immunohistochemistry for receptor of AGEs (RAGE) was performed with human carotid atheroma. Western blotting was performed to assess the activation of MAP kinase system in the cultured RAoSMC. AGEs increased RAoSMC proliferation and were associated with increased phosphorylation of ERK and p38 kinase by time and dose dependent manner. The MAP kinase activity was decreased by RNA interference for RAGE. AGEs stimulation increased reactive oxygen species (ROS) generation in cultured RAoSMC. From this study it is concluded that AGEs played a key role in RAoSMC proliferation via MAP kinase dependent pathways. Activation of vascular smooth muscle cell (VSMC) proliferation by MAP kinase system and increased formation of ROS may be the possible mechanisms of AGEs induced diabetic vasculopathy.
Animals ; Carotid Artery Diseases/metabolism/pathology ; Cell Proliferation/drug effects ; Cells, Cultured ; Diabetic Angiopathies/*etiology/metabolism/pathology ; Extracellular Signal-Regulated MAP Kinases/metabolism ; Glycosylation End Products, Advanced/adverse ; Humans ; MAP Kinase Signaling System/drug effects/*physiology ; Phosphorylation/drug effects ; RNA, Small Interfering/pharmacology ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species/metabolism ; Receptors, Immunologic/antagonists & inhibitors/metabolism

BACKGROUND/OBJECTIVES: Nelumbo leaves have been used in traditional medicine to treat bleeding, gastritis, hemorrhoids, and halitosis. However, their mechanisms have not been elucidated. MATERIALS/METHODS: The present study prepared two Nelumbo leaf extracts (NLEs) using water or 50% ethanol. Inflammatory response was induced with LPS treatment, and expression of pro-inflammatory mediators (inducible nitric oxide synthase, cyclooxygenase-2, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6 and nitric oxide (NO) and prostaglandin E₂ (PGE₂) productions were assessed. To determine the anti-inflammatory mechanism of NLEs, we measured nuclear factor-κB (NF-κB) activity. Major metabolites of NLEs were also analyzed and quantified. RESULTS: NLEs effectively reduced the expression and productions of pro-inflammatory mediators such as IL-1β, IL-6, TNF-α, PGE₂, and NO. NLEs also reduced NF-κB activity by inhibiting inhibitor of NF-κB phosphorylation. Both extracts contained catechin and quercetin, bioactive compounds of NLEs. CONCLUSIONS: In this study, we showed that NLEs could be used to inhibit NF-κB-mediated inflammatory responses. In addition, our data support the idea that NLEs can ameliorate disease conditions involving chronic inflammation.
Catechin ; Cyclooxygenase 2 ; Dinoprostone ; Ethanol ; Gastritis ; Halitosis ; Hemorrhage ; Hemorrhoids ; Inflammation ; Interleukin-6 ; Interleukins ; Macrophages ; Medicine, Traditional ; Metabolomics ; Necrosis ; Nelumbo* ; Nitric Oxide ; Nitric Oxide Synthase ; Phosphorylation ; Quercetin ; Water

Aortic interruption is a very rare disease that can be classified into congenital and acquired aortic interruption. Congenital aortic interruption generally implies an interruption of the aortic arch and no case of congenital abdominal aortic interruption has been reported. Acquired aortic interruption, on the other hand, can be caused by atherosclerosis, thrombosis, saddle embolism, and arteritis such as Takayasu arteritis. We experienced a case of congenital abdominal aortic interruption accompanied by one well-developed collateral flow presented with secondary hypertension in a 28-year-old female patient.
Adult ; Aorta, Abdominal ; Aorta, Thoracic ; Arteritis ; Atherosclerosis ; Embolism ; Female ; Hand ; Humans ; Hypertension* ; Rare Diseases ; Takayasu Arteritis ; Thrombosis

A 33-year-old man was admitted to our hospital with chest pain and exertional dyspnea. Two-dimensional echocardiography showed prominent trabeculations and deep intertrabecular recesses, findings consistent with noncompaction of the ventricular myocardium. Thoracoabdominal CT and cardiac magnetic resonance imaging (CMR) revealed situs ambiguous with polysplenia and noncompaction of the left ventricular myocardium. CMR also demonstrated delayed enhancement of the trabeculations located at the apical portion of the left ventricle. The coronary angiogram was normal. This is the first case of noncompaction of the ventricular myocardium associated with situs ambiguous with polysplenia.
Abnormalities, Multiple/*pathology ; Adult ; Echocardiography ; Heart Ventricles/abnormalities ; Humans ; Magnetic Resonance Imaging ; Male ; Myocardium/*pathology ; Spleen/*abnormalities ; Syndrome ; Tomography, X-Ray Computed

BACKGROUND: We aimed to study the importance of diabetes education by investigating diabetes education rate and the associations between the presence/absence of diabetes education and the clinical outcomes of diabetic patients in Korea. METHODS: In the Fifth Korea National Health and Nutrition Examination survey (KNHANES V), a cross-sectional national survey during 2010 and 2012, 1498 subjects aged over 30 years and older were diagnosed with diabetes by doctors. The subjects were analyzed by a complex samples model. RESULTS: Only 20.3% of diabetes patients received diabetes education, and this was not significantly different between age groups. Education was delivered in hospitals/clinics, public health centers, and public lectures (15.7%, 3.0% and 1.4%, respectively). After adjusting for age, sex, and duration of diabetes, the factors independently associated with the presence of diabetes education were higher education level, frequent walking habit, and parameters regarding the presence of dyslipidemia, insulin treatment, and non-pharmacologic treatment. Among continuous variables, only the duration of diabetes was associated with diabetes education status; metabolic parameters were not associated with diabetes education status. CONCLUSION: Diabetes is a chronic disease and education on diabetes is very important. The education rate was low and quality of the education is doubtful. An effort to raise the rate of diabetes education and further study to raise the quality of diabetes training are necessary.
Chronic Disease ; Diabetes Mellitus* ; Dyslipidemias ; Education* ; Epidemiology ; Humans ; Insulin ; Korea ; Lectures ; Nutrition Surveys* ; Public Health ; Walking

Hyperkalemia is a common adverse effect of treatment for heart failure and is associated with high mortality and morbidity. The cardiac manifestations of hyperkalemia include various electrocardiogram changes. We describe a case of a 74-year-old woman with heart failure and permanent atrial fibrillation who reverted to normal sinus rhythm during recovery from hyperkalemia.
Aged ; Atrial Fibrillation ; Electrocardiography ; Female ; Heart Failure ; Humans ; Hyperkalemia

PURPOSE: Metabolic syndrome (MS) has been reported as a potential risk factor of coronary artery disease (CAD). The aims of this study were to assess whether there was a relationship between MS score and CAD angiographic severity, and to assess the predictive value of individual components of MS for CAD. MATERIALS AND METHODS: We retrospectively enrolled 632 patients who underwent coronary angiography for suspected CAD (394 men, 61.0 +/- 10.6 years of age). MS was defined by the National Cholesterol Education Program criteria with the waist criterion modified into a body mass index (BMI) of more than 25 kg/m2. The MS score defined as the number of MS components. CAD was defined as > 50% luminal diameter stenosis of at least one major epicardial coronary artery. CAD angiographic severity was evaluated with a Gensini scoring system. RESULTS: Of the patients, 497 (78.6%) had CAD and 283 (44.8%) were diagnosed with MS. The MS score was significantly related to the Gensini score. High fasting blood glucose (FBG) was the only predictive factor for CAD. A cluster including high FBG, high blood pressure (BP), and low high-density lipoprotein cholesterol (HDL-C) showed the highest CAD risk. CONCLUSION: The MS score correlates with the angiographic severity of CAD. The predictive ability of MS for CAD was carried almost completely by high FBG, and individual traits with high BP and low HDL-C may act synergistically as risk factors for CAD.
Aged ; *Coronary Angiography ; Coronary Artery Disease/*complications/etiology/radiography ; Female ; Humans ; Male ; Metabolic Syndrome X/*complications/radiography ; Middle Aged ; Retrospective Studies ; Risk Factors ; Severity of Illness Index