BACKGROUND: The purpose of this study was to investigate the mechanism of endothelium-dependent and independent responses to endothelins (ETs) in porcine coronary artery. METHODS: The vascular rings of left anterior descending artery or left circumflex artery from 7 pigs were suspended in conventional organ chambers for the measurement of isometric force. To evaluate relaxation responses, vascular rings with endothelium were exposed to ET-1 and ET-3. To evaluate contraction responses, vascular rings with and without endothelium were exposed to ET-1 and ET-3 in the presence or absence of BQ 123 (ET(A) receptor antagonist) or TAK-044 (ET(A) and ET(B) receptor antagonist). RESULTS: Transient relaxation responses of vascular rings occurred after exposure of ET-1 and ET-3. These transient responses disappeared after preincubation with N-nitro-L arginine. There was an increased contractions of vascular rings according to increasing concentration of ET-1 and ET-3. The initial responses were enhanced in vascular rings without endothelium in ET-1 and ET-3. In vascular rings with endothelium, the contraction responses were more reduced in vascular rings with preincubation of BQ 123 than in vascular rings without BQ 123 in ET-1. In vascular rings without endothelium, the contraction responses were more reduced in vascular rings with preincubation of TAK-044 than in vascular rings without TAK-044 in ET-1. CONCLUSION: ET(B) receptor on the endothelium might mediate the transient vasodilator responses to ET-1 and ET-3 through release of nitric oxide in porcine coronary artery. ET(A) and ET(B) receptor on vascular smooth muscle cells might mediate vasoconstrictor responses to ETs.
Arginine ; Arteries ; Coronary Vessels* ; Endothelins* ; Endothelium ; Muscle, Smooth, Vascular ; Nitric Oxide ; Receptors, Endothelin ; Relaxation ; Swine

BACKGROUND: Systemic anticoagulation therapy has been recommended to prevent subacute thrombosis after intracoronary stening. Recent data, however, suggest that antiplatelet therapy might be an effective alternative to anticoagulation therapy. We evaluated the effect of antithrombotic regimens on subacute thrombosis and short-term clinical course after successful implantation of Cordis coronary stent, which is a flexible, balloon expandable, radiopaque tantalum stent. METHOD: Two hundred and seventy-five consecutive patients with 290 lesions were treated with 356 Cordis stents implantation. According to post-stent antithrombotic regimen, patients were divided into three groups ; 165 patients with 175 lesions received aspirin 200mg/day, ticlopidine 500mg/day and warfarin for one month(Group 1), 66 patients with 69 lesions received aspirin and ticlopidine(Group 2) and 44 patients with 46 lesions received aspirin alone(Group 3) after successful Cordis stenting. RESULTS: The overall procidural success rates were 97.7% in group 1, 98.6% in group 2 and 100% in group 3. More than 65 percents of the patients were eligible for elective stenting aspirin, ticlopidine and warfarin, 0% in patients with aspirin and ticlopidine, and 6.8% in patients assigned to the treatment with aspirin alone. CONCLUSION: The Cordis coronary stent is an effective endovascular stent in various clinical indications including unstable angina and acute myocardial infarction. Antiplatelet therapy using aspirin and ticlopidine after successful Cordis coronary stenting is promising alternative to anticoagulation therapy to overcome the drawbacks of stenting. However, post-stent antithrombotic therapy with aspirin alone is associated with significant rate of stent thrombosis.
Angina, Unstable ; Aspirin ; Coronary Artery Disease ; Humans ; Korea* ; Myocardial Infarction ; Stents* ; Tantalum ; Thrombosis ; Ticlopidine ; Warfarin

Although flexion and extension lateral views were known the most preferable diagnostic method of instability of lumbar spine, many authors had reported that there were some findings which suggested instability of lumbar spine in plain films. This study was undertaken to analyze clinical aspect and plain film findings of dynamic instability of lumbar spine and to suggest indication of dynamic X-ray to find out the causes of low back pain. A retrospective analsysis was perfomed on 30 patients who had dynamic instability of lumbar spine without spondylolithesis between January 1996 and March 1997. They were reviewed in sex, age, symptom duration and instability level, etiologic factor etc. And then their plain films and flexion and extension lateral views were reviewed. Following results were obtained. Dynamic instability was more frequent in women than in man and occured younger age in women. The mean symptom duration was 5 years and 10 months and simple degenerative change was the most common etiologic factor. In plain films, traction spur and dome shaped end plate were common findings and the L4-5 intervertebral disc space was most frequently involved(23/30 cases). Translation was occured more frequently in flexion position(23/30 cases). The mean dynamic translation distance was 4.7mm, the mean sagittal rotational angle was 16.2degreesand the mean angular displacement was 3.2degrees. Conclusively, among the diagnostic criteria af instability of lumbar spine, translational distance was the most common finding. Flexion and extension lateral views have diagnostic value in patients who complaint back pain from unknown origin, in old age, for prolonged symptom duration, or those who have findings associated with instability in plain films.
Back Pain ; Female ; Humans ; Intervertebral Disc ; Low Back Pain ; Retrospective Studies ; Spine* ; Spondylolisthesis* ; Traction

Locking of the metacarpophalangeal(MP) joint of thumb in mild hyperextension is relatively uncommon problem. The most frequently recognized cause appears that proximal palmar ligament or volar plate were ruptured tranversely with its distal part riding over the volar prominence of the radial condyle of the first metacarpal head. We experienced two cases of locking of the MP joint of the thumb due to volar plate injury. Closed reduction was failed in both cases and open reduction was done by cutting the constricted ligament hundle over the radial condyle of the first metacarpal head. Our description of this mechanism is supported by expeimental evidence that we obtained from the cadeveric specimens. The height of radial side condyle of first metacarpal head is higher than ulna side of that by 1.76mm in both hands of 16 cadeveric specimen. So we are going to report these cases with a review of the literature, and suggest that the preferable location of surgical incision in open reduction is radial side of metacarpal head.
Hand ; Head* ; Joints ; Ligaments ; Metacarpal Bones* ; Metacarpophalangeal Joint* ; Thumb* ; Ulna ; Palmar Plate

Posterior lumbar apophyseal fracture characterized by osteochondral fragments from posterior rim of a lumbar vertebral body, has often been misdiagnosed as herniated disc or spinal stenosis due to its similarity of symptoms. But recent use of CT scan facilitated the diagnosis of the lesion as a separate entity. This study was performed to verify the clinical characteristics, to find out the mechanism of injury and to determine the most effective method of diagnosis and treatment. Authors reviewed 17 patients(14 male, 3 female) who were subjected to surgical treatment at Department of Orthopaedic Surgery, Seoul National University Hospital for posterior lumbar spophyseal fracture during the period of 1990-1992, and followed up for average of 1 year and 6 months(range 1 to 3 years). Thirteen patients (76%) were related to a history of trauma or strenuous physical activity prior to the onset of symptoms. The mechanism of injury was the rapid flexion with axial compression in 7, hyperextension in 4, and pure axial compression in 2 patients. The mean age at the time of injury was 20 years(range 10 to 31 years). All patients presented low-back pain radiating to lower extremities and 11 patients showed neurogenic intermittent claudication. The mean age at the time of surgical intervention was 23 years and 10 months(range 15 to 31 years), and the mean duration of symptoms was 3 years(range 2 months to 13 years). Simple X-ray revealed the lesion in only 3 cases but CT scan demonstrated the characteristic osteochondral fragment displaced posteriorly into the spinal canal and the corresponding defect with degenerative changes in all patients. The fracture occured through the superior apophyseal rim of L5 in 9 superior rim of L4 in 3, inferior rim of L4 in 2, inferior rim of L5 in, superior rim of L2 in 1, and superior rim of L1 in 2 patients. Two patients had concomitant fractures at two levels. All patients except one were treated with posterior decompression including the removal of the displaced fragment and posterolateral fusion with pedicular screws was carried out to prevent further degenerative change and instablilty. One patient with the lesion at the superior rim of L1 was treated by anterior decompression and fusion. All patients showed relief of pain and claudication with satisfactory results. One patient had partial tear of L4 root with slight weakness of greater toe dorsiflexion, but it recovered in 4 months. In conclusion, posterior lumbar spophyseal fracture predominantly affected young males and the most common causative mechanism was rapid flexion with axial compression. The CT scan facilitated identification of the lesion. The most frequently affected site was the superior rim of L5. Satisfactory results could be achieved bvy adequate posteriior decompression with the removal of the fragment and posterolateral fusion with pedicular screws.
Decompression ; Diagnosis ; Humans ; Intermittent Claudication ; Intervertebral Disc Displacement ; Lower Extremity ; Male ; Methods ; Motor Activity ; Seoul ; Spinal Canal ; Spinal Stenosis ; Tears ; Toes ; Tomography, X-Ray Computed

The objectives of this study are to investigate the prevalence of occupation related carpal tunnel syndrome(CTS) among workers in a condom industry; to analyse the sensitivity and specificity of clinical signs or symptoms such as hand diagram, Tinel's sign and Phalen's sign in carpal tunnel syndrome; and to test vibration threshold test using audiometry as a technically easy and noninvasive method in the diagnosis of carpal tunnel syndrome in stead of nerve conduction velocity(NCV). The study group was divided into exposed group(39 cases)and non-exposed group(48 cases) based on whether or not excessive use of wrist movements exist. 1. There are statistically significant differences in symptoms and signs of carpal tunnel syndrome such as hand diagram, Tinel's sign and Phalen's sign between exposed and non-exposed group(p<0.05). 2. Six cases(9 hands) were confirmed as carpal tunnel syndrome by NCV. Five cases(7 hands) belonged to exposed group, 1 case(2 hands) to nonexposed group. As there are significant differences in prevalence of carpal tunnel syndrome between two groups(p<0.05), excessive use of wrist in occupation is a risk factor of carpal tunnel syndrome. 3. When we use NCV as a gold standard in the diagnosis of carpal tunnel syndrome, sensitivity and specificity of hand diagram, Tinel's sign and Phalen's sign is as followed; hand diagram; sensitivity 88.9%, specificity 84.2%. Tinel's sign; sensitivity 55.6%, specificity 72.8%. Phalen's sign; sensitivity 14.3%, specificity 88.4%. Among above clinical signs and symptoms, hand diagram is the best clinical screening test. 4. The differences of vibration threshold between median and ulnar nerve at the same time are useful in the diagnosis of carpal tunnel syndrome but the time change of vibration threshold of median nerve over time are not sensitive enough. It is concluded that vibration threshold between median and ulnar nerve at the same time can be used as a supplementary or alternative criterion to indicate that the nerve dysfunction is located in the carpal tunnel.
Audiometry ; Carpal Tunnel Syndrome* ; Condoms* ; Diagnosis ; Hand ; Mass Screening ; Median Nerve ; Neural Conduction ; Occupations ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Ulnar Nerve ; Vibration ; Wrist

Moyamoya disease is a progressive occlusive cerebrovascular disease that can cause severe permanent disability. To minimize the ischemic deficit, various surgical methods have been tried. Six cases treated surgically are presented, 10 sides with encephaloarteriosynangiosis and 1 side with superficial temporal-middle cerebral artery anastomosis and encephalomyosynangiosis. Among these six cases, three cases were associated with intracerebral and intraventricular hemorrhage, and two cases were associated with intracerebral and intraventricular hemorrhage and demonstrable aneurysm, and the other was associated with cerebral infarction. All patient were reviewed and had not ischemic deficit or rebleeding during the follow-up period. The patient's clinical status and results are presented and literatures that have been reported are reviewed.
Aneurysm ; Cerebral Arteries ; Cerebral Infarction ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Moyamoya Disease

Laparoscopic wedge resection for treating a gastric submucosal tumor is a widely accepted and feasible procedure. As the skills for performing laparoscopic surgery have been developed, a great deal of effort has also been given to minimize the size of the abdominal wound and its scar. Some studies have introduced single port laparoscopic surgery for these purposes, but most of these single port laparoscopic surgeries were carried out to perform appendectomy and cholecystectomy. There have been fewer reports on this for gastric surgeries. We report here on 2 cases of single port laparoscopic gastric wedge resection for treating gastric submucosal tumor.
Appendectomy ; Cholecystectomy ; Cicatrix ; Laparoscopy

Primary splenic tumors are rare and mainly found incidentally on radiologic studies. Among them, sclerosing angiomatoid nodular transformation (SANT) of the spleen is a new entity defined as a benign pathologic lesion. Most SANTs have no clinical symptoms and are occasionally accompanied by other splenic diseases such as malignancies. So, the exact diagnosis of the nature of the splenic tumor is mandatory for further treatment. But, preoperative diagnosis is not easy since it is difficult to obtain the tissue from the spleen for pathological study. Recently, laparoscopic splenectomy has become the more standard procedure for the spleen for diagnosis and treatment. Here, we report a rare case of SANT diagnosed following laparoscopic splenectomy.
Spleen ; Splenectomy ; Splenic Diseases

BACKGROUND: Postmenopausal osteoporosis is the main problem in women, but senile osteoporosis is believed to occur after 65 years and affects men and women equally. Measurement of biochemical markers in conjunction with bone mineral density (BMD) determination can detect individual patients at the greatest risk of developing osteoporosis. METHODS: We measured serum osteocalcin levels as a bone formation marker, and urinary deoxypyridinoline (DPD) levels as a bone resorption marker, in 2190 men (from 22 to 83 year-old), and 1209 women (from 25 to 80 year-old). The age and sex related variations of serum osteocalcin and urinary DPD levels were analysed. The serum osteocalcin and urinary DPD levels were compared with BMD. These biochemical bone turnover markers were compared with each other. RESULTS: In women, serum osteocalcin and urinary DPD levels were increased with age from forties to sixties, after then showed decrease from seventies. In men, serum osteocalcin levels were slightly decreased with age, but DPD levels were slightly increased with age in men. These biochemical bone markers and BMD showed negative correlations. Osteocalcin and DPD levels showed positive correlations, especially in women. Osteocalcin levels were higher in men than women, age before fifth decades but lower in men than women after fifties. DPD levels was higher in women than men through all the age. CONCLUSION: Osteocalcin and DPD levels showed age and sex related variations in healthy Koreans. In management of patients with a risk of osteoporosis, consideration of variations according to the age and sex should be given.
Biomarkers ; Bone Density ; Bone Resorption ; Female ; Humans ; Male ; Middle Aged* ; Osteocalcin* ; Osteogenesis ; Osteoporosis ; Osteoporosis, Postmenopausal