This study was designed to observe anoxia-induced responses and to clarify their possible mechanisms in porcine basilar and circle of Willis arteries. Anoxia produced a transient vasoconstriction, which then recovered to the basal tension of a 3-5 min. later, and the reoxygenation that follows produced the biphasic(relaxation-contraction) response in the intact endothelial rings under resting tension. The anoxia-induced contraction was potentiated by pretreatment with KC1 and PGF2alpha. Reoxygenation produced only sustained relaxation. Removal of the endothelium and pretreatment with nimodipine or indomethacine markedly attenuated the anoxia-induced contractions. Anoxia transiently and significantly increased cyclic GMP contents in the endothelium-intact preparations, but did not affect them in the endothelium-removed ones. The above results suggest that anoxia-induced contraction is endothelium-dependent and is resultant to the release of a Prostaglandin-like substance(s) .
Anoxia* ; Arteries ; Cerebral Arteries* ; Circle of Willis ; Cyclic GMP ; Dinoprost ; Endothelium ; Indomethacin ; Nimodipine ; Relaxation ; Vasoconstriction

BACKGROUND: There has been reports which suggest that non-specific symptom of patients with mitral valve prolapse is associated with autonomic dysfunction. METHODS: To assess autonomic dysfunction of patients, we examined five cardiovascular reflex tests in 25 asymptomatic MVP patients(identified as MVP group), 25 symptomatic MVP patients(identified as MVP syndrome group) and 25 control group. RESULTS: In the five cardiovascular autonomic function tests, abnormalities of Valsalva ratio were detected in 1(4%) control group, 7(28%) MVP group, 9(36%) MVP syndrome group, heart rate response to deep breathing in 0(0%), 2(8%), 4(16%) respectively, immediate heart rate response to standing in 0(0%), 2(7.4%), 2(8%) respectively and in postural hypotension, there were no abnormal group. Abnormalities of blood pressure response to sustained handgrip were only detected in 2(8%) MVP syndrom group. According to the five categories of cardiovascular autonomic functon tests, normal in 24(96%) and early damage in 1(4%) were detected in control group. In the MVP group, normal 17(68%), early damage 6(24%) and definite damage 2(8%) were noted. In the MVP syndrome group, normal 9(36%), early damage 13(52%), definite damage 1(4%) and combined damage 2(8%) were detected. In case of heart rate response to deep breathing, we found significant differences between control and MVP syndrome group(p=0.043), and between MVP and MVP syndrome group(p=0.0043). In case of heart rate response to standing, between control and MVP syndrome group(p=0.0009), between MVP and MVP syndrome group(p=0.001), the differences were noted. In case of blood pressure response to standing, between control group and MVP group(p=0.0019), between MVP and MVP syndrome group(p=0.0075), we found significant differences. Resulting from our study, heart rate response to deep breathing and standing, blood pressure response to standing were of considerable value in assessing the autonomic dysfunction of patients with mitral valve proapse. CONCLUSION: We found autonomic dysfunction in addition to increased autonomic tone and responsiveness which have been already known previously in mitral valve prolapse. And autonomic dysfunction was more severe in symptomatic patients with mitral valve prolapse than asymptomatic ones.
Blood Pressure ; Heart Rate ; Humans ; Hypotension, Orthostatic ; Mitral Valve Prolapse* ; Mitral Valve* ; Reflex ; Respiration

BACKGROUND: High blood pressure is prevalent in obesity and diabetes, especially noninsulin dependent diabetes mellitus, and both conditions are insulin resistant state. METHOD: To test whether resistance to insulin-stimulated glucose uptake and hyperinsulinemia are involved in the pochogenesis of hypertension, author measured glucose, insulin and C-Peptide reponse after oral glucose loading in 52 cases of essential hypertension and 62 cases of normal controls who had been admitted to the ward of internal medicine, Pusan National University Hospita. RESULTS: Basal plasma glucose, insulin and C-Peptide levels in control subjects were 92.1+/-36.8mg/dl, 8.7+/-5.5microu/ml and 2.2+/-1.8ng/ml and in hypertensive subjects were 95.7+/-32.6mg/dl, 12.2+/-5.3microu/ml and 2.9+/-1.6ng/ml. The basal insulin level was markedly higher than tat of control subjets (p<0.05). The basal glucose and C-Peptide levels in hypertensive patioents were higher than controls but statistically not significant. Plasma glucose levels in time course after glucose load in hypertensive patients showed significantly higher levels in 60,90minutes than controls. Plasma insulin levels in hypertensives in 90 minutes were significantly higher. The C-Peptide levels in hypertensives showed significantly higher in each times 30,60,90,120 minutes than controls. In hypertensive patients, body weight, blood pressure levels and duration of hypertension were not significantly correlated with responses of glucose, insalin and c-peptioce. Hypertensive patients aboce the age of 50 showed significantly higher glucose levels in 60,90,120 minutes than under age of 50. CONCLUSION: These results indicate some tendency of disturbed glucose turnover or insulin-resistant state in essential hypertension. This metabolic disturbance in essential hypertension should be considered in the management of hypertensive patients.
Blood Glucose* ; Blood Pressure ; Body Weight ; Busan ; C-Peptide* ; Diabetes Mellitus ; Glucose ; Humans ; Hyperinsulinism ; Hypertension* ; Insulin Resistance ; Insulin* ; Internal Medicine ; Obesity ; Plasma*

Atlantoaxial joint is a complex and unique structure which promotes rotation of head. Disruption of the transverse ligament and odontoid process fracture caused by trauma result in atlantoaxial instability. The instability must be corrected to relieve pain and to reduce the risk of neural damage and possibility of sudden death. The most recent and technologically advanced fixation method of C1-2 instability is the use of C1-2 transarticular screw fixation. The transarticular screw fixation augmented with interspinous wiring technique provide immediate multidirectional rigid fixation and increase the fusion rate of atlantoaxial instability. It can be employed in situations where the posterior arch of C1 is absent or fractured and in situations where standard wiring techniques pose risky posterior subluxation of C1 on C2, or for congenital odontoid anomalies. Twenty-one patients with atlantoaxial instability were operated with posterior transarticular screw fixations augmented with interspinous C1-2 strut graft and posterior wire fixation technique. All patients restored C1-2 stability without complication. This technique seems to be superior biomechanically when compared with other posterior fixation methods. Precaution is needed to avoid the vertebral artery injury.
Atlanto-Axial Joint ; Death, Sudden ; Head ; Humans ; Ligaments ; Odontoid Process ; Transplants ; Vertebral Artery

BACKGROUND: Mitral stenosis is charcterized by decrease in mitral valve area anatomically and increase in transmitral pressure gradient hemodynamically. And these changes have been used to quantify the severity of mitral stenosis clinically. To evaluate the clinical usefulness of mitral valve resistance as a hemodynamic parameter in patients with mitral stenosis, we compared the mitral valve resistance to the clinical status of the patient with mitral stenosis, the other hemodynamic parameters and static parameter. METHODS: We analyzed and reviewed the data obtained from the consecutive 27 patients with mitral stenosis(7 male, 20 female : mean age 38+/-9 years) who had been underwent percutaneous mitral valvuloplasty(PMV). RESULTS: Befor PMV, the mitral valve resistance was significantly correlated with exercise capacity on treadmill test(r=-0.37, p<0.05), mitral valve area(r=-0.72, p<0.01), transmitral mean pressure gradient(r=0.83, p<0.01),not with cardiac output, mixed venous oxygen saturation. After PMV, the mitral valve resistance was significantly correlated with mitral valve area (r=-0.72, p<0.01), transmitral mean pressure gradient(r=0.90, p<0.01).According to the results summerizing and comparing the values of before and after percutaneous mitral valvuloplasty, the mitral valve resistance had good relationship with preexisting paramerters of severity such as mitral valve area(r=-0.82, p<0.01), transmitral mean pressure gradient (r=0.92, p<0.01). CONCLUSION: This results indicate that the mitral valve resistance is a useful hemodynamic parameter in patients with mitral valve stenosis and reflects the exercise capacity during the treadmill test which was the objective parameter of practical and clinical status of the patient well than the other hemodynamic parameters in case of remarkably reduced transmitral valve blood flow due to severe mitral valve stenosis, because the degree of change in the mitral valve resistance in relagion to the degree of change in transmitral valve blood flow is relatively more constant than the other hemodynamic parameters.
Cardiac Output ; Exercise Test ; Female ; Hemodynamics* ; Humans ; Male ; Mitral Valve Stenosis* ; Mitral Valve* ; Oxygen

It has been well documented that transient forebrain global ischemia causes selective neuronal degeneration in hippocampal CA1 pyramidal neurons with a delay of a few days. The mechanism of this delayed hippocampal CA1 pyramidal neuronal death (DND) is still controversial. To delineate the mechanisms of the DND, the effects of treatment with MK-801, an NMDA receptor antagonist, kynurenic acid, a NMDA/non-NMDA receptor antagonist, and/or cycloheximide, a protein synthesis inhibitor, on the DND were investigated in male Wistar rats. To examine the participation of apoptotic neuronal death in the DND, TUNEL staining was performed in ischemic brain section. Global ischemia was induced by 4-vessel occlusion for 20 min. All animals in this study showed the DND 3 and 7 days after the ischemic insult. The DND that occurred 3 days and 7 days after the ischemia were not affected by pretreatment with MK-801 (I mg/kg), but markedly attenuated by the pretreatment with kynurenic acid (500 mg/kg). Treatment with cycloheximide (1 mg/kg) also markedly inhibited the DND. The magnitudes of attenuation by the two drugs were similar. The magnitude of attenuation by co-treatments with kynurenic acid and cycloheximide was not greater than that with any single treatment. TUNEL staining was negative in the sections obtained 1 or 2 days after the ischemic insults, but it was positive at hippocampal CA1 pyramidal cells in sections collected 3 days after the ischemia. These results suggested that the DND should be mediated by the activation of non-NMDA receptor, not by the activation of NMDA receptor and that the activation of AMPA receptor should induce the apoptotic process in the DND.
Animals ; Apoptosis ; Brain* ; Cycloheximide ; Dizocilpine Maleate ; Excitatory Amino Acid Antagonists* ; Glutamic Acid* ; Humans ; In Situ Nick-End Labeling ; Ischemia* ; Kynurenic Acid ; Male ; N-Methylaspartate ; Neurons* ; Prosencephalon ; Pyramidal Cells ; Rats* ; Rats, Wistar ; Receptors, AMPA ; Receptors, Glutamate*

BACKGROUND/AIMS: The Follicular Lymphoma International Prognostic Index (FLIPI) and FLIPI2 are well-known prognostic models for patients with follicular lymphoma (FL). However, their prognostic relevance has not been examined before in Korean patients with FL. METHODS: We reviewed clinical and laboratory information from our database of patients between 1995 and 2012. In total, 125 patients were stratified in three categories according to FLIPI or FLIPI2 scores: low-, intermediate-, and high-risk groups. We compared FLIPI and FLIPI2 in terms of progression-free survival (PFS) and overall survival (OS). RESULTS: Among the 125 patients, the prognostic value of FLIPI and FLIPI2 was evaluated in 73 patients who fulfilled the criteria of both prognostic models. Risk stratification by FLIPI and FLIPI2 showed significant differences in unfavorable parameters among each risk group, particularly between low- and intermediate-risk groups. The high-risk group b was significantly associated with poor PFS on both FLIPI and FLIPI2 (p < 0.05). However, the OS was significantly different only in the risk groups determined by FLIPI2 (p = 0.042). In a subgroup analysis of patients who received rituximab-containing chemotherapy, the risk stratification of both prognostic models showed a significant impact on PFS, especially in the low-risk group. CONCLUSIONS: FLIPI and FLIPI2 are appropriate prognostic models in Korean FL patients, especially for discriminating low-risk patients from intermediate- and high-risk groups.
Disease-Free Survival ; Drug Therapy* ; Humans ; Lymphoma, Follicular* ; Prognosis

Primary cardiac malignancy is very rare. Angiosarcoma is the most frequent malignant cardiac tumor and associated with a very unfavourable outcome. We report the case of an cardiac angiosarcoma complicated with cardiac tamponade revealed by echocardiography with pericardiocentesis and confirmed histopathologically in a 25 years old man.
Adult ; Cardiac Tamponade* ; Echocardiography ; Heart Neoplasms ; Hemangiosarcoma* ; Humans ; Pericardiocentesis

Injuries to the internal jugular vein rarely occur in Korea. However, neck veins are damaged more frequently than any other structure by neck stab injuries, and jugular venous injuries are caused almost exclusively by penetrating neck trauma. Vascular injury is the leading cause of death from trauma. Bleeding from injury to jugular veins is a main contributing factor of mortality as a result of penetrating neck trauma. When we meet a patient of neck stab injury, we must do a careful physical examination and some selective special diagnostic studies. Patients with penetrating neck injuries who are taken directly to the operating room are those with severe external hemorrhage and expanding hematoma and those who are hemodynamically unstable despite of resuscitation. A 22-year-old woman received a stab injury to the neck. On the neck CT scan, the patient was revealed to have a pseudoaneurysm caused by transection of the internal jugular vein. The patient recovered well from the injury as a result of a selective operation, an end-to-end anastomosis. We report that case of a penetrating neck injury resulting in transection of the internal jugular vein and give a review of other reported cases.
Aneurysm, False ; Cause of Death ; Female ; Hematoma ; Hemorrhage ; Humans ; Jugular Veins* ; Korea ; Mortality ; Neck Injuries ; Neck* ; Operating Rooms ; Physical Examination ; Resuscitation ; Tomography, X-Ray Computed ; Vascular System Injuries ; Veins ; Young Adult

X-linked agammaglobulinemia (XLA) is characterized by early onset of recurrent bacterial infection, markedly reduced levels of all major classes of immunoglobulins in the serum and few mature B cells in the blood. XLA is known to be associated with mutations in Bruton's tyrosin kinase (Btk). The Btk protein consists of 5 functional domains; the pleckstrin homology (PH) domain, the Tec homology (TH) domain, the Src homology 3 (SH3) domain, the SH2 domain, and the kinase (SH1) domain. Mutations in all domains of the Btk gene have been shown to cause XLA. The large number of Alu elements within the human genome provides abundant opportunities for unequal homologous recombination events between Alu repeats, resulting in human disease. We present a case of XLA with deletion of introns 15-18 of Btk gene which were mediated by an Alu-Alu recombination event.
Agammaglobulinemia* ; Alu Elements ; B-Lymphocytes ; Bacterial Infections ; Genome, Human ; Homologous Recombination ; Humans ; Immunoglobulins ; Introns* ; Phosphotransferases ; Recombination, Genetic* ; src Homology Domains