Pilocarpine is a direct cholinergic agonist and reduces intraocular pressure by enhancing aqueous outflow. A recent study reveals that pilocarpine induces apoptotic cell death in retinal ganglion cells; activation of bax and caspase-3 is a possible mechanism of the cell death. The objective of this study is to determine whether nitric oxide is involved in apoptotic retinal ganglion cell death which is induced by pilocarpine. R18A5 retinal ganglion cells were treated with 1 mM pilocarpine. After 20 hours of incubation, NADPH-d staining assay and immunocytochemistry of nNOS, iNOS, and NF-KB were performed. In retinal ganglion cells treated with pilocarpine, intense NADPH-d histochemical reactivity was present, whereas NADPH-d reactivity was weak in control. The immunoreactivity of iNOS was increased significantly and the immunoreactivity of nNOS was increased slightly in retinal ganglion cells treated with pilocarpine. The activation of NF-KB was demonstrated by staining of nuclei in retinal ganglion cells exposed to pilocarpine, whereas such features were not seen in untreated control cells. This study provides the first evidence that nitric oxide synthase is increased in retinal ganglion cells treated with pilocarpine, and nitric oxide may be a mediator of the cell death mechanism.
Apoptosis ; Caspase 3 ; Cell Death ; Cholinergic Agonists ; Immunohistochemistry ; Intraocular Pressure ; NF-kappa B ; Nitric Oxide Synthase* ; Nitric Oxide* ; Pilocarpine* ; Retinal Ganglion Cells* ; Retinaldehyde*

PURPOSE: To evaluate the clinical features of the patients with episcleritis and scleritis. METHODS: Retrospective chart review was performed for above patients that had been followed from 1986. 8. 8 to 2001. 6. 4. RESULTS: The number of patients with episcleritis was 17 (49%) and that of scleritis was 18 (51%). Ocular complication occurred in 59% of patients with episcleritis and 72% of patients with scleritis. Keratitis was the most common ocular complication. No patient with episcleritis had a decrease in visual acuity, whereas 33% of patients with scleritis did. Systemic diseases were found in 69% of episcleritis whereas 77% of patients with scleritis associated with systemic diseases. Rheumatoid arthritis was the most common one in both groups of patients. CONCLUSIONS: Ocular complications, systemic diseases, and decrease in visual acuity are associated more of commonly with scleritis than episcleritis. When scleritis is suspected, careful examinations for associated ocular complications should be performed and be followed with history taking and evaluation for associated systemic disease.
Arthritis, Rheumatoid ; Humans ; Keratitis ; Retrospective Studies ; Scleritis* ; Visual Acuity

Nasopharyngeal carcinoma (NPC) is one of the infrequently occurring malignant tumors in childhood. It is different from the adult form of the disease by its close association with Epstein-Barr virus infection, lymphoepithelial histology, and the high incidence of locoregional advancement of the disease. However, these tumors are associated with higher cure rates as they are very sensitive to radiation. We report two cases of pediatric nasopharyngeal carcinoma with locoregional advancement.
Adult ; Herpesvirus 4, Human ; Humans ; Incidence ; Nasopharyngeal Neoplasms ; Pediatrics

Chronically draining cutaneous sinus tracts are frequently misdiagnosed and incorrectly treated. Diagnostic errors can result in multiple surgical excisions and biopsies, long-term antibiotic therapy, and even radiation therapy or electrodessication. The most common cause of skin drainage is a chronically infected tooth. A sinus tract from a mandibular osteomyelitis is very rare and hard to detect. A 36-year-old woman was presented to the hospital with a 1.5 year history of purulent discharge from a cutaneous sinus present at submandibular region. The patient had received three excisions and drainage procedures but the drainage recurred. The neck computed tomography revealed a focal disruption with radiolucence on the posterior surface of the left inferior mandibular body. The disease was completely cured after the excision of sinus tract and thorough curettage of the affected lesion of the mandible. We report a cutaneous submandibular draining sinus tract that developed from a mandibular osteomyelitis unrelated to a tooth inflammation
Adult ; Biopsy ; Curettage ; Diagnostic Errors ; Drainage ; Female ; Humans ; Inflammation ; Mandible ; Neck ; Osteomyelitis ; Skin ; Tooth

BACKGROUND: Intravenous ergonovine and intracoronary acetylcholine tests have been used to induce coronary artery spasm, however, potential preblems with each test require a safer and more specific test. METHODS: To evaluate the usefulness of the intracoronary ergonovine provocation test in patients with coronary artery spasm, this test was performed in 83 patients(male 47, female 36) with normal or near-normal looking coronary angiography or insignificant lesion less than 50% in diameter after routine diagnostic coronary angiography. Ten micrograms of ergonovine maleate diluted in 1 ml of saline was injected into right coronary artery up to 2 times and into left coronary artery up to 3 times. Induction of coronary arterial narrowing more than 75% of luminal diameter with typical chest pain and/or ECG changes in two or more adjacent leads was considered as a positive test. RESULTS: Intracoronary ergonovine provocation tests were positive in 33 patients among 83 patients. In 24 patients, coronary artery spasm was induced in RCA, 12 patients in LAD and 8 patients in LCX. Coronary artery spasm of 2 sites was observed in 11 patients. In 27 patients, typical chest pain was developed with spasm. The ECG changes during spasm were ST elevation in 19 patients, ST depression in 3 patients, T wave change only in 2 patients and no change in 9 patients. The provocation tests showed focal spasm in 23 patients(70%) and diffuse spasm in 10 patients(30%). CONCLUSION: Intracoronary ergonovine provocation test appears to be a safe and effective method to provoke the coronary artery spasm.
Acetylcholine ; Chest Pain ; Coronary Angiography ; Coronary Vessels* ; Depression ; Electrocardiography ; Ergonovine* ; Female ; Humans ; Phenobarbital ; Spasm*

The ventriculoatrial(VA) intervals during supraventricular tachycardia(VAsvt) and during pacing with same cycle length as tachycardia(VApace) were analysed in 48 patients to evaluate the usefullness in determining the mechanism of paroxysmal supraventricular tachycardia(PSVT) and the sites of accessory pathways. The results are as follows : 1)In differenciation AV nodal reentry from AV reentry mechanism, VAsvt(25.6+/-21.5 vs 148.0+/-27.7msec, p<0.01), VApace-VAsvt(135.3+/-15.7 vs 55.0+/-33.5msec,p<0.01), and VAsvt/VApace(0.15+/-0.10 vs 0.75+/-0.14,p<0.05) were useful. Cutoff values were 95msec in VAsvt, 110msec in VApace-VAsvt and 0.5 in VAsvt/VApace. 2) There were no overlaps in VA intervals between the AV nodal reentry group and the AV reentry group with posteroseptal accessory pathway.3) In AV reentry tachycardia, VApace-VAsvt>50msec(sensitivity 81%,specificity 100%) and VAsvt/VAace<0.7(sensitivity 71%, specificity 100%) suggested the high probability of left free wall accessory pathway. In Conclusion, VAsvt, VApace-VAsvt and VAsvt/VApace are useful parameters in determining the mechanism of PSVT and the sites of accessory pathways.
Humans ; Sensitivity and Specificity ; Tachycardia

INTRODUCTION: The purpose of this study was to evaluate the possibility of the acellular dermal matrix (ADM) as a barrier membrane for bone regeneration, and to evaluate the osteogenic effect of ADM as a carrier system for rhBMP-2 in the rat calvarial defect model. MATERIALS AND METHODS: An 8-mm, calvarial, critical-size osteotomy defect was created in each of 60 male Spraque-Dawley rats(weight 250~300g). Three groups of 20 animals, each received either rhBMP-2(0.025mg/ml) in an ADM carrier, ADM only, or negative surgical control. And each group was divided i nto 2- and 8 -weeks healing intervals. The groups were evaluated by histologic and histomorphometric parameters(10 animals/group/healing intervals). Data were expressed as means+/-standard deviations(m+/-SD). Comparisons between experimental and control groups were made using two-way ANOVA and post hoc t-test. Comparisons between 2 weeks and 8 weeks were made using paired t-test. The level of statistical difference was defined as P< 0.05. RESULTS: The ADM group and rhBMP-2/ADM group results in enhanced local bone formation in the rat calvarial defect at both 2 and 8 weeks. The amount of defect closure and new bone formation were significantly greater in the rhBMP-2/ADM group relative to ADM group(P<0.05). At 8 weeks, the majority of ADM in the defect was contracted, and integrated with surrounding host tissues. In addition, host cell infiltration and neovascularization of the ADM in the absence of an inflammatory response were observed, and the newly formed bone around ADM showed a continuous remodeling and consolidation. CONCLUSION: The results of the present study indicated that ADM may be used as a barrier membrane for bone regeneration and that may be employed as a delivery system for BMPs.
Acellular Dermis* ; Animals ; Bone Regeneration ; Humans* ; Male ; Membranes ; Osteogenesis* ; Osteotomy ; Rats

BACKGROUND: Eisenmenger syndrome is a complication of heart dease with left-to-right shunt in which the pulmonary arterial pressure is increased due to increased pulmonary vascular resistance and the shunt directions becomes bidirectional or reversed at the level of atria, ventricies, or great arteries. Corrective surgery is impossible unless there is substantial reactive change pulmonary vascular resistance. METHOD: To identify clinical and hemodynamic features and observe natural history of adult patients with Eisenmenger syndrome, a retrospective clinical study was done on 61 patients(male:female=39:22) with Eisenmenger syndrome who were admitted to Seoul National University Hospital from September, 1979 to A piril, 1989, and were confirmed after cardiac catheterization and angiography. RESULTS: VSD was most freguent underlying defect(31 cases, 51%), followed by PDA(12 cases, 20%), ASD(9 cases,15%) and Combined lesion(9 cases, 15%). The average age was 27.3 years with the peak incidence in third decades. Effort intolerance(96.7%), palpitation(75.4%), hemoptysis(19.7%), and syncope(8.2%) were common symptoms, and cyanosis(62.3%), clubbing(63.9%) and increased heart sound were freguently(86.9%) observed. The mean pressure of the pulmonary artery and the total pulmonary vascular resistance were markedly elevated with the mean value of 76.7+/-14.2mmgHg and 29.3+/-12.HU respectively, 4 of the 19 patients who were given 100% oxygen inhalation showed reversibility of the pulmonary vascular resistance. During follow up(mean:40+/-29 months), Complications include infective endocarditis(1 case), brain abcess(2 case), atrial fibrillation(3 case), acute renal failure(1 case) and gout(2 case). 6 patients(10%) died during medical follow-up period(mean:40+/-29 months). Congestive heart failure and pulmonary infarction after cardiac catheterization including one postoprative death were causes of death. CONCLUSION: VSD, ASD, and PDA were common underlying defects of adult Eisenmenger syndrome. Complication was not uncommon and the common cause of death was congestive failure. The prognosis of the patients with Eisenmenger syndrome may not be so dismal as has been thought, though the exact survival to be determined.
Adult* ; Angiography ; Arterial Pressure ; Arteries ; Brain ; Cardiac Catheterization ; Cardiac Catheters ; Cause of Death ; Eisenmenger Complex* ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Sounds ; Hemodynamics ; Humans ; Incidence ; Inhalation ; Natural History* ; Oxygen ; Prognosis ; Pulmonary Artery ; Pulmonary Infarction ; Retrospective Studies ; Seoul ; Vascular Resistance

BACKGROUND: Pulmonary venous flow(PVF) is closely related to left atrial pressure(LAP) and percutaneous mitral commissurotomy(PMC) reduces LAP rapidly. However, PVF pattern in mitral stenosis(MS) with sinus rhythm after PMC remains to be elucidated. METHODS: Transesophageal echocardiographic pulsed Doppler examination was performed within 24 hours before and after PMC to evaluate PVF pattern in 10 patients of MS with sinus rhythm. RESULTS: Before PMC, both peak velocity(PV) and velocity time integral(VTI) during systole had significant negative correlations with mean LAP(r=-0.70, r=-0.79, respectively). After PMC, both systolic PV and VTI increased significantly without significant changes in diastolic PV and VTI. However, there was no significant correlation between systolic PV and mean LAP, and between systolic VTI and mean LAP after PMC. CONCLUSION: In mitral stenosis with sinus rhythm, these data suggest that systolic PVF decreases with increase of mean LAP and PMC could reverse this change without affecting diastolic PVF. However, acute hemodynamic changes of left atrium induced by PMC may contribute to the absence of correlation between mean LAP and systolic PVF after PMC.
Echocardiography* ; Heart Atria ; Hemodynamics ; Humans ; Mitral Valve Stenosis ; Systole

BACKGROUND AND OBJECTIVES: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. SUBJECTS AND METHODS: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. RESULTS: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. CONCLUSION: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
Axis, Cervical Vertebra ; Biomarkers ; Dilatation ; Echocardiography ; Electrocardiography ; Heart ; Hominidae ; Humans ; Hypokinesia ; Medical Records ; Natriuretic Peptide, Brain ; Prognosis ; Pulmonary Embolism ; Retrospective Studies ; Sensitivity and Specificity ; Ventricular Dysfunction, Right