OBJECTIVES: The deleterious effects of air pollution on various health outcomes have been demonstrated. However, few studies have examined the effects of air pollution on liver enzyme levels. METHODS: Blood samples were drawn up to three times between 2008 and 2010 from 545 elderly individuals who regularly visited a community welfare center in Seoul, Korea. Data regarding ambient air pollutants (particulate matter < or =2.5 mum [PM2.5], nitrogen dioxide [NO2], ozone [O3], carbon monoxide, and sulfur dioxide) from monitoring stations were used to estimate air pollution exposure. The effects of the air pollutants on the concentrations of three liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and gamma-glutamyltranspeptidase [gamma-GTP)]) were evaluated using generalized additive and linear mixed models. RESULTS: Interquartile range increases in the concentrations of the pollutants showed significant associations of PM2.5 with AST (3.0% increase, p=0.0052), ALT (3.2% increase, p=0.0313), and gamma-GTP (5.0% increase, p=0.0051) levels; NO2 with AST (3.5% increase, p=0.0060) and ALT (3.8% increase, p=0.0179) levels; and O3 with gamma-GTP (5.3% increase, p=0.0324) levels. Significant modification of these effects by exercise and alcohol consumption was found (p for interaction <0.05). The effects of air pollutants were greater in non-exercisers and heavy drinkers. CONCLUSIONS: Short-term exposure to air pollutants such as PM2.5, NO2, and O3 is associated with increased liver enzyme levels in the elderly. These adverse effects can be reduced by exercising regularly and abstinence from alcohol.
Aged ; Aged, 80 and over ; Air Pollutants/analysis/*toxicity ; Alanine Transaminase/blood ; *Alcohol Drinking ; Aspartate Aminotransferases/blood ; Environmental Exposure ; *Exercise ; Female ; Humans ; Linear Models ; Liver/*drug effects/enzymology ; Male ; Nitrogen Dioxide/chemistry/toxicity ; Ozone/chemistry/toxicity ; Particulate Matter/analysis/toxicity ; Sulfur Dioxide/chemistry/toxicity ; gamma-Glutamyltransferase/blood

PURPOSE: Although a number of clinical parameters are well known to affect dry eye (DE) disease, it is unknown which factor mostly affects the discomfort of DE. Blepharitis is recognized as one of the leading causes of evaporative-type DE disease, but there have been no large-scale study to investigate the effect of blepharitis on DE symptoms. The purpose of this study was to evaluate the factors influencing subjective ocular discomfort in DE patients with blepharitis and to determine which parameter is most highly related to severity of blepharitis. METHODS: This investigation was a cross-sectional, clinical study. The test population consisted of DE patients suffering from moderate blepharitis. Seventy-three subjects aged 22 to 81 years (mean age 56.36) were enrolled, 49 of whom completed the investigation on a total of 49 eyes. A detailed assessment was conducted, including history taking, visual analog scale (VAS) pain scoring, ocular surface disease index (OSDI) questionnaire, blepharitis severity grading (score 0-4), conjunctival, corneal fluorescein staining (score 0-4), and tear break up time (TBUT) assessment. RESULTS: The results revealed significant correlations between subjective symptoms and blepharitis severity. Significant increases in overall VAS score, OSDI score (p = 0.031, p = 0.006) were recorded in DE patients with severe blepharitis. Conjunctival erosion was significantly related to VAS score (p = 0.016). Other parameters were not significantly related with VAS and OSDI scores. Additionally, conjunctival erosion was related with blepharitis severity (p < 0.0001), and corneal erosion was not correlated with blepharitis severity. TBUT also did not show any statistical correlation with blepharitis. CONCLUSIONS: Our results showed that blepharitis severity is the main factor influencing subjective pain and discomfort in DE patients, although blepharitis severity was not related with the known clinical parameters of DE such as corneal erosion and TBUT. This study indicates that targeting treatment for blepharitis can significantly improve quality of life for patients suffering from DE disease.
Blepharitis* ; Clinical Study ; Fluorescein ; Humans ; Quality of Life ; Tears ; Visual Analog Scale

BACKGROUN: Neointimal hyperplasia is major cause of instent restenosis in coronary artery and stenosis in arteriovenous fisula for hemodialysis. Erythropoietin is known to show proliferative effect on vascular smooth muscle cells in vitro study, but there is few in vivo study. This study investigated the effect of erythropoietin given subcutaneously to injured carotid arteries of rats on neointimal hyperplasia. METHODS: Sprague-Dawley rat underwent common carotid artery (CCA) balloon injury. Erythropoietin was given subcutaneously to balloon-injured rats (n=6) in 100 U/Kg/week by dividing three times. The control group (n=6) was treated with normal saline only. Two weeks later, the lumen and the neointimal area were obtained and compaired. Actively proliferating cells of neointimal area were observed by microscopy using PCNA staining method. RESULTS: Luminal area was 0.233 +/- 0.073 mm2, 0.112 +/- 0.047 mm2 in the control and the erythropoietin treated group respectively. The area was significantly smaller in the treatment group (p<0.05). Neointimal area and neointimal area/medial area ratio were 0.148 +/- 0.029 mm2, 0.226 +/- 0.056 mm2 and 1.169 +/- 0.146 min, 1.953 +/- 0.465 min in the control and the erythropoietin treated group respectively (p<0.05), but no significant difference was observed in medial area between the control and the erythropoietin treated group. Actively proliferating cells of neointimal area were more commonly observed in erythropoietin treated group. CONCLUSION: Erythropoietin increases neointimal cell proliferation in the rat carotid artery injury model. So, erythropoietin treatment may contributes to the development of arteriovenous fistula stenosis caused by neointimal hyperplasia but, further studies are required to elucidate the mechanism and the effect of erythropoietin at various time and dose in neointimal hyperplasia.
Animals ; Arteriovenous Fistula ; Carotid Arteries* ; Carotid Artery Injuries* ; Carotid Artery, Common ; Cell Proliferation ; Constriction, Pathologic ; Coronary Vessels ; Erythropoietin* ; Hyperplasia* ; Microscopy ; Muscle, Smooth, Vascular ; Phenobarbital ; Proliferating Cell Nuclear Antigen ; Rats* ; Rats, Sprague-Dawley ; Renal Dialysis

Hypothyroidism has various cardiovascular manifestation and exhibits electrocardiographic change. The QT dispersion on surface ECG reflects regional variations in myocardial repolarization. The effect of L-thyroxine treatment on ECG parameters, such as QT dispersion, in patients with primary hypothyroidism were investigated. This study involved 18 patients (3 men, 15 women, ages: 48+/-18 yr) with primary hypothyroidism. All patients were checked with a standard 12-lead ECG before and after L-thyroxine treatment. Various ECG parameters were then measured twice. The mean L-thyroxine treatment duration was 22+/-2.7 months. The mean thyroid-stimulating hormone levels of patients before and after therapy were 40.2+/-29.8 microU/mL, 3.6+/-4.6 microU/mL (p<0.001) and free-T4 levels were 0.44+/-0.38 ng/dL, 1.51+/-0.39 ng/dL (p<0.001). After L-thyroxine treatment, QT interval (395+/-42 vs. 380+/-24 msec, p<0.05), QTc interval (434+/-32 vs. 417+/-23 msec, p<0.05), QT dispersion (45+/-23 vs. 30+/-13 msec, p=0.008), QTc dispersion (49+/-23 vs. 32+/-14 msec, p=0.005) significantly decreased. There were no significant changes in the PR and RR intervals, as well as the QRS duration. Our findings suggest that the thyroid hormone affects ventricular inhomogenicity, and that L-thyroxine replacement therapy may reduce malignant ventricular arrhythmia and sudden cardiac death in primary hypothyroidism.
Thyroxine/*therapeutic use ; Middle Aged ; Male ; Hypothyroidism/*drug therapy/physiopathology ; Humans ; Female ; Electrocardiography/*drug effects ; Adult

Though exercise T1-201 myocardial perfusion-scintigraphy is an important test in the diagnosis and evaluation of coronary artery disease, this test is limited in cases with poor physical conditions and unstable angina and the physical characteristics of thallium are not ideal for nuclear imaging of the myocardium. Recently, technetium-99m-labelled agent(99mTc-MIBI) has been developed to improved the quality of imaging and for easy usage in myocardial perfusion scan. Therefore, we performed dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 25 subjects who were suspeced to have coronary artery disease and the results obtanined were as follows ; 1) The overall diagnostic sensitivity of dipyridamole 99mTc-MIBI perfusion scintigraphy was 73.4%, while specificity was 66.7%. 2) Per vessel sensitivity for coronary artery disease diagnosis by the test was 71.4% and a per vessel specificity for coronary artery disease was 95.7%. 3) In all 75 coronary arteries, LAD had a sensitivity of 66.7%(10/15) and a specificity of 100%(10/10); RCA had a sensitivity of 75%(6/8) and a specificity of 82.4%(14/17); LCX had a sensitivity of 60%(3/5) and a specificity of 100%(20/20). 4) After infusion of dipyridamole, the most frequent adverse effect was chest pain which was seen in 8 cases(32%). The headache was seen in 7 cases(28%). Most of the symptoms were mild in severity and subsided spontaneously but 3 subjects were severe enough to require intravenous administration of aminophylline. In conclusion, dipyridamole 99m2011-06-17Tc-MIBI myocardial perfusion scintigraphy is a useful and safe test for diagnosis of coronary artery disease.
Administration, Intravenous ; Aminophylline ; Angina, Unstable ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Dipyridamole* ; Headache ; Myocardial Perfusion Imaging* ; Myocardium ; Perfusion ; Perfusion Imaging ; Sensitivity and Specificity ; Thallium

BACKGROUND: Electrocardiographic abnormalities were studied to find if they were reversible during adequate hormonal treatment and to investigate regional inhomogenicity of ventricular repolarization in patients with Sheehan's syndrome. METHODS: Eleven women with Sheehan syndrome, who treated with prednisolone and levothyroxine, were the subjects of this study. Before and after hormonal replacement, the plasma thyroxine, cortisol and resting standard EKG were checked RESULTS: The most frequent electrocardiographic finding was inversion or flattening of the T waves, which occurred in 10 patients, with QT prolongation (7 patients), ST depression (2 patients) being the other findings. After prednisolone and levothyroxine replacement, the T wave abnormalities were normalized in 8 patients (80%) and the ST depression all patients. The QT (437 27 msec vs. 379 29 msec, p<0.05) and QTc intervals (478 80 msec vs 403 73 msec, p<0.005) were shortened by hormone replacement. CONCLUSION: High incidences of electrocardiographic abnormalities, including T wave inversion or flattening, QT prolongation and ST depression, were noted in patients with Sheehan's syndrome. The majority of these abnormalities recovered due to hormone replacement. The QT and QTc interval values were significantly shortened after treatment. Therefore, the regional inhomogenicity of ventricular repolarization may recover with hormone replacement
Depression ; Electrocardiography* ; Female ; Humans ; Hydrocortisone ; Hypopituitarism* ; Incidence ; Plasma ; Prednisolone ; Thyroxine

Amyloidosis is not a single disease entity but a term applied to a complex of disorders associated with deposition of insoluble fibrillar proteins in virtually pure form in various tissues of the body. This disease is encountered sometimes in America or Europe, but rarely in Korea. We had experienced one case of primary cardiac amyloidosis who was admitted to Won Kwang University Hospital due to dyspnea on exertion. This cardiac amyloidosis was confirmed by echocardiogram and endomyocardial biopsy with congo-red stain. We will report a case and review the pertinent medical literature.
Americas ; Amyloidosis* ; Biopsy ; Cardiomyopathies ; Dyspnea ; Europe ; Korea

Hyperthyroidism has been associated with changes in muscle function such as thyrotoxic myopathy, thyrotoxic periodic paralysis and thyroid opthalomopathy, but rarely rhabdomyolysis. Usually serum creatinine kinase is either normal or low in hyperthyroidism. Only 3 reports described association between rhabdomyolysis and hyperthyroidism, no previous literatures have thyrotoxic periodic paralysis associated rhabdomyolysis. Patients with hypokalemic periodic paralysis sometimes elevated serum muscle protein during recovery from paralytic attack, but the mechanism was not well known. We report a patient who presented with clinical feature of thyrotoxic periodic paralysis and increasing serum CK, myoglobin during recovery from paralysis.
Creatinine ; Humans ; Hyperthyroidism ; Hypokalemic Periodic Paralysis ; Muscle Proteins ; Muscular Diseases ; Myoglobin ; Paralysis* ; Phosphotransferases ; Rhabdomyolysis* ; Thyroid Gland

BACKGROUND: Epidural analgesia is the most effective way of providing pain relief during labor.However, its effect on the second stage of labor is controversial.This study examined the effect of epidural analgesia combined with caudal analgesia on the second stage of labor. METHODS: Forty three multiparous women were divided into three groups, non-epidural group, epidural group and epidural with caudal group.Epidural analgesia was maintained with patient-controlled epidural analgesia (0.09375% ropivacaine with 0.0002% fentanyl) in both the epidural and epidural with caudal groups.The epidural with caudal group was injected with 0.09375% ropivacaine into the caudal epidural space after inserting the lumbar epidural catheter.The assessments made throughout labor included the visual analogue score (VAS), patient's satisfaction, motor block and duration of the second stage. RESULTS: There were no significant differences in the patient's satisfaction, VAS and motor block between the epidural group and epidural with caudal group.There were no significant differences in the duration of the second stage between the non-epidural, epidural and epidural with caudal groups. No cesarean or instrumental deliveries were performed. CONCLUSIONS: Epidural with caudal analgesia offers no additional benefit during the second stage of labor.However, it carries no added risk on the maternal outcome.
Amides ; Analgesia ; Analgesia, Epidural ; Epidural Space ; Female ; Humans ; Labor Pain ; Pregnancy

The Dieulafoy's lesion is an unusual cause of gastrointestinal hemorrhage that results from the erosion of abnormally large submucosal artery. The lesion is usually located in the stomach, although it may occur anywhere in the gastrointestinal tract. Lower GI bleeding from Dieulafoy- like lesion of rectum is very rare. We describe one patient with extragastric Dieulafoy's disease, in the rectum. Diagnosis was made by endoscopy. Recently, endoscopy is important in the treatment of Dieulafoy-like lesion of rectum including epinephrine injection and coagulation therapy. We treated with the endoscopic management using ligation technique. We report a case that the 65-year old women had a extragastric Dieulafoy's lesion on the rectum, treated by endoscopic ligation with O-ring.
Aged ; Arteries ; Diagnosis ; Endoscopy ; Epinephrine ; Female ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ligation* ; Rectum* ; Stomach