PURPOSE: Asthma features not only infiltration of various inflammatory cells including eosinophils into bronchus but increased bronchial hyperresponsiveness which comes from bronchial epithelial cells damaged by toxic granular protein like MBP and ECP released from the activated eosinophils. Recently, several authors have reported that nasal mucosa histologic findings are similar to an inflammatory change of lower airway in respiratory allergic diseases. Based on the latter, we performed this study to compare serum ECP with nasal wash fluid ECP by their ages and to find out contribution of eosinophils in infants and children with wheezing. METHODS: The 62 patients in age from 6 months to 14 years who were admitted due to acute asthma from June 1995 to May 1996 were divided into 3 groups by their ages as follows : group A for less than 2 years old, group B for 2-4 years old and group C for 5-14 years old. The 32 children with no previous history of wheezing or no respiratory symptoms on admission were enrolled as control subject. Serum ECP & nasal wash fluid ECP from each age group with asthma were measured and compared with control, and the relationship between serum ECP and atopic findings were studied. RESULTS: 1) The geometric mean level of serum ECP were significantly higher in wheezing children than in control in all three age group as follows : 16.5+/-7.1micorgram/l for group A, 28.9+/-18.7micorgram/l for group B, 45.9+/-34.8micorgram/l for group C. 2) The geometric mean level of nasal wash fluid ECP were significantly higher in wheezing children than in control in all age group as follows : 11.3+/-7.1micorgram/l for group A, 21.3+/-15.2micorgram/l for group B, and 30.2+/-18.2micorgram/l for group C. 3) Serum ECP had correlation with nasal wash fluid ECP & blood eosinophils in group B and C, except group A. CONCLUSION: On acute asthma attack, the mean ECP level of serum & nasal wash fluid from all children including infancy were significantly higher than control and this suggests that the role of eosinophils to airway inflammation in many wheezing infants may be the same as that in older children with asthma.
Asthma ; Bronchi ; Child* ; Child, Preschool ; Eosinophils ; Epithelial Cells ; Humans ; Infant ; Inflammation ; Nasal Mucosa ; Respiratory Sounds

The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.
Brain ; Echocardiography ; Heart Ventricles ; Humans ; Sepsis ; Shock, Septic* ; Stroke* ; Thorax ; Thrombosis*

PURPOSE: To confirm the production of extra-hypothalamic gonadotropin releasing hormone (GnRH) and GnRH receptor in bladder mucosal epithelia, and a potential role of GnRH on the bladder, normal human bladder tissues, and primary cultured dog bladder mucosal epithelia were studied. MATERIALS AND METHODS: For this study, normal human bladder tissue from 4 patients and primary cultured normal bladder mucosal epithelial cells from 2 dogs were used. For localization of extra-hypothalamic GnRH and the extra-pituitary GnRH receptor, in situ hybridization and immunohistochemical staining were done. To evaluate the roles of exogenous GnRH in bladder mucosal cells, the culture media were supplemented with charcoal stripped serum and 4 different concentrations of GnRH (0, 10(-3), 10(-5) and 10(-7)M). The effect of exogenous GnRH was evaluated using a hemocytometer and fluorescence activated cell sorter (FACS). RESULTS: GnRH and GnRH receptors, and their mRNA signals were localized in most of the both human bladder mucosal epithelia and dog bladder mucosal epithelia, but not in a few cells. There were no significant GnRH effects on cellular proliferation and cell cycle changes (p<0.05). CONCLISIONS: Bladder mucosal epithelium produces GnRH and GnRH receptors, but they do not effect either the proliferation or cell cycle changes. Although the exact function of extra-hypothalamic bladder GnRH is unknown, GnRH and GnRH receptors would be assumed to have unknown autocrine or paracrine relationships with each other.
Animals ; Cell Cycle ; Cell Proliferation ; Charcoal ; Culture Media ; Dogs ; Epithelial Cells ; Epithelium ; Fluorescence ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans ; In Situ Hybridization ; Mucous Membrane ; Receptors, LHRH* ; RNA, Messenger ; Urinary Bladder*

Venous thromboembolism is a relatively common condition in inhospital patients, but it may also manifest as a lethal disease. However, the diagnosis is not suspected clinically in the vast majority of cases. Most hospitalized patients are at risk of venous thromboembolism, but the risk can be reduced significantly by appropriate prophylaxis. We herein report a case of a huge right atrial thrombus that presented as sudden cardiogenic shock during bipolar endoprosthesis of the hip due to a femoral neck fracture. Although the patient was elderly and immobile for 3 days before hip surgery, she did not receive prophylaxis for venous thromboembolism. More attention should be paid to venous thromboembolism prophylaxis in high-risk patients.
Aged ; Femoral Neck Fractures ; Heart Atria ; Hip ; Humans ; Pulmonary Embolism ; Shock, Cardiogenic ; Thrombosis ; Venous Thromboembolism

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 +/- 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.
Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/diagnosis/*mortality ; Comorbidity ; Coronary Angiography/*statistics & numerical data ; Coronary Stenosis/mortality/radiography ; Female ; Humans ; Incidence ; Kidney Diseases/*diagnosis/*mortality ; Kidney Function Tests/*statistics & numerical data ; Male ; Middle Aged ; Prognosis ; Reproducibility of Results ; Republic of Korea/epidemiology ; Risk Assessment ; Sensitivity and Specificity ; Survival Rate ; Tomography, X-Ray Computed/*statistics & numerical data

BACKGROUND/AIMS: Most current knowledge regarding amiodarone toxicity derives from clinical trials. This study was performed to investigate the incidence and risk factors of overall adverse effects of amiodarone in real-world practice using a large sample size. METHODS: Between January 1, 2000 and March 10, 2012, a total of 930 consecutive patients who had been treated with amiodarone for arrhythmia were reviewed retrospectively. An amiodarone-associated adverse event was considered in cases of discontinuation or drug dose reduction due to an unexpected clinical response. RESULTS: The mean daily dose of amiodarone was 227 +/- 126 mg, and the mean duration was 490 +/- 812 days. During the mean follow-up duration of 982 +/- 1,137 days, a total of 154 patients (16.6%) experienced adverse effects related to amiodarone, the most common being bradycardia or conduction disturbance (9.5%). Major organ toxicities in the thyroid (2.5%), liver (2.2%), eyes (0.6%), and lungs (0.3%) were rare. All patients recovered fully without complications after amiodarone discontinuation or dose reduction. The only independent predictor of adverse effects was the duration of amiodarone treatment (odds ratio, 1.21; 95% confidence interval, 1.03 to 1.41; p = 0.016, per year). CONCLUSIONS: Low-dose amiodarone is well tolerated in a real-world clinical population. Further studies with a prospective design are needed to confirm this finding.
Aged ; Amiodarone/administration & dosage/*adverse effects ; Anti-Arrhythmia Agents/administration & dosage/*adverse effects ; Arrhythmias, Cardiac/drug therapy ; Atrioventricular Block/chemically induced/epidemiology ; Bradycardia/chemically induced/epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Risk Factors

Acute stent thrombosis after percutaneous coronary intervention (PCI) is still problematic because of the subsequent development of myocardial infarction and poor prognosis. The incidence of acute stent thrombosis, occurring within 0-24hours after PCI, is relatively low, but underlying causes and treatment strategy are not well defined. Multi-vessel disease, ST-elevated myocardial infarction (STEMI), and large thrombotic burden are known risk factors of acute stent thrombosis. Thrombus aspiration, balloon angioplasty and glycoprotein IIb/IIIa receptor blocker could be therapeutic options. Recently we experienced two cases of acute stent thrombosis which developed during PCI with the aggravation of chest pain, and acute stent thrombosis were diagnosed immediately and successfully treated. Here we report two cases of acute stent thrombosis during PCI for one patient with STEMI and the other with acute coronary syndrome, which were successfully treated with thrombus aspiration and intravenous infusion of glycoprotein IIb/IIIa receptor blocker.
Acute Coronary Syndrome* ; Angioplasty, Balloon ; Chest Pain ; Coronary Thrombosis ; Glycoproteins ; Humans ; Incidence ; Infusions, Intravenous ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Risk Factors ; Stents* ; Thrombosis*

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.
Angioplasty, Balloon, Coronary ; Atrial Fibrillation* ; Cerebral Infarction ; Diagnosis ; Drug-Eluting Stents ; Embolism ; Humans ; Intracranial Embolism ; Middle Aged ; Middle Cerebral Artery ; Myocardial Infarction* ; Stroke*

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction.
Angioplasty, Balloon, Coronary ; Atrial Fibrillation* ; Cerebral Infarction ; Diagnosis ; Drug-Eluting Stents ; Embolism ; Humans ; Intracranial Embolism ; Middle Aged ; Middle Cerebral Artery ; Myocardial Infarction* ; Stroke*

Double right coronary arteries (RCA) are very rare congenital anomalies of coronary artery. We report a case of double RCA with total occlusion, incidentally found by collateral flows. A 71-year-old patient underwent percutaneous coronary intervention of left coronary arteries for angina, and the presence of double RCA was missed at initial coronary angiography (CAG). About 20 months later, second CAG was performed due to recurrent angina, and the CAG showed newly developed collateral flow suggesting the presence of the other missed RCA. There was a total occlusion at missed RCA and the lesion was successfully revascularized with drug eluting stent. If there was no collateral flow, the other RCA could not be found and its critical lesion could not be managed properly. Our case suggests that collateral flow can be a useful clue in detecting coronary anomaly. Besides, it is important to fully understand coronary anatomy, not to miss uncommon coronary lesion.
Acute Coronary Syndrome ; Aged ; Coronary Angiography ; Coronary Vessels* ; Heart Defects, Congenital ; Humans ; Percutaneous Coronary Intervention ; Stents