The symptoms of hypertrophic cardiomyopaty frequently result from impaired left ventricular relaxation, abnormal left ventricular filling, and decreased compliance of left ventricle in spite of normal systolic function. Several studies have suggested that the assessment of transmitral flow velocity waveform with pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy provide a noninvasive and clinically useful expression of left ventricular diastolic performance. In this study, pulsed Doppler echocardiography was used to measure diastolic indices from transmitral flow velocity waveform and thereby to assess left ventricular diastolic function in 20 patients with hypertrophic cardiomyopathy (14 septal hypertrophy, 3 apical hypertrophy, and 3 concentric hypertrophy). The diastolic indices to measure are isovolumic relaxation time(IVRT), deceleration time(DT), pressure half time(PHT), deceleration of early diastolic flow(DEF), EF slope, peak flow velocity in early diastole(PFVE), peak flow velocity during atrial systole(PFVA), and PFVE/PFVA ratio. The diastolic indices obtained from patients were compared with those in 20 age-matched control subjects without heart disease. The relationship between left ventricular wall thickness index(Th Index) and diastolic indices were evaluated. In addition, the effect of calcium channel-blocking agent on left ventricular diastolic function were evaluated. The results were as follows ; 1) There were no significant differences in RR interval, BP, end-systolic left ventricular dimension, and end-diastolic left ventricular dimension, but significant differences in interventricular septal thickness, posterior wall thickness, and left atrial dimension between hypertrophic group and control group. 2) The systolic index(ejection fraction) showed no significant difference between hypertrophic group and control group. 3) All diastolic indices except PFVA showed significant differences between hypertrophic group and control group. 4) Th Index did not showed a significant correlation with the diastolic indices except PFVE/PFVA. 5) There were no significant changes in RR interval, BP end-systolic left ventricular dimension, end-diastolic left ventricular dimension, left atrial dimension, and ejection fraction between medication and drug withdrawal. IVRT significantly increased after drug withdrawal. But other diastolic indices showed no significant changes after drug withdrawal. According to above results the assessment of left ventricular diastolic function by pulsed Doppler echocardiography was a clinically useful method in detecting diastolic dysfunction in patients with hypertrophic cardiomyopathy. Calcium channel-blocking agent may have beneficial effect in improving left ventricular diastolic function in patients with hypertrophic cardiomyopathy.
Calcium* ; Cardiomyopathy, Hypertrophic* ; Compliance ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Heart Diseases ; Heart Ventricles ; Humans ; Hypertrophy ; Relaxation

OBJECTIVES: Posttraumatic stress disorder(PTSD) has been primarily associated with emotional problems. Recently, however, the impact of PTSD on cognitive processes has interested a growing number of researchers. The current study is aimed at investigating the cognitive aspects of PTSD at both behavioral and neurological levels. METHODS: We recruited individuals with PTSD who survived the Daegu subway explosion in 2003 as well as non-PTSD individuals as a control group. To evaluate the inhibitory processes and the neural mechanisms, we had these individuals perform the negative priming task simultaneously with functional MRI scanning. RESULTS: Behaviorally, the negative priming effect was intact in the control group but was not evident in the PTSD group. In the imaging results, only the PTSD group showed the negative priming effect (i.e., increased activation of the negative priming condition as opposed to the neutral condition) in the dorsolateral prefrontal cortex, anterior cingulate cortex, and inferior temporal gyrus. The PTSD group also showed increased activity for the positive priming condition as opposed to the neutral condition in the claustrum. These results confirm and extend the previous findings that the integrity of the ACC is compromised in the trauma survivors due to disrupted white matter tract. CONCLUSIONS: The current results suggest that deteriorated performance of the PTSD group may be due to the functional problem as well as the structural abnormalities.
Basal Ganglia ; European Continental Ancestry Group ; Explosions ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Prefrontal Cortex ; Railroads ; Stress Disorders, Post-Traumatic ; Survivors

No abstract available.
Animals ; Gonadotropin-Releasing Hormone* ; Rats* ; RNA, Messenger* ; Testis*

Extragonadal choriocarcinoma arising in the stomach of a 53-year-old male is presented. The tumor was diagnosed as choriocarcinorna of the stomach by histologic examination and immunohistologic method of biopsy specimens. The tumor showed the multiple metastases to the lung and liver. The level of human chorionic gonadotropin was significantly increased in the serum. The patient died of hepatic failure at the 26th hospital day.
Biopsy ; Choriocarcinoma* ; Chorionic Gonadotropin ; Female ; Humans ; Liver ; Liver Failure ; Lung ; Male ; Middle Aged ; Neoplasm Metastasis ; Pregnancy ; Stomach

In order to elucidate the existence and locality of DARP in the human brain, immunohistochemical identification was done in the brain tissues. This glycoprotein was distributed in paraventricular nucleus and thalamic reticular nucleus of diencephalon, substantia nigra and inferior colliculus of mesencephalon, medial vestibular nucleus, medial longitudinal nucleus, lateral reticular nucleus of medulla oblongata. And they follows a close distribution to that of catecholamine (CA) rich in either CA fiber or CA neuronal cell groups as previously reported by others using tyrosine hydroxylase (TH) as a marker. This striking similarities in the topographic arrangement of the DARP-positive reaction product and the TH-positive reaction product is another argument favoring the view that DARP is involved in the regulation of catecholaminergic neurons.
Brain* ; Diencephalon ; Dopamine* ; Glycoproteins ; Humans* ; Inferior Colliculi ; Medulla Oblongata ; Mesencephalon ; Neurons ; Paraventricular Hypothalamic Nucleus ; Strikes, Employee ; Substantia Nigra ; Tyrosine 3-Monooxygenase ; Vestibular Nuclei

BACKGROUND/AIMS: Although cardiovascular (CV) risk factors are well established, some patients experience acute myocardial infarction (AMI) even without any risk factors. METHODS: We analyzed total 11,390 patients (63.6 ± 12.6 years old, 8,401 males) with AMI enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health from November, 2011 to December, 2015. Patients were divided into two groups according to the presence of any CV risk factors (group I, without risk factors, n = 1,420 [12.5%]; group II, with risk factors, n = 9,970 [87.5%]). In-hospital outcomes were defined as in-hospital mortality and complications. One-year clinical outcomes were defined as the composite of major adverse cardiac events (MACE). RESULTS: Group I was older (67.3 ± 11.6 years old vs. 63.0 ± 12.7 years old, p < 0.001) and had higher prevalence of female gender (36.2% vs. 24.8%, p < 0.001) than the group II. Group I experienced less previous history of angina pectoris (7.0% vs. 9.4%, p = 0.003) and the previous history of cerebrovascular accidents (3.4% vs. 6.9%, p < 0.001). In-hospital mortality (2.6% vs. 3.0%, p = 0.450) and complications (20.6% vs. 20.0%, p = 0.647) were no differences between the groups. And 1 year clinical outcomes (5.7% vs. 5.1%, p = 0.337) were no differences between the groups. In multivariate logistic regression analysis, serum creatinine level (hazard ratio, 1.35; 95% confidence interval, 1.05 to 1.75; p = 0.021) were independent predictors of 1 year MACE in patients without any CV risk factors. CONCLUSIONS Elderly female patients were prone to develop AMI even without any modifiable CV risk factors. We suggest that more intensive care is needed in AMI patients without any CV risk factors who have high serum creatinine levels.

BACKGROUND/AIMS: It is well known that smoking is associated with clinical outcomes in patients with acute myocardial infarction (AMI). In this study, we aimed to predict the one-year mortality in AMI patients that smoked. METHODS: Of the AMI patients who were enrolled in the Korean Acute Myocardial Infarction Registry-National Institutes of Health study, 5,110 were current smokers (57.1 ± 11.6 years, male 95%), and these patients were included in the present study. Patients were divided into two groups; group I (survival group, n = 4,844, 56.5 ± 11.3 years, male 95%) and group II (deceased group, n = 266, male 88%). Clinical characteristics, coronary angiographic findings, procedural characteristics, and independent factors related to one-year mortality were analyzed. RESULTS: In group II, the incidence of hypertension and diabetes were significantly higher than in group I, and the patients were significantly older. Patients with history of angina pectoris, myocardial infarction, and heart failure were significantly more common in group II than in group I. Smoking duration and pack-years of smoking were also significantly longer in group II than in group I. Multivariate analysis revealed that creatine > 2 mg/dL, left ventricular ejection fraction < 40%, Killip class ≥ II, age ≥ 65 years, and post-percutaneous coronary intervention thrombolysis in myocardial infarction (post-PCI TIMI) flow ≤ II were independent factors of mortality during the one-year follow-up. CONCLUSIONS: The predictors of one-year mortality in AMI patients with smoking were renal and left ventricular dysfunction, high Killip class, old age, and low post-PCI TIMI flow.
Academies and Institutes ; Angina Pectoris ; Creatine ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Incidence ; Male ; Mortality* ; Multivariate Analysis ; Myocardial Infarction* ; Smoke ; Smoking ; Stroke Volume ; Ventricular Dysfunction, Left

BACKGROUND AND OBJECTIVES: In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. SUBJECTS AND METHODS: From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year. RESULTS: There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002). CONCLUSION: Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.
Angioplasty ; Arteries ; Coronary Artery Disease ; Drug-Eluting Stents ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention

PURPOSE: The diagnostic criteria of gastric intraepithelial neoplasia (IEN) are controversial across the world. We investigated how many discrepancies occur in the pathologic diagnosis of IEN and early gastric carcinoma in endoscopic submucosal dissection (ESD) specimens, and evaluated the reasons of the discordance. MATERIALS AND METHODS: We retrospectively reviewed 1,202 ESD specimens that were originally diagnosed as gastric IEN and early carcinoma at 12 institutions. RESULTS: The final consensus diagnosis of carcinoma were 756 cases, which were originally 692 carcinomas (91.5%), 43 high-grade dysplasias (5.7%), 20 low-grade dysplasias (2.6%), and 1 others (0.1%), respectively. High- and low-grade dysplasia were finally made in 63 and 342 cases, respectively. The diagnostic concordance with the consensus diagnosis was the highest for carcinoma (91.5%), followed by low-grade dysplasia (86.3%), others (63.4%) and high-grade dysplasia (50.8%). The general kappa value was 0.83, indicating excellent concordance. The kappa values of individual institutions ranged from 0.74 to 1 and correlated with the proportion of carcinoma cases. The cases revised to a final diagnosis of carcinoma exhibited both architectural abnormalities and cytologic atypia. The main differential points between low- and high-grade dysplasias were the glandular distribution and glandular shape. Additional features such as the glandular axis, surface maturation, nuclear stratification and nuclear polarity were also important. CONCLUSION: The overall concordance of the diagnosis of gastric IEN and early carcinoma in ESD specimens was excellent. It correlated with the proportion of carcinoma cases, demonstrating that the diagnostic criteria for carcinoma are more reproducible than those for dysplasia.
Consensus ; Diagnosis ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: As a result of various independently proposed nomenclatures and classifications, there is confusion in the diagnosis and prediction of biological behavior of gastroenteropancreatic neuroendocrine tumors (GEP-NETs). A comprehensive nationwide study is needed in order to understand the biological characteristics of GEP-NETs in Korea. MATERIALS AND METHODS: We collected 4,951 pathology reports from 29 hospitals in Korea between 2000 and 2009. Kaplan-Meier survival analysis was used to determine the prognostic significance of clinicopathological parameters. RESULTS: Although the GEP-NET is a relatively rare tumor in Korea, its incidence has increased during the last decade, with the most significant increase found in the rectum. The 10-year survival rate for well-differentiated endocrine tumor was 92.89%, in contrast to 85.74% in well differentiated neuroendocrine carcinoma and 34.59% in poorly differentiated neuroendocrine carcinoma. Disease related death was most common in the biliary tract (62.2%) and very rare in the rectum (5.2%). In Kaplan-Meier survival analysis, tumor location, histological classification, extent, size, mitosis, Ki-67 labeling index, synaptophysin expression, lymphovascular invasion, perineural invasion, and lymph node metastasis showed prognostic significance (p<0.05), however, chromogranin expression did not (p=0.148). The 2000 and 2010 World Health Organization (WHO) classification proposals were useful for prediction of the prognosis of GEP-NET. CONCLUSION: The incidence of GEP-NET in Korea has shown a remarkable increase during the last decade, however, the distribution of tumors in the digestive system differs from that of western reports. Assessment of pathological parameters, including immunostaining, is crucial in understanding biological behavior of the tumor as well as predicting prognosis of patients with GEP-NET.
Biliary Tract ; Carcinoma, Neuroendocrine ; Digestive System ; Humans ; Incidence ; Intestinal Neoplasms ; Korea ; Lymph Nodes ; Mitosis ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Pancreatic Neoplasms ; Population Characteristics ; Prognosis ; Rectum ; Stomach Neoplasms ; Survival Rate ; Synaptophysin ; World Health Organization