No abstract available.
Myocardial Infarction*

Idiopathic restrictive cardiomyopathy is characterized by clinical and hemodynamic findings of restrictive cardiomyopathy in the absence of morphologic cause. The differential diagnosis between idiopathic restrictive cardiomyopathy and noncalcified constrictive pericarditis is difficult but the distinction is crucial because of the therapeutic implication. The diagnosis of idiopathic restrictive cardiomyopathy is aided by echocardiography and cardiac catheterization, cardiac magnetic resonance imaging. The patients should be approached systemically to differentiate from noncalcified constritive pericarditis.
Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Restrictive* ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Pericarditis ; Pericarditis, Constrictive

Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.
Alcoholism ; Autopsy* ; Coronary Artery Disease ; Disabled Persons ; Esophagitis* ; Esophagogastric Junction ; Esophagus ; Fatty Liver ; Hematemesis ; Hemorrhage ; Humans ; Hypopharynx ; Inflammation ; Malnutrition ; Middle Aged ; Necrosis ; Perfusion ; Pigmentation ; Upper Gastrointestinal Tract

To evaluate effect of coronary collateral circulation on left ventricular function in patients with acute myocardial infarction, global ejection fraction(EF), left ventricular end distolic pressure(LVEDP), peak creatine kinase(CK) level and regional wall motion were analysed and compared in 30 patients with acute myocardial infarction according to grade of coronary collateral circulation. Patients with total or near total(above 95% of diameter) occlsion of left anterior descending coronary artery without significant lesion in right coronary artery or left circumflex artery were selected and divided into 3 groups according to the degree of collateral circulation on coronary angiography, to be compared by the index of ejection fraction, peak creatine kinase level, left ventricular and diastolic pressure and regional wall motion. The result are as following : 1) There were no statistically significant differences in ejection fraction, peak creatine kinase level, left ventricualr and diastolic pressure among the groups. 2) Regional wall motion of infarct related area of G2+3 group(adequate collateral) were better than that of G0(no collateral) group(p<0.05). Therefore, adequate coronary collateral circulation in acute myocardial infarction is thought to have beneficial effect on left ventricular function especially in regional wall motion of infarct related area.
Arteries ; Blood Pressure ; Collateral Circulation* ; Coronary Angiography ; Coronary Vessels ; Creatine ; Creatine Kinase ; Humans ; Myocardial Infarction* ; Ventricular Function, Left*

BACKGROUND: Endothelin, a very potent vasoconstricting substance released from the endothelium, has been known to be elevated in various cardiovascular disorders, however, the sites of endothelin porduction as well as the influence of acute hemodynamic changes upon plasma endothelin-1 concentration remains elucidated. METHODS: In order to evaluate the probable site of endothelin production and relationship between levels of plasma endothelin and hemodynamic variables, six patients with moderate to severe mitral stenosis underwent percutaneous mitral commissurotomy(PMC) were included. Measurement of mean pulmonary arterial pressure, cardiac output as well as plasma endothelin-1 concentration of renal vein, main pulmonary artery, and ascending aorta were performed before and 20 minutes after PMC. RESULTS: After PMC, cardiac output increased significantly, whereas mean pulmonary artery pressure and transvalvular pressure gradient were reduced significantly(both p<0.05). Before PMC, plasma endothelin-1 concentration tended to be higher in renal vein(6.12+/-3.7pg/ml) and pulmonary artery(5.07+/-1.7) than that in aorta(3.05+/-1.2pg/ml). After hemodynamic improvement with PMC, plasma endothelin-1 concentration decreased at all the site, however the change at pulmonary artery was statistically significant. CONCLUSION: These results suggest that endothelin-1 may be produced mainly somewhere in systemic venous circulation such as kidney rather than pulmonary circulation, and plasma endothelin-1 concentration tends to decrease in response to the acute hemodydnamic im provement.
Aorta ; Arterial Pressure ; Cardiac Output ; Endothelin-1* ; Endothelins ; Endothelium ; Hemodynamics ; Humans ; Kidney ; Mitral Valve Stenosis ; Plasma* ; Pulmonary Artery ; Pulmonary Circulation ; Renal Veins

BACKGROUND AND OBJECTIVES: Atrial fibrillation is one of the most prevalent arrhythmia with clinical significance. Recently, some subset of paroxysmal atrial fibrillation was reported to be originated from a focal, rapidly firing source inside the large thoracic veins, such as pulmonary veins, superior vena cava and coronary sinus. The pulmonary veins are known to be the most frequent source of this type of atrial fibrillation. The proximal segment of pulmonary vein was reported to be made up with cardiac muscle cells. This study was performed 1)to define the characteristics of action potential of cardiac myocytes inside the rabbit pulmonary vein in single cell preparation, 2)to observe the changes in action potential and current activation to acetylcholine and isoproterenol, and 3)to compare these changes with those in atrial myocytes. METHOD AND RESULTS: In most of rabbit specimens, myocardial tissue extended over the pulmonary vein for a few millimeters(1-2.5mm). Single atrial myocyte and myocyte in pulmonary vein were successfully isolated. With using whole cell patch clamp technique, spontaneous activities of action potentials(APs) with diastolic depolarization were observed in 75% of pulmonary vein myocytes, in contrast to the absence of spontaneous activity in atrial myocytes. During spontaneous APs of pulmonary vein myocytes, the maximal diastolic potential was -50.5+/-6.5 mV and peak potential was 32.5+/-9.5 mV, and the frequency of APs was 1-2.5 Hz. During perfusion of isolated pulmonary vein myocytes with acetylcholine, resting membrane potential was hyperpolarized and spontaneous APs activity was markedly reduced or completely disappeared. These effects were observed in very low concentration of acetylcholine, even with 1-2 nM. The analysis of change of currents by applying step pulse revealed this response was mediated by activation of IK(ACh) and the current change was more prominent in pulmonary vein myocytes than atrial myocytes. The responses of these cells to isoproterenol were variable from increased spontaneous APs to inhibition of APs. CONCLUSION: This study revealed that pulmonary vein myocytes was another automatic pacemaking focus, same as sinoatrial nodal and Purkinje cells. These characteristics explain why focal atrial fibrillation was frequently initiated inside pulmonary veins.
Acetylcholine ; Action Potentials* ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Coronary Sinus ; Fires ; Isoproterenol ; Membrane Potentials ; Muscle Cells ; Myocytes, Cardiac* ; Perfusion ; Pulmonary Veins* ; Purkinje Cells ; Veins ; Vena Cava, Superior

BACKGROUND: Understanding the regulatory mechanisms of the smooth muscle cells differentiation is one of the central issues in researches of atherogenesis where smooth muscle cells undergo dedifferentiation and regain embryonic phenotype. Smooth muscle myosin heavy chain isoforms(SM1,SM2) are important molecular markers to define the stage of smooth muscle cell differentiation. METHODS: In order to establish an in vitro model of smooth muscle cell differentiation using a pluripotent murine embryonal teratocarcinoma cell line(P19 cell), we first isolated cDNA clone of mouse SM1 and then tried various chemicals to induce P19 cells to differentiate into smooth muscle cells, The expression of Sm1 and alpha-smooth muscle actin was examined using RNase protection assay, Western blotting and indirect immunofluorescence. RESULTS: In the presence of luM retinoic acid, a small proportion of P19 cells could be in duced to differentiate into smooth muscle cells expressing SM1 as well as alpha-smooth muscle actin since day 8 after treatment. By blocking the Brain-2 expression, thus inhibiting neuronal differentiation, we could obtain more abundant differentiated smooth muscle cells. Sequential immunofluorescencc demonstrated that it took weveral days for smooth muscle myosin heavy chain to organize completely in differentiation smooth muscle cells. On the other hand, 10nM retinoic acid, 1% dimethyl sulfoxide or 2mM hexamethylene bisacetamide could not indduce P19 cell to differentiate to smooth muscle cells. CONCLUSION: In conclusion, P19 cells can be induced to differentiate into smooth muscle cells and this in vitro system will be useful in understanding the regulation of SM1 gene expression as well as of angiogenesis.
Actins ; Animals ; Atherosclerosis ; Blotting, Western ; Clone Cells ; Dimethyl Sulfoxide ; DNA, Complementary ; Fluorescent Antibody Technique, Indirect ; Gene Expression ; Hand ; Mice ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Myosin Heavy Chains ; Neurons ; Phenotype ; Ribonucleases ; Teratocarcinoma* ; Tretinoin

No abstract available.

Gastrointestinal ganglioneuromatosis is a rare neoplastic condition that can occur in association with von Recklinghausen's disease with multiple endocrine neoplasia type II B. The main locations are the ileum, colon, and appendix. We report a case of diffuse ganglioneuromatosis of the appendix associated with a mesenteric and ileocecal plexiform neurofibroma in von Recklinghausen's disease.
Appendix* ; Colon ; Ileum ; Multiple Endocrine Neoplasia ; Neurofibroma, Plexiform ; Neurofibromatosis 1

In old age, a traumatic pulmonary pseudocyst is an extremely rare condition that generally develops after blunt chest trauma. It is more common among pediatric and young adult patients. We report three elderly patients who presented with chest symptoms after blunt chest trauma and whose computed tomography showed post-traumatic pulmonary pseudocysts.
Aged ; Humans ; Thoracic Injuries ; Thorax ; Young Adult