No abstract available.
Histamine* ; Pruritus*

To assess the likelihood of procedural success in patients with multivessel coronary artery disease, 46 consecutive patients (male 34, female 12, mean age 60+/-9 years) umderwent single or multiple site angioplasty. The clinical diagnosis of unstable angina was in 20(44%), stable angina in 10 and acute or old myocardial infarction in 16. Coronary angiographic findings of 2 vessel disease was in 38(83%), triple vessel disease in 8. Left ventricular function was generally well preserved (mean ejection fraction 65+/-12%, range 30-82%) and mean 2.0 stenosis per patient angic, lasty had attempted. Single vessel angioplasty (SVA) was performed in 13 and multivessel angioplasty (MVA) in 33. Procedural success was achieved in 79(86%) out of total 92 stenoses. Sixty-six(88%) out of 75 stenoses in MVA and 13(76%) out of 17 stenoses in SVA had procedural success respectively. According to angiographic morphology of lesions, procedural success of type A stenoses was 17/17(100%), type B stenoses 57/66(86%) and type C stenoses was 5/9(33%). In 13 failures included inability to pass the guide wire cross the lesion in 7, inability to guide the griding catheter in 2 and inability to dilate lesions in 4. Before and after angioplasty, treadmill test (modified Bruce protocol)could be performed in 29 patients. Total duration of exercise and maximal double product improved significantly from 8.5+/-2.3 minute 5188+/-2403 to 12.2+1.3 min., 23,062+/-4111 respectively (p<0.001). 17 out of 24 patients who had positive treadmill test before angioplasty showed negative conversion after procedure. Complications included dissection in 29, prolongd chest pain in 5, acute closure in 3, cardiac tamponade in 1 and ventricular fibrillation due to side branch oclusion in 1. Thus, coronary angioplasty in selected paients with multivessel coronary artery disease might be useful and have relatively good immediate results, but the long-term efficacies with other forms of treatment must be evaluated prospectively.
Angina, Stable ; Angina, Unstable ; Angioplasty* ; Cardiac Tamponade ; Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Exercise Test ; Female ; Humans ; Myocardial Infarction ; Ventricular Fibrillation ; Ventricular Function, Left

BACKGROUND AND OBJECTIVES: Platelets play an important role in the pathogenesis of acute coronary syndrome. Prostacyclin inhibits platelet aggregation, smooth muscle cell proliferation and vasoconstriction, and it counteracts thromboxane A2 activity. The purpose of this study is to evaluate the association between a single nucleotide polymorphism in the prostacyclin synthase gene and myocardial infarction in Koreans. SUBJECTS AND METHODS: We studied total 119 patients (M: F=72: 47, mean ages=57.9). We compared 60 acute coronary syndrome patients who underwent coronary angiography with the diagnosis of acute myocardial infarction (MI), with 59 normal control group patients who had normal coronary angiograms. With the use of polymerase chain reaction-restriction fragment length polymorphism analysis, we identified a single nucleotide polymorphism, C1117A, in exon 8. RESULTS: The genotype distribution and allele frequencies were significantly different between the control group and MI group. Frequency of the genotype C1117A was: AA: AC: CC=3.4%: 30.5%: 66.1% in control group, respectively, and AA: AC: CC=1.7%: 10.0%: 88.3% in MI group, respectively. Prostacyclin synthase polymorphism was observed in the MI group and the control group, but the frequency of the CC genotype was high in MI group (odds ratio, 3.88; 95% CI 1.49-10.88, p=0.003). Compared to control group, being male, having diabetes, hypertension or obesity, and the smoking rate were high in MI group. There were not significantly differences between genotypes for clinical characteristics. CONCLUSION: We conclude that the C1117A polymorphism in exon 8 of the prostacyclin synthase gene is associated with MI, and it may be a genetic marker of MI in Koreans.
Acute Coronary Syndrome* ; Coronary Angiography ; Diagnosis ; Epoprostenol* ; Exons ; Gene Frequency ; Genetic Markers ; Genotype ; Humans ; Hypertension ; Male ; Myocardial Infarction ; Myocytes, Smooth Muscle ; Obesity ; Platelet Aggregation ; Polymorphism, Single Nucleotide ; Smoke ; Smoking ; Thromboxane A2 ; Vasoconstriction

3-Deazaadenosine (DZA), one of the potent inhibitors of S-adenosylhomocysteine hydrolase, is known to possess several biological properties including an induction of apoptosis. To evaluate a possibility that DZA may be utilized for the treatment of human leukemia, we studied molecular events of cell death induced by DZA in human leukemia HL-60 and U-937 cells. DZA induced a specific cleavage of poly ADP-ribose polymerase (PARP) and an activation of the cysteine protease caspase-3/CPP32 which is known to cleave PARP. DZA-mediated nuclear DNA-fragmentation was completely blocked in the presence of a universal inhibitor of caspases (z-VAD-fmk) or the specific inhibitor of caspase-3 (z-DEVD-fmk) unlike of cycloheximide (CHX). DNA fragmentation was preceded by the lowering of c-myc mRNA in the DZA treated cells. In addition, DZA-induced apoptosis was blocked by pretreatment with adenosine transporter inhibitors such as nitrobenzylthioinosine (NBTI) and dipyridamole (DPD). Taken together, these results demonstrate that DZA-induced apoptosis initiated through an active transport of DZA into human leukemia cells, is dependent on the caspase-3-like activity without de novo synthesis of proteins and possibly involves c-myc down-regulation.
Adenosine/metabolism ; *Apoptosis ; Biological Transport, Active ; Carrier Proteins/metabolism ; Caspases/*metabolism ; Down-Regulation ; Enzyme Activation ; Genes, myc ; HL-60 Cells ; Human ; Leukemia, Promyelocytic, Acute/*drug therapy ; Thioinosine/*analogs & derivatives/pharmacology ; Transcription Factors/genetics ; Tubercidin/*pharmacology ; U937 Cells

Only a few tests can evaluate the function of the saccule and inferior vestibular nerve. Vestibular-evoked myogenic potentials (VEMP) are inhibitory potentials recorded in the contracting muscles, usually in the sternocleidomastoids (SCM), when sound stimuli are applied. A disynaptic pathway originating in the saccule is known to mediate VEMP. The main pathway of saccule-induced inhibitory postsynaptic potentials to ipsilateral SCM motoneurons seems to be the medial vestibulospinal tract which descends within the medial longitudinal fasciculus. VEMP have been applied to determine saccular function in many disorders involving the peripheral vestibular apparatus. However, the characteristics and the diagnostic values of VEMP require further exploration in central vestibulopathies. In this review, the basic principles and recording methods of VEMP are overviewed. We will also review VEMP responses found in central as well as peripheral vestibular disorders. Despite several issues that need further elucidation, such as the exact neural pathway mediating VEMP, aging effects on VEMP, and normalization of the muscle contraction during the recording, VEMP allows us exclusive information on the function of saccule and its neural pathway, which cannot be provided by other vestibular function tests.
Aging ; Brain Stem ; Cerebellum ; Contracts ; Inhibitory Postsynaptic Potentials ; Muscle Contraction ; Muscles ; Negotiating ; Neural Pathways ; Saccule and Utricle ; Vertigo ; Vestibular Function Tests ; Vestibular Nerve ; Vestibule, Labyrinth

BACKGROUND: Early reperfusion therapy with thrombolytic agents or primary PTCA is most important to salvage ischemic myocardium in acute myocardial infarction(AMI). Timely reperfusion of jeopardized myocardium clearly improves hemodynamics, decreases infarct size and improves survival. The extent of protection appears to be directly related to the rapidity of reperfusion after onset of coronary occlusion. Although the intravenous thrombolysis is a feasible therapy in the patients with evolving AMI, the benifit of thrombolytic therapy decreases because of the time delay after onset of symptom. This study was perfomed to analyze the factors time delay between onset of symptom and the thrombolytic therapy with retrospective and prospective questionaire in the patients with AMI. METHOD: Eighty one patients with AMI were included in this study who came to the emergency room(ER) of Chungnam National University Hospital(CNUH) from Feburary 1995 to October 1996. Delay between door and thrombolytic therapy was defined as hospital time delay. RESULTS: Thrombolytic therapy(rt-PA or urokinase iv) was done in 60 patients(74.1%) and mean prehopital time delay was significantly decreased in the patients with thrombolytic therpapy when compared with those without thormbolytic threapy(462+/-90 vs 1375+/-473 minutes, p=0.005). There were no singificant factors for prehospital time delay such as age, sex, redsidence, ER near residence, transfer time to ER near residence, family status, family history of AMI, severity of chest pain, presence of risk factors of cardiovascular disease(CVD), previous CVD, degree of education, history of other disease and routine check, transfer methods. The only 8 patients(9.8%) knew about AMI and 7 patients among these patient came to ER earlier and received thrombolytic therapy. From 57 referred patients, 40 patients(70.2%) received reperfusion therapy and only 30 patients(52.6%) had recored EKG in the referred hospital. In the analysis of hospital delay from patient's arrival to the thrombolytic therapy, the arrival time at weekdays and weekend had no differences, but hospital delay were significantly prolonged when patients arrived at ER in the night. CONCLUSION: Since prehospital time delay is a most important factor of time delay for the effective thrombolytic therapy in AMI, the pubic education program and effective transport system are needed. And routine record of EKG in patient with chest pain in the local hospital is very helpful to start effective thromolytic therapy at ER. The well designed prospective study with more patinets in our local region is essential to get more accurate information about transport system and to improve survival rate in patients with AMI.
Chest Pain ; Chungcheongnam-do ; Coronary Occlusion ; Education ; Electrocardiography ; Emergencies ; Fibrinolytic Agents ; Hemodynamics ; Humans ; Myocardial Infarction* ; Myocardium ; Prospective Studies ; Reperfusion ; Retrospective Studies ; Risk Factors ; Survival Rate ; Thrombolytic Therapy* ; Urokinase-Type Plasminogen Activator

For the treatment of coarction of aorta, surgical intervention has been known as a standard therapy.During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient beween ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation (2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angioplasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angioplasty for coarctation of aorta is the first case reported in Korea.
Adolescent ; Adult* ; Aneurysm ; Angioplasty ; Angioplasty, Balloon* ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Blood Pressure ; Child ; Dilatation ; Emergency Service, Hospital ; Femoral Artery ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Infant ; Korea ; Subclavian Artery ; Upper Extremity ; Young Adult

Diffuse neonatal hemangiomatosis is rare and a life-threatening disorder characterized by multiple cutaneous and visceral hemangiomas. The organs most commonly affected are the liver, lung. brain, GI tract. The complications are high output cardiac failure, hemorrhage, Kassabach-Meritt syndrome, etc. A 30-day-old girl was diagnosed to have diffuse neonatal hemangiomatosis by her multiple cutaneous and hepatic hemangiomas. She was treated with corticosteroid and interferon alfa-2a. During the treatment the number and size of hemangiomas were markedly reduced.
Brain ; Female ; Gastrointestinal Tract ; Heart Failure ; Hemangioma ; Hemorrhage ; Humans ; Interferons ; Liver ; Lung

By using differential display, we identified one of the genes encoding the multi-subunit complex protein V-ATPase, c subunit gene (ATP6L), and showed alterations of the gene expression by oxidative stresses. Expression of the ATP6L gene in Neuro-2A cells was increased by the treatment with H2O2 and incubation in hypoxic chamber, implying that the expression of the ATP6L gene is regulated by oxidative stresses. To examine mechanisms involved in the regulation of the gene expression by oxidative stresses, the transcriptional activity of the rat ATP6L promoter was studied. Transcription initiation site was determined by primer extension analysis and DNA sequencing, and promoter of the rat ATP6L and its deletion clones were constructed in reporter assay vector. Significant changes of the promoter activities in Neuro-2A cells were observed in two regions within the proximal 1 kbp promoter, and one containing a suppressor was in -195 to -220, which contains GC box that is activated by binding of Sp1 protein. The suppression of promoter activity was lost in mutants of the GC box. We confirmed by electrophoretic mobility shift and supershift assays that Sp1 protein specifically binds to the GC box. The promoter activity was not changed by the H2O2 treatment and incubation in hypoxic chamber, however, H2O2 increased the stability of ATP6L mRNA. These data suggest that the expression of the ATP6L gene by oxidative stresses is regulated at posttranscriptional level, whereas the GC box is important in basal activities of the promoter.
Animals ; Clone Cells ; Gene Expression* ; Hydrogen Peroxide ; Oxidative Stress* ; Rats ; RNA, Messenger ; Sequence Analysis, DNA ; Transcription Initiation Site ; Vacuolar Proton-Translocating ATPases*

Opioid analgesia is the primary pharmacologic intervention for managing pain. However, opioids can cause various adverse effects including pruritus, nausea, constipation, and sedation. Respiratory depression is the most fatal side effect. Therefore, cautious monitoring of respiratory status must be done after opioid administration. Here, we report a patient who suffered from respiratory depression with deep sedation and aspiration pneumonitis after intrathecal morphine administration.
Analgesia ; Analgesics, Opioid ; Constipation ; Deep Sedation ; Humans ; Morphine ; Nausea ; Pneumonia ; Pruritus ; Respiratory Insufficiency