No abstract available.
Humerus*

In order to observe the change of epicardial ECG(Eep), left ventricular pressure, left ventricular dp/dt and the development of arrhythmia during regional myocardial ischemia and reperfusion, proximal LAD was ligated for 30 minutes and reperfused suddenly for 30 minytes in eleven mongrel dogs which were grouped into control(n=6) and diltiazem(n=5) group. In diltiazem group, diltiazem infusion was started 10 minutes prior to reperfusion with the speed of 0.02mg/kg/min for 25 minutes. The amount of injury current was measured from TQ segment and ST segment changes of Eep, and its effect on the incidence of reperfusion arrhythmia was evaluated. Eep, LV pressure, LV dp/dt and ECG were simultaneously recoreded with the paper speed of 100mm/sec at predetermined time intervals, and 6 channel ECG(standard lead I, II, III, AVR, AVL, AVF) was recorded continuously with paper speed of 10mm/sec throughout the experiment. The results were as follows ; 1) After ligation of LAD, the polarity QRS of Eep changed to show monophasic shape from 3-4 minutes, TQ segment depressed to reach minumum level at 4-7 minutes and ST segment elevated to reach maximum level at 4-5 minutes. These changes recovered rapidly to pre-ligation state after reperfusion, and this tendency was not affected by diltiazem. 2) The absolute value of LV dp/dt max and LV dp/dt min decreased 10% at 2-4 minutes after LAD ligation, and began to recover from 7 minutes after reperfusion to reach peak recovery value at 20 minutes after reperfusion in control group. In diltiazem group, it decreased 15% after diltiazem infusion and began to recover from 1 minutes after reperfusion to reach peak recovery value at 7 minutes after reperefusion. 3) Ischemic ventricular fibrillation was observed at the time of maximum TQ depression and ST segment elevation and 4 out of 6 events were developed within 5 minutes after LAD ligation. The cases with Isch-Vf developed Rep-Vf without exception, which was observed in 8 out of 11 cases and was noted within 1 minutes after reperfusion except one. 4) Maximum ST elevation was significantly higher in group with Rep-Vf then in group without Rep-Vf(Rep-Vf(+);18.5+/-11.1, Rep-Vf(-);10.3e+/-6.9, p<0.05), and also maximum ST elevation was significantly higher in group with both Isch-Vf and Rep-Vf then in group with only Rep-Vf(Isch-Vf+Rep-Vf;28.5+/-7.8, Rep-Vf only;10,5+/-4.7, P<0.01). 5) The incidende of reperfusion ventricular fibrillation was 83% in control group(5 out of 6) and 60% in diltiazem group(3 out of 5), but the inhibitory effect of diltiazem on the reperfusion Vf could not be confirmed due to the difference of the incidence of ischemic Vf between the two groups(control group;67%(4 out of 6), ditiazem group;20%(1out of 5)). In conclusion, maximum injury current developed 4-7 minutes after coronary artery ligation, and maximum ST elevation value was significantly related with the development of ischemic Vf and reperfusion Vf, and the inhibitory effect of diltiazem on the reperfusion ventricular fibrillation could not be confirmed in this study.
Animals ; Arrhythmias, Cardiac* ; Coronary Vessels* ; Depression ; Diltiazem* ; Dogs ; Electrocardiography* ; Incidence ; Ligation* ; Myocardial Ischemia ; Reperfusion* ; Ventricular Fibrillation ; Ventricular Pressure

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dura. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord herniation manifesting as ventrolateral protrusion of thoracic spinal cord through a dural defect.
Rare Diseases ; Spinal Cord Diseases ; Spinal Cord*

A ganglion cyst is a tumor-like lesion that contains mucous or myxoid material in the fibrous capsule. We report a case of ganglion cyst located in the lumbar anterior epidural space and causing lumbar radiculopathy. Computed tomography and magnetic resonance imaging revealed the cyst as a cystic lesion with wall en-hancement. Myelography showed that it was not filled with contrast medium and not connected with the dura, nerve root, or facet joint.
Epidural Space* ; Ganglion Cysts* ; Magnetic Resonance Imaging ; Myelography ; Radiculopathy ; Spinal Canal ; Zygapophyseal Joint

Usually fungal infections caused by opportunistic and pathogenic fungi had been an important cause of morbidity and mortality among immunocompromised patients. However clinical data and investigations for immunocompetent pathogenic fungal infections had been rare and neglected into clinical studies. Especially Cryptococcal brainstem abscess cases mimicking brain tumors were also much more rare. So we report this unusual case. This 47-year-old man presented with a history of progressively worsening headache and nausea for 1 month and several days of vomituritions before admission. Neurological and laboratory examinations performed demonstrated no abnormal findings. Previously he was healthy and did not have any significant medical illnesses. A CT and MRI scan revealed enhancing 1.8x1.7x2.0 cm mass lesion in the left pons having central necrosis and peripheral edema compressing the fourth ventricle. And also positron emission tomogram scan demonstrated a hot uptake of fluoro-deoxy-glucose on the brainstem lesion without any evidences of systemic metastasis. Gross total mass resection was achieved with lateral suboccipital approach with neuronavigation system. Postoperatively he recovered without any neurological deficits. Pathologic report confirmed Cryptococcus neoformans and he was successively treated with antifungal medications. This is a previously unreported rare case of brainstem Cryptococcal abscess mimicking brain tumors in immunocompetent host without having any apparent typical meningeal symptoms and signs with resultant good neurosurgical recovery.
Abscess* ; Brain Neoplasms* ; Brain Stem* ; Cryptococcus ; Cryptococcus neoformans ; Edema ; Electrons ; Fourth Ventricle ; Fungi ; Headache ; Humans ; Immunocompromised Host ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Nausea ; Necrosis ; Neoplasm Metastasis ; Neuronavigation ; Pons

The antihypertensive effects of single daily dose of long-acting propranolol(Inderal LA(R)) were observed in 29 cases of essential hypertension, and the results were as follows; 1) Age distribution of the cases was from 39 years to 72 years with the mean age of 51.3. And there were 13 female and 16 male patients. 2) Mean value of the hypotensive effects in systolic and diastolic blood pressure were 22.9 mmHg, and 11.5 mmHg, respectively. 3) The results of the antihypertensive effects were as follows; good 31.0%, fair 34.5%, poor 20.7%, and failure 13.8%. 4) The decrement of heart rate with long-acting propranolol was 9.3 per minute in average. 5) 1 case of nausea and 2 cases of lassitude were noted, but these symptoms were subsided spontaneously with continous medication.
Age Distribution ; Blood Pressure ; Fatigue ; Female ; Heart Rate ; Humans ; Hypertension ; Male ; Nausea ; Propranolol

Diffuse tremendous thickening of gastric wall caused by excessive proliferation of the mucosa of unknown causewas first decribed by Menetrier in 1888. The disease is highly uncommon, but the exact preoperative diagnosis iscrucial because of the more excellent prognosis than other malignant lesions including gastric lymphoma andinfiltrative gastric carcinoma. The authors recently experienced a case of Menetrier's disease which had beendiagnosed as gastric lymphoma preoperatively. Radiologic differentiation is not impossible between this extermelyrare disease and other mimicking malignant lesions, that is the reason why we introduce radiographic findings ofthe case by comparison with gastric lymphoma of giant rugal type and infiltrative gastric carcinoma. Typical upperG-I series findings of the case are: 1) Enlarged tortuous proximal gastric rugal folds only along the greatercurvature, 2) Perpendicular lines of barium spicules trapped by apposed folds with clubbed or forked appearance,3) Abrupt transition of transion to normal stomach, 4) No luminal narrowing and retained but sluggish peristalsis.Thus radiologists can diagnose Menetrier's disease scrupulously based on critical application of enlarged foldspattern and extent of the lesion in association with other radiologic features and clinial history of fairly longduration. Brief review of clinical and pathologic features about Menetrier's disease is included.
Barium ; Diagnosis ; Diagnosis, Differential ; Gastritis, Hypertrophic ; Hypertrophy ; Lymphoma ; Mucous Membrane ; Phenobarbital ; Prognosis ; Stomach

Studies describing the effects on blood pressure control by hemodialysis(HD) or continuous amulatory peritoneal dialysis(CAPD) have yielded conflicting results with respect to 24 hour blood pressure control, diurnal variation and blood pressure loads. The aim of the study was to investigate the effect of beginning with HD or CAPD on blood pressure control, diurnal variation and blood pressure loads using ambulatory blood pressure monitoring(ABPM). Twen-ty-seven end-stage renal disease(ESRD) patients(12 on HD and 15 on CAPD) were enrolled into the study. Patients with cardiovascular diseases, erythro-poietin therapy, or severe edema were excluded. ABPM were performed two times before and after the initiation of dialysis. Mean duration of interval between pre- and post-dialysis ABPM were 17+/-4 days on HD and 13+/-3 days on CAPD. Daytime and nighttime were defined as the time from 6:00 AM to 10:00 PM and from 10:00 PM to 6:00 AM of the next day. Systolic and diastolic loads were defined as the percentage of the incidence of systolic and diastolic blood pressure over l% and 90mmHg. Dipper meaning the presence of normal diurnal difference were defined as the differences of daytime- nighttime mean arterial pressure more than 5mmHg. In HD patients, mean systolic and diastolic blood pressure and mean arterial pressure were significantly decreased after dialysis during 24 hour, day- time and nighttime. In CAPD patients, those were also significantly decreased after dialysis during 24 hour, daytime and nighttime(p<0.05). Diurnal differences were increased after CAPD(3.3+/-9.4 vs 5.4+/-6.8mmHg) but decreased after HD(4.3+/-6.2 vs 2.4+/-10.8mmHg) and the differences of diurnal difference between two groups were significantly different(+2.1+/-9.0 vs 1.9+/-8.4mmHg, p<0.05). Proportions of dipper among patients were increased from 16.7 to 66.7% in HD and from 33.3% to 60% in CAPD without statistical significance between two groups. Systolic and diastolic loads were significantly decreased after HD(from 75.0+/-38.0 to 37.5+/-43.8%, from 45.2+/-29.7 to 12.5+/-12.8%, respectively, p<0.05) and after CAPD(from 63.1+/-30,1 to 32.3+/-27.1%, from 43.4+/-36.2% to 12.2+/-16.9%, respectively, p<0.05). Systolic and diastolic loads of daytime and nighttime were significantly decreased after each dialysis modality except nighttime diastolic pressure load in HD. In conclusions, both HD and CAPD improve BP control in ESRD patients. CAPD has more benefit to control of diurnal variations in ESRD patients.
Arterial Pressure ; Blood Pressure* ; Cardiovascular Diseases ; Dialysis ; Edema ; Humans ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis*

Leptin, which is a plasma protein produced by the obese gene, is expressed and secreted by adipocytes. The clearance of lepdn from the circulation is unknown. But, markedly elevated serum leptin concentrations have recently been reported in patients with chronic renal failure. The purpose of the present study was to investigate plasma leptin concentration of patients with chronic renal failure and evaluate the factors affecting plasma leptin levels. Plasma leptin, insulin, and body mass index were determined in 34 patients with chronic renal failure and 55 control subjects. The plasrna leptin concentrations were not significantly different between patients with chronic renal failure and control subjects (9.4+/-11.8 vs 4.9+/-4.2ng/ml, P>0.05). The serum leptin concentrations were not significantly higher in both male and female CRF patients compared with control subjects (3.96+/-5.72 vs 2.48+/-1.65, P=0.1947, 17.07+/-14.02 vs 7.49+/-4.63ng/ml, P=0.07, respectively). And, there was no significant correlation between serum creatinine and plasma leptin. However, there was significant correlation between plasma leptin concentration and insulin level (P<0.05). We fit a multiple linear regre- ssion analysis with plasma leptin level as the dependent variable in CRF. Sex (male vs female) (P< 0.001) and insulin (P=0.004) were independently associated with plasma leptin level in CRF. These results suggested that plasma leptin level was regulated or affected by multiple factors inclu- ding sex and insulin resistance. Additional study is required to evaluate relationship between plasma leptin and insulin resistance in chronic renal failure.
Adipocytes ; Body Mass Index ; Creatinine ; Female ; Humans ; Insulin ; Insulin Resistance ; Kidney Failure, Chronic* ; Leptin* ; Male ; Plasma*

Microscopic polyangiitis is a primary systemic vasculitis which involve small arterioles and capillaries. Clinical manifestations show generalized weakness, fever, myalgia, weight loss. oliguria, proteinuria, skin rash, neuromuscular symtoms, and pulmonary, gastrointestinal symtoms. Prednisolone and cyclophosphamide therapy is effectve, more than 80% of patients with microscopic polyangiitis survive for longer than 5years. However, about 50% of patients will have at least one relapse in the 4-5years after initial treatment. There is a very strong correlation between the presence of ANCA(especially p-type) and microscopic polyangiitis. We herein report a case of microscopic polyandiitis with the review of literature. A 65 years-old woman admitted to our hospital due to general weakness, fever, generalized edema, and dyspnea. Laboratory result showed high serum creatinine and CRP, moderate proteinuria, and microscopic hematuria. P-ANCA was 1:1280 positive in indirect immunofluorescence method, and kidney biopsy showed focal segmental necrotizing glomerulonephritis, crescent formation, fibrin clots, PMN and lymphocytes infiltrations in small arterioles and capillries. Immunofluorescence study was negative. Her clinical feature, laboratory findings, and the kidney biopsy result were compatible with microscopic polyangiitis. The patient had been treated with prednisolone and cyclophosphamide. P-ANCA titration was decreased 1:320 at the 19th day of treatment and was negative about 2months later.
Aged ; Antibodies, Antineutrophil Cytoplasmic ; Arterioles ; Biopsy ; Capillaries ; Creatinine ; Cyclophosphamide ; Dyspnea ; Edema ; Exanthema ; Female ; Fever ; Fibrin ; Fluorescent Antibody Technique ; Fluorescent Antibody Technique, Indirect ; Glomerulonephritis ; Hematuria ; Humans ; Kidney ; Lymphocytes ; Microscopic Polyangiitis* ; Myalgia ; Oliguria ; Prednisolone ; Proteinuria ; Recurrence ; Systemic Vasculitis ; Weight Loss