Antiphospholipid antibodies are found in association with collagen-vascular diseases including systemic lupus erythematosus[SLE]. As the laboratory tests suggest impaired coagulation, the patients having antiphospholipid Ab have been reported to be prone to develop thrombosis. The authors present three patients with antiphospholipid antibodies in SLE who had suffered from retinal vascular occlusions. Case 1 with central retinal vein occlusion who had both lupus anticoagulant and anticardiolipin Ab resulted in visual loss. Case 2 with branch retinal vein occlusion who was positive for only lupus anticoagulant experienced moderate visual disturbance. Case 3 with branch retinal artery occlusion who was positive for both lupus anticoagulant and anticardiolipin Ab died without ocular follow-up examination. We consider that SLE patients with the antiphospholipid Ab may be at high risk to develop disturbances in vision due to thromboembolism from a hypercoagulable state.
Antibodies, Antiphospholipid* ; Follow-Up Studies ; Humans ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic* ; Retinal Artery Occlusion ; Retinal Vein ; Retinal Vein Occlusion ; Retinaldehyde ; Thromboembolism ; Thrombosis

PURPOSE: It is very rare to observe the thrombus formation next to the ateriovenous crossing(AV crossing) in branch retinal vein occlusion(BRVO). We investigated two cases with the thrombus in BRVO. MATERIALS AND METHODS: Two of 347 cases with BRVO to perform the fluorescein angiography(FAG) were observed to form the intravascular thrombus next to the AV crossing. RESULTS: The vascular wall in the area of thrombus was hyperfluorescent in FAG. The fluorescence was visible in the early arteriovenous phase and it increased in the mid-phase of the angiogram. Investigatons for systemic hypertension and hyperlipidemia in two cases were positive. The vascular wall in the area of thrombus in one case revealed as hyperfluorescence exaggeratedly in length by forward and backward movement of the thrombus during performing FAG. And the leakage of fluorescein from the venule next to the AV crossing was not observed. In the other case, the vascular wall in the area of thrombus revealed the small hyperfluorescent spot and the leakage of fluorescein. CONCLUSIONS: The pathogenesis of thrombus formation in the retinal vein resulting in retinal vein occlusion is not well understood. Although poststenotic turbulence of blood flow after an AV crossing or a preexisting vessel wall alteration combined with alterations of blood fluidity may induce thrombus formation, it was uncertain in our cases whether or not the thrombus formation was associated with hyperlipidemia, systemic hypertension, and hypercoaguable states.
Fluorescein ; Fluorescence ; Hyperlipidemias ; Hypertension ; Retina* ; Retinal Vein ; Retinal Vein Occlusion ; Thrombosis* ; Veins* ; Venules

With increasing number of high-risk, advanced atherosclerotic patients, crossover femoro-femoral bypass (FFB) became commonly chosen extra-anatomic bypass for symptomatic iliac artery occlusive disease. But the causes FFB graft failure have not been clarified yet. PURPOSE: We aimed to investigate the natural course of native artery disease, the causes of graft occlusion and recurrent leg ischemia after FFBs. METHOD: Among 162 primary FFBs for atherosclerotic iliac occlusive disease, 45 patients who underwent follow-up arteriography for recurrent ischemic symptom were enrolled. We investigated the interval changes between initial preoperative and follow-up angiograms and categorized them as inflow, outflow and/or graft lesions. The significant changes between 2 angiograms was arbitrarily defined as progression of lesion into stenosis >50% or occlusion. And the patients were divided into 2 groups as patent FFB group and occluded FFB group. We compared interval changes on angiograms between patient and occluded FFB groups to find out any difference and tried to determine the ultimate causes of recurrent leg ischemia considering not only the interval changes but the preexisting, untreated leg arterial lesions. RESULT: The follow-up angiography was most commonly performed within 1 year after FFB with mean interval of 21.2 +/- 21.6 months. Interval changes between 2 angiograms were 24 (53.3%) FFB grafts occlusion, 8 (17.8%) inflow iliac disease progression, and 26 (57.8%) ouflow arterial occlusion. Comparing the interval changes between patent and occluded FFB groups, the significantly higher frequency of outflow occlusion was noted in occluded FFB group (75% vs 38.1%, P=0.012). The most common finding on follow-up angiongram responsible for the recurrent ischemia was also outflow arterial occlusion even in patent FFB group. CONCLUSION: The most common cause of graft occlusion and recurrent leg ischemia was outflow arterial occlusion after FFB.
Angiography ; Arteries ; Constriction, Pathologic ; Disease Progression ; Follow-Up Studies ; Humans ; Iliac Artery ; Ischemia* ; Leg* ; Transplants*

PURPOSE: To evaluate and compare the inter-individual variability and normal limits of Humphrey SITA and Octopus TOP which were recently developed for shortening test time and decreasing the patient's fatigue. METHODS: Humphrey SITA and Octopus TOP tests were performed on 100 normal Korean subjects and their test results were analyzed. RESULTS: The average test duration was 294.02+/-29.61 seconds in SITA and 147.93+/-9.78 seconds in TOP. There was no significant difference between the two perimetric tests in MD (mean deviation), but PSD (pattern standard deviation) of TOP program was significantly higher than that of SITA (P< 0.01). Mean sensitivity of SITA was 30.15+/-1.00 dB and that of TOP was 26.79+/-1.11 dB, so mean sensitivity of SITA was about 3 dB higher than that of TOP. In topographical map, averaged threshold sensitivity decreased with the eccentricity in both perimetries. Topographically, SITA showed the more regularly increasing standard deviation of threshold sensitivity toward periphery of visual field, but TOP showed the irregular pattern of distribution of the standard deviation. Most of the subjects (88.8%) replied that they were more comfortable with the TOP than the SITA program because of the shorter test time. CONCLUSION: Inter-individual variability in the normal Korean subjects was smaller in Humphrey SITA than Octopus TOP program, but Octopus TOP had the advantage of shorter duration of the test and lower fatigue.
Fatigue ; Octopodiformes* ; Visual Field Tests* ; Visual Fields

PURPOSE: Although varicose veins are common, the primary cause predisposing to venous reflux of great saphenous vein is controversial. We compared histologic features and expressions of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) in the great saphenous veins (GSVs) of normal and patients with varicose veins. METHOD: Ten normal proximal GSV and each twenty diseased proximal, mid, and distal above-knee GSV vein segments were used for this analysis. We compared venous architecture with histology and expression and localization of MMP and TIMP with immunohistochemistry. RESULT: Compared with normal veins, varicose veins showed thickening and disorganization of intimal and medial connective tissue elements. Elastic fibers of varicose vein were fragmented and degenerated. By the immunohistochemistry, MMP-1 and MMP-2 were more strongly expressed than MMP-9, TIMP-1 and TIMP-2 either normal and varicose veins. MMPs were localized to endothelial cells, medial connective tissues and adventitial microvessels in normal veins. Whereas they were more diffusely localized to subintimal and medial connective tissues in varicose veins. Compared with proximal varicose veins, TIMP-2 was more significantly expressed in distal varicose veins. CONCLUSION: In varicose veins, vein wall architectures are disorganized and MMPs are more prominently expressed in these degenerative subintimal and medial areas.
Connective Tissue ; Elastic Tissue ; Endothelial Cells ; Humans ; Immunohistochemistry ; Matrix Metalloproteinases* ; Microvessels ; Saphenous Vein* ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2 ; Varicose Veins* ; Veins

Erythema nodosum is a common variant of panniculitis. It is characterized by tender erythematous nodule and plaque on the anterior aspect of the leg. The etiology is not fully understood. It may be associated with a variety of disorders, including infection, medication, autoimmune disorders, pregnancy, and malignancy. A 33-year-old Korean woman presented with 1 week history of painful erythematous plaques on both knees. She was 7 weeks pregnant with assisted reproductive therapy, and had been maintained on daily intramuscular progesterone injection for 4 weeks. Histological examination of the lesions revealed septal panniculitis without vasculitis. Two days after discontinuing progesterone injection, the symptoms and lesions started to resolve. Herein we present a case of erythema nodosum caused by progesterone injection for endometrial preparation.
Adult ; Erythema ; Erythema Nodosum ; Female ; Humans ; Knee ; Leg ; Panniculitis ; Pregnancy ; Progesterone ; Reproductive Techniques, Assisted ; Vasculitis

Black esophagus is a rare condition of the esophagus that manifests as endoscopic findings of black-colored esophageal mucosa, which is usually caused by acute esophageal necrosis. We report a case of alcoholic patient who developed black esophagus. The 85-year-old man was admitted to Severance Hospital due to copious hematemesis over 2 days. Upper gastrointestinal endoscopy showed black-colored mucosa in the distal esophagus. Endoscopic biopsies of the esophagus revealed necrotic tissue, without any viable cells. Follow-up upper gastrointestinal endoscopy performed after supportive care with a proton-pump inhibitor, sucralfate, and total parenteral nutrition resulted in the remarkable healing of the esophageal wall with no complications.
Aged, 80 and over ; Alcoholics ; Alcoholism ; Biopsy ; Endoscopy, Gastrointestinal ; Esophagus ; Follow-Up Studies ; Hematemesis ; Humans ; Mucous Membrane ; Necrosis ; Parenteral Nutrition, Total ; Sucralfate

BACKGROUND: Pacing-induced atrial electrical remodeling (AER) is characterized by shortening of atrial effective refractory period (A-ERP) and its altered rate adaptation. In paroxysmal atrial fibrillation (AF), periods of AF occur with interveneing normal sinus rhythm (NSR) when atria recover from the preceding AER. Previous episodes of AF may precondition the atrial myocardium and cause different time course of AER in subsequent episodes of AF. But the influence of the preceding AER on the subsequent AER has not been described. METHODS: Four mongrel dogs were anesthetized with enflurane. After thoracotomy, silicon band with 3 pairs of electrodes was sutured to the lateral wall of the left atrium. Atrial pacing was performed after 2 wks of recovery and autonomic blockade. Pacing protocol consisted of rapid atrial pacing (RAP) at 500 bpm (for 60 min) and recovery in NSR (for 60 min) which was repeated three times. A-ERP was measured every 10 min. The same pacing protocol was repeated after pretreatment with verapamil (0.1 mg/kg/hr). RESULTS: 1) With 60 min of RAP, A-ERP decreased significantly (126+/-6 ms vs. 105+/-7 ms, p<0.005). 2) After cessation of pacing, A-ERP returned to 98% of baseline value in 15 minutes. Recovery from AER occurred faster than AER (78 vs 21 ms/h). 3) After pretreatment with verapamil, RAP decreased A-ERP from 127+/-5 ms to 116+/-5 ms. AER, the reduction in A-ERP, was significantly attenuated by pretreatment with verapamil (deltaERp=17+/-7 vs. 9+/-0.2 %, p<0.05). 4) When RAPs were repeated, AER showed a tendency of acceleration, but it was not statistically significant (deltaERp=22 ms, 24 ms, 28 ms at the end of 60 min pacing for the 1st, 2nd, 3rd pacing). CONCLUSION: RAP induced AER in conscious dog atria and it was reduced by pretreatment with calcium channel blocking agent, verapamil. Upon repeated atrial stimulations, AER did not accelerate or decelerate when the atria recovered from the preceding AER.
Acceleration ; Animals ; Atrial Fibrillation ; Atrial Remodeling* ; Calcium ; Calcium Channels ; Dogs* ; Electrodes ; Enflurane ; Heart Atria ; Myocardium ; Silicones ; Thoracotomy ; Verapamil

The aconite root has been used in oriental medicine to improve metabolism of debilitated patient and to cure acute dysuria, cardiac weakness, gout, neuralgias and rheumatism. The crude drug "bu-shi" or "cho-oh", which is obtained from the Aconitum roots, contains the potent poisons aconitine, mesaconitine, jesaconitine, and hypaconitine, which are C
Aconitine ; Aconitum* ; Adult ; Alkaloids ; Animal Experimentation ; Arrhythmias, Cardiac* ; Dizziness ; Dysuria ; Gout ; Hemodynamics ; Humans ; Medicine, East Asian Traditional ; Metabolism ; Nausea ; Neuralgia ; Poisons ; Rheumatic Diseases ; Shock* ; Tachycardia ; Tachycardia, Ventricular ; Torsades de Pointes ; Ventricular Fibrillation ; Vomiting

To produce a novel antihypertensive angiotensin I-converting enzyme (ACE) inhibitor from yeast, a yeast isolate, designated G-14 showing the highest ACE inhibitory activity was obtained and identified as Malassezia pachydermatis based on morphological, biochemical and cultural characteristics. The maximal extracellular ACE inhibitor production was obtained from M. pachydermatis G-14 when the strain was cultured in YEPD medium containing 0.5% yeast extract, 3.0% peptone and 2.0% glucose at 30degrees C for 24 h and the final ACE inhibitory activity was 48.9% under the above condition.
Angiotensins* ; Cultural Characteristics ; Glucose ; Malassezia* ; Peptidyl-Dipeptidase A* ; Peptones ; Yeasts