OBJECTIVES: Anticardiolipin antibody (ACA) and lupus anticoagulant (LA) are acquired antiphospholipid antibodies (APAs), which are regarded as important risk factors far vascular thrombosis and recurrent fetal loss. Although the clinical relevance of APAs in dialysis patients is uncertain, recent studies have suggested that APAs are involved in bioincompatibility and thrombogenic complications in hemadialysis (HD) patients. METHOD: We performed a cross sectional study of ACA and LA in 50 stable HD patients and their 68 vascular accesses (52 native arteriovenous fistulae and 16 synthetic arterovenous grafts), with the analysis of factors associated with the presence of APAs and the retrospective evaluation of vascular access occlusion (VAO). LA was assessed by platelet neutralization method whereas IgG-ACA was measured by a solid phase ELISA. Values higher than 23GPLU/ml (IgG phospholipid units) were considered to be positive for IgG-ACA and positive values for LA was more than 8 seconds in prolongation of the clotting time with human platelet lysate. Vascular access survival was assessed by Kaplan- Meier method, RESULTS: The mean age of the subject (M:F 21:29) was 46 years and the mean duration of hemodialysis was 49 months. The frequency of VAO in entire subjects was 0.45+/-0.98 episodes/patient year. The median value of IgG-ACA was 16.0 GPLU/ml with a distribution from 2.7 to 46.1GPLU/ ml. The median titer of I.A was 4.5 (3.1-45.6) seconds. Fourteen patients (28%) were found to have at least one episode of VAO. In spite of comparable clinical and biochemical data according to the presence of VAO, the titers of IgG-ACA (13.6+/-7.7 vs, 20.3+/-8.7GPLIJ/ml, P<0.05) and LA (4.5+/-2.9 vs. 11.7 +/-12.6sec, P<0.05) were significantly higher in VAO group. Six out of 50 patients(12%) had an increased titer of IgG-ACA and LA was found in 11 patients(22%). No patients were positive for ACA and LA simultaneously. There was no significant difference in sex, etiology of ESRD, diabetic status, the dosage of heparin during HD or the amount of erythropoietin administered according to the presence of APAs. We could not find any significant correlation between the titer of APAs and age, duration of dialysis, blood pressure, platelet count and biochemical parameters. In the patients with positive ACA, the frequency of VAO was 1.05+/-0.12 episodes/patient year, which was significantly higher than patients without ACA (0.33+/-0.17 episodes/ patient year, P<0.05). In the patients with the presence of LA(1.06+/-0.43 vs. 0.12+/-0.06 episodes/ patients year, P<0.01). The median vascular access survival time in IgG-ACA positive patients (32.7 months) was significantly decreased compared to 66.8 months in IgG-ACA negative group. CONCLUSION: Our data suggest that the presence of APAs (ACA and/or LA) affects the event-free vascular access survival in HD patients. Therefore the evaluation of APAs status have to be included in the diagnostic strategies for the patients with recurrent VAO. Further studies are necessary to explore the pharmacologic intervention method to decrease APAs and prevent VAO in HD patients.
Antibodies, Anticardiolipin* ; Antibodies, Antiphospholipid ; Arteriovenous Fistula ; Blood Platelets ; Blood Pressure ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Heparin ; Humans ; Kidney Failure, Chronic ; Lupus Coagulation Inhibitor* ; Platelet Count ; Renal Dialysis* ; Retrospective Studies ; Risk Factors ; Thrombosis

Malignant bone tumors would be classified as primary malignant bone tumors, secondary malignant bone tumors, and metastatic bone tumors. Primary malignant bone tumors are rare diseases occupying 1% of adult cancers, and 6% of pediatric cancers. The chief complaint of malignant bone tumor patients is pain different from that of malignant soft tissue tumor patients. Diagnostic procedures start with clinical evaluation including current illness, past medical history, family history, and physical examination. Then we take a radiograph first and obtain important and diagnostic clues from it. However pathological diagnosis and information about the extent of tumor are required to obtain a more definite diagnosis and staging. Examinations for detection of local and systemic tumor extent are scintigraphy, computed tomography (CT), magnetic resonance imaging, and positron emission tomography-CT. If the clinical and radiographic information suggests aggressive or malignant bone tumor, the patient should be referred to a bone tumor specialist without further evaluations.
Adult ; Biopsy ; Bone Neoplasms ; Diagnosis ; Electrons ; Humans ; Magnetic Resonance Imaging ; Physical Examination ; Radionuclide Imaging ; Rare Diseases ; Specialization

No abstract available.
Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Myositis*

The clinical usefulness of polymerase chain reaction (PCR) for the diagnosis of trichomoniasis was evaluated in comparison with other conventional tests. PCR was used for specific detection of Trichomonas vaginalis by primers based on the repetitive sequence cloned from T. vaginalis (TV-E650). Between June 1996 and August 1997, 426 patients visited the department of obstetrics and gynecology, Hanyang University Kuri Hospital and were examined for trichomoniasis using wet mount examination, Papanicolaou (Pap) smear, culture and PCR. One hundred and seventy-seven patients (group A) visited with the symptoms of vaginal discharge and 249 patients (group B) visited for regular cervical Pap smear with no vaginal symptoms. From group A (n = 177), 3 infections (2.0%) were detected by wet mount, 6 infections (3.3%) by Pap smear and culture, and 17 infections (10.4%) by PCR. From group B (n = 249), 4 patients (1.6%) were found to have T. vaginalis by culture and 6 infections (2.4%) were detected by PCR. Therefore, in both groups, PCR for T. vaginalis showed a higher detection rate compared with conventional wet mount, Pap smear or culture. The detection by PCR was specific for T. vaginalis since no amplification was detected with DNAs from other protozoa and Candida albicans. The sensitivity and specificity of PCR were 100%. This method could detect T. vaginalis in vaginal discharge at a concentration as low as 1 cell per PCR mixture. These results indicate that PCR could be used as a specific and sensitive diagnostic tool for human trichomoniasis.
Female ; Human ; Polymerase Chain Reaction* ; Sensitivity and Specificity ; Trichomonas Vaginitis/diagnosis*

Semantic dementia is a rare, distinct form of frontotemporal lobar degeneration, characterized by a deficit in semantic memory with relative preservation of attention and executive functions. We report a case of semantic dementia that pre-sented with a 3-year history of progressive word-finding difficulty and prosopagnosia. Brain MRI showed prominent atrophic changes in the left temporal region and neuropsychological tests demonstrated semantic memory deficits.
Brain ; Executive Function ; Frontotemporal Dementia* ; Frontotemporal Lobar Degeneration ; Magnetic Resonance Imaging ; Memory ; Memory Disorders ; Neuropsychological Tests ; Prosopagnosia ; Semantics*

BACKGROUND AND OBJECTIVES: Exercise myocardial perfusion scans in patients with hypertrophic cardiomyopa-thy have shown reversible perfusion abnormalities with unknown clinical significance. We performed this study to characterize dipyridamole Tl-201 SPECT imaging and correlate with clinical findings in patients with hyper-trophic cardiomyopathy. METHODS: Tl-201 SPECT was performed in 25 patients of hypertrophic cardiomyopa-thy with asymmetric septal hypertrophy and 20 normal controls after dipyridamole infusion (0.56 mg/kg). Myocardial wall was divided into 8 segments. Tl-201 uptake and relative washout rate were calculated. RESULTS: Tl-201 SPECT showed significantly lower Tl-201 uptake in basal septal (81.3+/-3.4% vs 78.2+/-6.4%, p<0.05) and apical septal wall on stress (88.2+/-4.7% vs 83.9+/-6.5%, p<0.05) and higher apical septal (86.6+/-5.2% vs 89.2+/-3.1%, p<0.05) and apical anterior wall uptake (88.7%+/-4.0% vs 91.4+/-4.9%, p<0.05) on redistribution images in patients with hypertrophic cardiomyopathy. Basal lateral wall uptake of hypertrophic cardiomyopathy was significantly lower than normal control on both stress (84.7+/-3.5% vs 81.2+/-7.3%, p<0.05) and redistribution images (85.0+/-5.8% vs 76.8+/-7.2%, p<0.0001). The septum/lateral uptake ratio of patients on rest image was significantly higher than that of normal controls (0.98+/-0.07 vs 1.07+/-0.10, p<0.001). There was no difference in age, sex, symptom, cardiac medication and the parameters of 2D-echo including left ven-tricular outflow obstruction between subgroups of normal vs abnormal washout in patients with hypertrophic cardiomyopathy. CONCLUSION: Dipyridamole Tl-201 myocardial SPECT shows reduced coronary vasodilatory capacity of myocardium, especially septum in patients with hypertrophic cardiomyopathy. High septal/lateral uptake ratio on redistribution image may be a characteristic finding. However, no correlation between abnorm-al Tl-201 washout and clinical findings was observed.
Cardiomyopathies ; Cardiomyopathy, Hypertrophic* ; Dipyridamole* ; Humans ; Myocardium ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*

To validate ventricular diastolic phase parameters of reconstructed transmitral flow rate curve by M-mode, 2-dimensional and pulsed Doppler Echocardiography, these parameters were compared with same parameters by left ventriculography. The study population was 22 patients who received both coronary arteriography and echocardiographic examination. Transmitral flow rate curve and left ventricular filling volume curve were reconstructed from transmitral flow velocity curve by pulsed Doppler, mitral annulus diameter by two diameter by two dimensional and diastolic motion of both mitral leafltes by M-mode echocardiography. From left ventriculography, left ventricular filling volume curve and transmitral flow rate curve were made using area-length method by Sandler and Dodge. From trasmitral flow fraction, 1/2 diastolic time filling fraction, normalized peak filling volume, 1/3 diastolic time filling fraction, 1/2 diastolic time fraction, normalized peak early filling rate and ratio of early to late peak filling rate were measured. Correlation between same parameters derived from echocardiography and left ventriculography were observed. 1) Total diastolic filling volume:correlation coefficient r=0.47, P<0.05. 2) 1/3 diastolic time filling fraction:correlation coefficient r=0.90, P<0.001. 3) 1/2 diastolic time filling fraction:correlation coefficient r=0.80, P<0.001. 4) Normalized peak early filling rate:correlation coefficient r=0.57, P<0.01. 5) Ratio of early to late peak filling rate:correlation coefficient r=0.85, P<0.001. Therefore, left ventricular diastolic phase parameters of reconstructed transmitral flow rate curve using, M-mode, 2-dimensional and pulsed Doppler echocardiography seems to be useful for the noninvasive evaluation of the left ventricular diastolic function.
Angiography ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Humans

BACKGROUND: Abnormal platelet activation has been identified in several disorders characterizedby vascular patholo-gy including coronary artery disease, Alzheimer disease, myeloproliferative disorders, diabetes, preeclampsia, inflam-matory bowel disease and glomerular disease. Antiplatelet therapy has been valuable in the management of some of these conditions. The aim of this study is to verify usefulness of mean platelet component (MPC) concentration as a marker of thrombotic process in patients with cerebral infarction. Our hypothesis is that MPC as measured by the ADVIA(R) 120 hematology system is used to detect and monitor platelet activation associated with thrombotic process of ischemic stroke. METHODS: To study the existence of platelet activation at the onset of cerebral infarction, mean platelet concentration of platelets were measured daily during post-stroke 10 days. Thirty-four acute thrombotic cerebral infarction and seventeen age-matched healthy persons were selected for this study. To investigate the time course of the platelet MPC changes observed in stroke patients, the blood samplings for MPC measuring were done and analyzed on the ADVIA 120(R) system. RESULTS: There was a statistically significant decrease in MPC concentration of the platelets at post-stroke 3rd to 7th day compared to the control group ( p < 0.05). CONCLUSIONS: We conclude that a reduction of MPC as measured by the ADVIA 120(R) hematology system may be used to detect and monitor thrombotic process associated with platelet activation in ischemic stroke.
Alzheimer Disease ; Blood Platelets* ; Cerebral Infarction ; Coronary Artery Disease ; Hematology ; Humans ; Myeloproliferative Disorders ; Platelet Activation* ; Pre-Eclampsia ; Stroke*

BACKGROUND: Peritoneal fibrosis is one of the major causes of technical failure in patients on peritoneal dialysis. Epithelial-to-mesenchymal transition (EMT) of the peritoneum is an early and reversible mechanism of peritoneal fibrosis. Human peritoneal mesothelial cells (HPMCs) have their own renin-angiotensin-aldosterone system (RAAS), however, it has not been investigated whether aldosterone, an end-product of the RAAS, induces EMT in HPMCs, and which mechanisms are responsible for aldosterone-induced EMT. METHODS: EMT of HPMCs was evaluated by comparing the expression of epithelial cell marker, E-cadherin, and mesenchymal cell marker, alpha-smooth muscle actin after stimulation with aldosterone (1-100nM) or spironolactone. Activation of extracellular signal-regulated kinase (ERK)1/2 and p38 mitogen-activated protein kinase (MAPK) and generation of reactive oxygen species (ROS) were assessed by western blotting and 2',7'-dichlorofluororescein diacetate staining, respectively. The effects of MAPK inhibitors or antioxidants (N-acetyl cysteine, apocynin, and rotenone) on aldosterone-induced EMT were evaluated. RESULTS: Aldosterone induced EMT in cultured HPMCs, and spironolactone blocked aldosterone-induced EMT. Aldosterone induced activation of both ERK1/2 and p38 MAPK from 1 hour. Either PD98059, an inhibitor of ERK1/2, or SB20358, an inhibitor of p38 MAPK, attenuated aldosterone-induced EMT. Aldosterone induced ROS in HPMCs from 5 minutes, and antioxidant treatment ameliorated aldosterone-induced EMT. N-acetyl cysteine and apocynin alleviated activation of ERK and p38 MAPK. CONCLUSION: Aldosterone induced EMT in HPMCs by acting through the mineralocorticoid receptor. Aldosterone-induced generation of ROS followed by activation of ERK, and p38 MAPK served as one of the mechanisms of aldosterone-induced EMT of HPMCs.
Actins ; Aldosterone* ; Antioxidants ; Blotting, Western ; Cadherins ; Cysteine ; Epithelial Cells ; Humans ; p38 Mitogen-Activated Protein Kinases ; Peritoneal Dialysis ; Peritoneal Fibrosis ; Peritoneum ; Phosphotransferases ; Protein Kinases ; Reactive Oxygen Species ; Receptors, Mineralocorticoid ; Renin-Angiotensin System ; Spironolactone

PURPOSE:The stenosis of vascular access for hemodialysis is caused by neointimal hyperplasia with the proliferation of vascular smooth muscle cells (SMC) as a prominent feature. C-reactive protein (CRP) is known to be produced in vascular SMC and can promote SMC proliferation. However, it is unclear of which factors regulate CRP production in neointimal hyperplasia. In the present study, we evaluated the factors affecting production of CRF in aortic SMC. METHODS:Human aortic SMC were cultured in a American type culture collection (ATCC) medium containing 10% FBS. Platelet-derived growth factor (PDGF) (10, 100 ng/mL), interferon-gamma(INF-gamma (1, 10, 100 ng/mL), hydroxymethylglutaryl-coA reductase inhibitor (lovastatin) (10 ?M/L) were added. After 72 hours, the level of CRP in SMC was measured by Western blot analysis and cell proliferation was assessed by MTT dye reduction assay. We used RT-PCR to observe PDGF receptor expression in SMC. RESULTS:Both INF-gammaand PDGF were found to stimulate CRP production and SMC proliferation. In contrast, lovastatin inhibited PDGF or INF-gammainduced CRP production and SMC proliferation. The expression of PDGF receptor-alphain aortic SMC was increased after treatment of 100 ng/mL of IFN-gamma CONCLUSION:SMC proliferation and CRP production in SMC are stimulated by PDGF or INF-gammaand inhibited by statin.
Acyl Coenzyme A ; Blotting, Western ; C-Reactive Protein ; Cell Proliferation ; Constriction, Pathologic ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hyperplasia ; Interferon-gamma ; Lovastatin ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Oxidoreductases ; Platelet-Derived Growth Factor ; Receptors, Platelet-Derived Growth Factor ; Renal Dialysis