BACKGROUND: While the effects of excitatory amino acids have been characterized in the central nervous system, relatively little is known about their possible modulation of elements responsible for hyperalgesia within peripheral tissue. The purpose of this study was to investigate the role of excitatory amino acid receptors in mechanical hyperalgesia induced by a subcutaneous injection of Freund's complete adjuvant (FCA) into the rat hind paw. METHODS: Inflammations were induced by injecting FCA on the dorsal surface of the right hind paw of rats. Effects of excitatory aminoacid agonists or antagonists on mechanical hyperalgesia were investigated by a subcutaneous injection of a drug to the inflamed paw. Mechanical hyperalgesia was expressed as percent change in paw withdrawal threshold compared to baseline value that was measured before drug injection after inflammation was induced with FCA. RESULTS: In normal rats, an intraplantar (i.pl.) injection of L-glutamate, but not of D-glutamate (3 pmol/0.1 ml each) produced a mechanical hyperalgesia in the hind paw with a lowered paw paw-withdrawal threshold to pressure. In rats that developed the mechanical hyperalgesia associated with inflammation in the hind paw following an i.pl. injection of FCA (0.15 ml), the injection of a N-methyl-D-aspartate (NMDA) receptor antagonist, MK-801 (1 pmol/0.1 ml) into the inflamed paw increased the paw pressure threshold (24.24.6% increase from baseline, P < 0.05). On the other hand, the injection of a non-NMDA receptor antagonist, 6-cyano-7-nitroqiunoxaline-2,3-dione (CNQX, 10 pmol/0.1 ml) into the inflamed paw had no effect on the FCA-induced lowering of the paw pressure threshold. CONCLUSIONS: The results suggest that NMDA, but not non-NMDA receptors play a substantial role in mediating the development of mechanical hyperalgesia induced in the inflamed paw following an i.pl. FCA injection.
6-Cyano-7-nitroquinoxaline-2,3-dione ; Animals ; Central Nervous System ; Dizocilpine Maleate ; Excitatory Amino Acids ; Glutamic Acid ; Hand ; Hyperalgesia* ; Inflammation ; Injections, Subcutaneous ; N-Methylaspartate* ; Negotiating ; Rats* ; Receptors, Glutamate

We report a rare case of acute acalculous cholecystitis (ACC) caused by Salmonella enteritidis infection in a previously healthy 9-year-old boy. Salmonella enteritidis was isolated from stool and bile culture. The diagnosis of ACC was established upon clinical, laboratory, and ultrasonographic findings. The patient was successfully treated using percutaneous transhepaticcholecystic drainage (PTCCD) in combination with antibiotics therapy.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Bile ; Child ; Drainage ; Humans ; Salmonella ; Salmonella enteritidis

BACKGROUND: Restenosis remains as the major limitation of percutaneous translumainal coronary balloon angioplasty (PTCA). Although its mechanism remains incompletely understood, proliferative action of arterial smooth muscle cells has been found to play an important role on restenosis by neointimal formation after PTCA. Glycosaminoglycan-containing compounds, including Sulodexide (Vessel Due , ALFA, Wasserman, S.p.A, Italy), inhibit the proliferation and maigration of vascular smooth muscle cells in vitro. OBJECTIVES: This study was performed to assess the efficacy of Sulodexide, a glycosaminoglycan compound with antithrombotic and antiproliferative properties, in preventing restenosis after PTCA. METHOD: Two hundred eighty-four patients with ischemic heart disease were randomized to receive either the standard PTCA without Sulodexide in 144 patients (control group, M : F = 99 : 45, Age = 58 +9 or -9), 160 lesions or the standard PTCA with Sulodexide in 140 patients (treated group, M : F = 89 : 51, age = 58 +10 or -10), 158 lesions. Successful angioplasties were performed in 258 atheromatous coronary lesions in 224 patients for whom follow-up angiographic data were obtained 6 month later. Quantitative coronary angiographic analysis (QCA) was performed before , immediate after PTCA and 6-month later. Angiographic restenosis (>50% diameter stenosis at follow-up) was the primary end point : miniamal luminal diameter at follow-up angiogram was the secondary end point. RESULT: Successful PTCA was 97.6% and 97.5% in the standard PTCA with Sulodexide and the standard PTCA without Sulodexide, respectively. Although reference vessel size and minimal luminal diamater after PTCA were larger in the control group than in the Sulodexide group(2.94+0.11 or-0.11 vs 2.83+0.13 or -0.13 mm and 2.26+0.12 or -0.12 vs 2.18+0.08 or -0.08 mm, respectively, p=NS), there was a increased tendency of minimal lumen diameter at 6 months angiogram in the Sulidexide group than in the control group (1.12+0.50 or -0.50 vs 1.07 + 0.53 or -0.53 mm, respectively, p=NS). Angiographic restenosis occured in 42% of lesions in the Sulodexide group and 52% of the control group (p=NS). CONCLUSIONS: Sulodexide treatment had a tendency to reduce restenosis rate in 6 months after coronary angioplasty. However, further study is necessary to verify the antiproliferative effect of Sulodexide with much larger number of patients.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Muscle, Smooth, Vascular ; Myocardial Ischemia ; Myocytes, Smooth Muscle ; Phenobarbital ; Prospective Studies*

No abstract available.

BACKGROUND: In patients with variant angina, previous data have been inconclusive as to whether basal coronary artery tone is elevated at the spastic sites and nonspastic sites. The purpose of this study was to assess the basal coronary artery tone and to evaluate the responsiveness to acetylcholine and ergonovine in patients with variant angina. METHODS: Basal coronary artery tone was assessed by obtaining the percent increase in coronary artery diameter induced by nitroglycerin in 66 patients with variant angina and 26 control subjects. We also compared the basal coronary tone and the constrictive responses to acetylcholine and ergonovine between the 31 patients with variant angina whom spasm was provoked by the low doses of acetylcholine(Ach; intracoronary, 20microg) or ergonovine(Erg; intravenous, 50microg)(Group 1) and the 35 patients provoked by higher doses of acetylcholine(intracoronary, 100microg) or ergonovine(intravenous cumulative dose of 350microg)(Group 2). RESULTS: Patients with variant angina whom spasm was provoked by low doses of acetylcoline and ergonovine, have a more tendency of combine fixed disease(mix disease), multivessel spasm and high disease activity. Basal coronary artery tone at the spastic sites was significantly elevated in the Group 1 in whom spasm was provoked by low doses of acetycholine and ergonovine than that in Group 2(44+/-17 vs 13+/-11%, respectively, p<0.05). Basal coronary artery tone of spasm-related artery, but not nonspasm related artery, at the non spastic site was greater in the Group 1 than that in Group 2 (26+/-14 vs 16+/-10%, respectively, p<0.05). In the patients with variant angina in whom spasm was provoked by higher dose of acetylcholine or ergonovine, basal coronary artery was comparable at the spastic and nonspastic sites and was not different from that in the control subjects. The magnitude of vasoconstrictive responses to acetylcoline and ergonovine, at the nonspastic sites, were also greater in Group 1 than those in Group 2 and the control groups(Ach; 40+/-20 vs 26+/-11. 27+/-12% : Erg ; 37+/-18 vs 12+/-8, 13+/-10%, respectively, p<0.05). CONCLUSION: These findings suggest that elevated basal coronary artery tone of the spastic sites and nonspastic sites of spasm-related artery in patients with variant angina may be related to occurrence of coronary spasm.
Acetylcholine* ; Arteries ; Coronary Vessels* ; Ergonovine* ; Humans ; Muscle Spasticity ; Nitroglycerin ; Spasm*

Aortic intramural hematoma(AIH) is known as a variant of acute dissection due to rupture of the vasa vasorum without a intimal tear. In elderly hypertension patients patients with aortic dissection but without the characteristic echocardiographic findings of a double-channel aorta, this disease entity should be suspected and attention should be given to find segmental wall thickening of the aorta >0.7cm. AIH may progress to typical dissection or to rupture in considerable number of the patients, so careful follow-up is necessary and the same management principles for the patients with dissection can be applied in this variant. We report two cases of AIH showing typical eccentric mural thickening without dissection membrane with transesophageal echocardiographic follow-up.
Aged ; Aorta ; Echocardiography ; Echocardiography, Transesophageal* ; Follow-Up Studies ; Hematoma* ; Humans ; Hypertension ; Membranes ; Rupture ; Vasa Vasorum

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) has been broaden in reccent years. However,we considered many aspects in performing angioplasty in patient with multivessel disease. There were procedural success rate, complication, risk, restenosis and long-term effect. So we evaluated the initial success rate, safety and follow-up results. METHODS: To assess the likelihood of initial success in patients with multivessel coronary artery disease, single or multiple site angioplasy were performed at 449 lesions from 273 patients(Male 202,Female 71, Mean age 60.0+/-9.4 years). To evaluate the restenosis rate of angioplasty in multivessel disease, follow-up coronary angiogram were performed at 164 lesions from 95 patients at average 6months after angioplasty. RESULTS: The extent of coronary artery disease revealed that two vessel disease were 200(73.3%) and triple vessel disease were 73(26.7%). Single vessel angioplasty(SVA) was performed in 180(40.1%) lesions and multivessel angioplasty(MVA) was performed in 269(59.9%) lesions. Procedural success was achieved 377(84.0%) out of total 449 lesions. The proccdural success rate was 81.1% in SVA and 85.9% in MVA. According to major epicardial coronary artery, procedural success rate of left anterior descending artery was 82.0%, left circumflex artery 92.4% and right coronary artery 79.4%. According to angiographic morphology of lesions, procedural success rate of type A was 95.7%, type B 88.9% and type C 56.4%. Complete revascularization was done in 87 patients(31.9%) out of 273 patients. Major cause of failure of angioplasty in multivessel disease was inability to pass the guide wire cross the lesion due to total occlusion. Complications included dissection in 101, acute closure in 7(9.7%), coronary artery perforation in 2, cardiogenic shock in 1 and ventricular fibrillation in 1. Follow-up coronary angiography revealed the restenosis rate was 42.2%. CONCLUSION: Coronary angioplasty in selected patients with multivessel coronary artery disease might be useful and have relatively good immediate and long-term results.
Angioplasty* ; Arteries ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Shock, Cardiogenic ; Ventricular Fibrillation

We report on 4 cases with a unilateral single ectopic ureter associated with ipsilateral dysplastic or hypoplastic kidney and the usefulness of preoperative magnetic resonance(MR) urography in revealing the ureteral course and detecting the insertion site of ectopic ureter. Among two cases of unilateral single ectopic ureter associated with dysplastic kidney, one drains into the seminal vesicle and the other drains into the urethra. The other two cases have unilateral single ectopic ureter associated with hypoplastic kidney that drain into the vagina. In all cases, MR urography shows the ureteral course and insertion site of ectopic ureter regardless of the renal function. We believe that MR urograhy is a useful technique for the diagnosis of unilateral single ectopic ureter associated with hypofunctioning kidney.
Child* ; Diagnosis ; Humans ; Kidney* ; Seminal Vesicles ; Ureter* ; Urethra ; Urography* ; Vagina

BACKGROUND: Detection of left ventricular regional wall motion abnormality(RWMA) by 2 dimensional echocardiography during ergonovine provocation(Erg Echo) can be used for noninvasive diagnosis of coronary vasospasm(CVS). The aim of this study was to test the safety and diagnostic validity of Erg Echo as a screening test in patients with chest pain syndromes before coronary angiography was undertaken. METHODS: From Mar 1993 to Jun 1994, Erg Echo was performed in 80 consecutive patients (56 males) with chest pain syndromes suggestive of variant angina, after the confirmation of negative treadmill or normal stress myocardial perfusion scan using thallium 201. A bolus of ergonovine maleate was injectedd at 5min intervals up to total cumulative dosage of 0.35mg with echocardiographic montioring of the left ventricular wall motion. Twelve leads ECG was also recorded every 3min after each ergonovine injection. The positive criteria of the test was transient ST segment clevation or depression greater than 0.1mV in 12-leads ECG or development of RWMA. Coronary angiography was undertaken 2(+/-4) days after Erg Echo, and spasm provocation test with acetylcholine, or ergonovine was done in case of normal angiogram or luminal narrowing of less than 70%. The appearance of total or subtotal occlusion of a major coroary artery associated with ST segment elevation or depression on the ECG or chest pain, or both, was considered to be a manifestation of spasm. RESULTS: According to the invasive angiographic criteria, 56 patients revealed CVS ; CVS was ruled oup in 19 patients showing near normal angiogram with negative spasm provocation test and in 5 patients with restion high degree fixed stenosis(luminal narrowing of 97+/-4%). Erg Echo could diagnose CVS before the angiography with the sensitivity of 91%(51/56,95% confidence interval [CI] ; 84-98%) and the specificity of 88%(21/24,95% CI ; 75-100%). Of 53 patients showing RWMA in Erg Echo, 42%(22/53) revealed no significant changes in the simultaneously recorded ECG and characteristic ST elevation was recorded in only 38%(20/53). There was no case of myocardial infarction or fatal arrhythmia during Erg Echo. CONCLUSION: Erg Echo befor the coronary angiography is safe and can e utilized as a reliable diagnostic screening test of CVS in patients with negative tradmill or normal stess myocardial perfusion scan, This finding suggests that invasive coronary angiography can be avioded in selected patients for the diagnosis of vasospastic angina.
Acetylcholine ; Angiography ; Arrhythmias, Cardiac ; Arteries ; Chest Pain ; Coronary Angiography* ; Coronary Vasospasm* ; Depression ; Diagnosis* ; Echocardiography* ; Electrocardiography ; Ergonovine* ; Humans ; Mass Screening ; Myocardial Infarction ; Perfusion ; Phenobarbital ; Sensitivity and Specificity ; Spasm ; Thallium

BACKGOUND: When ischemia reduces blood supply, hypothermia remains the sine qua non for reducing demand. An alternative to whole body deep hypothermia is an isolated cerebral hypothermia via perfusion of cooled blood through one internal carotid artery. The goal of this study was to evaluate the effect of isolated cold hemisphere perfusion during the cerebral ischemia on the formation of brain edema. METHODS: The studies were designed to perfuse a saline solution into both carotid arteries with a different temperature (left 15degreesC, right 38degreesC) in the same animal. Cerebral ischemia was produced by a combination of the both carotid artery saline perfusion and systemic hypotension to a mean arterial blood pressure of 40 mmHg for 10 minutes. Ninety minutes after reperfusion, brain water contents were measured using the kerosene/bromobenzene density gradient and compared with warm saline perfusion and normal control group. RESULTS: Brain water content of cold saline perfusion hemisphere measured at 90 minutes after ischemia showed decreased water content compared to warm saline perfusion hemisphere (p<0.05). CONCLUSIONS: Cerebral cold saline perfusion during the ischemia decreased the formation of brain edema. These results showed hypothemia is one of the most effective ways to protect brain from the ischemia.
Animals ; Arterial Pressure ; Brain Edema* ; Brain Ischemia ; Brain* ; Carotid Arteries ; Carotid Artery, Internal ; Edema ; Hypotension ; Hypothermia* ; Ischemia* ; Perfusion ; Reperfusion ; Sodium Chloride