BACKGROUND: Radiofrequency(RF) catheter ablation has rapidly emerged as the treatment of choice for symptomatic reentrant arrythmia associated with accessory pathway or atrioventricular node conduction. Rarely RF catheter ablation therapy can produce the cardiac perforation, ventricular function insufficiency and arrythmia. So, the purpose of this study was to determine the correlation between the RF energy and muscle injury. METHODS: Bovine skeletal muscle was immersed in normal saline, and the entire chamber was heated to 36-37degrees C by water bath. The 4mm tip 7 Fr electrode catheter was placed horizontally on the skeletal muscle surface withoup pressure. RF energy was delicered to tissue for the pulse duration of 10, 20, 30, 40, 50, 60 seconds and voltage of 10, 15, 20, 25, 30, 35, 40, 45volt and total 432 lesions were produced. Horizontal, vertical lesion diameters and depths were measured, and the area and volume of lesion were calculated. RESULTS: Increasing voltage and duration of RF increased the horizontal and vertical diameter, depth, area and volume of lesion(p<0.0001). The RF pulse duration and voltages made lesion below 5mm depth were 45volt applied dbelow 20seconds, 40volt applied below 25seconds, 35volt applied below 32seconds, 30volt applied below 38seconds, 25volt applied during any duation of time. CONCLUSION: So, for prevention of undesirable tissue damage, the adequate pulse duration and voltage of RF must to be delivered to tissue.
Arrhythmias, Cardiac ; Atrioventricular Node ; Baths ; Catheter Ablation ; Catheters ; Electrodes ; Hot Temperature ; Muscle, Skeletal* ; Ventricular Function ; Water

We report VEGF-induced angiogenic gene therapy in a patient with critical limb ischemia, who did not respond to conventional treatment. This patient was the first case in a dose-escalating series of phase I clinical trial. The patient had severe resting pain, gangrene and diffuse ulcer in his left foot. Total 1,000 micro gram of naked DNA encoding human VEGF165 was administered intramuscularly to 8 sites of the left lower extremity. Four weeks after the first 1,000 micro gram injection, a second 1,000 micro gram was administered to the same sites (total dose: 2,000 micro gram). After gene therapy, resting pain gradually reduced and the amount of analgesics taken by the patient decreased. The ischemic wound of lower extremity slightly improved. However, there was no complete wound healing at 12 weeks of treatment. Digital subtraction angiography at 12 weeks after gene therapy showed an increase in collateral vessels at the mid-tibial, ankle and foot arch levels. Immediately and up to 12 weeks, there was no complication related to gene therapy. These findings may be cautiously interpreted to indicate that intramuscular injection of naked plasmid DNA of VEGF165 may induce therapeutic angiogenesis in a patient with critical limb ischemia. Further clinical evaluation of VEGF-induced gene therapy is needed to evaluate the safety and efficiency of this treatment.
Analgesics ; Angiography, Digital Subtraction ; Ankle ; DNA ; Endothelial Growth Factors ; Extremities* ; Foot ; Gangrene ; Genetic Therapy* ; Humans ; Injections, Intramuscular ; Ischemia* ; Lower Extremity ; Peripheral Vascular Diseases ; Plasmids ; Ulcer ; Vascular Endothelial Growth Factor A* ; Wound Healing ; Wounds and Injuries

BACKGROUND: Glycemic variability is associated with the development of diabetic complications through the activation of oxidative stress. This study aimed to evaluate the effects of a dipeptidyl peptidase 4 inhibitor, vildagliptin, or a thiazolidinedione, pioglitazone, on glycemic variability and oxidative stress in patients with type 2 diabetes. METHODS: In this open label, randomised, active-controlled, pilot trial, individuals who were inadequately controlled with metformin monotherapy were assigned to either vildagliptin (50 mg twice daily, n=17) or pioglitazone (15 mg once daily, n=14) treatment groups for 16 weeks. Glycemic variability was assessed by calculating the mean amplitude of glycemic excursions (MAGE), which was obtained from continuous glucose monitoring. Urinary 8-iso prostaglandin F₂α, serum oxidised low density lipoprotein, and high-sensitivity C-reactive protein were used as markers of oxidative stress or inflammation. RESULTS: Both vildagliptin and pioglitazone significantly reduced glycated hemoglobin and mean plasma glucose levels during the 16-week treatment. Vildagliptin also significantly reduced the MAGE (from 93.8±38.0 to 70.8±19.2 mg/dL, P=0.046), and mean standard deviation of 24 hours glucose (from 38±17.3 to 27.7±6.9, P=0.026); however, pioglitazone did not, although the magnitude of decline was similar in both groups. Markers of oxidative stress or inflammation including urinary 8-iso prostaglandin F₂α did not change after treatment in both groups. CONCLUSION: In this 16-week treatment trial, vildagliptin, but not pioglitazone, reduced glycemic variability in individuals with type 2 diabetes who was inadequately controlled with metformin monotherapy, although a reduction of oxidative stress markers was not observed.
Blood Glucose ; C-Reactive Protein ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Dipeptidyl Peptidase 4 ; Dipeptidyl-Peptidase IV Inhibitors ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Inflammation ; Lipoproteins ; Metformin* ; Oxidative Stress* ; Pilot Projects* ; Thiazolidinediones

Leiomyosarcoma of the duodenum is an uncommon tumor and have not specific symptoms and signs, almost all cases of tumor were diagnosed in operating room. This tumor is generally firm, relatively well encapsulated, lobulated and often soft if they undergo hemorrhagic necrosis. Most authors emphasized the relative number of mitosis as the most reliable findings of leiomyosarcoma. Recently, we experienced a case of leiomyosarcoma of duodenum which was confirmed by operative and pathological diagnosis.
Diagnosis ; Duodenum* ; Leiomyosarcoma* ; Mitosis ; Necrosis ; Operating Rooms

Autoimmune insulin syndrome is characterized by a combination of fasting hypoglycemia, high total serum insulin concentrations, and the presence of autoantibodies to the native human insulin in serum. A healthy 69-year-old man developed spontaneous hypoglycemia after being given some medications for the common cold. His laboratory finding shows endogenous hyperinsulinism. Therefore, an insulinoma was suspected but the imaging study shows no mass lesion in the pancreas and the anti-insulin antibody titer was high(>100U/mL). He had no specific medication history except for a treatment of a current upper respiratory infection (URI). Among the URI medication, it was found that N-acetylcysteine contains a sulfhydryl group and could induce autoimmunization. The patient was treated with corticosteroid for 3 months. His anti-insulin antibody titer had decreased to normal level and has not shown any hypoglycemic episodes for more than one and a half years. We present this case with a review of relevant literature.
Acetylcysteine ; Aged ; Autoantibodies ; Common Cold ; Humans ; Hyperinsulinism ; Hypoglycemia ; Insulin Antibodies ; Insulin* ; Insulinoma ; Pancreas

BACKGROUND: Metabolic syndrome (MS) is characterized by insulin resistance accompanied by one or more of the following: obesity, hypertension, impaired glucose tolerance, low HDL cholesterol levels, and/or hypertriglyceridemia. However, the precise underlying pathogenic mechanism of MS is not known. Several recent reports have suggested a positive association between components of MS and markers of the acute-phase response, including C-reactive protein (CRP). These results imply that MS is accompanied by an ongoing inflammatory process. The purpose of our study was to evaluate the association between circulating levels of C-reactive protein, a sensitive systemic marker of inflammation, with components of metabolic syndrome in Korean adults. METHODS: A total of 1,461 subjects aged between 20 and 81 years, who visited the Health Management Center at Korea university between November 2000 and February 2001 were studied. We investigated the correlation between CRP levels and components of MS. The components of MS were categorized, and age-sex adjusted mean values of CRP calculated for the categorized components. The BMI was categorized into 5 classes, and the CRP levels examined according to their BMI class. In addition, subjects with a different number of the MS components were grouped as follows: group 1 for 0 components, group 2 for 1 components, group 3 for 2 components and group 4 for > or = 3 components, and the CRP levels calculated for each group. RESULTS: There were significant positive correlations of CRP levels with age, BMI, TG, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBS), uric acid, insulin,and homeostasis model assessment IR (HOMAIR). A significant inverse correlation was observed between CRP levels and serum HDL. From the multivariate analysis, age and BMI were significantly correlated with CRP levels. The means of the CRP for the categorized components of MS were significantly higher in the BMI categories: > or =25 for female/27 for male, TG > or =200 mg/dL, fasting plasma glucose > or =126 mg/dL and blood pressure > or =140/90 mmHg, and the CRP levels by BMI class were: 1.19 (BMI <18.5), 1.54 (BMI 18.5~22.9), 1.59 (BMI 23.0~24.9), 1.77 (BMI 25.0~29.9) and 2.07 (BMI >30.0) mg/L. Furthermore, the increase in the CRP levels in relation to the numbers of MS were 1.46 (group 1), 1.70 (group 2), 1.95 (group 3) and 2.11 mg/L (group 4) with statistical significance. CONCLUSION: The above data showed associations between the CRP levels and the different components of MS. This might suggest that MS in Koreans could be accompanied by a systemic inflammation response
Acute-Phase Reaction ; Adult* ; Blood Glucose ; Blood Pressure ; C-Reactive Protein ; Cholesterol, HDL ; Fasting ; Glucose ; Homeostasis ; Humans ; Hypertension ; Hypertriglyceridemia ; Inflammation ; Insulin Resistance ; Korea ; Male ; Multivariate Analysis ; Obesity ; Uric Acid

BACKGROUND: This study was designed to evaluate the clinical, endocrinological and histological characteristics of adrenal incidentalomas. METHODS: Eighty patients (41, males; 38, females; age range 17-80 years) who were diagnosed with adrenal incidentaloma at Korea University Hospital from 1992 to 2003 were studied retrospectively. RESULTS: Endocrinological investigation revealed 16 pheochromocytomas (20%), nine Cushing's syndromes (11%), eight primary aldosteronism (10%) and 46 non-functioning tumors (58%). Forty-four patients received operations, and biopsies were performed on two patients. Pathologic examination revealed 16 adrenocortical adenomas (20%), five carcinomas (6%), 13 pheochromocytomas (16%), three metastatic cancers (4%), and other tumors (10%). The diameter of the carcinomas (mean: 10.8 cm, range: 5-19 cm) were significantly larger than the diameter of benign adenomas (mean: 2.84 cm, range: 1-6 cm) (p=0.002). According to the receiver operating charactenstic (ROC) curve analysis, the cut-off value of tumor size for discriminate malignant tumor was 4.75 cm (sensitivity 90%, specificity 58%). Twenty-four patients with non-functioning tumors were followed up for a period of 3 to 72 months. During the follow up period, two patients showed an increase in tumor size of more than 1 cm, and one patient developed Cushing's syndrome. Changes in mass size and function were observed only between 10 and 26 months after the initial diagnosis. CONCLUSIONS: These data show that an endocrine evaluation should be performed in all adrenal incidentalomas, and an adrenalectomy is recommended for tumors 5 cm or greater or tumors with adrenocortical hyperfunction. In addition, these tumors should be monitored for changes in mass size and function for a follow up period of approximately 26 months.
Retrospective Studies ; Pheochromocytoma/diagnosis ; Middle Aged ; Male ; Korea ; *Incidental Findings ; Humans ; Female ; Carcinoma/diagnosis ; Aged, 80 and over ; Aged ; Adult ; Adrenocortical Adenoma/diagnosis ; Adrenal Gland Neoplasms/*diagnosis ; Adolescent

BACKGROUND: Pheochromocytoma may arise within the adrenal medulla, or in other locations where sympathetic ganglia or chromaffin tissues are known to exist. Approximately 0.1% of hypertensive patients have pheochromocytoma. Most of this hypertension can be cured by surgical removal of the tumor, but lethal complication can develop if proper treatment is not prepared. Therefore, accurate diagnosis and preoperative preparation is very important. The objective of this study was to evaluate the clinical characteristics of pheochromocytoma and the blood pressure change following tumor removal. METHOD: The medical records of 45 patients [29 cases of intra-adrenal, 16 cases of extra-adrenal (paraganglioma)] diagnosed with of pheochromocytoma at Korea University Medical Center between 1991 and 2001 were reviewed. RESULTS: Twenty of the cases were male and 25 were female. The mean age of these patients was 43 years old. Hypertension, headaches, palpitations and impaired glucose tolerance were observed more frequently in cases of intra-adrenal tumor than in those of extra-adrenal. In the extra-adrenal group, abdominal pain, hypertension and nausea were more frequently observed. A biochemical study showed that the sensitivity of the test for catecholamines and metabolites in 24 hours urine was over 80%. For the localization of tumors we used abdominal CT and MIBG. The sensitivities of the CT and MIBG for the tumor localization were 97 and 91%, respectively. Blood pressures during the operations were effectively controlled by preoperative treatment with phenoxybenzamine (non-competitive, non-selective -adrenoreceptor antagonists). CONCLUSION: Surgical treatment cured 23 of the 30 cases of hypertension with pheochromocytoma. We have to take careful approaches in the care of the patient who may have pheochromocytoma, due to the various clinical signs and symptoms.
3-Iodobenzylguanidine ; Abdominal Pain ; Academic Medical Centers ; Adrenal Medulla ; Adult ; Blood Pressure ; Catecholamines ; Diagnosis ; Female ; Ganglia, Sympathetic ; Glucose ; Headache ; Humans ; Hypertension ; Korea ; Male ; Medical Records ; Nausea ; Paraganglioma ; Phenoxybenzamine ; Pheochromocytoma* ; Tomography, X-Ray Computed