BACKGROUND: Vascular endothelial dysfunction (VED) plays a pivotal role in the pathogenesis of atherosclerosis and is associated with insulin resistance and with visceral obesity. Therefore, in this study the predicting factor of vascular endothelial dysfunction was investigated in healthy premenopausal obese women by pulse-wave analysis (PWA) combined with provocative pharmacological testing. METHODS: Thirty three obese women (BMI> or =25), aged 20~45 y and 25 age-matched control subjects (BMI; 18.5~22.9) were examined. All women were sedentary (<1 hr/wk of physical activity), non-smoker and were excluded if they had type 2 diabetes melitus, hypertension, hyperlipidemia, cardiovascular disease, or acute inflammatory disease and were studied in folicullar phase of the cycle, within the first week after cessation of menstrual bleeding. They underwent determination of anthropometric measurements, metabolic variables, adipose tissue regional distribution, and endothelial function by performing pulse-wave analysis (PWA) combined with provocative pharmacological testing. RESULTS: Augmentation Index (AIx) fell significantly after the administration of salbutamol, which causes endothelium-dependent vasodilatation, but response was significantly reduced in obese women compared with controls (10.28 6.72% vs 17.2 6.84%, P=0.0003). The change in after Nitroglycerin, which causes endothelium-independent vasodilatation, did not differ significantly (30.86 9.67% vs 30.6 10.11%, P=0.9172). In our obese subjects, visceral adipose tissue area was independently a significant predictor of vascular endothelial dysfunction (beta= 0.1381, P=0.0038, Adj-R2=0.348). CONCLUSION: Increased abdominal adiposity is a powerful independent predictor of VED in obese healthy women. Future studies of vascular endothelial function should account for the independent effects of abdominal fat.
Abdominal Fat ; Adipose Tissue ; Adiposity ; Albuterol ; Atherosclerosis ; Cardiovascular Diseases ; Female ; Hemorrhage ; Humans ; Hyperlipidemias ; Hypertension ; Insulin Resistance ; Intra-Abdominal Fat ; Nitroglycerin ; Obesity, Abdominal ; Vasodilation

BACKGROUND: Propranolol, a beta-blocker and well known anti-hypertensive medication, has been used as the first-line therapy for pediatric hemangioma since 2010. The objective of this study is to analyze the efficacy and safety of propranolol when used to treat pediatric hemangioma patients for one year or longer in a single institution.METHODS: A retrospective chart review analysis was done of 65 pediatric hemangioma patients treated with oral propranolol as the first-line therapy from 2010 to 2016. The patients were examined regularly at an interval of 1 to 2 months for changes in hemangioma size, growth and development, and occurrence of acute side effects of propranolol such as hypotension, hypoglycemia and bronchial constriction.RESULTS: Twenty patients were treated with propranolol for a year or longer and their median age was 202 days (range, 36 to 4,284 days) and mean duration of treatment was 22.5 months (range, 12 to 49 months). At 12 months of treatment, the average percentage of size decrement was 40.5%. When the weight and height percentile were compared between at diagnosis and 12 months post-treatment, all 20 patients showed normal growth curve and development. Patients did not show any acute side effects of propranolol during 12 months of treatment. One patient experienced hypoglycemia induced seizure, but this event was subsequently diagnosed as ketotic hypoglycemia induced from prolonged fasting.CONCLUSION: Propranolol was effective and well tolerated in children with hemangioma when used for one year or longer.
Bronchoconstriction ; Child ; Diagnosis ; Fasting ; Growth and Development ; Hemangioma ; Humans ; Hypoglycemia ; Hypotension ; Propranolol ; Retrospective Studies ; Seizures

Lowe syndrome is a rare genetic disease that appears to cause various clinical symptoms involving the eye, nervous system, and kidney. While a mutation of the OCRL1 gene is known to be responsible for this syndrome, the exact pathophysiology remains unclear. Various multi-organ symptoms are characteristic of Lowe syndrome, but skin lesions have rarely been described. Recently, mechanisms for the association of Lowe syndrome and skin lesions have been proposed. We report this case of Lowe syndrome involving multiple epidermal cysts on the scalp in a 6-year-old male child.
Child ; Epidermal Cyst ; Eye ; Humans ; Kidney ; Male ; Nervous System ; Oculocerebrorenal Syndrome ; Scalp ; Skin

INTRODUCTION: Protamine reversal of heparin anticoagulation often produces profound hypotension. However, the precise mechanisms of its hypotensive effect have not been fully elucidated. Using a canine model, we explored the effects of cyclo-oxygenase inhibitor, indomethacin (INDO), and nitric oxide synthetase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) either alone or both on the cardiopulmonary responses to protamine. METHODS: Fifty-four mongrel dogs in five groups were studied during 1.5% halothane anesthesia. GroupI (n=17) received heparin (300 IU/kg iv) followed by protamine (3 mg/kg iv over 30 s) 5 min after the heparin. The same protocol were used in groups II (n=11), III (n=12), and IV (n=7), except that L-NAME (20 mg/kg), INDO (10 mg/kg), and INDO (10 mg/kg) plus L-NAME (10 mg/kg) were infused over 10 min beginning 30 min before the protamine injection, respectively. Animals in group V (n=7) were given protamine (3 mg/kg) alone. Mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), left ventricular end-diastolic pressure (LVEDP), LVdP/dt and cardiac output and left circumflex coronary flow (LCX flow) via Doppler flowmeter and heart rate were continuously recorded in baseline conditions and up to 15 min. Plasma NOx (NO2-, NO3-) levels were also measured before (baseline) and 3, 5, 10, and 15 min after protamine injection. RESULTS: In group I, protamine caused immediate but transient decreases of MAP (41%), cardiac index (CI, 58%), dP/dt (28%), and LVEDP (62%) and increases of MPAP (38%) and systemic and pulmonary vascular resistance indices (SVRI, 30%; PVRI, 316%). INDO significantly attenuated the hemodynamic responses to protamine, whereas L-NAME did not affect them at all. INDO plus L-NAME prevented protamine-induced hypotension, but CI (-24%) and LVEDP (-30%) showed similar changes as those in group II. Protamine increased MPAP but inconsistently, meanwhile no correlation was found between the magnitude of increase of MPAP and decrease of MAP at peak responses in groups I-IV. LCX flow increased significantly (124~188%) immediately after protamine infusion without any changes in plasma NOx levels in groups I-IV. Neither significant hemodynamic effects nor NOx release was found in animals given protamine alone. CONCLUSION: Protamine in the presence of heparin induces profound hypotension which may be mediated by a prostanoid and other potent vasodilators. In addition, increase of PAP and NO release may not play a significant role in the protamine-induced hypotension.
Anesthesia ; Animals ; Arterial Pressure ; Cardiac Output ; Dogs* ; Flowmeters ; Halothane ; Heart Rate ; Hemodynamics ; Heparin ; Hypotension* ; Indomethacin ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Plasma ; Prostaglandin-Endoperoxide Synthases ; Protamines* ; Vascular Resistance ; Vasodilator Agents

The effects of acidosis and alkalosis on vascular smooth muscle contractions were studied. Ring segments(3-4 mm in length) of rabbit abdominal aorta and pulmonary artery were mounted in the tissue bath(for respiratory study) and superfusion device(for metabolic study) for isometric tension recording. Respiratory acidosis and alkalosis were obtained by increasing and lowering the PCO2(80 and 15 mmHg, respectively). Metabolic acidosis and alkalosis were obtained by lowering and increasing the HCO3 concentration(12 and 50 mEq/l, respectively). After precontraction with norepinephrine(10-7 M), Vessels were exposed to acidosis and alkalosis for 30 minutes. The study was done with and without endothelium. The mechanism of vasorelaxation and vasoconstriction were confirmed with Ca2+ activated K+ channel blocker and Ca2+ free Krebs solution. The results were as follows: 1) Respiratory and metabolic acidosis induced significant vasorelaxation in both group of abdominal aorta and pulmonary artery(p<0.05). In endothelium intact group, vasorelaxation was greater than endothelium removed group. especially in respiratory acidosis was statistically significant(p<0.05). 2) Respiratory and metabolic alkalosis induced significant vasoconstriction in both group of abdominal aorta and pulmonary artery(p<0.05). In endothelium intact group, vasoconstriction was lesser than endothelium removed group, but was not statistically significant. 3) Acidosis induced vasorelaxation was blocked by tetraethylammonium(TEA). 4) Alkalosis induced vasoconstriction was blocked by Ca2+ free Krebs solution. These results suggested that: 1) Acidosis induced vasorelaxation. 2) alkalosis induced vasoconstriction 3) Vasorelaxation during acidosis was induced by K+ efflux through the Ca2+ activated K' channel. 4) Vasoconstriction during alkalosis was induced by Ca2+ influx.
Acid-Base Equilibrium* ; Acidosis ; Acidosis, Respiratory ; Alkalosis ; Aorta, Abdominal ; Endothelium ; Muscle, Smooth, Vascular ; Pulmonary Artery ; Vasoconstriction ; Vasodilation

BACKGROUND: Recently, the diagnosis of non-alcoholic fatty liver disease (NAFLD) has been made more frequently, as the use of ultrasonography on health screening has been on the rise. The aim of this study was to elucidate the relationship between NAFLD and the metabolic syndrome defined by NCEP-ATP III criteria. METHODS: A total of 1,675 subjects, who attended for routine physical check?ups, were screened. Among those, 401 subjects were selected after excluding the subjects with either significant alcohol consumption, evidence of viral or toxic hepatitis, significant liver or renal dysfunction, or overt thyroid disease. NAFLD was diagnosed if the subjects had a "bright liver" on ultrasonographic examination. The diagnosis of metabolic syndrome was made according to the criteria of NCEP-ATP III established in 2001. RESULTS: The prevalence of NAFLD was 27.2%. Blood pressure, body weight, body mass index, waist circumference, and serum levels of total cholesterol, triglyceride, fasting glucose and liver enzymes were higher among the subjects with NAFLD than the control. The prevalence of obesity, IFG/DM, dyslipidemia and hypertension was higher in the NAFLD group. The prevalence of the metabolic syndrome was 19.2%, which was higher in the NAFLD group than the control group. The odds ratio of NAFLD for the metabolic syndrome was 6.458 (95% C.I. 3.178~13.124). CONCLUSION: NAFLD was closely associated with the metabolic syndrome regardless of the presence of obesity.
Alcohol Drinking ; Blood Pressure ; Body Mass Index ; Body Weight ; Cholesterol ; Diagnosis ; Drug-Induced Liver Injury ; Dyslipidemias ; Fasting ; Fatty Liver* ; Glucose ; Hypertension ; Liver ; Mass Screening ; Obesity ; Odds Ratio ; Prevalence ; Thyroid Diseases ; Triglycerides ; Ultrasonography ; Waist Circumference

PURPOSE: In this study, we aimed to review the clinical presentation of preterm infants with gastrointestinal perforations and compare the clinical features of gastric perforation with other intestinal perforations. METHODS: The medical records of preterm neonates with pneumoperitoneum, admitted to the neonatal intensive care unit (NICU) between January 1994 and December 2013, were retrospectively reviewed. RESULTS: Twenty-one preterm infants underwent exploratory laparotomy to investigate the cause of the pneumoperitoneum. The sample consisted of five patients (23.8%) with gastric perforation and 16 patients (76.2%) with intestinal perforation. No statistical differences were found in the birth history and other perinatal factors between the two groups. Underlying necrotizing enterocolitis, bilious vomiting, and paralytic ileus preceding the perforation were statistically more common in the intestinal perforation group. All preterm infants with gastric perforation survived to discharge; however, six preterm infants with intestinal perforation expired during treatment in the NICU. In the gastric perforation group, sudden pneumoperitoneum was the most common finding, and the mean age at diagnosis was 4.4+/-1.7 days of life. The location and size of the perforations varied, and simple closure or partial gastrectomy was performed. CONCLUSION: Patients with gastric perforation did not have a common clinical finding preceding the perforation diagnosis. Although mortality in previous studies was high, all patients survived to discharge in the present study. When a preterm infant aged less than one week presents with sudden abdominal distension and pneumoperitoneum, gastric perforation should first be excluded. Prompt exploratory laparotomy will increase the survival rates of these infants.
Diagnosis ; Enterocolitis, Necrotizing ; Gastrectomy ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Intestinal Perforation ; Intestinal Pseudo-Obstruction ; Laparotomy ; Medical Records ; Mortality ; Pneumoperitoneum ; Reproductive History ; Retrospective Studies ; Stomach Rupture ; Survival Rate ; Vomiting

PURPOSE: The in vitro dissolution of intrahepatic stones was evaluated using the various solvent mixtures. MATERIALS AND METHODS: Sixty four intrahepatic stones from 16 patients were used. Four kinds of solvent mixtures(No. 1 = basic buffer + EDTA, No. 2=1 + Sulfobetain-12, No. 3=2 + N-acetylcysteine, No. 4=3 + urea) were used. Dissolution rates were determined by measuring the weight loss of stones after 6, 12, 24, 48 hours incubation periods, respectively. RESULTS: The highest dissolution rates in dissolving intrahepatic stones were achieved with No. 4 solvent mixture(1% W/V EDTA/80mM, Sulfobetain-12/1 M, urea, pH 9.5). CONCLUSION: lntrahepatic stones could be largely dissolved up to about 70% of their initial weight after 48 hours incubation period in vitro.
Acetylcysteine ; Edetic Acid ; Humans ; Hydrogen-Ion Concentration ; Urea ; Weight Loss

STUDY DESIGN: There is a prospective study of 80 Sprague-Dawley rats which were made at the spinal cord lesion T5/6 level, sparing only one ventral quadrant. We monitered medullary reticulospinal neurons(RtN) evoked potentials at the L2/3 level which laminectomy was performed. OBJECTIVE: to investigate changes in the physiological responses of motor neurons to stimulation of the medullary reticular formation following partial spinal cord lesions sparing only the ventral quadrant. SUMMERY AND BACK GROUND DATA: There were many report that the animals with spinal cord lesion recovered well-coordi-nated fourlimb locomotion within 2-3 weeks. The time course of the functional recovery of this hindlimb locomotion was cor-related with the recovery of motor evoked potentials(MEP), which originate from reticular nuclei. Therefore, it was hypothe-sized that the return of locomotor function after incomplete spinal cord injury may partially rely on the reorganization of descending inputs to ventral horn neurons previously occupied by damaged afferents. MATERIALS AND METHODS: Total 80 Sprague-Dawley rats were used in this study. Under sterile conditions, spinal cord lesions were made at the T5/6 level using a No. 11 blade, sparing only one ventral quadrant. The animals allowed to survive from one day to 61 days. To monitor RtN evoked potentials, laminectomies were performed at L2/3 level. Field potentials were recorded using a glass microelectrode filled with 2 M NaCl(1.5-2.0 M Ohm). Cord dorsum potentials were also epidurally monitored at L2/3 using a pair of teflon-coated wires. The gigantocellular reticular nucleus ipsilateral to the spared ventral cord was stimulated using a monopolar tungsten microelectrode. RESULTS: The field potentials generated in the ventral horn of the lumbar cord were recorded bilaterally. In some animals field potentials were monitored just before and right after the spinal cord lesion. 1) Following spinal cord lesion at T5/6, the amplitude of RtN evoked potentials declined significantly in the L2/3 ventral gray matter of the completely lesioned side. Field potentials monitored below the ipsilaterally spared ventral quadrant remained unchanged. Depressed RtN evoked potentials in the ventral cord gradually increased during the next four weeks, and finally reached greater than 4 times of the amplitude monitored on the contralateral side. 2) The sites in which field potentials could be monitored in the lumbar spinal cord were mapped. In normal rats, the largest field was monitored near the ventral margin of the gray matter. On the other hand, in spinal cord injured ani-mals, the largest field potentials were located in more dorsal aspects of the ventral horn, suggesting a structural reorganization of the descending inputs has taken place. CONCLUSION: The RtN evoked potentials in the ventral horn increased gradually for several weeks after the injury. The returned RtN evoked potentials below the completely lesioned side of spinal cord were larger than those seen in normal spinal cord. The time course of returning evoked potentials below the lesioned side of the spinal cord seems to coincide with the resti-tution of same-side hindlimb locomotion.
Animals ; Anterior Horn Cells ; Evoked Potentials ; Evoked Potentials, Motor* ; Glass ; Hand ; Hindlimb ; Horns ; Laminectomy ; Locomotion ; Microelectrodes ; Motor Neurons ; Neurons* ; Prospective Studies ; Rats* ; Rats, Sprague-Dawley ; Reticular Formation ; Spinal Cord Injuries* ; Spinal Cord* ; Tungsten

BACKGROUND: Means to measure death anxiety, death depression and sense of symbolic immortality with approved validity and reliability does not yet exist in Korea. METHODS: Existing English questionnaires such as Templer Death Anxiety Scale (TDAS), Death Depression Scale (DDS), Sense of Symbolic Immortaligy Scale (SSIS) were translated into Korean by 5 translators, and then reviewed by 3 non-participants of translation for collegial summary and this summary was counter-translated again by another 2 non-participants. Another 3 non-participants of translation and counter-translation were chosen to examine the two sentences of each item. Then reexamination was done by retranslating and counter-translating the parts with errors. Aftr pretest on ordinary people. the completed questionnaires were given to medical students, residents and nurses of a university hospital. Pastors and missionaries were selected as comparison group. RESULTS: Kuder-Richardson or Cronbach-alpha that represent internal consistency of TDAS, DDS and SSIs was 0.69, 0.84 and 0.78. The three sentences that lowered internal consistency of SSIS was deleted. BDI and DDS showed a positive correlation (0.32, P=0.02), suggesting proved construct validity. Correlation coefficient that proves construct validity of TDAS and DDS was 0.54 (P<0.01), of SSIS and TDAS -0.23(P=0.04), of SSIS and DDS -0.29(P=0.01). The TDAS and DDS(P<0.01), DDS and BDI(P=0.02) have shown a positive correlation were shown. There was significant difference in the score of SSIS(P<0.01). The same results in cases where the 3 sentences was deleted. CONCLUSION: Korean versions of TDAS, DDS and SSIS were reliable and valid.
Anxiety* ; Attitude to Death ; Depression* ; Humans ; Korea ; Missions and Missionaries ; Reproducibility of Results* ; Students, Medical ; Surveys and Questionnaires