BACKGROUND: Intracellular calcium overload is a common final feature of the ischemic-reperfused heart and mediates the genesis of irreversible cell damage. Reactive oxygen medabolites have been known to play and important role as toxic mediators in myocardial injuries resulting from ischemia and reperfusion. In order to investigate the mechanism of intracellular calcium accumulation in the ischemic-reperfused myocardium, the present study observed the possible contribution of the reactive oxygen metabolite to the calcium transport of cardiac mitochondria. METHODS: Mitochondrial were isolated from rabbit hearts. The effects of a reactive oxygen metabolite, H2O2 on calcium uptake and release, redox states of endogenous pyridine nucleotides and glutathiones of mitochondria respiring with succinate were observed. Calcium uptake and release were monitored by dual-wave length spectrophotometer using a calcium indicator, arsenaze III. Contents and redox states of pyridine nucleotides and glutathiones were measured by enzymatic methods using spectrofluorometer and HPLC. RESULTS: Hydrogen peroxide(10-500microM) promoted calcium release dose-dependently from CA++-preloaded mitochondria, but did not affect the mitochondrial calcium uptake. The H2O2-induced calcium release was accompanied by simultaneous oxidation of the pyridine nucleotides and decrease in the content of the reduced form of glutathione(GSH). When mitochondria were treated with BCNU(N,N=bis(2-chloroethyl)-N-nitrosourea) to inhibit glutathione reductase and so as to reduce the GSH content, there were no increase in calcium release from the mitochondria. These results may indicate that H2O2 increases the permeability of cardiac mitochondrial membrane to calcium in association with the changes in redox state of endogenous pyridine nucleotides, but not with that of glutathiones. CONCLUSION: It is suggested that the reactive oxygen metabolites induce the release of calcium from mitochondria by altering the redox state of pyridine nucleotides, and it may partly be involved in the elevation of cytosolic calcium concentration in the ischemic-reperfused myocardial cells.
Calcium* ; Chromatography, High Pressure Liquid ; Cytosol ; Glutathione Reductase ; Heart ; Hydrogen ; Ischemia ; Mitochondria* ; Mitochondrial Membranes ; Myocardium ; Nucleotides ; Oxidation-Reduction ; Oxygen* ; Permeability ; Reperfusion ; Succinic Acid

Three children with osteogenesis imperfecta who were treated with fragmentation, realignment and intramedullary rod fixation (Sofield and Millar, 1959) have been followed up for considerable period. Repeated fractures in other sites as well as deformities occurred in overgrown part as the children grew up necessitated further operations of same kind. However, level of activity afterwards was found very much enhanced by the operations in general.
Child ; Congenital Abnormalities ; Humans ; Osteogenesis Imperfecta ; Osteogenesis

No abstract available.
Female ; Fibronectins* ; Hypertension, Pregnancy-Induced* ; Plasma* ; Pregnancy*

The Schatzki ring, a submucosal fibrotic thickening of the lower esophagus, occurs at the squamocolumnar junction and is invariably associated with an esophageal histal hernia The ring is discrete narrowing covered with squamous epithelium on its superior aspect and columnar epithelium on its inferior aspect, with various degrees of submucosal fibrosis supporting the annulair ring. Symptoms, when present, are generally those of distal esophageal obstruction to the passage of solids and highly associated with ring diameter. The pathogenesis and etlology are obscure. But one theory suggests that they are caused by gastroesophageal reflux. The vast maiority of symptomatic Schatzki rings sre ameneble to dilation, a few patients will require surgical antireflux measures after dilatation. We have experienced a case of Schatzki ring associated with reflux esophagitis and esophageal hiatal hernia by the esophagogram after barium swallowing and endoscopy. So we report this case with brief review of the previous literatures.
Barium ; Carcinosarcoma ; Deglutition ; Dilatation ; Endoscopy ; Epithelium ; Esophageal Neoplasms ; Esophagitis, Peptic* ; Esophagus* ; Fibrosis ; Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal* ; Humans

Recent immunological investigations have demonstrated that the patients with psoriasis have various humoral and cellular immune abnormalities, such as increased serum IgG, IgE and secretory IgA, anti-IgC factor in psoriatic lesions, in peripheral blood lymphocytes and in serum, rhumatoid-like factors in IgA and IgG classes of immunoglobulins, antinuclear antibodies (ANA; reacting with the basal cell nuclei of uninvolved skin., anti-stratum corneum antibody and complements in psoriatic scales, immuoglobulin and complement bearing polymorphonuclear leucocytes in the Muro microabscess. These abnormal findings are enough to suggest an autoimmune mechanism in the pathogenesis of psoriasis. Several investigators have also reported the results of T cell enumeration in the peripheral blood in psoriatic patients. However, the results are not in general agreement,. Thee present study was undertaken to clarify any abnormality in the proportion of T cells in the peripheral blood in psoriatic patients. Forty-one patients with active psoriasis registered at the Department of Dermatology, Seoul National University Hospital entered this study from May, 1979 through April, 1980. Twelve healthy medical and paramedical personel the comprised the control group. Active and total T cells were enumerated by the method of E-rosetting technique, and the results were as follows. 1, in normal controls, the active and total T celIs identified as E rosetteforming cells accounted for 61.6+7.4% and 68.1+8.9% of the total lymphocyte population, respectively. 2. In patients with psoriasis, significant decrease of active T cells (54. 2,+11.0%,p<0.005) and total T cells (62.2+11.2%, p<0.05) was observed. More profound reduction of T cells was noted in patients with wide spread psoriasis than those with limited extent.
Antibodies, Antinuclear ; Cell Nucleus ; Complement System Proteins ; Dermatology ; Humans ; Immunoglobulin A ; Immunoglobulin A, Secretory ; Immunoglobulin E ; Immunoglobulin G ; Immunoglobulins ; Lymphocytes ; Psoriasis* ; Research Personnel ; Seoul ; Skin ; T-Lymphocytes* ; Weights and Measures

BACKGROUND: Pain on injection is one of the major disadvantages of propofol. To solve this problem, many investigations have been done. We postulated that the duration of pre-treatment of local anesthetics might affect the incidence and nature of injection pain. METHODS: Seventy seven patients were involved in our study. They were divided into control group (group C, n = 25); pre-treatment with normal saline and study group (n = 52); pre-treatment with 0.1% lidocaine 1 ml/kg/h for 30 min before propofol injection. The study group was subdivided into 2 groups, one receiving maintenance fluid (group LF, n = 28) and one not (group LS, n = 24). A vein on the dorsum of the hand was used for the intravenous line in all patients. Pain assessment was made twice, immediately after injection of first half dose of propofol and after injection of the remaining half dose. The speed of propofol injection was 0.5 ml/sec. After measuring pain with the visual analogue scale (VAS) and pain scoring (PS) during propofol injection, the highest score in each case was used for comparison. RESULTS: The values of VAS and PS of group LF were not different from group C. However the corresponding values of group LS were lower than those of group C (P<0.05). CONCLUSIONS: From our results, it can be suggested that the duration of 30 min pre-treatment of lidocaine without maintenance fluid is one method for reducing the incidence and nature of pain induced by propofol.
Anesthetics, Local ; Hand ; Humans ; Incidence ; Lidocaine* ; Pain Measurement ; Propofol ; Veins

No abstract available.
Child* ; Humans ; Korea* ; Myocarditis* ; Rheumatic Fever*

OBJECTIVE: the enzymes cyclooxygenase(COX)-1 and -2 are necessary for the synthesis of prostaglandins. COX-2 is usually absent in normal cells and is upregulated and expressed as a product of the "immediate early" gene during inflammatory processes. In previous studies, the expression of COX-2 has been shown to be induced by prointlammatory cytockines, and suggestions have been made that overexpression of COX-2 supresses apoptosis and is directly related to tumor growth. We the authors have attempted to determine a relationship between the tumor invasion and metastasis of uterine cervical cancer and COX and apoptosis by comparing the protein expression of apoptosis and COX-I and COX-2 in tumor tissues confirmed with cytokeratin, and therefe determine the clinicopathologic risk factors. MATERIALS AND METHODS: The subjects were 18 patients who were FIGO stage IB uterine cervical cancer patients who underwent surgery at the Ajou University Medical Center. The 18 cases were comprised of 12 cases of squamous cell carcinoma, 3 cases each of adenocarcinoma and adenosquamous carcinoma. There were 9 cases with lymph node or prarametrial involvement and 13 cases with lymphvascular space involvement. All tissues obtained from the cases were subject to immunohistochemical staining for COX-1, -2 and TUNEL method for apoptosis detection, and the following results were obtained. RESULTS: Tumor tissues confirmed by cytokeratin wae separated into tumor surface, tumor stroma, and invasion site portions, and in which increased apoptosis was observed in the tumor surface and tumor stmma, but not in the invasion sites. COX-2 expression was observed in all tumor tissues, which was especially strong in the tumor invasion site. Therefore, it is suggested that COX-2 expression may supress cell apoptosis at the site of tumor invasion. When COX-2 expression was investigated when the cases were divided into groups with regard to the presence or absence of lymph node or parametrial involvement, there was statistically significant (Mann-Whitney U test) COX-2 expression seen microscopically in the tumor stroma (p-value=0.028) and tumor invasion site (p-value=0.040) compared to the tumor surface (p-value=0.499). In other words, in surgically treated stage IB cervical cancer patients, COX-2 was significantly expressed when lymph node or parametrial involvement was present. CONCLUSIONS: These results suggest that the expression of COX-2 in stage IB cervical cancer patients may downregulate apoptosic processes and thus enhances tumor invasion and metastasis.
Academic Medical Centers ; Adenocarcinoma ; Apoptosis ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Humans ; In Situ Nick-End Labeling ; Keratins ; Lymph Nodes* ; Neoplasm Metastasis* ; Prostaglandin-Endoperoxide Synthases* ; Prostaglandins ; Risk Factors ; Uterine Cervical Neoplasms*

OBJECTIVE: Although antipsychotic treatments are effective for schizophrenia, at least 25% of schizophrenic patients have little response to conventional neuroleptics. Although patients respond well to antipsychotics initially, they often result in heavy loss of costs and social burden due to the frequent relapse which often require intensive institutional care while the patients experience significant social and functional disabilities. Many studies have come out recently concerning the cost of schizophrenia and its cost-effectiveness in treatment. Clozapine has the risk of agranulocytosis and greater initial cost, however, it has been reported to be cost-effective for the treatment of refractory schizophrenia because of its highly effectiveness, in addition, it has reduced rehospitalization rates and hospital stays. The purpose of this retrospective study was to ascertain the cost-effectiveness of clozapine treatment for patients with refractory schizophrenia in Korea. METHOD: We studied 17 patients with refractory schizophrenia treated by clozapine over a two year period. The numbers of hospitalization, hospital stays two years before clozapine treatment, and two years after clozapine treatment were investigated. Direct costs of psychiatric hospitalization, outpatient treatment, and other costs were estimated. Data on patients' clinical characteristics, use of mental health services and information about the cost of treatments were collected from psychiatric hospitalization records, outpatient records and hospital administration records. Some of the patient data information before the introduction of clozapine treatment were gathered through direct interviews of their families. Therapeutic outcome measures included the Clinical Global Impression (CGI) scale and Global Assessment of Functioning (GAF) score. RESULT: At the initial clozapine treatment, the mean age of subjects was 29 (+/- 7.9) years old. The mean duration of previous psychiatric treatment was 8 (+/- 3.0) years. Average total direct costs were reduced from \4,106,480 in the second pretreatment year to \2,338,427 in the second posttreatment year while the mean hospitalization costs, a percentage of total direct costs, were reduced from 82.9% to 27.4%. Also, the mean hospital stays per year were decreased from 83.4 days to 15.7 days, the mean numbers of hospitalization from 0.59 to 0.18. CGI scale scores and GAF scores showed a statistically significant clinical improvement between before and after clozapine treatment. CONCLUSION: These results suggest that a long-term treatment of clozapine for patients with refractory schizophrenia is indeed more cost-effective than conventional neuroleptic treatment. We suggest more comprehensive and prospective study due to the limitations of this retrospective study.
Agranulocytosis ; Antipsychotic Agents ; Clozapine* ; Hospital Administration ; Hospitalization ; Humans ; Korea ; Length of Stay ; Mental Health Services ; Outcome Assessment (Health Care) ; Outpatients ; Recurrence ; Retrospective Studies ; Schizophrenia*

PURPOSE: The purpose of this study was to identify the correlation between communication skills for emotional empathy and academic achievement on the Clinical Performance Examination (CPX). METHODS: One hundred twelve medical school students were observed to determine the extent to which they applied communication skills for emotional empathy (preparation stage: interview attitude, respect; rapport stage: encouragement, active listening, will for support; empathy stage: verbal expression empathy, nonverbal expression empathy, acceptance) to the CPX, as well as their level of understanding of these skills to calculate the Pearson r, which can be used to determine the correlation between communication skills and academic achievement (hematochezia, fatigue, abnormal menstruation, chest pain, alcohol problems). RESULTS: Male students had higher scores than females for all communicational skills except verbal expression empathy. Fourth-year students had statistically more significant correlations than third-year students with regard to the rapport stage 'active listening' and empathy stage 'nonverbal expression' and abnormal menstruation and chest pain. Correlations were also more significant for hematochezia in the preparation stage 'interview attitude,' rapport stage 'encouragement,' and empathy stages 'verbal and nonverbal expression' and 'acceptance.' The empathy stage 'nonverbal expressions' was more significant for fourth-year students with alcohol problems. Third-year students largely had negative correlations between emotional empathy communication skills and CPX academic achievement, especially between the preparation stage 'respect' and abnormal menstruation, and between the rapport stage 'encouragement' and hematochezia. CONCLUSION: There was a significant correlation between hematochezia, wherein MS students deliver bad news to patients, and communication skills for emotional empathy.
Achievement ; Chest Pain ; Clinical Competence ; Empathy ; Fatigue ; Female ; Gastrointestinal Hemorrhage ; Humans ; Male ; Menstruation ; Schools, Medical