BACKGROUND: Established risk factors for coronary artery disease include smoking, hypertension, diabetes mellitus and hypercholesterolemia. However, these account for less than 50% of the actual incidence of coronary artery disease and the importance of other risk factors is being increasingly realized. It has been known that insulin resistance associated with hyperinsulinemia is a pivotal link to several risk factors of coronary artery disease, including hypertension, glucose intolerance, dyslipidemia and obesity. Recently both experimental and clinical studies have produced evidence suggesting that high plasma insulin level may promote the development of atherosclerotic vascular diseasa. Several prospective studies showed independently that high plasma insulin is associated with an increased risk of major coronary artery disease. In our study, plasma glucose, insulin and C-peptide level were determined with oral glucose tolerance test to assess the insulin resistance or hyperinsulinemia as a risk factory of coronary artery disease. METHOD: From September 1993 to April 1995, after excluding patients with hypertension, diabetes mellitus, hypercholesterolemia and obesity, 17 patients with significant coronary artery stenosis and 10 control subjects with normal coronary finding were selected among the 226 patients who undertook coronary angiography. In the 17 cases(M:F=15:2) of coronary artery disease group, the mean age was 54+/-10 years, and in the 10 cases(M:F=8:2) of control group, 51+/-9 years. All were matched for age, gender and body mass index. Blood pressure, lipid and lipoprotein were measured and smoking history was assessed. Glucose, insulin and C-peptide responses to oral glucose tolerance test were also determined. RESULT: 1) There was no significant difference in systolic and diastolic and diastolic blood pressure, total-cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, ApoA and smoking history except ApoB between the subjects with coronary artery disease and normal control subjects. 2) In oral glucose tolerance test, the plasma glucose levels were not significantly different in the two groups. plasma insulin and C-peptide levels at 60 and 120 minutes were higher in the patient group than control, but the results lack statistical significance. The area under the insulin curve and C-peptide curve were larger in patient group than control, but the result lack statistical significance also. CONCLUSION: Although our study dose not prove the hypothesis that insulin resistance or hyperinsulinemia is statistically an independent risk factor for coronary artery disease, this study showed the tendency of insulinresistance to be correlated with development of coronary artery disease. As this study has limitations due to small sample size, further study is required to confirm the role of hyperinsulinemia using a larger sample size.
Apolipoproteins A ; Apolipoproteins B ; Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Peptide ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diabetes Mellitus ; Dyslipidemias ; Glucose ; Glucose Intolerance ; Glucose Tolerance Test ; Humans ; Hypercholesterolemia ; Hyperinsulinism ; Hypertension ; Incidence ; Insulin Resistance* ; Insulin* ; Lipoproteins ; Obesity ; Plasma ; Prospective Studies ; Risk Factors* ; Sample Size ; Smoke ; Smoking ; Triglycerides

No abstract available.

We evaluate the effects of diltiazem in 19 patients with ischemic heart disease (15 patients) of classical anginal pectoris & 4 patients of variant angina) by means of clinical status & electrocardiographic changes and obtain the results as follows: 1. The pulse rate & blood pressure were decreased by diltiazem slightly but these decreases were not significant in statistical meaning. 2. Diltiazem administration of 4 weeks duration normalized EKG completely in 4 patients & partially in 3 patients among the 13 patients who showed abnormal resting EKG initially. 3. All 19 patients who received diltiazem showed clinical improvement; 9 patients had excellent responses, 7 patients good responses & 3 patients fair responses. 4. Diltiazem had side effects in 3 patients, drowsiness, mild euphoria & possibly tolerance respectively in each patients.
Angina Pectoris* ; Blood Pressure ; Diltiazem ; Electrocardiography ; Euphoria ; Heart Rate ; Humans ; Myocardial Ischemia ; Sleep Stages

The Her-2/neu protooncogene encodes a transmembrane tyrosine kinase that is structurally homologous to the receptor for epidermal growth factor. Its amplification and overexpression are associated with poor prognosis in breast cancer patients. Neu differentiation factor is a ligand for Her-2/neu protooncogene and was detected in ras-transformed rat fibroblasts. Heregulin (human homologue of neu differentiation factor) is a 44-kilodalton glycoprotein that stimulates tyrosine phosphorylation and induces growth arrest or stimulation and differentiation in human breast cancer cell lines. In this study we examined the expression of heregulin mRNA by nested reverse transcription (RT) PCR with fresh tissue, Her-2/neu protein, ICAM-1 and steroid receptors by immunohistochemistry, and DNA ploidy pattern by flow cytometry with paraffin-embedded tissue in invasive breast carcinoma. We compared the data with nodal status, lymphovascular invasion, steroid receptor status and DNA ploidy pattern. For RT-PCR to heregulin mRNA, 38 cases of fresh breast cancer tissue were obtained. Total 68 cases of invasive breast carcinoma tissue were fixed in formalin, which were used for routine histology, immunohistochemistry and flow cytometry. The results are as follows; 1) Heregulin mRNA was expressed in 86.1% of patients with invasive breast carcinoma and 100% of patients with benign breast lesion using nested RT-PCR analysis. 2) Her-2/neu protein was overexpressed in 50.0% of tumors using immunohistochemistry. The expression of Her-2/neu protein was significantly correlated with high counts of lymph nodes with metastasis (p<0.05), and high nuclear grade (p<0.05). 3) Her-2/neu protein overexpression was significantly correlated with a high DNA index(p<0.05). All of the tumors showing Her-2/neu protein overexpression and no heregulin mRNA expression revealed near tetraploid DNA content. However, both Her-2/neu overexpression and heregulin mRNA expressing tumors revealed near tetraploidy in 38.9% and diploidy in 50.0%. Based on these results, heregulin mRNA expression rate was 86.1% in human invasive breast carcinoma. Her-2/neu protein overexpression is associated with high positive lymph node number and DNA index. Statistically significant reverse correlation with lymph node metastasis is not present.
Animals ; Breast Neoplasms* ; Breast* ; Cell Line ; Diploidy ; DNA* ; Epidermal Growth Factor ; Fibroblasts ; Flow Cytometry ; Formaldehyde ; Glycoproteins ; Humans* ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; Lymph Nodes ; Neoplasm Metastasis* ; Neuregulin-1* ; Phosphorylation ; Ploidies* ; Polymerase Chain Reaction ; Prognosis ; Protein-Tyrosine Kinases ; Rats ; Receptors, Steroid ; Reverse Transcription ; RNA, Messenger* ; Tetraploidy ; Tyrosine

We reviewed 37 skin biopsies obtained from 35 patients with secondary syphilis during the period of 9 years from January 1980 to June 1988, which had been diagnosed by dark field examination, serologic tests for syphilis, and identification of spirochetes by immunoperoxidase method (avidin-biotin complex) in the skin biopsies. We investigated the histologic features of the skin lesions in secondary syphilis according to the types and patterns of inflammatory cell infiltration in the dermis, vascular reactions and epidermal changes. We matched these histologic findings with the clinical features of the skin lesions. The results were as follows; 1) The histologic patterns of dermal infiltrate in order of frequency were as follows; junctional pattern in 14 biopsies (38%), lichenoid pattern in 10 biopsies (27%), diffuse pattern in 5 biopsies (14%), patchy pattern in 3 biopsies (8%), normal pattern in 3 biopsies (8%) and undertermined in 2 biopsies (5%). 2) The dermal infiltration of plasma cells was found in 24 biopsies (65%). All the biopsies of diffues and lichenoid patterns, 7 biopsies of junctional and one biopsy of patchy pattern showed plasma cells but none in normal pattern. 3) Eosinophils were observed in the dermis in 11 biopsies (30%). There was no difference in incidence of eosinophils in the dermis among morphologic patterns. However, they were frequently seen in the dermis and epidermis of condyloma lata (4 of 7 biopsies). 4) The vascular changes in the dermis included endothelial cell swelling in 23 biopsies (62%), endothelial cell proliferation in 22 biopsies (60%) and vascular dilatation in 10 biopsies (27%). They were most commonly observed in the lichenoid pattern followed by diffuse and junctional patterns. Three cases showed lymphocytic vasculitis. 5) Epidermal changes were seen in all of the biopsies exocytosis, parakeratosis, hydropic change of basal cells, acanthosis, spongiosis, keratinocyte necrosis and hyperkeratosis in the order of frequency. 6) In relation to the clinical manifestations, junctional pattern (14 biopsies) consisted of 6 papulosquamous lesions, 5 macules and 3 papules. Lichenoid pattern (10 biopsies) consisted of 7 papulosquamous lesions and 3 papules. All the biopsies showing diffuse pattern (5 biopsies) appeared in condyloma lata. Patchy pattern (3 biopsies) consisted of 2 macules and 1 papule. All of the normal pattern (3 biopsies) appeared in macules. In conclusion, with dermal and epidermal changes, the acknowlegement of the 5 basic histologic patterns in secondary syphilis seems to be very helpful for the diagnosis of syphilis.
Incidence ; Biopsy

Histopathological changes under occulsive dressing with 0.1% triamcinolone acetonide cream, 0 025% fluocinolone acetonide cream, and 1% hydrocortisone cream were compared each other and with the changes following topical application of 5% ammoniated mercury ointment without occulsion in five cases of psoriasis vulgaris. 1) The earliest changes noticed were the diminution of the papillary edema, the appearence of the granular layer and the disappearence of parakeratosis. 2) A week after treatment, the remarkable changes revealed were the thinning of the epidermis, the diminution of acanthosis, papil]ary edema and cell infiltration of the upper dermis and the appearence of the granular layer. 3)The capillary dilatation remained unchanged even two weeks after treatment in all groups. 4) Among these drugs, the best respanse revealed was triamcinolone cream, the next was fluocinolone cream. The response of hydrocortisone cream was poorer than fluocinolone cream and ammoniated mercury ointment was even more poorer than hydrocortisone cream.
Adrenal Cortex Hormones* ; Bandages* ; Capillaries ; Dermis ; Dilatation ; Edema ; Epidermis ; Fluocinolone Acetonide ; Hydrocortisone ; Parakeratosis ; Psoriasis* ; Triamcinolone ; Triamcinolone Acetonide

This study was performed to evlauate the usefulness of red ginseng extract as an adjuvant therapeutic agent to improve immune function in immune compromizing gastrointestinal carcinoma patients. We treated 48 patients with two regimens after we undertook the curative resection for gastrointestinal carcinoma: 1) only chemotherapy and immunotherapy (control group), 2) chemotherapy and immunotherapy with 4500-5400mg red ginseng for 6 months (study group). For investigating the immunologic alternations alongside the numerical changes in peripheral blood lymphocyte and their subsets in the gastrointestinal carcinoma patients, lymphocyte surface markers were determined by monoclonal antibodies on the preoperative 1st day, and postoperative 5th day, 1 month, 3 month and 6 month in 28 controls and 20 red ginseng groups in gastrointestinal carcinoma patients which were recruited at Korea University Hospital from March, 1995 to December, 1995. The mean value for body weight was increased in the ginseng group than in the control group. There were no significant differences of serum hematocrit, hemoglobin, total protein and albumin in both groups. The total lymphocyte count was much more increased in the ginseng group than in the control group. The number of T cell, B cell, CD8, CD4, NK cell and activated T cell were increased in ginseng group more than in control group. The T cell was significantly increased on postoperative 5th day, 3 month and 6 month, and B cell on postoperative 6 month in ginseng group than in control group. The CD8 was significantly increased on postoperative 3 month and 6 month, CD4 on postoperative 5th day, and NK cell and activated T cell also on postoperative 6 month in ginseng group than in control group. In conclusion, red ginseng may be useful as a longterm adjuvant therapeutic agent for improving the immune function and anticarcinogenic effect after curative operation for immune compromizing gastrointestinal carcinoma patients.
Antibodies, Monoclonal ; Anticarcinogenic Agents ; Body Weight ; Drug Therapy ; Hematocrit ; Humans ; Immunotherapy ; Killer Cells, Natural ; Korea ; Lymphocyte Count ; Lymphocytes ; Panax*

The distributions and morphological characteristics of neurons displaying immunoreactivity to the catecholamine synthetic enzymes, tyrosine hydroxylase[TH], dopamine-beta-hydroxylase[DBH], and phenyletha-nolamine-N-methyltransferase[PNMT] were examined in the adjacent sections of the diencephalon of the striped field mouse [Apodemus agrarius coreae].Only TH-, and no DBH- or PNMT-immunoreactive neurons were found in the diencephalon. In the preoptic area, TH-immunoreactive neurons were found in the anterior preoptic nucleus of Loo[APN], periventricular preoptic nucleus, medial preoptic nucleus, lateral preoptic nucleus and suprachiasmatic nucleus. In the hypothalamus, TH-immunoreactive neurons were found in theparaventricular hypothalamic nucleus, periventricular gray, retrochiasmatic area,anterior hypothalamic nucleus of anterior hypothalamic area and retrochiasmatic region of the hypothalamus. In the rostral tuberal region of the hypothalamus, TH-immunoreactive neurons were found in the paraventricular nucleus, periventricular gray and arcuate nucleus. In the midtuberal region of the hypothalamus, TH-immunoreactive neurons were found in the paraventricular nucleus, dorsomedial hypothalamic nucleus, zona incerta and arcuate nucleus. In the caudal tuberal region of the hypothalamus, dorsal hypothalamic nucleus, posterior hypothalamic complex and arcuate nucleus.
Animals ; Anterior Hypothalamic Nucleus ; Arcuate Nucleus ; Diencephalon* ; Dopaminergic Neurons* ; Dorsomedial Hypothalamic Nucleus ; Hypothalamus ; Immunohistochemistry ; Mice ; Neurons ; Paraventricular Hypothalamic Nucleus ; Preoptic Area ; Subthalamus ; Suprachiasmatic Nucleus ; Tyrosine

PURPOSE: RFCA has been proven to be an effective and safe tool for treating different kinds of tachycardia in adults. This study was designed to analyze the efficacy of this method in children and adolescents. METHODS: Seventy-eight patients referred to Gachon Medical School, Gil Hospital for ablation of supraventricular(SVT) and ventricular tachycardia(VT) between January 1997 and February 1999 were included in this study. An electrophysiologic study was performed in the same session to assure the diagnosis, and meet the appropriate criteria for ablation. All patients had regular follow-up at our center. RESULTS: Mean age of the patients was 9.9 years. Thirty-seven patients had Wolff-Parkinson- White syndrome, atrioventricular nodal reentrant tachycardiain in 12 patients, atrial flutter in 11 patients, atrial tachycardia in 9 patients, Mahaim tachycardia in 2 patients, nodoventricular tachycardia in one patients and VT in 6 patients was found. Seventy-seven patients were treated successfully(98.7%), 75 patients were treated in a single procedure, but 2 patients needed a second attempt. RFCA treatment failed in only one patient with nodoventricular tachycardia. In three of the 77 successfully treated patients(3.9%), tachycardia recurred after 1-3 months but could be treated by a further intervention. The duration of follow up after RFCA was from 2 to 27 months. CONCLUSION: RFCA is a highly effective method in the treatment of SVT and VT in children and adolescents. The major benefit of this technique is its potential as a cure for a chronic disease. RFCA can be used as the primary treatment for SVT and VT.
Adolescent* ; Adult ; Atrial Flutter ; Catheter Ablation* ; Child* ; Chronic Disease ; Diagnosis ; Follow-Up Studies ; Humans ; Schools, Medical ; Tachycardia*

Acute appendicitis in children under the age of 12 has remained the surgical emergency condition with the highest percentage of misdiagnosis leading to removal of a normal appendix. From January 1994 to April 1997, 312 children (176 boys, 136 girls) were admitted to Jun-ang Gil Hospital with the impression of acute appendicitis. The average age was 8.6 years (2 to 12 years). We reviewed medical records retrospectively for demographics, presenting signs, symptoms, findings of abdominal ultrasonography (USG) and barium enemas, and surgical results. The patients were divided in 2 groups as follows: group I (n=144) received immediate operations without further evaluation, group II (n=168) was treated after a delay for observation and/or special studies (USG and/or barium enema). Group II was subdivided into Group IIa (n=119) (treatment after study) and Group IIb (n=49)(treatment by clinical observations only). In group I, 124 patients were confirmed intraoperatively as having acute appendicitis, and 20 cases were not. In IIa, 36 patients underwent exploratory surgery and 30 cases revealed acute appendicitis. The remaining 83 patients were discharged because of symptomatic relief. In group IIb, 43 patients underwent exploratory surgery and acute appendicitis was revealed in 35. The diagnostic accuracies of groups were 86%, 95% and 84%. The sensitivity, specificity and diagnostic accuracy of an abdominal ultrasonography (n=105) were 96.1%, 82.1% and 92.4%, respectively. Those of a barium enema (n=63) were 94.7%, 100%, and 95.2% respectively. When both modalities were used (n=49), the results were 95.6%, 100% and 95.9%, respectively. The frequencies of a perforated appendicitis had no difference among the groups. In conclusion, in a child suspected of having acute appendicitis, if there are no apparent toxic signs or panperitonitis, surgical observation, USG, and/or a barium enema can decrease the number of unnecessary appendectomy without increasing the risk of perforation.
Appendectomy ; Appendicitis* ; Appendix ; Barium ; Child* ; Demography ; Diagnostic Errors ; Emergencies ; Enema ; Humans ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography