The 2007 European Society of Hypertension/European Society of Cardiology guidelines acknowledged that the central (aortic) blood pressure (BP), which is the pressure exerted on the heart and brain, may differ from the pressure that is measured at the arm. They also recognized that central pressure may predict outcome in specific populations and is affected differently by antihypertensive drugs. These guidelines also regarded an increased carotid-femoral pulse wave velocity as subclinical organ damage and classified increased arterial stiffness into high/very-high risk. Clinical studies have indicated that the central BP and central hemodynamics (aortic stiffness, augmentation index) are important components in the determination of cardiovascular risk in some patients. More importantly, recent large-scale trials have shown that central hemodynamics may constitute a worthwhile treatment target. In addition, central hemodynamics can now be assessed reliably noninvasively with a number of devices. Accordingly, because arterial stiffness and central hemodynamics are markers and manifestations of organ damage, they independently predict future cardiovascular events.
Antihypertensive Agents ; Arm ; Blood Pressure ; Brain ; Cardiology ; Heart ; Hemodynamics ; Humans ; Pulse Wave Analysis ; Vascular Stiffness

The authors report a case of brain abscess associated with pulmonary arteriovenous malformation(AVM). As right to left shunt in systemic circulation can precipitate brain abscess in congenital cyanotic heart disease, arteriovenous fistula in pulmonary AVM is an etiologic factor of brain abscess. Brain abscess associated with pulmonary AVM is very rare and has so far been lacking in previous report in Korea. The pertinent literatures of brain abscess associated with pulmonary AVM are also reviewed.
Arteriovenous Fistula ; Arteriovenous Malformations* ; Brain Abscess* ; Brain* ; Heart Diseases ; Korea

A 7-year-old Thoroughbred gelding was admitted to Equine Hospital, Korea Racing Association for evaluation and treatment of colic. Based on the size and duration of the large colonic and cecal impaction, a routine ventral midline celiotomy and large colon enterotomy were performed to relieve the impaction. Six days following surgery the gelding exhibited signs of lethargy, fever, inappetence and diarrhea. Eleven days following surgery, the jugular veins showed a marked thrombophlebitis. On the sixteenth day of hospitalization the gelding died suddenly. Upon physical examination, the horse was febrile, tachycardic and tachypnoeic. Thoracic excursion appeared to be increased; however, no abnormal lung sounds were detected. No cough or nasal discharge was present. Hematology revealed neutrophilic leukocytosis. Serum biochemistry was normal but plasma fibrinogen increased. In necropsy, fibrinopurulent fluid was present in the thoracic cavity. There were firm adhesions between visceral pleura and thoracic wall. White, mixed and red thrombi were formed in both jugular veins from the insertion point of IV catheter. Histopathological examination showed fibrinopurulent inflammation and vascular thrombosis in the lung. The pleura showed edematous thickening and severe congestion. The clinicopathological and pathological findings suggest that septic thrombi associated with septic thrombophlebitis metastasized into the pulmonary circulation and were entrapped in the pulmonary parenchyma and provoked pleuropneumonia.
Animals ; Colic/*surgery ; Fatal Outcome ; Histocytochemistry ; Horse Diseases/*pathology ; Horses ; Male ; Pleuropneumonia/complications/pathology/*veterinary ; Postoperative Complications/pathology/*veterinary ; Sepsis/complications/pathology/veterinary ; Thrombophlebitis/complications/pathology/*veterinary

The authors treated 26 cases of extramedullary tumors around foramen magnum and craniocervical junction by various surgical approaches between 1982 and February 1993. They are 12 meningiomas, 9 neurinomas, 3 chordomas, 1 teratoma and 1 capillary lymphangioma. Among them, 7 cases are located at anterior portion of foramen magnum, 6 cases at anterolateral portion, 2 cases at lateral portion, 7 cases at posterolateral portion, and 4 cases are posteriorly located. These tumors were attacked via various surgical approaches. 19 cases were treated by conventional suboccipital approach, 5 cases by far lateral suboccipital approach and 2 cases of chordoma by transoral approach which was combined with far lateral suboccipital approach. So, 19 cases of tumors were removed completely, but 7 cases were subtotally removed. There was 1 case of operative mortality and in 2 cases of meningioma there was permanent lower cranial nerve palsy. Pyogenic meningitis due to CSF leakage developed in 2 cases of chordoma which were treated by transoral approach.
Capillaries ; Chordoma ; Cranial Nerve Diseases ; Foramen Magnum* ; Lymphangioma ; Meningioma ; Meningitis ; Mortality ; Neurilemmoma ; Teratoma

A 7-year-old Thoroughbred horse was admitted to the Equine Hospital, Korea Racing Association with signs of colic. Based on the size of impactions, the clinical signs, the results of abdominal paracentesis and medical treatment, the prognosis was poor. The horse died 3 hours later following hopeless discharge. At necropsy, the caecum and large colon were fully filled with fecal contents and there was a rupture (10 cm in dia) in the latero- ventral caecum. The mucosa of the ileo-caecal and caeco- colic valves appeared to the hyperemic, edematous and ulcerous. There were many tapeworms in the affected mucosa. Histopathologically, lesions included hyperaemia, a deep necrotic inflammatory lesion and ulcers in the mucosa and submucosa of ileo-caecal and caeco-colic valves. One hundred thirty four faecal samples were obtained from 16 stables and submitted to parasitic examination. A total of 4 genera of eggs were recovered: Stongylus spp (82.1%), Anoplocephala perfoliata (10.5%), Bovicola equi (0.7%) and Parascaris equorum (1.5%). The major findings in this study are the presence of A perfoliata and its suspected association with the colic which led into an eventual caecal rupture. This study indicates the needs for an epidemiological survey of colic that is associated with Anoplocephala.
Animals ; Cecal Diseases/etiology/pathology/*veterinary ; Cestoda ; Cestode Infections/complications/pathology/*veterinary ; Colic/etiology/*veterinary ; Fatal Outcome ; Fecal Impaction/complications/parasitology/veterinary ; Feces/parasitology ; Horse Diseases/etiology/*parasitology/pathology ; Horses ; Ileocecal Valve/parasitology/pathology ; Intestinal Diseases, Parasitic/parasitology/pathology/*veterinary ; Intestinal Mucosa/parasitology/pathology ; Korea ; Parasite Egg Count/veterinary ; Prognosis ; Rupture, Spontaneous/pathology/veterinary

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) is considered an important index of the functional significance of coronary artery stenosis, but is influenced by several factors, such as left ventricle hypertrophy (LVH), diabetes mellitus (DM), hyperlipidemia and smoking. Measurement of the coronary flow velocity of the left anterior descending coronary artery (LAD) by transthoracic Doppler echocardiography (TTDE) is feasible, and provides reliable information. The purpose of this study was to investigate the relationship between CFR and LVH, DM, hyperlipidemia and hypertension in patients with or without coronary artery disease, and to assess the prominent factors influencing CFR. SUBJECTS AND METHODS: Coronary angiographies were performed in 38 patients to evaluate chest pain. The distal LAD flow velocity was measured by TTDE, and the CFR calculated as a ratio of the hyperemic and baseline mean diastolic velocities. The CFR was compared with clinical, echocardiographic and angiographic parameters. RESULTS: The CFR was similar in patients both with and without hypertension, DM, high LDL-cholesterol levels and low ejection fraction(<40%). The mean CFR was lower in patients with (50% LAD stenosis than in patients with no significant stenosis. The CFR of patients with a left ventricle wall thickness of (12mm was lower than in those without LVH. The multivariate analysis of the aforementioned factors showed that LVH was the factor most influencing to the CFR (p<0.05). CONCLUSION: When using CFR as a functional parameter of LAD stenosis, one should consider LVH as one of the factors attributed to CFR modification.
Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Circulation ; Coronary Stenosis ; Coronary Vessels ; Diabetes Mellitus ; Echocardiography ; Echocardiography, Doppler* ; Heart Ventricles ; Humans ; Hyperlipidemias ; Hypertension ; Hypertrophy ; Multivariate Analysis ; Smoke ; Smoking

BACKGROUND AND OBJECTIVES: Angiotensin-receptor blockers (ARBs) have beneficial effects on cardiovascular, metabolic, and inflammatory parameters in addition to controlling blood pressure (BP). However, few comparative clinical studies have been conducted with different ARBs. We compared these effects in patients with uncomplicated hypertension who were receiving telmisartan or valsartan. SUBJECTS AND METHODS: The subjects were patients with essential hypertension (48.4+/-9.6 years) who were randomly assigned to take either telmisartan (80 mg/day, n=30) or valsartan (160 mg/day, n=30) for 12 weeks. Their anthropometric, laboratory, vascular, and echocardiographic data were measured at baseline and at the end of the study. RESULTS: Baseline characteristics were not significantly different between the two groups, except for the carotid-femoral pulse wave velocity (cfPWV; telmisartan group vs. valsartan group; 841.2+/-131.0 vs. 761.1+/-104.4 cm/s, p<0.05). After 12 weeks, BP had fallen to a similar extent with mean reductions in the systolic and diastolic BP of 20.7+/-18.1 and 16.3+/-13.0 mm Hg (p<0.001, respectively) for the telmisartan and 22.5+/-17.0 and 16.8+/-9.3 mm Hg (p<0.001, respectively) for the valsartan group. Although the cfPWV and left ventricular mass index (LVMI) fell significantly only with the administration of telmisartan, they were not significantly different when baseline cfPWV was considered. The differences in the cfPWV and LVMI changes from baseline between the two groups were also not significant after adjusting for baseline cfPWV. No significant changes in other vascular, metabolic, or inflammatory parameters were observed with either treatment. CONCLUSION: The effects of a 12-week treatment with the two ARBs, telmisartan and valsartan, on cardiovascular, metabolic, and inflammatory parameters were not different in patients with uncomplicated hypertension.
Benzimidazoles ; Benzoates ; Blood Pressure ; Humans ; Hypertension ; Pulse Wave Analysis ; Tetrazoles ; Valine ; Valsartan

BACKGROUND/AIMS: There have been reports that interatrial septal (IAS) thickness is increased in patients with atrial fibrillation (AF). This study was performed to investigate whether IAS thickness determined by transthoracic echocardiography (TTE) represents the amount of left atrium (LA) structural and functional remodeling. METHODS: The study population consisted of 104 consecutive patients who underwent catheter ablation (CA) for AF (paroxysmal atrial fibrillation [PAF], 82; persistent atrial fibrillation [PeAF], 22). IAS thickness and left atrium volume (LAV) using TTE, and LA voltage (LAVOL) using 3-dimensional electroanatomical mapping system were assessed during sinus rhythm. RESULTS: IAS thickness was significantly correlated with maximal LAV (LAVmax) (r = 0.288, p = 0.003), mean LAVOL (r = -0.537, p < 0.001), total left atrium emptying fraction (LAEFtotal; r = -0.213, p = 0.030), and active LAEF (LAEFactive; r = -0.249, p = 0.014). IAS thickness was greater in the high-risk group (> or = 2) compared to other groups according to CHA2DS2-VASc score (p = 0.019). During a follow-up of 19.6 months, 23 subjects (22.1%; PAF, 17; PeAF, 6) had recurrence of arrhythmia. Univariate analysis showed that LAVmax, minimal LAV, mean LAVOL, LVEFtotal, LVEFactive, and IAS thickness were associated with recurrence of arrhythmia. However, on multivariate analysis, only mean LAVOL and LAEFactive were independent risk factors for recurrence. CONCLUSIONS: Although IAS thickness showed significant correlations with parameters for LA structural and functional remodeling, this parameter alone could not independently predict recurrence of arrhythmia after CA for AF.
Action Potentials ; Adult ; Aged ; Area Under Curve ; Atrial Fibrillation/physiopathology/*radiography/surgery/*ultrasonography ; *Atrial Function, Left ; *Atrial Remodeling ; Atrial Septum/physiopathology/*radiography/*ultrasonography ; Catheter Ablation ; Chi-Square Distribution ; *Echocardiography, Doppler ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Linear Models ; Male ; Middle Aged ; *Multidetector Computed Tomography ; Multivariate Analysis ; Predictive Value of Tests ; Prospective Studies ; ROC Curve ; Recurrence ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND AND OBJECTIVES: The intracoronary injection of acetylcholine (Ach) has been shown to induce coronary spasms in patients with variant angina. Clinical significance and angiographic characteristics of patients with a significant response to lower Ach dosages are as-yet non-clarified compared with patients responding to higher Ach doses. SUBJECTS AND METHODS: A total of 3034 consecutive patients underwent coronary angiography with Ach provocation tests from January 2004 to August 2010. Ach was injected in incremental doses of 20, 50, 100 microg into the left coronary artery. Significant coronary artery spasm was defined as focal or diffuse severe transient luminal narrowing (>70%) with/without chest pain or ST-T change on the electrocardiogram (ECG). We compared the clinical and angiographic characteristics of patients who responded to a lower Ach dose (20 or 50 microg, n=556) to those that responded to a higher Ach dose (100 microg, n=860). RESULTS: The baseline clinical and procedural characteristics are well balanced between the two groups, except diabetes was higher in the lower Ach dose group and there were differences in medication history. After adjusting for confounding factors, the lower Ach dose group showed more frequent temporary ST elevation and atrioventricular block on the ECG. Furthermore, the group of patients who responded to the lower Ach dose was associated with a higher incidence of baseline and severe spasm than those who responded to a higher Ach dose. CONCLUSION: Patients with a significant response to a lower Ach dose were associated with more frequent ST elevation, baseline spasm, and more severe spasm compared with those who responded to a higher Ach dose, suggesting more intensive medical therapy with close clinical follow-up is required for those patients.
Acetylcholine ; Angina Pectoris, Variant ; Atrioventricular Block ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Humans ; Incidence ; Phenobarbital ; Spasm

PURPOSE: Numerous investigations have been conducted in order to determine the potential carcinogenic or chemopreventive activity of capsaicin. The aim of this study is to characterize the effects of capsaicin on colon cancer cells, and provide valuable information concerning the application of capsaicin in chemoprevention as well as for therapeutic purposes. METHODS: CoLo320DM and LoVo cells (human colon cancer cell line) were treated with capsaicin. In order to access cell viability and altered morphology, an MTT assay was performed and the cells were microscopically examined. Decreasing DNA staining was accessed by FACS. The cells were stained with FITC labeled annexin V and analyzed by FACS to detect cellular membrane alteration during apoptosis. The cells were stained with DiOC6(3) and Hydroethidine and analyzed by FACS in order to access ROS and dleta psi m. RESULTS: Capsaicin decreased cell viability in a dose-dependent manner. Capsaicin produced a cell morphology corresponding to the apoptotic features including cell shrinkage and chromatic condensation. Capsaicin treated cells induced a loss of nuclear DNA leading to hypoploidy in a dose-dependent manner. Cells were excluded by double staining with PI and FITC labeled annexin v and detected by FACS. We show that treatment of CoLo320DM, L0Vo cells with increasing concentrations of capsaicin parallel an increase in the percentage of red fluorescent cells (HE-->Eth) that reflect ROS hypergeneration and a decrease in the percentage of green fluorescent cells that reflect delta psi m disruption. CONCLUSION: These results clearly demonstrate that capsaicin-induced colon cancer cell death is apoptotic.
Annexin A5 ; Apoptosis* ; Capsaicin ; Cell Death ; Cell Line* ; Cell Survival ; Chemoprevention ; Colon* ; Colonic Neoplasms* ; DNA ; Fluorescein-5-isothiocyanate ; Humans* ; Membranes