BACKGROUND: QT dispersion(QTD : QTmax-QTmin) or JT dispersion(JTD:JTmax-JT-min)in 12 leads ECG has been known to reflect regional variations in ventricular repolarization and has been reported to bel one of the marker of regional myocardial ischemia. To evaluate the significance of QTD or JTD of exercise ECG in diagnosis of coronary artery disease, we studied 106 patients(mean age, 56.9 years old, male 63) who were referred for the evaluation of chest pain on exertion. METHOD: Treadmill exercise stress test with modified Bruce protocol and coronary angiography were performed in 106 patients with chest pain on exertion. ST-segment depression by >1.0 mm 0.08 second after J-point during or after exercise in exercise test and >50% stanosis of epicardial artery in coronary angiogram were defined as positive. Of 106 patients, 41 had positive exercise ECG and positive coronary angiogram(true positive, TP), 20 had positive exercise ECG and negative coronary angiogram(false positive, FT), 20 had negative exercise ECG and positive coronary angiogram(faalse negative, FN), and 23 had negative exercise ECG and negative coronary angiogram(true negative, Tn). QT and JT interval in 12 leads were measured at baseline and peakexercise and were corrected for heart rate using Bazett's formula. QTD and JTD were measured by calculation the difference between the maximum QT and mininum QT and that between maximum JT and minumum JT. RESULTS: QTD at baseline for TP(72.8ms)was prolonged compared to Tn(52.2ms,P<0.01), but was not different from that for FT(70.2 ms). At peak exercise, QTD for TP(81.3 msec) was significantly prolonged(p<0.01), while QTD for FP(71.2 msec) was not different from that for TN(56.8 msec). JTD at baseline(78.4 msec) and at peak exercise(88.2 msec) for TP were significantly prolonged compared to those for TN(55.2msec and 55.1msec p<0.01,p<0.01, respectively), but those for FP were not porlonged(77.0msec and 79.0msec, respectively). QTD and JTD at peak exercise were more markedly prolonged in patients with sever stenosis of coronary artery(p=0.053 and p<0.05, repectively) and multivessels diseases(p<0.01, 0<0.05) than those with less severe disease and single vessel disease. Patients with left anterior descending artery lesion had greater QTD and JTD at peak exercise than those with other vessels lesion(p<0.01). In addition to standard criteria with ST segment displacement in exercise EGC, inclusion of exercise induced QTD of more than 60msec increased the sensitivity of exercise ECG from 66.7% to 83.3%, and JTD of more than 70msec increased the specificity from 52% to 76.0%. CONCLUSION: Measurement of QT dispersion and JT dispersion of exercise ECG may be useful method to identify the severity of coronary artery disease and to improve diagnostic accuracy of exercise ECG in coronary artery disease.
Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Depression ; Diagnosis ; Electrocardiography* ; Exercise Test ; Heart Rate ; Humans ; Male ; Myocardial Ischemia ; Sensitivity and Specificity

BACKGROUND/AIMS: Hypoxia-inducible factor-1alpha (HIF-1alpha) is a central transcriptional factor involved in the cellular responses related to various aspects of cancer biology, including proliferation, survival, and angiogenesis, and the metabolism of the extracellular matrix in hypoxia. This study evaluated whether adenovirus-mediated small hairpin RNA (shRNA) against HIF-1alpha (shHIF-1alpha) inhibits cell proliferation and angiogenesis in hepatocellular carcinoma (HCC) cell lines. METHODS: Knockdown of HIF-1alpha expression was constructed by adenovirus-mediated RNA interference tools, and HCC cell lines infected with shHIF-1alpha coding virus were cultured under a hypoxia condition (1% O2) for 24 hours. Following infection, the expression levels of HIF-1alpha, angiogenesis factors, and matrix metalloproteinase (MMP) were examined using Western blotting. Cell proliferation and angiogenesis were measured by a cell proliferation assay (MTT assay) and an angiogenesis-related assay (invasion and tube-formation assay), respectively. RESULTS: Adenovirus mediated inhibition of HIF-1alpha induced suppression of tumor growth in HCC cell lines. It also down-regulated the expression of angiogenesis factor and MMP proteins. Angiogenesis as well as mobility of vascular cells to tumor was suppressed by adenovirus-mediated shHIF-1alpha-infected groups in human umbilical vein endothelial cells (HUVECs). CONCLUSIONS: These data suggest that adenovirus-mediated inhibition of HIF-1alpha inhibits the invasion, tube formation, and cell growth in HUVECs and HCC cells.
Adenoviridae/genetics ; Carcinoma, Hepatocellular/*blood supply/metabolism/therapy ; Cell Line, Tumor ; Cell Proliferation ; Endothelial Cells/metabolism ; Gene Knockdown Techniques ; Genetic Vectors ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit/*antagonists & ; Liver Neoplasms/*blood supply/metabolism/therapy ; Matrix Metalloproteinases/metabolism ; Neovascularization, Pathologic/genetics/metabolism/*therapy ; RNA Interference ; RNA, Small Interfering/metabolism

BACKGROUND: Pathologic grading, one of the most important prognostic factors of papillary urothelial neoplasia (PUN) of the urinary bladder, has been revised continuously. The current study focused on the analysis of interobserver agreement on PUN of the urinary bladder bet- ween 1973 WHO classification (WHO 1973) and 1998 WHO/ISUP classification. METHODS: Seventy five cases from 15 institutions were collected, and after review by Korean Society of Urogenital Pathology (KSUP), 30 cases were selected as follows; group I, WHO grade 1 and papillary urothelial neoplasm of low malignant potential by ISUP (7 cases), group II, WHO grade 2 and low-grade papillary urothelial carcinoma (16 cases), and group III, WHO grade 3 and high-grade papillary urothelial carcinoma (7 cases). Seventy five general surgical pathologists who participated in this study were asked to grade the tumors based on WHO/ISUP classification. Interobserver agreement between the participants' diagnosis and KSUP consensus diagnosis was analyzed by kappa value. RESULTS: Interobserver agreement assessed by kappa value for all diagnostic groups was very low; for group I, kappa value was -0.900893722; for group II, -0.944650025, and for group III, -0.876728996. The overall kappa value of pathology residents was better than that of practicing pathologists. CONCLUSIONS: The 1998 WHO/ ISUP classification could not be easily translated from the 1973 WHO classification and because of poor interobserver agreement, it appears that further work would be needed before it can be practically applied.
Carcinoma, Transitional Cell ; Classification* ; Consensus* ; Diagnosis ; Pathology* ; Urinary Bladder Neoplasms ; Urinary Bladder*

BACKGROUND: Coronary angiography have become important and integral components in the investigation of patients with cardiovascular disease. Technical improvement combined with an increased need of coronary angiography, and efforts to decrease the length of inpatient hospital stay have prompted the development of outpatient coronary angiography. In this study, we compared the procedure-related complications and costs of inpatient and outpatient coronary angiography when performed at the same institution. In addition, we attempted the coronary angiography as outpatient setting in patients with unstable angina, old age, and anticoagulation therapy, who have been regarded as contraindication for outpatient procedure. METHODS: Diagnostic coronary angiography was performed in 199 cases as inpatient setting, and 225 cases as outpatient setting at Korea University Guro Hospital From January through July 1996. There was no significant difference in sex, age, risk factor, blood pressure, cholesterol level, and ejection fraction. We did not give the heparin during the procedure and, use the Judkins' method in all patients. After the procedure, pressure dressing was done with compressor device for 15 minutes, then sandbag was applied on the puncture site. In outpatient, they took bed rest for 6 hours in one-day care room. RESULTS: 1) In the inpatient group, there were 6 cases(3.0%) of catheterization-related complication, and there were 7 cases(3.1%) of complication in the outpatient group. There was no major complication in both groups, such as death, myocardial infarction, stroke, and perforation of heart and great vessels. In the inpatient group, 2 cases of arrhythmia, 3 cases of hematoma at puncture site, and 1 case of femoral artery pseudoaneuryrsm occurred. In the outpatient group, 2 cases of arrhythmia, 1 case of hematoma at puncture site, 2 cases of skin rash, 1 case of acute febrile reaction, and 1 case of femoral artery dissecting aneurysm developed. There was no significant difference in the rate of complications between two groups(p=0.947). 2) In the outpatient group, there were 28 cases of unstable angina, 6 cases of old age more than 75 years, and 5 cases of anticoagulant has been taken. No catheterization-related complication occurred in those groups. 3) The costs and duration of hospital stay in the inpatient group were won480,230+/-86,800 and 50.3+/-12.3 hours and those in the outpatient group were won276,870+/-32,050 and 8.3+/-1.2 hours. There was significant difference between two groups in the costs and duration of hospital stay(p<0.01, p<0.01). CONCLUSIONS: Outpatient coronary angiography could be done safely with low complication rate, and could reduce the costs and hospital stay. For high risk group such as unstable angina, old age, and anticoagulation therapy, there was no complication in this study, but more experiences and available data should be accumulated to be accepted as a general guideline.
Aneurysm, Dissecting ; Angina, Unstable ; Arrhythmias, Cardiac ; Bandages ; Bed Rest ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Coronary Angiography* ; Exanthema ; Femoral Artery ; Heart ; Hematoma ; Heparin ; Humans ; Inpatients ; Korea ; Length of Stay ; Myocardial Infarction ; Outpatients* ; Punctures ; Risk Factors ; Stroke

BACKGROUND AND OBJECTIVES: We undertook this study to assess the initiation and maintenance mechanisms of atrial fibrillation (AF) and their relationships with the anatomical structures of the left atrium (LA) and pulmonary veins (PVs). SUBJECTS AND METHODS: Thirty-seven patients (33 men, mean age 50, range 25-68 years) with paroxysmal AF (n=29) and persistent AF (n=8) who underwent mapping of the LA and PV using 3D non-contact endocardial mapping system (EnSite 3000) were enrolled. The multielectrode array and ablation catheter were positioned in the LA via the double transseptal approach. Atrial premature beats (APBs) which triggered initiation of AF that lasted longer than 1 min were mapped and the activation sequence was analyzed on isopotential color maps. Wave front dynamics and the relationship with the underlying structures were assessed. RESULTS: More than half, 56.4%, of APBs from PV were related to the initiation of AF, but not related to the maintenance of AF. A quarter, 25.6%, of APBs from PV not only initiated AF, but also maintained AF without continuous triggering. Mixed type and indeterminate type of AF was 5.0% and 12.8%, respectively. During AF, the mean number of wavelets was 1.45 (maximum 3 in 76.5%). Anatomical structures showing slow conduction and wavebreaks were mostly located at the septopulmonary bundle (86.5%) and the posterior roof of the LA between the left superior PV and right superior PV (54.1%). CONCLUSION: Focal repetitive activity from PV played an important role in both the initiation and maintenance of AF. Specific anatomical structures such as septopulmonary bundle or posterior roof of the LA were related to the heterogeneous conduction delay and spontaneous wavebreak, which was also important in the maintenance of AF.
Atrial Fibrillation* ; Atrial Premature Complexes ; Cardiac Complexes, Premature ; Catheters ; Heart Atria ; Humans ; Male ; Pulmonary Veins ; Structure-Activity Relationship

BACKGROUND: Cosmetics can affect the skin condition profoundly, and yet no survey has been performed in Koreans visiting dermatology clinics. OBJECTIVE: To assess knowledge and consumer behavior regarding cosmetics in Koreans visiting dermatology clinics. METHODS: A questionnaire consisting of 43 questions concerning demographics and use/knowledge/selection/purchase of cosmetics was given to patients and accompanying persons who visited dermatologic clinics in university and private clinic settings. RESULTS: In total 1,015 subjects (73.2% females, mean age 32.5 years) completed the survey. Education level was college or higher in 72.8%. Thirty-one percent had been diagnosed with a skin disorder, atopic dermatitis and seborrheic dermatitis being the most frequent diagnoses (33.7% and 16.8%, respectively). The frequency of makeup/sunscreen/functional cosmetics use, amount of sunscreen use, recognition of functional cosmetics, and knowledge of shelf life were significantly correlated with level of education. Among “functional cosmetics,” whitening products were used most frequently (29.2%). Regardless of education level, 79.2% purchased cosmetics without checking ingredients, and 85.7% were unaware of the all-ingredient-labelling regulations, and yet subjects considered ingredient the most important factor when purchasing a product. CONCLUSION: Outpatient subjects in their twenties and thirties are the most knowledgeable about cosmetics in Korea.
Consumer Behavior ; Demography ; Dermatitis, Atopic ; Dermatitis, Seborrheic ; Dermatology* ; Diagnosis ; Education ; Female ; Humans ; Korea ; Outpatients ; Skin ; Skin Care ; Social Control, Formal

Polycystic liver is the most common extra-renal manifestation associated with autosomal dominant polycystic kidney disease (ADPKD), comprising up to 80% of all features. Patients with polycystic liver often suffer from abdominal discomfort, dyspepsia, or dyspnea; however, there have been few ways to relieve their symptoms effectively and safely. Therefore, we tried transcatheter arterial embolization (TAE), which has been used in treating hepatocellular carcinoma. We enrolled four patients with ADPKD in Seoul National University Hospital, suffering from enlarged polycystic liver. We embolized the hepatic arteries supplying the dominant hepatic segments replaced by cysts using polyvinyl alcohol particles and micro-coils. The patients were evaluated 12 months after embolization for the change in both liver and cyst volumes. Among four patients, one patient was lost in follow up and 3 patients were included in the analysis. Both liver (33%; 10%) and cyst volume (47.7%; 11.4%) substantially decreased in two patients. Common adverse events were fever, epigastric pain, nausea, and vomiting. We suggest that TAE is effective and safe in treating symptomatic polycystic liver in selected ADPKD patients.
Aged ; Catheterization ; Cysts/*therapy ; Embolization, Therapeutic/instrumentation/*methods ; Female ; Hepatic Artery ; Humans ; Liver/pathology/physiology ; Liver Diseases/pathology/*therapy ; Middle Aged ; Polycystic Kidney, Autosomal Dominant/diagnosis/*therapy ; Polyvinyl Alcohol/therapeutic use ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: Bcl-2 protein is related to the inhibition of apoptosis via the mitochondrial pathway and Bcl-2's anti-oxidant effect. During the development of atherosclerosis, apoptosis is known to play an important role in the pathophysiologic behavior of atherosclerotic vascular disease in the medium-sized arteries. Apoptosis may be a compensatory reaction to regulate the cellular density of various tissues during the cellular proliferation process such as happens with tissue injury and during the development of atherosclerosis. The consequences of apoptosis in atherosclerosis may be related to the formation of an acellular lipid core, plaque instability and the loss of vascular wall integrity and remodeling. We sought to determine the effect of Bcl-2 gene expression on the development of primary atherosclerosis in apolipoprotein E deficient mouse, which is one of the typical animal models that are used for the development of peripheral atherosclerosis. MATERIALS AND METHODS: Bcl-2 transgenic mice were cross hybridized with apolipoprotein E deficient mice. Systemic analysis of the distribution and severity of their atherosclerotic lesions was done by dissecting microscopy, and the histological characteristics of the lesions were evaluated in normal chow-fed, 9-month-old apolipoprotein-E deficient/Bcl-2 transgenic mice (n=6) and apolipoprotein-E deficient mice (n=6). RESULTS: The distribution and severity of atherosclerotic lesions at the peripheral arteries were less in the apolipoprotein-E deficient/Bcl-2 transgenic mice. Acellular lipid core formation, destruction of the smooth muscle cell layers in the media and infiltration of inflammatory cells in the adventitia were much less in the apolipoprotein-E deficient/Bcl-2 transgenic mice. The lipid profile was similar in both groups. CONCLUSION: The effect of Bcl-2 gene expression on the peripheral atherosclerosis was related with the inhibition or the delay of atherosclerotic lesion progression, such as the reduction of amount of the acellular lipid core, maintenance of vascular smooth muscle cell integrity and the reduction of adventitial inflammation, and this was achieved regardless of serum cholesterol level.
Adventitia ; Animals ; Antioxidants ; Apolipoproteins* ; Apoptosis ; Arteries ; Atherosclerosis ; Cell Proliferation ; Cholesterol ; Genes, bcl-2* ; Humans* ; Infant ; Inflammation ; Mice* ; Mice, Transgenic ; Microscopy ; Models, Animal ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Vascular Diseases

BACKGROUND AND OBJECTIVES: Various intravenous (IV) antiarrhythmic drugs in patients with atrial fibrillation (AF) refractory to electrical cardiooversion have been attempted. We assessed the efficacy of IV propafenone in patients with AF who failed to achieve normal sinus rhythm using standard external direct current (DC) cardioversion. SUBJECTS AND METHODS: Of the 77 AF patients who underwent a DC cardioversion, 18, who were refractory for up to a maximal 360 joules of external DC cardioversion, were included in this study. Propafenone was infused for 10 minutes at doses of 2 mg/kg (n=3), 2.5 mg/kg (n=8), and 3 mg/kg (n=7) followed by repeated DC cardioversion. RESULTS: The mean age of the patients receiving propafenone was 55+/-14 years and 21% were women. The mean ejection fraction and the average diameter of the left atrium were 56+/-5% and 42+/-7 mm, respectively. The AF cycle length increased following propafenone infusion form 160+/-23 ms to 278+/-62 ms (p<0.05). The AF converted to a normal sinus rhythm following propafenone infusion in three patients. Thirteen patients were successfully cardioverted following IV propafenone infusion, with a mean accumulated energy of 410+/-216 joules (689+/-373 joules prior to propafenone infusion, p<0.05). Cardioversion failed in 2 patients;therefore, the success rate of the cardioversion in patients who received IV propafenone was 88.9% (16/18). No significant adverse effects were observed. CONCLUSION: IV propafenone can be safely used to enhance the efficacy of cardioversion in patients with AF refractory to transthoracic DC cardioversion.
Anti-Arrhythmia Agents ; Atrial Fibrillation* ; Electric Countershock* ; Female ; Heart Atria ; Humans ; Propafenone*

BACKGROUND AND OBJECTIVES: The role of coronary stenting in the treatment of patients with small vessels (<3.0 mm) in AMI is not well defined. The purpose of this study was to investigate the influence of vessel size on the long-term clinical and angiographic outcome following primary stenting in AMI. SUBJECTS AND METHODS: The study comprised 130 AMI patients with successful primary stent implantation within 12 hours of chest pain onset. Patients were divided into two groups according to the vessel size of the infarct related artery, with the respective ranges of the groups being <3.0 and > or =3.0 mm. The primary end points were the major adverse cardiac events including death, recurrent myocardial infarction, or target vessel revascularization at follow-up. The incidence of angiographic restenosis (> or = 50% of diameter stenosis) was assessed as a secondary end point. Event-free survival in the small vessel group (less than 3mm of reference vessel diameter) was 62.5% at 23.7+/-13.0 months and 76% in the large vessel group (p<0.001) at 23.5+/-12.0 months. The follow-up angiographic restenosis rate was significantly higher in the small vessel group (61% vs. 32% in the small and large vessel groups, respectively, p=026). CONCLUSION: Acute myocardial infarction patients with small vessels present a higher risk for an adverse outcome following primary stenting.
Arteries ; Chest Pain ; Coronary Restenosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction* ; Stents*