Isolated and severe left main coronary ostial stenosis is a rare case. In the majority of these patients ostial stenosis was associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu's aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year young female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia and smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography(TEE) showed acute angle takeoff of the left main coronary artery. She underwent surgical angioplasty of coronary ostia with a patch of autologous pericardium. After angioplasty, TEE showed dilatation of left main coronary ostium and her clinical symptom improved.
Angioplasty ; Aortic Valve ; Aortitis ; Chest Pain ; Constriction, Pathologic* ; Coronary Vessels ; Diabetes Mellitus ; Dilatation ; Female ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II ; Hypertension ; Pericardium ; Smoke ; Smoking ; Syphilis ; Syphilis, Cardiovascular

BACKGROUND: Three cell separators are being used and they collect platelets with different centrifuge speed and duration. Because centrifugation may cause platelet activation, the differences of centrifuge speed and duration are important in controlling the quality of apheresis platelet products. We compared many parameters of activation of platelets collected by Spectra (Cobe BCT, Lakewood, CO, USA), CS3000plus (Baxter Healthcare, Fenwal Division, Round Lake, IL, USA) and Mobile Collection SystemTM (MCS, Haemonetics co., Braintree, MA, USA). METHODS: Platelets were collected from ninety-five normal donors with Spectra (n=39), CS3000plus (n=19) and MCS (n=37). We underwent the procedure according to the automatic program set. We measured platelet yield and assayed pH, hypotonic shock respose (HSR), CD62 (p-selectin, GMP140) expression and beta-thromboglobulin in each stored unit on day 0 and day 3 for evaluation of the storage lesions. RESULTS: Platelet yield per product was 3.7 +/- 1.2 x 1011, mean final product volume was 316 +/- 69 mL and mean procession time was 100 +/- 19 minutes. Mean collection efficiency was 42.5 +/- 8.3%. The cell separator volume of product collected by CS3000plus was the smallest while platelet concentration and total yield were the highest in the product collected by Spectra. The pH of the products were 7.1 +/- 0.1 on day 0 and 6.7 +/- 0.4 on day 3. Hypotonic shock response was 69 +/- 13 % on day 0 and 28 +/- 17 % on day 3. P-selectin expression was 19 +/- 9 % (4.2 +/- 1.9 relative fluorescence intensity, RFI) on day 0 and 60 +/- 22 % (17.9 +/- 14.2) on day 3. beta-thromboglobulin was 28.5 +/- 7.0 IU/107 platelets on day 0 and 31.3 +/- 7.2 IU/107 platelts on day 3. The comparison of the three cell separators showed that on day 0 platelet product of MCS has lower pH and higher beta-thromboglobulin release than others (p<0.05). And on day 3 platelet product of MDS has better hypotonic shock response than others (p<0.05). Other parameters revealed no differences among three cell separators. The expression of p-selectin was shown to correlate highly with pH reduction (r=0.72), but not with the release of beta-TG (r=0.24). CONCLUSIONS: Most parameters showed no differences among three cell separators, but apheresis platelet concentrates processed by MCS showed lower pH on day 0 and higher beta-thromboglobulin concentration on day 0 and day 3 than apheresis platelet concentrates processed by Spectra or CS3000plus and hypotonic shock response on day 3 was the lowest in CS3000plus. So platelet activation produced during apheresis processing was lowest in apheresis platelet concentrates with Spectra.
beta-Thromboglobulin ; Blood Component Removal* ; Blood Platelets* ; Centrifugation ; Delivery of Health Care ; Fluorescence ; Humans ; Hydrogen-Ion Concentration ; Lakes ; Osmotic Pressure ; P-Selectin ; Platelet Activation* ; Tissue Donors

Multiple coronary arteries to communicating with the left ventricular fistulae is a very rare congenital anomaly in adults. This anomaly involves three major coronary arteries that have a direct communication between these arteries and the left ventricle. Hemodynamically, it induces myocardial ischemia due to coronary steal syndrome and diastolic volume overload from a left-to-left shunt. A 70-year-old woman with essential hypertension was admitted to our clinic to evaluate complaints of exertional dyspnea. Clinical examination revealed a diastolic murmur at the apex. A coronary angiogram showed a common fistular channel connecting the right coronary artery, the left circumflex coronary artery, and the first large diagonal branch of the left anterior descending coronary artery with the left ventricular chamber. The patient's symptoms were relieved by the administration of calcium channel blocker and angiotensin II receptor blocker. We report a very rare case of three major coronary arteries communicating to the left ventricular fistulae via a common channel.
Adult ; Aged ; Arteries ; Calcium Channels ; Coronary Vessel Anomalies ; Coronary Vessels* ; Dyspnea ; Female ; Fistula* ; Heart Murmurs ; Heart Ventricles ; Humans ; Hypertension ; Myocardial Ischemia ; Receptors, Angiotensin

Astrocytes are non-excitable cells in the brain and their activity largely depends on the intracellular calcium (Ca²⁺) level. Therefore, maintaining the intracellular Ca²⁺ homeostasis is critical for proper functioning of astrocytes. One of the key regulatory mechanisms of Ca²⁺ homeostasis in astrocytes is the store-operated Ca²⁺ entry (SOCE). This process is mediated by a combination of the Ca²⁺-store-depletion-sensor, Stim, and the store-operated Ca²⁺-channels, Orai and TrpC families. Despite the existence of all those families in astrocytes, previous studies have provided conflicting results on the molecular identification of astrocytic SOCE. Here, using the shRNA-based gene-silencing approach and Ca²⁺-imaging from cultured mouse astrocytes, we report that Stim1 in combination with Orai1 and Orai3 contribute to the major portion of astrocytic SOCE. Gene-silencing of Stim1 showed a 79.2% reduction of SOCE, indicating that Stim1 is the major Ca²⁺-store-depletion-sensor. Further gene-silencing showed that Orai1, Orai2, Orai3, and TrpC1 contribute to SOCE by 35.7%, 20.3%, 26.8% and 12.2%, respectively. Simultaneous gene-silencing of all three Orai subtypes exhibited a 67.6% reduction of SOCE. Based on the detailed population analysis, we predict that Orai1 and Orai3 are expressed in astrocytes with a large SOCE, whereas TrpC1 is exclusively expressed in astrocytes with a small SOCE. This analytical approach allows us to identify the store operated channel (SOC) subtype in each cell by the degree of SOCE. Our results propose that Stim1 in combination with Orai1 and Orai3 are the major molecular components of astrocytic SOCE under various physiological and pathological conditions.
Animals ; Astrocytes* ; Brain ; Calcium* ; Homeostasis ; Humans ; Mice

A 59-year-old man visited an emergency room due to the sudden onset of severe dysarthria with a drowsy mental status. MRI demonstrated T2 prolongation and restricted diffusion involving the splenium of the corpus callosum and bilateral frontal white matter neurological signs and symptoms were mild, and the recovery was complete within a week. Follow-up MRI performed one month later revealed complete resolution of the lesions. The clinical and radiological courses were consistent with previously reported reversible isolated splenial lesions in mild encephalitis/encephalopathy except for the presence of frontal lesions. This case suggests that such reversible lesions can occur outside the splenium.
Corpus Callosum* ; Diffusion ; Dysarthria ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Middle Aged

Renal cell carcinoma (RCC) is one of the most malignant tumors in urology, and due to its insidious onset patients frequently have advanced disease at the time of clinical presentation. Thus, early detection is crucial in management of RCC. To identify tumor specific proteins of RCC, we employed proteomic analysis. We prepared proteins from conventional RCC and the corresponding normal kidney tissues from seven patients with conventional RCC. The expression of proteins was determined by silver stain after two-dimensional polyacrylamide gel electrophoresis (2D-PAGE). The overall protein expression patterns in the RCC and the normal kidney tissues were quite similar except some areas. Of 66 differentially expressed protein spots (p<0.05 by Student t-test), 8 different proteins from 11 spots were identified by MALDI-TOF-MS. The expression of the following proteins was repressed (p<0.05); aminoacylase-1, enoyl-CoA hydratase, aldehyde reductase, tropomyosin alpha-4 chain, agmatinase and ketohexokinase. Two proteins, vimentin and alpha-1 antitrypsin precursor, were dominantly expressed in RCC (p<0.05).
Aged ; Aldehyde Reductase/analysis ; Amidohydrolases/analysis ; Carcinoma, Renal Cell/*metabolism/pathology ; Comparative Study ; Electrophoresis, Gel, Two-Dimensional ; Enoyl-CoA Hydratase/analysis ; Female ; Fructokinases/analysis ; Humans ; Kidney Neoplasms/*metabolism/pathology ; Male ; Middle Aged ; Proteome/*analysis ; Proteomics/*methods ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Tropomyosin/analysis ; Ureohydrolases/analysis ; Vimentin/analysis ; alpha 1-Antitrypsin/analysis

Mice deficient in the toll-like receptor (TLR) or the myeloid differentiation factor 88 (MyD88) are resistant to acute liver failure (ALF) with sudden death of hepatocytes. Chalcone derivatives from medicinal plants protect from hepatic damages including ALF, but their mechanisms remain to be clarified. Here, we focused on molecular basis of piperidylmethyloxychalcone (PMOC) in the treatment of TLR/MyD88-associated ALF. C57BL/6J mice were sensitized with D-galactosamine (GalN) and challenged with Escherichia coli lipopolysaccharide (LPS, TLR4 agonist) or oligodeoxynucleotide containing unmethylated CpG motif (CpG ODN, TLR9 agonist) for induction of ALF. Post treatment with PMOC sequentially ameliorated hepatic inflammation, apoptosis of hepatocytes, severe liver injury and shock-mediated death in ALF-induced mice. As a mechanism, PMOC inhibited the catalytic activity of TGF-β-activated kinase 1 (TAK1) in a competitive manner with respect to ATP, displaced fluorescent ATP probe from the complex with TAK1, and docked at the ATP-binding active site on the crystal structure of TAK1. Moreover, PMOC inhibited TAK1 auto-phosphorylation, which is an axis in the activating pathways of nuclear factor-κB (NF-κB) or activating protein 1 (AP1), in the liver with ALF in vivo or in primary liver cells stimulated with TLR agonists in vitro. PMOC consequently suppressed TAK1-inducible NF-κB or AP1 activity in the inflammatory injury, an early pathogenesis leading to ALF. The results suggested that PMOC could contribute to the treatment of TLR/MyD88-associated ALF with the ATP-binding site of TAK1 as a potential therapeutic target.
Adenosine Triphosphate ; Animals ; Apoptosis ; Catalytic Domain ; Chalcone ; Death, Sudden ; Escherichia coli ; Hepatocytes ; In Vitro Techniques ; Inflammation ; Liver ; Liver Failure, Acute* ; Mice ; Myeloid Differentiation Factor 88 ; Phosphotransferases ; Plants, Medicinal ; Toll-Like Receptors

Chronic pancreatitis causes a variety of complications such as glucose intolerance, pancreatic pseudocyst and duodenal obstruction. However pericardial effusion is very rarely complicated with chronic pancreatitis and life-threatening. The hypothesis of the development of pleuropericardial effusion in chronic pancreatitis has been variously proposed; fistula formation through esophageal or aortic hiatus, local transfer of pancreatic enzyme. Recently, we experienced a case of pleuropericardial effusion complicated by chronic recurrent pancreatitis causing cardiac tamponade. There was a contrast leakage appearing from the pancreatic duct to the mediastinum in endoscopic retrograde pancreaticography. The transpapillary pancreatic stent insertion led to the disappearance of pleuropericardial effusion on the radiography. We report this unusual manifestation of chronic recurrent pancreatitis with the review of literature.
Cardiac Tamponade* ; Duodenal Obstruction ; Fistula ; Glucose Intolerance ; Mediastinum ; Pancreatic Ducts ; Pancreatic Pseudocyst ; Pancreatitis* ; Pancreatitis, Chronic ; Pericardial Effusion ; Radiography ; Stents

Although formaldehyde is well known to cause type 4 hypersensitivity, immunoglobulin E (IgE)-mediated hypersensitivity to formaldehyde is rare. Here, we report a case of recurrent generalized urticaria after endodontic treatment using a para-formaldehyde (PFA)-containing root canal sealant and present a review of previous studies describing cases of immediate hypersensitivity reactions to formaldehyde. A 50-year-old man visited our allergy clinic for recurrent generalized urticaria several hours after endodontic treatment. Prick tests to latex, lidocaine, and formaldehyde showed negative reactions. However, swelling and redness at the prick site continued for several days. The level of formaldehyde-specific IgE was high (class 4). Thus, the patient was deemed to have experienced an IgE-mediated hypersensitivity reaction caused by the PFA used in the root canal disinfectant. Accordingly, we suggest that physicians should pay attention to type I hypersensitivity reactions to root canal disinfectants, even if the symptoms occur several hours after exposure.
Disinfectants/*adverse effects ; Formaldehyde/*adverse effects ; Humans ; Hypersensitivity, Immediate/*chemically induced ; Immunoglobulin E/*immunology ; Male ; Middle Aged ; Recurrence ; Skin Tests ; Time Factors ; Urticaria/*chemically induced/diagnosis ; Zinc Oxide-Eugenol Cement/*chemistry

BACKGROUND: Subclinical hypothyroidism is frequently discovered from hypercholesterolemic adults. It is defined as an asymptomatic state which characterized by normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH) level. Hypercholesterolemia is a major risk factor for coronary heart disease, however hypercholesterolemia caused by hypothyroidism can be easily managed by thyroid hormone replacement. The screening of thyroid disease in hypercholesterolemia patient must be emphasized in order to find out correctable hypothyroidism. So we screened the prevalence of overt and subclinical hypothyroidism at different hypercholesterol levels in middle-aged men and women and also analyzed the correlation between TSH and total cholesterol level. METHODS: We measured serum TSH levels and FT4 by radioimmunoassay from 491 patients with hypercholesterolemia. The subjects were divided into two groups according to serum cholesterol level. Group I was serum cholesterol > or = 240 -<300 mg/dL and group II was > or = 300 mg/dL. Subclinical hypothyroidism was defined as TSH levels higher than 4 mU/L, in the presence of normal FT4 concentration. RESULTS: The overall prevalence of subclinical and overt hypothyroidism was 3.4% and 2.5% in men and 4.7% and 3.5% in women of middle age. In men the prevalence of overt and subclinical hypothyroidism increased from 2.3% of group I to 16.1% in the group II (p<0.05). In women that increased from 5.2 % to 12.9 % (p<0.05). After age correction, an increase of 1 mU/L TSH in men was associated with an increase of 3.2 mg/dL total cholesterol (p<0.01). A similar trend was also found in women (2.1 mg/dL p=0.052). CONCLUSION: In this population, the prevalence of hypothyroidism is up to 16.1% in middle-aged men, 12.9% in middle-aged women with high total cholesterol and it may justify screening of thyroid disease in hypercholesterolemic patients especially in clinical practice.
Adult* ; Asymptomatic Diseases ; Cholesterol* ; Coronary Disease ; Female ; Humans ; Hypercholesterolemia ; Hypothyroidism* ; Male ; Mass Screening ; Middle Aged ; Prevalence* ; Radioimmunoassay ; Risk Factors ; Thyroid Diseases ; Thyroid Gland ; Thyrotropin ; Thyroxine