BACKGROUND: Nonrheumatic atrial fibrillation is common in elderly and associated with an increased risk for thromboembolism. Left atrial spontaneous echo contrast(SEC) and thrombus. which are easily detected by transesophageal echocardiography(TEE) in patients with rheumatic mitral valve disease and atrial fibrillation, have been known as markers of thromboembolism. However, most of the previous studies on left atrial SEC and thrombus were performed in rheumatic mitral valve disease or various conditions including rheumatic mitral valve disease. Therefore this study was underaken in order to investigatd 1) the prevalence of left atrial SEC and thrombus, and 2) clinical and echocardiographic variables related to left atrial SEC and thrombus in nonrheumatic atrial fibrillation. METHODS: In patients with estabished atrial fibrillation over 7 days, we examined the clinical gistory and performed transthoracic echocardiography(TTE) and TEE simultaneously. Enlisted patients were those without rheumatic mitral valve disease, prosthetic valves, previous thromboembolism, and recent anticoagulant therapy. RESULTS: 1) Left atrial SEC was detected in 32(62.7%) of 51 patients and left atrial thrombus in 10(19.6%). All thrombi were located in the left atrial appendage. 2) In univariate analysis, SEC positive group showed higher prevalence of congestive heart failure(CHF)(56.3% vs 0%, p<0.001), lower ejection fraction(42.2+/-14.1% vs 50.8+/-9.7%, p<0.05), lower left atrial appendage blood flow velocity(peak positive flow velocity ; 18.7+/-11.1cm/sec vs 32+/-12.4cm/sec, p<0.01, and peak negative flow velocity ; 21.4+/-12.4cm/sec vs 31.9+/-12.8cm/sec, p<0.01) than SEC negative group. Multivariate analysis identifed CHF as an independent variable related to left atrial SEC(p=0.02, Odds ratio ; 2.38, 95% CI ; 1.18-4.82). 3) In univariate analysis. left atrial thrombus positive group showed higher prevalence of CHF(70% vs 26.8%, p<0.05), larger left atrial demension(34+/-3.4mm/m2 vs 30.6+/-4.6mm/m2, p<0.05) than thrombus negative group. Multivariate analysis identifed CHF as an independent variable related to left atrial thrombus(p=0.04, Odds ratio ; 4.30, 95% CI ; 1.11-16.68). 4) Left atrial thrombus is more frequent in SEC positive group than in SEC negative group(28.1% vs 5.3%), however, there was no statistical significance(p=0.07). CONCLUSION: 1) Left atrial SEC is common in nonrheumatic atrial fibrillation and significantly related to CHF. 2) Left atrial thrombus is frequently detected in SEC positive patients, however, it is more realted to CHF than left atrial SEC itself.
Aged ; Atrial Appendage ; Atrial Fibrillation* ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Mitral Valve ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Thromboembolism ; Thrombosis*

BACKGROUND: Twenty-four-hour ambulatory blood pressure(ABP) monitoring has become increasingly popular for diagnosing and treating hypertension. Therefore the reference value of normotensive subjects was necessary for interpretation of hypertensive subjects. Several studies were reported on reference values in normotensive subjects. The purpose of this study was to determine 24-hour ABP in normotensive Korean adults stratified for sex and five age groups. This study also assessed ABP in relation to a family history of hypertension, smoking and body mass index(BMI). METHODS: ABP monitoring was performed in 200 healthy normotensive volunteers(ranged in age from 20 to 69 years, five decades, 20 men and 20 women per each decade), over 24 hours, taking measurement at 30-min intervals. The 24-hour interval was divided into day-time(6am-10pm) and night-time(100pm-6am) periods. Mean ABP and pressure loads(percentage of systolic readings>140mmHg, diastolic readings>90mmHg) were obtained. RESULTS: The mean ABP in 200 subjects was 113+/-8.6/72+/-6.9mmHg over 24 hours, 117+/-9.7/75+/-7.0mmHg during day-time, and 106+/-9.8/67+/-8.3mmHg at night-time, and pressure loadd averaged 5.1+/-7.4/7.9+/-8.9% over 24 hours. The +2 standard deviation(SD) as the upper limit of normal was 130/86mmHg over 24 hours in 200 subjects. The mean ABP and pressure load were 116+/-7.6/74+/-7.6mmHg and 6.4+/-8.3/10.1+/-10.2% in 100 subjects of men, and 110+/-8.3+/-70+/-6.6mmHg, 3.7+/-6.0/5.7+/-6.8% in women. Mean ABP and pressure load showed significant difference in relation to age group and sex, however, no significant difference in relation to a family history of hypertension or smoking. In relation to BMI group, diastolic blood pressure and diastolic pressure load were significantly different.
Adult* ; Blood Pressure* ; Female ; Humans ; Hypertension ; Male ; Reference Values ; Smoke ; Smoking

Recently, devices using radiofrequency energy have been developed for arthroscopic soft tissue ablation and shrinkage. The purpose of this study was to evaluate effect of radiofrequency energy on the biomechanical competence of thermal shrinkage of anterior cruciate ligament and was to demonstrate a new approach for radiofrequency energy, applying to ligamentous tissue in a dynamic fashion. Twelve New Zealand White rabbits, were divided into two experimental groups by right and left hindlimbs. Thermal shrinkage of the anterior cruciate ligament of rabbits produced using radiofrequency energy generator(N=12, group I). And untreated control group(N=12, group II). The percent shrinkage was calculated from the change of length of anterior cruciate ligament after radiofrequency energyinduced thermal shrinkage. The maximal tensile stress and linear stiffness of anterior cruciate ligament as biomechanical competence were assessed. The results obtained were as follows: 1. In the group I the percentage of shrinkage was 29.50Fo on the average. 2. The average of maximal tensile stress to failure was 271.24 kN in group I and 283.50 kN in group II. There was no significant difference(p=0.24) in the maximal tensile stress between two groups. 3. The average of linear stiffness in group I(179.16kN/mm) was higher than that of group II(148.20kN/mm). But there was no significant difference(p=0.078) between two groups. This study shows that radiofrequency energy appears to be safe to use on therma1 shrinkage of anterior cruciate ligament, which necessitate a mechanical tensile strength.
Animals ; Anterior Cruciate Ligament* ; Hindlimb ; Ligaments ; Mental Competency ; Rabbits ; Tensile Strength

3-Deazaadenosine (DZA), a cellular methylation blocker was reported to induce the caspase-3-like activities-dependent apoptosis in U-937 cells. In this study, we analyzed the activation pathway of the caspase cascade involved in the DZA-induced apoptosis using specific inhibitors of caspases. In the U-937 cells treated with DZA, cytochrome c release from mitochondria and subsequent activation of caspase-9, -8 and -3 were observed before the induction of apoptosis. zDEVD-Fmk, a specific inhibitor of caspase-3, and zLEHD-Fmk, a specific inhibitor of caspase-9, prevented the activation of caspase-8 but neither caspase-3 nor caspase-9, indicating that caspase-8 is downstream of both caspase-3 and caspase-9, which are activated by independent pathways. zVAD-Fmk, a universal inhibitor of caspases, kept the caspase-3 from being activated but not caspase-9. Moreover, ZB4, an antagonistic Fas-antibody, exerted no effect on the activation of caspase-8 and induction of apoptosis by DZA. In addition, zVAD-Fmk and mitochondrial permeability transition pore (MPTP) inhibitors such as cyclosporin A (CsA) and bongkrekic acid (BA) did not block the release of cytochrome c from mitochondria. Taken together, these results suggest that in the DZA-induced apoptosis, caspase-8 may serve as an executioner caspase and be activated downstream of both caspase-3 and caspase-9, independently of Fas receptor-ligand interaction. And caspase-3 seems to be activated by other caspses including IETDase-like enzyme and caspse-9 seems to be activated by cytochrome c released from mitochondria without the involvement of caspases and CsA- and BA- inhibitory MPTP.
Amino Acid Chloromethyl Ketones/pharmacology ; Apoptosis/*drug effects ; Bongkrekic Acid/pharmacology ; Caspases/*metabolism ; Cell Line ; Cyclosporine/pharmacology ; Cytochrome c/drug effects/metabolism ; Enzyme Activation ; Human ; Leukocytes, Mononuclear/cytology ; Ligands ; Membrane Glycoproteins/metabolism ; Tubercidin/*pharmacology ; U937 Cells

3-Deazaadenosine (DZA), a cellular methylation blocker was reported to induce the caspase-3-like activities-dependent apoptosis in U-937 cells. In this study, we analyzed the activation pathway of the caspase cascade involved in the DZA-induced apoptosis using specific inhibitors of caspases. In the U-937 cells treated with DZA, cytochrome c release from mitochondria and subsequent activation of caspase-9, -8 and -3 were observed before the induction of apoptosis. zDEVD-Fmk, a specific inhibitor of caspase-3, and zLEHD-Fmk, a specific inhibitor of caspase-9, prevented the activation of caspase-8 but neither caspase-3 nor caspase-9, indicating that caspase-8 is downstream of both caspase-3 and caspase-9, which are activated by independent pathways. zVAD-Fmk, a universal inhibitor of caspases, kept the caspase-3 from being activated but not caspase-9. Moreover, ZB4, an antagonistic Fas-antibody, exerted no effect on the activation of caspase-8 and induction of apoptosis by DZA. In addition, zVAD-Fmk and mitochondrial permeability transition pore (MPTP) inhibitors such as cyclosporin A (CsA) and bongkrekic acid (BA) did not block the release of cytochrome c from mitochondria. Taken together, these results suggest that in the DZA-induced apoptosis, caspase-8 may serve as an executioner caspase and be activated downstream of both caspase-3 and caspase-9, independently of Fas receptor-ligand interaction. And caspase-3 seems to be activated by other caspses including IETDase-like enzyme and caspse-9 seems to be activated by cytochrome c released from mitochondria without the involvement of caspases and CsA- and BA- inhibitory MPTP.
Amino Acid Chloromethyl Ketones/pharmacology ; Apoptosis/*drug effects ; Bongkrekic Acid/pharmacology ; Caspases/*metabolism ; Cell Line ; Cyclosporine/pharmacology ; Cytochrome c/drug effects/metabolism ; Enzyme Activation ; Human ; Leukocytes, Mononuclear/cytology ; Ligands ; Membrane Glycoproteins/metabolism ; Tubercidin/*pharmacology ; U937 Cells

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the relationship between the expression of Bcl-2, Bax, p27 and lymph node metastasis (LNM) in papillary thyroid cancer (PTC). SUBJECTS AND METHOD: The thyroid tissue samples were obtained randomly from the department of pathology at Kangbuk Samsung Hospital. The specimens were from 72 patients, comprising 25 patients with thyroid nodular hyperplasia (TNH), 23 PTC without LNM, and 24 PTC with LNM between January 2006 and May 2008. Immunohistochemical staining for Bcl-2, Bax, and p27 was performed, and quantified blindly by three pathologists who had no clinical information of the patients. Immunohistochemical expression was scored as high (>25% of cells stained) or low (0-25%). RESULTS: Expression of Bcl-2 was scored as high for 1 (4%) TNH, 3 (13%) PTC without LNM and 4 (17%) PTC with LNM cases. Expression of Bax was scored as high for 0 (0%) TNH, 9 (39%) PTC without LNH and 16 (67%) PTC with LNM cases. Expression of p27 was scored as high for 13 (52%) TNH, 12 (52%) PTC without LNM and 13 (54%) PTC with LNM cases. Expression of Bax in the PTC with LNM group was scored higher than TNH (p<.01) and PTC without LNM (p<.05). There was no statistically difference in the immunoreactivity for Bcl-2 and p27 among the three groups. However, some positive expressions of p27 were noted at the cytoplasm of the PTC. CONCLUSION: Our results suggest that immunohistochemical analysis of Bax may be helpful in the diagnosis of PTC and in the evaluation of lymph node metastatic potential in PTC.
Carcinoma, Papillary ; Cytoplasm ; Factor IX ; Humans ; Hyperplasia ; Lymph Nodes ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms

Monoclonal gammopathy occurs in one-third of the patients with mucosa-associated lymphoid tissue lymphoma (MALT lymphoma). However, monoclonal gammopathy has been rarely reported in Korea. Paraprotenemia accompanying MALT lymphoma is strongly correlated with involvement of the bone marrow, and this involvement leads to the progression of the disease. Here, we present a case of a 66-yr-old man diagnosed with IgM monoclonal gammopathy and stage IV extranodal marginal zone lymphoma of the small intestine, with the involvement of the bone marrow.
Aged ; Antineoplastic Agents/therapeutic use ; Bone Marrow/pathology ; Drug Therapy, Combination ; Electrophoresis, Polyacrylamide Gel ; Humans ; Immunoglobulin M/analysis ; Intestinal Neoplasms/complications/drug therapy/*pathology ; Lymphatic Metastasis ; Lymphoma, B-Cell, Marginal Zone/complications/drug therapy/*pathology ; Male ; Neoplasm Staging ; Paraproteinemias/blood/complications/*pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

BACKGROUND/AIMS: This study was designed to investigate the role of gastric acid in the extent of H. pylori-induced gastritis. METHODS: Twenty eight mice were innoculated with live H. pylori. They were allocated into four groups. Mice in group I received no treatment, group II mice were treated with sham injection, group III received 125microgram/kg body weight of pentagastrin, while group IV received 250microgram/kg body weight of pentagastrin subcutaneously three times a week. After 7 months, the mucosal pH, H. pylori density, neutrophils and monocytes infiltration, and the degree of atrophy were assessed in the stomach. RESULTS: In the gastric body, the densities of H. pylori were not different among groups. The degree of neutrophil infiltration was significantly lower in group IV compared to other groups (p<0.05). The degree of monocyte infiltration was also significantly lower in group IV than group III (p<0.05). In the gastric antrum, there was no significant difference of the H. pylori density, neutrophil and monocyte infiltration, and degree of atrophy among the groups. The mice with the gastric mucosal pH lower than mean of 3.2 had significant lower level of H. pylori density (1.4 vs. 2.4, p=0.04), and infiltration of neutrophils (0.9 vs. 2.3, p=0.018), and monocytes (1.2 vs. 1.8; p=0.011) than the those with mucosal pH above 3.2 in the body of stomach. CONCLUSIONS: Gastric acid plays a role in suppressing the proximal propagation of H. pylori-induced gastritis to the body of stomach.
Animals ; Female ; Gastric Acid/*metabolism ; Gastric Mucosa/pathology ; Gastritis/immunology/*microbiology ; Helicobacter Infections/*immunology/microbiology ; *Helicobacter pylori/isolation & purification ; Hydrogen-Ion Concentration ; Mice ; Mice, Inbred C57BL ; Models, Animal

PURPOSE:We analysed the spectrum of diagnoses made in a consecutive group of children referred for signs of precocious puberty and evaluated the clinical and endocrinologic characteristics. METHODS:Retrospective analysis of 375 children (365 girls and 10 boys) referred for evaluation of signs of precocious puberty between January 2003 and May 2007 was done. Results:The conditions causing precocious puberty were early puberty (36.3%), true precocious puberty (30.4%), premature thelarche (29.1%), pseudo-precocious puberty (3.7%), and premature pubarche (0.5%). Among girls, there were differences in the age of onset of puberty (premature thelarche, 5.4+/-2.6 years vs. true precocious puberty, 6.9+/-1.1 years vs. early puberty, 8.6+/-0.5 years). True precocious puberty girls showed higher height SDS (standard deviation score), weight SDS, BMI (body mass index) percentile, basal FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol, more accelerated growth velocity and bone age than those with premature thelarche. True precocious puberty patients showed higher height SDS, weight SDS, and more bone age advancement when compared to those with early puberty. Later onset (>2 years) premature thelarche appeared in 89 girls (81.7% of premature thelarche) at 6.4+/-1.6 years, and among 42 patients followed-up, 8 girls developed true precocious puberty later. CONCLUSION:Common conditions causing precocious puberty are early puberty, true precocious puberty, and premature thelarche. Although premature thelarche may be regarded as a benign condition, true precocious puberty can develop in some patients, so careful follow-up will be needed.
Age of Onset ; Child ; Estradiol ; Follicle Stimulating Hormone ; Follow-Up Studies ; Humans ; Luteinizing Hormone ; Puberty ; Puberty, Precocious

BACKGROUND AND OBJECTIVES: The traditional form of reconstruction of multiple defects after head and neck cancer ablation has been the two-combined regional flaps or that of one regional flap and skin graft. Such flaps, however, have functional and aesthetic problems such as donor site morbidity, and post-operative stenosis and fistula. MATERIALS AND METHODS: We reviewed clinical data of eleven head and neck cancer patients who have been reconstructed with bilobed flaps or gemini flaps after ablation from November 1988 to October 1998. The patients were divided into four groups. Type I flap is bilobed flap consisting of one bed and fused skin, type II flap is gemini flap consisting of one bed and separated skin, type III flap is gemini flap consisting of separated skin and bed, and type IV flap is bilobed flap or gemini flap composed of free bone graft. RESULTS: The survival rate of bilobed flaps and gemini flaps was 91%. The most common complication was fistula, followed by donor vein thrombosis and total loss of flap. CONCLUSIONS: The advantages of bilobed flaps and gemini flaps were one-stage operation, and aesthetic effect for reduced bulk of thinned radial free forearm flap, and diminished morbidity of donor site. Bilobed flaps and gemini flaps were also used for salvage operation of the patients who had been treated with concomitant chemo-radiotherapy, or combined chemo-radiotherapy, or radiotherapy alone for malignant tumors of head and neck.
Constriction, Pathologic ; Fistula ; Forearm ; Head and Neck Neoplasms* ; Head* ; Humans ; Neck ; Radiotherapy ; Skin ; Survival Rate ; Thrombosis ; Tissue Donors ; Transplants ; Veins