Intimal hyperplasia is considered to be a most frequent cause attributing to occlusion of a blood flow after vascular surgeries such as endarterectomy, bypass surgery and angioplasty. Clearly this response is a significant cause of morbidity in patients undergoing vascular procedures and studies to find out the strategy for avoid intimal hyperplasia are of great importance. The precise pathophysiologic pathways leading to the development of intimal hyperplasia have not been yet clear. The initial event is thought to be damage to the vascular intimal endothelium. Intimal hyperplasia is the characteristic fibromuscular cellular response on intimal injury and some author advocated the "response-to-injury" hypothesis of atherogenesis to be inducing factors of intimal hyperplasia. Endothelial cells release a number of vasoactive substances such as relaxing factor, including nitric oxide(NO). The NO has not only relaxing effect to the smooth muscle cells, but also inhibitory effect to intimal hyperplasia. In this study, we investigated on rat inhibitory effect of NO donor(SNAP, SNP) to intimal hyperplasia on endothelial denudation and reversed by coadministration of the NO synthase inhibitor, L-NAME. Balloon catheter denudation of common carotid artery was performed in 35 rats pharmacologically treated from 3 days before to 14 days after surgery(5 mg/kg/day, intraperitoneally) and divided into 5 groups: control group, without any medical treatment; SNAP group, S-Nitroso-N- acetylpenicillamine; SNP group, sodium nitroprusside; SNAP+L group, both SNAP and N(G)-Nitro-L-arginine methylester; SNP+L group, both sodium nitroprusside and N(G)-Nitro-L-arginine methylester. Animals were killed and left common carotid arteries were perfused and fixed with 10% formalin solution at 14 days after endothelial denudation. Cross sectional intima-to-media area ratios(I-M ratio, intimal area/[intimal area medial area]x100) were calculated by an image analyzer system and serum level of NO was measured directly by electrochemical methods. The results of the this experimental study were as follows: 1) Morphometric analysis of cross sections showed marked intimal thickening in the control group with an mean I-M ratio of 64.71+/-4.96%. In contrast, the I-M ratios in the SNAP group were significantly reduced by 53.14+/-7.86%(P<0.05) and in the SNP group by 43.43+/- 9.32%(P<0.05). The IM ratios of animals treated with L-NAME in group SNAP-L and group SNP-L were 68.43+/-3.91% and 67.71+/-5.50% respectively(P=NS). No significant change was noted when L-NAME was coadministered with SNAP and SNP compared to control group. 2) The serum level of NO in SNAP group(2509.7+/-354.95 nM) and SNP group(3430.4+/-236.70 nM) were significantly increased compare to control group(1339.2+/-101.04 nM)(P<0.05). Coadministration of L-NAME in group SNAP-L(1719.8+/-483.65 nM) and group SNP-L(1415.7+/-219.04 nM)were no significant changed compare to control group(1339.2+/-101.04 nM). These experiments suggest that SNAP and SNP reduced intimal hyperplasia and increased serum level of NO, reversed by coadministration of L-NAME. The relation between the intimal hyperplasia suppression and NO increase should be speculated.
Angioplasty ; Animals ; Atherosclerosis ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Endarterectomy ; Endothelial Cells ; Endothelium ; Formaldehyde ; Humans ; Hyperplasia ; Microelectrodes ; Myocytes, Smooth Muscle ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide ; Nitroprusside ; Rats

Midventricular obstructive hypertrophic cardiomyopathy (MOHCM) is a rare variant of hypertrophic cardiomyopathy. Apical dilatation and myocardial infarction can be complicated without significant coronary artery disease. We report a case of apical dilatation in a patient with MOHCM without atherosclerotic coronary artery disease. A 76-year-old woman was admitted for recent cerebral infarction and consulted to cardiologist for abnormal electrocardiographic findings. She had been suffering from exertional dyspnea (NYHA II) for about four years. Two dimentional-echocardiography revealed midventricular obstructive hypertrophy with an apical dilatation and paradoxical jet flow from the apical aneurysm to the left ventricular outflow tract during early diastole. Cardiac catheterization demonstrated dyskinesia in the apical wall with midventricular obstruction and a peak-to-peak intraventricular pressure gradient of 110 mmHg during pull-back from the apical high-pressure chamber to the subaortic low-pressure chamber in the left ventricle. Coronary angiograms showed no significant stenotic lesion of the coronary arteries. She was prescribed oral beta-adrenergic antagonist to decrease the intraventricular pressure gradient.
Aged ; Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Cerebral Infarction ; Coronary Artery Disease ; Coronary Vessels ; Diastole ; Dilatation* ; Dyskinesias ; Dyspnea ; Electrocardiography ; Female ; Heart Ventricles ; Humans ; Hypertrophy ; Myocardial Infarction ; Ventricular Pressure

BACKGROUND: Since the bioavailability of itraconazole capsule is influenced by patients gastric acidity, it results in treatment failure due to its low dissolution and subsequent low absorption when administered in fasting. Itraconazole Melt-Extrusion tablet has been lately developed in order to improve its dissolution profile. It is the first clinical study to evaluate the efficacy and safety of itraconazole Melt-Extrusion tablet in Korea. OBJECTIVE: This study was conducted to evaluate the efficacy and safety of itraconazole melt-extrusion tablet 400mg daily for 1 week(pulse therapy) for hyperkeratotic type of tinea pedis and manus. METHODS: A clinical and mycological investigation was made of 812 outpatients with hyperkeratotic type of tinea pedis and/or tinea manus who had visited at 52 general hospitals under the lead of the Korean Dermatological Association from June to December, 1998. Patients confirmed by clinically and microscopically as hyperkeratotic type of tinea pedis and/or tinea manus were administered 2 tablets twice a day for one week and followed up for 8 weeks from the start of the medication. RESULTS: The results were summarized as follows; 1. Clinical symptoms of hyperkeratotic type of tinea pedis and/or tinea mauns were significantly improved at the end of study, week 8(p<0.001). 2. Clinical response rate, defined as more than 50% decrease of the sum of the clinical symptom scores, was 79.3%(512/646). 3. Mycological cure rate, dafined as both culture and KOH negative at week 8, was 78.2%(244 /312). 4. 40(5.5%) patients, of the 727 patients evaluable for drug safety evaluation, were reported to have adverse event. CONCLUSION: Itraconazole Melt-Extrusion tablet 400mg/day for 1 week (pulse therapy) is effective and safe in the treatment of hyperkeratotic type of tinea pedis and/or tinea manus.
Absorption ; Biological Availability ; Fasting ; Gastric Acid ; Hospitals, General ; Humans ; Itraconazole* ; Korea ; Outpatients ; Tablets ; Tinea Pedis* ; Tinea* ; Treatment Failure