BACKGROUND: Flecainide is an antiarrhythmic agent that is used primarily in the treatment of cardiac arrhythmias. Some evidences also suggest that flecainide can participate in alveolar fluid clearance and inflammatory responses. This experiment was aimed to evaluate the effects of flecainide on sepsis induced acute lung injury in a rat model. METHODS: Rats were treated with subcutaneous infusion of saline or flecainide (0.1 or 0.2 mg/kg/hr) by a mini-osmotic pump. Subcutaneous infusion was started 3 hours before and continued until 8 hours after intraperitoneal injection of saline or endotoxin. Animals were sacrificed for analyses of severity of acute lung injury with wet to dry (W/D) ratio and lung injury score (LIS) in lung and inflammatory responses with level of leukocyte, polymorphonuclear neutrophils (PMNs) and inteleukin-8 (IL-8) in bronchoalveolar lavages fluid (BALF). RESULTS: Flecainide markedly improved dose dependently sepsis induced acute lung injury as analysed by W/D ratio (from 2.24 ± 0.11 to 1.76 ± 0.09, p < 0.05) and LIS (from 3 to 1, p < 0.05), and inflammatory response as determined by leukocyte (from 443 ± 127 to 229 ± 95, p < 0.05), PMNs (from 41.43 ± 17.63 to 2.43 ± 2.61, p < 0.05) and IL-8 (from 95.00 ± 15.28 to 40.00 ± 10.21, p < 0.05) in BALF. CONCLUSIONS: Flecanide improve sepsis induced acute lung injury in rats by controlling inflammatory responses.
Acute Lung Injury* ; Animals ; Arrhythmias, Cardiac ; Bronchoalveolar Lavage ; Flecainide* ; Infusions, Subcutaneous ; Injections, Intraperitoneal ; Interleukin-8 ; Leukocytes ; Lung ; Lung Injury ; Models, Animal ; Neutrophils ; Rats ; Sepsis*

Eighteen cases of osteonecrosis of the femoral head associated with macromolecular polyvinylpyrrolidone (PVP) deposition were analysed on the basis of clinical, radiologic and pathologic features. The cases were observed during 8 years period from January, 1974 to December, 1981. The pathogenesis of the osteonecrosis of the femoral head due to PVP storage in reticuloendothelial system were discussed in detail. Parenteral administration of high-molecular PVP in repeated, long duration led to osteonecrosis of the femoral head. Storage of PVP in the histiocytes of the bone marrow resulted in osteonecrosis of the femoral head followed by microciculation disturbance. PVP-induced osteonecrosis were manifested as multiple foci of necrosis involving not only the femoral head, other long bones around joints, but also the visceral reticuloendo-thelial system characterized by infiltrates of histiocytes laden with PVP. The patients with PVP induced osteonecrosis complianed multiple joint pain in their early course of the disease. On roentgenogram, osteonecrosis were often noted in the hip, shoulder, knee, and ankle in order or frequency. Foamy histiocytes laden with PVP were characteristic on hematoxylin-eosin stain diagnostic on Weigert's elastica, phosphotungstic acid hematoxylin, and Congo red stains. As far as rationale of the treatment concerning a number of staging systems for Osteonecrosis, the choice of surgical procedures were similar to those given by W.F. Enneking et al. In the series, we have performed two hips in total surface replacement, 26 hips in total hip replacement mostly for 3rd generation-configuration of Charnley prosthesis. In addition, one case for free vascularized fibula graft and trans-trochanteric rotational osteotomy after Sugioka were also included for this study. The result of treatment was rather optimistic. However, complications have occured in 4 hips of 3 patients which required removal of whole prosthetic components. Therefore, we underwent revisional surgery in three out of four hips subsequently during the short post-poerative follow-up. These will be published in the future.
Ankle ; Arthralgia ; Arthroplasty, Replacement, Hip ; Bone Marrow ; Coloring Agents ; Congo Red ; Fibula ; Follow-Up Studies ; Head ; Hematoxylin ; Hip ; Histiocytes ; Humans ; Joints ; Knee ; Mononuclear Phagocyte System ; Necrosis ; Osteonecrosis ; Osteotomy ; Phosphotungstic Acid ; Povidone ; Prostheses and Implants ; Rubber ; Shoulder ; Transplants

Subclinical hyperthyroidism and subclinical hypothyroidism are characterized by abnormal thyroid stimulating hormone (TSH) with normal free thyroxine. Subclinical thyroid diseases, to date, have received less attention compared with other thyroid diseases since they are asymptomatic. This study aimed to verify the association between subclinical thyroid diseases and cardiovascular diseases (CVDs) risk score in the Korean population. This was a population-based cohort study using data collected from 3,722 subjects (aged ≥ 30 years) during the 6th Korea National Health and Nutrition Examination Survey (KNHANES VI; 2013–2015). Gender-specific Framingham risk scores were calculated to identify the association between subclinical thyroid diseases and 10-year CVD risk score. Complex survey, with consideration of sampling weight, was analyzed using generalized linear models after stratification by gender. The TSH reference range was between 0.61 and 6.91 mIU/L in this study. TSH showed a positive association with the 10-year CVD risk score only in the female population (P = 0.001). There were significant differences in the least squares means of 10-year CVD risk score by the effect of subclinical hypothyroidism compared with euthyroidism (normal group) in females, after adjusting for body mass index, white blood cell, and urine iodine (P = 0.006 and Bonferroni corrected P = 0.012). In conclusion, subclinical hypothyroidism is associated with increased 10-year CVD risk score in the female Korean population aged 30 years or more. Therefore, we recommend to clinically checkup major CVD risk factors in female patients with subclinical hypothyroidism aged 30 years or more.
Body Mass Index ; Cardiovascular Diseases* ; Cohort Studies ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Iodine ; Korea ; Least-Squares Analysis ; Leukocytes ; Linear Models ; Nutrition Surveys ; Reference Values ; Risk Factors ; Thyroid Diseases* ; Thyroid Gland* ; Thyrotropin ; Thyroxine

PURPOSE: To analyze the results of a 5-12 year (mean, 7 years, 5 months) follow-up of femoral revision THA using the Wagner(R) stem. MATERIALS AND METHODS: Of 79 revision THA patients enrolled in the study between March 1991 and January 2000, there were 64 cases of aseptic loosening (69 hips, 44 males and 20 females) during a minimum 5-year follow-up. In addition, postoperative complications and clinical and radiographic results were evaluated. RESULTS: The Harris hip score improved from 48.6 to 91.2 points, postoperatively. There were 3 revisions due to failed stem fixation and aseptic loosening. The Kaplan-Meier survivorship analysis, with failure defined as a removal of the Wagner(R) stem, revealed a 97.1% survival at a 12-year follow-up. Besides the revisions, there were 66 hips that were hip-related symptom-free. However, there was claudication in 1 case. Radiographic findings included subsidence of the implant (5 cases, 7.5%, all less than 10 mm), calcar femorale atrophy (4 cases, 6.0%), stress shielding (4 cases, 6.0%), and heterotopic ossification (5 cases, 7.5%). Postoperative peroneal nerve palsy (2 cases) resolved completely within the following 6 months. CONCLUSION: We obtained a stable fixation and satisfactory results in the cases we studied using the Wagner(R) revision stem.
Arthroplasty, Replacement, Hip* ; Atrophy ; Follow-Up Studies ; Hip ; Humans ; Male ; Ossification, Heterotopic ; Paralysis ; Peroneal Nerve ; Postoperative Complications ; Survival Rate

No abstract available.
Cholera* ; Korea*

BACKGROUND: The exercise stress testing(Treadmill Test) is one of the preferred noninvasive methods of identifying patients with coronary artery disease. ST-segment elevation during or immediately after exercise is uncommon and in most patients, it was associated with prior infarction, left ventricular hypertrophy or left bundle branch block, Exercise-induced ST-segment elevation has been attributed to ventricular wall motion abnormalities, and ischemia due to either coronary vasospasm or ervere proximal coronary stenosis. We examined the clinical, angiographic, and prognostic significance of 16 patients with exercise induced ST-segment elevation. METHODS: 16 patients with exercise-induced ST-segment elevation were retrospectively reviewed. The symptom-limited exercis testing was performedn using a modified Bruce protocol and in patients with acute myocardial infarction(AMI), low level exercise testing(Myocardial infarction protocol) was used. The significant ST-segment elecation was defined as a > or =1mm change present in >1 lead measured at 0.08 sec after J point and in > or =3 consecutive beats. Coronary arteriogram and percutaneous transluminal coronary angioplasty(PTCA) was performed using standard techniques within 7 days of initial exercise testing and a luminal diameter stenosis of >50% was considered significant. RESULTS: 1) We have studied 2076 exercise tests and 16 patients(M/F:15/1, Mean age : 58 years) developed exercise-induced ST-segment elevation. The initial diagnosis were acute myoca rdial infarction(AMI) in 12, variant angina in 2, effort angina in 1 and unstable angina in 1 patient. 9 of 12 patients with AMI were treated with thrombolytic agent(Urokinase 2.5 to 3 million unit) within 6 hours from the onset of chest pain. 2) Mean maximal ST-segment elevation was 2.6mm(range 1-5mm). The leads which showed exercise-induced ST-segment elevation were corresponded to the location of severe coronary stenosis in typical effort angina, to spasm site in variant angina, and to infarction site in AMI. 11 Patients had follow-up exercise testing and showed abolition of exercise-induced ST-segment elevation in 4 of 5 patients with AMI and 1 patient with effort angina after PTCA, and 1 patient with variant angina and 3 of 4 patient with AMI after medication. 3) In 12 patients, coronary angiography was performed, and showed 95% and 90% stenosis at proximal LAD in 2 patients with effort angina and >80% stenosis at proximal or mid lesion of infarct-related artery in 7 patients with AMI. In variant angina, one patient showed normal coronary artery and another patient showed 60% stenosis at mid LAD. On LV angiogram, there were moderate to severe hypokinesia instead of akinesia or dyskinesia at infarction site in all patients with AMI and showed normal LV contractility in patients with effort or variant angina. PTCA were successfully performed in 7 patients(effort angina 2, AMI 5). 4) The clinical follow up for 16 patients were obtained for mean follow-up duration of 17 months and during the clinical follow-up, 1 variant angina patient with mild stenosis at proximal LAD was died with ventricular fibrillation after discontinution of medication. There were CABG due to restenosis in 1 patient and cerebrovascular accident in 1 patient. CONCLUSION: 1) The exercise-induced ST-segment elevation signifies severe ischemia due to either severe proximal coronary stenosis or coronary arterial spasm. In AMI, this findings suggests the residual ischemia(or residual viable myocardium) in addition to left ventricular dyssynergy or aneurysm. 2) Adverse cardiac events can be provented by revascularization in patients who had critical coronary stenosis and by medical therapy in those with coronary vasospasm or mild coronary stenosis.
Aneurysm ; Angina, Unstable ; Arteries ; Bundle-Branch Block ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vasospasm ; Coronary Vessels ; Diagnosis ; Dyskinesias ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertrophy, Left Ventricular ; Hypokinesia ; Infarction ; Ischemia ; Phenobarbital ; Retrospective Studies ; Spasm ; Stroke ; Ventricular Fibrillation

BACKROUND: Polymorphism of glycoprotein IIIa on human platelets is one of the factors in alloimmunization that causes neonatal alloimmune thrombocytopenia (NATP), and the granulocyte antigens NA1 and NA2 are often targets of granulocytes antibodies causing neonatal alloimmune neutropenia (NANP). Currently, serotyping relies on the properties of the typing sera or antibodies and technique used. Genotyping circumvents the problems associated with serotyping. METHODS: The genomic DNA of 200 unrelated pregnant women admitted to Taegu Fatima Hospital was typed for three platelet glycoprotein IIIa-specific antigens (HPA-1, HPA-4, and HPA-6w) and granulocyte antigens (NA1 and NA2). Allele specific amplification test using primer designed to study HPA-1 and HPA-4, restriction fragment length polymorphism to study HPA-6w, and sequence specific primers for NA1 and NA2 were used for genotyping. RESULTS: The genotype frequencies were HPA-1(a+b-) 100%, HPA-4 (a+b-) 97.5%, HPA-4(a+b+) 2.5%, HPA-6w(a+b-) 97%, and HPA-6w(a+b+) 3%. These frequencies are similar to Japanese but different from Caucasian. The gene frequencies of NA1 and NA2 were 0.56 and 0.44 respectively. There are no cases of alloimmune thrombocytopenia and neutropenia in newborns from the 200 studied women. CONCLUSIONS: The differences in genotype frequencies among platelet glycoprotein IIIa-specific antigens and in the gene frequencies of NA in Koreans are shown as compared with other ethnic groups. Therefore it is needed to find the proper screening target antigens and antibodies for Korean NATP and NANP patients.
Alleles ; Antibodies ; Antigens, Human Platelet ; Asian Continental Ancestry Group ; Blood Platelets* ; Daegu ; DNA ; Ethnic Groups ; Female ; Gene Frequency ; Genotype* ; Glycoproteins* ; Granulocytes* ; Humans ; Infant, Newborn ; Mass Screening ; Neutropenia ; Polymorphism, Restriction Fragment Length ; Pregnant Women ; Serotyping ; Thrombocytopenia ; Thrombocytopenia, Neonatal Alloimmune

BACKGROUND: It is known that severe infection and inflammation lead to hemostatic abnormalities. Recently, much attention is focused on the mechanisms of infection or inflammation and on how it plays a central role in effecting the coagulation system. Disseminated intravascular coagulation in particular, is a common phenomenon in patients with sepsis, but the clinical implications of this condition are not clear. Therefore we attempted to evaluate the changes of the coagulation system in patients with sepsis and studied the factors that lead to such changes. METHODS: One hundred one patients diagnosed with sepsis were enrolled in this study. The patients were clinically evaluated for underlying disease and data for inflammatory status and coagulative changes were evaluated retrospectively. RESULTS: The WBC count increased in 76% and decreased in 6% of sepsis patients in comparison to the reference interval. The platelet count decreased in 65.3%. Changes in coagulative tests such as prothrombin time, activated partial thromboplastin time, antithrombin III, and D-dimer were observed in 70.4%, 52.7%, 87.2% and 100% of the patients, respectively. Correlation between ESR and fibrinogen was the highest in relation to the other coagulation factors. CRP also showed the highest correlation with fibrinogen in contrast to the other coagulation factors. CONCLUSIONS: This study confirmed the clear activation of coagulation in patients with sepsis. Of the evaluated factors involved in coagulation and fibrinolysis, fibrinogen showed the highest correlation to indices representing the inflammatory state. However further studies on the anticoagulant pathway are necessary in elucidating this matter.
Adult ; Aged ; Aged, 80 and over ; Bacterial Infections/diagnosis ; Biological Markers/analysis ; *Blood Coagulation ; Blood Coagulation Tests ; C-Reactive Protein/analysis ; Disseminated Intravascular Coagulation/*diagnosis/etiology ; Female ; Humans ; Inflammation/diagnosis ; Male ; Middle Aged ; Platelet Count ; Retrospective Studies ; Sepsis/*blood/complications/diagnosis ; Statistics as Topic

The primary hyperparathyroidism, accompanied with a wide scope of bone resorption in every bone matrix of the body, cyst formation, deformity and pathologic fracture, is a generalized disease which causes atrophy and weakness of skeletal muscle and a disturbance of the digestive system as well as renal function. The primary cause of this disease is an adenoma and a hyperplasia of the parathyroid gland. However, all the progress of the disease can be stopped through surgical excision. The authors medically confirmed the diagnoses through typical radiologic findings, electrolyte and enzyme level of serum and urine and by carotid arteriography on four patients(a 41 year ald male, and 28, 35 and 36 year old females) who had complained of generalized weakness, pain and motion limitation. The authors obtained the following results after surgical excision and continuous follow-up study with medication for 7 years, 3 years, 17 months and 13 months each: 1. Of the four cases, 3 cases were female patients and 1 case was a male patient which showed females outnumbered males 3 times in our study. 2. By age distribution, most cases fell in middle age. 3. All the cases were chief cell type of adenoma. 4. It is conjectured that the symptoms has nothing to do with age or history. 5. In all the cases, serun calsium showed a marked decrease immediately after the surgery but recovered to normal limits within 2 months. 6. In all the cases, serum phosphorus showed an irregular increase immediately after the surgery but also stavilized gradually to normal limits within 2 to 3 months. 7. In all the cases, serum alkaline phosphatase was stable for 3 months after the surgery, then gradually decreased. 8. According to the X-rays, subperiosteal resorption of phalangeal bones almost completely disappeared in 3 months. Cyst and brown tumor disappeared in 6~12 months. Granular mottling of the skull almost completely disappeared in 6 months. Intra articular calcification in 2 cases almost completely disappeared in 6 months, 3 cases which showed loss of lamina dura developed edentia during treatment. 9. In 4th case, small multiple cysts and several small brown tumors of the pelvis healed well, but several lager ones were still unhealed after 10 years of treatment. In first case, the cyst in proximal shaft of the left femur is reduced in size but still evident after 7years of treatment. This case needs further study and observation.
Adenoma ; Age Distribution ; Alkaline Phosphatase ; Angiography ; Atrophy ; Bone Matrix ; Bone Resorption ; Clinical Study ; Congenital Abnormalities ; Diagnosis ; Digestive System ; Female ; Femur ; Follow-Up Studies ; Fractures, Spontaneous ; Humans ; Hyperparathyroidism, Primary ; Hyperplasia ; Male ; Middle Aged ; Muscle, Skeletal ; Parathyroid Glands ; Parathyroid Neoplasms ; Pelvis ; Phosphorus ; Skull

No abstract available.
Pulmonary Embolism*