BACKGROUND: Exercise tests (ET), hyperventilation tests (HVT) and cold pressor tests (CPT) have been used to induce coronary artery spasm. However their diagnostic significance and the circadian variation of exercise test response in patients with vasospastic angina are still uncertain. METHODS: To elucidate the circadian variation of ET response and to evaluate the diagnostic significance of non-pharmacological provocation tests, 21 consecutive patients with pure vasospastic angina were studied. Six ETs were performed in the early morning, late morning, and late afternoon in consecutive days, 2 HVTs and 2 CPTs in the early morning. The circadian distribution and types of angina (at rest, on physical activity, or both) from before admission to after discharge (mean follow-up periods 19+/-9 months) were evaluated by clinical history, clinical records and Holter recordings. Circadian distribution of anginal attacks recorded through the all observation periods were classified into 3 patterns (morning and night : MN, morning and afternoon or evening : M+F/E, morning, night and afternoon and/or evening : MN+F/E). RESULTS: One hundred and eleven ETs (39 early morning, 38 late morning, 34 late afternoon tests), 35 HVTs and 33 CPTs were performed. ETs showed 14 positive responses (36%) in the early morning, 14 (37%) in the late morning and 12 (35%) in the late afternoon without any circadian variation. Among the 11 patients who underwent all 6 exercise tests, 3 patients (27%) showed at least one positive response in the early morning, 4 (36%) in the late morning and 4 (36%) in the late afternoon. Subgroups of the subjects according to the types and activity of angina and the numbers of spastic artery also failed to show any circadian variation in ET response, but M+F/E group of circadian pattern of angina showed a peak of positive response in the early morning (p<0.05). HVTs showed significantly higher positive response (23/35, 66%, p<0.05) than ETs (14/39, 36%) and CPTs showed significantly lower positive response (2/33, 6%, p<0.01) than ETs in the early morning. Double tests with more than 1 positive response couldn't increase the positive response in ETs (9/19, 47%), and CPTs (2/14, 14%) but increased significantly in HVTs(15/16, 94%, p<0.05), particularly in the group with low activity (7/8, 86%, p<0.01). ETs showed ST segment elevation in 29 (72%) and depression in 11 (28%) of the 40 positive tests, HVTs in 21 (91%) and 2 (9%) of the 23 positive tests and CPTs in 2 (100%) and 0 (0%) of the 2 positive tests. The ST segment elevation was significantly higher in HVTs than in ET (p<0.05). CONCLUSION: These findings suggest that the exercise test in the early morning do not increase positive response and is not a sensitive diagnostic test associated with occasional depression of ST segment, but hyperventilation test, especially if repeated, is a very sensitive test with predominant elevation of ST segment in patients with vasospastic angina.
Arteries ; Circadian Rhythm ; Coronary Vasospasm ; Coronary Vessels ; Depression ; Diagnostic Tests, Routine ; Exercise Test* ; Follow-Up Studies ; Humans ; Hyperventilation ; Motor Activity ; Muscle Spasticity ; Spasm

BACKGROUND: The diagnostic significance of ECG ergonovine test and the incidence of vasospastic angina in patients with chest pain are still uncertain. METHODS: From May 1998 to June 1999, 133 consecutive patients with chest pain were admitted for diagnostic coronary angiography. ECG ergonovine provocation tests were performed in 64 patients who have a clinical history suggesting vasospatic angina, including 27 of 28 patients with vasospastic angina documented electrocardiographically, or who's coronary angiographic findings could not be explained by their clinical history. Ergonovine was administered intravenously in incremental dose of 0.05, 0.1, 0.2, 0.3, 0.4 mg up to total cumulative dosage of 1.0mg during coronary angiography(41 cases), in the exercise laboratory(21 cases) or both(2 cases). RESULTS: Of 133 patients with chest pain, vasospastic angina was documented in 32(24%), unstable angina in 52(34%), stable angina in 10(8%), and others in 39(29%). Angiography demonstrated coronary spasm in 4 additional patients as well as 22 patients with vasospastic angina documented electrocardiographically, but ergonovine tests in the exercise laboratory showed positive response in 5 of 6 patients with vasospastic angina documented. Among the 25 patients with coronary spasm proved angiographically during ergonovine test, ECG findings at the time of coronary spasm were ST segment elevation in 21(84%), depression in 1(4%) and no change in 3(12%) patients, who had branch vessel spasm, 3 vessel spasm or incomplete spasm on coronary angiogram. Of the 31 patients with vasospastic angina who underwent ergonovine tests, positive response occurred in 24(77%) after a cumulative dose of < or = 0.4mg and in additional 3(10%) after the higher dose of >0.4mg. However the other 4(13%) had no ECG changes even after the higher dose(>0.4mg) of ergonovine. CONCLUSION: This results suggest that vasospastic angina appear to be a common cause of chest pain, and ECG ergonovine test with high dose can improve diagnostic sensitivity but cannot detect some patients with vasospastic angina.
Angina, Stable ; Angina, Unstable ; Angiography ; Chest Pain ; Coronary Angiography ; Depression ; Electrocardiography* ; Ergonovine* ; Humans ; Incidence ; Spasm

Torsades de pointes is characterized by paroxysms of ventricular tachycardia at rates typically greater than 200 beats/min in which QRS morphology shows alternating polarity in an undulating pattern so that the complexes appear to be twisting about the beseline;this arrhythmia is virtually always associated with prolongation of the QT interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administred. Torsades de pointes was diagnosed in 4 patients;the first with hypokalemia, the second with congenital QT prolongation syndrome, the third with amiodarone, the fourth with organophosphorous and hypokalemia. Treatment of these patients consisted of potassium supply, isoproterenol, lidocaine, phenobarbital, tenormin, phenytoin, cardioversion, atropine. Three patients improved successfully, but one patient died, as a direct result of the ensuing ventricular fibrillation and cardiac arrest on one hour after admission.
Amiodarone ; Arrhythmias, Cardiac ; Atenolol ; Atropine ; Electric Countershock ; Fatal Outcome ; Heart Arrest ; Humans ; Hypokalemia ; Isoproterenol ; Lidocaine ; Phenobarbital ; Phenytoin ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes* ; Ventricular Fibrillation

No abstract available.
Dementia* ; Humans ; Urinary Incontinence*

This study was undertaken to know the extent of apoptosis, expression of bcl-2 and proliferating cell nuclear antigen (PCNA) in uterine cervical intraepithelial neoplasia (CIN; 15 cases) and invasive carcinoma (27 cases) and to evaluate them as a prognostic marker. Apoptosis was analysed by using the in situ apoptosis detection kit and bcl-2 and PCNA were detected by the immunohistochemical method. The results were as follows: Apoptotic indices (AI) in the invasive carcinoma (mean: 4.3) were 10-times higher than that in the CIN (mean: 0.43). Bcl-2 was expressed 60% of the cases in the dysplastic cells of the CIN II and CIN III, 33.3% of cases in the invasive carcinoma and not expressed in the CIN I except basal cells. The expression of the PCNA was increased by the grades of CIN and was strong in invasive carcinoma. The mean survival time of the patient with invasive carcinoma was significantly decreased in the higher AI index (above 4.3) than in the lower AI index (below 4.3). There was no significant correlation between the extent of apoptosis and the expression of bcl-2. According to the above results, AI are able to be used as an independent prognostic marker in the invasive cervical carcinoma, and bcl-2 and PCNA have an important role in the tumorigenesis of uterine cervical carcinoma.
Apoptosis* ; Carcinogenesis ; Cervical Intraepithelial Neoplasia* ; Humans ; Proliferating Cell Nuclear Antigen* ; Survival Rate

Vasopressin, a neurohypophyseal peptide hormone, is the endogenous agonist at V1a, V1b, and V2 receptors. The most important physiological function of vasopressin is the maintenance of water homeostasis through interaction with V2 receptors in the kidney. Vasopressin binds to V2 receptor and increases the number of aquaporin-2 at the apical plasma membrane of collecting duct principal cells. That induces high water permeability across the membrane. Several non-peptide vasopressin receptor antagonists have been developed and are being studied primarily for treating conditions characterized by hyponatremia and fluid overload. Further studies are needed to determine how they are best used in these situations.
Aquaporin 2 ; Cell Membrane ; Homeostasis ; Hyponatremia ; Kidney ; Membranes ; Permeability ; Receptors, Vasopressin ; Vasopressins

Tolvaptan treatment is costly, often accompanied by aquaresis-related adverse events, and requires careful monitoring by medical staff due to the possibility of hepatotoxicity. Nevertheless, it is the only disease-modifying drug to date that has been shown to successfully delay renal replacement therapy. For more patients to receive proper treatment, medical doctors, the rest of the medical team, and the patient must all work together. This paper reviews parameters that can help identify rapid autosomal dominant polycystic kidney disease progressors, who are the target of tolvaptan therapy. It is expected that these parameters will help nephrologists learn practical prescription methods and identify patients who can benefit from tolvaptan treatment. Although several strategies can be used to find rapid progressors, the present review focuses on a practical method to identify rapid progressors according to the presence or absence of evidence and the factors associated with rapid progression based on the Mayo image classification.

Chronic mitral regurgitation may be well tolerated for decades because of favorable conditions like increased preload and decreased afterload. However, in some patients with underlying overt myocardial dysfunction, opertive correction of mitral regurgitation may result in persistent left ventricular dysfunction. Myocardial dysfunction in mitral regurgitation initially occurs subclinically and may becoma irreversible before symptoms of congestive heart failure develop. In order to identify latent myocardial dysfunction, we evaluated prognostic values of several indices from patient's characteristics, echocardiogram, cardiac catheterization data and contrast left ventriculogram in 49 patients with chronic mitral regurgitation who received mitral valve replacement. The patients were defined as Groups I who had improved symptoms with decreased left ventricular end-diastolic dimension after operation and Group II who had persistent symptoms and progressed left ventricular end-diastolic dimension, or not decreased until left ventricular end-diastolic dimension 60mm after operation. The results were as follows: 1) There was no significant difference in age, sex, duration of symptoms, preoperative NYHA functional status, and aortic cross clamping time during operation between Group I and Group II. 2) There was no significant difference in echocardiographic left ventricular end-diastolic dimension between group I and group II. There were significantly more dilated left ventricular end-diastolic dimension of Group II than that of Group I and significantly more depressed fractional shortening of Group II than that of Group I. There was significantly more increased end-diastolic wall stress of Group II than of Group I. 3) There was no significant difference in cardiac index, mean pulmonary artery pressure, mean pulmonary capillary wedge pressure and left ventricular end-diastoic pressure between Group I and Group II. 4) There were significantly more increased end-diastolic volume index and end-diastolic volum index of Group II than those of Group I, but no significant difference in ejection fraction between Group I and Group II. There was significantly more decreased ratio of end-diastolic circumferential midwall stress to end-diastolic volume index of Group II than that of Group I. 5) In Group I, end-systolic dimension, end-systolic dimension and end-systolic wall stress were decreased significantly after operation. In Group II, end-systolic dimension was decreased significantly after operation. 6) Values for combination of end-systolic left ventricular dimension greater than 28mm/m2 and end-systolic wall stress greater than 190mmHg predicted a Group II outcome with a sensitivity of 88.2%, a specificity of 93.8%, positive predictive value of 88.2% and negative predictive value of 93.8%. Values of combination of end-systolic left ventricular dimension greater than 28mm/m2 and fractional shortening less than 32% predicted a Group II outcome with a sensitivity of 88.2% a specificity of 90.6%, positive predictive value of 83.3% and negative predictive value of 93.5%, a specificity of 90.6%, positive predictive valve of 83.3% and negative predictive value of 93.5%. According to the above results, noninvasive hemodynamic variables such as end-systolic left ventricular dimension, fractional shortening and end-systolic wall stress would be useful guideline for follow-up and determining the optimal time for surgical intervention in patients with chronic mitral regurgitation.
Cardiac Catheterization ; Cardiac Catheters ; Constriction ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Hemodynamics ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sensitivity and Specificity ; Ventricular Dysfunction, Left

Sudden cardiac death (SCD) refers to the unexpected natural death from a cardiac cause within a short time period, generally within an hour from the onset of symptoms, in a person without any prior fatal condition. Despite the tremendous advances in the field of cardiovascular medicine, the incidence of SCD continues to rise. In 60 to 80 percent of cases, SCD occurs in the patients with coronary artery disease. Most instances of SCD are thought to involve ventricular tachycardia degenerating to ventricular fibrillation and subsequent asystole. Since the implantable cardioverter defibrillator (ICD) is effective in terminating ventricular tachycardia and fibrillation, the application of ICD has increased markedly. However, the application of ICD needs to be individualized for the patient, similar to drug therapies in LV systolic dysfunction. This review discusses the current understanding on SCD, risk stratification, and management goals for reducing SCD, particularly with the ICD usage.
Coronary Artery Disease ; Death, Sudden, Cardiac ; Defibrillators ; Heart Arrest ; Humans ; Incidence ; Tachycardia, Ventricular ; Ventricular Fibrillation

We experienced two cases of occupational asthma induced by Elk dander in Elk-feeders and confirmed these cases by the bronchial provocation test with Elk dander. Both of them showed dual asthmatic response. They also showed positive reaction to the skin prick test with EIK dander. Now one of them has no asthmatic symptoms at all after complete avoidnce of EIK dander.
Asthma, Occupational* ; Bronchial Provocation Tests ; Dander ; Skin