BACKGROUND: Study on epigenetics of urothelial carcinomas has expanded and allowed better understanding of their correlation with clinicopathologic features. The aim of this study was to determine reliable predictive epigenetic markers for patients with urothelial carcinoma of urinary bladder. METHODS: In 64 urothelial carcinomas of the urinary bladder, methylationspecific polymerase chain reaction with RAS association domain family 1A (RASSF1A), adenomatous polyposis coli (APC), death-associated protein-kinase (DAPK), runt-related transcription factor 3 (RUNX3), p14, p16 and MGMT was performed and correlated the results with p53 mutations, DNA ploidy, clinicopathologic parameters and recurrences. RESULTS: Hypermethyation of RASSF1A, APC, DAPK, RUNX3, p14, p16 and MGMT promoters was observed in 35 (54.7%), 29 (45.3%), 18 (28.1%), 18 (28.1%), 9 (14.1%), 2 (3.1%), and 6 (9.4%) cases, respectively. Hypermethylation of RUNX3 and APC was significantly associated with high histologic grades and aneuploidy. Methylation of DAPK was significantly associated with muscle invasion. Methylation of DAPK and RUNX3 genes was significantly associated with recurrence. In survival analyses, methylation of RUNX3 gene and methylation-high (methylation at two or more loci) phenotype was significantly associated with poor recurrence-free survival. CONCLUSIONS: Methylation of RUNX3 gene and methylation-high phenotype are significant indicator of recurrence.
Adenomatous Polyposis Coli ; Aneuploidy ; DNA ; Epigenomics ; Genes, Tumor Suppressor ; Humans ; Methylation ; Muscles ; Phenotype ; Ploidies ; Polymerase Chain Reaction ; Prognosis ; Recurrence ; Transcription Factor 3 ; Urinary Bladder

PURPOSE: We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. MATERIALS AND METHODS: In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. RESULTS: The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8degrees to 8.4/95.4degrees at the last follow-up. A mean of 19.5degrees of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4degrees. Near full ROM was achieved in 3 cases. There were no major complications. CONCLUSIONS: In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.

Despite the frequent occurrence of peritonitis in patients with continuous ambulatory peritoneal dialysis (CAPD), fungal peritonitis is uncommon and usually associated with antibiotics and immunodeficiency. Most of the fungal isolates are usually Candida albicans, Candida parapsilosis, Candida guilliermondii or Candida torulopsis. The authors report a case of fungal CAPD related peritonitis due to Candida zeylanoides that occurred in a patient with the absence of the usual risk factors for fungal peritonitis. Treatment with intravenous fluconazole was successful.
Anti-Bacterial Agents ; Candida ; Candida albicans ; Candida glabrata ; Candidiasis ; Fluconazole ; Humans ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Risk Factors

BACKGROUND: Lipoprotein lipase(LPL) plays a pivotal role in triglyceride-rich lipoprotein metabolism. It removes TG-rich lipoprotein from circulation by hydrolysing TG and produces active form of HDL. It also affects the development and maintenance of obesity by regulating the fatty acid metabolism of the adipose tissue. Many studies about the association of the genetic variation of LPL and dyslipidemia have been performed, but the results were not consistent. We tried to characterize the phenotypes of the LPL genetic variation in Korean. METHODS: Healthy Korean adults (n=110) were genotyped for Hind III/Pvu II RFLP and Ser447Ter mutation of the LPL gene by PCR-digestion method. We investigated the association of the genetic variations with the lipids, the lipoprotein concentrations and the body mass index(BMI). RESULTS: The allele frequencies of Hind III RFLP, Pvu II RFLP and Ser447Ter mutation were H1:H2=33%:67%, P1:P2=40%:60% and Ser447: Ter447=90%:10%. Ser447Ter mutation carriers had higher HDL cholesterol level than non-carriers (59+/-10mg/dl versus 53+/-11mg/dl, p=0.049) and the Pvu II RFLP is associated with increased body mass index. (P1P1:P1P2:P2P2 = 22.1+/-2.0 kg/m2: 23.5+/-2.7 kg/m2: 24.5+/-2.6 kg/m2, p=0.003) CONCLUSION: The genetic variations of the LPL gene in healthy Korean adult resulted in increased HDL cholesterol and increased BMI. These results were different from previous studies. This difference may reflect the racial difference from the diet and the linkage disequilibrium
Adipose Tissue ; Adult* ; Body Mass Index* ; Cholesterol, HDL ; Diet ; Dyslipidemias ; Gene Frequency ; Genetic Variation ; Humans ; Linkage Disequilibrium ; Lipoprotein Lipase* ; Lipoproteins* ; Metabolism ; Obesity ; Phenotype ; Polymorphism, Restriction Fragment Length

BACKGROUND: Nitric oxide, also known as endothelial derived relaxing factor(EDRF), regulates the vascular tone and inhibits the proliferation of vascular smooth muscle cells and platelet adhesions and endothelium-leukocyte interactions. Thus, nitric oxide may be involved in the pathogenesis of atherosclerosis and vasospasm. We analyzed the genotype distributions of two eNOS gene polymorphisms in normal healthy Koreans and compared it with those in the patients with acute coronary syndrome and variant angina. METHODS: We analyzed the two eNOS polymorphisms (eNOS A/B polymorphism is the variable numbers of tandem repeat in intron 4 and eNOS T/G polymorphism is a mis-sense mutation in exon 7) using PCR and clinical characteristics of the risk factors for coronary artery disease in 142 normal healthy Koreans and 164 patients with acute coronary syndrome and 104 patients with variant angina. RESULTS: The genotype distribution of A/B polymorphism of eNOS gene, A/A, A/B, B/B was 4.9%, 21.1%, 74% in control group and 2.4%, 12.8%, 84.8% in the patients with acute coronary syndrome(p=0.02) and 2.9%, 16.3%, 80.8% in the patients with variant angina(p=NS), respectively. The genotype distribution of T/G polymorphism of eNOS gene, T/T, T/G, G/G was 1.4%, 15.5%, 83.1% in control group and 0.6%, 21.3%, 78.1% in the patients with acute coronary syndrome(p=NS) and 0%, 18.3%,81.7% in the patients with variant angina(p=NS), respectively. The odds ratio for acute coronary syndrome of non B/B(A/A & A/B) to B/B was 0.489 (95% CI : 0.257-0.928). We found that age, sex (male), diabetes mellitus, hyperlipidemia, smoking, B/B genotype were independent risk factors for acute coronary syndrome. But, in variant angina, smoking was the only significant independent risk factor(odds ratio=5.934, 95% CI 2.843-12.388, p< 0.05). CONCLUSION: The B/B genotype frequency of eNOS gene was significantly higher in patients with acute coronary syndrome than in normal controls. But neither A/B nor T/G polymorphism of eNOS gene was associated with variant angina. These results suggest that eNOS gene may play some roles in the pathogenesis of ACS rather than vasospasm.
Acute Coronary Syndrome* ; Atherosclerosis ; Blood Platelets ; Coronary Artery Disease ; Diabetes Mellitus ; Exons ; Genotype ; Humans ; Hyperlipidemias ; Introns ; Muscle, Smooth, Vascular ; Nitric Oxide ; Odds Ratio ; Polymerase Chain Reaction ; Risk Factors ; Smoke ; Smoking ; Tandem Repeat Sequences

BACKGROUND: The restenosis after coronary angioplasty is the unresolved problem even if the improvement of interventional skills and pharmacological therapies. Nitric oxide, known as endothelial derived relaxing factor (EDRF), regulates the vascular tone and inhibits the proliferation of vascular smooth muscle cells and platelet adhesions and endothelium-leukocyte interactions. Nitric oxide is produced by endothelial nitric oxide synthase (eNOS). We studied the significance of eNOS gene polymorphism for the prediction of restenosis after coronary angioplasty in Koreans with ischemic heart disease. METHODS: We analyzed the two eNOS poly-morphisms using PCR (eNOS A/B polymorphism is the VNTR in intron 4 and eNOS T/G polymorphism is a missense mutation in exon 7) in 199 Korean patients who had 257 lesions undergoing percutaneous coronary angioplasty (ballooning=152, stenting=105). The angiography was repeated 6 months later to assess the relation between the rate of restenosis and types of eNOS gene polymorphism. RESULTS: We found no significant differences of restenosis rate in eNOS A/B and T/G polymorphism in those with balloon angioplasty or with stent (restenosis rate of A/A, A/B, B/B, respectively (n=257): 25% (1/4), 26% (14/53), 31% (62/200) (p=not significant), and T/T, T/G, G/G (n=249): 0% (0/3), 36% (16/44), 29% (58/202)(p=not significant)) Patients with A allele (non BB) or GG phenotype had lower restenosis rate, so we analyzed protective effect of non BB and GG phenotype on restenosis, but there was no significant statistical difference (restenosis rate of non BB and GG, BB and non GG respectively: 20% (15/57), 34% (16/47)(p=not significant)). CONCLUSION: eNOS A/B and T/G polymorphism is not associated with a significantly elevated risk of restenosis after coronary angioplasty.
Alleles ; Angiography ; Angioplasty* ; Angioplasty, Balloon ; Blood Platelets ; Exons ; Humans ; Introns ; Muscle, Smooth, Vascular ; Mutation, Missense ; Myocardial Ischemia* ; Nitric Oxide ; Nitric Oxide Synthase Type III ; Phenotype ; Polymerase Chain Reaction ; Stents

BACKGROUNDS: The development of a noninvasive, accurate imaging technique for assessing coronary artery bypass graft patency is of major clinical importance because increasing numbers of patients have undergone coronary artery bypass surgery. The electron beam tomography, by virtue of its rapid data acquisition time and good spatial resolution, may be useful in this regard. The purpose of this study is to determine the accuracy of three-dimensional coronary angiography by electron beam tomography (EBT) in the assessment of patency of coronary artery bypass grafts. METHODS: Twenty-five patients who had undergone coronary artery bypass graft surgery were included. All patients underwent EBT and conventional coronary angiography for the evaluation of the status of bypass grafts. Three dimensional reconstruction of the heart and bypass grafts were performed and compared with selective angiography of the bypass grafts. RESULTS: Fifty-seven saphenous vein grafts (SVG) and 22 left internal mammary artery (LIMA) were evaluated for occlusion or patency. The sensitivity and specificity of EBT in the evaluation of LIMA patency were 80%, 82.4%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG patency were 91.7% and 91.1%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG according to the coronary territory were : 1) SVG to left anterior descending artery 100%, 100%:2) SVG to diagonal branch 100%, 100%:3) SVG to left circumflex artery 100%, 88.9%:4) SVG to right coronary artery 75%, 85.7%. CONCLUSION: Three-dimensional coronary angiography by electron beam tomography is a promising, useful and relatively accurate diagnostic technique for the evaluation of graft patency in patients who had undergone coronary artery bypass graft surgery.
Angiography ; Arteries ; Coronary Angiography* ; Coronary Artery Bypass* ; Coronary Vessels* ; Heart ; Humans ; Mammary Arteries ; Saphenous Vein ; Sensitivity and Specificity ; Tomography, X-Ray Computed* ; Transplants ; Virtues

BACKGROUNDS: The development of a noninvasive, accurate imaging technique for assessing coronary artery bypass graft patency is of major clinical importance because increasing numbers of patients have undergone coronary artery bypass surgery. The electron beam tomography, by virtue of its rapid data acquisition time and good spatial resolution, may be useful in this regard. The purpose of this study is to determine the accuracy of three-dimensional coronary angiography by electron beam tomography (EBT) in the assessment of patency of coronary artery bypass grafts. METHODS: Twenty-five patients who had undergone coronary artery bypass graft surgery were included. All patients underwent EBT and conventional coronary angiography for the evaluation of the status of bypass grafts. Three dimensional reconstruction of the heart and bypass grafts were performed and compared with selective angiography of the bypass grafts. RESULTS: Fifty-seven saphenous vein grafts (SVG) and 22 left internal mammary artery (LIMA) were evaluated for occlusion or patency. The sensitivity and specificity of EBT in the evaluation of LIMA patency were 80%, 82.4%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG patency were 91.7% and 91.1%, respectively. The sensitivity and specificity of EBT in the evaluation of SVG according to the coronary territory were : 1) SVG to left anterior descending artery 100%, 100%:2) SVG to diagonal branch 100%, 100%:3) SVG to left circumflex artery 100%, 88.9%:4) SVG to right coronary artery 75%, 85.7%. CONCLUSION: Three-dimensional coronary angiography by electron beam tomography is a promising, useful and relatively accurate diagnostic technique for the evaluation of graft patency in patients who had undergone coronary artery bypass graft surgery.
Angiography ; Arteries ; Coronary Angiography* ; Coronary Artery Bypass* ; Coronary Vessels* ; Heart ; Humans ; Mammary Arteries ; Saphenous Vein ; Sensitivity and Specificity ; Tomography, X-Ray Computed* ; Transplants ; Virtues

PURPOSE: To evaluate the efficacy of computed tomography(CT) in detecting pericardial adhesion. MATERIALS AND METHODS: CT of 32 patients with 'redo-valve surgery' was retrospectively evaluated for the location and appearance of their surgically confirmed pericardial adhesion. CT of 20 cases without cardiac or pericardial disease was reviewed as normal control. RESULTS: Nodular increased density at the site of adhesion between the sternum and the right atrium(RA) or ascending aorta(n=10), retrosternal dirty fat(n=10), obliteration of the pericardial fat(n=28), cardiac contour change with or without nodular epicardial fat accumulation(n=10), diffuse pericardial thickening(n=14), and pericardial calcification(n=13) were considered to be important findings. We also noticed an additional findings of beak-like projection of RA appendage(n=13), but was considered less significant because they were also observed in 4 normal subjects. CONCLUSION: CT scan is an effective, simple, and noninvasive method for predicting pericardial adhesion that may be occurred after redo-valve surgery.
Humans ; Retrospective Studies ; Sternum ; Tomography, X-Ray Computed

Ventricular arrhythmia is known as a major cause of sudden death in patients with heart disease, especially in patients with myocardial infarct. Programmed electrical stimulation (PES) is used in order to identify patients with high risk of ventricular arrhythmia, but it is invasive. So ventricular late potential is studied, which can be performed safely. Ventricular late potential was measured in the 65 normal subjects, 17 patients with in-hospital period acute myocardial infarction and 29 patients with old myocardial infarction using signal-averaged high resolution EKG, Mac-15. The positive criteria of ventricular late potential was one of the following : The duration of TQRS is more than 120 msec, or the amplitude of RMS is less than 25microV, or the duration of LP 40 is more than 40 msec. The results are as follows : 1) Among 65 normal subjects(male ; 33, female ; 32), total QRS duration(TQRS)was 103.9+/-8.3msec(mean S.D), terminal 40msec root mean square amplitude(RMS) 47.8+/-24.3uV and terminal 40msec mean amplitude was 32.5+/-15.4uV. Variables of ventricular late potential showed no significant difference by age. 10 subjects showed positive ventricular late potential. 2) Among 17 patients with in-hospital period myocardial infarction, there was no significant difference in variables of ventricular late potential between patients with ventricular arrhythmia(3 subject) and patients without ventricular arrhythmia(14 subjects). 3) Among 29 subjects with old myocardial infarction, TQRS showed significant differrence between patients with ventricular arrhythmia(3 subjects) and patients without ventricular arrhythmias(26 subjects). All of the patients with ventricular arrhythmia(100%) and 6 subjects(24%) of the patients without ventricular arrhythmia showed positive ventricular late potential, and the difference was significant statistically between groups(p value<0.05). This showed that ventricular late potential is helpful in predicting the risk of ventricular arrhythmia among patients with old myocardial infarction.
Arrhythmias, Cardiac* ; Death, Sudden ; Electric Stimulation ; Electrocardiography ; Female ; Heart Diseases ; Humans ; Myocardial Infarction*