The Effect of Atorvastatin on Serum Lipid Levels among Patients with Hypercholesterolemia

BACKGROUND: Recently, the incidence of cardiovascular diseases has increased in Korea. Hypercho-lesterolemia is a major risk factor for cardiovascular diseases. Atorvastatin (Lipitor(R)) is prescribed for the treatment of hyperlipidemia in Korea, but its effect has not been studied. Therefore, we investigated the lipid lowering effect of atorvastatin in Koreans. METHODS: This study included 82 hypercholesterolemic patients who visited the Department of Family Practice of Ajou University Hospital from January 1, 2000 to December 31, 2001. The mean age of the subjects was 47.8 years in the range of 27 to 66 years. Our study included 41 controls and 41 subjects who were administered atorvastatin 20 mg daily for 3 months. Fasting serum lipid levels were measured at baseline and at 3 months. Specific dietary and exercise interventions were not instructed. RESULTS: At 3 months, the serum total cholesterol and LDL were significantly lower in atorvastatin group than in the control group (Total cholesterol; -5.5+/-16.7%, vs 25.5+/-15.8%, P<0.05, LDL cholesterol; 1.4+/-28.5%, vs -30.1+/-28.9%, P<0.05). The serum triglyceride in atorvastain group showed no significant difference relative to the controls (Control: -5.8+/-34.2%, Atorvastatin: -3.5+/-54.8%, P=0.81). But, Serum triglyceride level decreased by -14.3+/-33.2% in the control and -39.0+/-23.2% in the atorvastatin group among the patients whose baseline triglyceride level was over 200 mg/dl (P<0.05). There was no significant differences in HDL-cholesterol (Control: 3.0+/-22.6%, ATORVASTATIN: -0.9+/-18.8%, P=0.38). The effect of atorvastatin was not influenced by age, sex, BMI and other risk factors. CONCLUSION: Atorvastatin lowered significantly the serum total cholesterol, LDL and triglycerides in Korea. Regardless of age, sex, BMI, but had no effect on HDL level.

The Clinical Significance of Increased Prostate Specific Antigen Concentration in Routine Check-Up

BACKGROUND: As prostate cancer in men is increasing in Korea, the need for early detection by mass screening has become an important issue. Screening tests for early detection of prostate cancer are digital rectal examination, transrectal ultrasonography (TRUS) and prostate specific antigen (PSA) test. PSA test has been mainly used for prostate cancer screening in health promotion centers. However, PSA has a high sensitivity but low specificity. Therefore, PSA concentration can be increased not only in prostate cancer, but also in several benign prostate diseases such as benign prostate hyperplasia (BPH), prostatitis, and prostate ischemia. Also, PSA concentration can increase in the elderly. Therefore, we investigated the results of follow-up PSA tests, in the cases of increased PSA concentration on screening. METHODS: In 538 cases, the PSA concentration were increased over 2.5 ng/ml among total 17,302 males checked up on screening test at Ajou University Hospital from January 1999 to December 2001. Two hundred and four cases followed up with TRUS or prostate biopsy were chosen. We investigated 89 cases who performed follow- up PSA test. On the basis of the results of biopsy or TRUS, the subjects were classified into non-disease group, benign prostate disease group and prostate cancer group (possible or confirmed prostate cancer group). RESULTS: The mean age of non-disease group was 35.5 5.9 years, which was significantly lower than that of benign prostate disease group and prostate cancer group (P<0.05). Compared to the mean age of prostate cancer group (60.6 10.4 years) and non-prostate cancer group (53.1 12.3 years), prostate cancer group was significantly older than non prostate cancer group (P=0.005). When the lower limit of age was set to 40 years (mean-2SD), confirmed prostate cancer group was significantly older than other groups (p<0.001). The PSA concentration of confirmed prostate cancer group (11.33 7.58 ng/ml) was significantly higher than that of non-prostate disease group (4.35 2.22 ng/ml) and possible prostate cancer group (4.44 2.29 ng/ml) (P<0.05). The follow-up PSA level of confirmed prostate cancer group (10.13 6.13 ng/ml) was significantly higher than that of non-prostate disease group (2.55 0.97 ng/ml), BPH group (4.33 3.80 ng/ml), prostatitis group (3.61 2.17 ng/ml), prostate cyst group (3.00 1.86 ng/ml) and possible prostate cancer group (3.81 2.82 ng/ml) (P<0.05). CONCLUSION: It is recommended that screening test for prostate cancer be performed after the age of 40. While follow-up PSA test is needed when the PSA is increased up to less than 10 ng/ml, prostate biopsy may be desired in the PSA value of 10.0 ng/ml or greater.

Role of N-terminal Hydrophilic Amino Acids in Molecular Translocation of CTLA-4 to Cell Surface

BACKGROUND: This study was aimed to differentiate two forms of CTLA-4 (CD152) in activated peripheral blood lymphocyte and clarify the mechanism how cytoplasmic form of this molecule is targeted to cell surface. METHODS: For this purpose we generated 2 different anti-human CD152 peptide antibodies and 5 different N'-terminal deletion mutant CTLA4Ig fusion proteins and carried out a series of Western blot and ELISA analyses. Antipeptide antibodies made in this study were anti-CTLA4pB and anti- CTLA4pN. The former recognized a region on extracellular single V-like domain and the latter recognized N'-terminal sequence of leader domain of human CD152. RESULTS: In Western blot, the former antibody recognized recombinant human CTLA4Ig fusion protein as an antigen. And this recognition was completely blocked by preincubating antipeptide antibody with the peptide used for the antibody generation at the peptide concentration of 200 ug/ml. These antibodies were recognized human CD152 as a cytoplasmic sequestered- and a membrane bound- forms in phytohemagglutinin (PHA)- stimulated peripheral blood lymphocyte (PBL). These two forms of CD152 were further differentiated by using anti-CTLA4pN and anti-CTLA4pB antibodies such that former recognized cytosolic form only while latter recognized both cytoplasmic- and membrane- forms of this molecule. Furthermore, in a transfection expression study of 5 different N'-terminal deletion mutant CTLA4Ig, mutated proteins were secreted out from transfected cell surface only when more than 6 amino acids from N'-terminal were deleted. CONCLUSION: Our results implies that cytosolic form of CTLA-4 has leader sequence while membrane form of this molecule does not. And also suggested is that at least N'-terminal 6 amino acid residues of human CTLA-4 are required for regulation of targeting this molecule from cytosolic- to membrane- area of activated human peripheral blood T lymphocyte.

A Case of Fabry Disease Diagnosed by Molecular Analysis of alpha-galactosidase A Gene / 대한신장학회잡지

Fabry disease is a X-linked lysosomal storage disorder caused by deficiency of alpha-galactosidase A. This abnormality in enzyme results intracellular accumulation of globotriaosylceramide and leads to severe painful neuropathy with progressive renal, cardiovascular, and cerebrovascular dysfunction and early death. We report a 35 year-old man who had been suffered from acroparesthesia aggravated by body temperature elevation and with asymptomatic renal function impairment, which were proven to be due to Fabry disease. We performed gene analysis by PCR direct sequencing and confirmed missense mutation of GLA gene. Recently enzyme replacement of alpha-galactosidase was introduced and we think that the importance of early diagnosis and treatment should be emphasized.

Prevention and Treatment of Experimental Glomerulonephritis Using Recombinant Uteroglobin / 대한신장학회잡지

Glomerulonephritis(GN) is characterized by cognate immune responses against self or non-self antigen. It is suggested that the crescentic GN is a manifestation of cell-mediated immune response akin to delayed type hypersensitivity. Uteroglobin(UG) is a steroid-dependent, immunomodulatory, and cytokine-like protein. It was reported that UG prevented fibronectin(Fn) deposition in the glomeruli of normal mice to form Fn-UG heterodimers that competed with Fn self-aggregation. We hypothesized that UG would prevent the development of experimental GN induced by anti-glomerular basement membrane globulin(anti-GBM Ab) in mice through immunomodulatory properties. GN was induced by intravenous injection of 4.5 mg rabbit anti-GBM Ab to mice(C57BL/6). Renal injury was evaluated at 7, 14, and 21 days thereafter. UG-treated mice(n=10) were received for 3 days(0.5 mg/mouse/day) beginning 1 hour after anti-GBM Ab injection. Also, disease-control mice(n=10) were received PBS for 3 days after anti-GBM Ab. Proteinuria was significantly reduced in the mice treated with UG when compared with the disease-control mice after 7 and 14 days of anti-GBM Ab injection. The amount of proteinuria was similar between UG treated and normal control mice. The mesangial matrix expansion and cellular crescent were markedly attenuated by the injection of UG. The proliferative responses of mesangial cells(C57BL/6) to LPS were blunted with the addition of UG in dose-dependent manner. In this study, we revealed the preventive effects of UG in the experimental model of glomerulonephritis. This result in turn could provide the basis for the treatment of human disease such as chronic glomerulonephritis.

A Case of microscopic pulmonary metastasis of papillary thyroid carcinoma / 대한내과학회지

Although the papillary thyroid carcinoma generally follows an indolent course characterized by slow growth and abscence of distant metastasis, distant metastases to extrathyroid organ may occur in the lung, bone and brain in about 5% of patients. The lung metastases are usually diagnosed by plain X-ray, chest CT and 131I whole body scan. However, we present a case of papillary thyroid carcinoma with microscopic pulmonary metastasis that could not be detected by conventional method, such as chest X-ray, chest CT and 131I whole body scan. A 62-year-old female visited due to traumatic hemopneumothorax. In the pathology of resected tissues from lacerated lung parenchyme, metastatic papillary carcinoma was diagnosed without evidence of abnormality in radiologic examination and we diagnosed and treated an asymptomatic papillary thyroid carcinoma.

Histologically Confirmed Bone Formation in the Carbon Fiber Cage Implant

The authors report the first case of histologically confirmed bone formation in the carbon fiber cage implant which used in posterior lumbar interbody fusion. A case of degenerative lumbar disc desease was treated by posterior lumbar interbody fusion with carbon fiber cage implant and local bone from posterior decompression. One year after the operation the cage was migrated into the spinal canal and compressed dural sac and nerve root. The cage was removed and investigated by light microscope. The histologic examination revealed viable bony traveculae in the cage. This finding suggest autogenous bone in the cage has a biologic bone-growth function after interbody fusion.

US-guided Biopsy of Renal AIIografts using 18G Biopsy Gun:Analysis of 200 Cases

PURPOSE: We evaluated the effectiveness and safety of 18G biopsy gun with US guidence in the transplanted kidneys. MATERIALS AND METHODS: We performed 200 US-guided percutaneous biopsies using 18G biopsy gun. Diagnostic efficacy and complication of the biopsy in these patients were analyzed. RESULTS: Biopsy specimens were adequate for histologic diagnoses in 193 patients(96.5%). The mean of the biopsy frequency was 3, the mean of total glomerular number was 21.64 and the mean glomerular number per one biopsy was 6.93. Major complications occured in 3 (1.5%) of the 200 biopsies; hematuria developed in two patients, AV fistula in one. These complications were successfully controlled either by only transfusion or by coil embolization. There were no statistical differences in blood pressure, hemoglobin, BUN/Cr between pre- and post-renal biopsies. CONCLUSION: US-guided percutaneous biopsy of renal allograft with 18G biopsy gun is simple, safe, and accurate method in evaluating the renal allograft dysfunction.

Intramedullary Neurilemmoma of the Spine: Case Report

Intramedullary schwannomas without evidence of Von Recklinghausen's disease are extremely rare. We report a case of solitary intramedullary schwannoma of the dorsal spinal cord and review the literature on these rare neoplasms. The possible etiology of the tumor as well as wome difficulties encountered in the diagnostic procedure and treatment are discussed.