The effect of sildenafil on right ventricular remodeling in a rat model of monocrotaline-induced right ventricular failure / 소아과

PURPOSE: Pulmonary arterial hypertension (PAH) leads to right ventricular failure (RVF) as well as an increase in pulmonary vascular resistance. Our purpose was to study the effect of sildenafil on right ventricular remodeling in a rat model of monocrotaline (MCT)-induced RVF. METHODS: The rats were distributed randomly into 3 groups. The control (C) group, the monocrotaline (M) group (MCT 60 mg/kg) and the sildenafil (S) group (MCT 60 mg/kg+ sildenafil 30 mg/kg/day for 28 days). Masson Trichrome staining was used for heart tissues. Western blot analysis and immunohistochemical staining were performed. RESULTS: The mean right ventricular pressure (RVP) was significantly lower in the S group at weeks 1, 2, and 4. The number of intra-acinar arteries and the medial wall thickness of the pulmonary arterioles significantly lessened in the S group at week 4. The collagen content also decreased in heart tissues in the S group at week 4. Protein expression levels of B-cell lymphoma-2 (Bcl-2)-associated X, caspase-3, Bcl-2, interleukin (IL)-6, matrix metalloproteinase (MMP)-2, endothelial nitric oxide synthase (eNOS), endothelin (ET)-1 and ET receptor A (ERA) in lung tissues greatly decreased in the S group at week 4 according to immunohistochemical staining. According to Western blotting, protein expression levels of troponin I, brain natriuretic peptide, caspase-3, Bcl-2, tumor necrosis factor-α, IL-6, MMP-2, eNOS, ET-1, and ERA in heart tissues greatly diminished in the S group at week 4. CONCLUSION: Sildenafil alleviated right ventricular hypertrophy and mean RVP. These data suggest that sildenafil improves right ventricular function.

Cardiovascular Screening in Asymptomatic Adolescents with Metabolic Syndrome

BACKGROUND: In recent days, the prevalence of childhood metabolic syndrome (MS) has increased substantially due to the increasing rate of childhood obesity on a global scale. The aims of this study were to detect the important parameters and provide the screening system to prevent cardiovascular disease in adolescents with MS. METHODS: Ninety one male adolescents were divided into two groups based on the presence or absence of MS. Anthropometric measurement and laboratory study were studied. Intimal medial thickness and pulse wave velocity were estimated. Left ventricular mass index (LVMI), ejection fraction, myocardial velocity, strain and strain rate were measured by tissue Doppler imaging and strain rate imaging. RESULTS: The prevalence of MS was 7.7%. Weight, body mass index (BMI), waist circumference (WC), glucose, insulin, homeostasis model assessment of insulin resistance, triglyceride and LVMI were significantly increased in the MS group. High density lipoprotein-cholesterol (HDL-C), peak early diastolic myocardial velocity (e'), systolic myocardial velocity (s') and global longitudinal strain were significantly lower in the MS group. In univariant analysis, LVMI was significantly correlated with BMI, WC, fat %, fat mass, systolic blood pressure, alanine aminotransferase, total cholesterol (TC) and low density lipoprotein-cholesterol. e' was significantly correlated with BMI, fat %, fat mass, and HDL-C. Global circumferential strain had significant correlation with glucose and TC. Basal anterolateral strain rate was significantly correlated with weight, BMI, WC, fat %, and fat mass. CONCLUSION: LVMI, strain and strain rate are practical and accurate parameters for assessment of left ventricular function in adolescents with MS.

Clinical characteristics and serum N-terminal pro-brain natriuretic peptide as a diagnostic marker of Kawasaki disease in infants younger than 3 months of age / 소아과

PURPOSE: The incidence of Kawasaki disease (KD) is rare in young infants (less than 3 months of age), who present with only a few symptoms that fulfill the clinical diagnostic criteria. The diagnosis for KD can therefore be delayed, leading to a high risk of cardiac complications. We examined the clinical characteristics and measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of these patients for assessing its value in the early detection of KD. METHODS: We retrospectively reviewed the data of young infants diagnosed with KD from 2004 to 2012. The control group included 20 hospitalized febrile patients. Laboratory data, including NT-proBNP were obtained for each patient in both groups. RESULTS: Incomplete KD was observed in 21/24 patients (87.5%). The mean fever duration on admission was 1.36+/-1.0 days in the KD group. Common symptoms included erythema at the site of Bacille Calmette-Guerin inoculation (70.8%), skin rash (50.0%), changes of oropharyngeal mucosa (29.1%), and cervical lymphadenopathy (20.8%). The mean number of major diagnostic criteria fulfilled was 2.8+/-1.4. Five KD patients (20.8%) had only one symptom matching these criteria. The incidence of coronary artery complications was 12.5%. The mean serum NT-proBNP level in the acute phase, in the KD and control groups, were 4,159+/-3,714 pg/mL and 957+/-902 pg/mL, respectively, which decreased significantly in the convalescent phase. CONCLUSION: Incomplete KD was observed in 87.5% patients. Serum NT-proBNP might be a valuable biomarker for the early detection of KD in febrile infants aged <3 months.

Anesthetic management of HELLP syndrome complicating primary antiphospholipid syndrome: A case report / 대한마취과학회지

Antiphospholipid syndrome (APS) is defined as an autoimmune disorder characterized by recurrent thrombosis or obstetrical morbidity. A 29-year-old woman who was diagnosed with APS underwent emergency cesarean delivery at 23 weeks' gestation. She had a seizure attack and her laboratory findings were: AST/ALT 1459/1108 IU/L, LDH 1424 IU/L, 30% hematocrit, a platelet count of 43 x 10(3)/ml and urine protein (4+). We describe the anesthetic experience of catastrophic HELLP syndrome with antiphospholipid syndrome and we review the relevant literature.

A Comparison of Outcomes after Acute and Chronic Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of a reconstruction with an autogenous hamstring tendon for an acute and chronic anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: We reviewed 71 patients who had undergone an ACL reconstruction with an autogenous hamstring tendon from December 2003 to June 2006. The patients were divided into two groups, reconstruction for an acute injury with 34 knees and reconstruction for a chronic injury with 37 knees. The clinical results were evaluated using the Lysholm score, International Knee Documentation Committee (IKDC) score, Lachman test, Pivot shift test, KT-1000 arthrometer, and a Cybex isokinetic test for the strength of the knee flexor and extensor. The presence of associated intra-articular lesions was also investigated. RESULTS: There were no significant differences between the two groups in terms of the stability evaluated by the Lachman test, pivot shift test and KT-1000 arthrometer at the final follow-up (p=0.732, 0.479, 0.078). However, the acute group scored significantly higher with respect to the clinical outcome measured by the Lysholm scores and IKDC rating system at the final follow-up (P=0.042, 0.012). There was a significantly higher incidence of associated intra-articular lesions in the chronic group than those in the acute group (P=0.003). CONCLUSION: A reconstruction for acute ACL injuries showed more satisfactory clinical results and less associated intraarticular lesions than a reconstruction for chronic ACL injuries.

Diagnosis in Extension Injuries of the Lower Cervical Spine / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate diagnostic criteria using plain lateral radiography, the incidence of traumatic disc herniation and the degree of neurologic deficit in extension injury of the lower cervical spine. MATERIALS AND METHODS: We analyzed 28 patients with extension injury of the lower cervical spine, by measuring the retropharyngeal, retrotracheal space and the intervertebral space at the injured level in plain lateral radiography. We selected 40 patients as a control group for the prevertebral soft tissue space measurement. RESULTS: Widening was found in the retropharyngeal space (6.8 +/-2.9 mm) and in the retrotracheal space (15.2 +/-3.8 mm) compared with the control group (4.2 +/-0.7 mm, 12.6 +/-1.9 mm, p<0.05). No significant increase in the injured intervertebral space was observed with respect to the normal upper and lower disc space. Neurologic deficit occurred in 25 cases (89%); with root injury in 11 cases and cord injury in 14 cases. There were 19 posterior disc herniations (68%), which were associated with neurologic deficits in all cases. CONCLUSION: Extension injuries should be suspected in the presence of soft tissue injury of the anterior column without fracture or dislocation by the radiologic study of the lower cervical spine. Magnetic resonance imaging study is believed to be an essential diagnostic modality for the accurate evaluation and proper management of the lower cervical spine injuries.