Higher Plasma Thrombospondin-1 Levels in Patients With Coronary Artery Disease and Diabetes Mellitus

BACKGROUND AND OBJECTIVES: Thrombospondin-1 (TSP-1) is associated with atherosclerosis in animals with diabetes mellitus (DM). But, no study has investigated the role of TSP-1 in human atherosclerosis. This study investigated the relationship among plasma TSP-1 concentration, DM, and coronary artery disease (CAD). SUBJECTS AND METHODS: The study involved 374 consecutive subjects with suspected CAD, who had undergone coronary angiography to evaluate effort angina. Patients were divided into four groups as follows: DM(-) and CAD(-), DM(-) and CAD(+), DM(+) and CAD(-), and DM (+) and CAD(+). RESULTS: We found that plasma TSP-1 levels were higher in patients with DM(+) and CAD(+) (n=103) than those in other patients (n=271) (p<0.01). A multivariate analysis showed that male gender {odds ratio (OR), 2.728; 95% confidence interval (CI), 1.035-7.187}, high density lipoprotein-cholesterol (OR, 0.925; 95% CI, 0.874-0.980), glycated hemoglobin (OR, 1.373; 95% CI, 1.037-1.817), and plasma TSP-1 (OR, 1.004; 95% CI, 1.000-1.008) levels were independently associated with the presence of CAD in patients with DM. CONCLUSION: Plasma TSP-1 levels were higher in patients with DM(+) and CAD(+) than those in other patients, and plasma TSP-1 levels were independently associated with the presence of CAD in patients with DM. These findings show a possible link between human plasma TSP-1 concentration and CAD in patients with DM.

A Case of Left Ventricular Noncompaction Accompanying Fasciculo-Ventricular Accessory Pathway and Atrial Flutter

Left ventricular hypertrabeculation/noncompaction (LVHT) is an uncommon type of genetic cardiomyopathy characterized by trabeculations and recesses within the ventricular myocardium. LVHT is associated with diastolic or systolic dysfunction, thromboembolic complications, and arrhythmias, including atrial fibrillation, ventricular arrhythmias, atrioventricular block and Wolff-Parkinson-White syndrome. Herein, we describe a patient who presented with heart failure and wide-complex tachycardia. Echocardiography showed LVHT accompanied with severe mitral regurgitation. The electrophysiologic study revealed a fasciculo-ventricular accessory pathway and atrial flutter (AFL). The AFL was successfully treated with catheter ablation.

Rapidly Progressive Cardiac Manifestation of Behcet's Disease Involving Conduction System and Aortic Valve

Cardiac conduction system impairment is a rare clinical manifestation of Behcet's disease. We report a patient who showed 1st degree atrioventricular block at first presentation, and showed aggravated finding of 3rd degree atrioventricular block on five months later. His cardiac manifestation finally developed to acute severe aortic regurgitation on six months later from his first cardiac manifestation. We observed this rapid progression during 6 months and successfully improved symptom and disease severity of the patient with treatment targeting Behcet's disease.

Optimal Antithrombotic Strategy in Patients With Atrial Fibrillation After Coronary Stent Implantation

BACKGROUND AND OBJECTIVES: Little evidence is available on the optimal antithrombotic therapy following percutaneous coronary intervention (PCI) in patients with atrial fibrillation (AF). We investigated the outcomes of antithrombotic treatment strategies in AF patients who underwent PCI. SUBJECTS AND METHODS: Three hundred sixty-two patients (68.0% men, mean age: 68.3+/-7.8 years) with AF and who had undergone PCI with stent implantation between 2005 and 2007 were enrolled. The clinical, demographic and procedural characteristics were reviewed and the stroke risk factors as well as antithrombotic regimens were analyzed. RESULTS: The accompanying comorbidities were as follows: hypertension (59.4%), diabetes (37.3%) and congestive heart failure (16.6%). The average number of stroke risk factors was 1.6. At the time of discharge after PCI, warfarin was prescribed for 84 patients (23.2%). Cilostazol was used in addition to dual antiplatelet therapy in 35% of the patients who did not receive warfarin. The mean follow-up period was 615+/-385 days. The incidences of major adverse cardiac events (MACE), stroke and major bleeding were 11.3%, 3.6% and 4.1%, respectively. By Kaplan-Meier survival analysis, warfarin treatment was not associated with a lower risk of MACE (p=0.886), but it was associated with an increased risk of major bleeding (p=0.002). CONCLUSION: Oral anticoagulation therapy after PCI may increase hemorrhagic events in Korean AF patients.

A Case of Hemodynamically Unstable Bradycardia after Risperidone Overdose

Risperidone is an atypical antipsychotic medication commonly used to treat psychotic illness, such as schizophrenia. It has strong serotonin and dopamine receptor antagonism and antagonist activity at alpha-adrenergic receptors and histamine receptors. An overdose of risperidone can cause tachycardia, hypertension, hypotension, prolonged QT interval, and bradycardia. Risperidone overdose is rare,but life-threatening. Here, we present the rare case of a 33- year-old woman who ingested risperidone overdose for the purposes of suicide, developing hemodynamically unstable bradycardia with trifascicular block, leading to fatality. Lessons from our case report are of urgent consideration for temporary pacemaker insertion, and use of alpha-1 agonist, such as phenylephrine in cases of hemodynamically unstable bradycardia by risperidone overdose. Prompt and appropriate identification and interventions are essential for the successful management of risperidone overdose.

A Case of Pseudosarcomatous Change of an Inflammatory Colon Polyp Associated with Tuberculous Colitis / 대한소화기내시경학회지

"Pseudosarcomatous change" occurs when sarcoma-like atypical cell hyperplasia is grossly indistinguishable from malignant tumor. Pseudosarcoma often exists in those areas of the gastrointestinal track where ulcer or erosion commonly takes place. This may indicate atypical granulomatous cell proliferation during a period of healing, as well as benign atypical change in the mesenchyme due to chronic inflammatory reaction. Both the visual appearance and intestinal involvement of tuberculous colitis are variable, and tuberculosis may result in reactive mesenchymal change associated with ulcer or polyp, which is that's induced by chronic inflammation. We report here on a case of a young female pulmonary tuberculosis patient who suffered with a pseudosarcoma of the ascending colon, and this was associated with tuberculous colitis. The patient underwent successful sugical resection. We report on this case, along with a review of the relevant literature.

An anomalous union of the pancreaticobiliary duct that was treated by drainage of the accessory ampulla / 대한내과학회지

An anomalous union of the pancreaticobiliary duct is defined as a condition in which the junction between the common bile duct and the pancreatic duct is located outside the duodenal wall. Therefore, the sphincter of Oddi does not influence the junction; there is always communication between these ducts, and so pancreatic juice flows into the biliary tract through the communication, which may cause pancreaticobiliary diseases. Pancreas divisum is a congenital variant of the pancreatic ductal anatomy, and the mechanism is that the dorsal and ventral pancreatic buds fail to fuse during the gestation. We report here on a 21 year old woman who previously had suffered with recurrent pancreatitis, and an anomalous union of the pancreaticobiliary duct associated with the incomplete type of pancreas divisum was revealed by ERCP. She was treated with minor papilla sphincterotomy and stent insertion.

Two Cases of Sigmoid Volvulus Treated by Emergency Colonoscopic Reduction Procedure / 대한소화기내시경학회지

A volvulus of the colon is a twisting of a redundant segment of the colon at its narrow mesentery. A sigmoid volvulus is the most common type. This disorder may spontaneously reduce and recur as a chronic problem. However, it more frequently becomes acute as a result of an obstruction, which can lead to strangulation and gangrene with a high mortality if not treated promptly. Colonoscopic reduction and decompression is the preferred initial treatment for patients with a sigmoid volvulus who show no signs of bowel strangulation, which may be the cause of the high mortality associated with emergency surgery. We experienced 2 cases of a sigmoid volvulus in a 44-year-old female and a 51-year-old male. The sigmoid volvulus was diagnosed by simple abdominal film and treated successfully by an emergency colonoscopic reduction. We report our experience on the use of colonoscopy to treat sigmoid volvulus with a reviews of the relevant literlature.

A Case of Primary Colonic Lymphoma with Peritoneal Carcinomatosis and Pleural Effusion / 대한소화기내시경학회지

Primary gastrointestinal lymphomas are quite rare with the stomach and small bowel being the most frequent site. Colon involvement is observed in only 10~20% of all gastrointestinal lymphomas. A colonic lymphoma presents with non-specific abdominal pain, weight loss, a change in bowel habits, bleeding, intestinal obstruction, intussusception and a palpable mass. A colonic lymphoma can be indicated using a barium enema, abdominal CT and colonoscopy. The correct diagnosis is obtained by a colonoscopic biopsy. We report a case of primary colonic non-Hodgkin's lymphoma with peritoneal carcinomatosis and a right pleural effusion.

Basaloid Squamous Cell Carcinoma of the Rectum Manifesting as Multiple Submucosal Lesions / 대한소화기내시경학회지

Basaloid squamous carcinoma is a rare, pooly differentiated variant of squamous cell carcinoma. It occurs in various sites, including the upper digestive tract, the esophagus, lung, anus, cervix and thymus. It has been postulated that basaloid carcinoma may arise from outside of the anal canal, such as at where the cloacogenic embryologic cells rest, the squamous metaplastic epithelium, or the totipotential basal cells. This tumor is a distinct entity that should be carefully distinguished from basal cell carcinomas of the anal canal, which is a condition that has a very good prognosis, and anal or perianal squamous cell carcinomas, which have a different path of spread and they vary considerably in their behavior. We report here on a patient with basaloid squamous carcinoma in the distal rectum that manifested as multiple submucosal lesions, and the patient presented with abdominal pain and blood tinged stool.

A Statistical analysis of Dermatologic Emergency Patients Visiting the Emergency Room over 10 Years (1986 - 1995) / 대한피부과학회지

BACKGROUND: Dermatologic emergency patients who visit the emergency room increase in number every year. But there is no report about the statistical analysis of such visits. OBJECTIVES & METHODS: We reviewed 326 new dermatologic emergency patients who uisited the emergency room of Dongsan Medical Center in Taegu from 1986 to 1995 to study the age, sex, monthly and yearly distributior, arrival time, length of visit, prevalence of common dermatoses, admission rate and death rate. RESULTS: The results are summarized as follows: 1. Of 326 patients, there were 151 males and 175 females. The sex ratio of male to female was 1: 1.15. The number of patients increased with each year. 2. In age distribution, there were 23(7%) under 10;46(14%) between 11-20,55(17%) between 21-30;49(15% ) between 31-40;33(10%) between 41 50; 62(19% ) between 51-60 years,39(12% ) between 61-70 and 19(6%) between 71-80 years. 3. In monthly and arrival time distribution, the peak month incidence occurred in August(24 %), and the lowest incidence in December(1%). The peak incidence of arrival time occurred PM 6-12 hours and the lowest incidence AM 0-6 hour. 4. In the distribution about length nf visit, 73% of patients stayed more than 10 hours, 23% 5-10 hours and 4% less than 5 hours. 5. Of the most common derrnatoses, acute urticaria was seen in 124 cases(38%), and herpes zoster. in 94 cases (29%). In age distribution, acute urticaria was most preualent between the age of 0-30 and herpes zoster between 50-70. 6. The admission rate was 43%(140 cases). The death rate was 1.2%(3 cases). CONCLUSION: Our study of e nergency patients revealed that dermatologic emergency patients who visited the emergency room had increased in number every year and the distribution of patients is quite different from that of outpatients.

Extracellular Matrix, TGF - beta Gene and Ha-ras Oncogene Expression in Type I Neurofibromatosis / 대한피부과학회지

BACKGROUND: Neurofibroma, the hallmark of neurofibromatosis, is a cutaneous or subcutaneous lesion, with a variable clinical presentation. Histologically, neurofibroma consists of proliferation of nerve derived cellular elements, together with an abundant, collagenous extracellular matrix. Specifically, neurofibroma has been shown to contain 30-50% collagen in its matrix. Objective 5. METHODS: We examined the expression of extracellular matrix genes (collagen, fibronectin, laminin), TGF-b mRNA and Ha-ras oncogene mRNA by using Northern and slot-blot hybridization and immunoperoxidase stains. Result: In Northern blot analysis, Ha-ras and TGF-b genes revealed respectively, 8.8kb and 2. 5kb sized mRNA transcripts in neurofibroma. These parameters were normal in the control. The expression of these genes were 1.9, 2.0 fold increased in neurofibroma. In slot-blot analysis, expression of type I collagen showed fibronectin genes to be 2,401+210, 540+43, respectively, in neurofibroma. So there were 3.7 fold, 2.1 fold, differences respectively, compared to the normal control. However, there were no significant changes of type IV collagen and laminin Bl mRNA levels between neurofibroma and normal skin tissues. Irnmunoperoxidase staining by rnonoclonal anti type IV collagen antibody in neurofibroma showed type IV collagen to be diffusely and weakly stained in tissue. On staining by monoclonal anti-laminin antibody, laminin was stained in a matrix and around vessels. CONCLUSION: The increased expression of extracellular matrix genes may suggest that there is a subpopulation of fibroic cells in neurofibroma which are stimulated by TGF-b. Ha-ras genes which might have accumulated with the differentiation of neural tissue may be related to the pathogenesis of neurofibroma tissue formation. Further studies are needed to determine whether the other factors are related to the pathogenesis of neurofibroma.

A Case of Atypical Lupus Vulgaris Developing at a Skin Graft Site

Lupus vulgaris is most prevalent on exposed parts, especially the face but can also develop on exetremities. Lupus vulgaris originates from tuberculosis elsewhere in the body by hematogenous, lymphatic, or contiguous spread. A 19-year-old male patient came to our department. The patient had had many recurrent oozing and verrucous plaques and crusts on the left foot for one year. A skin biopsy from the lesion on the left dorsum of the foot showed scattered well defined granulomas consisting of the epithelioid cell clusters with Langerhans and foreign body type giant cells in the mid dermis. Caseation necrosis was slight. There were no bacilli on AFB staining. The multi test CMI for tuberculin was highly positive. A chest X-ray did not show any abnormal findings. The presence of Mycobacterium tuberculosis DNA was demonstrated by polymerase chain reactions (PCR) for detection of mycobacterial DNA from a routinely prepared paraffin-embedded skin specimen. Herein we report a very atypical case of lupus vulgaris confirmed by PCR.

A Clinical Study of 133 Patients with Rosacea / 대한피부과학회지

BACKGROUND: A clinical study of rosacea has never been reported in Korea. OBJECTIVE: The purpose of this study was to elucidate the clinical observations of rosncea. METHODS: During a 5-year-period from Jan. 1990 to Dec. 1994, 133 patients were evaluated with regard to age, sex, location of skin lesions, clinical type, duration, and precipitating factors. RESULTS AND CONCLUSIONS: 1. Of the 7,787 cases amongst outpatients, 133 cases(1.7% ) were dignosed with rosacea. Of there 46 were male patients and 87 females, giving a sex ratio of 1:1.9 in favor of females. 2. The most common type of rosacea was vascular rosacea(60.2%) 3. The average duration of rosacea was 3.4 years. 4. Rosacea afflict persons aged 40-49 most frequently. 5. The predilection sites of the rosacea were : cheek(42.9%), nose(23.3%), entire face(11.3%), cheek & nose(9%), zygomatic area(6.8%), extra-facial area(3.8%), forehead(2.9%). 6, The aggravating factors of rosacea were : unknown cause(32.3%), coffee & tea(18%), alcohol(13.5%), emotional stress(10.5%), sun exposure(9.8%), multi-factoral(7.5%), drugs(steroids)4.6%).

Assessment of Left Ventricular Diastolic Pressures with Pulmonary Venous Flow and Transmitral Inflow by Doppler Echocardiography

BACKGROUND: Doppler variable of mitral inflow have been used to assess left ventricular siastolic function indirectly. Pulmonary venous flow(PVF) variables could supplement mitral inflow in the estimation of left ventricular diastolic function. The purpose of this study are to assess the feasibility of PVF measurement by using transthoracic pulsed wave Doppler echocardiogram and to estimate the LV end-diastolic pressure with PVF parameters. METHODS: Fifty six patients underwent transthoracic pulsed wave Doppler echocardiagraphy (HP Sonos 1500) within 2 hours before left heart catheterization for the measurement of left ventricular pressure. RESULTS: 1) Measurement of transthoracic PVF was feasible in 50 patients(89.3%). 2) The difference between the duration of pulmonary venous reversal flow and mitral A wave(D difference, delta D) was strongly correlated with left ventricular end diastolic pressure(r=0.73, p or =12mmHg(sensitivity 90.6%, specificity 50.0%). CONCLUSION: PVF could be assessed with transthoracic Doppler ultrasound with good feasibility. PVF may be an important parameter in the evaluation of left ventricular diastolic function. PVF reveral duration exceeding that of mitral A wave would be a marker of elevated left ventricular end diastolic pressure(> or =12mmHg). Plumonary venous flow . Transmitral inflow . Left ventricular end diastolic pressure. Transthorasic doppler echocardiography.

A Case of Ecthyma Gangrenosum Associated with Liver Abscess / 대한피부과학회지

Ecthyma Gangrenosum is a rapidly progressing skin infection charact,erized by edema, hemorragic bullae and necrosis. Ecthyma Gangrenosum occurs almost exclusively in severely imrnunocompromised patients during the course of pseudomanas aeruginosa septisemia. A 5 month-old boy was transferred to our department because of multiple well defined central necrotic black-colored large erythematous bullae. In the bacterial cultures of skin, stool and liver aspiration fluid, Pseudomonas aeruginosa was grown. In the abdominal ultrasonogram and computed tomogram, the multiple liver abscess, hepatomegaly and ascites were shown on both hepatic lobes. Herein we report a case of ecthyma gangrenosum associated with liver abscess.

Detection of Type VII Collagen mRNA in Scleroderma Fibroblasts / 대한피부과학회지

BACKGROUND: Type VII collagen is a relatively low abundance extracellular matrix protein among the collagenous molecules. Among the minor collagens. type VII collagen has been demon strated by a immunolocalization studies to be component of anchoring fibrils and structures extending perpendicularly from the lamina densa to the upperpapillary dermis. OBJECTIVE: The purpose of his study is to determine the expression of the type VII collagengene in a group of scleroderma patients as compared to normal skin. METHODS: We have examined the levels of type VII collagen mRNA using quantitative reverse transcription PCR and in sit gybridization in scleroderma skin fibroblasts. Immunofluorescent staining with anti-type VII collan antibody was performed in vitro and in vivo to evaluate the expression of type VII collagen at protein level. RESULTS: 1. the ratio of type VII collagen/GAPDH RT-PCR product were 63.3+/-15.3 in scleroderma and 21.7+7.6 in normal fibroblasts by RT-PCR. 2. The expression of type VII collagen mRNA was considerably lower than type I in scleroderma. A few positive signals by in situ hybridization with type VII collagen cDNA were shown in the dermis. 3. The staining was markedly enhanced in scleroderma fibroblasts and tissues compaired with normal subjects in imunofluorescent staining with anti-Type VII collagn antibody. CONCLUSION: RT-PCR and immunofluorescent staining with antibodies to type VII collagen shows enhanced gene expression in scleroderma skin fibroblasts These data suggest that type VII collagen may be the main soruce of the sclerotic change of skin in scleroderma.

Effects of Interleukin-4 on Extracellular Matrix Gene Expression in Normal Skin Fibroblasts Cultures

BACKGROUND: Interleukin-4(IL-4) is a 20 kDa glycoprotein and is now known to possess fibrogenic activities. OBJECTIVE: The purpose of this study is to evaluate the effect of IL4 on the extracellular matrix gene expression. METHODS: Quantitation of collagenous protein synthesis, Northern and dot-blot hybridization, transfection experiments and CAT assay in normal human skin fibroblasts were done. RESULTS: Maximal elevation of collagen synthesis was presented at the concentration of IL-4 being S.Ong/ml. In Northern and dot-blot analysis, each level of type I collagens and fibronectin mRNA increased 3.0, and 2.8-fold, respectively in IL4 treated fibroblasts. In CAT to c assay, the percentage of acetylation was 8.3% in the untreated control group and 23.1% in 5.Ong/ml of the IL-4 treated group in normal fibroblasts. The promoter activity was in creased 2.8-fold in II.4(5.Ong/ml) treated fibroblasts compared to the control groups. CONCLUSION: IL4 might be a fibrogenic cytokine that could be important in promoting the biogenesis of collagen proteins. This could be due to increased transcription.

A Case of Primary Disseminated Cutaneous Aspergillosis in Chrinic Active hepatitis / 대한피부과학회지

An 41-year-old woman with chronic active hepatitis developed multible asymptomatic erythematous papules, plaques and purpuras on the both lower leg, feet, forearms and hands. Some lesions progressed to ulcers with central black colored necrotic eschars. Biopsies and cultures demorrstrated a fungus, aspergillus fumigatus a the etilogic agent. No evicience of involvement of other organs by aspergillus fumigatus was found. Intravenous amphotericin B therapy was discontinued because of he immediate adverse effects. The patient received treatment with oral itaconazole(200mg/day) and intravenous fluconazole(400mg/day), but skin lesions have been recurring repeatedly.

Expression of the Extracellular Matrix Gene in Response to Insulin and Insulin-like Growth Factor in Cultured Skin Fibroblasts

BACKGROUND: Diabetes mellitus is a heterogeneous group of disorders characterized by high serum glucose levels and by disturbances of carbohydrate and lipid metabolism. There are many cutaneous signs of this common endocrinopathy, such as nercobiosis lipoidica diabeticorum, diabetic bullosis, shin spot, diabetic pruritus, etc. OBJECTIVE: In this study, we investigated whether extracellular matrix gene expression in cultured skin fibroblast is influenced by insulin and Insulin-like growth factor-I(IGF-I). METHOD: Total RNA was isolated from insulin or IGF-I treated human skin fibroblasts. The Northern blot and slot-blot hybridization were then conducted. RESULTS: The mRNA levels of pro α1(I) collagen, pro α1(I11) collagen, fibronectin in insulin and IGF-I treated normal skin fibroblasts increased compared with untreated normal skin fibroblasts. CONCLUSION: Our results show that insulin and IGF-I stimulate collagen formation in normal skin fibroblast at physiological concentrations. Therefore, these demonstrate that insulin can modulate the expression of extracellular matrix gene.