Preventive Effect of Pretreatment with Intravenous Nicorandil on Contrast-Induced Nephropathy in Patients with Renal Dysfunction Undergoing Coronary Angiography (PRINCIPLE Study)

PURPOSE: To investigate the effect of pretreatment with intravenous nicorandil on the incidence of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing coronary angiography. MATERIALS AND METHODS: This randomized controlled multicenter study enrolled a total of 166 patients (nicorandil n=81; control n=85) with an estimated glomerular filtration rate 0.5 mg/dL increase or >25% rise in serum creatinine (SCr) concentration within 48 hours of contrast exposure compared to baseline. RESULTS: The final analysis included 149 patients (nicorandil n=73; control n=76). The baseline characteristics and the total volume of the used contrast (Iodixanol, 125.6+/-69.1 mL vs. 126.9+/-74.6 mL, p=0.916) were similar between the two groups. The incidence of CIN also did not differ between the nicorandil and control groups (6.8% vs. 6.6%, p=0.794). There was no difference between the two groups in the relative change in SCr from baseline to peak level within 48 hours after coronary angiography (-1.58+/-24.07% vs. 0.96+/-17.49%, p=0.464), although the nicorandil group showed less absolute change in SCr than the control group (-0.01+/-0.43 mg/mL vs. 0.02+/-0.31 mg/mL, p=0.005). CONCLUSION: Prophylactic intravenous infusion of nicorandil did not decrease the incidence of CIN in patients with renal dysfunction undergoing coronary angiography.

Mouse Single Oral Dose Toxicity Test of Bupleuri Radix Aqueous Extracts

The aim of this study was to evaluate the single oral dose toxicity of Bupleuri Radix (BR) aqueous extracts, it has been traditionally used as anti-inflammatory agent, in male and female mice. BR extracts (yield = 16.52%) was administered to female and male ICR mice as an oral dose of 2,000, 1,000 and 500 mg/kg (body weight) according to the recommendation of Korea Food and Drug Administration (KFDA) Guidelines. Animals were monitored for the mortality and changes in body weight, clinical signs and gross observation during 14 days after dosing, upon necropsy; organ weight and histopathology of 14 principal organs were examined. As the results, no BR extracts treatment related mortalities, clinical signs, changes on the body and organ weights, gross and histopathological observations against 14 principal organs were detected up to 2,000 mg/kg in both female and male mice, except for soft feces and related body weight decrease detected in male mice treated with 2,000 mg/kg. Therefore, LD50 (50% lethal dose) and approximate LD of BR aqueous extracts after single oral treatment in female and male mice were considered over 2000 mg/kg, respectively. Although it was also observed that the possibilities of digestive disorders, like soft feces when administered over 2,000 mg/kg of BR extracts in the present study, these possibilities of digestive disorders can be disregard in clinical use because they are transient in the highest dosages male only.

The Ultrasound-guided Selective Nerve Root Injections in the Lower Cervical Spines

OBJECTIVE: To introduce the technique of the ultrasound-guided selective nerve root injection in the lower cervical spine and to evaluate its accuracy and distribution patterns of injections. METHOD: Thirty-one patients with the cervical radiculopathies (C5 to C7) from cervical disc herniation were enrolled in this study. Targeted nerve root image was obtained and the needle was introduced to its dorsal surface under the ultrasound guidance. Then 2 ml of contrast media was injected which was followed by fluoroscopic image. The accurate injection was defined as the contrast media placed over the neural foramen along the targeted nerve root. RESULTS: 24 of 31 (77.4%) procedures were assesed to be accurately placed and there was no significant complication. The accuracy of injection was lower at the C7 nerve root (70.0%) than other nerve roots. In all cases, large amount of back flow to the brachial plexus and spread to the adjacent nerve roots were observed. CONCLUSION: In the lower cervical spines, ultrasound-guided selective nerve root injections might be considered as a radiation free, safe and available method.

The Effect of Yacon (Smallanthus sonchifolius) Extract against Dibutyltin Dichloride-induced Pancreatitis / 대한해부학회지

Yacon is used in folk medicines as a medicinal tea for hypoglycemia. In a recent study described herein, anti-oxidative, -bacterial, -fungal activities and cell protective functions of leaf extract of Smallanthus sonchifolius have been reported. In this study, to evaluate the effect on pancreatitis by using yacon extract (YE), we examined the efficacy of YE on DBTC (8 mg/kg)-induced pancreatitis in rats. After the treatment of DBTC on day 21, highly increased inflammatory cells, necrosis of acinar cells and connective tissues were observed. However, the inflammation was strongly inhibited in YE as compared to control group (CON). As a result of immunoreactions against HSP27, HSP70 and MAC387, weak or no possibilities of normal group (NOR) were observed in pancreas, whereas in immunoreactions against HSP27 and HSP70, strong expression of CON was observed in acinar and duct cells on day 14. However, the expression of HSP27 was decreased in acinar cells for CON treatment on day 21 as compared to 14 days observation, whereas strong expression of HSP27 was observed in duct cells and blood vessels on day 21. As regards the immunoreactions against HSP70, weak or no possibilities of CON were observed in duct cells and blood vessels as well as in acinar cells on day 21. In CON, time-dependent increase of MAC387 was observed. However, the expressions of HSP27 and HSP70 were weakly observed in YE as compared to CON on day 14 with strong positive reaction in acinar cells on day 21. Immunoreactions against MAC387 were decreased in YE on day 14 than day 7, which increased on day 21 as compared to day 14. These results suggested that yacon extract has inhibitory and mitigatory effects against DBTC-induced pancreatitis.

The Impact of Apolipoprotein A-I Polymorphisms on the Lipid Profiles in Middle Aged Healthy Men and Women

BACKGROUND AND OBJECTIVES: Apolipoprotein A-I is the major lipoprotein constituent of high density lipoprotein in plasma. In this study, the role of two polymorphisms in the apo A-I gene was investigated on the serum lipid profiles and apo A-I levels in healthy men and women. SUBJECTS AND METHODS: Blood samples were obtained from 417 subjects (M : F=169 : 248, mean age 47.2 years). The apo A-I genotypes were determined by SNP-IT assays using the SNPstream 25KTM system. RESULTS: The frequencies of the A allele at the XmnI restriction site and position -75 bp were 0.25/0.23 and 0.19/0.17 in men and women, respectively. A strong positive linkage disequilibrium (D'=0.990) between two polymorphisms was detected. In men, the A allele at the XmnI restriction site was associated with significantly lower levels of triglyceride (p=0.028) compared to the G/G subjects, but no significant associations were detected between the G-75A polymorphism and any of the lipid traits examined. In women, each A allele for the XmnI restriction site and -75 bp polymorphisms were significantly associated with higher levels of apo A-I (p=0.032 and p=0.012). In the multiple regression analysis, the HDL, being a current drinker and the A allele of the XmnI restriction site polymorphism were major determinants of the serum apo A-I levels in women (R2=0.272, p<0.05). CONCLUSION: Our study showed that the A allele at XmnI restriction site in the apo A-I gene was associated with decreased triglyceride levels in men. Each A allele of two polymorphisms was associated with an elevated apo A-I level in women.

A Case of Libman-Sacks Endocarditis with Moderate Mitral Regurgitation

Libman-Sacks endocarditis is characterized by noninfectious vegetations on the cardiac valves of patients with systemic lupus erythematosus (SLE). Valvular abnormalities are found in about one third of patients with primary anitiphospholipid syndrome. SLE patients, with antiphospholipid antibodies, have a higher prevalence of valvular involvement than those without these antibodies. A 29 year old man was referred for evaluation of severe orthopnea. He presented with the clinical features of multi-organ failure (heart, lung and kidney). His serological and immunological findings were typical of a SLE flare up. His level of anticardiolipin antibody (IgG) was highly increased and his lupus anticoagulant was positive. A blood culture revealed no growth of bacterial organism. Transthoracic and transesophageal echocardiography showed non-mobile, verrucous vegetations on the anterior leaflet of the mitral valve, with moderate mitral regurgitation.

Multiple Coronary Artery-Left Ventricular Microfistulae in a Patient with Apical Hypertrophic Cardiomyopathy: A Demonstration by Transthoracic Color Doppler Echocardiography

Among the congenital coronary artery fistulae, multiple coronary artery microfistulae arising from the left and right coronary artery and emptying into the left ventricle are very rare and little is known of their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. A 67-year- old woman was referred for the evaluation of chest pain at exertion, and shortness of breath. Electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic color Doppler echocardiography, using a high frequency transducer with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.

A Case of Multiple Coronary Artery-Left Ventricular Microfistulae Demonstrated by Transthoracic Doppler Echocardiography

Of the congenital coronary artery fistulae, the multiple coronary artery microfistulae, arising from the left and right coronary artery emptying into the left ventricle, are very rare. Little is known about their anatomic and clinical features, especially in apical hypertrophic cardiomyopathy. The clinical findings are heterogeneous, but include, in most cases, a history of typical or atypical angina pectoris. A 67 year old woman was referred for evaluation of chest pain on exertion, and a shortness of breath. The electrocardiographic and echocardiographic findings were typical of apical hypertrophic cardiomyopathy. Coronary arteriography showed normal epicardial coronary arteries, but multiple coronary artery-left ventricular microfistulae arising from the left and right coronary arteries. Transthoracic Doppler echocardiography, using a high frequency transducer, with a low Nyquist limit, demonstrated multiple coronary artery-left ventricular microfistulae just beneath the apical impulse window.

CT Staging of Renal Pelvis Tumor

PURPOSE: To assess the value of computed tomography (CT) in the preoperative staging of transitional cellcarcinoma (TCC) of the renal pelvis. MATERIALS AND METHODS: We retrospectively evaluated the CT TNM staging of 38patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990and January 1998. In CT staging for differentiation between early-stage (TO-2) and advanced-stage disease (T3-T4),three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness orirregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosisproximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologicresults, and was compared with pathologic staging. RESULTS: Pathologic results revealed 19 cases of early stagedisease (TO=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38);fourcases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%,and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosisproximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion forearly-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, andthe specificity of advanced-stage disease was 95%. CONCLUSION: When hydronephrosis proximal to a tumor wasconsidered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate.