Real-Time 3-Dimensional Echocardiography of the Heart 13 Years After Partial Left Ventriculectomy

No abstract available.

Exendin-4 Protects Oxidative Stress-Induced beta-Cell Apoptosis through Reduced JNK and GSK3beta Activity

Oxidative stress induced by chronic hyperglycemia in type 2 diabetes plays a crucial role in progressive loss of beta-cell mass through beta-cell apoptosis. Glucagon like peptide-1 (GLP-1) has effects on preservation of beta-cell mass and its insulin secretory function. GLP-1 possibly increases islet cell mass through stimulated proliferation from beta-cell and differentiation to beta-cell from progenitor cells. Also, it probably has an antiapoptotic effect on beta-cell, but detailed mechanisms are not proven. Therefore, we examined the protective mechanism of GLP-1 in beta-cell after induction of oxidative stress. The cell apoptosis decreased to ~50% when cells were treated with 100 microM H2O2 for up to 2 hr. After pretreatment of Ex-4, GLP-1 receptor agonist, flow cytometric analysis shows 41.7% reduction of beta-cell apoptosis. This data suggested that pretreatment of Ex-4 protect from oxidative stress-induced apoptosis. Also, Ex-4 treatment decreased GSK3beta activation, JNK phosphorylation and caspase-9, -3 activation and recovered the expression of insulin2 mRNA in beta-cell lines and secretion of insulin in human islet. These results suggest that Ex-4 may protect beta-cell apoptosis by blocking the JNK and GSK3beta mediated apoptotic pathway.

Combined Open and Endovascular Repair for Aortic Arch Pathology

BACKGROUND AND OBJECTIVES: We describe our experience with combined open and endovascular repair in patients who have aortic arch pathology. SUBJECTS AND METHODS: This study is a retrospective analysis of 7 patients who underwent combined open and endovascular repair for aortic arch pathology. Medical records and radiographic information were reviewed. RESULTS: A total of 7 consecutive patients (5 men, 71.4%) underwent thoracic stent graft implantation. The mean age was 59.9+/-16.7 years. The indication for endovascular repair was aneurysmal degeneration in 5 patients, and rupture or impending rupture in 2 patients. In all 7 cases, supra-aortic transposition of the great vessels was performed successfully. Stent graft implantation was achieved in all cases. Surgical exposure of the access vessel was necessary in 2 patients. A total of 9 stent grafts were implanted (3 stent grafts in one patient). The Seal thoracic and the Valiant endovascular stent graft were implanted in 6 patients and 1 patient, respectively. There were no post-procedure deaths or neurologic complications. In 2 patients, bleeding and injury of access vessel were noted after the procedure. Postoperative endoleak was noted in 1 patient. One patient died at 10 months after the procedure due to a newly developed ascending aortic dissection. No patients required secondary intervention during the follow-up period. The aortic diameter decreased in 4 patients. In 3 patients, including 1 patient with endoleak, there was no change in aortic diameter. CONCLUSION: Our experience suggests that combined open and endovascular repair for aortic arch pathology is safe and effective, with few complications.

Coronary Artery Perforation Following Implantation of a Drug-Eluting Stent Rescued by Deployment of a Covered Stent in Symptomatic Myocardial Bridging

We successfully rescued a patient whose coronary artery perforated following implantation of a drug-eluting stent (DES), by deploying a stent-graft in symptomatic myocardial bridging. Our case demonstrated that coronary perforation could be handled without difficulty when perforated myocardial bridging is confined to the interventricular groove

The prognostic value of NT-proBNP, Troponin I, and hs-CRP in patients with acute coronary syndrome / 대한내과학회지

BACKGROUND/AIMS: Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I, and high-sensitivity C-reactive protein (hs-CRP) are each associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). We evaluated the prognostic value of NT-proBNP and a multi-marker risk approach with the simultaneous assessment of NT-proBNP, troponin I, and hs-CRP in patients with ACS. METHODS: We included 277 patients who were admitted for ACS between January and December 2006. We measured NT-proBNP, troponin I, and hs-CRP within 24 hours of the onset of symptoms. Patients were followed for a median of 559 days for cardiovascular events, including death, new myocardial infarction, heart failure, or rehospitalization for ACS. RESULTS: NT-proBNP was the most powerful predictor of clinical outcome among the biomarkers (HR 3.65, 95% CI 2.11-6.30), followed by the peak troponin I and hs-CRP (HR 2.08, 95% CI 1.12-3.87;HR 1.99, 95% CI 1.18-3.37, respectively), but not the baseline troponin I. A multi-marker risk approach with the simultaneous assessment of NT-proBNP, hs-CRP, and peak troponin I was significantly associated with cardiovascular events, especially the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). CONCLUSIONS: NT-proBNP is the most powerful, independent predictor of clinical outcome among the cardiac biomarkers. Since the peak troponin I level provides more prognostic information than the baseline level, follow-up measurement of troponin I may be warranted for risk stratification. The multi-marker risk approach appears to have better prognostic performance than any marker in isolation.

Echocardiographic Assessments of Left Atrial Strain and Volume in Healthy Patients and Patients With Mitral Valvular Heart Disease by Tissue Doppler Imaging and 3-Dimensional Echocardiography

BACKGROUND AND OBJECTIVES: The purpose of the current study was to assess left atrial (LA) physiology in relation to associations between LA volume change and regional tissue velocities and strains, and to extend this information to patients with mitral stenosis (MS) or mitral regurgitation (MR). SUBJECTS AND METHODS: Twenty-two healthy persons, 22 patients with moderate-to-severe MS, and 22 patients with moderate-to-severe MR were studied. Tissue velocities, strains, and time-volume curves of the LA were acquired using tissue Doppler imaging and 3-dimensional echocardiography. RESULTS: In healthy controls, the maximal LA volume was negatively correlated with the posterior wall longitudinal systolic strain (r=-0.45, p=0.03). The time-to-maximal LA volume was positively correlated with the time-to-posterior wall longitudinal peak strain (r=0.46, p=0.03) and the time-to-circumferential peak strain (r=0.59, p=0.004). The LA active emptying fraction (LAactEF) was positively correlated with the posterior wall longitudinal peak systolic and late diastolic tissue velocities. In patients with MS, the maximal LA volume was negatively correlated with the posterior wall radial peak systolic velocity and the longitudinal late diastolic velocity. In patients with MS, the LAactEF had an additional positive correlation with the anterior wall longitudinal and circumferential systolic velocities, whereas the patients with MR had an additional positive correlation between the LAactEF and the lateral wall longitudinal peak strain as compared with the healthy cantrols. CONCLUSION: LA longitudinal and circumferential deformations are more related than radial deformation to determining LA volume and function. The LA of patients with MS revealed a greater pathologic physiology than those of patients with MR.

Inferior Sinus Venosus Type Atrial Septal Defect Initially Presenting Pulmonary Hypertension on Transthoracic Echocardiography

Inferior sinus venosus type atrial septal defect (ASD) is a rare congenital cardiac deformity that occurs between the inferior vena cava and right atrium. Inferior sinus venosus defect is difficult to diagnose through transthoracic echocardiography because of its location which is infero-posterior to the fossa ovalis. Increasing pulmonary arterial pressure and pulmonary vascular resistance in patients with sinus venosus defect usually occur earlier than other types of ASD. We report a case of 19-year-old man who presented exertional dyspnea due to inferior sinus venous type ASD with mild pulmonary hypertension. In this case, we found clues from slight diastolic flattening of interventricular septum and shortened acceleration time of right ventricular outflow tract on initial transthoracic echocardiography, leading right heart catheterization and transesophageal echocardiography to reveal this rare type of ASD.

Global Circumferential Strain by 2-Dimensional Speckle Tracking Method for the Evaluation of the Left Ventricular Function

BACKGROUND AND OBJECTIVES: The speckle tracking method using 2-dimensional (2D) echocardiography is not affected by the tethering of neighboring segments and angulation. Global circumferential strain (GCS) of the left ventricle (LV) has been suggested as a systolic index and correlated with LV contractility. The purpose of this study was to investigate whether acute changes in preload affect global circumferential strain and to evaluate the usefulness of GCS by the speckle tracking method. SUBJECTS AND METHODS: 2D echocardiography was performed in 69 patients with end-stage renal disease before and after hemodialysis to measure the LV end-diastolic volume and LV ejection fraction. 2D images were acquired from the short-axis view of the mid-LV for the evaluation of GCS. RESULTS: Mean LV end-diastolic volume significantly decreased from 91.2+/-33.3 mL to 72.3+/-32.0 mL (p+/-0.05), and LV ejection fraction decreased from 63.6+/-13.1% to 60.0+/-11.2% (p=0.006) after hemodialysis. However, mean GCS showed no significant change after hemodialysis (17.2+/-5.3% vs. 16.6+/-4.7%, p=0.13). GCS was found to be well correlated with LV ejection fraction (r=0.54, p<0.05) and peak systolic mitral annular velocity (r=0.46, p=0.000), but not with LV preload (r=0.06, p=0.622). CONCLUSION: GCS using the speckle tracking method is a useful index for the evaluation of LV systolic function because it is not affected by acute preload change and is correlated with LV ejection fraction and peak systolic mitral annular velocity.

Distribution of Adenoviral Vector in Brain after Intravenous Administration

The delivery of transgenes to the central nervous system (CNS) can be a valuable tool to treat CNS diseases. Various systems for the delivery to the CNS have been developed; vascular delivery of viral vectors being most recent. Here, we investigated gene transfer to the CNS by intravenous injection of recombinant adenoviral vectors, containing green fluorescence protein (GFP) as a reporter gene. Expression of GFP was first observed 6 days after the gene transfer, peaked at 14 days, and almost diminished after 28 days. The observed expression of GFP in the CNS was highly localized to hippocampal CA regions of cerebral neocortex, inferior colliculus of midbrain, and granular cell and Purkinje cell layers of cerebellum. It is concluded that intravenous delivery of adenoviral vectors can be used for gene delivery to the CNS, and hence the technique could be beneficial to gene therapy.

Assessment of Normal Mitral Annulus Velocity by Doppler Tissue Imaging

BACKGROUND AND OBJECT: We want to know reference values of mitral annulus velocity by Doppler tissue imaging which has been thought as a new parameter of left ventricular diastolic function. Including mitral inflow parameters, many parameters which have been used in the evaluation of left ventricular diastolic function are affected by several conditions, so sometimes they can not provide information about left ventricular diastolic function. The knowledge of mitral annulus velocity by Doppler tissue imaging will provide new guidelines for evaluation of diastolic function. However, reference values in normal and changes according to an age have not been fully evaluated. METHODS: We examined 246 patients with no symptoms related to the cardiac systolic and diastolic dysfunction and 80 healthy volunteers according to an age. Early ( E ) and late ( A ) transmitral flow velocity and the ratio of early to late peak velocity ( E/A ) were obtained by pulsed Doppler echocardiography. Early diastolic velocity of mitral annulus ( E' ) and peak atrial systolic velocity of mitral annulus ( A' ) were obtained from the medial ( or septal ) corner of the mitral annulus and subsequently from lateral corner by Doppler tissue imaging. We obtained E', A' and the ratio of E' to A' ( E'/A' ) and E/ E' according to an age. RESULTS: E' from medial corner was the highest in subjects in their twenties and declined gradually and A' from medial corner was the lowest in a same age group and increased gradually. E'/A' ratio from medial corner was the highest in subjects in their twenties and declined gradually and reversed in subjects in their forties. E', A' and E'/A' from lateral corner were showed like as medial corner similarly but E'/A' was reversed in the subjects in their fifties. E/ E' from medial and lateral corner was the lowest in subjects in their twenties and increased gradually with age. In comparison between transmitral flow velocity and mitral annulus velocity, there are good relationship in E/A and E'/A' ( p=0.01 ). CONCLUSION: We measured reference values of mitral annulus velocity by Doppler tissue imaging and E/ E' according to an age.

A Case of Left Atrial Myxoma Presenting as Acute Pulmonary Edema

Myxomas are the most common primary benign cardiac tumor. In general, myxoma has a benign growth and chronic entity, so symtoms of myxoma are vague and mild. Therefore the association of an atrial myxoma with acute pulmonary edema and syncope appears to be very rare. Even though very rare, detection of myxoma is important because it is usually fatal in several cases if unrecognized and untreated. We experienced a case of left atrial (LA) myxoma presenting as acute pulmonary edema and syncope of unknown cause in 47 years old female patient. A mass located on left atrium was excised en bloc, and the patient recovered uneventfully. We report the case along with literature review.

Congenital aortopulmonary fistula presenting as an exertional dyspnea

Aortopulmonary fistula is an exceedingly rare vascular malformation. It is commonly derived after chest injuly or from complication of chest operation and aortic dissection and congenital aortopulmonary fistula is only several cases combined with Tetralogy of Fallot or aortic stenosis. But a congenital aortopulmonary fistula without any hemodynamic abnormalities was not reported. A 56-year old man with exertional dyspnea was admitted. In an examination on admission, there were no abnomalities. Aortography showed an aortopulmonary fistula that branches from the ascending aorta adjacent to the right coronary artery, running to the main pulmonary artery. Transcatheter coil embolization was performed and he was discharged 7 day after embolization without complication. Exertional dyspnea disappeared and careful follow up has be performed periodically.

Left Ventricular Myxoma Associated Acute Pulmonary Embolism

Primary tumors of the heart are rare, three quarter of the tumors are benign, and nearly half of the benign heart tumors are myxomas. Cardiac myxoma usually originate in the left atrium about 75 percent, however, only 3 to 4 percent of myxoma are detected in the left ventricle. We report on a 32 years old woman with left ventricular myxoma who presented with shortness of breath, chest tightness, and general weakness. Acute pulmonary embolism and left ventricular myxoma were found on a perfusion lung scan and echocadiogram. A mass located on septal wall of left ventricle was excised en bloc. The patient recovered uneventfully and careful follow up has be performed periodically.

Long or Multiple Stenting in Primary Angioplasty

BACKGROUND: Primary stenting as a direct reperfusion procedure after acute myocardial infarction might reduce recurrent myocardial infarction and target vessel revascularization. However, result of long or multiple stenting in the long or tandem lesions were not known. METHOD: From Jan. 1996 to Dec. 1998, patients with acute myocardial infarction including cardiogenic shock were undergone primary stenting using long or multiple stent. The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat angioplasty of the infarct-related vessel. The results were compared with age, sex, lesion, and risk matched standard stenting group. RESULT: Baseline characteristics were similar for the 20 patients who underwent standard length stenting and the 13 patients who underwent long or multiple stenting. Stent diameter was similar in two group (3.4+/-0.3 mm vs. 3.5+/-0.4 mm, p=0.65), but total stent length was longer in long or multiple stenting group (15.5+/-1.8 mm vs. 40.18.4 mm, p=0.01). Average numbers of stent using in multiple stenting were 1.5+/-0.7. Stenting in the infarct-related artery was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 25% (5/20) in the standard stent group and 31%(4/13) in the long or multiple stent group (p=0.5). CONCLUSION: Outcomes of long or multiple stenting including mortality, recurrent myocardial infarction and target vessel revascularization was similar to standard stenting. Long or multiple stenting after acute myocardial infarction may possible procedure in some selective cases having long or tandem lesion.

Bowel Stricture Caused by Acute Ischemic Colitis after Intraaortic Balloon Counterpulsation

Intraaortic balloon counterpulsation (IAB) has been shown to prolong survival in the critically ill cardiac patients. Originally developed for use in the patients with cardiogenic shock, the indications have been expanded. But despite technical advances, the complication rate associated with IAB remains high. The most commonly reported complications include damage to the femoral artery and distal embolization. Other reported major complications are balloon rupture, limb loss, bleeding, systemic infection and bowel infarction. We report a patient complicated by ischemic colitis causing stenosis and intestinal obstruction after IAB insertion.

Balloon Angioplasty and Stent-Supported Angioplasty for Acute Myocardial Infarction

BACKGROUND: Although the superior reperfusion and improved clinical outcome following angioplasty for acute myocardial infarction (AMI) have been well known, 10 to 15% of reinfarction and recurrent ischemia in hospital are main limitation of primary percutaneous transluminal coronary angioplasty (PTCA). This study was undertaken to examine the safety and feasibility of stent-supported primary angioplasty in acute myocardial infarction. METHODS: Between July 1995 and Jun. 1997, 32 patients underwent direct or rescue PTCA, including patients with cardiogenic shock. After PTCA, stenting was attempted in patient with dissection or having more than 30% of residual stenosis. Result: In patient with direct PTCA, angiographic success rate was obtained in 91% (30/32). Stenting was attempted in 15 of 30 patients. These patients had suboptimal results (8 patients), non-occlusive dissection (3 patients) and acute occlusion (2 patient). Thrombolysis in myocardial infarction (TIMI) grade 3 flow was restored in 28 patients (93%). In one patient no-reflow phenomena was observed following stent insertion. Despite intra-aortic balloon pumping, there was one death during the hopitalization due to cardiogenic shock following PTCA. Subacute stent thrombosis developed in two patients. 27 patients (90%) were event-free and clinically improved through out the follow up period (11.5+/-5.2 month). Quantitative angiography showed excellent angiographic result after stenting compared with balloon PTCA (2.4+/-0.6 mm vs. 3.4+/-0.3 mm p<0.01). CONCLUSION: After failure of initial angioplasty, coronary stenting can be a supportive therapeutic strategy. Coronary stenting results in a high degree of angiographic success, a low incidence of subacute thrombosis.

An Electron Microscopic Study on Cytoplasmic Organelles of the Cilicated Cell in Tracheal Epithelium in o-Chlorobenzylidene malononitrile (CS)gas exposed rat / 체질인류학회지

The effects of tear gas, o -chlorobenzylidene malononitrile (CS) on the cytoplasmic organelles were studied in the ciliated cell of rat tracheal epithelium. Albino rats (Sprague -Dawley strain), weighing about 150gm, were used as experimental animals. The experimental animals were exposed to 2.0 g/m 3 of CS gas for 20 minutes per day for the succesive 3 days. The experimental animals were sacrified at 1, 3, 6, 12 hours and 1, 3 and 5 days after final exposure to CS gas. Specimens obtained from the trachea were pre -fixed in 2% glutaraldehyde -2.5% paraformaldehyde and post -fixed in the 1% osmium tetroxide for electron microscopic study. The results obtained were as follows: 1. In 1 hour CS gas exposed group, rough endoplasmic reticulum with dilated cisternae, and mitochondria with disrupted double membrane in the ciliated cells are found. 2. In 3 hours and 6 hours CS gas exposed groups, dilated, segmented and sacculated cisterane of rough endoplasmic reticulum, mitochondria with dissolved cristae and disrupted double membrane, and Golgi complex with atrophied cisternae are observed in the ciliated cell. 3. In 12 hours CS gas exposed group, some mitochondria with swollen cristae is found in the ciliated cell. 4. In 1 day CS gas exposed group, mitochondria with dissolved cristae, Golgi complex with hypertrophied cisternae, and autophagic vacuole are found. 5. In 3 day and 5 day CS gas exposed groups, numerous mitochondria, well -developed rough endoplasmic reticulum, and supranuclear Golgi complex are found in ciliated cell. The results of the present study suggest that the o -chlorobenzylidene malononitrile (CS) gas is cytotoxic to the ciliated cells in tracheal epithelium inducing some degenerative changes, which are recovered with the lapse of time.

Four Cases of Typhlitis, Developed in Neutropenic State and Treated with Medical Conservative Management / 대한암학회지

Typhlitis is a life threatening necrotizing enterocolitis of the cecum, ascending colon and terminal ileum seen in severely neutropenic patients, however its pathogenesis is not identified up to this time.The incidence of typhlitis in leukemic patient is 10~12%, estimated by postmortem examination, and 46% in induction chemotherapy of leukemia. Recently, entity incidence is more high due to increasing challenges to high dose chemotherapy in solid tumors.We experienced four cases of typhlitis, one was developed in the circumstance of neutropenia induced by induction chemotherapy for acute myelocytic leukemia and others in neutropnia due to primary diseases without chemotherapy, ig, chronic myelocytic leukemia, acute lymphocytic leukemia, myelodysplastic syndrome.All cases were treated with high dose broad spectrum antibiotics in early phase of disease and its outcome was good, so that, early diagnosis of typhlitis is essential, then prompt treatment with high dose antibiotics and intravenous fluid before onset of transmural necrosis is associated with lower morbidity and mortality than surgical resection.

A Case of Metastatic Epididymal and the Other Metastatic Testicular Carcinoma from Sigmoid Carcinoma / 대한암학회지

Metastatic tumor of the epididymis is a rare tumor. There are around 31 cases in the literature until now. The primary tumor was from the prostate in 18 cases, large and small intestine in 6 cases, kidney in 4 cases, stomach in 2 cases and pancreas in 1 case. We recently experienced a case of metastatic carcinoma to the epididymis from a primary cancer in the sigmoid colon and the other case of metastatic carcinoma to the testis and the liver from a sigmoid adenocarcinoma.

Two Cases of Spontaneous Coronary Artery Dissection

Spontaneous coronary artery dissection(SCD) is a rare entity that is infrequently diasnosed antemortem. The majority of patients have presented with acute myocardial infaction or sudden death. the etiology, prognosis and treatment of this entity remain ill-defined. We report two cases of SCD which were diagnosed by coronary agniogram and intracoronary ultrasound.