Characteristics of dietary pattern and tissue mineral in premenstrual syndrome patients / 대한산부인과학회지

About 80% of premenopausal women experience premenstrual syndrome (PMS), but the definite etiology or effective treatment is still under the investigation. In this study, serum and tissue mineral analysis, which are essential for biosynthesis and secretory regulation of neurotransmitters, We evaluate what kind of changes in mineral levels is correlated to the presence of PMS. This study also include the approaches that entail changes to diet and lifestyle so that symptoms of premenstrual disorders can be alleviated. 61 women who were recruited on volunteer basis and completed Modified Moss Menstrual Distress Questionnaire (MMDQ) and devided into 2 groups, scored less than 10 points, as control group, and women scored higher than 11 points, as PMS group. They were asked to fill out questionnaires about their diet patterns and submitted to tissue mineral and serum analysis to evaluate the levels of Ca, Mg, Na, K, Cu, and Zn. In the control group, serum Mg and Zn were relatively high but within normal reference range, but showed high level of Mg and Zn in tissue. For Mini Dietary Assessment Index (MDAI), the score of control group was 33.8 and that of PMS group 19.7, showed statistical significance (P<0.05). The score of daily calcium-taking group was 21.6+/-3.7 whereas that of seldom calcium-taking group was 39.6+/-6.2 (P<0.05). The score of daily magnesium-taking group was 9.75+/-2.7 whereas that of seldom magnesium-taking group was 26.0+/-4.9 (P<0.05). In this study, we conclude the importance of dietary and lifestyle modifications could prevent and treat symptoms of PMS and minerals had significant roles of regulating PMS especially Ca, Mg and Zn. Further studies about roles of these minerals and possible therapeutic applications using minerals in PMS are needed.

Treatment of a High Pressure Injection Hand Injury / 대한정형외과학회잡지

PURPOSE: To evaluate the serious effects of a paint gun injury and to determine the proper treatment. MATERIALS AND METHODS: The authors reviewed 30 cases of paint gun injuries of the hand that were treated from March, 1990 to September, 2000. We extended the original wound and removed the paint as soon as possible. The wound was left open, and debridementrepeated and delayed wound closure performed. The authors evaluated the results according to the Strickland evaluation method, and analysedthe results with respect to treatment delay and extent of injury. RESULTS: Delayed treatment, invasion of the paint along the neurovascular bundle and extensive injury resulted in a poor outcome. Amputationwas inevitable in 4 cases in which treatment had been delayed or when blood vessels had been invaded by the paint. CONCLUSION: Paint gun injury should be considered an emergency requiring immediate debridement. The surgeon should warn the patient that even after proper treatment, poor outcome can result.

A case of infective endocarditis complicated with asymptomatic cerebral mycotic aneurysm / 대한내과학회지

Cerebral mycotic aneurysm is an uncommon complication of infective endocarditis. In spite of low incidence, mycotic aneurysm is a serious complication because of the high risk of its rupture. Therefore, early diagnosis and management of cerebral mycotic aneurysm are imperative before the rupture. We experienced a case of asymptomatic cerebral mycotic aneurysm in a 30-year old man with infective endocarditis. He was admitted for splenic and renal infarction due to systemic embolization. The echocardiography showed severe mitral regurgitation, mitral valve prolapse and vegetation on the mitral valve. Streptococcus mitis was identified from blood cultures. In the course of antibiotics therapy, brain magnetic resonance image and 4-vessel cerebral angiography were performed, which revealed multiple unruptured cerebral mycotic aneurysms. Considering the high risk of rupture we performed mitral valve replacement with bioprosthesis. On follow-up cerebral angiography after the valve replacement surgery, one of aneurysms was enlarged, and successfully treated by surgical intervention without complication. We report one case of mycotic aneurysm without neurologic symptom in an infective endocarditis patient, who was treated without serious sequelae of the aneurysm.

Hemodynamic Analysis of Coronary Circulation in Angulated Coronary Stenosis Following Stenting

The present study in angulated coronary stenosis used human in vivo hemodynamic parameters and computed simulation, both qualitatively and qualitatively, to evaluate the influence of flow velocity and wall shear stress (WSS) on coronary atherosclerosis, the changes of hemodynamic indices following coronary stenting, and their effect on evolving in-stent restenosis. Initial and follow-up coronary angiographies in patients with angulated coronary stenosis were performed (n=60). The optimal degree of coronary stenting for angulated coronary stenosis had two models, the less than 50% angle changed group (model 1, n=33) and the more than 50% angle changed group (model 2, n=27). This angle change was based on the percentage change of vascular angle between pre- and post-intracoronary stenting. The flow-velocity wave obtained from in vivo intracoronary Doppler study data was used for in vitro numerical simulation. Spatial and temporal patterns of the flow-velocity vector and recirculation area were drawn throughout the selected segment of coronary models. WSS of pre- and post-intracoronary stenting was calculated from three-dimensional computer simulation. As results, follow-up coronary angiogram demonstrated significant difference in the percentage of diameter stenosis between the two groups (group 1: 40.3 +/- 30.2 vs. group 2: 25.5 +/- 22.5%, p < 0.05). Negative shear area on 3D simulation, which is consistent with the re-circulation area of flow vector, was noted on the inner wall of the post-stenotic area before stenting. The negative WSS disappeared after stenting. High spatial and temporal WSS before stenting fell within the range of physiologic WSS after stenting. This finding was more prominent in model 2 (p < 0.01). The present study suggests that hemodynamic forces exerted by pulsatile coronary circulation, termed WSS, might affect the evolution of atherosclerosis within the angulated vascular curvature. Moreover, geometric characteristics, such as the angular difference between pre- and post- intracoronary stenting might define optimal rheologic properties for vascular repair after stenting.

Autoantibody against, Malondialdehyde-Modified Low Density Lipoprotein in Patients with Non-Diabetic Unstable Angina: A Potential Role in Immunologic Reaction of Plaque Instability

The role of autoantibody against oxidized low-density lipoprotein (LDL) in the pathogenesis of atherosclerosis is still unknown. The purpose of this study was to determine whether autoantibodies against malondialdehyde (MDA)-modified LDL are associated with coronary artery disease (CAD) and clinical presentations of CAD in non-diabetic patients without acute myocardial infarction (AMI). We determined the serum levels of autoantibody against MDA-modified LDL by ELISA in 71 patients with angiographically significant CAD (> or = 50% diameter stenosis in at least 1 vessel) and 80 controls without angiographically significant CAD. Among the total 151 subjects, 30 subjects did not have any clinical ischemic event, 90 subjects had stable angina symptoms, and 31 subjects had unstable angina symptoms. The autoantibody titer, expressed mean optical density units, was significantly higher in patients with CAD than in controls (0.177+/- 0.014 versus 0.127+/- 0.011, respectively; p=0.006) and higher in unstable angina group than in stable angina group (0.240+/- 0.025 versus 0.145+/- 0.007, respectively; p < 0.001). By logistic regression analysis, the high autoantibody titer was associated significantly with CAD (P=0.008), independent of age, gender, body mass index, triglyceride concentration, and the ratio of total cholesterol-high density lipoprotein (HDL) cholesterol. In multiple regression analysis, presence of CAD, smoking history and low HDL-cholesterol level were independent factors associated with a increased anti-oxLDL Ab titer. The autoantibody titer was significantly lower in nonsmoker than smoker (p=0.019) and higher in low HDL- cholesterol (< or = 35 mg/dl) group than in high HDL-cholesterol group (p=0.012). Elevated autoantibody titer was associated with CAD and the unstable clinical presentation of CAD. Our results suggest that immune response to oxidized LDL may play a role in the pathogenesis of atherosclerosis and plaque instability.

Long-term prognostic factors after aortic valve replacement of severe aortic stenosis

Background: The long term prognostic factors of aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) with normal and low left ventricular function are not well known in Korean population METHODS: Between 1990 and 1999 , 73 patients (52 male, 21 female, mean age: 58+/-10.7) with severe AS underwent AVR in Yonsei cardiovascular hospital. Patients were excluded if they had concomitant valvular operations other than AVR, previous AVR, or more than moderate amount aortic valve regurgitation, and under 18 years old. Overall survival was estimated by the Kaplan-Meier method, and the Cox proportional hazards model analyzed the predictors that influence long-term survival. RESULTS: The causes of aortic stenosis were degenerative (44 case, 60%), congenital (26 case, 36%), and rheumatic (3 case, 4%). The preoperative characteristics (mean+/-SD) included ejection fraction (EF), 58+/-16.5%: mean aortic pressure gradient, 63+/-20 mmHg: aortic valve area, 0.62+/-0.13cm2. Simultaneous coronary artery bypass surgery and percutaneous transluminal coronary angioplasty were performed in 8 cases and 2 cases, respectively. The comparative results of the pre/post operative echocardiography of the total patients showed a significant improvement: EF of 58+/-17/64+/-12%, aortic valve area(AVA) of 0.64+/-0.15/1.54+/-0.63 cm2, mean pressure gradient (MPG) of 63+/-21/23+/-13mmHg, left ventricular end-diastolic dimension (LEEDD) of 54+/-9/50+/-9mmHg, left ventricular posterior wall thickness in systole (LV-PW) of 18+/-2/16+/-2mm. The comparative results of the pre/post operative echocardiography of low EF patients (<35%) also showed a significant improvement: EF of 30+/-4/55+/-15%, AVA of 0.59+/-0.14/ 1.67+/-0.85 cm2, MPG of 52+/-20/ 21+/-12 mmHg, LVEDD of 58+/-8/ 51+/-6 mm. Operative (30-day) mortality was 2.7% (2 of 73 patients). Six additional patients died during follow-up. The survival of patients group was 86% at 5 years and 78% at 10 years. The predictors of long-term postoperative survival were preop-EF (p<0.05,R=0.26) and presence of significant coronary artery disease (CAD) (p<0.01,R=0.35). CONCLUSION: Postoperative long-term survival of the severe AS after AVR was negatively related to reduced preop-EF and presence of significant CAD. Therefore, the early operative treatment before the occurrence of irreversible left ventricular dysfunction and concomitant appropriate management of coronary artery disease is necessary for the improvement of the survival after AVR.

Potential role of leptin in angiogenesis: leptin induces endothelial cell proliferation and expression of matrix metalloproteinases in vivo and in vitro

Leptin, the product of ob gene, is an endocrine hormone that regulates adipose tissue mass. Recently, leptin has been found to generate a growth signal involving a tyrosine kinase-dependent intracellular pathway and promote angiogenic processes via activation of leptin receptor (Ob-R) in endothelial cells. However, it is not clear how leptin functions to promote multi-step processes involved in the neovascularization at the atherosclerotic plaque. We have examined the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) and Ob-R in human atherosclerotic lesions, leptin-mediated angiogenesis in vivo and in vitro. Immunohistochemical analysis of human atherosclerotic aorta revealed an increased expression of Ob-R in the intima of neorevascularized regions and of both MMPs and TIMPs predominantly in the endothelial lining of intimal neovessels and macrophages/foam cells. In the rat corneal angiogenesis assay, leptin elicited a comparable sensitivity of angiogenic activity to those of vascular endothelial growth factor (VEGF). The immunohistological analysis of the leptin-treated rat cornea showed definitive rises in Ob-R, MMPs and TIMPs expression as well as those of VEGF receptor (VEGFR-1). Leptin (10-40 ng/ml) induced proliferation of the human umbilical vein endothelial cells (HUVECs) and elevation of MMP-2, MMP-9, TIMP-1, and TIMP-2 expression in a dose-dependent manner. Leptin also induced increases of MMP-2, MMP-9, TIMP-1, and Up-regulated the human coronary artery smooth muscle cells (HCASMCs). These findings suggest that leptin, a hormone with pluralistic properties including a mitogenic activity on vascular endothelial cells, plays a role in matrix remodeling by regulating the expression of MMPs and TIMPs. Taken together, our findings further provide evidences for leptin's role as an angiogenesis inducer in the normal organ (rat cornea) and in aberrant vasculature under duress like atherosclerosis.

Acute Myocardial Infarction in the Young Adult

BACKGROUND: Myocardial infarction in young adults may differ from that in the elderly is terms of clinical characteristics and angiographic findings. The aim of this study was to evaluate the prevalence of various risk factors ; also, coronary angiographic characteristics of acute myocardial infarction in patient under 40 years old were compared to that in patient over 40 years old. METHODS: We studied 239 patients with acute myocardial infarction who were admitted to Wonju Christian Hospital from 1990 to 1995 and evaluated the clinical and coronary angiographic characteristics. RESULTS: The incidence of acute myocardial infarction in patients under 40 years old was 10.8% (26/239) and were predominently. In men, risk factor analysis revealed the followings ; hypertension was more frequent in elderly patients, and in contrast, smoking history was more frequent in younger patients. Other risk factors did not significantly differ between the two groups. Normal coronary artery was more frequent in the younger patients. The diameter stenosis of the infarct related artery was also less servere in the younger patients. In-hospital morbidity and mortality were not significantly different between the two groups. CONCLUSIONS: Men and smokers were predominent in patients with acute myocardial infarction under 40 years old. The vessel involvement and the diameter stenosis of infarct related artery were less servere in patients with acute myocardial infarction under 40 years old than patients over 40 years old.

Serum Myoglobin as a Biochemical Marker to Rule Out Acute Myocardial Infarction

BACKGROUND: Diagnosis of AMI in the patients presenting with chest pain of an atypical nature or with a nondiagnostic ECG requires the evaluation of certain biochemical markers. Biochemical markers most often used for the early detection of myocardial damage are CK-MBact, troponin, and myoglobin. The clinical value of measuring serum myoglobin was compared to that of troponin and CK-MBact in the patient with acute chest pain syndrome. METHOD: We studied timed, sequential measurements of serum myoglobin, CK-MBact and troponin-T obtained from 72 patients who were admitted for the evaluation of suspected AMI within 12 hours after the chest pain onset. Patients with a history of recent trauma, cardiogenic shock, renal failure, or who had received recent cardiopulmonary resuscitation were excluded. We calculated the sensitivity, specificity, negative predictive value, and positive predictive value. Data were analyzed with the Chi-square test for differences in proportion. A value of p<0.05 was considered statistically significant. RESULT: 1) The mean time from symptom onset to arrival at the emergency department was 3.5+/-0.6 hours. 2) There were no statistical differences in age, sex and risk factors between AMI, angina pectoris and atypical chest pain group. 3) The negative predictive value of myoglobin was significantly higher than those of CK-MBact and troponin-T from 3 to 6 hours after the onset of chest pain. 4) The time to peak of myoglobin level was shorter than those of CK-MBact and troponin-T in AMI patients. CONCLUSION: Within 3 to 6 hours after the onset of symptoms, myoglobin is a better marker than CK-MBact or troponin-T in ruling out AMI for the patient with acute chest pain syndrome.

A Case of Takaysu Arteritis Associated with Complete Obstruction of Descending Thoracic Aorta and Stenosis of the Right Coronary Artery

Takaysu arteritis is a systemic disease characterized by stenosis or obstruction of aorta and its branches. Its etiology is unknown but clinical and serologic data suggest autoimmune process. Coronary artery involvement has been uncommon, but potentially fatal complication of Takayasu arteritis. A 41-year old female patients was presented with exertional dyspnea and anterioi chest pain of 2 week duration. Systolic bruit was heard at the both middle portion of internal carotid artery areas. Both radial arteries were palpated well but both femoral, popliteal and doralis pedis arteries were palpated weakly. Aortogram showed complete obstruction of descending thoracic aorta and collateral circulation of internal mammary artery. Coronary angiogram showed 80% stenosis at the middle portion of the right coronary artery. Calcium channel blocker and antiplatelet agent were prescribed. And her clinical symptom improved.

Atrial Fibrillation in Patients with Hyperthyroidism / 대한내분비학회지

Hyperthyroidism is a well known cause of atrial fibrillation. It is also known that control of hyperthyroidism can usually curb thyrotoxic atrial fibrillation and restore sinus rhythm. In this study, 282 patients with hyperthyroidism were investigated to quantify the incidence of atrial fibrillation, and to identify the vulnerable groups. In addition, we compared two groups of subjects with atrial fibrillation-one group with hyperthyroidism and the other group without

A Case Of Primary Antiphospholipid Antibody Syndrome / 대한류마티스학회지

Antiphospholipid antibody syndrome(APS) has been proposed for those patients with systemic lupus erythematosus(SLE) or with other connective tissue disease who have antiphospholipid antibody and manifestations of venous thrombosis, arterial occlusions, thrombocytopenia, hemolytic anemia, recurrent fetal loss, leg ulcers, and livedo reticularis. A primary antiphospholipid antibody syndrome(PARS), implying those patients who do not have any features of lupus or other connective tissue disease, has been mentioned in many reports but not definitely defined in our country, We recently experienced one case of primary antiphospholipid syndrome with neurologic manifestation. We present this case with a review of the literature.

The Effect of Thrombolysis on the Status of Infarct-Related Coronary Artery and Left Ventricular Function in Acute Myocardial Infarction

BACKGROUND: Patency of the infarct-related coronary artery may influence LV remodeling, provide a more stable electrophysiologic milieu and improves the outcome of patient with acute myocardioal infarction. The result from clinical trials have confirmed that early reperfusion in humans induced by a thrombolytic agent is associated with limitation of infarct size, preservation of ventricular function, and improved survival. The purpose of this study was evaluate the effect of thrombolytic therapy on the severity of the residual stenosis, antegrade flow of infarct-related coronary artery after acute myocardial infarction, and investigate left ventricular function and regianal wall motion abnormality depending on the thrombolytic therapy. METHODS: A retrosperctive study was performed in 166 patients with acute myocardial infarction with underwent coronary angiography within 8 days after acute attack from Oct. 1990 to Sep. 1994. Patients were grouped as thrombolysis group(n=64) who had undertaken urokinase infusion therapy within 6 hours of symptom onset and conservatively treated group(n=102) who had not received thrombolytic trerapy. At 8+/-7days, cardiac catheterization was performed. Status of the infarct related artery was assessed by resiudal % diameter stenosis, TIMI and collateral trading. Left ventricular function and wall motion were analyzed. RESULTS: 1) The was no statistical differenccs in age, sex and risk factors(diabetes, hypertension, smoking and hypercholesterolemia)between two groups. 2) The peak serum CK level was higher(2719+/-2333 vs 1951+/-2064 IU/L) and time to peak CK enzyme level was shorter(19+/-13 vs 32+/-24 hr) in thrombolysis group than conservatively treated group. 3) There was lower incidence of total occlusion(12.5% vs 30.4%), residual % diameter stenosis of infarct-related artery(67+/-34% vs 80+/-27%) and better antegrade flow(TIMI grade 0-1, 12.5% vs 32.4%) in thrombolysis group than conservatively treated group(p0.05). CONCLUSION: Thrombolytic therapy in acute myocardial infarction resulted in dquisition of early infarct-related arterial patency, effectiove antegrade flow and reduced incidence of totoal occlusion of infarct-related artery. Left ventricular ejection fraciton, regional wall motion score was not affected by thrombolytioc therapy in inhospital period.

A Case of Ectopic Orbital Meningioma

A 37 year-old male was suffered from proptosis without visual loss for 5 months. The orbit CT scan showed an eyeball-sized, extraconal, intraorbital soft tissue mass. The mass was removed by modified Kronlein operation and was diagnosed as the transitional type of meningioma by light microscopic and electron microscopic findings. After, surgery, there is no recurrence after 6 months.

A Case of Bilateral Central Serous Chorioretinopathy in a Chronic Tibial Osteomyelitis Patient

Central serous chorioretinopathy (CSC) is characterized by central serous retinal detachment. It occurs usually in young adult male, and bilateral involvement is uncommon. We have experienced bilateral CSC occurred in a 33 year old male patient with chronic tibial osteomyelitis. We treated only the right eye with krypton laser to compare the course of laser treated eye with untreated opposite eye. There was no difference between the course of two eyes in our case.