Protection of nigral dopaminergic neurons by AAV1 transduction with Rheb(S16H) against neurotoxic inflammation in vivo

We recently reported that adeno-associated virus serotype 1 (AAV1) transduction of murine nigral dopaminergic (DA) neurons with constitutively active ras homolog enriched in brain with a mutation of serine to histidine at position 16 [Rheb(S16H)] induced the production of neurotrophic factors, resulting in neuroprotective effects on the nigrostriatal DA system in animal models of Parkinson’s disease (PD). To further investigate whether AAV1-Rheb(S16H) transduction has neuroprotective potential against neurotoxic inflammation, which is known to be a potential event related to PD pathogenesis, we examined the effects of Rheb(S16H) expression in nigral DA neurons under a neurotoxic inflammatory environment induced by the endogenous microglial activator prothrombin kringle-2 (pKr-2). Our observations showed that Rheb(S16H) transduction played a role in the neuroprotection of the nigrostriatal DA system against pKr-2-induced neurotoxic inflammation, even though there were similar levels of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-1-beta (IL-1β), in the AAV1-Rheb(S16H)-treated substantia nigra (SN) compared to the SN treated with pKr-2 alone; the neuroprotective effects may be mediated by the activation of neurotrophic signaling pathways following Rheb(S16H) transduction of nigral DA neurons. We conclude that AAV1-Rheb(S16H) transduction of neuronal populations to activate the production of neurotrophic factors and intracellular neurotrophic signaling pathways may offer promise for protecting adult neurons from extracellular neurotoxic inflammation.

Dynamic relocalization of NHERF1 mediates chemotactic migration of ovarian cancer cells toward lysophosphatidic acid stimulation

NHERF1/EBP50 (Na⁺/H⁺ exchanger regulating factor 1; Ezrin-binding phosphoprotein of 50 kDa) organizes stable protein complexes beneath the apical membrane of polar epithelial cells. By contrast, in cancer cells without any fixed polarity, NHERF1 often localizes in the cytoplasm. The regulation of cytoplasmic NHERF1 and its role in cancer progression remain unclear. In this study, we found that, upon lysophosphatidic acid (LPA) stimulation, cytoplasmic NHERF1 rapidly translocated to the plasma membrane, and subsequently to cortical protrusion structures, of ovarian cancer cells. This movement depended on direct binding of NHERF1 to C-terminally phosphorylated ERM proteins (cpERMs). Moreover, NHERF1 depletion downregulated cpERMs and further impaired cpERM-dependent remodeling of the cell cortex, suggesting reciprocal regulation between these proteins. The LPA-induced protein complex was highly enriched in migratory pseudopodia, whose formation was impaired by overexpression of NHERF1 truncation mutants. Consistent with this, NHERF1 depletion in various types of cancer cells abolished chemotactic cell migration toward a LPA gradient. Taken together, our findings suggest that the high dynamics of cytosolic NHERF1 provide cancer cells with a means of controlling chemotactic migration. This capacity is likely to be essential for ovarian cancer progression in tumor microenvironments containing LPA.

Beneficial Effects of Silibinin Against Kainic Acid-induced Neurotoxicity in the Hippocampus in vivo

Silibinin, an active constituent of silymarin extracted from milk thistle, has been previously reported to confer protection to the adult brain against neurodegeneration. However, its effects against epileptic seizures have not been examined yet. In order to investigate the effects of silibinin against epileptic seizures, we used a relevant mouse model in which seizures are manifested as status epilepticus, induced by kainic acid (KA) treatment. Silibinin was injected intraperitoneally, starting 1 day before an intrahippocampal KA injection and continued daily until analysis of each experiment. Our results indicated that silibinin-treatment could reduce seizure susceptibility and frequency of spontaneous recurrent seizures (SRS) induced by KA administration, and attenuate granule cell dispersion (GCD), a morphological alteration characteristic of the dentate gyrus (DG) in temporal lobe epilepsy (TLE). Moreover, its treatment significantly reduced the aberrant levels of apoptotic, autophagic and pro-inflammatory molecules induced by KA administration, resulting in neuroprotection in the hippocampus. Thus, these results suggest that silibinin may be a beneficial natural compound for preventing epileptic events.

Case Presentations of Charity Operations by Il Woong Cleft Lip and Palate Foundation in Deozhou, China

Takayasu's Arteritis Treated by Percutaneous Transluminal Angioplasty with Stenting in the Descending Aorta

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3- dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasu's arteritis was made according to the new angiographic classification of Takayasu's arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up.

Influence of Preoperative One Lung Ventilation in the Lateral Position on Arterial Oxygenation during Subsequent One Lung Ventilation / 대한마취과학회지

BACKGROUND: There are a few reports with conflicting results regarding the potentiation of hypoxic pulmonary vasoconstriction (HPV) by repeated hypoxic challenges. The aim of this study was to determine if preoperative one lung ventilation (OLV) in the lateral position (LP) for a short time decreases the development of arterial hypoxemia and improves the level of arterial oxygenation via the potentiation of HPV in patients undergoing thoracic surgery with OLV. METHODS: Forty patients were randomly divided into two groups according to presence or absence of preoperative OLV. Preoperative OLV in LP was achieved for 10 minutes with 100% O2 in group P (n = 20). Thereafter, the two lungs were again ventilated with 50% O2 until OLV with 100% O2 had been achieved. In group C (n = 20), the two lungs were continuously ventilated with 50% O2 until OLV with 100% O2 was achieved. The arterial blood samples were obtained 15 minutes after the two lung ventilation in the supine position (baseline) during preoperative OLV in LP, before pulmonary vein ligation, as well as before and after pulmonary artery ligation. The development of arterial hypoxemia (peripheral blood oxygen saturation in pulse oximetry < 95%) in patients undergoing thoracic surgery with OLV was also recorded. RESULTS: Arterial hypoxemia during OLV was observed in 2 cases in group C and 3 cases in group P. There was a similar level of arterial oxygen tension during OLV between the two groups. CONCLUSIONS: This study showed that the preoperative OLV in LP for 10 minutes neither potentiated the HPV response during OLV nor decreased the frequency of arterial hypoxemia during OLV.

Head and Neck Positional Change Causes the Alteration in Endotracheal Cuff Pressure / 대한마취과학회지

BACKGROUND: Endotracheal tube movement due to changes in the position of the head and neck can affect the intracuff pressure and volume. The alteration in the endotracheal cuff pressure after positional changes of the head and neck were examined and compared to that in the neutral position. METHODS: 20 adult male patients undergoing orotracheal intubation for endoscopic sinus surgery under general anesthesia were studied. A reinforced tube (internal diameter 8.0 mm) was used for endotracheal intubation. If the initial intracuff pressure exceeded 22 mmHg, it was set to the adjusted intracuff pressure, defined as an intracuff pressure ranging from 15 to 20 mmHg. After recording the adjusted intracuff pressure in the neutral position, repeated measurements after positional changes to 45 degrees flexed, 45 degrees extended and fully rotated positions of the head and neck were taken. The sealing intracuff pressure and volume required for the elimination of audible air-leaks were re-measured in the neutral position, and the changes in the sealing pressure after positional changes of the head and neck were then repeatedly measured. Lastly, the genuine sealing pressure and volume were measured in the flexed, extended and rotated positions. RESULTS: The adjusted intracuff and sealing pressures were higher in the flexed, extended and rotated positions than in the neutral position (P<0.01). The genuine sealing pressure in flexion and rotation were lower than that in the neutral position (P<0.05). The genuine sealing volumes were smaller in the other positions than in the neutral position (P<0.01). CONCLUSIONS: It is recommended to make genuine sealing pressure of intracuff pressure under direct pressure monitoring after positional changes of the head and neck.

The Usefulness of Three-phase Bone Scan and Thermography for Making the Diagnosis of CRPS-I / 대한통증학회지

BACKGROUND: Complex regional pain syndrome (CRPS) is a painful and disabling disease, yet the diagnosis of this can be difficult to confirm by purely objective measures. Therefore, we performed three-phasic bone scans and thermography as a work up in order to determine their predictive value and usefulness for making the diagnosis of CRPS. METHODS: 44 patients who had been diagnosed with CRPS type-1, according to the modified criteria, were evaluated. All the patients were examined by performing a three-phasic bone scan and thermography as part of a work-up for diagnostic confirmation. The diffuse increased tracer uptake in the delayed image (phase III) was estimated by the positive findings. The findings were considered positive for CRPS if the thermographic findings showed temperature asymmetries between the affected and non-affected extremities of more than 1.00 degrees C RESULTS: A review of the three-phasic bone scan for 44 patients indicated that 16 patients (36.4%) had diffusely positive scans, and thermographic abnormalities were noted in 35 of 44 patients (79.5%). CONCLUSIONS: The use of thermography in clinical settings can play an important role in the diagnosis of CRPS. However, a three-phasic bone scan alone cannot provide a completely accurate diagnosis, so it is imperative that the three-phasic bone scan data be integrated with the clinical evaluation and the other relevant tests.

Comparison of the Effects of Etomidate and Propofol on Redistribution Hypothermia during General Anesthesia / 대한마취과학회지

BACKGROUND: Redistribution hypothermia can be modified by the effects of induction anesthesia on the systemic vascular resistance. This study compared the effects of etomidate and propofol on redistribution hypothermia during general anesthesia. METHODS: Forty patients were randomly allocated into one of two groups, based on the induction agent used: Group E (n = 20) received 0.2 mg/kg of etomidate and group P (n = 20) received 2.5 mg/kg propofol. After intubation, anesthesia was maintained with sevoflurane and 50% nitrous oxide in oxygen in both groups. The core and peripheral temperatures were measured, and the peripheral temperature gradients (forearm minus fingertip) were used as an index of an arteriovenous shunt. RESULTS: The patients in both groups demonstrated intense vasoconstriction prior to the induction of anesthesia with similar skin-temperature gradients. After induction, group P showed more rapid and significant vasodilation than group E (P = 0.02). The difference in vasodilation between the two groups disappeared from 5 minutes after intubation. The pre-induction core temperatures were similar in both groups. After induction, the core temperatures in group P were consistently lower than those in group E (P < 0.01). The core temperatures during the first hour of anesthesia decreased by 1.5 +/- 0.4 degrees C in group P but only by 0.9 +/- 0.4 degrees C in group E. Conclusions: Propofol caused more rapid and aggravated redistribution hypothermia during surgery than etomidate due to the earlier arteriovenous shunt vasodilation.

Factors Influencing Postoperative Urinary Retention in Female Patients Undergoing Total Knee Replacements / 대한마취과학회지

BACKGROUND: Postoperative urinary retention is defined as the inability to void with a full bladder during the postoperative period. It affects both sexes in all ages following all types of operation, including patients who previously had no micturition problems. We investigated the incidence and risk factors of urinary retention following long spinal anesthesia for total knee replacement. METHODS: We retrospectively studied a number of factors that may be associated with urinary retention in 98 women. The outcome variable of logistic regression models are urinary retention and severe urinary retention. The potential explanatory variables are age, height, weight, history of hypertension, DM and abnormal urology, heavy bupivacaine dose, types of patient-controlled analgesia, time to regression of spinal block to sacral segments (Tregression), amount of fluid and duration of surgery. We constructed a multiple linear regression model of the time from subarachnoid injection to spontaneous voiding (Tvoiding) in relation to above variables. RESULTS: The overall rate of urinary retention and severe retention were 57.1% and 30.6%. Tregression was identified as significant explanator of an increased probability for urinary retention (P = 0.002), Tregression and DM for severe urinary retention (P <0.001, P = 0.054). In the multiple linear regression model, three variables - Tregression, age, abnormal urological history were identified to have significant t-values (3.902, 3.107, 2.284) with Tvoiding (P <0.001, P = 0.003, P = 0.025). CONCLUSION: Old age, DM, abnormal urological history, delayed recovery of spinal anesthesia are risk factors to urinary retention or delayed spontaneous voiding.

Which Predictable Variables Identify Patients at Risk of Arterial Hypoxemia during One-Lung Ventilation?: Analysis of Preoperative and Intraoperative Variables / 대한마취과학회지

BACKGROUND: Two hundred seventy-eight patients undergoing thoracic surgery were retrospectively analyzed to determine whether which variable can predict the identification of patients at risk of arterial hypoxemia developing during one-lung ventilation (OLV). METHODS: According to the value of SpO2, the patients were divided two groups. Group L (n = 62) had SpO2 values of less than 95%, whereas group H (n = 216) those of more than 95%. Preoperative and intraoperative data, including past medical history, current therapy, and usual preoperative and intraoperative tests, were collected and used as predictable variables for arterial hypoxemia during OLV by binary logistic regression (forward conditional method) subsequent to independent t-test and Chi-square test, as appropriate. RESULTS: Preoperative (past medical history with pulmonary resection of a lobectomy in dependent lung, hypertension, arrhythmias, and predicted diffusion capacity for carbon monoxide < or = 70%) and intraoperative (arterial oxygen tension/inspiratory oxygen fraction during two-lung ventilation <528 mmHg, right thoracotomy) variables were considered as predictable factors that identified patients at risk of arterial hypoxemia during OLV. CONCLUSION: Caution to the increased risk of arterial hypoxemia during OLV is needed in patients that have aforementioned preoperative and intraoperative variables.

In Vitro and in Vivo Comparison of Antifibirinolytic Activity of Aprotinin and Tranexamic Acid Using a Thromboelastographic Method in Rabbits / 대한마취과학회지

BACKGROUND: Aprotinin and tranexamic acid are commonly used antifibrinolytics during liver transplantation, or cardiac surgery. However, it is not clear which drug is more effective to ameliorate the fibrinolysis. The aim of the study was to investigate the antifibrinolytic effect of both drugs at previously reported blood concentration and dose. METHODS: After inducing fibrinolysis by administering recombinant tissue plasminogen activator to rabbits, we checked the in vitro and in vivo antifibrinolytic effects at previously reported blood concentration and dose, and determined the minimum antifibrinolytic blood concentration. The previously reported blood concentration was 200 KIU/ml for aprotinin and 10 mcg/ml for tranexamic acid, and the previously reported dose was 4 mg/kg bolus plus 1 mg/kg/hr infusion for aprotinin and 10 mg/kg bolus plus 1 mg/kg/hr for tranexamic acid. RESULTS: In vitro experiment, there was effective antifibrinolytic action at previously reported blood concentration of aprotinin and the minimum antifibrinolytic blood concentration was 40 KIU/ml. For tranexamic acid, there was no antifibrinolytic action at previously reported blood concentration and the minimum antifibrinolytic blood concentration was 100 mcg/ml. In vivo experiment, there was antifibrinolytic action at previously reported dose of aprotinin and the minimum antifibrinolytic dose was 60% of previously reported dose. For tranexamic acid, there was no antifibrinolytic action at previously reported dose and the minimum antifibrinolytic dose was 10 times previously reported dose. CONCLUSION: The previously reported blood concentration and dose of aprotinin were greater and those of tranexamic acid were less than the minimum antifibrinolytic blood concentration and dose.

Clinical Significance of B-Mode Ultrasound of Common Carotid Artery for Prediction of Severity of Coronary Artery Disease: Important Parameters on Hand Measurement

BACKGROUND AND OBJECTIVES: As a predictor of atherosclerosis, the intima-media thickness (IMT) of the common carotid artery (CCA) shows only a weak correlation with the extent of coronary artery disease (CAD). The purpose of this study was to evaluate the hand measured IMT value of the CCA as reliable and strong predictors of the severity of coronary artery atherosclerosis. SUBJECTS AND METHODS: We performed an ultrasonographic examination of the right CCA by using a 15 MHz linear array transducer in 268 patients (M: F=160: 108, mean age 61.2+/-10.2) who underwent coronary angiography to evaluate ischemic heart disease. The internal dimension, maximal IMT, irrespective of location and morphology (focal or diffuse), and the IMT of 6 more randomly selected points in the CCA were measured. We classified the plaques as type A (low or equal echo density compared with adventitia) or type B (higher echo density than adventitia). Modified Gensini scores were calculated, as a marker of the extent of CAD, and compared with the results of the IMT examination. RESULTS: Carotid plaques were detected in 156/268 (58%) patients. 119 and 37 patients were types A and B, respectively. The Gensini score was significantly higher in patients with type B (40.6+/-23.5) than type A plaques (29.3+/-21.7) (p=0.01). Modified Gensini score was correlated with age (r=0.22 p<0.001), mean IMT (r=0.178, p=0.004) and maximal IMT (r=0.296, p<0.001). After adjusting for age, the maximal IMT was the sole independent variable reflecting the severity of CAD (p=0.001). CONCLUSION: The maximal IMT, together with the type of CCA plaque morphology, provides more reliable information about the severity of CAD than the conventional mean IMT.

A Comparison of Manual and Mechanical Ventilation in Terms of the Adequacy of Ventilation during Intrahospital Transport of Neurosurgical Patients in the Immediate Postoperative Period / 대한마취과학회지

BACKGROUND: Ambu-bags and portable ventilators can provide intubated patients with ventilation during intrahospital transport, where it is desirable to maintain normocarbia. This study was designed to compare the amount of variation in ventilation that occur during the intrahospital transport of neurosurgical patients ventilated either manually or with a portable ventilator. METHODS: 40 patients were randomized to receive either manual ventilation (Group A, n = 20) during transport or ventilation by a portable ventilator (Group P, n = 20) during the immediate postoperative period. In group A, an adult laerdal resuscitator bag with a reservoir bag (2,600 ml) was used and oxygen (15 L/min) was supplied from a portable oxygen tank. In group P, a portable ventilator was set to controlled mechanical ventilation or synchronized intermittent mandatory ventilation mode, 8.5-10 ml/kg of tidal volume, 1:2 of inspiratory to expiratory ratio, and 100% oxygen concentration. Respiratory rates were adjusted to maintain normocarbia. Hemodynamic parameters were recorded before and during transport. Arterial blood gas levels were also obtained before and during transport. RESULTS: PaCO2 during transport was significantly lower in Group A than in Group P (P < 0.05). Manually ventilated patients showed greater deviations from normocarbia (35-45 mmHg) than mechanically ventilated patients (P < 0.01). PaO2 during transport was no different in the two groups. Blood pressure and heart rates during transport increased significantly in both groups versus before transport (P < 0.01). CONCLUSIONS: The use of a portable ventilator can effectively maintain normocarbia and produce the stable ventilatory pattern during the intrahospital transport of neurosurgical patients during immediate postoperative period.

The Efficacy and Incidence of Side Effects in Patient Controlled Analgesia Using Hydromorphone / 대한마취과학회지

BACKGROUND: Hydromorphone, a derivative of morphine, has the same actions and uses as morphine, has about eight times more potency on a milligram basis. Hydromorphone is used for the relief of moderate to severe pain. There has been no report in Korea on patient controlled analgesia (PCA) using hydromorphone. Here, the efficacy and incidence of side effects of PCA, with hydromorphone, were investigated. METHODS: 68 patients scheduled for spinal, urological, gynecological and general surgery were enrolled. Patients received standardized general anesthesia, with the PCA initiated at the end of surgery. Parameters for PCA were a 0.1 mg bolus and 0.05 mg/hr infusion of hydromorphone, with a 10 min lockout interval. A verbal rating scale (1: none, 2: very mild, 3: mild, 4: moderate, 5: severe) of pain, nausea (mild, moderate, severe), vomiting, dizziness and somnolence were assessed at 6, 12, 24 hr postoperatively. The amount of hydromorphone used and the requirements for symptomatic relief were also recorded. RESULTS: The mean pain scores were 3.5+/-0.8, 2.9+/-0.8 and 2.5+/-0.7, and the amounts of hydromorphone delivered were 1.0+/-0.1, 1.8+/-1.0 and 2.7+/-1.3 mg, 6, 12 and 24 hr postoperatively, respectively. The incidence of nausea, vomiting, dizziness and somnolence were 17.6, 4.4, 8.8 and 1.5%, respectively. CONCLUSIONS: Intravenous PCA, with hydromorphone, was effective in controlling postoperative pain, with fewer eide effects than morphine, as reported in the literature.

Radiofrequency catheter ablation in idiopathic ventricular tachycardia showing left bundle branch block and inferior axis: the significanece of morphologic variation of R wave on right precordial leads / 대한내과학회지

BACKGROUND: Radiofrequency catheter ablation (RFCA) becomes an useful treatment for idiopathic ventricular tachycardia, especially right ventricular outflow tract ventricular tachycardia (RVOT VT) typically originates from "superior septal" aspect of right ventricular outflow tract. However, some of the right ventricular outflow tachycardias remain resistant despite repeated attempts of RFCA. This study was focused to search the electrocardiographic characteristics suggesting procedural success of radiofrequency ablation in RVOT VT and ventricular tachycardia that can not be ablated by conventional approach confined to right ventricular outflow tract even though to show similar electrocardiographic morphology. METHODS: The study subjects were 25 patients who underwent RFCA with the diagnosis of RVOT VT. We classified the study subjects into 2 groups and in group 1 (N=17, Age 47.5 +/- 16.8) in those successful RFCA was possible in RVOT. In group 2 (N=8, Age 54.8 +/- 8.0), the removal of VT was not possible with the RFCA confined in RVOT. We analyzed the morphologic characteristics of QRS complex of VT or ventricular premature beats in right precordial leads; V(1-3). The QRS and R wave duration, height of R wave, depth of S wave, R/S ratio and R wave duration index were measured. RESULTS: There was no difference of age and sex between group 1 and 2 (Group 1: N=17, Male 29.4%, Age 49.5 +/- 16.8 vs Group 2: N=8, Age 54.8 +/- 8.0, Male 37.5%). The maximal QRS duration in V(1-3) was 144.2 +/- 23.6 ms in group 1 and 136.3 +/- 25.1 ms in group 2. The R wave duration and R wave duration index were not different either between group 1 and 2. However, the R wave duration of lead V 3 in group 2 was 97.0 +/- 34.4 ms and significantly longer than 65.0 +/- 26.0 msec in Group 1 (p=0.04). R wave duration index also showed significant difference between two groups: 72.0 +/- 23.5% of group 2 vs 45.4 +/- 17.8% of group 1. In comparison of R wave height and depth of S wave in V(1-3) between two groups, the R/S ratio of lead V3 in group 2 showed the ratio of 343.4 +/- 227.7% which was significantly larger than 97.4 +/- 92.2% in group 1. CONCLUSION: For the practice of RFCA for RVOT VT, morphologic characterstics of VT or VPC showing wide R wave and high R/S wave ratio in precordial leads, especially in V3 could be an useful electrocardiographic indicator to suspect the unusual focus of idiopathic VT showing inferior axis and LBBB pattern.

Referred Shoulder Pain due to Liver Abscess: A case report / 대한통증학회지

Referred pain is not localized to the site of its cause, but referred to an area that may be an adjacent distant from such a site. With respect to this, there is the possibility of misdiagnosis in the treatment of referred pain patient. We experienced a case of a 31-years-old male patient complaining of right shoulder pain, which subsided after a bursa injection. The patient revisited our clinic after 3 weeks complaining not only of right shoulder pain, but also of right upper quadrant pain and fever. He was diagnosed as having a liver abscess by an imaging study.

Efficacy of Low Frequency Stimulator in Patients with Frozen Shoulder / 대한통증학회지

BACKGROUND: Frozen shoulder is not an uncommon disease, which is associated with chronic pain and joint movement limitation. However, there are numerous devices to assist in the treatment of shoulder pain, but their efficacy has not been proven and their use remains immensely controversial. Therefore, a randomized clinical study was conducted to determine the effectiveness of a low-frequency stimulator for the treatment of frozen shoulder. METHODS: A randomized clinical trial was carried out on 40 patients with frozen shoulder, with 40 patients assigned to two groups; a control treatment group (group C, n = 20) and a low frequency stimulator application group (group T, n = 20). Both groups were given a routine treatment modality, such as trigger point injection, intramuscular stimulation or suprascapular nerve block etc. The level of the shoulder pain was evaluated using a 100mm VAS (visual analog scale) at each visit, with the limitation in the range of motion simultaneously evaluated. RESULTS: All the subjects improved after treatment, with the VAS scores after termination of treatment showed a statistically significant reduction (P < 0.05). However, there was no significant difference between the two groups. One month after termination of 5 cycles of treatment, group T maintained their improved state, whereas the pain in some of those in group C reemerged, which also showed a statistically significant difference (P < 0.05). The limitation in the range of motion improved, with most subjects able to resume daily activity. CONCLUSIONS: Although the low frequency stimulation provided no more pain relief than routine treatment, the effect was significantly prolonged. From this result, low frequency stimulation can be considered to aide the therapeutic effect of classical frozen shoulder therapy.

A Case of Acute Myocardial Infarction Caused by Coronary Thrombus Associated with a Myocardial Bridge and Slow Coronary Flow

Acute myocardial infarction is generally caused by the rupture or erosion of an atheromatous plaque and thrombosis. Acute myocardial infarction associated with a myocardial bridge or slow coronary flow is rare. We experienced a case of acute myocardial infarction, caused by a coronary thrombus in association with a myocardial bridge and slow coronary flow. A 33-year-old man presented with the sudden onset of chest pain. A diagnostic coronary angiography revealed an intraluminal contrast-filling defect, proximal to the myocardial bridge in the left anterior descending artery, with TIMI-2 flow. After an intracoronary injection of 150,000 units of urokinase and an intravenous injection of abciximab, the patient's chest pain subsided, with the follow-up coronary angiography showing the disappearance of the coronary thrombus.

4 Cases of Intracardiac Metastasis of Hepatocellular Carcinoma

Antemortem diagnosis of inferior vena cava (IVC) and cardiac metastasis of hepatocellular carcinoma (HCC) is difficult but important to decide on treatment strategy. There are only a few cases of cardiac metastasis of HCC which have been diagnosed antemortem by echocardiography. We experienced 3 cases of IVC and Right atrial metastasis and 1 case of Left atrial metastasis of HCC. The tumor was discovered during computed tomography scanning. The patients had exhibited no signs of cardiac involvement. In this case, transesophageal echocardiography was valuable in providing information regarding the exact location of the tumor and its relation to surrounding anatomical structures. Left atrial metastasis of HCC is unusual patterns and probably related to tumor growth from the pulmonary veins following massive metastasis to the lung.