A Case of Churg-Strauss Syndrome with Endomyocardial Fibrosis / 대한류마티스학회지

Cardiac involvement is an important cause of mortality in patients with Churg-Strauss syndrome. The typical cardiac presentation of Churg-Strauss syndrome includes pericarditis, myocarditis, and cardiomyopathy. Endomyocardial fibrosis has rarely been described in patients with Churg-Strauss syndrome. We experienced a patient with Churg-Strauss syndrome who exhibited exertional dyspnea and endomyocardial fibrosis visualized as delayed enhancement on cardiac magnetic resonance imaging (MRI). After glucocorticoid treatment, the patient's symptom resolved, and the eosinophil count decreased to normal. Nine months later, the delayed-enhanced lesion on the cardiac MRI nearly disappeared. Here, we report a case of endomyocardial fibrosis in a patient with Churg-Strauss syndrome with a literature review.

The Effects of Helicobacter Pylori & Cytomegalovirus Infection on the Risk of Restenosis after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: Previous studies have suggested that chronic infection may play a role in the pathophysiology of restenosis after coronary angioplasty. The purpose of our study was to investigate the relation between Helicobacter pylori(H. pylori) or cytomegalovirus (CMV) infection, and restenosis. METHODS: Fifty nine patients with coronary artery disease underwent percutaneous transluminal coronary angioplasty (PTCA) and follow-up coronary angiography (59+/-13 years, 66% male). H. pylori and CMV IgG antibody titers were measured prospectively. The minimal luminal diameter and reference diameter before and immediately after angioplasty and at follow-up were measured with quantitative analysis. RESULTS: Restenosis occurred in 23 of the 59 (39%) patients. For H. pylori, patients with high antibody titer (upper half, > or =40 U/ml) had a higher restenosis rate than patients with low antibody titer (lower half, < 40 U/ml). Seventeen of the 29 (59%) patients with high antibody titer had restenosis, while 6 of the 30 (20%) patients with low antibody titer had restenosis (p=0.002, RR=2.39, 95% CI 1.35 to 6.37). After adjustment for covariates, including age, sex, body mass index, hypercholestrolemia, hypertension, diabetes mellitus, smoking, diagnosis at admission, modality of intervention, postprocedure minimal luminal diameter, lesion length, and lesion type, H. pylori antibody titer was independently predictive of restenosis (p=0.005). For CMV, patients with high antibody titer did not have a higher restenosis rate than patients with low antibody titer. CONCLUSION: High antibody titer against H. pylori may be an independent risk factor of restenosis after PTCA. However, there was no association between CMV antibody titer and the risk of restenosis.

eNOS gene polymorphism in patients with acute coronary syndrome or variant angina in Korean / 대한내과학회지

BACKGROUND: Nitric oxide, also known as endothelial derived relaxing factor(EDRF), regulates the vascular tone and inhibits the proliferation of vascular smooth muscle cells and platelet adhesions and endothelium-leukocyte interactions. Thus, nitric oxide may be involved in the pathogenesis of atherosclerosis and vasospasm. We analyzed the genotype distributions of two eNOS gene polymorphisms in normal healthy Koreans and compared it with those in the patients with acute coronary syndrome and variant angina. METHODS: We analyzed the two eNOS polymorphisms (eNOS A/B polymorphism is the variable numbers of tandem repeat in intron 4 and eNOS T/G polymorphism is a mis-sense mutation in exon 7) using PCR and clinical characteristics of the risk factors for coronary artery disease in 142 normal healthy Koreans and 164 patients with acute coronary syndrome and 104 patients with variant angina. RESULTS: The genotype distribution of A/B polymorphism of eNOS gene, A/A, A/B, B/B was 4.9%, 21.1%, 74% in control group and 2.4%, 12.8%, 84.8% in the patients with acute coronary syndrome(p=0.02) and 2.9%, 16.3%, 80.8% in the patients with variant angina(p=NS), respectively. The genotype distribution of T/G polymorphism of eNOS gene, T/T, T/G, G/G was 1.4%, 15.5%, 83.1% in control group and 0.6%, 21.3%, 78.1% in the patients with acute coronary syndrome(p=NS) and 0%, 18.3%,81.7% in the patients with variant angina(p=NS), respectively. The odds ratio for acute coronary syndrome of non B/B(A/A & A/B) to B/B was 0.489 (95% CI : 0.257-0.928). We found that age, sex (male), diabetes mellitus, hyperlipidemia, smoking, B/B genotype were independent risk factors for acute coronary syndrome. But, in variant angina, smoking was the only significant independent risk factor(odds ratio=5.934, 95% CI 2.843-12.388, p< 0.05). CONCLUSION: The B/B genotype frequency of eNOS gene was significantly higher in patients with acute coronary syndrome than in normal controls. But neither A/B nor T/G polymorphism of eNOS gene was associated with variant angina. These results suggest that eNOS gene may play some roles in the pathogenesis of ACS rather than vasospasm.

Effect of lipoprotein lipase gene polymorphism on lipid profile and body mass index in healthy Korean adult / 대한내과학회지

BACKGROUND: Lipoprotein lipase(LPL) plays a pivotal role in triglyceride-rich lipoprotein metabolism. It removes TG-rich lipoprotein from circulation by hydrolysing TG and produces active form of HDL. It also affects the development and maintenance of obesity by regulating the fatty acid metabolism of the adipose tissue. Many studies about the association of the genetic variation of LPL and dyslipidemia have been performed, but the results were not consistent. We tried to characterize the phenotypes of the LPL genetic variation in Korean. METHODS: Healthy Korean adults (n=110) were genotyped for Hind III/Pvu II RFLP and Ser447Ter mutation of the LPL gene by PCR-digestion method. We investigated the association of the genetic variations with the lipids, the lipoprotein concentrations and the body mass index(BMI). RESULTS: The allele frequencies of Hind III RFLP, Pvu II RFLP and Ser447Ter mutation were H1:H2=33%:67%, P1:P2=40%:60% and Ser447: Ter447=90%:10%. Ser447Ter mutation carriers had higher HDL cholesterol level than non-carriers (59+/-10mg/dl versus 53+/-11mg/dl, p=0.049) and the Pvu II RFLP is associated with increased body mass index. (P1P1:P1P2:P2P2 = 22.1+/-2.0 kg/m2: 23.5+/-2.7 kg/m2: 24.5+/-2.6 kg/m2, p=0.003) CONCLUSION: The genetic variations of the LPL gene in healthy Korean adult resulted in increased HDL cholesterol and increased BMI. These results were different from previous studies. This difference may reflect the racial difference from the diet and the linkage disequilibrium

Modification of the Cox-Maze Procedure for Atrial Fibrillation with Large Left Atrium: Development of Surgical Technique to Increase the Left Atrial Contractility / 대한흉부외과학회지

BACKGROUND: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. MATERIAL AND METHOD: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). RESULT: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). CONCLUSION: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.

Significance of eNOS Gene Polymorphism for the Prediction of Restenosis after Coronary Angioplasty in Patients with Ischemic Heart Disease

BACKGROUND: The restenosis after coronary angioplasty is the unresolved problem even if the improvement of interventional skills and pharmacological therapies. Nitric oxide, known as endothelial derived relaxing factor (EDRF), regulates the vascular tone and inhibits the proliferation of vascular smooth muscle cells and platelet adhesions and endothelium-leukocyte interactions. Nitric oxide is produced by endothelial nitric oxide synthase (eNOS). We studied the significance of eNOS gene polymorphism for the prediction of restenosis after coronary angioplasty in Koreans with ischemic heart disease. METHODS: We analyzed the two eNOS poly-morphisms using PCR (eNOS A/B polymorphism is the VNTR in intron 4 and eNOS T/G polymorphism is a missense mutation in exon 7) in 199 Korean patients who had 257 lesions undergoing percutaneous coronary angioplasty (ballooning=152, stenting=105). The angiography was repeated 6 months later to assess the relation between the rate of restenosis and types of eNOS gene polymorphism. RESULTS: We found no significant differences of restenosis rate in eNOS A/B and T/G polymorphism in those with balloon angioplasty or with stent (restenosis rate of A/A, A/B, B/B, respectively (n=257): 25% (1/4), 26% (14/53), 31% (62/200) (p=not significant), and T/T, T/G, G/G (n=249): 0% (0/3), 36% (16/44), 29% (58/202)(p=not significant)) Patients with A allele (non BB) or GG phenotype had lower restenosis rate, so we analyzed protective effect of non BB and GG phenotype on restenosis, but there was no significant statistical difference (restenosis rate of non BB and GG, BB and non GG respectively: 20% (15/57), 34% (16/47)(p=not significant)). CONCLUSION: eNOS A/B and T/G polymorphism is not associated with a significantly elevated risk of restenosis after coronary angioplasty.