Role of the Nuclear Transcription Factor NF-kappa B Caused by Acute Hypoxia in the Heart

PURPOSE: Nuclear factor-kappa B(NF-kappa B) is now recognized as playing a potential role in programmed cell death and the adaptive response to various stress. Cellular hypoxia is a primary manifestation of many cardiovascular diseases. It seems that vascular endothelial growth factor (VEGF) and insulin like growth factor-I(IGF-I) have a function as a protective molecule in the heart against several stress including hypoxia. In this study, the role of NF-kappa B to the cellular response and regulation of protective molecules against the acute hypoxia in the heart was studied. METHODS: To cause acute hypoxic stress to the heart, Sprague Dawley rats were exposed to hypoxic chamer(N2 92% and O2 8%). After the hypoxic exposure, nuclear proteins, total proteins and mRNA were isolated from heart. Translocation of the transcription factors NF-kappa B, NF-ATc, AP-1 and NKX-2.5 were evaluated by electrophoretic mobility shift assay(EMSA). The expression of IGF-I and VEGF were studied before and after the hypoxic stress by competitive-PCR, Northern hybridization and Western hybridization. To confirm the role of the NF-kappa B in the heart, the rats also were pretreated with diethyl-dithiocarbamic acid(DDTC) into peritoneal cavity to block NF-kappa B translocation into nucleus. RESULTS: The expression of NF-kappa B, AP-1 and NF-ATc were increased by the hypoxic stress. Increased expression of the VEGF and IGF-I were also observed by the hypoxic stress. However, the blocking of the NF-kappa B translocation reduced those expressions of VEGF and IGF-I. CONCLUSION: These results suggest that NF-kappa B has a protective role against the acute hypoxia through several gene expression, especially VEGF and IGF-I in heart muscle.

Effect of Antiepileptic Drugs on Bone Metabolism and Growth in Epileptic Children

PURPOSE: Long-term administration of anticonvulsants for children with convulsive disorder may cause osteomalacia, depending on dosage, duration, types, and combination of anticonvulsants administered. This study was performed to examine the effect of anticonvulsant drugs on bone mineral density in epileptic children. METHODS: Forty-eight epileptic children aged 3 to 15 years were enrolled in this study. They were treated with antiepileptic drugs such as carbamazepine(group I), valproic acid(group II), or a combination of several drugs(group III) for long periods time from 6 months to 84 months. Bone mineral density was measured using dual energy absorptiometry(Madison, Wisconsin, U.S.) on the lumbar vertebrae during the period of Dec. 1, 1996-Jul. 1, 1997. Calcium, phosphorus, and alkaline phosphatase were also concomitantly measured in the sera of subjects for comparative analysis. Statistical analysis was performed using drugs and duration of therapy through specific z-score. Analysis for bone mineral density of anticonvulsant treated subjects were compared to results with published data. RESULTS: Bone mineral density was significantly decreased only in the carbamazepine-treated group, especially in children who received carbamazepine therapy for more than 18months. Z-scores of the other groups were also slightly decreased though they were not significant. And serum concentration of calcium and phosphorus levels were within normal ranges, but alkaline phosphatase levels were significantly increased(P<0.01). CONCLUSION: Measurement of bone mineral density might be required in epileptic children who received antiepileptic drugs. Administration of vitamin D should also be recommended in epileptic children, especially if they have been treated with antiepileptic drugs for a long time.

A Case of Nephrotic Syndrome in Behcet's Syndrome

Electron microscopy (EM) can provide a valuable contribution to light microscopy (LM) in the interpretation of fine needle aspiration cytology (FNAC) specimen, especially in the diagnosis of the tumor. However, considerable care in processing the specimen is mandatory to recover the cells and avoid altering the fine structures. We experienced a case of malignant melanoma in 33-yrs-old female, diagnosed by EM study of FNAC specimen from the axillary mass, who was initially thought as dissem- inated carcinomatosis on LM study. The technique of EM study on FNAC specimen consisted of washing the needle and syringe in 2.5% glutaraldehyde after a rapid stain (Diff-Quik), which was used to obtain a preliminary diagnostic impression and to assure the adequacy of the EM specimen. After centrifugation in the steps of fixation and dehydration, the sediment was made into an epon block and examined. The whole processing time of EM study can be shortened within 7 or 8 hours, and results can be available within 48 to 72 hours. Our experience suggests the EM study on FNAC can be a useful diagnostic method in the diagnosis of difficult FNAC cases.

A Case of Pulmonary Artery Sling Associated with Left Bronchial Stenosis and Patent Ductus Arteriosus

Pulmonary artery sling is a rare and potentially lethal vascular anomaly wherein the anomalous left pulmonary artery arises from the posterior aspect of the right pulmonary artery and passing to the left lung between the trachea and the esophagus which causes respiratory distress in infants and children due to the extrinsic compression of the airway by the anomalous vessel. Associated anomalies are common, particularly those of the tracheobronchial tree. The most common lesions are hypoplasia of the distal trachea and right main stem bronchus. About 50 percent of patients have cardiovascular anomalies, such as in the left superior vena cava, atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic arch anomalies, tetralogy of Fallot 1 etc. We experienced a case of a 6-year-old boy who showed dyspnea and frequent pneumonia. He was diagnosed with pulmonary artery sling associated with left bronchial stenosis, patent ductus arteriosus, and left superior vena cava which was parven by echocardiographic examinations, spiral computerized tomography of the chest and cineangiography. We report this case with related literature.

A Case of Peripheral Pulmonary Artery Aneurysm without Pulmonary Hypertension

Aneurysm of the pulmonary artery is a rare entity. Aneurysm of the peripheral artery are even less common. An 14-year-old girl was admitted for the evaluation of cardiac murmur. There was a variable grade 2/6 systolic murmur along the left sternal border. The chest x-ray showed a round mass in the right perihilar region. Echocardiogram demonstrated a small muscular ventricular septal defect with mild tricuspid regurgitation. The pulmonary arterial pressures were normal at cardiac catheterization, but pulmonary angiography indicated an aneurysm of the intrapulmonary portion of the right pulmonary artery. Surgical intervention was advised. However, the patient discharged againt operative plan. The literature on this entity is reviewed, and the diagnosis and etiology are discussed.