Comparison of Regeneration Effects of Direct and Alternating Microcurrent Therapy on Atrophied Calf Muscle in a Rabbit

Objective@#We compared the regenerative effects of microcurrent therapy (MT) according to the type of electric current, which were direct current microcurrent therapy (DCMT) and alternating current microcurrent therapy (ACMT) on atrophied calf muscle in cast-immobilized rabbit. @*Methods@#Rabbits were allocated into control group (sham MT), ACMT group, and DCMT group.Before starting treatment, right gastrocnemius (GCM) muscle was immobilized by cast for 2 weeks. Compound muscle action potential of tibial nerve in nerve conduction study, circumference of calf muscle using a ruler, and thickness of medial and lateral GCM muscle measured by ultrasound, cross sectional area (CSA), and proliferating cell nuclear antigen (PCNA) ratios (%) of muscle fibers were measured on the immunohistochemical analysis. @*Results@#The mean atrophic changes (%) in right medial and lateral GCM muscle thickness, right calf circumference, and amplitude of CMAP of the right tibial nerve in ACMT group and DCMT group were significantly lower than those in control group, respectively (p＜0.05). The mean CSA (μm 2 ) of type I and type II and PCNA ratios (%) of medial and lateral GCM muscle fibers in ACMT group and DCMT group were significantly greater than those in control group, respectively (p＜0.05). There were no significant differences between the ACMT group and DCMT group at all parameters. @*Conclusion@#This study demonstrated that ACMT and DCMT showed better regeneration effect than sham MT. Microcurrent may be effective in regeneration of atrophied muscle regardless of the type of current.

Comparison of Regeneration Effects of Direct and Alternating Microcurrent Therapy on Atrophied Calf Muscle in a Rabbit

Objective@#We compared the regenerative effects of microcurrent therapy (MT) according to the type of electric current, which were direct current microcurrent therapy (DCMT) and alternating current microcurrent therapy (ACMT) on atrophied calf muscle in cast-immobilized rabbit. @*Methods@#Rabbits were allocated into control group (sham MT), ACMT group, and DCMT group.Before starting treatment, right gastrocnemius (GCM) muscle was immobilized by cast for 2 weeks. Compound muscle action potential of tibial nerve in nerve conduction study, circumference of calf muscle using a ruler, and thickness of medial and lateral GCM muscle measured by ultrasound, cross sectional area (CSA), and proliferating cell nuclear antigen (PCNA) ratios (%) of muscle fibers were measured on the immunohistochemical analysis. @*Results@#The mean atrophic changes (%) in right medial and lateral GCM muscle thickness, right calf circumference, and amplitude of CMAP of the right tibial nerve in ACMT group and DCMT group were significantly lower than those in control group, respectively (p＜0.05). The mean CSA (μm 2 ) of type I and type II and PCNA ratios (%) of medial and lateral GCM muscle fibers in ACMT group and DCMT group were significantly greater than those in control group, respectively (p＜0.05). There were no significant differences between the ACMT group and DCMT group at all parameters. @*Conclusion@#This study demonstrated that ACMT and DCMT showed better regeneration effect than sham MT. Microcurrent may be effective in regeneration of atrophied muscle regardless of the type of current.

Aorta-right Atrial Tunnel Accompanying Infective Endocarditis / 대한내과학회지

Aorta-right atrial tunnel is a vascular anomaly that originates from the aortic sinus and terminates in either the superior vena cava or the right atrium. The patency of the tunnel can result in volume overload in both ventricles, bacterial endocarditis, aneurysm formation, and spontaneous rupture. Transesophageal echocardiography was performed in a 42-year-old male patient diagnosed with infectious endocarditis, and vegetation of the mitral and aortic valves, right atrial enlargement, and an extracardiac blood vessel connecting the aorta to the right atrium were discovered. Therefore, we were able to diagnose an aorta-right atrial tunnel leading to infectious endocarditis and proceeded with surgical treatment. Together with a review of the literature, we present a case report of a patient with aorta-right atrial tunnel accompanied by infectious endocarditis.

A Case of Intracranial Wooden Foreign Body: Mimicking Pneumocephalus / 대한신경손상학회지

Intracranial wooden foreign bodies are rare. In addition, such objects are difficult to identify with conventional radiographic techniques, such as X-ray radiography or brain computed tomography. A 48-year-old man presented to our emergency room with a headache. Even though he had a history of trauma, he had no external wounds and showed no neurological deficits at the initial examination. He was initially diagnosed with trauma-related pneumocephalus. He developed a delayed intracranial infection and underwent surgery to remove the wooden foreign body. The present case illustrates the necessity for special attention to patients suspected of having pneumocephalus with a rare presentation during the initial examination. Early surgical removal of the intracranial foreign body is necessary to prevent complications.

Correlation between Head Trauma and Outcome of Chronic Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Our study examined the prognostic factors involved in the outcome of patients with chronic subdural hematoma (CSDH) who had undergone burr hole drainage procedures, and investigated the association between outcome and traumatic head injury. In addition, we explored factors related to recurrence. METHODS: This study enrolled 238 patients with CSDH who had undergone burr hole drainage. Patients with history of head injury were categorized into the head trauma group and were compared with the no head trauma group. Outcome was considered good when modified Rankin Scale scores improved from admission to discharge and the final follow-up. RESULTS: Among 238 patients, 127 (53.4%) were included in the head trauma group. One hundred thirty-three (55.9%) patients demonstrated good outcome at discharge, and 171 (71.8%) patients demonstrated good outcome at the final follow-up. None of the factors examined was significantly correlated with good outcome at discharge. However, only history of head injury (p=0.033, odds ratio 0.511, 95% confidence interval 0.277-0.946) was significantly correlated with poor outcome at long-term follow-up. Recurrence occurred in 20 (8.4%) cases in the total cohort and 11 (55%) patients in the head trauma group. CONCLUSION: History of head trauma is correlated with poor outcome at long-term follow-up in CSDH patients having undergone burr hole drainage. Therefore, CSDH patients with history of head injury are susceptible to poor outcome, warranting more careful evaluation and treatment after burr hole drainage.

Delayed Perilesional Ischemic Stroke after Gamma-knife Radiosurgery for Unruptured Deep Arteriovenous Malformation: Two Case Reports of Radiation-induced Small Artery Injury as Possible Cause

Radiation-induced vasculopathy is a rare occurrence, however, it is one of the most serious complications that can occur after gamma-knife radiosurgery (GKRS). The authors present two cases of incidentally found deep cerebral arteriovenous malformation (AVM), which were treated by GKRS, where subsequently there occurred delayed-onset cerebral infarction (11 and 17 months after GKRS) at an area adjacent to the AVM. In both cases, perforators of the M1 segment of the middle cerebral artery were included in the radiation field and delayed injury to these is suggested to be the mechanism of the ischemic event.

Late Onset Infection of Pneumocystis jirovecii Infection in a Renal Transplant Recipient / 대한이식학회지

Pneumocystis jirovecii pneumonia (PCP) can be a life-threatening opportunistic infection after kidney transplantation, occurring most frequently in the first 12 months with the symptoms of dyspnea, cough, fever, and hypoxia. Prophylaxis for PCP is usually applied during the first 3 months to 1 year after transplantation, but late onset incidence of PCP can be detected. We report on a patient who developed PCP 9 years after renal transplantation. The patient showed indolent onset of acute respiratory distress and was treated with trimethoprim-sulfamethoxazole and corticosteroid therapy. Previous rescue treatment of acute cellular rejection with ongoing maintenance of an elevated level of immunosuppressants may have predisposed the patient to PCP.

Treatment of Renal Transplant Recipients with Concurrent Acute Cellular Rejection and Transplant Renal Artery Stenosis / 대한이식학회지

Transplant renal artery stenosis (TRAS) is a common surgical complication after kidney transplantation (KTP) and is the cause of allograft dysfunction. TRAS is a potentially curable cause of refractory hypertension and allograft dysfunction which accounts for approximately 1% to 5% of cases of post-transplant hypertension. Acute cellular rejection (ACR) is also common after KTP, which is the main cause of allograft dysfunction. Although the incidence of ACR has declined with the advent of new immunosuppressive drugs, it is still around 15% worldwide. Although each disease is frequently seen individually, seeing both together is rare. A 42-year-old man with end stage renal disease underwent KTP, and the donor was his younger brother. Four months after KTP, his serum creatinine was increased to 2.1 mg/dL, and renal biopsy showed interstitial lymphocytic infiltration and tubulitis. With the diagnosis of acute T-cell mediated rejection, steroid pulsing therapy was started, but it was resisted. Therefore thymoglobulin 60 mg (1 mg/kg/day) was administered for 6 days, but serum creatinine was 1.8 mg/dL. Abdomen magnetic resonance angiography showed TRAS, stenosis at the anastomosis site and lobar artery in the lower pole. Percutaneous transluminal angiography was performed successfully. After balloon angioplasty, the stenotic lesion showed a normal size and blood flow. The patient's renal function returned to normal levels and he is currently being followed up for 9 months.

Febuxostat for the Treatment of Chronic Tophaceous Gout in a Patient on Continuous Ambulatory Peritoneal Dialysis / 대한내과학회지

Hyperuricemic patients with gouty arthritis or tophi, a serum uric acid concentration of 8.0 mg/dL or higher, and complications should be treated with urate-lowering drugs. Conventionally, allopurinol is used to treat hyperuricemia and gout, but it is necessary to adjust the dosage according to the degree of renal impairment. Uncommonly, allopurinol may have severe or fatal side effects. The non-purine xanthine oxidase inhibitor febuxostat undergoes hepatic metabolism and may require less dose adjustment in association with renal function. It is considered to be an alternative treatment for hyperuricemic patients with chronic kidney disease. Our experience suggests that low-dose febuxostat is a promising alternative to allopurinol for the treatment of gouty arthritis or tophi in peritoneal dialysis patients.

Left Atrium Compressed by a Traumatic Focal Aneurysm of the Thoracic Aorta / 대한내과학회지

A 78-year-old woman presented to our hospital with progressive dyspnea (NYHA class I-II) and epigastric discomfort that had developed after a traffic accident. She had a history of hypertension and cerebral infarction, but no history of cardiovascular disease. Her blood pressure was 130/70 mmHg and her heart rate was 66 beats/min and regular. The electrocardiogram showed normal sinus rhythm. The chest X-ray revealed bilateral pleural effusions. Transthoracic echocardiography (TTE) demonstrated an aneurysm of the descending thoracic aorta compressing the left atrium (LA). Left and right ventricular systolic function was preserved. Whole-body computed tomography (CT) angiography revealed that a focal 40-mm-diameter saccular aneurysm in the descending aorta at the level of T7-8, with an intramural hematoma, was compressing the LA and left pulmonary vein. After surgical management, follow-up TTE and CT showed decompression of the LA and left pulmonary vein.

Prognostic Value of Left Atrium Remodeling after Primary Percutaneous Coronary Intervention in Patients with ST Elevation Acute Myocardial Infarction

The purpose of this study is to assess the relationship between left atrial (LA) size and outcome after acute myocardial infarction (AMI) in patients undergoing primary percutaneous coronary intervention (PCI) and to evaluate dynamic changes in LA size during long-term follow-up. Echocardiographic analyses were performed on 253 AMI patients (174 male and 79 female, 65.4 +/- 13.7 yr) undergoing PCI. These subjects were studied at baseline and at 12 months. Clinical follow-up were done at 30.8 +/- 7.5 months. We assessed LA volume index (LAVI) at AMI-onset and at 12-month. Change of LAVI was an independent predictor of new onset of atrial fibrillation or hospitalization for heart failure (P = 0.002). Subjects who survived the 12-month period displayed an increased LAVI mean of 1.86 +/- 4.01 mL/m2 (from 26.1 +/- 8.6 to 28.0 +/- 10.1 mL/m2, P < 0.001). The subject group that displayed an increased LAVI correlated with a low left ventricular ejection fraction, large left ventricle systolic and diastolic dimensions and an enlarged LA size. In conclusion, change of LAVI is useful parameter to predict subsequent adverse cardiac event in AMI patients. Post-AMI echocardiographic evaluation of LAVI provides important prognostic information that is significantly greater than that obtained from clinical and laboratory parameters alone.

Relation between Anemia and Vulnerable Coronary Plaque Components in Patients with Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis

The aim of the present study was to evaluate the plaque components and the predictors of thin-cap fibroatheroma (TCFA) in anemic patients with acute coronary syndrome using virtual histology-intravascular ultrasound (VH-IVUS). Anemia was defined according to criteria of the World Health Organization, (i.e. , hemoglobin levels < 13 g/dL in men and < 12 g/dL in women) and we compared VH-IVUS findings between anemia group (171 patients, 260 lesions) and non-anemia group (569 patients, 881 lesions). Anemia group had greater % necrotic core (NC) volume (21% +/- 9% vs 19% +/- 9%, P = 0.001) compared with non-anemia group. Hemoglobin level correlated negatively with absolute NC volume (r = -0.235, P < 0.001) and %NC volume (r = -0.209, P < 0.001). Independent predictors of TCFA by multivariate analysis were diabetes mellitus (odds ratio [OR], 2.213; 95% confidence interval [CI], 1.403-3.612, P = 0.006), high-sensitivity C-reactive protein (OR, 1.143; 95% CI, 1.058-1.304, P = 0.012), microalbuminuria (albumin levels of 30 to 300 mg/g of creatinine) (OR, 2.124; 95% CI, 1.041-3.214, P = 0.018), and anemia (OR: 2.112; 95% CI 1.022-3.208, P = 0.028). VH-IVUS analysis demonstrates that anemia at the time of clinical presentation is associated with vulnerable plaque component in patients with acute coronary syndrome.

Comparison of Clinical Outcomes between ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Myocardial Infarction in Patients Younger Than 40 Years Who Underwent Percutaneous Coronary Artery Intervention / 대한내과학회지

BACKGROUND/AIMS: The prevalence of coronary artery disease has increased in young adults. We evaluated the differences in clinical characteristics and clinical outcomes in young patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). METHODS: A total of 164 patients with acute myocardial infarction who underwent percutaneous coronary intervention were divided into two groups: the STEMI group (120 patients; mean age, 35.7 +/- 3.8 years; 118 males) and the NSTEMII group (44 patients; mean age, 35.7 +/- 4.3 years; 43 males). We analyzed clinical and angiographic characteristics and major adverse cardiac events (MACE), including death from any cause, non-fatal myocardial infarction, target lesion revascularization, and coronary artery bypass graft surgery, during a 1-year clinical follow-up of the two groups. RESULTS: During hospitalization, Killip class II acute myocardial infarction (5.8% vs. 15.9%, p = 0.041) was observed more frequently in the NSTEMI group. The levels of troponin-I (66.9 +/- 103.6 vs. 26.6 +/- 38.5 ng/mL, p = 0.014) and N-terminal pro-brain natriuretic peptide (733.0 +/- 1,018.1 vs. 476.2 +/- 374.5 pg/mL, p = 0.012) were significantly higher in the STEMI group. One-year MACE did not differ between the two groups. By multiple logistic regression analysis, bare metal stents (odds ratio, 3.360; 95% confidence interval, 1.105-10.217; p = 0.033) and high lipoprotein (a) levels (odds ratio, 1.047; 95% confidence interval, 1.020-1.075; p = 0.001) were independent predictors of 1-year MACE. CONCLUSIONS: Young patients with STEMI and NSTEMI have similar clinical outcomes. Bare metal stents and high serum lipoprotein (a) levels are independent predictors of MACE during 1-year clinical follow-ups in young patients with acute myocardial infarction.

A Fatal Case of Simultaneous, Very Late Thrombosis Involving Three Drug-Eluting Stents in Three Coronary Arteries

Late stent thrombosis is one of the most serious complications associated with morbidity and mortality after coronary drug-eluting stent implantation, and is mainly caused by the withdrawal of antiplatelet agents. We report our experience of late stent thrombosis simultaneously involving three different coronary arteries in a young male patient who was treated with three drug-eluting stents two years ago. The patient stopped taking antiplatelet agents for several days. The patient did not recover from cardiogenic shock, even after repeated ballooning with thrombus aspiration, intra-aortic balloon pumping, and temporary pacing during cardiopulmonary resuscitation.

Effects of long-term triple anti-platelet therapy with low-dose cilostazol after drug-eluting stent implantation / 대한내과학회지

BACKGROUND/AIMS: A recent clinical trial demonstrated that triple anti platelet therapy resulted in significantly larger minimal luminal diameter and lower restenosis rate compared with conventional therapy after bare metal stent (BMS) implantation. However, it is uncertain that this result will be repeated after drug eluting stent (DES) implantation, especially with low dose cilostazol therapy. Thus, we performed a prospective, randomized study to evaluate the effectiveness of long term triple therapy with low dose cilostazol after DES implantation. METHODS: We analyzed 109 patients (132 lesion) prospectively, who underwent successful coronary DES implantation. The patients were divided into two groups according to combined anti platelet regimen: triple combination of aspirin, clopidogrel, and low dose cilostazol (50 mg/bid) (Group I, n=56) or dual combination of aspirin and clopidogrel (Group II, n=53) for 6 months. The minimal luminal diameter and binary restenosis rate were compared at 6 month follow up by coronary angiogram. The rates of stent thrombosis, major adverse cardiac events (MACE), and bleeding complication were also analyzed. RESULTS: The baseline clinical and angiographic characteristics were not different between the two groups. Angiographic follow-up was performed in 80 patients (109 lesions, 74%). The minimal luminal diameter at 6 month was 2.25+/-0.63 mm in group I and 2.30+/-0.56 mm in group II (p=0.742). Restenosis occurred in 4 patients (7.2%) in group I and 3 patients (5.6%) in group II (p=0.611). There were no differences in the rates of stent thrombosis, MACE, or bleeding complications between the two groups. CONCLUSIONS: Long term triple anti platelet therapy with low dose cilostazol after DES implantation was not effective in obtaining larger minimal luminal diameter or reducing restenosis rate, but it was used safely without increasing bleeding complication.

Three Sporadic Cases of Acute Hepatitis E / 대한소화기학회지

Acute hepatitis E is an endemic disease, commonly reported in Indian subcontinent, China, Africa, Central America, and so forth. It is a self-limiting disease like other acute hepatitis except in pregnant patient. Although sporadic hepatitis E is noted all over the world, most of them are associated with travel history to HEV-endemic area. In Korea, Hepatitis E is rarely reported. Moreover, sporadic acute hepatitis E without travel history to HEV-endemic area is very rare. We experienced three sporadic cases of acute hepatitis E, without travel history. All of them presented acute hepatitis symptoms, elevated aminotransferase, and positive IgM HEV Ab. Symptoms and aminotransferase levels were normalized during hospitalization and IgM HEV Ab converted negative after 4-8 months. We report three sporadic cases of onset-acute hepatitis E without travel history to HEV-endemic area.

Immunohistochemical comparison of the telomerase expression between low-grade and high-grade gastric dysplasia / 대한내과학회지

BACKGROUND: Telomeres are simple repeats elements located at each end of the chromosomes of eukaryotic cells. The main function of telomeres is to cap the chromosome end and protect it from enzymatic attack. Telomerase that facilitates the synthesis of telomere has been detected in not only cancer, but also in precancerous lesion. In this study, we compared the telomerase expression between low-grade and high-grade gastric dysplasia. METHODS: The telomerase expression of 43 patients with gastric dysplasia (22 low-grade and 21 high-grade) was evaluated by immunohistochemical staining in tissues. RESULTS: The telomerase expression was much higher in the tissues from the patients with high-grade gastric dysplasia than in those tissues of the patients with low-grade gastric dysplasia. CONCLUSIONS: Activation of telomerase may be related with the malignant potentiality in gastric cells. Further studies are needed to define the role of telomerase in gastric tumorigenesis.

A Case of Coronary Air Embolism of the Left Coronary Arteries that Manifested as Cardiogenic Shock

Coronary air embolism remains a serious complication of coronary catheterization despite performing careful procedure to prevent this. We report here on a case of massive coronary air embolism that was complicated by cardiogenic shock in a 52-year-old male patient with angina pectoris. The patient had a stenosis in the middle left anterior descending artery (LAD) and percutaneous coronary intervention (PCI) was planned for the LAD lesion. During PCI, inadvertent manipulation of a pressure line induced massive air embolism in both proximal left coronary arteries, and this manifested as cardiogenic shock. The patient recovered after supportive measures and successive intracoronary injections of nitroglycerin and then he eventually underwent successful PCI.

The Effect of Primary Percutaneous Coronary Intervention after the Administration of Tirofiban Alone or Tirofiban Combined with Low dose Alteplase in Patients with Acute Myocardial Infarction on ST Elevation Resolution, TIMI Flow and Short-Term Clinical O

BACKGROUND AND OBJECTIVES: The combination of platelet glycoprotein IIb/IIIa inhibitors and a low dose thrombolytic agent may produce early Thrombolysis In Myocardial Infarction (TIMI) 3 flow and a high rate of ST elevation resolution in an ST elevation acute myocardial infarction (STEMI). The clinical effect of tirofiban combined with low dose alteplase, prior to primary percutaneous coronary intervention (PCI) in STEMI, were evaluated on the ST elevation resolution, TIMI flow and 30-day clinical outcomes. SUBJECTS AND METHODS: Following aspirin, clopidogrel and standard heparin, 45 patients with STEMI were randomized into 2 groups; tirofiban administration (Group I; n=23, 64+/-10 years; 15 male) or combined administration of tirofiban with 40 mg alteplase prior to primary PCI (Group II; n=22, 59+/-11 years; 19 male). The pre- and post-interventional TIMI flow grades, ST elevation resolution and bleeding complications were compared between the two groups. The major adverse cardiac events (MACE) were compared between the two groups during 30-days of clinical follow-up. RESULTS: Group II had a higher pre-interventional TIMI flow (TIMI flow> or =2: 34.8% vs. 90.9%, p<0.0001) and rate of ST elevation resolution (49.0+/-27.8% vs. 66.6+/-27.2%, p=0.045) than Group I. A major bleeding complication developed in 1 (5.0%) Group II patient, and minor bleeding complications developed 1 patient from each group (Group I; 9.5% vs. Group II; 10%, p=0.959). CONCLUSION: Combined administration of tirofiban with alteplase prior to primary PCI leads to a higher TIMI flow and more frequent ST elevation resolution, without bleeding complications, compared to a single administration of tirofiban.

The Changes of Body Compositions and Associated Factors in CAPD Patients During First One Year / 대한신장학회잡지

PURPOSE: CAPD is an important treatment modality along with hemodialysis and kidney transplantation in end stage renal disease. Malnutrition is very common and associated with increased morbidity and mortality in CAPD patients. The cause of malnutrion in CAPD patients might be multifactorial. This prospective study was carried out to investigate nutritional changes for 1 year after initiation of peritoneal dialysis by measurement body composition, especially lean body mass (LBM) using bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DEXA) and to evaluate the factors associated with malnutrition in CAPD patients. METHODS: Among new CAPD patients from May, 2001 to Dec, 2002 in our hospital, 25 patients were enrolled. Body weight, LBM, LBM percen t (%LBM), fat mass, fat mass percent (%fat mass), ECF volume and ECF/TBW were compared between 1st month and 12th month after initiation of PD. The biochemical parameters, Urea kinetic modeling, Peritoneal equilibration test, the amounts of glucose absorption through the dialysate, the amounts of protein and albumin loss through the dialysate were measured at the same time point with measurement of the body composition. RESULTS: There were significantly decreased LBM (46.3+/-9.1 kg to 44.7+/-9.0 kg in BIA, 45.7+/-9.3 kg to 42.1+/-7.9 kg in DEXA, p< 0.05, respectively) but significantly increased fat mass (16.3+/-6.2 kg to 20.2+/-7.9 kg in BIA, 15.7+/-6.6 kg to 20.1+/-7.4 kg in DEXA, p<0.01, respectively) during first one year. Mean weekly Kt/V were significantly correlated with the changes of LBM (r=-0.64 in BIA, r=-0.81 in DEXA, p<0.01, respectively). With the multiple regression test, 1st month weekly Kt/V in BIA and DEXA were significant predictors of the changes of LBM for 1 year (beta-coefficients: -0.573 in BIA, -0.773 in DEXA, p<0.01, respectively). CONCLUSION: Adequate dialysis, especially 1st month adequacy, is very important for maintaining good nutritional status for one year after initiation of peritoneal dialysis.