Modulation of Melanin Synthesis by Amaranthus spp. L Seed Extract in Melan-a Cells

Anti-melanogenic effects of amaranth (AT), one of the key source of squalene, were investigated in melanocytes. Amaranth seed powder was extracted with water and melan-a cells were treated with various concentrations of AT. By using HPLC, content of myo-inositol, one of potential active components, was measured in the crude extract of AT.AT reduced the melanin content in melan-a melanocytes and down-regulated melanogenic enzyme activity such as tyrosinase, TRP-1 and TRP-2. By regulating melanogenic enzyme activity, AT may be a potential natural source for whitening agent. Myo-inositol was detected in AT by HPLC and may be one of the active compounds from AT involved in the regulation of anti-melanogenesis. In this study, we demonstrated that AT has anti-melanogenesis properties. This new function of amaranth may be useful in the development of new skin-whitening products and its value as food.

Association Between Plaque Thickness of the Thoracic Aorta and Recurrence of Atrial Fibrillation After Ablation

BACKGROUND AND OBJECTIVES: Several predictors of recurrence of atrial fibrillation (AF) after ablation have been identified, including age, type of AF, hypertension, left atrial diameter and impaired left ventricular ejection fraction. The aim of this study was to investigate whether the atherosclerotic plaque thickness of the thoracic aorta is associated with a recurrence of AF after circumferential pulmonary vein ablation (CPVA). SUBJECTS AND METHODS: Among patients with drug-refractory paroxysmal or persistent AF, 105 consecutive (mean age 58+/-11 years, male : female=76 : 29) patients who underwent transesophageal echocardiography and CPVA were studied. The relationships between the recurrence of AF and variables, including clinical characteristics, plaque thickness of the thoracic aorta, laboratory findings and echocardiographic parameters were evaluated. RESULTS: A univariate analysis showed that the presence of diabetes {hazard ratio (HR)=3.425; 95% confidence interval (CI), 1.422-8.249, p=0.006}, ischemic heart disease (HR=4.549; 95% CI, 1.679-12.322, p=0.003), duration of AF (HR=1.010; 95% CI, 1.001-1.018, p=0.025), type of AF (HR=2.412, 95% CI=1.042-5.584, p=0.040) and aortic plaque thickness with > or =4 mm (HR=9.514; 95% CI, 3.419-26.105, p or =4 mm) was an independent predictor of recurrence of AF after ablation (HR=7.250, 95% CI=1.906-27.580, p=0.004). CONCLUSION: Significantly increased aortic plaque thickness can be a predictable marker of recurrence of AF after CPVA.

Nasopharyngeal Metastasis from Colon Cancer / 대한내과학회지

Metastatic adenocarcinoma from the gastrointestinal tract to the nasopharynx is rare. The histological morphology of this lesion is indistinguishable from the colonic variant of primary head and neck adenocarcinoma or intestinal-type adenocarcinoma (ITAC) of the nasal cavity. This is a report of metastatic adenocarcinoma of colorectal origin to the nasopharynx in a 58-year-old man who was previously treated for adenocarcinoma of the sigmoid colon. A histopathological study of the specimen from the nasopharynx demonstrated a tumor that was identical to the patient's previous primary tumor from the colon. There was no tumor mass in the nasal cavity or paranasal sinuses. The nasopharyngeal tissue expressed cytokeratin 20 and CDX-2, but not cytokeratin 7. The patient received palliative radiation after the diagnosis. Distinguishing metastatic adenocarcinoma from the gastrointestinal tract from ITAC can be difficult. The clinical manifestation is important in differentiating these conditions. It is important to recognize these as metastatic lesions because treatment is primarily palliative.

A Case of Chloroquine-Induced Cardiomyopathy That Presented as Sick Sinus Syndrome

A 52-year-old woman with rheumatoid arthritis who had been treated with prednisone and hydroxychloroquine for >12 years presented with chest discomfort and a seizure. She was diagnosed with restrictive cardiomyopathy combined with sick sinus syndrome. A myocardial muscle biopsy was performed to identify the underlying cardiomyopathy, which showed marked muscle fiber hypertrophy, fiber dropout, slightly increased interstitial fibrous connective tissue, and extensive cytoplasmic vacuolization of the myocytes under light microscopy. Electron microscopy of the myocytes demonstrated dense, myeloid, and curvilinear bodies. The diagnosis of hydroxychloroquine-induced cardiomyopathy was made based on the clinical, hemodynamic, and pathologic findings. This is the first case report describing chloroquine-induced cardiomyopathy involving the heart conduction system.

A SGB treatment case of a patient's postoperative intractable hiccup: A case report

Hiccups occur due to sudden glottic closure connected to inspiratory muscle and diaphragm's involuntary spasm. Hiccups have been known to be caused organically, psychologically, and by some unknown causes, yet, their pathophysiologic mechanism is still unknown. There are non-drug treatments such as hyperventilation, drinking water, pharynx and larynx stimulation, and Valsalva maneuver: and drug treatments such as antipsychotics and antiepileptics. Nerve block can be also considered. A 67-year-old man, who was hospitalized due to his months' long hiccup, had begun hiccups 5-6 months after an operation of radical subtotal gastrectomy with Billroth I anastomosis due to his early gastric cancer. During follow-ups of 4 weeks and 12 weeks after one treatment of bilateral SGB, the patient no longer complained hiccups. In conclusion, SGB treatment for intractable hiccup is an alternative method to palliative therapy or pharmacotherapy when either method is ineffective as a cure.

Phrenic nerve palsy following coracoid infraclavicular brachial plexus block / 대한마취과학회지

Various methods of infraclavicular brachial plexus block have been introduced in the past, of which Wilson's coracoid infraclavicular brachial plexus block, a more lateral approach, consequently thought to be easier and safer. While only a few cases of transient ipsilateral phrenic nerve palsy after infraclavicular brachial plexus block have been reported, we describe a rare case of phrenic nerve palsy after Wilson's coracoid infraclavicular brachial plexus block.

Isolated Left Ventricular Noncompaction Cardiomyopathy Accompanied by Severe Mitral Regurgitation

Isolated left ventricular noncompaction cardiomyopathy (IVNC) is a cardiomyopathy thought to be caused by arrest of normal embryogenesis of the endocardium and myocardium. This abnormality is often associated with other congenital cardiac defects. A 21-year-old man presented to the emergency department with worsening exertional dyspnea during the previous 2 months. Two-dimensional and Doppler echocardiography revealed an enlarged left atrium (LA) and a markedly dilated left ventricle (LV) with preserved LV systolic function, severe mitral valve regurgitation, and prolapse due to chordae rupture. The myocardium of the LV and right ventricle (RV) had excessively prominent trabeculations and deep intertrabecular recesses. He is the first patient in Korea who has undergone mitral valve replacement surgery because of severe mitral valve regurgitation and prolapse due to chordae rupture accompanied by IVNC.

Extensive Primary Cardiac Lymphoma Diagnosed by Percutaneous Endomyocardial Biopsy

Primary cardiac lymphoma (PCL) is an extranodal non-Hodgkin's lymphoma exclusively located in the heart and/or pericardium. It is rare in immunocompetent patients and represents 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. The clinical behavior is aggressive and the early symptoms are cardiac failure, syncope, arrhythmia, or pericardial effusion. Although echocardiography, computed tomography (CT) scan, magnetic resonance image (MRI) are the mainly used imaging techniques to detect cardiac tumors, pathologic examination is always required to confirm the diagnosis. Diagnosis of PCL is difficult due to non-specific clinical manifestations and requires invasive approach to get histopathologic evidence. While surgery with systemic chemotherapy or in combination with irradiation has been attempted, the only effective treatment is chemotherapy. However, the prognosis remains poor. We report on a 42-year-old woman who is diagnosed histopathologically as PCL by cardiac catheterization assisted percutaneous endomyocardial biopsy and treated successfully by anthracycline based chemotherapy.

Assessment of the Quality of Postherpetic Neuralgia Related Korean Internet Sites

BACKGROUND: There is no assessment of internet sites that carry information on chronic pain disease. So we assessed the quality of information about postherpetic neuralgia available on Korean internet sites. METHODS: The keywords 'postherpetic neuralgia', 'herpes zoster, neuropathic pain', 'herpes zoster, pain', 'herpes zoster' were searched in Korean on four search engines in Korea between the 1st to the 15th of May, 2009. We evaluated the outcome on two factors; the aspect of the contents which is subdivided into two categories, the content and authorship, and the technical aspect including web design, and efficiency. RESULTS: A total of 26 internet sites were found. Among these sites, 6 (23%) informed by anesthesiologist. The average score of the 26 internet sites was only 37.4 +/- 20.1 out of a total of 100. A mean score of the contents was 13.3 +/- 8.3 out of 40 points, the authorship was 10.0 +/- 6.7 out of 20 points, the design was 9.2 +/- 5.3 out of 20 points, the efficiency was 6.8 +/- 4.3 out of 20 points. When comparing the score between anesthesiologist and non-anesthesiologist, the contents was 18.7 +/- 7.4 vs. 11.7 +/- 7.9, the authorship was 13.4 +/- 4.7 vs. 9.0 +/- 6.8, the design was 12.5 +/- 4.2 vs. 8.3 +/- 5.2 and the efficiency was 6.8 +/- 4.5 vs. 4.3 +/- 4.0 (P < 0.05). CONCLUSIONS: There is a need for more accurate information about postherpetic neuralgia on the Korean internet by anesthesiologists.

Usefulness of ultrasound-guided infraclavicular brachial plexus block: a comparison with nerve stimulation method / 대한마취과학회지

BACKGROUND: Recently, ultrasound guidance in clinical procedures including brachial plexus block has gained popularity. This method has been considered to be an efficient and a useful method with real-time visualization. Many reports have showed the usefulness of ultrasound-guided brachial plexus block. We evaluated the usefulness of ultrasound guidance in infraclavicular brachial plexus block compared with nerve stimulation. METHODS: Thirty patients were randomized into two groups of US group (ultrasound-guided block) and NS group (nerve stimulation). Blocks were performed with mepivacaine 2% and bupivacaine 0.5% with epinephrine 1:200,000 (total volume 40 ml). Block execution time, onset time, success rate, patient's discomfort and complications were measured and statistically evaluated for the comparison. RESULTS: Block execution time were 88.3 +/- 48.1 sec in US group and 172.7 +/- 103.1 sec in group NS, respectively (P = 0.017). Onset time were 16.0 +/- 6.9 min and 17.7 +/- 7.8 min (P = 0.434). Success rates were 93.3% and 80.0% (P = 0.283). Patient's discomfort was not significantly different. Pain in patients with fractured arm was significantly lower in US group (P = 0.004). CONCLUSIONS: An ultrasound-guided infraclavicular brachial plexus block is useful with less time consumption and less discomfort in patients with fracture of arm. Success rate and onset time were acceptable.

An Anesthetic Experience in a Patient with Menkes Disease: A case report / 대한마취과학회지

Menkes disease, so-called kinky hair disease or steely hair disease, is a rare X-linked recessive disorder of intracellular copper transport protein ATP7A defect, due to mutation of ATP7A gene, resulting in copper deficiency. It is characterized by seizure, retarded neurological development, kinky hair, skeletal abnormality, recurrent infection and subnormal body temperature. In addition, gastroesophageal reflux with the risk of aspiration is another important feature. This article is the first report of anesthetic management in a patient with Menkes disease who underwent gastrostomy and bladder diverticulectomy in Korea.

The Relationship between Endoscopic Degrees and Prognostic Factors in Pseudomebranous Colitis / 대한소화기내시경학회지

BACKGROUND/AIMS: Leukocytosis and hypoalbuminemia are known to be poor prognostic factors. The aim of this study was to determine how the leukocyte counts and albumin level are related to the colonic endoscopic findings. METHODS: Fifty three pseudomembranous colitis (PMC) patients confirmed by a lower endoscopy were analyzed. Endoscopic degree of pseudomembranous plaque was classified into four grades. The endoscopic severity was classified into two groups (group A: G I~II, group B: G III~IV). RESULTS: The mean age was 64.9 years, the mean onset of diarrhea after exposure to antibiotics was 12.9 days, the reasons for admission were medical (58.5%, 31) and surgical (41.5%, 22). Frequently the causative antibiotic was cephalosporin (81.1%, 43/53), and the mean WBC counts and albumin level were 13,045/mm3 and 3.13 g/dL, respectively. The endoscopic degrees of PMC was grade I (9.4%, 5), grade II (32.1%, 17), grade III (41.5%, 22), and grade IV (17%, 9). The patients' WBC counts and albumin level were not associated with the endoscopic severity. The age, gender, causative antibiotics, diabetes showed no correlation. CONCLUSIONS: There were no correlations between the known poor clinical prognostic factors (leukocystosis and hypoalbuminemia) and the endoscopic severity.

Activation of Nuclear Factor-kappaB in the Atherosclerotic Human Coronary Artery / 대한해부학회지

Paraffin sections of atherosclerotic vessels were classified into initial lesion, preatheroma and complicated severe lesion by classification method from American Heart Association. Activation of NF-kappaB was hardly detectable in the initial atherosclerotic lesion. In the preatheroma, activated NF-kappaB was enhanced in the neointimal smooth muscle cells and macrophages in the lipid core. In contrast, activated NF-kappaB increased markedly in the neointimal and medial smooth muscle cells in the severe atherosclerotic vessel wall. However, in the severe lesion, NF-kappaB activation was diminished in the macrophages of lipid core. Our findings show that NF-kappaB was activated in the smooth muscle cells with the progression of atherosclerosis in the human coronary artery.

The Usefulness of Positional Change in Endoscopic Hemostasis for Bleeding Dieulafoy's Lesion / 대한소화기내시경학회지

BACKGROUND/AIMS: Dieulafoy's lesion is a rare cause of massive upper gastrointestinal bleeding, most commonly in the proximal stomach. Although the mechanical hemostatic method has been widely used, it is difficult to access for complete application. This study evaluated the utility of a positional change in patients with a bleeding Dieulafoy's lesion. METHODS: Between January 2003 and March 2004, 15 patients with a bleeding Dieulafoy's lesion were randomly assigned to either a positional change group (right decubitus or supine, n=7) or a left decubitus group (n=8). The demographic characteristics, endoscopic variables, and clinical outcomes were analyzed. RESULTS: The patients' characteristics at entry were similar in both groups. Initial hemostasis was achieved in all patients. Recurrent bleeding developed in only one patients in the left decubitus group. The mean procedure time was significantly shorter in the positional change group than in the left decubitus group (4.5+/-3.4 min vs. 7.4+/-5.2 min, p<0.05). The ineffective hemoclip number (respectively, 0.3+/-0.1 vs. 1.4+/-1.2, p<0.05) was significantly different in the two groups. No major procedure-related complications occurred in the positional change group. CONCLUSIONS: Endoscopic hemostasis with a positional change is an effective and safe method for treating in a bleeding Dieulafoy's lesion.

Evaluation of Colon Pattern using Virtual CT Colonoscopy in Patients with Difficult Colonscopic Insertion / 대한소화기내시경학회지

BACKGROUND/AIMS: The successful colonoscopic insertion has been predicted by several clinical factors including female gender, obesity, poor bowel preparation, and a history of surgery. In addition, anatomical differences, such as Kudo's pattern (B, C of the sigmoid colon), rotation of the hepatic and splenic flexure, and the diameter of the sigmoid colon have also been considered to affect the success of colonoscopic insertion. The aim of this study was to evaluate the anatomical factors using virtual CT colonscopy in the case where the colonoscopic insertion is difficult. METHODS: From April 2005 to June 2005, 32 patients who experienced a delayed insertion time > or =10 minutes during colonoscopy (Group I) and other 34 patients whose insertion time was <10 minutes (Group II) were examined by virtual CT colonoscopy. The shape of the sigmoid colon was compared with Kudo's pattern, rotation of hepatic (HFR) and splenic flexure (SFR), and the diameter of the most distended sigmoid colon at the supine position (SCD) in both groups. Excessive SFR or HFR was defined if the splenic flexure or hepatic flexure was rotated by more than 360 degrees from the natural course of the colon. RESULTS: There were significant differences between group I (M : F=16 : 16, mean age: 61.7+/-13.8, SCD: 40.9+/-7.4 mm) and group II (M : F=25 : 9, mean age: 46.9+/-11.4, SCD: 39.7+/-7.2 mm) in terms of gender, age, BMI (24.1+/-3.5 kg/m2 in group I, 23.5+/-2.1 kg/m2 in group II), and the colonoscopic insertion time (18.1 minutes in group I, 6.3 minutes in group II). The Kudo's pattern was as follows: pattern A : B : C=23.3% : 36.7% : 40.0% in group I, and pattern A : B : C=50.0% : 37.5% : 12.5% in group II. Excessive rotation of the splenic flexure was 50% in group I, and 21.9% in group II. However, there were no clinical significant difference in bowel preparation, sedation, previous bowel operation, the type of cathartics and SCD. CONCLUSIONS: Anatomical differences can affect a difficult colonoscopic insertion, which includes shape of the sigmoid colon, excessive rotation of the splenic flexure. However a further large randomized trial study will be needed.

Evaluation of Colon Pattern using Virtual CT Colonoscopy in Patients with Difficult Colonscopic Insertion / 대한소화기내시경학회지

BACKGROUND/AIMS: The successful colonoscopic insertion has been predicted by several clinical factors including female gender, obesity, poor bowel preparation, and a history of surgery. In addition, anatomical differences, such as Kudo's pattern (B, C of the sigmoid colon), rotation of the hepatic and splenic flexure, and the diameter of the sigmoid colon have also been considered to affect the success of colonoscopic insertion. The aim of this study was to evaluate the anatomical factors using virtual CT colonscopy in the case where the colonoscopic insertion is difficult. METHODS: From April 2005 to June 2005, 32 patients who experienced a delayed insertion time > or =10 minutes during colonoscopy (Group I) and other 34 patients whose insertion time was <10 minutes (Group II) were examined by virtual CT colonoscopy. The shape of the sigmoid colon was compared with Kudo's pattern, rotation of hepatic (HFR) and splenic flexure (SFR), and the diameter of the most distended sigmoid colon at the supine position (SCD) in both groups. Excessive SFR or HFR was defined if the splenic flexure or hepatic flexure was rotated by more than 360 degrees from the natural course of the colon. RESULTS: There were significant differences between group I (M : F=16 : 16, mean age: 61.7+/-13.8, SCD: 40.9+/-7.4 mm) and group II (M : F=25 : 9, mean age: 46.9+/-11.4, SCD: 39.7+/-7.2 mm) in terms of gender, age, BMI (24.1+/-3.5 kg/m2 in group I, 23.5+/-2.1 kg/m2 in group II), and the colonoscopic insertion time (18.1 minutes in group I, 6.3 minutes in group II). The Kudo's pattern was as follows: pattern A : B : C=23.3% : 36.7% : 40.0% in group I, and pattern A : B : C=50.0% : 37.5% : 12.5% in group II. Excessive rotation of the splenic flexure was 50% in group I, and 21.9% in group II. However, there were no clinical significant difference in bowel preparation, sedation, previous bowel operation, the type of cathartics and SCD. CONCLUSIONS: Anatomical differences can affect a difficult colonoscopic insertion, which includes shape of the sigmoid colon, excessive rotation of the splenic flexure. However a further large randomized trial study will be needed.

Pathophysiological Role of Angiopoietin-2 in Human Coronary Atherosclerosis / 대한해부학회지

Neovascularization is well known to occur in human atherosclerotic plaques; however, its pathophysiological roles, mechanism, and stimuli still remain unclear. Angiopoietin-1 and -2 belong to another vascular-specific growth factor family and regulate angiogenesis. Angiopoietin-2 (Ang-2) provides a destabilizing signal for endothelial cells, leading to vessel regression or sprouting depending on the presence of other angiogenic factor. But role and distribution of Ang-2 in atherosclerosis are not well known. Thus, we studied 1) the distribution and amount of Ang-2 2) the relationship between Ang-2 expression and vascular morphometrical change 3) the relationship between Ang-2 expression and neovascularization in atherosclerotic lesions. Paraffin sections from 36 human coronary arterial segments were characterized as normal, preatheroma, atheroma, fibroatheroma and complicated lesion according to American heart association classification. Expression of Ang-2 and related factors were examined using immunohistochemistry and western blotting with antibodies against Ang-2, CD31 (endothelial cells), alpha-actin (vascular smooth muscle cells), CD36 (monocyte & macrophage), Tie-2 and VEGF. Expression of Ang-2 was not shown in normal arterial segment. Ang-2 were localized in lumen-lining endothelium, macrophage, some SMCs of atheromatous plaque in advanced lesion. Amount of Ang-2 was increased according to progression of atherosclerosis. Intraplaque microvessels had Ang-2 and VEGF positive endothelial cells and number of those in plaque increased according to progression of disease. Intimal neovascularization is correlated with intimal thickening in atherosclerotic lesion (R2 = 0.7424). Therefore, they suggest that Ang-2 has an important role in the progression of human coronary atherosclerosis, as well as in neovascularization. This study implicates Ang-2 as an important potential therapeutic target in vascular disease

The Breast Adenomyoepithelioma

Adenomyoepithelioma occurs often in the salivary gland. But adenomyoepithelioma of the breast is very rare, and diagnostic tools are not found. The biological characters of disease are not fully understood. These days, a few case was reported in Korea with development of pathologic diagnostic tools. At first, we diagnosed this case as breast cancer and did MRM operation. But this case was diagnosed as adenomyoepithelioma at the special immunohistochemistry stain. Most of the adenomyoepithelioma is benign disease, but this case was malignant change. We experienced one case of malignant adenomyoepithelioma of the breast and report the case with review of literatures.

Survival Analyses in Breast Cancer According to Over-expression and Amplification of HER2 / 한국유방암학회지

PURPOSE: HER2 is a 185-kDa transmembrane protein, which shares a considerable homology with the epidermal growth factor receptor. The over-expression of HER2 has been reported to be associated with a poor clinical outcome in breast cancer. In clinical practice and research studies, immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH) have commonly been used for the detection of HER2. The aim of this study was to evaluate the prognostic significance of HER2 according to the results of IHC and FISH for HER2. METHODS: IHC and FISH were performed on the same breast cancer specimens from 388 Korean patients, with a mean follow-up duration of 59.8 months, with survival analyses were made according to the results of the HER2 detection methods; A0485 Ab (DAKO, Denmark) and the HER2 test kit (DAKO HerceptTest(TM), Denmark) for IHC, and the HER2 FISH kit (Vysis Inc., Downers Grove, Ill) for FISH were used. RESULTS: The IHC showed HER2 over-expression rates of 34.8% and 26.8% by the A0485 antibody and HercepTest, respectively. The rate of HER2 amplification by FISH in the same specimen was 25.8%. HER2 was confirmed as an independent prognostic factor by multivariate analyses regardless of the detection methods. In the survival analyses, according to the IHC results for HER2, only the 3+ scoring group in the positive results was associated with a poor survival. However, the positive group in the FISH test revealed a significantly worse survival than the FISH-negative group. CONCLUSION: For the prediction of survival of patients with breast cancer, the FISH test would be more useful than IHC, especially in the 2+ scoring IHC cases.

Survival Analyses in Breast Cancer According to Over-expression and Amplification of HER2 / 한국유방암학회지

PURPOSE: HER2 is a 185-kDa transmembrane protein, which shares a considerable homology with the epidermal growth factor receptor. The over-expression of HER2 has been reported to be associated with a poor clinical outcome in breast cancer. In clinical practice and research studies, immunohistochemistry (IHC) and fluorescence in-situ hybridization (FISH) have commonly been used for the detection of HER2. The aim of this study was to evaluate the prognostic significance of HER2 according to the results of IHC and FISH for HER2. METHODS: IHC and FISH were performed on the same breast cancer specimens from 388 Korean patients, with a mean follow-up duration of 59.8 months, with survival analyses were made according to the results of the HER2 detection methods; A0485 Ab (DAKO, Denmark) and the HER2 test kit (DAKO HerceptTest(TM), Denmark) for IHC, and the HER2 FISH kit (Vysis Inc., Downers Grove, Ill) for FISH were used. RESULTS: The IHC showed HER2 over-expression rates of 34.8% and 26.8% by the A0485 antibody and HercepTest, respectively. The rate of HER2 amplification by FISH in the same specimen was 25.8%. HER2 was confirmed as an independent prognostic factor by multivariate analyses regardless of the detection methods. In the survival analyses, according to the IHC results for HER2, only the 3+ scoring group in the positive results was associated with a poor survival. However, the positive group in the FISH test revealed a significantly worse survival than the FISH-negative group. CONCLUSION: For the prediction of survival of patients with breast cancer, the FISH test would be more useful than IHC, especially in the 2+ scoring IHC cases.