Lipoprotein-Associated Phospholipase A2 Is Related to Plaque Stability and Is a Potential Biomarker for Acute Coronary Syndrome

PURPOSE: Plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) binds to low-density lipoprotein. The levels of Lp-PLA2 reflect the plaque burden, and are upregulated in acute coronary syndrome (ACS). We investigated the diagnostic value of Lp-PLA2 levels and found that it might be a potential biomarker for ACS. MATERIALS AND METHODS: We classified 226 study participants into three groups: patients without significant stenosis (control group), patients with significant stenosis with stable angina (SA group), and patients with ACS (ACS group). RESULTS: Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) levels were significantly greater in the ACS group than in the SA group (p=0.044 and p=0.029, respectively). Multivariate logistic regression analysis revealed that Lp-PLA2 levels are significantly associated with ACS (odds ratio=1.047, p=0.013). The addition of Lp-PLA2 to the ACS model significantly increased the global chi2 value over traditional risk factors (28.14 to 35.602, p=0.006). The area under the receiver operating characteristic curve for Lp-PLA2 was 0.624 (p=0.004). The addition of Lp-PLA2 level to serum hs-CRP concentration yielded an integrated discrimination improvement of 0.0368 (p=0.0093, standard error: 0.0142) and improved the ability to diagnose ACS. CONCLUSION: Lp-PLA2 levels are related to plaque stability and might be a diagnostic biomarker for ACS.

Severe Mitral Regurgitation Due to Coronary Vasospasm, Confirmed by Ergonovine Echocardiography / 영남의대학술지

The common causes of organic mitral regurgitation (MR) include mitral valve prolapse (MVP) syndrome, rheumatic heart disease, and endocarditis. MR also occurs secondary to dilated cardiomyopathy and coronary artery disease. In acute severe MR, the hemodynamic overload often cannot be tolerated, and mitral valve repair or replacement must be performed immediately. We report herein a case of severe MR due to coronary vasospasm that was confirmed via ergonovine echocardiography in a 70-year-old man. He was scheduled to undergo mitral valve surgery, but it did not push through and he was put on medical therapy.

Spontaneous Coronary Artery Dissection Mimicking Coronary Spasm Diagnosed by Intravascular Ultrasonography

Spontaneous coronary artery dissection (SCAD) is a rare and occasionally life-threatening cause of acute coronary syndrome. Patients may present with clinical scenarios ranging from angina pectoris to cardiogenic shock to sudden cardiac death, and it may be a potentially life-threatening condition if not recognized. However, its etiology, pathophysiology and optimal therapeutic strategies have not been well understood. SCAD is diagnosed on the basis of coronary angiography, but complementary techniques as such intravascular ultrasound (IVUS) and optical coherence tomography should be considered for diagnostic clarification where appropriate. Likewise, the selection of treatment strategy depends upon the clinical manifestation, location and the extent of dissection and amount of ischemic myocardium at risk. Herein, we present the case of a 35-year-old woman who presented with acute myocardial infarction. She was diagnosed by IVUS with spontaneous diffuse dissection of the left anterior descending artery without atheroma, treated with percutaneous coronary stenting, and had a favorable clinical course and was discharged on medical therapy.

Efficacy and Safety of Biodegradable Microparticles in the Regeneration of Injured Rabbit Corpus Cavernosum: Primary Report / 대한남성과학회지

PURPOSE: This study analyzed the effectiveness of poly (lactic-co-glycolic acid) (PLGA) as a tissue recovery agent and determines the in vivo safety and efficacy of microparticle-based PLGA. MATERIALS AND METHODS: Fifteen 3-month-old male white rabbits were used. Allogenic adipose tissue derived stromal vascular fraction (SVF) was cultured and labeled with the fluorescent dye PKH26. The rabbits were divided into 4 groups: the SVF group, the PLGA group, the normal control group, and the disease control group. The right corpus cavernosal tissue of the rabbits was surgically removed in the selected portion, except in the normal control group. The defect space of each rabbit was replaced with 10(6) SVF cells in the SVF group and 0.1 g of biodegradable polymer solution in the PLGA group. Microscopic confirmation and analysis of tissue regeneration were performed after 8 weeks. Using confocal microscopy, the nuclei of the smooth muscle cells and SVF migration were examined. The composition of smooth muscle and fibrosis of the injured corpus cavernosum were compared and analyzed by Masson's trichrome stain. RESULTS: There were no signs of migration or rejection of the injected materials in any of the experimental groups. The mean amount of smooth muscle in the normal control group was 15.25+/-1.34 microm2 (right) and 13.90+/-0.703 microm2 (left); in the disease control group it was 11.10+/-0.87 microm2 (right) and 12.80+/-1.01 microm2 (left); in the SVF group it was 13.82+/-4.10 microm2 (right) and 13.96+/-3.94 microm2 (left); and in the PLGA group it was 12.89+/-1.39 microm2 (right) and 13.24+/-1.43 microm2 (left). Only the disease control group showed significant decreased smooth muscle in the left cavernosum (p0.05). Furthermore, no difference was found between any two groups (normal control versus SVF (p=0.705), normal control versus PLGA (p=0.88), SVF versus PLGA (p=0.23). CONCLUSIONS: PLGA microparticles had the same tissue restoring effect when compared with SVF and no adverse effect or migration of particles was found through the injection of PLGA or SVF. PLGA is safe and has the proper tissue recovery effect, saving additional tissue harvesting.

A Case of Central Pontine and Extrapontine Myelinolysis in a Patient with Maintenance Hemodialysis / 대한신장학회잡지

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) is a rare syndrome that is clinically characterized by quadriparesis, pseudobulbar palsy, and disturbance of consciousness. It commonly occurs in patients with rapid correction of hyponatremia and chronic alcoholism. We report a case of CPM and EPM in a 55-year-old male patient with maintenance hemodialysis. He had type 2 diabetes mellitus for more than 20 years and underwent hemodialysis for the past 7 months. He was admitted for left periorbital cellulitis and uremic symptoms. On the 34th hospital day, he had nausea, vomiting, decreased consciousness, dysarthria and quadriparesis. Laboratory data were revealed as follows:glucose, 117 mg/dL; sodium, 137.1 mEq/L; and serum osmolality, 277 mosm/L. Magnetic resonance imaging (MRI) of the brain revealed increased signal intensity in the pons, upper medulla, cerebellar peduncle and cerebral peduncle in T2 weighted images. This case was considered as primary CPM and EPM occurring in a patient with maintenance hemodialysis. With general supportive care, the patient has been recovered gradually and is being followed up on an outpatient basis.

Analysis of Serum Stored Iron Levels in Female Chronic Telogen Effluvium / 대한피부과학회지

BACKGROUND: Chronic telogen effluvium is a common problem in middle-aged women. It has been suggested that reduced iron stores are a cause of this type of baldness. OBJECTIVE: We performed this study in order to elucidate the pathogenesis of chronic telogen effluvium and to evaluate the differences in serum stored iron levels between normal females and those with chronic telogen effluvium. METHODS: Blood levels of hemoglobin, iron, ferritin, and TIBC were examined in 20 patients with chronic telogen effluvium and 20 normal females. RESULT: 1) Ferritin levels were significantly decreased in the patients group(p=0.008). 2) TIBC levels were significantly increased in the patients group(p=0.001). 3) There were no significant differences in Hb and serum iron in both groups (p<0.05). CONCLUSION: These findings suggested that the variation of serum ferritin level may play a role in the pathogenesis of chronic telogen effluvium, but further studies will be needed for evaluation of this condition.

A Case of Pityriasis Rubra Pilaris in an Infant / 대한피부과학회지

Pityriasis rubra pilaris is a rare papulosquamous and keratotic disease. The orange hue to the erythema, the thickening of the palms and soles and so called 'islands of normal skin' contribute to establish the diagnosis based on morphologic features. We present a 6-month-old male patient with multiple scaly erythematous patches and 'island of normal skin' on the face. There is no palmoplantar keratoderma, nor onychopathy. Histopathologic findings revealed alternating parakeratosis and hypergranulosis in the epidermis and mild perivascular lymphocytic infiltration in the dermis. Unlike to Griffiths classification, he showed good responses to topical steroid and UV phototherapy.

A Case of Sclerosing Panniculitis / 대한피부과학회지

Sclerosing panniculitis refers to the skin induration and hyperpigmentation of the legs that often occurs in patients who have venous insufficiency. Sclerosing panniculitis is similar to those described under the designations hypodermitis sclerodermiformis or lipodermatosclerosis. Histologically the septa of the subcutis become thickening by inflammation and fibrosis. Adipocytes coalesce to form small and large pseudocysts. Some of these are lined by refractile, amphophilic crenulated membranes. This alteration was referred to as lipomembranous change. We report a case of sclerosing panniculitis in a 40-year-old female patient presented as induration and depression of the skin and subcutaneous tissues of the lower third of the leg.

A Case of Sneddon's Syndrome / 대한피부과학회지

Sneddon's syndrome is an infrequent neurocutaneous disorder of unknown origin. It is characterized by the combination of livedo reticularis and cerebrovascular accident. We present a 57-year-old male patient with livedo reticularis and cerebrovascular accident. Magnetic resonance imaging of the head showed a sign of acute focal infarctions in the right cerebellar hemisphere and right vermis. He had netlike patterned, mottled bluish discoloration on both legs. Histopathologic finding revealed elongation and fusion of rete ridges and mild thickening of dermal capillaries.

A Case of Cutaneous Bronchogenic Cyst / 대한피부과학회지

Cutaneous bronchogenic cyst is an anomalous structure that arises from the tracheobronchial tree during embryonic development and is usually located in the area of the manubrium sternum or suprasternal notch. Histopathologically, bronchogenic cyst is lined by ciliated pseudostratified columnar epithelia with goblet cells. We report a case of cutaneous bronchogenic cyst in a 25-year-old male patient presented as a nodular lesion on the neck.

A Case of Bullous Pemphigoid in infant / 대한피부과학회지

Bullous pemphigoid may, very rarely, occur in infants, although it is usually a bullous disease of the elderly which is characterized by subepidermal bullae on erythematous and normal skin. We describe an infant with severe subepidermal blistering disorder with typical features for bullous pemphigoid.

A Case of Job's Syndrome / 대한피부과학회지

The Job's syndrome is a relatively rare primary immunodeficiency disorder characterized by recurrent staphylococcal infection and abscess formation, defective neutrophil chemotaxis, and markedly elevated serum IgE level. Clinical features are atopiclike dermatitis, furunculosis, paronychia, pulmonary bacterial pneumonia etc. We reported a case of Job's syndrome in a 12-year-old girl who had recurrent pneumonia, scaly pruritic dermatitis, fissured tongue, and nail dystrophy with elevated serum IgE level.

Attachment and Growth of Cultured Fibroblasts on Chitosan Sponge

Closure of large skin wounds with split-thickness skin graft requires extensive harvesting of autologous skin. The limitation of available donor areas has sought various kinds of skin equivalents for coverage of skin defects. Concept of living skin equivalent using fibroblast and keratinocyte is the most promising one. For seeking ideal artificial skin, we conducted a research of new dermal alternative using chitosan. Fibroblast scattered on chitosan and chitosan-collagen sponge polymers were cultured for 3 weeks and chitosan and chitosan-collagen sponge polymers were grafted on the back of 250 gm Sprague-Dawley rat. There was statistically significant difference in fibroblast attachment as well as fibroblast proliferation between chitosan and chitosan-collagen sponge. Four weeks after grafting, the grafted area was examined. In the area of chitosan sponge graft, there was no clinical sign of inflammation. However, mild inflammatory infiltration and a few multinucleated giant cells were observed. In contrast, chitosan-collagen sponge grafted area showed no foreign body reaction clinically and histologically. In conclusion, concomitant use of chitosan and collagen resulted in better fibroblast attachment and proliferation and minimal immunologic reaction than chitosan sponge.

Direct Cytotoxicity of Interferon-gamma (IFN-gamma) on Renal Cell Carcinoma Cell Line / 대한비뇨기과학회지

No abstract available.

A Case of Letterer-Siwe Disease in Adult / 대한피부과학회지

Letterer-Siwe disease is a one of Langerhans cell histiocytosis and characterized by proliferation of Langerhans cells. It's clinical features are onset of infancy, hemorrhagic crusted papules and petechiae, hepatomegaly, lymphadenopathy, localized bone defect, and fatal outcome. We report a 38-year-old woman with hepatomegaly, lymphadenopathy, scaly papules and petechiae on the trunk. The eletronmicroscopy showed a tennis racquet shaped Birbeck granules in cytoplasm of histiocyte. Systemic treatment with etoposide, cyclophosphamide, prednisone, and vincristine was effective.

Conticocancellous Iliac Bone Graft and Fibrin Sealant for Alveolar Cleft

Secondary bone grafting of the maxilla in the mixed transitional dentition stage has become a well accepted procedure in the surgical protocol for rehabilitation of patients with residual alveolar clefts. In our retrospective study we documented the excellent long term results obtained with iliac bone graft. For closure of alveolar cleft authors used combined corticocancellous bone of ilium with fibrin sealant on 54 children patients since 1994. The mean age of bone grafted patients was 6 years old. All patients were followed up from 6 to 48 months. Following exact assessment of the amount of bony defect was carried out through clinical and radiologic study including 3 demensional CT, sufficient amount of corticocancellous iliac bone onlay graft along the piriform aperture in addition to cancellous component inlay graft was carried out. Tooth eruption rate obtained from our method was 100%. In our studies, we experienced excellent results in terms of cleft closure, tooth eruption, bone incorporation and external nasal appearance.

Risk Factors of Primary Nocturnal Enuresis

Urinary cytology has become an essential element in the diagnosis and management of transitional cell carcinoma(TCC) of the urinary tract. It has the advantage of being noninvasive, inexpensive, and easily accessible. Besides that it can even detect malignancy when unsuspected at cystoscopy. We report a retrospective review of urine cytology in the diagnosis of 83 TCC cases that underwent 295 cytologic evaluation. All patients had biopsy-proven TCC of the bladder, ureter and renal pelvis. The overall inci- dence of the positive cytology cases was 66.2%. To define the cytologic features of tumor cells, we tried to use three cytologic gradings such as "grade 1", "grade 2", and "grade 3" according to the cytologic degree of anaplastic neoplastic cells. These cytologic gades of TCC were relatively well correlated with the histologic grade and tumor invasiveness. This result suggests that the recognition of characteristic cellular features of TCC can suspect the histologic grade and tumor stage. The false negative TCC cases were 78.9%. They showed severe inflammatory or bloody background and a few neoplastic cells. Therefore, a cautious approach for accurate interpretation, personal experience, and proper fixation and processing could expand the role of urinary cytology.

Correction of Cleft Lip Nasal Deformity in Secondary Unilateral Cleft Lip Tip-Plasty

Many operative techniques for the repair of cleft lip nasal deformities have been reported. However, the situation with regard to nasal deformity is less satisfactorily understood than lip deformity, in which we have experienced significant improvement led by enhanced understanding of the total anatomic deformity of the primary cleft lip and the consequent refinement of surgical techniques. Our purposes in tip plasty are the restoration of nasal tip symmetry and correction of the obtuse angle of the cleft side nostril. Additionally, an inconspicuous scar is one of the merits of our method. The alar cartilage war exposed through both the alar rim and transcolumella incision, and then interalar loose connective tissue based superiorly was dissected and elevated. Cleft side alar cartilage was cross-hatched(Lipsett technique) on the deformed dome and relocated superomedially by a 4-0 vicryl fixation suture. The elevated intera1ar loose areolar tissue was used for augmentation of the alar dome. Conchal cartilage graft on cleft side dome and septoplasty were carried out in cases of specific necessity. We have performed this procedure in 19 patients, aged between 15 to 19. Average follow-up period was one year. Results have been rated good to excellent by patients and surgeons. There has been no recurrence of this deformity.

Spontaneous Fracture of a Lumboperitoneal Shunt Catheter: A Case Report

Spontaneous fracture of the Silastic shunt catheter is a rare complication of lumboperitoneal shunt. A review of the literature revealed only one case in which spontaneous fracture occurred after this procedure. The authors report a case in which fracture of a lumboperitoneal shunt catheter occurred within the interspinous ligament probably due to repeated tension caused by flexion and extension during lumbar motion. The fractured proximal catheter was located entirely within the intrathecal space exclusively from the level of L1 to S1, and caused incomplete cauda equina syndrome.

A Case of Uric Acid Nephropathy as first presentation of Acute Lymphoblastic Leukemia / 대한내과학회지

Acute uric acid nephropathy is a kind of acute renal failure and results from uric acid crystal deposition within the collecting ducts and the distal tubules due to rapid increase of serum uric acid concentration. Hyperuricemia can be, in the relation to the underlying physiology, clas sified into the three categories. i.e., increased urate pro duction, decreased uric acid excretion, or a combination of the two. It is most commonly presented in the lympho proliferative or myeloproliferative disorders after effective cytolytic chemotherapy in the form of tumor lysis syn drome. But we have recently experienced a case of a 73 year-old female patient with acute lymphoblastic leuke mia whose first presentation was acute uric acid nephrop athy, spontaneously developed without chemotherapy and so report it with review of related literatures.