Death and Survival of Patients with Hansen's Disease in Colonial Korea / 의사학

The purpose of this research is to describe how Hansen's disease patients experienced the modern system of control of Hansen's disease introduced by Japan, and the inimical attitude of society against them in colonial Korea. The study also seeks to reveal the development of the system to eliminate Hansen's disease patients from their home and community to larger society and leprosarium in this era. Sorokdo Charity hospital (SCH), a hospital for Hansen's disease patients, was built in 1916, and vagrant Hansen's disease patients began to be isolated in this hospital beginning in 1917 by the Japanese Government-General of Korea (JGGK). Once the police detained and sent vagrant Hansen's disease patients to SCH, stigma and discrimination against them strengthened in Korean society. Because of strong stigma and discrimination in Korean society, Hansen's disease patients suffered from daily threats of death. First, their family members were not only afraid of the contagiousness of Hansen's disease but also the stigma and discrimination against themselves by community members. If a family had a Hansen's disease patient, the rest of community members would discriminate against the entire family. Furthermore, because Hansen's disease patients were excluded from any economic livelihood such as getting a job, the existence of the patients was a big burden for their families. Therefore, many patients left their homes and began their vagrancy. The patients who could not leave their homes committed suicide or were killed by their family members. The victims of such deaths were usually women, who were at the lower position in the family hierarchy. In the strong Confucian society in Korea, more female patients were killed by themselves than male patients. Moreover, all of patients victims in the murder were women. This shows that the stigma and discrimination against Hansen's disease patients within their families were stronger against women than men. Strong stigma and discrimination made the patients rely on superstition such as cannibalism. Patients believed that there were not any effective medicine. There were a few reports of patients who were cured, and many were treated with chaulmoogra oil in the modern Hansen's disease hospitals. Eating human flesh was known as a folk remedy for Hansen's disease. As such, patients began to kill healthy people, usually children, to eat their flesh. Increased stigma led to increased victims. Hansen's disease patients who left their homes faced many threats during their vagrancy. For survival, they established their own organizations in the late 1920's. The patients who were rejected to be hospitalized in the Western Hansen's disease hospital at Busan, Daegu, and Yeosu organized self-help organizations. The purpose of these organizations was first to secure the medicine supply of chaulmoogra oil. However, as stigma and discrimination strengthened, these organizations formed by Hansen's disease patients demanded the Japanese Government-General of Korea to send and segregate them on Sorok island. They did not know the situation of the inside of this island because news media described it as a haven for patients, and very few patients were discharged from this island to tell the truth. On this island, several hundreds of patients were killed by compulsory heavy labor, starvation, and violence. They were not treated as patients, but as something to be eliminated. Under strong suppression on this island, the patients resisted first by escaping this island. However, in 1937, some patients tried to kill a Korean staff but failed. Attempted murderers were all put in the jail, also located on this island. In 1941, a patient murdered another patient who had harassed other patients, and in 1942, Chunsang Lee, a patient, killed the director of Sorok island. These instances show that there was a system to eliminate Hansen's disease patients in colonial Korea.

Repetitive Transcranial Magnetic Stimulation for Wernicke-Korsakoff Syndrome: A Case Report

A 57-year-old man who was diagnosed with Wernicke-Korsakoff syndrome showed severe impairment of cognitive function and a craving for alcohol, even after sufficient supplementation with thiamine. After completing 10 sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS) at 100% of the resting motor threshold over the left dorsolateral prefrontal cortex, dramatic improvement in cognitive function and a reduction in craving for alcohol were noted. This is the first case report of the efficacy of a high-frequency rTMS in the treatment of Wernicke-Korsakoff syndrome.

Therapeutic Experience in a Patient with Complex Regional Pain Syndrome Related to Brachial Plexitis: A case report

We report our therapeutic experience in a patient with complex regional pain syndrome (CRPS) related to brachial plexitis. A 16-year-old female suffered from excruciating burning pain and allodynia abruptly developed on left shoulder. Cervical MRI was normal. Electrodiagnostic findings were compatible with acute brachial plexopathy. Hand swelling, dystrophic color change, desquamation, and anhidrosis were displayed. Three-phase bone scan revealed increased radio-uptake on left upper extremity. The course of the disease was slowly progressive with wax and wane pattern. Pain became gradually intractable to all therapeutic modalities and medications. She gradually improved with long-term multimodal pain management. After 2 years of disease-free period, CRPS recurred and the extent was more severe than the first attack. We tried oral mexiletine, risedronate, high dose multi-vitamin, and leukotriene modulator which were effective in reducing pain and allodynia. Hand swelling gradually subsided and functional regain was obtained.

The Effect of Thermo-undulation Therapy on the Patients with Chronic Low Back Pain

OBJECTIVE: To verify the effect of thermo-undulation therapy on the patients with chronic low back pain. METHOD: 115 patients with back pain (mean age: 51.2 year-old; male, female: 46, 69) were recruited. Experimental group (n=85) was subjected to thermo-undulation therapy for 30 minutes, once a day, five days a week during eight weeks and control group (n=30) was administered with sham procedure. Before and after the therapy, range of motion (ROM) the spine and flexibility of lower extremity muscles were evaluated with goniometry. The functional status was measured by Roland Morris disability questionnaire and quality of life was measured by the SF-36 (36-Item Short Form Health Survey Instrument) and SF-12 scales. The STAI-6 (Spielberger State-Trait Anxiety Inventory) was used for anxiety. We checked the intensity of pain by visual analog scale (VAS) and evaluated the effect of far-infrared ray with Digital Infrared Thermographic Imaging (DITI) technique. RESULTS: After therapy, the scores of muscle flexibility, spine ROM, VAS, Roland Morris disability questionnaire, SF-36, SF-12 and STAI-6 showed a tendency to improve in experimental group (p0.05). Only the temperature differences of experimental group by DITI were significantly lower than those of control group (p<0.05). CONCLUSION: Thermo-undulation therapy may be an adjuvant therapy for chronic low back pain.

Pain Evaluation with Surface Electromyography in Temporomandibular Myofascial Pain Dysfunction Syndrome

OBJECTIVE: To investigate usefulness of surface electromyography (sEMG) for the pain evaluation in the patients with temporomandibular myofascial pain dysfunction syndrome (TM-MPDS). METHOD: Twenty unilateral TM-MPDS patients (10 males, 10 females, duration of disease 6.6+/-5.6 months, age 28.5+/-3.0 years) and twenty healthy controls (10 males, 10 females, age 30.1+/-6.2 years) were recruited for this study. The patients were treated with trigger point injection therapy and cryotherapy once a week, and ultrasound thermotherapy four times a week for 2 weeks. Active electrodes were attached on temporalis and masseter muscles with reference electrode on chin and ground electrode on forehead. All of subjects were instructed to clench teeth for 5 seconds after full relaxation. For temporalis and masseter muscles, the amplitudes of clenching-EMG activities were obtained and the mean value of five biting cycles was calculated on both sides. sEMG, visual analog scale (VAS) and asymmetry index (AI) were assessed before and 2 weeks after treatment. RESULTS: For temporalis and masseter muscles, the amplitudes of affected side-EMG activity significantly decreased, and the AI of the patient group significantly increased compared with those of the control group (p<0.05, p< 0.05). The AI of the patient group significantly decreased after treatment (p<0.05, p<0.05). Higher AI in masseter muscle before treatment was significantly correlated with lower VAS after treatment (r=-0.487, p<0.05). CONCLUSION: It is suggested that sEMG would be useful for diagnosing and evaluating the pain in TM-MPDS.

Adult-onset Still's Disease with Dysphagia: Case report

We experienced a case of adult-onset Still's disease with dysphagia of soft tissue origin. A 38-year-old woman was admitted for intermittent high spiking fever, diffuse pain and swelling on anterior neck with dysphagia. Physical examination revealed a thin woman with trismus, board-like hardness of anterior neck, hepatomegaly, and erythematous evanescent rash on leg. Neck CT displayed bilateral cervical lymphadenopathy with soft tissue swelling, and tonsilitis. Chest and abdomen CT showed the inflammatory changes of multiple organs. Laboratory evaluation revealed neutrophilic leukocytosis, slightly increased alanine transaminase, negative antinuclear antibody and rheumatoid factor, and increased inflammatory markers. Skin, liver, colon, and pleural biopsy demonstrated the chronic inflammation. Videofluoroscopic swallowing study revealed laryngeal penetration with large amount residue in vallecular space and pyriform sinus, and incomplete cricopharyngeal relaxation. Gradual improvement in anterior neck pain and pulmonary edema and the decrease of effortful and multiple swallowing were observed with high dose steroid therapy.

Clinical Implication of Natriuretic Peptides and Left Atrial Volume for the Screening Methods of Advanced Diastolic Dysfunction in the Community

BACKGROUND: Recently, B-natriuretic peptide (BNP) level and left atrial volume index (LAVi) were known to correlate with indices of LV diastolic function. As a screening method, we tried to evaluate the efficacy to BNP, ANP, and LAVi to predict the advanced diastolic dysfunction that means myocardial relaxation abnormality and elevated LV filling pressure. METHODS: In 100 patients who referred for echocardiography, Doppler recording of the mitral inflow and tissue Doppler imaging of the mitral annulus were obtained and classified into 4 diastolic function grades (normal, impaired relaxation, pseudonormal, and restrictive). Advanced diastolic dysfunction was defined as pseudonormal and restrictive physiology. LAVi was measured by modified Simpson's method in apical 4-chamber view at end-systole. Plasma levels of BNP and ANP were measured on the same day as echocardiogram was done. RESULTS: BNP and ANP levels were increased as diastolic function grade was worsening (BNP : 60+/-92, 108+/-204, 778+/-1,023 and 1,426+/-1,421 pg/ml, p<0.001; ANP: 22+/-30, 23+/-26, 94+/-92, 96+/-61 pg/ml, p<0.001). LAVi was also increased as diastolic dysfunction was advanced: 24+/-7 ml/m2, 27+/-9 ml/m2, 37+/-12 ml/m2, 45+/-12 ml/m2, p<0.001. The areas under the curve of receiver-operator characteristic curve for BNP, ANP and LAVi to detect the advanced diastolic dysfunction were 0.91, 0.88 and 0.84, respectively. BNP of 137 pg/ml, ANP of 34 pg/ml, and LAVi of 30 ml/m2 were the best values of sensitivity and specificity, respectively. CONCLUSION: These data suggest that BNP, ANP and LAVi provide meaningful sensitivity and specificity for the detection of advanced diastolic dysfunction, respectively. Among these, BNP is better than ANP or LAVi for the screening method to predict the advanced diastolic dysfunction.

The Effect of Biofeedback Treatment in Children with Spastic-Diplegic Cerebral Palsy

OBJECTIVE: To investigate the effect of electromyography (EMG)-biofeedback treatment in children with spastic-diplegic cerebral palsy. METHOD: Twenty patients with spastic diplegia, who could recognize the auditory and visual stimulation, were recruited. Ten patients underwent EMG-biofeedback treatment with neurodevelopmental treatment (NDT) for 12 weeks, 3 times a week, total 1 hour a day, but age-, sex- and functional-matched ten controls underwent only NDT. Before and after the treatment, active range of motion, spasticity, muscle strength and Functional Independence Measure for Children (WeeFIM) and Gross Motor Function Measure (GMFM) were measured. RESULTS: In experimental group, there was a significant increase in active range of motion of hip and ankle joints (p0.05). Muscle strength of ankle dorsiflexor and hip extensor muscles was significantly improved (p<0.05). WeeFIM and GMFM scores significantly increased in an experimental group (p<0.05). CONCLUSION: EMG-biofeedback treatment in children with spastic-diplegic cerebral palsy might be an effective adjuvant to NDT through the muscle reeducation.

PPAR-gamma Agonist Attenuates Myocardial Fibrosis in a Type 2 Diabetic Rat Model

BACKGROUND AND OBJECTIVES: Receptor for advanced glycosylation end product (RAGE) plays an important role in the development of myocardial fibrosis in diabetics. Activation of peroxisome proliferator activated receptor (PPAR)-gamma agonist, rosiglitazone, reduces the RAGE expression. We investigated whether rosiglitazone could prevent left ventricle (LV) diastolic dysfunction and attenuate the myocardial fibrosis in a type 2 diabetic rat model. MATERIALS AND METHODS: Otsuka Long-Evans Tokushima Fatty (OLETF) rats were treated with rosiglitazone (20 mg/kg/d) for 20 weeks. At the age of 20 and 40 weeks, all rats underwent intraperitoneal glucose tolerance tests, hemodynamic studies and Doppler echocardiography. At the age of 40 weeks, the hearts were examined by performing histopathological and immunohistochemical analyses. RESULTS: At the age of 40 weeks, rosiglitazone significant improved the parameters of the LV diastolic function such as the E/A ratio (treated vs. untreated: 1.7+/-0.1 vs. 1.5+/-0.1, p<0.05), the deceleration time and the isovolumic relaxation time in the OLETF rats, and this was correlated histologically to the reduced LV collagen volume fraction in the rosiglitazonetreated OLETF rats (3.2+/-1.3% vs. 5.7+/-2.0%, respectively, p<0.001). Rosiglitazone also significantly reduced the percentage of staining of the LV CTGF (7.4+/-2.5% vs. 15.4+/-4.7%, respectively, p<0.001) and RAGE (1.1+/-0.4% vs. 2.0+/-0.8%, respectively, p<0.001), as compared with the untreated OLETF rats. CONCLUSION: These results suggest that rosiglitazone could prevent LV diastolic dysfunction and attenuate myocardial fibrosis in type 2 diabetic rats by its inhibition of the RAGE and CTGF expression. PPAR-gamma agonist may provide a potential therapeutic approach for diabetic heart disease.

Relationship of QT Dispersion to Echocardiographic Left Ventricular Function, Dimension and Mass in Patients with Coronary Artery Disease

BACKGROUND: Previous studies showed that increased QT dispersion has been observed during episodes of myocardial ischemia or infarction and identified the patients at risk of arrhythmia or sudden death. The aim of this study was to investigate the relation between QT dispersion and left ventricular (LV) function (systolic and diastolic), dimension and mass as well as to analyze the differences of this relationship according to the extent of angiographic coronary stenosis in patients with coronary artery disease. METHODS: The study population included 262 patients (male 129, female 133;average age 60 years). Echocardiography was done for the measurement of left ventricular function, dimension and mass on admission. Electrocardiography for QT and QTc (corrected QT) dispersion were recorded 25 mm/sec paper speeds before the coronary angiography. Patients were divided into two groups; Group A where angiographic coronary stenosis or =50%. RESULTS: The results were as follows: 1) QT dispersion was higher in those with depressed LV systolic function (EF or =50%) of the coronary artery were independent prognostic factors of prolonged QT dispersion (p<0.05). 6) QTc dispersion showed the same result as QT dispersion. CONCLUSION: LV systolic function (EF), some diastolic function (IVRT), dimension (LVDd, LVDs, LAD IVS), and mass are associated with the increased QT dispersion in patients with coronary artery disease, especially minimal angiographic stenosed (<50%) patients. So, we consider echocardiography is an important tool to predict the QT dispersion in patients with coronary artery disease.

Incidence of amiodarone-induced thyroid dysfunction in Korean / 대한내과학회지

BACKGROUND: Amiodarone is an effective antiarrhythmic agent, but it is used restrictively due to several side effects. Amiodarone has been caused thyroid dysfunction, thyroid hyperfunction or hypofunction in several clinical studies. In this study, we assessed the clinical features, frequency and nature of thyroid dysfunction in patients with amiodarone therapy METHODS: A total of 150 patients (Male;n=71, Female;n=79) was assessed. They had never had the history of thyroid disease and had been received amiodarone therapy. All the patient's medical records on therapeutic dose and duration, body weight, height, body mass index and thyroid function test were reviewed. Patient's underlying diseases were supraventricular arrhythmia (n=54) and ventricular arrhythmia (n=96). The dose of amiodarone was between 100 mg and 400 mg, and the mean duration of therapy was 36 months. We defined decreased TSH with elevated T3 and T4 as thyrotoxicosis, and elevated TSH as hypothyroidism RESULTS: Thyroid dysfunction was observed in 56 (37.3%) patients and their mean body mass index (BMI) was 23.6 kg/m2. Of them, thyrotoxicosis and hypothyroidism were observed in 5 (3.3%) patients and 51 (34%) patients, respectively. The difference of sex in hypothyroidism was almost not visible (male;n=24, female;n=27), also the correlation with BMI and thyroid function was not (mean BMI=23.7 kg/m2). Amiodarone was maintained for 46 months in hypothyroidism patients, that was more longer duration than normal thyroid patients (30 months). CONCLUSION: In korean patients with amiodarone therapy, one third patients presented thyroid dysfunction and most of them were hypothyroidism. No correlation was found between thyroid dysfunction and sex and BMI. Hypothyroidism prevalances in patients with long duration of amiodarone therapy, but high dose therapy may induce thyrotoxicosis.

Joubert Syndrome with Severe Hypotonia: A case report

Joubert syndrome first described by Joubert et al. in 1969 is a very rare congenital disorder, characterized by episodic hyperpnea, abnormal eye movement, hypotonia, ataxia, and mental retardation. This syndrome generally represents as autosomal recessive inheritance and main neuropathological finding is agenesis or aplasia of the cerebellar vermis. This patient represents significant generalized muscle hypotonia which is not affected by any other tone-modifying maneuvers. And so there is no significant neuromotor improvement with neurodevelopmental treatment such as Bobath method, Vojta method, or proprioceptive nerve facilitation technique and so on. We report the Joubert syndrome showing typical features with delayed development.

Delayed Cerebral Infarction after Resection of Craniopharyngioma

Delayed cerebral infarction after resection of craniopharyngioma is a uncommon entity, but leads to high morbidity and mortality. We present 3 such cases and discuss the etiology and pathogenesis with review of pertinent literatures. In our cases, delayed deterioration of consciousness was observed in all cases. All of them expired. The cause may be multifactorial and the surgical approach may contribute to the pathogenesis of delayed cerebral infarction. We suspect vasospasm might be the major mechanism of pathogenesis. Vessels were primed to spasm during operation due to blood in the cistern or mechanical injury. Vasoactive materials may have been liberated from the pituitary stalk or injured hypothalamus, either at the time of surgery, or later, after portions of tumor have undergone necrosis. The high degree of suspicion to detect vasospasm should be done in the case of the delayed deterioration of mental status at an early stage of craniopharyngioma surgery. Possible mechanism underlying this delayed cerebral infarction are discussed.

Correlation of the Time Interval from the Peak of Mitral E Wave to the Peak of Pulmonary Venous D Wave with Mitral Doppler Indexes

BACKGROUND: Pulmonary venous diastolic flow follows the pattern of mitral flow and is dependent on the pressure difference between the pulmonary vein and the left atrium (LA). The magnitude of the decrease in LA pressure in early diastole depends on both the volume of the blood leaving the LA and the stiffness of the left ventricle (LV) and the LA. Relaxation process is known to govern early diastolic compliance. We hypothesized that in patients with decreased early diastolic compliance due to LV relaxation abnormality, there may be rapid rise in LV and LA pressure, resulting in early peak of pulmonary venous D wave as early LV diastolic filling progress. This study was undertaken to define this hypothesis and to examine the relation of the time interval between E wave peak and D wave peak to mitral doppler indexes. METHOD: Patients with significant mitral or aortic valvular disease, or patients with LV ejection fraction below 60%, or patients who have pseudonormal or restrictive LV filling pattern on mitral and pulmonary venous Doppler, were excluded from this study. Mitral Doppler indexes including peak E velocity, peak A velocity, E wave acceleration time (EAT) and deceleration time (EDT) were measured. E/A ratio was calculated. The isovolumic relaxation time from aortic valve closure (Ac) to the onset of E wave , the time interval from Ac to the peak of E wave (AcE), the time interval from Ac to the peak of D wave, and the diastolic time from Ac to R of electrocardiogram (AcR) were measured by the pulsed wave Doppler and phonocardiography. The time interval from the peak of E wave to the peak of D wave (ED) was calculated by the subtraction of AcE from AcD. RESULTS: 1) ED is significantly shorter in patients with E/A or =1 (58.9+/-27.4 msec versus 74.7+/-17.2 msec, p<0.05). 2) ED correlated with IVRT (r=-0.400, p<0.01), AcR (r=0.414, p<0.01), but not with E/A ratio, EDT, or EAT. 3) Multivariate linear regression analysis with all the previously mentioned variables showed that IVRT, AcR, and EAT were independent determinants of the ED. CONCLUSION: This study demonstrates that the ED is shortened in patients who are regarded as having LV relaxation abnormality and that ED is affected by IVRT, AcR, and EAT.

Effect of Changes in Pulmonary Venous Flow Pattern by Preload Reduction on Distinguishing Pseudonormal Pattern from Normal

BACKGROUND AND OBJECTIVES: The degree of diastolic dysfunction may explain the difference in clinical symptoms between patients with similar degrees of systolic dysfunction. Pseudonormal mitral filling pattern with increased left ventricular filling pressure is a transitional stage of diastolic dysfunction and is difficult to distinguish from normal. Preload is one of factors affecting the diastolic filling patterns and mitral flow patterns may be influenced by changes in preload in the absence of changes in the left ventricular pressure-volume curve. The changes in the mitral flow velocities caused by preload reduction may be useful in distinguishing patients with a pseudonormal pattern from those with normal. The aim of this study was to establish whether the effect of changes in pulmonary venous flow pattern by preload reduction may be useful in distinguishing pseudonormal pattern from normal. MATERIALS AND METHODS: This study included 40 patients (men 25, female 15, average age 51.0+/-11.2 years) underwent left side cardiac catheterization among patients with normal or pseudonormal patterns. All patients with pseudonormal group had increased LVEDPr (>15 mmHg). The Doppler mitral inflow & pulmonary venous flow parameters at baseline and during reduction of preload using Valsalva maneuver were recorded. RESULTS: 1) There were no difference in sex, diabetes mellitus, hypertension and lipid profiles between both groups. The left ventricular systolic function was better and mean age was younger in normal than pseudonormal group (p 1.0 during Valsalva maneuver in normal group (p<0.05). In pseudonormal group, E velocity was significantly decreased but A velocity was not significantly changed and the E/A ratio was <1.0 during Valsalva (p<0.05). Therefore the change revealed masked LV relaxation abnormality pattern. 3) S and D velocities of pulmonary venous flow were significantly decreased and S/D ratio was significantly increased in both groups (p<0.05). The % changes before and after Valsalva maneuver showed that S velocity was less decreased, D velocity was more decreased and S/D ratio was more significantly increased in pseudonormal than normal group (p<0.05). That revealed masked LV relaxation abnormality pattern. CONCLUSIONS: The Valsalva maneuver for preload reduction is a relatively simple, easily applicable, safe and reproducible method of acutely reducing venous return. The assessment of changes in pulmonary venous flow pattern by preload reduction may be helpful in distinguishing pseudonormal and normal diastolic function in addition to changes in mitral inflow pattern.

Evaluation of Left Ventricular Diastolic Function in Coronary Artery Disease by Transthoracic Doppler Ultrasound Measurement of Mitral and Pulmonary Venous Flow Velocities

BACKGROUND: A widened left atrial pressure A wave occurs when left ventricular end-diastolic pressure is increased. It has been reported that increased duration of pulmonary venous flow reversal at atrial systolic pulmonary venous flow is shown to be related to increased left ventricular filling pressure in studies using transesophageal Doppler echocardiography. We evaluate the correlation between LVEDP measured by the invasive method and the mitarl and pulmonary venous flow index recorded by transthoracic Doppler echocardiography. METHODS: Left ventricular pressures at late diastole were measured by fluid-filled catheters in 70-consecutive coronary heart patients undergoing diagnostic cardiac catheterization. Pulmonary venous and mitral flow velocities were recorded by transthoracic pulsed Doppler ultrasound. Adequate recordings were obtained in the 70 patients. Diastolic function differentiated into four categories . RESULTS: Pulmonary venous flow reversal exceeding the duration of the mitral A wave predicted left ventricular end-diastolic pressure > or = 18mmHg with a sensitivity of 0.78 and a specificity of 0.95. Pulmonary venous flow reversal duration (PVad) exceeding 140msec predicted left ventricular end-diastolic pressure > or = 18mmHg with a sensitivity of 0.89 and a specificity of 0.93. This difference in flow duration (PVad-Ad, deltad) correlated well with increased LVEDP (r=0.537, p<0.001). PVad also correlated with increased LVEDP (r=0.503, p<0.001). CONCLUSIONS: If pulmonary venous flow reversal (PVad) exceeds both the duration of the mitral A wave and 140msec, it indicates an exaggerated increase in left ventricular end diastolic pressure.

The Effect of L-arginine on Neointima Formation in a Rat Vascular Injury Model

BACKGROUND: The inhibitory effects of nitric oxide(NO) on platelet adhesion and vascular smooth muscle cell(VSMC) proliferation may have a possible role inhibiting development of neointima following balloon catheter induced injury. We tested the hypothesis that L-arginine, the precursor of NO, would attenuate neointima formation following balloon catheter induced injury via regulation of antagonistic balance between proliferation and apoptosis of VSMC. METHODS: Adult, male Sprague-Dawley rats(300 to 400g) were anesthetized with ketamine (100mg/kg intraperitoneally). The left common and external carotid artery were exposed. For endothelial denudation, 2mm angioplasty catheter was introduced through the left external carotid artery into the left common carotid artery. The catheter was inflated at I atm. and withdrawn three times. Animals were randomized to receive 2.25% L-arginine in their drinking water(n=14) or placebo(n=16) from 2 days prior to and 9 days following denudation. VSMC proliferation was quantified by immunohistochemical staining with an antibody to the proliferating cell nuclear antigen(PCNA). The cells undergoing apoptosis were identified by terminal nucleotidyl transferase-mediated nick end labeling(TUNEL) method and morphologic changes by computerized planimetry and transmission electron microscopy. RESULTS: 1) The neointimal area in injured arteries were significantly reduced in L-arginine supplemented animals compared with placebo group(p<0.05). 2) L-arginine administration significantly reduced the number of PCNA positive cells in neointima when compared with placebo at 9 days(p<0.05). 3) Positive TUNEL cells were not influenced by L-arginine supplementation. 4) On transmission electron microscopy, there were no cells showing characteristics of apoptosis in neointima. CONCLUSION: These results suggested that the inhibitory effect of L-arginine on neointima formation is due to reduced VSMC proliferation, but is not due to increased VSMC apoptosis at the early time period after initmal injur .

Systolic Time Interval in Cardiac Pacing: Comparison of Atrioventricular, Ventriculoatrial and Ventricular Pacing

Permanent electrostimulation is the therapy of choice for syncope due to bradycardic rhythm disturbance. In maintaining optimal hemodynamic function, the role of atrial systole has been well recorgnized and the time relationship between atrial and ventricular systole have great relation with cardiac output. Assessment of optimal mode of cardiac pacing by nonivasive method is very important for the best hemodynamic effect. To evaluate the usefulness of systolic time interval for optimal pacing mode, we calculated systolic time interval by using ventricular pacing spike on electrocardiogram to aortic opening time/left ventricular ejection time by aortic pressure curve (invasive PEP/LVET) in various modes of cardiac pacing and measured cardiac output by thermodilution method simultaneously in 9 mongrel dogs. Basal pacing cycle length were 300 msec, and the atrioventricular (AV) and ventriculoatrial (VA) interval during AB & VA sequential pacing were set at 30 msec, 60 msec and 90 msec. The result were as follows: 1) The cardiac output at AV interval of 90 msec (1.65+/-0.23 L/min) is significantly higher than 30 msec (1.38+/-0.19 L/min) in AV sequential pacing. 2) The cardiac output in ventricular pacing is higher than VA sequential pacing, but no significant changes noted among VA interval 90 msec, 60 msec and 30 msec. 3) The invasive PEP/LVET at VA interval of 90 msec (0.85+/-0.17) is significantly lower than 60 msec (0.97+/-0.16) and 30 msec (1.01+/-0.16) in AV sequential pacing. 4) The invasive PEP/LVET among VA sequential pacing with 90 msec, 60 msec, 30 msec interval and ventricular pacing did not show any significant difference. 5) When AV interval changes from 90 msec to 30 msec during AV sequential pacing, cardiac output decreased and invasive PEP/LVET increased. 6) In VA sequential pacing, there were no changes of cardiac output and invasive PEP/LVET when VA interval changes from 90 msec to 30 msec. In conclusion, systolic time interval can be used for estimation of hemodynamic changes during AV sequential pacing considering our results and other authors' results of high correlation between invasive & noninvasive PEP/LVET.

A Case of Complete A-V Block due to Intra-His Block

His bundle recordings enable us to diagnose conduction disturbances not discernable in the standard leads, and to localize conduction block in the subdivisions of the conduction system. Cases of intra-His bundle block were first reported in 1970 by Narula and Samet. Thereafter many additional reports and studies were made. We report a case of 3degrees A-V block due to conduction block at the His bundle level. A 71-year-old woman was admitted because of dizziness. Surface ECG showed 3degrees A-V block. His bundle electrogram revealed typical split His potential. A-H intervals were 80 msec and H'-V intervals 50~70 msec. And there found no relation between AH and H'A. Atrial pacing resulted only prolongation of A-H to 90 msec but dissociation between h and H' was consistent. We implanted a permanent endocardial pacemaker in her chest.

Changes in Serum Electrolyte and Osmolarity Following Transurethral Resection of the Prostate / 대한비뇨기과학회지

Transurethral resection of prostate is widely popular, effective and easily performable surgery with the least limitation. It is well known that absorption of the irrigant and its following events are the most important factors determining the condition of the patients postoperatively. We studied the changes in serum electrolyte and osmolarity following transurethral resection of prostate in 78 patients of benign prostatic hypertrophy. We divided the patients into two groups, A and B. group A: those were given non-electrolyte solution only during the operation. group B: those were given electrolyte solution during the operation. We compare the results of each group. We also observe the relationship of these results to the irrigating fluid volume, Operation time and resected weight. Following results were obtained. 1. Serum sodium concentration was decreased in 28 cases of group A (75.6%, avg. 5.96mEq/L). 2. Serum sodium concentration was decreased in 16 cases of group B (43.2%, avg. 5.18mEq/L). 3. Serum osmolarity was decreased in 18 cases of group A (75%, avg. 8.83mOsm/kg). 4. Serum osmolarity was decreased in 14 cases of group B (50%, avg. 6. 78mOsm/kg). 5. These changes in serum sodium concentration and osmolarity showed no significance statistically. 6. These changes in serum sodium concentration and osmolarity showed no significant correlation with the amount of irrigant, operation time and resected weight, statistically.