Anomalous origin of the right pulmonary artery from the ascending aorta: diagnosis by magnetic resonance imaging

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital anomaly. Magnetic resonance imaging (MRI) was performed on three patients with anomalous origin of the right pulmonary artery from the ascending aorta. ECG-gated, T1-weighted, spin-echo MRIs and cine MRIs were obtained. In one patient, postoperative MRI was also obtained. Echocardiography and cardiac catheterization were performed in three patients and angiocardiography was performed in two. MRI clearly showed anomalous origin of the right pulmonary artery from the posterior aspect of the ascending aorta, as well as combined anomalies including patent ductus arteriosus, aortopulmonary window, and interruption of the aortic arch in all three patients. Echocardiography missed this anomaly in all three. We suggest that MRI is an accurate imaging modality in diagnosing anomalous origin of the right pulmonary artery from the ascending aorta, obviating the need to perform angiocardiography.

Thrombolysis for obstructed CarboMedics mitral valve prosthesis

Prosthetic valve thrombosis, a rare but fatal complication, can be successfully treated with tissue-type plasminogen activator and monitored by transthoracic and transesophageal echocardiography.

[Western medical theory introduced first to Korea]

Western Medical Theory, subject of this thesis, was derived from physiological theory of western medical science which was inserted in the translation of Jesuit doctrine by Adam Schall, German, who had arrived in 1622 at Peiking, China, as Jesuit missionary. This was reproduced by Lee Ik (1682-1763) in his book titled "Sungho Saisul". Through the contents of this medical theory, therefore, one is able to test to what extend the physiological knowledge of western medical science was in 1622, that is the beginning of 17th century, and, moreover, one can tell what effect the introduction of this medical theory had upon practical use of medical art in our country. Historical investigation of the contents of this medical theory concludes as follows: ...

Liver metastases from colorectal carcinoma: incidence, resectability, and survival results

We studied 328 cases of colorectal carcinoma (stages I-IV) seen at our hospital during a 19-year period. We found that 15% of these had liver metastasis (LM) at initial diagnosis, and 14% developed LM after resection of their primary cancers. Among the 73 patients with LM, the lesion was confined to the liver (LM only) in 40 patients. Using our criteria of "resectability" of LM, 45% with LM only had resectable LM lesions, but only 15% (six patients) actually had hepatic resections. We had no operative death nor major complication. Five of the six patients with LM resected lived 3 years or longer, but none of the other 34 patients with LM only (either non-resectable or resectable but not operated on) lived more than 35 months. Although our series is relatively small, our data are consistent with results coming from other national and institutional studies. The controversies and issues relating to resection of colorectal liver metastasis are discussed.

Morphological evidence for the antiatherogenic effect of scoparone in hyperlipidaemic diabetic rabbits

OBJECTIVE

Scoparone (6,7-dimethoxycoumarin), a coumarin isolated from a hypolipidaemic Chinese herb Artemisia scoparia, has vasodilator and antiproliferative activities and possesses free radical scavenging properties in vitro. The aim of the study was to investigate the morphological effects of scoparone in the antiatherogenic process in vivo by using hyperlipidaemic diabetic rabbits as an animal model.

METHODS

Male New Zealand White rabbits were divided into three groups: control (normal), hyperlipidaemic diabetic, and scoparone treated hyperlipidaemic diabetic. The plasma concentration of total cholesterol and triglycerides were determined. The thickness of the tunica intima was measured on paraffin sections of the aortas stained with Movat's pentachrome. The aortic samples were also processed for scanning and transmission electron microscopy.

RESULTS

Neither the lipid profile in the plasma nor the structures of the aortic wall from the control group showed abnormalities. In contrast, the aortas from the hyperlipidaemic diabetic group showed prominent atherosclerotic plaques. Large numbers of monocytes were found adherent to the luminal surface and a markedly thickened intima filled with many lipid laden foam cells was clearly observed. By comparison, the scoparone treated group showed less advanced atherosclerosis with a lower plasma cholesterol. In the scoparone treated rabbits, the proportion of the aortic surface area covered with macroscopic plaques was 30%, and the thickness of the tunica intima 17%, of that of the non-scoparone treated hyperlipidaemic diabetic rabbits.

CONCLUSIONS

Scoparone has an antiatherogenic action in hyperlipidaemic diabetic rabbits.

Diagnosis of coronary artery disease using dipyridamole thallium-201 imaging

Dipyridamole thallium-201 imaging, using single-photon emission computed tomography, was evaluated for its safety and diagnostic efficacy in 109 patients with angiographically documented coronary artery disease and 35 normal subjects. The most common side effects after the intravenous administration of dipyridamole thallium-201 (0.56 mg/kg) included chest pain in 41 patients, dizziness in 20 patients, headache in 16 patients, and ST segment depression > or = 1 mm in 15 patients. Aminophylline was required to reverse the side-effects in 46 patients, and 45 of the 46 patients experienced complete relief of symptoms. Of the 109 patients with coronary artery disease, 104 had abnormal dipyridamole thallium images. The per patient sensitivity was 95%. Of the 35 normal subjects, 27 had normal thallium images. The per patient specificity was 77%. The sensitivity and specificity for the individual vessels were 84% and 87% for the left anterior descending artery, 67% and 97% for the left circumflex artery, and 89% and 85% for the right coronary artery, respectively. Dipyridamole thallium-201 imaging is a relatively safe noninvasive method and is an effective alternative to exercise thallium-201 scintigraphy for the diagnosis of coronary artery disease.

Maternal role in type 2 diabetes mellitus: indirect evidence for a mitochondrial inheritance

BACKGROUND

The role of mitochondrial inheritance in type 2 diabetes mellitus has received much attention recently. In this study, three existing datasets in Taiwan are analysed to examine this theory.

METHODS

Two of the datasets were community surveys and one a hospital case series. Subjects who had information regarding their paternal or maternal diabetic status were selected for the present study. In the first dataset, 745 subjects had information about paternal diabetic status and 765 had information about maternal diabetic status. In the second dataset, 255 and 267 subjects had the paternal and maternal information, respectively. In the third, a total of 3625 subjects had information about both their paternal and maternal diabetic status. Diabetic status of the study subjects was determined by fasting plasma glucose levels and/or oral glucose tolerance test; their parental diabetic status was collected by interview.

RESULTS

The three datasets consistently demonstrated a significantly elevated odds ratio (OR) for reporting maternal diabetes (OR = 2.64, 95% confidence interval: 1.12-5.71) in diabetic patients as compared to non-diabetic subjects. The reporting of paternal diabetes, however, was not significantly different between diabetics and non-diabetics. In addition, the OR for reporting paternal diabetes were not significantly different between groups of different age-at-onset. With respect to maternal history, the OR increased significantly when age-at-onset was younger (test-for-trend P < 0.001).

CONCLUSIONS

Our findings support mitochondrial inheritance of type 2 diabetes mellitus in the human population. The age-modifying effect was also in accordance with the mitochondrial oxidative phosphorylation paradigm for degenerative diseases.

Paraffinoma of the penis

Augmentation of the body contour by localized injection of hard and soft paraffin rose to a zenith of popularity in the early 1900s, whereafter the severe destructive consequences of such injections became widely recognized. However in Korea, these injections are still performed much by nonmedical person. Paraffin or other mineral oil injection into body is no more a useful method to change body contour. We reviewed 26 cases of sclerosing lipogranuloma of penis with complications in recent 13 years after mean 18.5 months from previous injection of paraffin or vaseline. We conclude that the public should be informed of detrimental effects of paraffin injections and that the best treatment of penile paraffinoma is complete excision and appropriate penoplasty.

Effects of acute exercise on the changes of lipid profiles and peroxides, prostanoids, and platelet activation in hypercholesterolemic patients before and after treatment

The effects of acute exercise on the changes of plasma lipid profiles and peroxides, prostanoids and platelet activation in hypercholesterolemic patients before and after pravastatin 5 mg twice daily treatment for 4 weeks was studied in 30 (M/F = 21/9, age = 52 +/- 7, Mean +/- SD) patients with plasma total cholesterol level > 240 mg/dl. Pravastatin significantly reduced plasma total and low density lipoprotein cholesterol levels as expected. All patients before and after treatment and 30 healthy controls performed a treadmill exercise test using the standard Bruce protocol. The cardiac performance was similar in all groups. Treadmill exercise did not influence lipid levels after plasma volume correction. Hypercholesterolemic patients had significantly higher pre-exercise levels of malondialdehyde, thromboxane beta 2 and beta-thromboglobulin than after treatment or than pre-exercise levels in the control group. Treatment with lipid lowering drug pravastatin lowered the levels of these three parameters. At peak exercise, superoxide dismutase activity and 6-keto-PGF1 alpha were elevated. At 10 min post exercise only malondialdehyde returned to pre-exercise levels. The superoxide dismutase, thromboxane B2 and beta-thromboglobulin remained significantly higher. In the control subjects plasma beta-thromboglobulin and thromboxane 2 returned to pre-exercise levels. These results suggest that hypercholesterolemia may induce lipid peroxidation and platelet activation in resting status. Lowering of plasma cholesterol of pravastatin causes a concomitant decrease in plasma malondialdehyde, thromboxane and beta-thromboglobulin suggesting a decrease in lipid peroxidation and platelet activation. These changes were more pronounced in the hypercholesterolemic patients. Pravastatin treatment attenuated the increase in both malondialdehyde, beta-thromboglobulin and the prostanoids, but not to the level of normal subjects.

Effects of fish oil supplementation on the changes in myocardial cyclic adenosine monophosphate, inositol 1,4,5-triphosphate and mitochondrial calcium levels during acute coronary occlusion-reperfusion in cholesterol-fed rabbits

We studied the changes in myocardial second messengers and mitochondrial calcium levels during acute coronary occlusion-reperfusion in New Zealand white male rabbits fed a high cholesterol diet with or without fish oil supplementation. Group I, control rabbits, were fed a standard laboratory rabbit chow. In addition to the standard chow, Group II rabbits received a 1% cholesterol-enriched diet for 2 weeks, while Group III rabbits were fed a 1% cholesterol and 10% fish oil supplemented diet for 2 weeks. Acute coronary occlusion for 10 min or 1 h was induced by ligating the marginal branch of the left circumflex coronary artery. The vessel was then reperfused for 1 or 4 h in short- and long-term ischemia studies respectively. In the short-term ischemia study, myocardial samples taken from the cholesterol-fed rabbits had the highest cyclic adenosine monophosphate, inositol 1,4,5-triphosphate and mitochondrial calcium levels among the normal (nonischemic) and the ischemic areas of the three groups. The cholesterol and fish oil treated rabbits significantly suppressed the elevation of cyclic adenosine monophosphate (P < 0.05 compared with the cholesterol-fed rabbits in normal and ischemic areas respectively), but did not significantly attenuate the elevation of inositol 1,4,5-triphosphate and calcium levels. In the long-term ischemia study, the cholesterol-fed rabbits had the highest levels of these three messengers among the normal areas. However, only inositol 1,4,5-triphosphate level reached statistical significance (P < 0.05 compared with control). This group of rabbits had the lowest level of cyclic adenosine monophosphate, but the highest inositol 1,4,5-triphosphate and calcium levels among the ischemic areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Munchausen's syndrome and cancer

Munchausen's syndrome is a chronic factitious disorder characterized by frequent hospitalizations, self-inflicted injuries, and dramatic medical histories. People with this condition assume the role of a sick patient and submit to unnecessary invasive, painful, and even dangerous medical procedures. In review of the literature, there have been four reports of patients feigning oncological disease. We admitted a 27-year-old woman who had undergone operative insertion of a Port-A-Cath and multiagent chemotherapy for "advanced ovarian cancer." Physicians should be aware of Munchausen's syndrome in order to avoid costly medical procedures and unnecessary operations and to stop the patient's vicious circle of pathological lying and self-inflicted injury.

Nuclear area and DNA content in tumor and nontumor portions of hepatocellular carcinoma

The nuclear area and DNA content between tumor and nontumor portions of hepatocellular carcinoma (HCC) were compared. Thirty pairs of imprint smears were made from surgical specimens and stained with a modified Feulgen reaction. Two hundred nuclei were scanned with a microdensitometer at a wavelength of 550 nm. DNA histograms were plotted with lymphocytes as the internal control. Nuclear areas of 200 cells in each case were measured with Minimagiscan image analyzer. Hyperploidy (DNA index > 1.1) was 76.7% and 53.3% in tumor and nontumor portions, respectively. The S-phase fraction value was 7.9 +/- 3.5% (+/- SD) and 4.1 +/- 2.4% in tumor and nontumor portions of HCC (P < .001). The mean nuclear area of the tumor portion was significantly larger than that of its corresponding nontumor portion (232.9 +/- 68.1 vs. 137.6 +/- 15.5 microns2, P < .001). Marked anisonucleosis was found in both the tumor and nontumor portions of HCC. The mean coefficient of variation of mean nuclear areas was 27.8 +/- 10.4% and 22.9 +/- 4.9% in the tumor and nontumor portions, respectively (P < .05). DNA ploidy correlated well with mean nuclear area in the tumor portions (r = .730) but not in the nontumor ones. The results indicate that the three most important cytologic criteria of malignant cells--hyperchromatism, nuclear enlargement and anisonucleosis--are evident in both the tumor and nontumor portions of HCC.

Relationship between ventricular rate and cardiac output in mimic experimental atrial fibrillation

In treating atrial fibrillation (AF) the goal of ventricular rate reduction is still not determined. An animal model of AF was developed in which the relationship between ventricular rate and the parameters of cardiac function in AF can be studied. To simulate AF, complete heart block was chemically produced on open-chest dogs. Then, assisted by a portable computer, the ventricles were paced with a series of grossly irregular stimuli of predetermined rates, while atria were paced rapidly (500 beats/min). The resulting electrocardiogram and pressure were indistinguishable from the naturally occurring AF. It was found that in AF with ventricular rates that were lower than that of the control state, cardiac output was decreased. Cardiac output increased and reached a plateau when the ventricular rate increased to the level of the control state and then kept stable up to a rate of 320 beats/min. There was a discrepancy between the effective ventricular rate (rate of beats with pulse pressures > or = 25 mmHg in the femoral artery) and the electrical ventricular rate. When the electrical ventricular rate increased over the control ventricular rate the effective ventricular rate did not increase in a parallel manner. Rather, the effective ventricular rate leveled off at the control ventricular rate. This discrepancy may explain the parallel relationship between the effective ventricular rate and cardiac output.

Fish oil supplementation attenuates free radical generation in short-term coronary occlusion-reperfusion in cholesterol-fed rabbits

We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occlusion-reperfusion in controls and those rabbits (11 in each group) fed a 1% high cholesterol diet with or without 10% fish oil supplementation for one week. Acute coronary occlusion for 10 minutes was induced by ligating the marginal branch of the left circumflex coronary artery. The vessels were then reperfused for 1 hour. The cholesterol and fish oil treated rabbits had the lowest malondialdehyde levels both in the ischemic and non-ischemic (normal) areas, the least increase of malondialdehyde level in the ischemic area, and the highest 6-keto-PGF1 alpha/thromboxane B2 ratio in the non-ischemic area after reperfusion among the 3 groups. These rabbits had the highest myocardial superoxide dismutase levels both in the ischemic and normal areas, and the least decrease of superoxide dismutase level in the ischemic area. These data suggest that rabbits fed a high cholesterol diet with fish oil supplementation had an attenuated lipid peroxidation, which reflected a reduced free radical generation during a short-term coronary occlusion followed by reperfusion.

A new natural reservoir of hantavirus: isolation of hantaviruses from lung tissues of bats

Two species of bats were confirmed as new natural reservoirs of hantavirus. Antibodies to Hantaan virus were detected in 3.40% (23 of 677) of bats captured from 1989 to 1992 in Korea by the IFA technique. Areal distribution of immunofluorescent antibody were different, and seropositive rates were much high in sera of bats captured in summer (3.82%) and winter (5.82%). Viral antigens were observed in the lungs (3 of 16) and kidney (1 of 7). Two hantaviruses were isolated from lung tissues of E. serotinus and R. ferrum-equinum through a cell culture system, designated CUMC-92B8 and -92B48, respectively. Using Rous associated virus-2 reverse transcriptase-directed PCR and 2 oligonucleotide primer pairs, genomic sequences of the isolates were amplified. Amplified products of the isolates and reactivities to monoclonal antibodies very closely resembled those of Hantaan virus. These data suggest that the serotype of the isolates is closely related to Hantaan virus, and bats serve as reservoirs of hantavirus.

Correlation of flow cytometric and microdensitometric DNA content analysis in lung cancer

The DNA histograms of 29 histologically verified primary lung cancers were analyzed with flow cytometry and microdensitometry. Fresh tumor tissues were imprinted on the slide and air dried for modified Feulgen staining. Then the smears were scanned with a scanning microdensitometer at a wavelength of 550 nm. The S-phase fraction value was estimated from the DNA histogram with a cumulated probability scale. The remaining parts of the tumors were minced and prepared for dispersal as a single cell suspension for propidium iodide staining. The tumor cells were then analyzed with a flow cytometer at 488 nm. The correlation between the analyses measured with these two methods showed r = .75 for the DNA index, r = .71 for the S-phase fraction and r = .61 for the G0G1 population; P < .001. The DNA indices, S-phase fraction values and G0G1 populations obtained with flow cytometry and microdensitometry correlated well.

Isolated left main coronary ostial stenosis: intraoperative transesophageal echocardiography during surgical angioplasty

OBJECTIVE

We hypothesized that transesophageal echocardiography could be used to image the repair of a left ostium or main coronary artery following surgical angioplasty.

METHODS AND RESULTS

Six patients, all women, were found to have isolated left main coronary ostial stenosis. We performed preoperative transesophageal echocardiography (TEE) in three and intraoperative TEE in four of six patients. Their mean age was 48 years. They presented with severe angina (Class III or IV) with a short duration (6.8 +/- 7.8 months). They had a low incidence of risk factors while histopathologic examinations showed typical atherosclerosis in all four patients. Preoperative two-dimensional echocardiography demonstrated left main coronary ostial stenosis in three patients. We clearly observed the patency of the pericardial or saphenous venous patch with basal short-axis scan on two-dimensional and color Doppler echocardiography in all four patients after weaning them from cardiopulmonary bypass and finished operation without complications.

CONCLUSIONS

Our study shows that TEE can be used to image the repair of a left ostium or main coronary artery following surgical angioplasty and provide the surgeon with the required information about the adequacy of the repair.

Sick sinus syndrome as the early manifestation of cardiac hemochromatosis

The most important manifestations of heart disease in hemochromatosis are congestive heart failure and cardiac arrhythmia. The spectrum of disturbances in cardiac rhythm ranges from minor abnormalities on the electrocardiogram to supraventricular arrhythmia, atrioventricular conduction block, and ventricular tachyarrhythmia. Sinus node dysfunction is, however, rarely mentioned. The authors report a case of massive transfusion-induced hemochromatosis in which the patient presented with sick sinus syndrome as the early manifestation of cardiac involvement.

Protection by scoparone against the alterations of plasma lipoproteins, vascular morphology and vascular reactivity in hyperlipidaemic diabetic rabbit

1. The in vivo pharmacological effects of scoparone (6,7-dimethoxycoumarin) in a hyperlipidaemic diabetic rabbit model were investigated. 2. Three groups of rabbits were studied: (1) normal, (2) hyperlipidaemic and diabetic-untreated and (3) hyperlipidaemic and diabetic-scoparone treated. The hyperlipidaemic diabetic rabbits were fed with 1% cholesterol and treated with alloxan, a diabetogenic agent. The plasma levels of total cholesterol, total triglyceride, very low-density lipoprotein (VLDL) cholesterol, low density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol were markedly increased as soon as the rabbit became diabetic at the second week. Scoparone-treatment (5 mg kg-1 day-1, s.c.) significantly reduced the plasma lipid and lipoprotein cholesterol levels of the hyperlipidaemic diabetic rabbit to 73.3% of total cholesterol, 48.3% of total triglyceride, 66.0% of VLDL cholesterol, 55.7% of LDL cholesterol and 79.5% of HDL cholesterol. 3. Six weeks after cholesterol-feeding, the aortic arch and thoracic aorta were dissected for morphological and functional studies. In vascular rings from the untreated hyperlipidaemic diabetic rabbit, there was intimal thickening with accumulation of fatty streaks, foam cells and migration of smooth muscle cells to the intima. In the rabbits treated with scoparone, there were fewer pathological morphology changes found in vascular segments than in the untreated hyperlipidaemic diabetic rabbits. 4. In the vascular reactivity experiments, the phenylephrine-induced contraction and nitroprusside induced dilatation did not differ significantly among the three rabbit groups, except that the contraction was enhanced in the thoracic aorta of hyperlipidaemic diabetic rabbits either untreated or treated withscoparone, as compared to the normal group, and the sensitivity to nitroprusside was increased in the thoracic aorta of the scoparone-treated group as compared to the untreated group.5. The endothelium-dependent dilatation induced by acetylcholine was significantly attenuated in both the aortic arch and thoracic aorta from the hyperlipidaemic diabetic rabbits as compared to the normal rabbits. This attenuation was partially prevented, when scoparone (5 mg kg-1) was administered daily.6. These results suggest that scoparone protects against some alterations of plasma lipoproteins,vascular morphology and vascular reactivity in the hyperlipidaemic diabetic rabbit. These protective effects of scoparone may be partly related to its free radical scavenging property.