No abstract available.

Coronary involvement of polyarteritis nodosa (PAN) is rarely identified at premortem. Herein, we report a case of PAN presenting as acute myocardial infarction (MI). A 66-year-old man without previous history of heart disease presented with excruciating substernal chest pain of 3 hours duration. On admission, cardiac enzyme and ECG changes were compatible with acute MI of inferior wall. Emergency coronary angiography showed multiple aneurysmal dilatations of both left and right coronary arteries (RCA) and total occlusion with large thrombi at mid-RCA. After balloon angioplasty and intracoronary urokinase, huge coronary aneurysm was defined at mid-RCA and coronary flow partially improved. The patient was transferred to coronary care unit and continous intravenous heparin infusion was started. On the 7th hospitalization day, the patient was discharged in good condition. Two months later, follow-up coronary angiography showed no significant luminal narrowings in RCA with multiple aneurysmal dilatation, but abdominal angiography revealed multiple aneurysms in right renal and superior mesenteric arteries. These findings were compatible with the diagnosis of PAN. The patient was started on prednisone 60mg once daily and cytoxan 125mg bid. At follow-up 8 month later, there was no recurrence of symptoms.
Aged ; Aneurysm ; Angiography ; Angioplasty, Balloon ; Chest Pain ; Coronary Aneurysm ; Coronary Angiography ; Coronary Care Units ; Coronary Vessels ; Cyclophosphamide ; Diagnosis ; Dilatation ; Electrocardiography ; Emergencies ; Follow-Up Studies ; Heart Diseases ; Heparin ; Hospitalization ; Humans ; Mesenteric Artery, Superior ; Myocardial Infarction* ; Phenobarbital ; Polyarteritis Nodosa* ; Prednisone ; Recurrence ; Urokinase-Type Plasminogen Activator

BACKGROUND AND OBJECTIVES: Although the standard management of an abdominal aortic aneurysm (AAA) is surgery, endovascular stent-graft treatment is more attractive for patients with significant co-morbid conditions. We evaluated the immediate and mid-term outcomes for the endovascular treatment of AAA. SUBJECTS AND METHODS: Between November 1996 and August 2004, 59 patients with an AAA (53 males, mean age 68.0+/-9.6 years, 3 cases with ruptured AAA) underwent an endovascular stent-graft repair at our institute. All patients were evaluated by an angiography, taken just after the completion of the procedure and at followed up with computed tomography (CT) at 1, 3, 6 and 12 months, and yearly thereafter. RESULTS: Technical success was achieved in 54 of the 59 patients (91.5%). The periprocedural mortality rate was 3.4% (2 of the 59 patients). A primary endoleak was found in 12 patients (20.3%)(type I; 9 patients, type II; 2 patients, type III; 1 patient), 2 of which required subsequent surgical conversion. Spontaneous resolution of an endoleak was seen in 4 patients (33.3%). The average follow-up period of 57 patients was 27.5 months (range from 72 days to 2581 days). In 8 patients (14.0%), a newly developed secondary endoleak was documented. A total 14 patients (23.7%) died during the follow-up period (rupture; 3, operation-related sepsis; 3, unrelated causes; 3, cardiac arrest; 1, unknown causes; 4). The cumulative survival rates at 30 days and at 1 and 2 years were found to be 93.0, and 85.7 and 76.3%, respectively, using Kaplan-Meier methods. Secondary intervention was required in 12 patients (21.8%), and surgical conversion in 4 (6.8%), with 2 (3.4%) requiring conversion to open surgery immediately after the intervention. In those with technical success, without endoleaks and graft failure, the survival rate during follow-up was higher (97.1%; rate with the exception of unrelated cause of death) than that of all the patients. CONCLUSION: The immediate and mid-term results suggest that the endovascular treatment of an AAA is technically feasible and effective. There was higher mortality and morbidity in primary and newly developed endoleak cases; therefore, proper selection of cases, according to the anatomical and clinical criteria, is essential, with meticulous regular follow-ups being critical for the optimal endovascular treatment of an AAA.
Angiography ; Aortic Aneurysm, Abdominal* ; Conversion to Open Surgery ; Endoleak ; Follow-Up Studies ; Heart Arrest ; Humans ; Male ; Mortality ; Sepsis ; Survival Rate ; Transplants ; Treatment Outcome

BACKGROUND AND OBJECTIVES: everal studies have demonstrated improved outcomes achieved with stents vice balloon angioplasty. The purpose of this study was to compare the clinical outcomes and risk factors for major adverse cardiac events (MACE) between the pre- and post-stent period. SUBJECTS AND METHODS: linical outcomes for 294 patients who had undergone balloon angioplasty alone in 1991 and 1992, were compared with those for of 320 patients who underwent stent implantation in 1998. The duration of follow-up was 12 months. RESULTS: here were more patients with diabetes and hyperlipidemia in the stent group (p<0.05). The stent group had significantly more 3-vessel diseases and complex lesion morphology (p<0.05). Cardiac event-free survival rates in the stent group at 1, 6, and 12 months were significantly higher than those in the balloon group (1, 6, 12 month:7.0 vs 93.9%, 89.6 vs 82.3%, 83.7 vs 77.2%, p=0.03). MACE rates were highly associated with lesion morphology (OR=2.6, 95% CI 1.4-4.9) and angiotensin converting enzyme (ACE) inhibitors (OR=2.4, 95% CI 1.3-5.4) in the balloon group, and hypertension in the stent group (OR=2.7, 95% CI 1.3-5.6). Excluding acute myocardial infarction in the stent group, risk factors included diabetes (OR=4.8, 95% CI 1.6-14.2) and hypertension (OR=4.4, 95% CI 1.2-15.7). The stent group had significantly higher event-free survival rates in the complex lesions (p=0.002), but showed no difference in simple lesions. CONCLUSION: ompared with balloon angioplasty in the early 1990s, stent implantation in 1998 was associated with higher early and late cardiac event-free survival rates. Risk factors included complex lesion morphology and the use of ACE inhibitors in balloon angioplasty, and hypertension and diabetes in the stent group.
Angioplasty, Balloon ; Angiotensin-Converting Enzyme Inhibitors ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Hyperlipidemias ; Hypertension ; Myocardial Infarction ; Peptidyl-Dipeptidase A ; Risk Factors ; Stents

No abstract available.
Pituitary Neoplasms*

PURPOSE: To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle. MATERIALS AND METHODS: From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria. RESULTS: There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle. CONCLUSION: Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.
Ankle ; Ankle Joint ; Arthritis ; Classification ; Female ; Follow-Up Studies ; Humans ; Male

The risk of cardiovascular disease is known to be increased in obstructive sleep apnea syndrome (OSAS). Its mechanism can be explained by the observation that the sympathetic tone increases due to repetitive apneas accompanied by hypoxias and arousals during sleep. Heart rate variability (HRV) representing cardiac autonomic function is mediated by respiratory sinus arrhythmia, baroreflexrelated fluctuation, and thermoregulation-related fluctuation. We evaluated the heart rate variability of OSAS patients during night to assess their relationship with the severity of the symptoms. We studied overnight polysomnographies of 59 male untreated OSAS patients with moderate to severe symptoms (mean age 45.4+/- 11.7 yr, apnea-hypopnea index [AHI]=43.2+/-23.4 events per hour, and AHI >15). Moderate (mean age 47.1+/-9.4 yr, AHI=15-30, n=22) and severe (mean age 44.5 +/-12.9 yr, AHI >30, n=37) OSAS patients were compared for the indices derived from time and frequency domain analysis of HRV, AHI, oxygen desaturation event index (ODI), arousal index (ArI), and sleep parameters. As a result, the severe OSAS group showed higher mean powers of total frequency (TF) (p=0.012), very low frequency (VLF) (p= 0.038), and low frequency (LF) (p=0.002) than the moderate OSAS group. The LF/HF ratio (p=0.005) was higher in the severe group compared to that of the moderate group. On the time domain analysis, the HRV triangular index (p=0.026) of severe OSAS group was significantly higher. AHI was correlated best with the LF/HF ratio (r(p)=0.610, p<0.001) of all the HRV indices. According to the results, the frequency domain indices tended to reveal the difference between the groups better than time domain indices. Especially the LF/HF ratio was thought to be the most useful parameter to estimate the degree of AHI in OSAS patients.
Adult ; Cardiovascular Diseases/*diagnosis/pathology ; Electrocardiography/methods ; *Heart Rate ; Humans ; Male ; Middle Aged ; Oximetry ; Oxygen/metabolism ; Plethysmography ; Polysomnography/methods ; Sleep ; Sleep Apnea, Obstructive/*diagnosis/pathology

BACKGROUND AND OBJECTIVES: Telmisartan (Micardis ), a selective type I angiotensin II receptor blocker, has recently been introduced as a new antihypertensive agent. We evaluated its anti-hypertensive effect and safety in mild to moderate hypertensive patients. MATERIALS AND METHODS: Telmisartan, 40 mg, was started once a day over the 4 week period in 45 patients with mild to moderate hypertension (35 male, mean age : 54.9 +/- 8.7 years). The dose was maintained in the patients whose blood pressures were controlled below 140/90 mmHg for the following 4 weeks. In those patients whose blood pressures did not fell below 140/90 mmHg, the dose was doubled to 80 mg per day for the following 4 weeks. Blood pressures were assessed at the 8th week of administration. For safety evaluation, laboratory tests were performed before and after treatment with telmisartan. Changes in heart rate and electrocardiogram were also observed. RESULTS: 1) The mean blood pressures in the sitting position were 161.6 +/- 14.7 mmHg(systolic) and 102.4 +/- 4.3 mmHg (diastolic) before treatment, which were lowered to 139.5 +/- 15.8 mmHg and 90.2 +/- 8.0 mmHg repectively after 8 weeks of treatment(p<0.05). 2) Heart rate was not significantly changed after treatment with telmisartan compared to pre-treatment (72.5 +/- 7.2/min vs. 71.7 +/- 7.5/min; p>0.05). 3) Laboratory tests revealed no significant abnormality by the treatment with telmisartan. 4) No significant side effects were observed during the treatment period. CONCLUSION: Telmisartan, 40 mg or 80 mg, once a day induced significant reduction in systolic and diastolic blood pressures without significant side effects in the patients with mild to moderate hypertension. Telmisartan is thought to be a well tolerated and effective antihypertensive medicine.
Electrocardiography ; Heart Rate ; Humans ; Hypertension ; Male ; Receptors, Angiotensin

PURPOSE: To evaluate the utility of quantification of coronary artery calcification using spiral CT. MATERIALS AND METHODS: Spiral CT scans of the heart were obtained in 25 patients with coronary artery disease diagnosed by coronary angiography and in six controls without coronary artery disease. Spiral CT was performedwith 3 mm collimation at 3 mm/sec table speed and the obtained volume data of the heart was reconstructed at 2 mm intervals. Total calcium scores of the 30 contiguous slices of the proximal coronary artery were calculated basedon the areas and peak density. Two groups were compared for total scores and sensitivity, and specificity and positive predictive values were calculated. RESULTS: The number of subjects with coronary calcification(totalcalcium score>0) detected by spiral CT were 20(80%) of 25 with coronary artery disease and 2(33%) of 6 without coronary artery disease. The sensitivity, specificity, and positive predictive values were 80%, 67% and 91% respectively. Sensitivity was 64%, specificity was 80% in patients aged < or =60. Sensitivity was 76% and specificity was 83%(total calcium score 10). CONCLUSION: Quantification of coronary artery calcification using spiral CT haslow specificity in the older group and low sensitivity in the younger group ; the procedure is therefore may notbe useful as a non invase screening test to predict the prescence of coronary artery disease. In the younger group, however, a cardiac workup is strongly indicated if calcification is present.
Arteries ; Calcium ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Heart ; Humans ; Mass Screening ; Sensitivity and Specificity ; Tomography, Spiral Computed*

OBJECTIVE: To compare clinicopathologic characteristics and surgical outcomes of laparoscopic surgery in women with endometrial cancer according to body mass index (BMI). METHODS: From June 2009 to October 2010, prospective observational study without randomization of 159 patients treated by laparoscopic surgery from 10 hospitals nationwide. RESULTS: Patients were divided according to the WHO guidelines for Asia-Pacific populations and the distributions of BMI were as follows: 3 patients (1.9%) in underweight (BMI < 18.5 kg/m2), 50 patients (31.4%) in normal weight (BMI, 18.5-22.9 kg/m2), 45 patients (28.3%) in overweight (BMI, 23.0-24.9 kg/m2), 49 patients (30.8%) in obese (BMI, 25.0-29.9 kg/m2), and 12 patients (7.5%) in morbid obese (BMI > or = 30.0 kg/m2). Age, history of previous surgery, surgery extend, and history of previous surgery were not different between non-obese patients (BMI < 25.0 kg/m2) and obese patients (BMI > or = 25.0 kg/m2). Co-morbidities were more common in obese patients but marginally significant (23.5% vs. 37.7%, p=0.072). Four patients (2.5%) were converted to abdominal surgery because of severe adhesion. Regarding to surgical outcomes, operation time was significantly longer in obese patients (199 min vs. 235 min, p=0.013) but blood loss, lymph node yield, hospital stay, Foley removal, transfusion rate and peri-operative complication were not statistically significant. Regarding to pathologic results, there were no difference in terms of lymphovasucular space invasion, tumor grade, histologic type, lymph node metastasis and FIGO stage. CONCLUSION: Clinicopathologic characteristics and surgical outcomes does not seem to be significantly influenced by BMI except operation time. So the laparoscopic approach can be the alternative method for obese patients.
Body Mass Index ; Endometrial Neoplasms ; Female ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Neoplasm Metastasis ; Obesity ; Overweight ; Prospective Studies ; Random Allocation ; Thinness