1.Relationship between Circardian Variation of Acute Myocardial Infarction and Morphologic Characteristics of Coronary Artery Lesions.
Hui Nam PAK ; Chang Gyu PARK ; Seung Hwan HAN ; Do Sun LIM ; Young Hoon KIM ; Hong Seog SEO ; Wan Joo SHIM ; Dong Joo OH ; Young Moo RO
Korean Circulation Journal 1996;26(1):20-28
BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable
;
Arrhythmias, Cardiac
;
Aspirin
;
Blood Platelets
;
Constriction, Pathologic
;
Coronary Vessels*
;
Eating
;
Female
;
Humans
;
Hypertension
;
Incidence
;
Myocardial Infarction*
;
Oxygen
;
Periodicity
;
Plasma
;
Smoking
;
Thorax
;
Thrombosis
;
Ulcer
2.Relationship between Circardian Variation of Acute Myocardial Infarction and Morphologic Characteristics of Coronary Artery Lesions.
Hui Nam PAK ; Chang Gyu PARK ; Seung Hwan HAN ; Do Sun LIM ; Young Hoon KIM ; Hong Seog SEO ; Wan Joo SHIM ; Dong Joo OH ; Young Moo RO
Korean Circulation Journal 1996;26(1):20-28
BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable
;
Arrhythmias, Cardiac
;
Aspirin
;
Blood Platelets
;
Constriction, Pathologic
;
Coronary Vessels*
;
Eating
;
Female
;
Humans
;
Hypertension
;
Incidence
;
Myocardial Infarction*
;
Oxygen
;
Periodicity
;
Plasma
;
Smoking
;
Thorax
;
Thrombosis
;
Ulcer
3.The Efficacy of the Alvarado Score in the Diagnosis of Acute Appendicitis.
Sung Min LEE ; In Taik CHANG ; Beom Gyu KIM ; Sung Jae CHA ; Yong Seok KIM ; Jun Seok PAK
Journal of the Korean Society of Coloproctology 2008;24(1):1-6
PURPOSE: Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis.
Abdomen, Acute
;
Anorexia
;
Appendectomy
;
Appendicitis
;
Emergencies
;
Fever
;
Humans
;
Leukocytosis
;
Sensitivity and Specificity
4.Multiple Gastrointestinal Stromal Tumors of the Small Intestine.
Jun Seok PAK ; Beom Gyu KIM ; Sung Jae CHA ; In Taik CHANG
Journal of the Korean Surgical Society 2005;69(2):172-175
Gastrointestinal stromal tumors (GISTs) are a heterogeneous group of mesenchymal neoplasms of the gastrointestinal tract. A great majority of GISTs occur in the stomach and small intestine, but multiple GISTs of the jejunum are rare. We experienced a case of multiple GISTs of the jejunum. A 57 year old woman was admitted due to general weakness and abdominal pain. The computer tomography of the abdomen revealed solid tumor in the jejunum. We removed tumor from jejunum by resection. Histological and immunohistochemical studies revealed a gastrointestinal stromal tumor of the intermediate malignant type.
Abdomen
;
Abdominal Pain
;
Female
;
Gastrointestinal Stromal Tumors*
;
Gastrointestinal Tract
;
Humans
;
Intestine, Small*
;
Jejunum
;
Middle Aged
;
Stomach
5.Effect of Local Administration of Lovastatin on Preventing Neointimal Hyperplasia in the Rat Carotid Artery Injury Model.
Gyo Seung HWANG ; Young Hoon KIM ; Hyun Soo LEE ; Byung Soo KIM ; Soo Jin LEE ; Hui Nam PAK ; Do Sun LIM ; Chang Gyu PARK ; Hong Seog SEO ; Wan Joo SHIM ; Dong Joo OH ; Young Moo RO
Korean Circulation Journal 1999;29(8):788-795
BACKGROUND AND OBJECTIVES: ovastatin, a HMG-CoA reductase inhibitor, is known to show antiproliferative effects on VSMC after vessel injury, but a large amount of the drug is needed orally for this purpose. This study investigated the effects of lovastatin given locally to injured carotid arteries of rats on reducing neointimal hyperplasia. MATERIALS AND METHOD: Lovastatin was given perivascularly to balloon-injured carotid arteries of 21 rats in 1 microM to the low-dose group, and 30 microM to the high-dose group. The control group was treated with pluronic gel only. Two weeks later, the lumen area, neointimal areas and the number of actively proliferating cells were obtained and compared. RESULTS: eointimal area was 0.113+/-0.032 mm2, 0.065+/-0.017 mm2, 0.072+/-0.017 mm2 in the control, low-dose and high-dose groups respectively. The area was significantly smaller in the treatment groups (p<0.05), but no significant difference was observed between the treatment groups. The number of actively proliferating cells per mm2 of neointimal area were 714.5+/-227.4, 688.4+/-333.7, and 1526.3+/-744.0 in the groups respectively, and the number was significantly high in the high-dose group (p<0.05). CONCLUSION: Local administration of lovastatin is effective in reducing neointimal hyperplasia after vascular injury, but extremely high doses are not needed locally for this purpose.
Animals
;
Carotid Arteries*
;
Carotid Artery Injuries*
;
Hyperplasia*
;
Lovastatin*
;
Oxidoreductases
;
Rats*
;
Vascular System Injuries
6.Factors Affecting Coronary Flow Reserve: Measured by Transthoracic Doppler Echocardiography.
Cheol Ung CHOI ; Wan Joo SHIM ; Seong Hwan KIM ; Gyu Nam HWANG ; Jong Il CHOI ; Soon Joon HONG ; Woo Hyuk SONG ; Do Sun IM ; Young Hoon KIM ; Chang Gyu PAK ; Hong Seok SEO ; Dong Joo OH ; Young Moo RO
Korean Circulation Journal 2002;32(11):958-964
BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) is considered an important index of the functional significance of coronary artery stenosis, but is influenced by several factors, such as left ventricle hypertrophy (LVH), diabetes mellitus (DM), hyperlipidemia and smoking. Measurement of the coronary flow velocity of the left anterior descending coronary artery (LAD) by transthoracic Doppler echocardiography (TTDE) is feasible, and provides reliable information. The purpose of this study was to investigate the relationship between CFR and LVH, DM, hyperlipidemia and hypertension in patients with or without coronary artery disease, and to assess the prominent factors influencing CFR. SUBJECTS AND METHODS: Coronary angiographies were performed in 38 patients to evaluate chest pain. The distal LAD flow velocity was measured by TTDE, and the CFR calculated as a ratio of the hyperemic and baseline mean diastolic velocities. The CFR was compared with clinical, echocardiographic and angiographic parameters. RESULTS: The CFR was similar in patients both with and without hypertension, DM, high LDL-cholesterol levels and low ejection fraction(<40%). The mean CFR was lower in patients with (50% LAD stenosis than in patients with no significant stenosis. The CFR of patients with a left ventricle wall thickness of (12mm was lower than in those without LVH. The multivariate analysis of the aforementioned factors showed that LVH was the factor most influencing to the CFR (p<0.05). CONCLUSION: When using CFR as a functional parameter of LAD stenosis, one should consider LVH as one of the factors attributed to CFR modification.
Chest Pain
;
Constriction, Pathologic
;
Coronary Angiography
;
Coronary Artery Disease
;
Coronary Circulation
;
Coronary Stenosis
;
Coronary Vessels
;
Diabetes Mellitus
;
Echocardiography
;
Echocardiography, Doppler*
;
Heart Ventricles
;
Humans
;
Hyperlipidemias
;
Hypertension
;
Hypertrophy
;
Multivariate Analysis
;
Smoke
;
Smoking
7.Who Can Perform Adjuvant Chemotherapy Treatment for Gastric Cancer? A Multicenter Retrospective Overview of the Current Status in Korea.
Jae Seok MIN ; Chang Min LEE ; Sung Il CHOI ; Kyung Won SEO ; Do Joong PARK ; Yong Hae BAIK ; Myoung Won SON ; Won Hyuk CHOI ; Sungsoo KIM ; Kyung Ho PAK ; Min Gyu KIM ; Joong Min PARK ; Sang Ho JEONG ; Moon Soo LEE ; Sungsoo PARK
Journal of Gastric Cancer 2018;18(3):264-273
PURPOSE: To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the difference in efficacy of AC administered by surgical and medical oncologists in patients with stage II or III gastric cancers. MATERIALS AND METHODS: We performed a retrospective observational study among 1,049 patients who underwent curative resection and received AC for stage II and III gastric cancers between February 2012 and December 2013 at 29 tertiary referral university hospitals in Korea. To minimize the influence of potential confounders on selection bias, propensity score matching (PSM) was used based on binary logistic regression analysis. The 3-year disease-free survival (DFS) rates were compared between patients who received AC administered by medical oncologists or surgical oncologists. RESULTS: Between February 2012 and December 2013 in Korea, the most commonly prescribed AC by medical oncologists was tegafur/gimeracil/oteracil (S-1, 47.72%), followed by capecitabine with oxaliplatin (XELOX, 16.33%). After performing PSM, surgical oncologists (82.74%) completed AC as planned more often than medical oncologists (75.9%), with statistical significance (P=0.036). No difference in the 3-year DFS rates of stage II (P=0.567) or stage III (P=0.545) gastric cancer was found between the medical and surgical oncologist groups. CONCLUSIONS: S-1 monotherapy and XELOX are a main stay of AC, regardless of whether the prescribing physician is a medical or surgical oncologist. The better compliance with AC by surgical oncologists is a valid reason to advocate that surgical oncologists perform the treatment of AC for stage II or III gastric cancers.
Capecitabine
;
Chemotherapy, Adjuvant*
;
Compliance
;
Disease-Free Survival
;
Hospitals, University
;
Humans
;
Korea*
;
Logistic Models
;
Observational Study
;
Propensity Score
;
Referral and Consultation
;
Retrospective Studies*
;
Selection Bias
;
Stomach Neoplasms*