BACKGROUND AND OBJECTIVES: An anatomic variant of left anterior descending coronary artery (LAD), termed "dual LAD", consists of early bifurcation of the proximal LAD into one early terminating branch (short LAD) which remains in the anterior interventricular sulcus (AIVS) and doesn't reach the apex, and the second (long LAD), which has a variable course outside the AIVS but returns to the distal sulcus and continues to the apex. Its incidence, angiographic features and clinical significance are investigated. MATERIALS AND METHOD: Consecutive 696 coronary angiograms during October 1997 through August 1998 were analyzed. RESULTS: A dual LAD variant was noted in 45 patients (6%) of the 696 patients. Type I, in which the long LAD descends on the left ventricular side of the AIVS before reentering the AIVS, was noted in 24 patients (53%) and type II, in which the long LAD descends on the right ventricular side of the AIVS before reentering the AIVS, in 21(47%). First septal branch was commonly originated from LAD proper in both type (54% vs 52%), but first diagonal branch from LAD proper (63%) in type I, from short LAD (71%) in type II. Presence of dual LAD was recognized before percutaneous coronary intervention (10) or bypass surgery (2) in 12 (63%) of 19 patients. Regional wall motion abnormalities (RWMA) were localized in distal septum or anterolateral wall in 2 patients with short or long LAD obstruction, respectively. CONCLUSION: Recognition of dual LAD is essential to prevent errors of interpretation of the coronary angiogram, to plan optimal strategy for percutaneous coronary intervention or bypass surgery, especially in case of total occlusion, and to understand localized septal or anterolateral RWMA.
Coronary Vessels* ; Humans ; Incidence* ; Percutaneous Coronary Intervention

BACKGROUND: Angiotensin-converting enzyme inhibitors(ACEi) do not decrease plasma angiotensin II levels in chronic use to the same extent as in acute use. this reincrease in angiotensin II level is explained either by a renin-mediated reactive rise in plasma angiotensin I or by non-ACE dependent angiotensin II generation. The aim of this study was to compare the additive effects of an ACEi and angiotensin II receptor antagonist(AT1a) in antiproteinuric effect, hyperkalemia, and hypotension. METHODS: 58 outpatients with chronic renal insufficiency were included and they were randomly classified into two groups : Group I(prescribed AT1a only), Group II(AT1a and ACEi combination therapy), and the changes of serum creatinine, the amount of proteinuria, the developement of hyperkalemia, and hypotension were evaluated. RESULTS: In group I, the amount of proteinuria decreased to 92.8% of initial amount at 1 month after the start of drugs. 2 of 28 patients(7.1%) developed hyperkalemia, and serum creatinine did not change (1.686+/-1.415mg/dL 1.821+/-1.301mg/dL, p=0.289). But in combination therapy group, serum creatinine level increased from baseline value of 1.466+/-0.619mg/dL to 1.800+/-0.881mg/dL(p=0.05), proteinuria did not change (101% of initial amount), and 7 of 30 patients(23.3%) developed hyperkalemia. CONCLUSION: Combination therapy seems to have no additive antiproteinuric effect, but serum creatinine and potassium levels should be closely monitered during the combination therapy.
Angiotensin I ; Angiotensin II* ; Angiotensins* ; Creatinine ; Humans ; Hyperkalemia ; Hypotension ; Outpatients ; Peptidyl-Dipeptidase A* ; Plasma ; Potassium ; Proteinuria ; Receptors, Angiotensin* ; Renal Insufficiency, Chronic

Neuroendocrine carcinomas of the colon and rectum are rare and have been known as either carcinoid tumors or undifferentiated cancers in the past. This type of tumor frequently occurred at cecum and is known for its aggressiveness and poor prognosis, differing from adenocarcinoma of colon. There has been no literature which describes endoscopic findings of colonic neuroendocrine carcinoma. Therefore, we report a case of neuroendocrine carcinoma of cecum in 36-year-old man with endoscopic findings. After right hemicolectomy followed by adjuvant chemotherapy, we have followed up the patient for 6 months without the evidence of recurrence.
Adenocarcinoma ; Adult ; Carcinoid Tumor ; Carcinoma, Neuroendocrine* ; Cecum* ; Chemotherapy, Adjuvant ; Colon ; Humans ; Peritonitis* ; Prognosis ; Rectum ; Recurrence

BACKGROUND/AIMS: In order to identify microsatellite instability (MSI), the test based on the polymerase chain reaction (PCR) can be used. However, PCR is not routinely performed in all hospital laboratories. Recently, immunohistochemistry (IHC) for MLH1 and MSH2 proteins has been reported as a rapid and useful method for MSI. However, the efficacy of IHC in the detection of the MSI has not been well established. The aim of this study was to evaluate the usefulness of IHC in the detection of the MSI by comparing it with the test results using PCR in colorectal cancer (CRC). METHODS: Paraffin-embedded normal and tumor tissues from seventy-five patients who underwent surgical resection of CRC were used. Abnormal expression of MLH1 and MSH2 protein was determined by IHC using MLH1 and MSH2 antibodies. Normal and tumor DNAs were obtained from thirty CRC tissues that showed abnormal expression of MLH1 and MSH2 proteins by IHC. The MSI status was confirmed by PCR using five markers. RESULTS: Thirty tumors showed abnormal expression of MLH1 and MSH2 proteins by IHC, but only three tumors out of them were confirmed to have MSI by PCR. CONCLUSIONS: This result suggests that IHC with MLH1 and MSH2 antibodies does not seem to be a useful method to identify MSI in CRC, therefore PCR is required for detection of the MSI.
Adaptor Proteins, Signal Transducing ; Aged ; Carrier Proteins ; Colorectal Neoplasms/*genetics ; DNA-Binding Proteins/*analysis ; Female ; Humans ; Immunohistochemistry ; Male ; *Microsatellite Repeats ; Middle Aged ; MutS Homolog 2 Protein ; Neoplasm Proteins/*analysis ; Nuclear Proteins ; Polymerase Chain Reaction ; Proto-Oncogene Proteins/*analysis