No abstract available.
Amyloidosis*

BACKGROUND/AIMS: Local drug delivery to the bile duct may be effective to prevent proliferative cholangitis (PC) through capability of high dose administeration with minimal systemic side effects. Paclitaxel is an anticancer drug whose side effect on the stabilization of microtubule leads to cell death. The aims of this study were to establish the proliferative cholangitis model in rat, mimicking biliary stricture in human, and to test whether paclitaxel-coated nylon thread prevents biliary stricture in a PC model of rat. METHODS: PC was induced by introducing a fine nylon thread into the bile duct in a rat from 1 week to 4 week. To evaluate the effects of paclitaxel as a locally-delivered anti-proliferative drug, dog gallbladder epithelial cells were exposed to sequential concentrations of paclitaxel (0.1microM, 1microM, 10microM, and 100microM) for 20 min. in vitro, and inhibition of proliferation was measured by (3)H-thymidine uptake assay. Paclitaxel- coated 5-0 nylon threads (1.8+/-0.5 ug/3 cm thread, measured by HPLC) were made by immersion of ethanolic paclitaxel (50 mg/ml) and evaporation of the solvent. Nylon threads were inserted into the bile duct of male Sprague-Dawley rats weighing 200~50 g. Paclitaxel (n=15) and control (n=15) groups were divided with or without paclitaxel-coating procedure. The paclitaxel effects were assessed by histomorphological examination one week after thread implantation. RESULTS: The decrease of (3)H-thymidine uptake was observed at 100microM of paclitaxel exposured for 20 minutes in the presence of epidermal growth factor (50 nM/ml) than control. PC model characterized by epithelial-glandular proliferation and fibrous thickening of the bile duct wall through 1~ week. This model was established at 1 week. The effect of paclitaxel-coated nylon thread into the bile duct were evaluated after 1 week. In paclitaxel treated the luminal area, luminal length and the ratio of lumen to bile duct cross sectional area increased by 276% (p=0.044), 87% (p=0.012) and by 330% (p=0.000), respectively, versus control. The total wall area, epithelial-glandular area, and stromal area were similar between paclitaxel treated group and control (p>0.05). The bile duct wall thickness of paclitaxel group decreased by 33% (p=0.011, 273 (90)microM vs 410 (95)microM, paclitaxel vs control). CONCLUSION: Paclitaxel-coated nylon thread into bile duct was effective for the suppression of luminal stenosis, and may offer a therapeutic option for biliary stricture and biliary stricture associated disease.
Animals ; Bile Ducts ; Cell Death ; Cholangitis* ; Constriction, Pathologic ; Dogs ; Epidermal Growth Factor ; Epithelial Cells ; Ethanol ; Gallbladder ; Humans ; Immersion ; Male ; Microtubules ; Nylons* ; Paclitaxel ; Phenobarbital ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Several kinds of stents have shown their safety and efficacy to treat acute or subacute closure after balloon angioplasty as well as to reduce restenosis rate. However, one of the limitations of stents is difficult to deploy especially in tortuos vessels, lesions at a bend, and distal to previously deployed stents. The Micro stent II, which was one of the most recently developed stents, ia a rapid-exchage balloon expandable stainless steel stent with a zigzag design connected with a continuous single weld in each 3mm segments. It scores over excellent trackability and optimum radio-opacity. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report our experiences with Micro-II stent implanatation in the first 76 patients at Tonsei cardiovascular center to assess its safety and efficacy in patients with complex coronary anatomy and clinical results in the first months. METHODS: Between January 1996 and July 1996, eighty-six Micro-II stent were implanted in the coronary arteries of 76 patients(male 65.8%, age 59+/-10 year). Forty-five patients had unstable angina, the others had stable angina(17pts), acute myocardial infarction(14pts). RESULTS: 1) Indication of stenting was de novo 51(59.3%), suboptimal result 25(29.1%), restenosis 1(1.2%) and 9(10.4%) of lesions were stented in bail out situation. 2) Single stent were implanted in 76(88.4%)lesions, overlapping stent in 10(11.6%)lesions. Among overlapping stents, the second stent with Micro-II stent and with another kind of stent were 4.6%, 7.0%, respectively. 3) Procedure related complication including a subacute closure was occurred in 1(1.2%) patient who had distal dissection and 45% residual stenosis. In 12(14%) lesions, preistent dissection has been noticed after stent impantation. 4) Angiographic success(defined as a residual stenosis of <30% without major dissection) was achieved in 82 of 86 attempts(95.3%). The procedual success rate(defined as a residual stenosis of <30% without occurrence of major clinical events within 4 weeks after procesure) was 96.1%(73/76 patients). Angiographic success and procedural success rate in calcified lesion were 100% and 100%, respectively. Angiographic success and procedural success rate in more than 45` angulated lesion were 97% and 100%, respectively. 5) The mean minimal luminal diameter of the target lesions was increased from 0.42+/-0.40mm before stent implantation to 2.93+/-0.50mm(p<0.001). The percentage of diameter stenosis was reduced from 86.49+/-13.04% to 1.40+/-7.11%(p<0.001) after stent implantation. CONCLUSION: Coronary stenting with AVE Micro-II stent can be safety performed and is particularly beneficial in tortuous and calcified arteries. There was a high tendency for peristent dissection which need to special consideration to avoid. Follow-up data is needed to assess mid and term patency. Coronary artery disease . AVE Micro-II stent . Immediate results.
Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Humans ; Phenobarbital ; Stainless Steel ; Stents*

BACKGROUND: Paroxysmal atrial fibrillation (PAF) causes not only severe symptoms and hemodynamic changes, but may progress to chronic atrial fibrillation. Autonomic nervous system or atrial premature beat (APB) has been suggested to contribute to the spontaneous initiation of PAF, but the exact mechanism has been largely unknown. METHODS: One hundred and twenty nine episodes of PAF lasting longer than 5 sec were analyzed in 18 patients (M:F=11:?). Two minutes of normal sinus rhythm before the onset of PAF, and the initial one minute of PAF were printed and analyzed. RESULTS: Most of PAFs were initiated by APBs (38%) or rapid atrial tachycardias (AT, 59%). The frequency of APBs tended to increase immediately before PAF onset (p=0.08). The coupling intervals and coupling indices were not significantly different between PAF-producing APBs and benign APBs. More than half of PAF episodes were initiated by rapid ATs (rate, 357+/-50 bpm). After the onset, they accelerated over several seconds and then degenerated into AF. In some cases, transition from AF to atrial flutter and vice versa were observed. Heart rate, measured at 60-second intervals during 2 minutes before PAF onset, did not change significantly (p=0.44). CONCLUSION: Most of PAFs were initiated by APBs or rapid ATs. Heart rate did not change significantly but the frequency of APBs tended to increase immediately before PAF onset. Rapid ATs frequently accelerated and degenerated into AF. In this regard, Holter monitoring could be useful in identifying patients with PAF triggered by rapid ATs.
Atrial Fibrillation* ; Atrial Flutter ; Autonomic Nervous System ; Cardiac Complexes, Premature ; Electrocardiography, Ambulatory* ; Heart Rate ; Hemodynamics ; Humans ; Tachycardia

Orbital complications of sinus disease continue to appear in clinical practice. Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. The classification which defines the degree of orbital extension is valuable, therapeutically and prognostically. The orbital apex syndrome is associated with an affection of the vessels and nerves passing through the superior orbital fissure and the optic foramen and characterized by visual loss and ophthalmoplegia. But it has minimal or no signs of orbital inflammation such as proptosis, chemosis, or lid edema. We experienced a case of temporary monocular visual loss and ophthalmoplegia caused by mucocele in the sphenoid sinus. Thus, we report, with a review of literature, a case of orbital apex syndrome caused by mucocele in the sphenoid sinus in a 53 year-old male patient.
Classification ; Edema ; Exophthalmos ; Humans ; Inflammation ; Male ; Middle Aged ; Mucocele* ; Ophthalmoplegia ; Orbit* ; Orbital Cellulitis ; Orbital Diseases ; Sinusitis ; Sphenoid Sinus* ; Vision Disorders

The percutaneous transfemoral approach has been routinely used for cardiac catheterization and coronary angioplasty. Local vascular complications following angioplasty are seen in 5% to 10% of patients, especially in those who need prolonged anticoagulation. Transradial access for coronary procedures dramatically reduces access site complications. We report a rare case of radial arteriovenous fistula, which developed after coronary angiography perfomed using the transradial approach.
Angioplasty ; Arteriovenous Fistula ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Angiography ; Humans ; Radial Artery

Hepatoid adenocarcinoma (HAC) is a rare type of extrahepatic carcinoma whose morphology is similar to that of hepatocellular carcinoma (HCC). Metachronous HCC and HAC in the same patient is extremely rare. The case of a 68-year-old man with chronic hepatitis B infection who had both HCC and HAC of the stomach is reported herein. Nine years previously this patient had been diagnosed with HCC and received a right lobectomy. HCC that recurred at the caudate lobe at 6 months after the operation was successfully treated with transarterial chemoembolization. The patient was followed up regularly thereafter without evidence of tumor recurrence for 9 years. In July 2010 his serum alpha-fetoprotein (AFP) level elevated from 6.5 ng/mL to 625.4 ng/mL, and he developed a probable single metastatic lymph node around the hepatic artery without intrahepatic lesions. Subsequent evaluation with upper endoscopy revealed a 4-cm ulcerative lesion on the antrum of the stomach. Subtotal gastrectomy was performed with lymph-node dissection. Histologic examination revealed a special type of extrahepatic AFP-producing adenocarcinoma-HAC with lymph-node metastasis-which indicates that HAC can be a cause of elevated AFP even in patients with HCC. HAC should be considered if a patient with stable HCC exhibits unusual elevation of AFP.
Adenocarcinoma/*diagnosis/drug therapy/secondary ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Camptothecin/analogs & derivatives/therapeutic use ; Carcinoma, Hepatocellular/*diagnosis/drug therapy/pathology ; Chemoembolization, Therapeutic ; Chemotherapy, Adjuvant ; Fluorouracil/therapeutic use ; Gastroscopy ; Humans ; Leucovorin/therapeutic use ; Liver Neoplasms/*diagnosis/drug therapy/pathology ; Lymph Nodes/surgery ; Lymphatic Metastasis ; Male ; Recurrence ; Silicates/therapeutic use ; Stomach Neoplasms/*diagnosis/drug therapy/secondary ; Titanium/therapeutic use ; Tomography, X-Ray Computed ; alpha-Fetoproteins/*analysis

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SES), as opposed to bare metal stents (BMS), have been shown to markedly reduce restenosis. However, many clinical trials have excluded the subset of patients (pts) with end-stage renal disease (ESRD). The aim of this study was to evaluate the clinical outcomes following SES implantation in ESRD pts. SUBJECTS AND METHODS: We analyzed the clinical outcomes in 50 pts from our registry following SES implantation, and compared the outcomes between those with ESRD receiving SES (SES-ESRD) and BMS (BMS-ESRD), and with non-ESRD pts following SES implantation (SES-non ESRD). RESULTS: A comparison of the SES-ESRD (50 pts, 72 lesions) with BMS-ESRD groups (42 pts, 45 lesions); those in the SES-ESRD group included; diabetes 78%, hypertension 94% and age 62+/-10 years. Those in the SES-ESRD group were more likely to have diabetes (diabetes of BMS-ESRD, 57%; p=0.04). The reference vessel diameters (RVD) of the SES-ESRD group were smaller (2.76+/-0.50 mm vs. 3.05+/-0.46 mm, p<0.001), but the lesion length was longer (25.6+/-7.0 mm vs. 19.1+/-8.8 mm, p<0.001) than those of the BMS-ESRD group. The SES-ESRD group had a lower 1-year major adverse cardiac events (MACE) rate than the BMS-ESRD group (6.0% vs. 33.3%; p<0.001). There were no differences in mortality and incidence of myocardial infarction between the two groups. The incidence of target vessel revascularization decreased significantly in the SES-ESRD group (2.0% vs. 19.0%, p=0.01). From a multivariate regression analysis, the use of SES was the only significant independent predictor of MACE (OR=0.054, 95% confidence interval 0.01 to 0.26, p<0.001). A comparison with SES-non ESRD group in our total registry (644 pts, 758 lesions); MACE in the SES-ESRD group (6.0%) was higher than in the SES-non ESRD group (3.1%), but there was no statistical significance (p=0.23). CONCLUSION: Compared with BMS, SES caused an improvement in the clinical outcomes in pts with ESRD.
Angioplasty* ; Humans ; Hypertension ; Incidence ; Kidney Failure, Chronic* ; Mortality ; Myocardial Infarction ; Stents*

No abstract available.
Myocardial Bridging

Minimally invasive surgery is being widely accepted in various fields of surgery. Although several appendectomy techniques have been reported but, there is no standardization. We report here the experiences of transumbilical endoscopic appendectomy in humans. Between July 2008 and September 2010, ten patients with appendicitis successfully underwent transumbilical endoscopic appendectomies. There were 7 cases of suppurative, 2 cases of gangrenous and 1 case of perforated in operative findings. The ages of the patients were 13-56 years (mean age, 32.7 +/- 15.4 years). Under general anesthesia, a 15-mm port was inserted through the umbilicus and then a two-channel endoscope was inserted in the peritoneal cavity. After appendix identification, counter-traction of the appendix with a direct abdominal wall puncture using a straight round needle prolene was performed to achieve good visualization of the operative field. Tissue dissection was performed using an endoscopic needle knife. Tissue grasping and resected appendix retrieval were done with endoscopic forceps. The average operation time was 79.5 +/- 23.6 minutes (range, 45 to 110 minutes). No procedures were converted to laparoscopic or open appendectomy. Hospital stay was 4-6 days. All patients completely recovered without complications. As it is highly maneuverable, we believe transumbilical endoscopic appendectomy can be a feasible method. And, as surgeons want to proceed from laparoscopic surgery to natural orifice transluminal endoscopic surgery, this procedure could be a triable method.
Abdominal Wall ; Anesthesia, General ; Appendectomy* ; Appendicitis ; Appendix ; Endoscopes ; Endoscopy ; Hand Strength ; Humans ; Laparoscopy ; Length of Stay ; Natural Orifice Endoscopic Surgery ; Needles ; Peritoneal Cavity ; Polypropylenes ; Punctures ; Surgical Instruments ; Surgical Procedures, Minimally Invasive ; Umbilicus