The aortic dissection is an acute aortic syndrome, caused by an intimal tear and subsequent splitting of the media by the pulsatile blood flow. Though there would be differences in the origin of aortic dissection and therapeutic modalities, the intermediate and long-term prognoses are poor. Endovascular Stent-graft implantation is a revolutionary technique in the treatment of aortic dissection. The endovascular stent grafting in aortic dissection is less invasive and feasible method and is an effective tool for closing the entry site and promoting clot formation, reducing the size of the false lumen. Therefore, endovascular Stent-graft implantation makes possible the desirable remodelling of aorta. We report 33 year-old male with aortic dissection in the thoracic aorta, which was treated with endovascular Stent-graft implantation. Over the favorable remodelling, his dissection was healed completely by the endovascular treatment using Stent-graft.
Adult ; Aorta ; Aorta, Thoracic* ; Blood Vessel Prosthesis ; Humans ; Male ; Prognosis

BACKGROUND AND OBJECTIVES: Combination of ticlopidine and aspirin has been accepted as a standard antiplatelet regimen after coronary stenting because it reduced the rate of cardiac events and hemorrhagic-vascular compli-cations compared with intensive anticoagulation. Ticlopidine use, however, may accompany serious side effects such as neutropenia or liver dysfunction. Cilostazol, a c-AMP phosphodiesterase inhibitor, is a novel antiplatelet agent which is known to have less side effects. MATERIALS AND METHODS: We compared the efficacy and safety of ci lostazol plus aspirin (CA) with ticlopidine plus asprin (TA) after elective coronary stenting. Patients were randomly assigned to receive either CA or TA two days before stenting. The primary end point was a composite of angiographic stent thrombosis, death, myocardial infarction (Q or Non-Q), repeat intervention or bypass su rgery at 30 days. The secondary end points were hemorrhagic-vascular complications, or drug side effects such as neutropenia, thrombocytopenia, or any side effects requiring cessation of drugs at 30 days. RESULTS: After randomization of 300 patients equally to each group, 4 patients were excluded from the analysis: 1 failure of stenting, 3 follow-up loss. The primary end point was reached in 2 patients (1.4% ) in CA group and 3 patients (2.0% ) in TA group (p=1.0). The rate of hemorrhagic-vascular complications was not different between the gr oups (1.4% vs 2.0%, p=1.0). The incidence of significant drug-related side effects was not statistically different between CA group and TA group (0.7% vs 2.7%, p=0.37). However, serious side effect such as neutropenia was seen only in TA group. CONCLUSION: Compared with TA, CA has comparable effect for the prevention of stent thrombosis and major cardiac events with similar rate of hemorrhagic-complications and drug-related side effects after elective coronary-artery stenting. Thus CA regimen can be a safe alternative to TA in elective implantation of coronary artery stent.
Aspirin ; Coronary Vessels ; Follow-Up Studies ; Humans ; Incidence ; Liver Diseases ; Myocardial Infarction ; Neutropenia ; Random Allocation ; Stents ; Thrombocytopenia ; Thrombosis ; Ticlopidine*

No abstract available.
Tumor Necrosis Factor-alpha*

BACKGROUND: Early detection of vascular change may improve prediction of subclinical stage of cardiovascular disease, allowing intervention to prevent overt vascular damage. High heart rate is known to increase cardiovascular morbidity and mortality rate in the general population and in individuals with cardiovascular disease. We aimed to investigate the association between resting heart rate (RHR) measured using electrocardiogram (ECG) and arterial stiffness measured using the cardio-ankle vascular index (CAVI) in men. METHODS: Data were collected from 5,629 men aged between 20 and 78 years who visited a single-site health promotion center. RHR was measured in a supine posture after resting for 10 minutes using an ECG. Arterial stiffness was measured using the CAVI. The cutoff value for high CAVI was ≥9.0. RESULTS: RHR was one of the major determinants of high CAVI after adjusting for age, waist circumference, mean arterial pressure, glycosylated hemoglobin level, triglyceride level, white blood cell count, and lifestyle factors. When RHR groups were defined according to the RHR quartiles, the odds ratio of group with RHR ≥70 bpm, for high CAVI was 3.62 (95% confidence interval [CI], 2.21–5.91) after adjusting for age and lifestyle factors. This association was not changed after adjusting for all other covariates (odds ratio, 2.39; 95% CI, 1.36–4.19). CONCLUSIONS RHR measured using ECG is significantly associated with arterial stiffness in men not taking medications for hypertension, dyslipidemia, or diabetes. These findings suggest that RHR may be useful in assessing cardiovascular risk in men.

Background: Non-alcoholic fatty liver disease fibrosis score (NFS) is a scoring system applied in clinical practice to predict advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Evidence shows that progression of steatohepatitis and liver fibrosis reduces the production of verylow- density lipoprotein. The aim of this study was to identify the association of NFS and serum low-density lipoprotein cholesterol (LDL-C) levels and in adults with NAFLD. Methods: Data were gathered from 24,889 subjects who had visited a health promotion center. NFS was calculated to assess the severity of fibrosis in all the subjects. Serum LDL-C levels were measured using a direct method. Results: Serum LDL-C levels tended to decrease with increasing NFS quartiles (P for trend<0.01). NFS was one of the major determinants of serum LDL-C level after adjusting for age, sex, lifestyle-related factors, and other covariates. The estimated mean serum LDL-C level was significantly lower in the highest quartile of NFS than in the lowest quartile of NFS. Conclusion NFS had a negative association with serum LDL-C levels in adults with NAFLD. Elevated LDL-C level is not only a risk factor of cardiovascular disease but also a predictive indicator of NAFLD severity.

BACKGROUND: Early detection of vascular change may improve prediction of subclinical stage of cardiovascular disease, allowing intervention to prevent overt vascular damage. High heart rate is known to increase cardiovascular morbidity and mortality rate in the general population and in individuals with cardiovascular disease. We aimed to investigate the association between resting heart rate (RHR) measured using electrocardiogram (ECG) and arterial stiffness measured using the cardio-ankle vascular index (CAVI) in men. METHODS: Data were collected from 5,629 men aged between 20 and 78 years who visited a single-site health promotion center. RHR was measured in a supine posture after resting for 10 minutes using an ECG. Arterial stiffness was measured using the CAVI. The cutoff value for high CAVI was ≥9.0. RESULTS: RHR was one of the major determinants of high CAVI after adjusting for age, waist circumference, mean arterial pressure, glycosylated hemoglobin level, triglyceride level, white blood cell count, and lifestyle factors. When RHR groups were defined according to the RHR quartiles, the odds ratio of group with RHR ≥70 bpm, for high CAVI was 3.62 (95% confidence interval [CI], 2.21–5.91) after adjusting for age and lifestyle factors. This association was not changed after adjusting for all other covariates (odds ratio, 2.39; 95% CI, 1.36–4.19). CONCLUSIONS: RHR measured using ECG is significantly associated with arterial stiffness in men not taking medications for hypertension, dyslipidemia, or diabetes. These findings suggest that RHR may be useful in assessing cardiovascular risk in men.
Arterial Pressure ; Arteriosclerosis ; Cardiovascular Diseases ; Dyslipidemias ; Electrocardiography ; Health Promotion ; Heart Rate ; Heart ; Hemoglobin A, Glycosylated ; Humans ; Hypertension ; Leukocyte Count ; Life Style ; Male ; Mortality ; Odds Ratio ; Posture ; Risk Assessment ; Triglycerides ; Vascular Stiffness ; Waist Circumference

Intracranial hemorrhage is one of the fatal complications related to general anesthesia, it can occur in patients with intracranial aneurysm, hypertension, vascular malformation, malignancy and blood dyscrasia. We have experienced a case of death from massive surbarachonoid hemorrhage during general anesthesia. A 38 Years old female patient who had no abnormality in past history, physical examination and laboratory finding preoperatively, admitted for vaginal hysterectomy becauae of secondary uterine prolapse. Anesthesia was performed under tracheal intubation with Halothane-Enflurane, O2,N2O and with induction by pentothal sodium and succinylcholine. After operation, the patient showed delayed recovery from anesthesia and both pupils were dilated without light reflex. In optic fundoscopic view, fundus was furfilled with red-pinkish blood and CSF in spinal tapping was dark bloody colored. Brain C-T showed generalized brain edema and hemorrhage density in sylvian cistern, basal cistern, lateral ventricle. Autopsy finding revealed massive subarachnoidal hemorrhage but not disclosed the site of ruptured intracranial aneurysm. Authors report this case of death from subarachnoid hemorrhage for warning of possible victim during general anesthesia for referencial review.
Adult ; Anesthesia ; Anesthesia, General* ; Autopsy ; Brain ; Brain Edema ; Delayed Emergence from Anesthesia ; Female ; Hemorrhage ; Humans ; Hypertension ; Hysterectomy, Vaginal* ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Intubation ; Lateral Ventricles ; Physical Examination ; Pupil ; Reflex ; Sodium ; Spinal Puncture ; Subarachnoid Hemorrhage* ; Succinylcholine ; Thiopental ; Uterine Prolapse ; Vascular Malformations

Diaphragm rupture often challenges the surgeon by it's subtle presentation in the face of more obvious injuries, equivocal chest roentgenography, and no obvious indication of celiotomy or thoracotomy. Delayed diagnosis is one variable implicated in increased morbidity and mortality. This retrospective study was performed to determine the diagnostic value of diaphragm rupture on initial evaluation and to present an algorithm for initial evaluation. We reviewed the hospital records and the radiographs of 37 patients with a blunt diaphragmatic rupture who were treated at Yongdong Severance Hospital during a period of 5 years. The blunt diaphragmatic ruptures in 14 (38.9%) of the thirty-seven patients were missed on initial admission. At admission, initial physical findings were diagnostic in 3 cases (8.1%), suspicious in 24 cases (64.9%) and normal in 10 cases (27%). On chest roentgenogram, findings were diagnostic in 6 cases (16.2%), suspicious in 28 cases (75.7%) and normal in 3 cases (8.1%). Chest CT scans were performed on 20 patients. Findings were diagnostic in 6 (30%) of these, suspicious in 11 (55%) and normal in 3 (15%). On the chest roentgenograms of the 15 cases with suspicious physical findings, which were diagnosed early, the findings were diagnostic in 4 cases (26.7%) and suspicious in 11 cases (73.3%). Chest CT scans were performed in 10 out of 15 cases with suspicious physical findings which were diagnosed early, and the findings were diagnostic in 3 cases (30%), suspicious in 6 cases (60%), normal in 1 case (10%). In 23 patients (61.1%), diagnosis was established within 48 hours. In 4 (17.4%) of these patients, the diaphragm rupture was detected at the time of the celiotomy performed for other injuries. In conclusion, a blunt diaphragm rupture can easily be missed in the absence of obvious indications for a celiotomy or a thoracotomy, because radiologic abnormalities are often interpreted as other injuries. In such cases, a high index of suspicion coupled with selective use of a CT scan, fluoroscopy, thoracoscopy, or laparoscopy may be necessary for early detection of the diaphragm rupture.
Delayed Diagnosis ; Diagnosis ; Diaphragm* ; Early Diagnosis* ; Fluoroscopy ; Hospital Records ; Humans ; Laparoscopy ; Mortality ; Radiography ; Retrospective Studies ; Rupture* ; Thoracoscopy ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed

Sister-chromatic exchanges measured in the peripheral lymphocytes of 15 non-smoking medical students after exposure to formaldehyde during a 24-week anatomy class showed a small but significant (p=0.0468) increase when compared with samples obtained from the same individuals immediately before exposure. Mean frequencies of sister-chromatic exchange of cultured peripheral lymphocytes were 5.40+/-0.24 from the samples before exposure and 5.87+/-0.22 from the same samples after exposure. Breathing-zone air samples collected by formaldehyde monitoring kit with digital colorimeter (SKC) showed a mean concentration of 0.72+/-0.02 ppm formaldehyde.
Formaldehyde* ; Humans ; Lymphocytes* ; Students, Medical*

Coronary artery ectasia is an uncommon disorder diagnosed in 1 to 4% of patients undergoing coronary arteriography. Coronary artery ectasia is often considered a variant of atherosclerotic coronary artery disease, although other causes should be considered. Complications from this disease usually occur as thrombo-embolic phenomena primarily due to thrombosis in the ectatic segment of the coronary artery. A 53-year old man was transferred to our ER, presenting with acute inferior wall infarction. Coronary angiogram showed a gigantic ectatic right coronary artery (RCA) with occlusion of the mid portion by a huge mural thrombus. We injected and infused glycoprotein IIb-IIIa inhibitor in the RCA, however the lysis of thrombus was minimal. Subsequently, we infused Urokinase into the RCA for 2 days. Follow-up angiography revealed partial lysis of the thrombus. The patient demonstrated no thrombo-embolic events during two months of coumadinization, and follow-up angiography revealed a complete lysis of the thrombus.
Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Dilatation, Pathologic* ; Follow-Up Studies ; Glycoproteins ; Humans ; Infarction ; Middle Aged ; Myocardial Infarction* ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Warfarin