No abstract available.

Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a 56-year-old woman.

The isolated coronary ostial stenosis is a lesion of the aortic wall that encroaches on the orifice of the left main coronary artery, atherosclerosis is belived to be a common cause and premenopausal female patients are most commonly affected. Stenosis of the left coronary ostium is a critical lesion which requires urgent myocardial revascularization including a surgical intervention because this lesion jeopardizes such a large volume of left ventricular myocardium. We report the case of a patient in whom percutaneous transluminal coronary angioplasty (PTCA) was performed successfully for the stenotic lesion of distal anastomotic site after surgical ostioplasty with autologous pericardium.
Angioplasty, Balloon, Coronary ; Atherosclerosis ; Constriction, Pathologic* ; Coronary Vessels ; Female ; Humans ; Myocardial Revascularization ; Myocardium ; Pericardium*

No abstract available.
Aneurysm

Objective To study the feasibility and safety of transradial approach for coronary interventions Methods Coronary intervention was tried to be performed via transradial approach in 116 patients with coronary heart disease (96 males, 20 females, mean age 57 44?9 40 years) Results Transradial puncture failed in 5 cases and coronary interventions were performed via transfemoral approach instead Coronary intervention failed in 2 cases although transradial puncture succeeded Both transradial puncture and coronary intervention succeeded in the rest 109 cases One hundred and thirty five narrowed coronary arteries were dilated (69 LAD, 26 LCX, 39 RCA, 1 venous graft) One hundred and forty eight coronary lesions, including 15 type A, 106 type B and 27 type C lesions were treated One hundred and ten stents were implanted in 105 coronary arteries of 98 patients Rotablator was performed in one case and intracoronary ultrasound detected for another Changing guiding catheter was necessary for 25 cases during the procedure Transfusion was needed due to puncture site bleeding in one case Big hematoma was found in two cases Perforation of a branch of brachial artery happened in another case No surgery repair needed Conclusion Coronary intervention via transradial approach was feasible, but the radial artery puncture was somewhat difficult, and guiding catheter support is poor to some extent One must be cautious about vascular damages near the puncture site

Liver function tests before treatment showed abnormalities of liver function tests during treatment, while 15(68. 2%) of 22 patients who had abnormal liver function tests before treatment showed abnormalities during treatment. In 12 of the 25 patients who showed abnormalities of liver function tests during treatment with allopurinol, allopurinol was stopped and all patients showed improvement of liver function tests. In remaining 13 patients, 10 patients were improved and other 2 patients showed only mild abnormalities of liver function tests despite of continuing allopurinol and 1 patient was lost during follow-up. CONCLUSION: Abnormalities of liver function tests were common during treatment with allopurinol. Most patiensts who had mild abnormalities of liver functions tests during treatment with allopurinol were improved regardless of continuing allopurinol.
Allopurinol* ; Follow-Up Studies ; Gout* ; Humans ; Liver Function Tests* ; Liver*

No abstract available.
Muscle, Smooth* ; Relaxation*

Acoustic stimulation test(AST), is currently being used as an alternative tool of nonstress test (NST). However, there are no standard guideline for analysis of AST. Computerized numerical analysis of AST would be helpful for development of diagnostic criteria of AST. Fifty-one normal pre-term pregnancies entered to this study after conventional 20-minutes NST and 10-minutes AST. Acoustic stimulations were performed using Fetal Acoustic Stimulator (Model 146, Corometrics, US). We analyzed the FHR response after acoustic stimulation using our on-line computerized FHR analysis system, HYFM-I & II software. The changes of loss of signal, baseline FHR, variability, number of fetal movements, and number of FHR accelerations were analyzed numerically. The loss of signal was increased about 2 fold(122.61%). The baseline FHR was increased from 144.57bpm to 156.81bpm(8.5%) after acoustic stimulation. Number of fetal movements was increased about 2 fold(from 2.1 to 4.12/10 minutes). FHR variability was also increased from 17.81 bpm to 26.37 bpm. After AST, number of FHR accelaration was increased 55.47%(10sec 10bpm) and 68.42%(15sec 15bpm), respectively. In this study, we acrumulated elemental FHR data using computerized system after AST. These data would be helpful in the accurate analysis of AST and also enable us to develop the objective interpretation system for AST.
Acceleration ; Acoustic Stimulation* ; Acoustics* ; Female ; Fetal Heart* ; Fetal Movement ; Heart Rate, Fetal* ; Pregnancy ; Pregnancy*

Ventricular arrhythmia and left ventricular dysfunction after hospital discharge in acute myocardial infarction are powerful predictors of sudden death. We evaluated the ventricular extrasystoles with 24 hour ambulatory electrocardiography at convalescent phase in 34 patients of acute myocardial infarction. Ventricular extrasystoles were observed in 19 patients (56%) and classified by Lown's grading system as grade 1 for 8 cases, grade 2 for 3 cases, grade 3 for 3 cases, grade 4 for 3 cases, and grade 5 for 2 cases. There was no relation between the develoment of ventricular extrasytoles and the risk factors of ischemic heart discase such as smoking, hypertension, hyperlipidemia, diabetes mellitus, and male sex. Also, the development of ventricular extrasystoles was independent to infarct site, regional wall motion abnormalities, and clinical manifestations of left ventricular dysfunction such as congestive heart failure and cardiomegaly. In conclusion, ventricular arrhythmia might independently predict the prognosis in survivors of acute myocardial infarction.
Arrhythmias, Cardiac ; Cardiomegaly ; Chymopapain ; Death, Sudden ; Diabetes Mellitus ; Electrocardiography, Ambulatory ; Heart ; Heart Failure ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Myocardial Infarction* ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Survivors ; Ventricular Dysfunction, Left ; Ventricular Premature Complexes*

BACKGROUND: Many physicians hesitate to discuss do-not-resuscitate (DNR) orders with patients or family members in critical situations. In the intensive care unit (ICU), delayed DNR decisions could cause unintentional cardiopulmonary resuscitation, patient distress, and substantial cost. We investigated whether the timing of DNR designation affects patient outcome in the medical ICU. METHODS: We enrolled retrospective patients with written DNR orders in a medical ICU (13 bed) from June 1, 2014 to May 31, 2015. The patients were divided into two groups: early DNR patients for whom DNR orders were implemented within 48 h of ICU admission, and late DNR patients for whom DNR orders were implemented more than 48 h after ICU admission. RESULTS: Herein, 354 patients were admitted to the medical ICU and among them, 80 (22.6%) patients had requested DNR orders. Of these patients, 37 (46.3%) had designated DNR orders within 48 hours of ICU admission and 43 (53.7%) patients had designated DNR orders more than 48 hours after ICU admission. Compared with early DNR patients, late DNR patients tended to withhold or withdraw life-sustaining management (18.9% vs. 37.2%, p = 0.072). DNR consent forms were signed by family members instead of the patients. Septic shock was the most common cause of medical ICU admission in both the early and late DNR patients (54.1% vs. 37.2%, p = 0.131). There was no difference in in-hospital mortality (83.8% vs. 81.4%, p = 0.779). Late DNR patients had longer ICU stays than early DNR patients (7.4 ± 8.1 vs. 19.7 ± 19.2, p < 0.001). CONCLUSIONS: Clinical outcomes are not influenced by the time of DNR designation in the medical ICU. The late DNR group is associated with a longer length of ICU stay and a tendency of withholding or withdrawing life-sustaining treatment. However, further studies are needed to clarify the guideline for end-of-life care in critically ill patients.
Advance Directives ; Cardiopulmonary Resuscitation ; Consent Forms ; Critical Illness* ; Hospital Mortality ; Humans ; Intensive Care Units ; Resuscitation Orders* ; Retrospective Studies ; Shock, Septic