No abstract available.
Humans ; Intensive Care Units* ; Critical Care* ; Korea*

No abstract available.
Allografts* ; Cyclosporine* ; Graft Survival* ; Transplants*

No abstract available.
Allografts* ; Cyclosporine* ; Graft Survival* ; Transplants*

The actions and side effcts of the benzodiazepine antagonist flumazenil were evaluated in a clinical study in which midazolam was used as an anesthetir induction agent. Anesthesia was maintained with nitrous oxide-oxygen-fentanyl. Sixty-five adult surgical patients received either 0.3 mg (3 ml) of flumazenil (33 cases) or 3 ml of saline (32 cases) at the conclusion of surgery. Blood pressure, pulse rate, and respiratory rate were checked before premedication, just before, 5 minutes, 30 minutes, and 120 minutes after the administration flumazenil or saline. Also level of consciouseness, orientation in time and space, and cooperativeness along with end tidal carbon dioxide and hemoglobin oxygen saturation were evaluated. Various larboratory parameters were checked before premedication and 24 hours after operation. The results were as follows: 1) The flumazenil group revealed improved level of consciousness, orientation in time and space, and cooperativeness which began just after the administration, and was maintained 30 minutes thereafter. 2) There was no difference in the changes of laboratory parameters between the two groups. 3) The changes of blood pressure, pulse rate, respiratory rate, and SaO2 showed no difference between those two groups. 4) The end tidal concentrations of carbon dioxide after drug administration were significantly lower in the flumazenil group than those of the saline group. 5) Tolerance to flumazenil (0.3 mg) was good without any side effect.
Adult ; Anesthesia* ; Benzodiazepines ; Blood Pressure ; Carbon Dioxide ; Consciousness ; Flumazenil* ; Heart Rate ; Humans ; Midazolam* ; Oxygen ; Premedication ; Respiratory Rate

Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. But the individual vasoactive agent has limitations in its clinical success and potential for side effects. So, the synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy of erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. A total of 223 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). Major underlying diseases were DM(115patients, 51.6%), hypertension(11 patients, 4.9%), spinal injury(three patients, 1.3%) and prior pelvic surgery(three patients, 1.3%). The volume of drug used ranged between 0.04 and 0.6ml(average:0.19ml). After a mean followup of 7.6 months(3-15 months), 141 patients(63.2%) left in the home injection program and among them, 125 patients(88.6%) had very high satisfaction. The drop-out rate was 36.8%(82 of 223) with most of the cases during early home phase. The causes of drop-out were the fear of needle or injection, inadequate response to injection, loss of interest and complications. Priapism(six patients, 3.8%), pain(six patients, 3.8%) and granuloma on injection site(one patient, 0.6%) were noticeable complications, but coporal fibrosis and systemic side effect were not noticed. In conclusion, Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and, most of all, very effective method for the treatment of the patients with erectile dysfunctions.
Drug Therapy ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies ; Granuloma ; Humans ; Male ; Needles ; Papaverine ; Phentolamine

BACKGROUND: In patients with myocardial infarction (MI) and chronic stable angina, the coronary flow reserve (CFR) is reduced not only in the region of myocardium perfused by the ischemia-related artery but also in the regions supplied by angiographically normal coronary arteries. The effect of myocardial stunning on the remote CFR is unknown, however. METHODS: In ten open-chest anesthetized dogs, left circumflex coronary artery was occluded for 15 minutes (myocardial stunning group, n=5) or for 30 minutes (MI group, n=5) and was followed by a reperfusion for 60 minutes. Before coronary occlusion and at 30 minutes and at 60 minutes after reperfusion, resting coronary blood flow (CBF) and maximal CBF after IV injection of each of adenosine (ADE) and acetylcholine (Ach) was measured with electromagnetic flow probe located in the proximal left anterior descending coronary artery. CFR was calculated as the ratio of maximal and resting CBF. RESULTS: At 30 minutes and 60 minutes after reperfusion, the remote resting CBF were significantly increased in both groups and the remote CFR was significantly decreased in both groups. The CFR of the MI group was lower than myocardial stunning group. The coronary vasodilator response to Ach was significantly lower than the response to ADE in both groups. CONCLUSION: After MI and myocardial stunning, there was severe coronary vasodilator abnormality in the remote myocardium and that was more marked after MI. The coronary vasodilator response to Ach was significantly lower than the response to ADE in both groups, suggesting endothelial dysfunction in remote myocardium.
Acetylcholine ; Adenosine ; Angina, Stable ; Animals ; Arteries ; Coronary Occlusion ; Coronary Vessels ; Dogs ; Humans ; Magnets ; Myocardial Infarction ; Myocardial Stunning* ; Myocardium ; Reperfusion

No abstract available.
Gout* ; Hyperuricemia*

BACKGROUND: Increased homocysteine levels are an independent risk factor for coronary artery disease (CAD). A common genetic mutation (nucleotide 677 C-to-T) in methylenetetrahydrofolate reductase (MTHFR), an enzyme required for efficient homocysteine metabolism, creates a thermolabile enzyme with reduced activity. Homozygotes of MTHFR mutation represent 5% to 12% of general population in Canada, America, and Japan. In this study, we examined the distribution of the MTHFR genotypes in CAD patients and healthy volunteers and the association between the genotypes and the total homocysteine level (tHcy). METHODS: We screened 60 Korean patients with CAD (CAD group) and 97 healthy volunteers (control group) for the MTHFR 677 C-to-T mutation. Fasting and post-methionine-load tHcy level, folic acid, and vitamine B12 level were determined with other clinical variables in CAD group. RESULTS: The frequency of the MTHFR V/V homozygous genotype was 20% in CAD group (with 40% heterozygous and 40% wild type) and 14% in control group (with 48% heterozygous and 38% wild type). In CAD group, homozygotes of MTHFR mutation had significant higher fasting tHcy level than wild type (homozygote, 18.83+/-6.37 micromol/L: wild type, 12.36+/-3.21 micromol/L: p<0.01). The tHcy level correlated with the age (r=0.425, p<0.01), the folate level (r=-0.534, p<0.01), and the presence of the mutant MTHFR gene (r=0.565, p<0.01) after adjustment of other clinical variables. CONCLUSION: We find that homozygotes of MTHFR mutation have higher homocysteine level independent of folic acid in patients with CAD. Large case-control study needed to confirm whether MTHFR mutation increases the risk of CAD independent of plasma tHcy level.
Americas ; Canada ; Case-Control Studies ; Coronary Artery Disease* ; Coronary Vessels* ; Fasting ; Folic Acid ; Genotype* ; Healthy Volunteers ; Homocysteine* ; Homozygote ; Humans ; Japan ; Metabolism ; Methylenetetrahydrofolate Reductase (NADPH2)* ; Plasma ; Risk Factors ; Vitamins

BACKGROUND AND OBJECTIVES: The objective of this study was to assess the in-hospital clinical outcome and 6 months follow-up angiographic results after flexible balloon expandable MultiLink coronary stenting. The impact of post-stenting excessive high pressure balloon dilation on late outcome is controversial. The other purpose was to investigate the impact of post-stenting high pressure balloon dilation (HPD group > or =14 atm) on clinical and angiographic outcome in comparison to moderate pressure dilation (MPD group < 14 atm). MATERIALS AND METHOD: The MultiLink stents were implanted in 124 patients (mean age 58+/-9, M/F=94/30) with 128 lesions. Post-stenting high pressure balloon dilation was performed to have less than 10% of residual stenosis and smooth in-stent lumen without IVUS guidance. RESULTS: The indications for stenting were elective in 88 lesions (69%), suboptimal angioplasty results in 27 lesions (21%), and bail-out in 13 lesions (10%). The incidence of in-hospital major adverse cardiac events was 1.6% and major vascular complication rate was 3.2%. The follow-up angiography was performed in 86 patients (69%) at 7.9+/-2.6 months. The angiographic restenosis rate was 22.7%. The acute gain of HPD group had a tendency to be higher than MPD group (HPD:MPD=2.33+/-0.51 mm:2.22+/-0.44 mm, p=0.08) and the late loss of MPD group had a tendency to be lower than HPD group (MPD:HPD=0.86+/-0.73 mm:0.95+/-0.84 mm, p=0.09). And the net gain and restenosis rate of both groups were similar respectively (HPD:MPD=1.38+/-0.94 mm:1.36+/-0.83 mm, p=ns, HPD:MPD=22.5%:22.9%, p=ns). CONCLUSION: The MultiLink coronary stent system is a safe and effective device with high procedural success rate and also has the acceptable angiographic restenosis rate for the treatment of coronary artery disease. The post-stenting excessive high pressure balloon dilation might not be necessary during the deployment of MultiLink stent.
Angiography ; Angioplasty ; Constriction, Pathologic ; Coronary Artery Disease ; Follow-Up Studies* ; Humans ; Incidence ; Stents*

PURPOSE: The triad of chest pain, normal coronary arteries and a positive stress test has been called microvascular angina. The link between coronary flow reserve(CFR) and Duke treadmill score(DTS) in patients with microvascular angina remains elusive. METHODS: We studied 108 subjects (M:F=8:60, mean age 54+/-9 yrs) with chest pain and normal coronary angiogram. Exercise treadmill test(ETT) was performed by Bruces protocol and the equation for calculating DTS was DTS=xercise time- (5xST deviation)-(4x exercise angina), with 0=one, 1=onlimiting, 2=exercise-limiting. The coronary flow velocity at diastole(PDV) using Transesophageal echocardiography (TEE) was obtained from the proximal left anterior descending coronary artery and coronary flow reserve(CFR) was calculated as the ratio of hyperemic PDV after the intravenous infusion of dipyridamole(0.56 mg/kg) to baseline PDV. RESULTS: 1) CFR was 3.04+/-0.45 in group with negative ETT and 2.19+/-0.62 in group with positive ETT(p<0.001). 2) CFR was 1.51+/-0.31 in high-risk group with a score of <-10, 2.39+/-0.63 in moderate-risk group with scores from -10 to + and 3.04+/-0.43 in low-risk group with a score of > or =+ on DTS(p< 0.001 versus low-risk, respectively). 3) DTS was significantly related to CFR (r=.704, p<0.001). CONCLUSION: The composite DTS is closely related to CFR using TEE and might be a useful tool that can help clinicians determine the severity of ischemia and evaluate the efficacy of treatment in patients with microvascular angina.
Chest Pain ; Coronary Vessels ; Echocardiography, Transesophageal* ; Exercise Test ; Humans ; Infusions, Intravenous ; Ischemia ; Microvascular Angina*