No abstract available.
Echocardiography*

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.
Calculi ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholestasis ; Cystic Duct* ; Deception* ; Dilatation ; Gallbladder ; Gallstones ; Humans ; Jaundice ; Mirizzi Syndrome* ; Neck ; Stents

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.
Calculi ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholestasis ; Cystic Duct* ; Deception* ; Dilatation ; Gallbladder ; Gallstones ; Humans ; Jaundice ; Mirizzi Syndrome* ; Neck ; Stents

BACKGROUND: The early coronary reperfusion with tissue type plasminogen activator(t-PA) influenced on the short term mortality and long term mobidity in acute myocardial infarction. The attention for thrombolysis with t-PA has been focused in identifying the optimal t-PA regimen and on the possibility of achieving effective and safe thrombolysis with a bolus of t-PA. Experimental data demonstrates that rapid t-PA infusion resulted in improved thrombolysis with minimal fibrinogenolysis and without excessive bleeding than prolonged infusion. METHODS: Consecutive patients presenting up to 6 hour from the onset of symptoms were recruited for the study. Aspirin(200mg daily) should be given immediately, 100mg t-PA was administered as two intravenous bolus injections of 50mg t-PA each given 30 minute apart, and followed by 5,000 unit heparin IV bolus with continuous infusion for 5 days. Angiography was performed at 60 and 90min after the first bolus and between 12-24 hour after study entry. After 7-10 days of myocardial infacrtion, coronary angiograms were performed in all patients who had been taken ddouble bolus t-PA. RESULTS: At 60min, angiography revealed infarct-related coronary artery patency of TIMI flow grade 3 in 15(88%) of 17 patients. At 90min, infarct-related coronary artery patency of TIMI flow grade 3 was achieved in 16(94%) of 17 patients. Bleeding episodes were mostly minor(6 of 33 patients, 18%), and hemorrhagic stroke was developed in 1 patients(1/33, 3.0%). Three patients(9.0%) died in hospitalization probably due to ventricular rupture. CONCLUSION: The administration of 100mg of double bolus t-PA in acute myocardial infarcion results in remarkably high early TIMI flow grade 3 on infarct-related coronary artery patency rates(88% and 94% at 60 and 90min, respectively). The bolus injection of t-PA may be simple and effective strategy in the treatment of acute myocardial infarction. However, large numbers of prospective study would be required.
Angiography ; Coronary Vessels ; Hemorrhage ; Heparin ; Hospitalization ; Humans ; Mortality ; Myocardial Infarction* ; Myocardial Reperfusion ; Plasminogen ; Rupture ; Stroke ; Tissue Plasminogen Activator*