No abstract available.
Cryptococcosis*

BACKGROUND: Catheter ablation using radiofrequency energy has been established as the most important mode of treatment in patients with accessory pathway. However the ablation of midseptal accessory pathways had been recognized as being more difficult to ablate than other located pathway because of the low incidence and the difficult localization of ablation site. This paper describes the electrophysiologic characteristics of successfully ablated midseptal accessory pathway using radiofrequency energy. METHOD: Routine electrophysiologic studies were performed in 13 patients with midseptal accessorypathway. Guided by the recording of VA interval, the ablation catheter was positioned in all patients in an area bounded anteriorly by the tip electrode of the His bundle catheter and posteriorly by the coronary sinus ostium. Local electrograms during orthodromic atrioventricular reentrant tachycardia or right ventricular apical pacing were compared for 13 patients with midseptal accessory pathway and consequent 13 patients with posteroseptal accessory pathway. RESULT: 13 patients with midseptal accessory pathway; eight with constant Wolff-Parfinson-White syndrome, one with intermittent Wolff-Parkinson-White syndrome and four with concealed bypass track underwent attempts at ablation of their pathway using radiofrequency energy. 11 accessory pathways were successfully ablated without complication during the firstsession. A second attempt at ablation was made in two patients with success(one; recurred case, the other one; failed case at the first session). In the surface 12-Lead ECG, all eight patientswith constant Wolff-Pakinsin-White syndrome had not shownen Qrs complex at lead 3. Two patient with midseptal accessory pathway had transient left bundle branch block during orthodromic tachycardia. The VA interval during left bundle branch block was not change compared to that during narrow complex tachycardia in both. In all patients with midseptal accessory pathway, the VA interval in his bundle electrogram were almost similar to that in the coronary sinus ostial electrogram, which was not observed in the patients with posteroseptal accessory pathway. CONCLUSION: We suggest that VA interval during orthodromic tachycardia and right ventricular apcial pacing is the most reliable market for identifying midseptal accessory pathway, especially distinguishing from posteroseptal accessory pathway.
Bundle of His ; Bundle-Branch Block ; Catheter Ablation ; Catheters ; Coronary Sinus ; Electrocardiography ; Electrodes ; Electrophysiologic Techniques, Cardiac ; Humans ; Incidence ; Tachycardia ; Wolff-Parkinson-White Syndrome

No abstract available.

Infective endocarditis is a disease that is characterized by the vegetations. Although cardiac complications remain the leading cause of death, endocarditis is complex, systemic illness with involvement of virtually all the organs. The spectrum and incidence of cardiovasular, neurologic, renal complications also are presented by direct embolism and immune- mediated phenomena. Systemic embolism is the common and serious complications associated with infective endocarditis. Mycotic aneurysm by septic embolization is known complication of bacterial endocarditis, but mycotic aneurysm of superior mesenteric artery is very rare complication and approximately 10 cases has been reported in the literature. Acute hemorrhagic pericarditis is unusual clinical manifestation of bacterial endocarditis and subject to catastrophic hemodynamic compromise secondary to cardiac tamponade. We report a case of bacterial endocarditis in 23 years old male who developed acute hemorrhagic pericarditis and hemoperitoneum due to rupture of mycotic aneurysm in superior mesenteric artery with brief review of lieratures.
Aneurysm, Infected* ; Cardiac Tamponade ; Cause of Death ; Embolism ; Endocarditis ; Endocarditis, Bacterial* ; Hemodynamics ; Hemoperitoneum* ; Humans ; Incidence ; Male ; Mesenteric Artery, Superior* ; Pericarditis* ; Rupture* ; Young Adult

No abstract available.
Animals ; Exocrine Glands* ; Nitric Oxide Synthase* ; Nitric Oxide* ; Rats*

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: Neurological injury after cerebral air embolism may be due to thromboinflammatory responses at sites of air-injured endothelium. Because heparin inhibits multiple thromboinflammatory processes. we hypothesized that heparin would decrease neurological impairment after cerebral air embolism. METHODS: Anesthetized rabbits received either heparin (n=14) or saline (n=13), 5 minutes before air injection (150 microliter/kg). Heparin was given as a 200 IU/kg bolus and followed by a constant infusion of 75 IU/kg/h for 2 hours. Equal volumes of salines were given to saline group. Two hours later, anesthesia was discontinued. Rabbits were neurologically evaluated 24 hours after air embolism. RESULTS: Heparin group had significantly less neurological impairment at 24 hours (34 14) than saline controls (52 8) (p=0.0013). CONCLUSIONS: When given prophylactically, heparin decreases neurological impairment caused by severe cerebral arterial air embolism.
Anesthesia ; Embolism, Air ; Endothelium ; Heparin* ; Rabbits*

BACKGROUND: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of metocurine, atracurium, doxacurium, and pipecuronium. This study examine neuromuscu-lar blocking effect and recovery of mivacurium in isolated rat phrenic-hemidiaphragm with two-weeks phenytoin pretreatment. METHOD: After the administration of 14 days of phenytoin 40 mg/kg, administered intraperitoneally twice daily (n=10), ED90, antagonism of neostigmine and 4-aminopyridine on the electrically evoked twitch response and train-of-four (TOF) stimulation were compared to control groups in isolated rat phrenic-hemidiaphragm preparation. RESULTS: ED90 was significantly greater in the phenytoin group than in the control group (319 +/- 39.5 g vs. 209.5 +/- 52.2 g, respectively). After the administration of neostigmine 0.75 M, the recovery of the single twitch and TOF ratio were significantly lesser in the phenytoin group than in the control group (single twitch; 19.6 +/- 6.6% vs. 69.2 +/- 9.4%, TOF ratio; 0.258 +/- 0.149 vs. 0.543 +/- 0.1, respectively). After the administration of 4-aminopyridine 40uM, the recovery of the single twitch and TOF ratio were no significant differrence between the phenytoin group and the control group (twitch; 118.1 +/- 25.3% vs. 122.6 +/- 24.8%, TOF ratio; 0.937 +/- 0.051 vs. 0.949 +/- 0.067, respectively). CONCLUSION: Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of mivacurium.
4-Aminopyridine ; Animals ; Atracurium ; Drug Interactions ; Neostigmine ; Neuromuscular Blockade* ; Phenytoin* ; Pipecuronium ; Rats*

PURPOSE: Cyclooxygenase (COX)-2 is an inducible isoform responsive to cytokines, mitogens, and growth factors, and is believed to be an important enzyme related to colorectal cancer (CRC). Existing evidence suggests that COX-2 expression is normally suppressed by wild-type p53 but not mutant p53, suggesting that loss of p53 function may result in the induction of COX-2 expression. The aim of this study was to determine the relationship between COX-2 expression and p53 levels in CRC. MATERIALS AND METHODS: Patients with sporadic colorectal adenocarcinoma (n=161) who underwent curative surgery in Chosun University Hospital were enrolled in this study. Expression of COX-2 and p53 proteins was examined by immunohistochemistry in paraffin-embedded cancer tissue blocks, and the relationship between COX-2 and/or p53 expression with clinicopathologic parameters was analyzed. RESUTLS: Expression of COX- 2 was positive in 47.8% of colorectal cancers, and significantly associated with the depth of tumor invasion (p= 0.042). In contrast, p53 was positive in 50.3% of the cases, and was associated with both age (p=0.025) and the depth of tumor invasion (p=0.014). There was no correlation between COX-2 expression and p53 expression (p=0.118). CONCLUSION: These results suggest that COX-2 expression might play an important role in the progression of colorectal cancer. However, COX-2 expression was not associated with mutational p53. Further studies are needed to clarify the regulatory mechanisms governing COX-2 overexpression in colorectal cancers.
Adenocarcinoma/*metabolism/pathology/surgery ; Aged ; Colorectal Neoplasms/*metabolism/pathology/surgery ; Cyclooxygenase 2/*metabolism ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Mutation ; Tumor Suppressor Protein p53/genetics/*metabolism

BACKGROUND AND OBJECTIVES: Myocardial bridge is congenital coronary anomaly and cause myocardial ischemia by milking effect. The general study of myocardial bridge is to be weak, so we examined a clinical study of myocardial bridge. MATERIALS AND METHOD: This study included 36 bridge cases out of 1048 patients who underwent coronary angiography due to chest pain from Jan. 1993 to Jul. 1998. Angiographic film, medical records and interview by telephone were reviewed retrospectively. Total follow-up duration was mean 27 months (1 month to 62 months). RESULTS: Incidence of myocardial bridges diagnosed by angiography was 3.4%. Angiography showed normal in 32, 1 vessel disease in 3 and 2 vessel disease in one patient. Mean reference diameter was 2.97+/-0.36mm, bridge diameter was 2.75+/-0.33mm in diastole, 1.12+/-0.47mm in systole. Myocardial bridge length was 12.50+/-7.44mm, mean % diameter stenosis was 59.26+/-17.7%. Myocardial bridge location was 80.6% in mid LAD and 13.9% in mid & distal LAD and 5.5% in distal LAD. There was no statistically significant correlation with sex, risk factor of coronary heart disease, resting electrocardigraphy, treadmill test, diameter and angulation of coronary artery, clinical symptom in the severity of myocardial bridge. But the severity of myocardial bridge correlated with bridge length(r=.5033). CONCLUSION: Clinical outcomes of bridge patients were relatively good during the mean follow up periods of 27 months. Myocardial bridge was more severe in younger age and longer bridge length.
Angiography ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Diastole ; Exercise Test ; Follow-Up Studies ; Humans ; Incidence ; Medical Records ; Milk ; Myocardial Ischemia ; Retrospective Studies ; Risk Factors ; Systole ; Telephone