We report the implantation of a balloon-expandable intravascular stent at proximal left anterior decending artery in a patients suffered from Canakian functional class III angina for 8 years. The patient received 3 times percutaneous transluminal coronary angioplasty at proximal left anterior descending and circumflex artery without benefits. Repeated angiography revealed restenosis at proximal left anterior descending artery. Atherectomy was tried with transluminal extraction catheter(TEC) with luminal dissection and coronary bypass graft followed. occluded vein grafts were defined by follow-up angiography and chest pain recurred. No residual stenosis or thrombosis was documented in 24 hour follow-up angiography and the patient was discharged without symptom at 10 days after stenting.
Angiography ; Angioplasty, Balloon, Coronary ; Arteries ; Atherectomy ; Chest Pain ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis ; Transplants ; Veins

PURPOSE: To investigate the effects of genistein on the survival and production of nitric oxide in cultured human trabecular meshwork cells (HTMC). METHODS: Primarily cultured HTMC were exposed to 0, 1, and 10 microm genistein using serum-deprived media. Production of nitric oxide and eNOS activity were assessed with the Griess assay and RT-PCR after exposure to genistein for 10 min and one day. Cellular survival was assessed via MTT assay after exposure to genistein for one day. RESULTS: Genistein significantly increased the production of nitric oxide after exposure for 1 min at 10 microm and for 1 day at 1 microm under serum-deprived conditions. Genistein increased eNOS activity and cellular survival in HTMC. CONCLUSIONS: Genistein increases cellular survival under serum-deprived conditions, accompanied with an increase in nitric oxide production after both short-term and long-term exposures.
Genistein ; Humans ; Nitric Oxide ; Trabecular Meshwork

PURPOSE: To report a long term result of vitrectomy, gas tamponade without laser retinopexy for serous macular detachment associated with an optic disc pit (ODP). CASE SUMMARY: A 13 year old boy with visual disturbance in the left eye showed serous macular detachment associated with an inferior temporal ODP. The abnormal vitreous strand over the optic disc implying vitreous traction and retinoschisis were revealed by the optical coherence tomography (OCT) examination. Pars plana vitrectomy after complete induction of posterior vitreous detachment without laser retinopexy, and gas tamponade with postoperative facedown positioning were performed. Complete retinal attachment occurred at 6 months after first operation but recurrent macula detachment occurred at 15 months after first operation. Additional gas tamponade resulted in successful retinal attachment for more than 2 years and visual improvement. CONCLUSIONS: Vitrectomy and gas tamponade without additional laser photocoagulation could be another option for the treatment of ODP maculopathy. But recurrent macular detachment might occur and simple gas tamponade was effective in this case. This result supports another factor in addition to vitreous traction may play a role in the development of the macular detachment associated ODP. Further studies are required to evaluate the effect of vitrectomy, gas tamponade without laser retinopexy for the treatment of ODP maculopathy.
Eye ; Light Coagulation ; Retinaldehyde ; Retinoschisis ; Tomography, Optical Coherence ; Traction ; Vitrectomy ; Vitreous Detachment

Surgical revascularization is very effective for the relief of chest pain, improvement of exercise tolerance and ventricular performance in certain ischemic heart diseases. Bypass graft angiography and native coronary angiography after coronary artery bypass graft(CABG) were required for the evaluation of graft patency, progression of the native coronary artery disease and to predict the prognosis of the patients after CABG. The cases included in this study involved 15 patients who underwent selective bypass graft angiography among 102 CABG cases. Thirty eight sites were bypassed by saphenous vein and two sites by internal mammary artery. The results were as follows: 1) The overall patency rate of the saphenous vein bypass graft was 76.3% and the two sites of the internal mammary artery bypass graft were both patent. 2) The patency rate of direct anastomosis was 86.2% and of sequential anastomosis, 44.4%. 3) In eight patients who underwent native coronary angiography, five patients showed progression of grafted coronary artery disease. Among them, two patients had accompanying progression of coronary artery disease in non-grafted vessels. 4) Follow up treadmill test performed in six patients showed improvement of exercise tolerance in all patients. 5) There was some increase in the ejection fraction of the left ventricle after CABG in six patients who received follow up left ventriculography.
Angiography* ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Exercise Test ; Exercise Tolerance ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mammary Arteries ; Myocardial Ischemia ; Prognosis ; Saphenous Vein ; Transplants*

Twenty-one patients undergoing aortic valve replacement for pure aoritic regurgitation were studied retrospectively to evaluate the left ventricular function and internal dimension change before, 1-6 weeks(early postoperative) and 2-36 months after(late postoperative) aortic valve replacement by serial echocardiography. Postoperatively, NYHA function class improved remarkably (from 3.3+/-0.6 to 1.4+/-0.7). Early postoperatively, left ventricular end-diastolic dimension (EDD), left ventricular end-systolic dimension(ESD), left ventricular fractional shortenting(FS) significantly decreased in all patients(7.6+/-1.2cm vs 5.8+/-1.5cm P<0.001, 5.5+/-1.3cm vs 4.7+/-1.3cm P<0.001, 39+/-12% vs20+/-8% P<0.001 respectively). Interventricular septum thickness(IVS) and posterior wall thickness (PW) were slightly thickened before(1.4+/-0.3cm, 1.3+/-0.3cm respectively) and in the early postoperative period (1.3+/-0.4cm, 1.3+/-0.3cm respectively) without significant interval change. Late postoperatively, EDD and ESD decreased significantly (7.8+/-1.2cm vs 5.1+/-0.8cm P<0.01, 5.1+/-1.1cm vs 3.4+/-0.8cm P<0.001. respectively), and FS increased significantly (25+/-9% vs 34+/-9%, P<0.05). Among 3 patients of so called high risk group mentioned by Henry(22,33), ESD and FS improved to normal range in 2 patients, and ESD decreased to 4.4cm and FS increased to 33% in the other one. EDD and ESD decreased significantly in both group I(preoperative ESD<5.5cm) and group II(preoperative ESD<5.5cm), without no decrement difference between two groups, and there was a significant difference of FS decrement between group I and group II at early postoperative period. Preoperative ESD correlated highly with the early postoperative EDD(r=0.89) and ESD(r=0.87) with statistical significance, and moderately high with late postoperative EDD(r=0.45), ESD(r=0.50) and FS(r=0.42) without statistical signiticance. We concluded that there was significant improvement in left ventricular function in pure aortic regurgitation patients postoperatively. Preoperative left ventricular and systolic dimension above 5.5cm and fractional shortenting below 25% are not so reliabel index of poor postoperative prognosis.
Aortic Valve Insufficiency* ; Aortic Valve* ; Echocardiography* ; Humans ; Postoperative Period ; Prognosis ; Reference Values ; Retrospective Studies ; Ventricular Function, Left

No abstract available.
Arteries* ; Hemorrhage* ; Ligation*

BACKGROUND: Electroconvulsive therapy (ECT) still remains a place in modern psychiatric practice. The anesthetic agent for ECT should provide smooth and rapid induction, rapid recovery and attenuation of the physiologic effects of ECT as well as minimal antagonistic effects on seizure activity. We performed a study to assess the comparative effects of propofol and thiopental sodium on seizure activity, hemodynamic stability, and recovery after ECT. METHODS: Ten patients scheduled for maintenance ECT participated in this prospective, randomized, crossover study. The induction dose was 1.5 mg.kg 1 of propofol and 3 mg.kg 1 of thiopental sodium. The lengths of motor and EEG seizure were measured after each electric stimuli. Mean arterial pressure, heart rate and recovery time were also compared between two groups. RESULTS: Both propofol and thiopental sodium were associated with mean motor and EEG seizure durations above thirty seconds. However, the improved hemodynamic stability associated with propofol and recovery time of propofol (8.1 +/- 2.8 min) was shorter than thiopental sodium (13.0 +/- 9.3 min). CONCLUSIONS: Compared with thiopental sodium, the use of propofol was associated with a clinically insignificant decrease in seizure duration and improved hemodynamic stability, recovery time. We conclude that propofol may be a useful alternative to thiopental sodium for ECT therapy.
Anesthetics* ; Arterial Pressure ; Cross-Over Studies ; Electroconvulsive Therapy* ; Electroencephalography ; Heart Rate ; Hemodynamics* ; Humans ; Propofol* ; Prospective Studies ; Seizures* ; Thiopental*

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility. For induced hypotension, many methods have been used. Recently esmolol is favored in induced hypotension because of its short action and easy controlability, but thoracic epidural block is seldom used in induced hypotension. So we compared the effect of esmolol and thoracic epidural block in induced hypotension. METHOD: Patients scheduled for spinal posterior fusion under general anesthesia were randomly divided into two groups. In thoracic epidural group (Group I, 20 patients), 8~10 ml of 2% lidocaine was injected into the epidural catheter located in T6-7 interspace in a bolus. In esmolol group (Group II, 20 patients), 0.5 mg/kg of esmolol received as loading dose and 50~150 microgram/kg/min infused continuously. We measured mean arterial pressure, central venous pressure, heart rate, amounts of administrated fluids, urine output and VAS score. RESULT: There were no statistically significant differences between the two groups in amounts of bleeding, administered fluid, urine output. The elapsed time to reach the state of induced hypotension (MAP 55~65 mmHg) is 15.1 2.4 min after lidocaine injection in Group I and 6.1 2.7 min after esmolol injection in Group II (p<0.05). There were statistically significant differences between two groups in mean arterial pressure in 10 min after the injection (p<0.05). But there was apparent difference in VAS score in postoperative 1 hrs, 2 hrs and 6 hrs (p<0.05). CONCLUSION: Thoracic epidural block is another method for induced hypotension. And postoperative pain control can be easily achieved by injection through epidural catheter.
Anesthesia, General ; Arterial Pressure ; Catheters ; Central Venous Pressure ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Lidocaine ; Pain, Postoperative

Continuous epidural analgesia with morphine via portable infusor(Baxter Infusor, BI) is a good technique for the management of intractable cancer pain. The method of subcutaneous tunnelling with portable infusor has been widely used for the cancer pain management. We examined the doses of morphine, duration of subcutaneous tunnelling, side effects, age distribution and causes of pain. The mean initial dose of morphine was 6.09 and the last 24.02 mg. Mean duration of subcutaneous tunnelling was 53.71 days and voiding difficulty, pruritus, respiratory depression were observed. Most of the patients were at the ages of 6th decade and the most common cause of pain was stomach cancer. It is suggested that the management of intractable cancer pain with epidural morphine through subcutaneous tunnelling via portable infusor is satisfactory and reliable.
Age Distribution ; Analgesia, Epidural ; Humans ; Infusion Pumps* ; Morphine ; Pain Management ; Pruritus ; Respiratory Insufficiency ; Stomach Neoplasms

BACKGROUND: We investigated relationships between generalized joint laxity and primary lumbar disc herniation occurrence and compared clinical outcomes after conservative treatment in lumbar disc herniation patients with and without generalized joint laxity. METHODS: The study group included 128 men, and the control group included 276 men matched for age and body mass index with the study group. The primary outcome measure was the presence or absence of generalized joint laxity using the Beighton scale. Clinical outcomes measured by the visual analog scale and the Oswestry disability index 2 years after conservative treatment were the secondary outcome measure. RESULTS: Generalized joint laxity prevalence was 13.2% in the study group and 5.1% in the control group, a significant difference (P=0.01). Spearman correlation analysis revealed that weight (r=0.162, P=0.03), body mass index (r=0.131, P=0.03), and generalized joint laxity (r=0.372, P<0.01) significantly correlated with lumbar disc herniation occurrence. In multivariate regression analysis, generalized joint laxity was the only significant lumbar disc herniation predictor (P=0.002; 95% confidence interval, 1.08 to 5.26). Generalized joint laxity in lumbar disc herniation patients was associated with worse clinical outcomes after conservative treatment measured by visual analog scale scores for lower extremity pain (P=0.02), lower back pain (P=0.03), and Oswestry disability index scores (P=0.03). CONCLUSION: Generalized joint laxity might be associated with lumbar disc herniation occurrence and might also be a negative predictor of worse clinical outcomes after conservative treatment.
Body Mass Index ; Humans ; Intervertebral Disc Displacement ; Joint Instability* ; Low Back Pain ; Lower Extremity ; Lumbar Vertebrae ; Male ; Outcome Assessment (Health Care) ; Prevalence ; Treatment Outcome* ; Visual Analog Scale