Coronary stent embolization is a rare event but may result in clinically relevant cardiac ischemia or peripheral embolization during the procedure. We report a case of systemic embolizations of two coil stents during the primary PTCA in acute myocardial infarction, who were treated successfully with a double wire helix technique and a gooseneck snare. Although in our experience this rare complication did not produce any clinical complications, care should be taken to prevent this possibility, especially in patients with significant vessel tortuosity, calcification, total occlusion, or mild stenosis proximal to the target lesion.
Constriction, Pathologic ; Humans ; Iliac Artery* ; Ischemia ; Myocardial Infarction ; SNARE Proteins ; Stents*

PURPOSE: The bone defects that are associated with shoulder anterior instability may be the causes of failure of arthroscopic surgery. For the treatment of traumatic shoulder instability, we tried to determine the arthroscopic techniques that can be used for the bone defect of the glenoid and the humeral head. The purpose of this study is to assess the surgical techniques for the arthroscopic reconstruction of the shoulder with anterior instability and bone defects. MATERIALS AND METHODS: We analyzed the articles that have been recently published on anterior shoulder instability and we assessed the arthroscopic surgical techniques. We compared the articles and the methods of arthroscopic surgical techniques for treating bone defects of the anteroinferior glenoid and the posterolateral humeral head, which were considered as the causes of recurrence of shoulder instability. RESULTS: There are the anteroinferior bone defects of the glenoid and Hill-Sachs lesions in the bone defects that appear in patients with anterior shoulder instability. These bone defects are currently the causes of failure of arthroscopic surgery. CONCLUSION: Open shoulder surgery may be the treatment of the choice for a shoulder with instability and significant bone defects of the glenoid and the humeral head. But efforts are being made to overcome the weaknesses of open surgery by the use of arthroscopy
Arthroscopy ; Humans ; Humeral Head ; Recurrence ; Shoulder

Surgical endarterectomy has been shown to be superior to medical treatment in the management of severe carotid stenosis. Endarterectomy, although effective, does have limitations, and percutaneous transluminal angioplasty with stent may offer an alternative modality of treatment. We report on a patient with severe coronary disease that femoral arterial cannulation was not possible due to aorto-femoral shunt operation and absent pulse. The transradial approach was used for aortography, bilateral carotid angiography and successful elective stent deployment in the left internal carotid artery. The transradial approach might be useful alternative in case of problems with femoral approach.
Angiography ; Angioplasty* ; Aortography ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Catheterization ; Coronary Disease ; Endarterectomy ; Humans ; Stents*

The author performed radiosurgery with linear accelerator(LINAC) on two patients who were unable to receive surgical treatment. A 75-year-old-male patient(case 1) whose main complaints were gait disturbance and headache had undergone total resection of cerebellar hemangioblastoma five years before the admission and the lesion recurred. Because the patient's general condition was poor, radiosurgery with LINAC was performed and at 1 month after the radiosurgery, obstructive hydrocephalus developed, and ventriculoperitoneal shunt was done. After 11 months, follow-up brain magnetic resonance image findings showed the decrease of the size of the tumor, and the patient's consciousness returned to alertness. He could also walk using a cane. A 28-year-old male paient(case 2) whose main complaints were vertigo, ataxia refused to receive surgical resection due to his religious beliefs, and radiosurgery was performed, after cyst aspiration with ommaya reservoir insertion as an alternative. Eighteen months later, the tumor size has decreased and there were no radiosurgical complications. The patient has been followed-up at the outpatient without any notable symptoms. Through these two cases, the authors experienced tumor control by LINAC radiosurgery when surgical treatment is not acceptable. Radiosurgery seems safe and effective in the treatment of hemangioblastoma, but there is the need for further evaluation.
Adult ; Ataxia ; Brain ; Canes ; Consciousness ; Follow-Up Studies ; Gait ; Headache ; Hemangioblastoma* ; Humans ; Hydrocephalus ; Male ; Outpatients ; Radiosurgery* ; Religion ; Ventriculoperitoneal Shunt ; Vertigo

OBJECTIVE: The safety and effectiveness of Guglielmi Detachable Coil(GDC) embolization for cerebral aneurysm has been well documented. However, domestically there are few reports. The purpose of this study is to analyze procedural complications that occurred during endovascular coilling performed for cerebral aneurysms retrospectively. METHODS: From January 1996 to December 2003, a total of 453 patients (484 aneurysms) who had undergone GDC embolization for cerebral aneurysm were selected. The aneurysms were classified according to rupture history, location, dome and neck size. Procedural complications such as aneurysmal rupture, thrombosis and occlusion of patent vessels due to coil escape were noted. RESULTS: Procedural complications occurred 49 cases (10.1%). Among these, there were 27 of procedure-related aneurysmal rupture (5.6%), 14 of thrombosis (2.9%), 8 of occlusion of patent vessels due to coil escape (1.7%). Death or severe neurological deficit were seen in 18 cases of procedure-related rupture, 9 cases of thrombosis and 4 cases of coil escape. Procedure-related mortality and morbidity rates for endovascular coiling were calculated to be 2.9% and 3.6% respectively. CONCLUSION: The potential complications associated with shape, size and relationship to parent vessels of each specific cerebral aneurysm must be considered carefully before treatment. In order to reduce complications, proper equipment, knowledge on the hemodynamics and vascular anatomy, and operator's expertise are desired.
Aneurysm* ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Mortality ; Neck ; Parents ; Retrospective Studies ; Rupture ; Thrombosis ; United Nations

OBJECTIVE: Distal anterior cerebral artery(DACA) aneurysms are relatively uncommon, and have special aspects. We discuss clinical features and surgical results of DACA aneurysms with review of literatures. METHODS: Among 725 cases of intracranial aneurysms operated from 1989 to 2001 in our hospital, 38 cases of DACA aneurysms were studied retrospectively. The clinical presentations, neurological findings, operative approaches and outcome were analyzed. RESULTS: The incidence of the DACA aneurysm was 5.2% of total 725 aneurysms. Multiple aneurysms were found in 10 patients. Among the 38 patients, 15 were men and 23 were women. The mean age was 49.8 years. 2 aneurysms were located at frontobasal artery, 5 at the origin of frontopolar artery, 28 at the bifurcation between callosomarginal and pericallosal artery, 3 at the origin of pericallosal artery. 32 patients had good outcomes after surgery. 4 patients remained disabled, and 2 patients died. Postoperative complications were vasospasm, cerebral infarction, intracranial hemorrhage, pneumonia. CONCLUSION: The incidence of DACA aneurysm was relatively rare than other location. We think that unilateral interhemispheric approach is useful for aneurysm in most DACA, and approaches should be chosen according to the location of aneurysm and presence or absence of multiple aneurysms. The Glasgow Outcome Scale score was good in patient with low Hunt & Hess grade preoperatively. And early operation can reduce the rate of rebleeding and improve outcome of DACA aneurysms.
Aneurysm ; Anterior Cerebral Artery* ; Arteries ; Cerebral Arteries ; Female ; Glasgow Outcome Scale ; Humans ; Incidence ; Infarction ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Male ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

BACKGROUND: Hyperplastic neointima is one of the major mechanisms of restenosis following balloon angioplasty in selected patients with symptomatic angina pectoris. Elevation of cellular cyclic nucleotide levels such as cAMP and cGMP are known to inhibit the proliferation of vascular smooth muscle cells. 3-isobutyl-1-methylxanthine (IBMX) increases intracellular cAMP and cGMP by nonselective inhibition of phosphodiesterases (PDEs). We conducted this study under the hypothesis that local delivery of IBMX could inhibit neointimal hyperplasia after balloon injury of the rat carotid artery. METHODS: Left common carotid artery of 10 week old male Sprague-Dawley rats were subjected to arterial injury by 2F Fogarty balloon catheter. After injury, animals were allocated to the control groups (control 1: injury control and control 2: pluronic gel plus DMSO control) and IBMX group, which received pluronic polymer gel, DMSO and IBMX mixture periadventitially. After 3 weeks, the rats were killed by overdose of ketamine, and the injured left arteries were pressure-fixed with 10% formalin and subjected to histomorphological analysis. RESULTS: Mean body weight of rats was not statistically different among study groups. The mean area of neointima (control group 1:0.28+/-0.05 mm2,Control group 2:0.27+/-0.08 mm2 , IBMX group:0.18+/-0.08 mm2 : p<0.05) and the mean ratio of neointima to medial area[versus (control group 1:1.89+/-0.37, control group 2:1.95+/-0.41, IBMX group: 1.41+/-0.47: p<0.05)] were significantly less in IBMX group. The mean area of external elastic lamina was significantly larger in control group 1 than IBMX group (0.57+/-0.07 mm2 versus 0.47+/-0.10 mm2 ) and mean luminal area showed no significant difference among groups (control group1:0.14+/-0.07 mm2 , control group 2: 0.10+/-0.05 mm2 , control group 3: 0.16+/-0.06 mm2). CONCLUSION: Peri-adventitial single administration of IBMX showed its effectiveness in reducing the neointimal proliferation in rat carotid balloon injury model. Furthermore we observed the positive correlation between intimal area and EELA suggesting vascular remodeling depending on the intima volume.
1-Methyl-3-isobutylxanthine* ; Angina Pectoris ; Angioplasty, Balloon ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Dimethyl Sulfoxide ; Formaldehyde ; Humans ; Hyperplasia ; Ketamine ; Male ; Muscle, Smooth, Vascular ; Neointima ; Phenobarbital ; Phosphoric Diester Hydrolases ; Polymers ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Hyperplastic neointima is one of the major mechanisms of restenosis following balloon angioplasty in selected patients with symptomatic angina pectoris. Elevation of cellular cyclic nucleotide levels such as cAMP and cGMP are known to inhibit the proliferation of vascular smooth muscle cells. 3-isobutyl-1-methylxanthine (IBMX) increases intracellular cAMP and cGMP by nonselective inhibition of phosphodiesterases (PDEs). We conducted this study under the hypothesis that local delivery of IBMX could inhibit neointimal hyperplasia after balloon injury of the rat carotid artery. METHODS: Left common carotid artery of 10 week old male Sprague-Dawley rats were subjected to arterial injury by 2F Fogarty balloon catheter. After injury, animals were allocated to the control groups (control 1: injury control and control 2: pluronic gel plus DMSO control) and IBMX group, which received pluronic polymer gel, DMSO and IBMX mixture periadventitially. After 3 weeks, the rats were killed by overdose of ketamine, and the injured left arteries were pressure-fixed with 10% formalin and subjected to histomorphological analysis. RESULTS: Mean body weight of rats was not statistically different among study groups. The mean area of neointima (control group 1:0.28+/-0.05 mm2,Control group 2:0.27+/-0.08 mm2 , IBMX group:0.18+/-0.08 mm2 : p<0.05) and the mean ratio of neointima to medial area[versus (control group 1:1.89+/-0.37, control group 2:1.95+/-0.41, IBMX group: 1.41+/-0.47: p<0.05)] were significantly less in IBMX group. The mean area of external elastic lamina was significantly larger in control group 1 than IBMX group (0.57+/-0.07 mm2 versus 0.47+/-0.10 mm2 ) and mean luminal area showed no significant difference among groups (control group1:0.14+/-0.07 mm2 , control group 2: 0.10+/-0.05 mm2 , control group 3: 0.16+/-0.06 mm2). CONCLUSION: Peri-adventitial single administration of IBMX showed its effectiveness in reducing the neointimal proliferation in rat carotid balloon injury model. Furthermore we observed the positive correlation between intimal area and EELA suggesting vascular remodeling depending on the intima volume.
1-Methyl-3-isobutylxanthine* ; Angina Pectoris ; Angioplasty, Balloon ; Animals ; Arteries ; Body Weight ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Dimethyl Sulfoxide ; Formaldehyde ; Humans ; Hyperplasia ; Ketamine ; Male ; Muscle, Smooth, Vascular ; Neointima ; Phenobarbital ; Phosphoric Diester Hydrolases ; Polymers ; Rats* ; Rats, Sprague-Dawley

PURPOSE: This study was designed to evaluate the correlation between the degree of kyphosis among adolescent spine deformities and low back pain in male adolescent using the 3-Dimensional Whole Body Scanner as screening tool for kyphosis. MATERIALS AND METHODS: The 3-Dimensional Whole Body Scanner was applied to 220 first-year, second-year and third-year high school male students in Seoul, in addition to administering a survey regarding the presence of back pain. From the gathered data, we calculated the A/B index to objectively analyze the degree of spinal deformity, more specifically, spinal kyphosis. We were able to obtain the A/B index of a total of 210 students except unmeasurable 10 students and analyzed the relationship between the degree of kyphosis and low back pain using logistic regression. RESULTS: 1. The average age, height, body weight and body mass index were 16.7+/-0.9 years old, 173.1+/-5.0 cm, 65.6+/-10.2 kg, 21.8+/-3.2 kg/m2. The average of A/B index is 11.3+/-3.65%. The maximum and minimum were 2% and 36%. A/B index data showed normal distribution. 2. Low Back Pain did not correlate with age, height, or weight, but with the degree of thoracic spine kyphosis. As the degree of thoracic spine kyphosis increased by 1%, 5%, and 10%, the incidence of low back pain increased by 1.2 times, 2.5(falling dots1.25) times and 6.2(falling dots1.210) times respectively. CONCLUSION: We concluded that the degree of kyphosis has a significant correlation to low back pain in male adolescences.
Adolescent ; Back Pain ; Body Height ; Body Mass Index ; Congenital Abnormalities ; Humans ; Incidence ; Kyphosis ; Low Back Pain ; Male ; Mass Screening ; Spine

The purpose of this study was to report a case with post-traumatic spinal epidural hematomas with abnormal neurologic findings, which is uncommon. A 40-year-old man presented at our clinic after a blunt trauma caused by a traffic accident in which he was a pedestrian. After admission, abnormal neurologic symptoms developed including loss of sensation and motor function in his left lower extremity. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 40% canal stenosis at the L5-S1 level. Decompression including hematoma evacuation was done. Symptoms started to be reduced 18 days after operation. He was treated conservatively with medications and all symptoms resolved completely during admission and there were no further neurologic sequelae. Post-traumatic lumbar spinal epidural hematoma with abnormal neurologic findings is an uncommon condition that may present belatedly after trauma with significant neurologic compromise.
Accidents, Traffic ; Adult ; Constriction, Pathologic ; Decompression ; Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Neurology ; Sensation