We performed 3 cases of pudendal-thigh flaps in patients with congenital absence of the vagina from June, 1996 through February, 1999. Pudendal-thigh flaps are posterior labial artery axial flaps based on the terminal vessels of the internal pudendal artery. The flaps are raised bilaterally in the groin crease just lateral to the labia majora and are then transposed toward the midline and sutured together to form a neovagina. With adequate flap dissection, reliable blood supply is maintained. Thus, complications such as flap necrosis do not occur and early wound healing is possible. It is s relatively simple technique which can be completed with little blood loss. This method can be completed in one stage, and the prolonged use of stents of dilators is not necessary, since the reconstructed vagina is stable. The linear scars of the donor sites are well hidden in the groin crease and perineum. Normal function is maintained postoperatively without change in sensation. The authors report these methods with a review of the literature.
Arteries ; Cicatrix ; Groin ; Humans ; Necrosis ; Perineum ; Sensation ; Stents ; Tissue Donors ; Vagina ; Wound Healing

BACKGROUND: Restenosis remains as the major limitation of percutaneous translumainal coronary balloon angioplasty (PTCA). Although its mechanism remains incompletely understood, proliferative action of arterial smooth muscle cells has been found to play an important role on restenosis by neointimal formation after PTCA. Glycosaminoglycan-containing compounds, including Sulodexide (Vessel Due , ALFA, Wasserman, S.p.A, Italy), inhibit the proliferation and maigration of vascular smooth muscle cells in vitro. OBJECTIVES: This study was performed to assess the efficacy of Sulodexide, a glycosaminoglycan compound with antithrombotic and antiproliferative properties, in preventing restenosis after PTCA. METHOD: Two hundred eighty-four patients with ischemic heart disease were randomized to receive either the standard PTCA without Sulodexide in 144 patients (control group, M : F = 99 : 45, Age = 58 +9 or -9), 160 lesions or the standard PTCA with Sulodexide in 140 patients (treated group, M : F = 89 : 51, age = 58 +10 or -10), 158 lesions. Successful angioplasties were performed in 258 atheromatous coronary lesions in 224 patients for whom follow-up angiographic data were obtained 6 month later. Quantitative coronary angiographic analysis (QCA) was performed before , immediate after PTCA and 6-month later. Angiographic restenosis (>50% diameter stenosis at follow-up) was the primary end point : miniamal luminal diameter at follow-up angiogram was the secondary end point. RESULT: Successful PTCA was 97.6% and 97.5% in the standard PTCA with Sulodexide and the standard PTCA without Sulodexide, respectively. Although reference vessel size and minimal luminal diamater after PTCA were larger in the control group than in the Sulodexide group(2.94+0.11 or-0.11 vs 2.83+0.13 or -0.13 mm and 2.26+0.12 or -0.12 vs 2.18+0.08 or -0.08 mm, respectively, p=NS), there was a increased tendency of minimal lumen diameter at 6 months angiogram in the Sulidexide group than in the control group (1.12+0.50 or -0.50 vs 1.07 + 0.53 or -0.53 mm, respectively, p=NS). Angiographic restenosis occured in 42% of lesions in the Sulodexide group and 52% of the control group (p=NS). CONCLUSIONS: Sulodexide treatment had a tendency to reduce restenosis rate in 6 months after coronary angioplasty. However, further study is necessary to verify the antiproliferative effect of Sulodexide with much larger number of patients.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Muscle, Smooth, Vascular ; Myocardial Ischemia ; Myocytes, Smooth Muscle ; Phenobarbital ; Prospective Studies*

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) has been broaden in reccent years. However,we considered many aspects in performing angioplasty in patient with multivessel disease. There were procedural success rate, complication, risk, restenosis and long-term effect. So we evaluated the initial success rate, safety and follow-up results. METHODS: To assess the likelihood of initial success in patients with multivessel coronary artery disease, single or multiple site angioplasy were performed at 449 lesions from 273 patients(Male 202,Female 71, Mean age 60.0+/-9.4 years). To evaluate the restenosis rate of angioplasty in multivessel disease, follow-up coronary angiogram were performed at 164 lesions from 95 patients at average 6months after angioplasty. RESULTS: The extent of coronary artery disease revealed that two vessel disease were 200(73.3%) and triple vessel disease were 73(26.7%). Single vessel angioplasty(SVA) was performed in 180(40.1%) lesions and multivessel angioplasty(MVA) was performed in 269(59.9%) lesions. Procedural success was achieved 377(84.0%) out of total 449 lesions. The proccdural success rate was 81.1% in SVA and 85.9% in MVA. According to major epicardial coronary artery, procedural success rate of left anterior descending artery was 82.0%, left circumflex artery 92.4% and right coronary artery 79.4%. According to angiographic morphology of lesions, procedural success rate of type A was 95.7%, type B 88.9% and type C 56.4%. Complete revascularization was done in 87 patients(31.9%) out of 273 patients. Major cause of failure of angioplasty in multivessel disease was inability to pass the guide wire cross the lesion due to total occlusion. Complications included dissection in 101, acute closure in 7(9.7%), coronary artery perforation in 2, cardiogenic shock in 1 and ventricular fibrillation in 1. Follow-up coronary angiography revealed the restenosis rate was 42.2%. CONCLUSION: Coronary angioplasty in selected patients with multivessel coronary artery disease might be useful and have relatively good immediate and long-term results.
Angioplasty* ; Arteries ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Shock, Cardiogenic ; Ventricular Fibrillation

No abstract available.
Leiomyoma* ; Vulva*

BACKGROUND: Detection of left ventricular regional wall motion abnormality(RWMA) by 2 dimensional echocardiography during ergonovine provocation(Erg Echo) can be used for noninvasive diagnosis of coronary vasospasm(CVS). The aim of this study was to test the safety and diagnostic validity of Erg Echo as a screening test in patients with chest pain syndromes before coronary angiography was undertaken. METHODS: From Mar 1993 to Jun 1994, Erg Echo was performed in 80 consecutive patients (56 males) with chest pain syndromes suggestive of variant angina, after the confirmation of negative treadmill or normal stress myocardial perfusion scan using thallium 201. A bolus of ergonovine maleate was injectedd at 5min intervals up to total cumulative dosage of 0.35mg with echocardiographic montioring of the left ventricular wall motion. Twelve leads ECG was also recorded every 3min after each ergonovine injection. The positive criteria of the test was transient ST segment clevation or depression greater than 0.1mV in 12-leads ECG or development of RWMA. Coronary angiography was undertaken 2(+/-4) days after Erg Echo, and spasm provocation test with acetylcholine, or ergonovine was done in case of normal angiogram or luminal narrowing of less than 70%. The appearance of total or subtotal occlusion of a major coroary artery associated with ST segment elevation or depression on the ECG or chest pain, or both, was considered to be a manifestation of spasm. RESULTS: According to the invasive angiographic criteria, 56 patients revealed CVS ; CVS was ruled oup in 19 patients showing near normal angiogram with negative spasm provocation test and in 5 patients with restion high degree fixed stenosis(luminal narrowing of 97+/-4%). Erg Echo could diagnose CVS before the angiography with the sensitivity of 91%(51/56,95% confidence interval [CI] ; 84-98%) and the specificity of 88%(21/24,95% CI ; 75-100%). Of 53 patients showing RWMA in Erg Echo, 42%(22/53) revealed no significant changes in the simultaneously recorded ECG and characteristic ST elevation was recorded in only 38%(20/53). There was no case of myocardial infarction or fatal arrhythmia during Erg Echo. CONCLUSION: Erg Echo befor the coronary angiography is safe and can e utilized as a reliable diagnostic screening test of CVS in patients with negative tradmill or normal stess myocardial perfusion scan, This finding suggests that invasive coronary angiography can be avioded in selected patients for the diagnosis of vasospastic angina.
Acetylcholine ; Angiography ; Arrhythmias, Cardiac ; Arteries ; Chest Pain ; Coronary Angiography* ; Coronary Vasospasm* ; Depression ; Diagnosis* ; Echocardiography* ; Electrocardiography ; Ergonovine* ; Humans ; Mass Screening ; Myocardial Infarction ; Perfusion ; Phenobarbital ; Sensitivity and Specificity ; Spasm ; Thallium

BACKGROUND: In patients with variant angina, previous data have been inconclusive as to whether basal coronary artery tone is elevated at the spastic sites and nonspastic sites. The purpose of this study was to assess the basal coronary artery tone and to evaluate the responsiveness to acetylcholine and ergonovine in patients with variant angina. METHODS: Basal coronary artery tone was assessed by obtaining the percent increase in coronary artery diameter induced by nitroglycerin in 66 patients with variant angina and 26 control subjects. We also compared the basal coronary tone and the constrictive responses to acetylcholine and ergonovine between the 31 patients with variant angina whom spasm was provoked by the low doses of acetylcholine(Ach; intracoronary, 20microg) or ergonovine(Erg; intravenous, 50microg)(Group 1) and the 35 patients provoked by higher doses of acetylcholine(intracoronary, 100microg) or ergonovine(intravenous cumulative dose of 350microg)(Group 2). RESULTS: Patients with variant angina whom spasm was provoked by low doses of acetylcoline and ergonovine, have a more tendency of combine fixed disease(mix disease), multivessel spasm and high disease activity. Basal coronary artery tone at the spastic sites was significantly elevated in the Group 1 in whom spasm was provoked by low doses of acetycholine and ergonovine than that in Group 2(44+/-17 vs 13+/-11%, respectively, p<0.05). Basal coronary artery tone of spasm-related artery, but not nonspasm related artery, at the non spastic site was greater in the Group 1 than that in Group 2 (26+/-14 vs 16+/-10%, respectively, p<0.05). In the patients with variant angina in whom spasm was provoked by higher dose of acetylcholine or ergonovine, basal coronary artery was comparable at the spastic and nonspastic sites and was not different from that in the control subjects. The magnitude of vasoconstrictive responses to acetylcoline and ergonovine, at the nonspastic sites, were also greater in Group 1 than those in Group 2 and the control groups(Ach; 40+/-20 vs 26+/-11. 27+/-12% : Erg ; 37+/-18 vs 12+/-8, 13+/-10%, respectively, p<0.05). CONCLUSION: These findings suggest that elevated basal coronary artery tone of the spastic sites and nonspastic sites of spasm-related artery in patients with variant angina may be related to occurrence of coronary spasm.
Acetylcholine* ; Arteries ; Coronary Vessels* ; Ergonovine* ; Humans ; Muscle Spasticity ; Nitroglycerin ; Spasm*

Aortic intramural hematoma(AIH) is known as a variant of acute dissection due to rupture of the vasa vasorum without a intimal tear. In elderly hypertension patients patients with aortic dissection but without the characteristic echocardiographic findings of a double-channel aorta, this disease entity should be suspected and attention should be given to find segmental wall thickening of the aorta >0.7cm. AIH may progress to typical dissection or to rupture in considerable number of the patients, so careful follow-up is necessary and the same management principles for the patients with dissection can be applied in this variant. We report two cases of AIH showing typical eccentric mural thickening without dissection membrane with transesophageal echocardiographic follow-up.
Aged ; Aorta ; Echocardiography ; Echocardiography, Transesophageal* ; Follow-Up Studies ; Hematoma* ; Humans ; Hypertension ; Membranes ; Rupture ; Vasa Vasorum

BACKGROUND: The intracoronary stent implantation is accepted as the treatment modality to reduce restenosis in comparison with balloon angioplasty in patients with coronary artery disease. In recent studies, the technique of high pressure balloon dilation for stent optimization has been shown to improve procedural success and to reduce the subacute closure after stenting. The late clinical outcome, however, is still uncertain after stenting with high pressure balloon dilation. Therefore, we evaluated the effect of high pressure balloon dilation on subsequent clinical courses after intracoronary stenting. METHOD: One hundred sixty nine patients with 176 lesions were treated with Palmaz-Schatz stent implantation. Intracoronary stenting without high pressure balloon dilation was perforned in 55 patients with 55 lesions(phase 1), whereas intracoronary stenting with high pressure balloon dilation was done in 114 patients with 121 lesions(phase 2). We compared the angiographic and clinical results immediately and at late follow-up period after atenting between phase 1 and phase 2. RESULTS: Coronary angiography was repeated at 6 months in 135 patients, 138 lesions(78%). The overall incidence of restenosis was 25%(31% in phase 1 and 22% in phase 2). The restenosis occurred in 18% of elective stenting on de novo lesions(23% in phase 1 and 15% in phase 2). The restenosis rate was significantly reduced after using high pressure balloon dilation in infarct-related artery, final luminal diameter>/=4.0 mm after stenting and bail-out procedure(p<0.05). In phase 2, the restenosis rate was significantly higher in the lesions that had been previously dilated(43% in restenotic lesion vs 15% in de novo lesion, p<0.05) and in type C lesion compared with the others(type A, type B1, type B2 and type C ; 22%, 22%, 15% and 57%, respectively, p<0.05). According to the final luminal diameter, the restenosis rate was 7% in case of final luminal diameter greater than 4.0 mm which was significantly lower than that of final luminal diameter less than 3.5mm(p<0.05). At univariate anaysis, factors affecting restnosis were post-stent minimal luminal diameter, balloon-to-vessel ratio, acute gain and restenotic lesion. However multivariate analysis showed post-stent minimal luminal diameter was the only factor affecting restenosis. CONCLUSION: As intracoronary stenting using high pressure balloon dilation technique without anticoagulation has a good immediate results, negligible stent thrombosis and has a tendency of lower rate of restenosis.
Angioplasty, Balloon ; Arteries ; Coronary Angiography ; Coronary Artery Disease ; Dilatation* ; Follow-Up Studies ; Humans ; Incidence ; Multivariate Analysis ; Phenobarbital ; Stents* ; Thrombosis

BACKGROUND: The intracoronary stent implantation is regarded as an effective treatment modality to reduce restenosis. However, subacute stent thrombosis and subsequent anticoagulation therapy have been major problems after stenting. The high-pressure inflation stenting reduced the incidence of stent thrombosis and resulted in less need of anticoagulation therapy. We intended to analyze the high-pressure inflation stenting with intravascular ultrasound(IVUS) and to evaluate different IVUS criteria of optimal stenting. METHOD: One hundred and forty eight patients with 160 lesions were treated with 175 stents of various types. IVUS images were obtained after angiographic optimization (<10% of residual stenosis) with high-pressure inflation stenting. The quantitative and qualitative off-line measurements of IVUS parameters were performed. RESULTS: More high-pressure or larger-sized balloon inflation was needed in 32 lesions (20%) after IVUS. The incomplete stent apposition was observed in 5 lesions (3%). The edge dissection occurred distally or proximally to stented site in 19 lesions (12%). The plaque prolapse was observed within the stent in 24 lesions (15%). In single stent implantation for discrete lesions, optimal stent expansion defined by IVUS was achieved in 69% with minimal stent lumen area of 90% of distal reference lumen area and in 75% with minimal stent lumen area of 80% of average reference lumen area. The IVUS criteria of minimal stent lumen area 9mm2 and 7-9mm2 was met in 29% and 29%, respectively. In stents implantation for diffuse lesions including long stent,multiple overlapping stents and hybrid stents implantation, optimal stent expansion defined by IVUS was achieved in 69% with minimal stent lumen area of 90% of distal reference lumen area and in 67% with minimal stent lumen area of 80% of average reference lumen area. The IVUS criteria of minimal stent lumen area 9mm2 and 7-9mm2 was met in 17% and 23%, respectively. CONCLUSION: IVUS provided a valuable informations leading to additional intervention in 20% of the lesions after angiographic optimization with high-pressure balloon inflation. Even though additional interventions were performed with IVUS-guidance, the optimal stent expansion by IVUS criteria was achieved in about 70%. Therefore, we suggest that IVUS might be used more generally to improve the acute results after coronary stenting.
Humans ; Incidence ; Inflation, Economic* ; Prolapse ; Stents* ; Thrombosis ; Ultrasonography*

BACKGROUND: To overcome the limitation of angiography, intravascular ultrasound(IVUS) is widely used to guide coronary stent implantation. We compared the quantitative measurements of IVUS and quantitaitve coronary angiographic(QVA) analysis after stent implantation. METHODS: Thirty nine patients with 39 coronary lesions underwent coronary stent implantation. The implanted stents were CrossFlex stent in 17, NIR stent in 13, Palmaz-Schatz stent in 6, Multilink stent in 2 patients, and Divysio stent in 1 patient. Post-stent IVUS procedure with automatic pullback device was performed successfully in all patients after angiographic optimization. IVUS and QCA measurements included the minimum lumen diameter at proximal and distal reference artery, and stented site after intracoronary administration of 0.2mg nitroglycerin. RESULTS: IVUS and QCA measurement of minimal luminal diameter(MLD) at proximal and distal reference artery, and stented site correlated reliably each other(r=0.62, p<0.01 ; r=0.77, p<0.01 ; r=0.73, p<0.01 respectively). Event if insignificant statistical difference, there was a tendency of larger MLD at proximal and distal reference artery by IVUS measurement than by QCA measurement(3.2+/-0.5mm vs. 3.1+/-0.4mm, p=0.2 : 3.1+/-0.6mm vs. 3.0+/-0.7mm, p=0.2, respectively). The MLD at stented site was significantly larger by QCA measurement than by IVUS measurement(3.2+/-0.6mm vs. 2.9+/-0.5mm, p<0.05). CONCLUSIONS: We concluded 1) the correlation between IVUS and QCA measurements of reference vessel and stented site was reliable. 2) There was a tendency of larger luminal diameter at reference vessel by IVUS than by QCA. 3) The minimal luminal diameter was measured significantly larger at stented site by QCA than by IVUS.
Angiography ; Arteries ; Coronary Vessels* ; Humans ; Nitroglycerin ; Phenobarbital ; Stents* ; Ultrasonography*