Profound reduction of anterograde coronary flow with concomitant ischemia is seen occasionally during percutaneous coronary intervention despite technically successful procedure. We found interesting coronary flow pattern in a patient with acute myocardial infarction, showing angiographic no reflow phenomenon after direct PTCA. The coronary blood flow pattern of the angiographic no-reflow phenomenon in this case was characterized by minimal systolic flow and sharp deceleration of diastolic flow. Coronary flow reserve calculated by the ratio of adenosine induced maximal hyperemic velocity and basal velocity was reduced. The Dopplertipped guide wire was useful for observation of phasic coronary flow pattern of angiographic no-reflow phenomenon.
Adenosine ; Deceleration ; Humans ; Ischemia ; Myocardial Infarction* ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention

Recent literatures suggest that pulmonary embolus secondary to renal cell cancer may be more common than previously suspected. A 63-year-old man, who suffered a massive tumor embolism to the right main pulmonary artery after surgery for renal cell carcinoma with vena caval and renal vein invasion, was treated by emergency pulmonary embolectomy using cardiopulmonary bypass. Renal cell carcinoma occasionally extends into the inferior vena cava as a tumor thrombus. In such patients, removal of the tumor thrombus from the inferior vena cava has to be performed in addition to radical nephrectomy. However, the massive pulmonary tumor embolism is a major potential hazard during radical surgical resection. To prevent intraoperative pulmonary embolisms, scheduled use of cardiopulmonary bypass with the cooperation of cardiovascular surgeons is recommended in addition to the standard proximal vena caval occlusion technique of clipping and clamping.
Carcinoma, Renal Cell* ; Cardiopulmonary Bypass ; Constriction ; Embolectomy ; Embolism ; Emergencies ; Humans ; Middle Aged ; Neoplastic Cells, Circulating* ; Nephrectomy ; Pulmonary Artery ; Pulmonary Embolism ; Renal Veins ; Thrombosis ; Vena Cava, Inferior

OBJECTIVES: Recirculation is one of the factors preventing effective hemodialysis(HD) and one of the methods which can detect vascular access stenosis. We analyzed the possible clinical risk factors and relationship between the recirculation rate(R) and adequacy of hemodialysis. Also, we attempted to find out whether vascular access stenosis actually exist in the high R group. METHODS: We examined the period of hemodialysis, the presence of diabetes mellitus(DM), use of artificial grafts, the venous pressure(VP) during HD, the difference(deltaKt/V) between prescribed Kt/V(Kt/V') and delivered Kt/V(Kt/V") in 113 patients(22 DM, 39 artifical graft patients) receving maintenence HD. R was obtained by two needle slow flow method. Fistulogram was performed in the high R group(R>10%) and if significant stenosis was found, surgical correction was performed followed by repeated R, VP, Kt/V" measurement. RESULTS: As a whole R was 5.6%(+/-8.8), VP was 92mmHg(+/-44), the duration of hemodialysis was 36 months(+/-25) and Kt/V" was 1.20 (+/-0.29). The VP of the group with artificial graft was higher than that of the group with native fistula, but there was no relationship between R and duration of HD, Kt/V", deltaKt/V as a whole. The VP and deltaKt/V of group with high R(>10%) were significantly higher than the group with low R(<10%). Positive correlation between R and deltaKt/V was demonstrated in the group with high R. In six patients with high R, fistulograms were taken and significant vascular stenosis were found. After surgical correction, R was significantly decreased from 25.5% to 5.2%. On the other hand, the R as well as the rate of diabetes or prosthetic grafts were higher in the group with high VP(>or=100mmHg) than in the group with low VP(<100mmHg) as well as in patients with diabetes or prosthetic grafts, CONCLUSION: We believe recirculation should be measured during maintenance HD especially when the patient has diabetes, artificial graft or high venous pressure during HD. When the recirculation rate is high, reconstructive vascular surgery with proprer mediacl management may lead to better dialysis adequacy.
Constriction, Pathologic ; Dialysis ; Fistula ; Hand ; Humans ; Needles* ; Renal Dialysis ; Risk Factors ; Transplants ; Venous Pressure

No abstract available.
Humans

No abstract available.
Academic Medical Centers* ; Infection Control*

No abstract available.
Academic Medical Centers* ; Infection Control*

The purpose of this study is to clarify the clinical usefulness of Computerized Balance Evaluation and Training System(COBETS) in treating the patients with balance disturbance. Twenty- three patients who received rehabilitative management due to their balance disturbance after brain damage were treated either by conventional physical therapy(PT) or by visual biofeedback balance training(VBBT) using COBETS for 4 weeks. The static and dynamic postural balance were evaluated at pre- and post-treatment conditions using COBETS balance assessment software. The neurologic and functional assessment and somatosensory evoked potential study were performed as well. Comparing with the control group, the patients treated by VBBT showed significantly improved static and dynamic postural control.
Biofeedback, Psychology* ; Brain ; Evoked Potentials, Somatosensory ; Humans ; Postural Balance

Objectives: In this prospective randomized controlled trial, we measured the primary and secondary stability of two surface-treated implants placed in the posterior maxilla, applied 3-month loading protocols, and compared and analyzed the short-term outcomes of the implants. Patients and Methods: From June 2018 to June 2019, patients with a residual bone height of 4 mm in the posterior maxilla were enrolled and randomly divided into two groups to place SA implants (Osstem Implants, Korea) in Group A and NH implants (Hiossen, USA) in Group B. Finally, 14 implants placed in 13 patients in Group A and 17 implants placed in 14 patients in Group B were analyzed. The measured primary and secondary stability of each implant was represented by implant stability quotient (ISQ), and treatment outcomes were evaluated. Results: Group A consisted of patients with an average age of 62.2 years (range, 48-80 years), and Group B consisted of patients with an average age of 58.1 years (range, 35-82 years). Primary stability was 73.86±6.40 and 71.24±5.32 in Groups A and B, respectively (P=0.222). Secondary stability was 79.07±5.21 in Group A and 78.29±4.74 in Group B (P=0.667). A steep increase in ISQ during the healing period was observed in Group B, though it was not significant (P=0.265). The mean follow-up period was 378.5±164.6 days in Group A and 385.3±167.9 days in Group B. All implants in each group met the success criteria, and the success rate was 100%. Conclusion Two surface-treated implants placed in the posterior maxilla with greater than 4 mm alveolar bone height exhibited successful one-year treatment outcomes if a primary stability of 65 or higher ISQ was obtained and a 3-month early loading protocol was applied.

Objectives: In this prospective randomized controlled trial, we measured the primary and secondary stability of two surface-treated implants placed in the posterior maxilla, applied 3-month loading protocols, and compared and analyzed the short-term outcomes of the implants. Patients and Methods: From June 2018 to June 2019, patients with a residual bone height of 4 mm in the posterior maxilla were enrolled and randomly divided into two groups to place SA implants (Osstem Implants, Korea) in Group A and NH implants (Hiossen, USA) in Group B. Finally, 14 implants placed in 13 patients in Group A and 17 implants placed in 14 patients in Group B were analyzed. The measured primary and secondary stability of each implant was represented by implant stability quotient (ISQ), and treatment outcomes were evaluated. Results: Group A consisted of patients with an average age of 62.2 years (range, 48-80 years), and Group B consisted of patients with an average age of 58.1 years (range, 35-82 years). Primary stability was 73.86±6.40 and 71.24±5.32 in Groups A and B, respectively (P=0.222). Secondary stability was 79.07±5.21 in Group A and 78.29±4.74 in Group B (P=0.667). A steep increase in ISQ during the healing period was observed in Group B, though it was not significant (P=0.265). The mean follow-up period was 378.5±164.6 days in Group A and 385.3±167.9 days in Group B. All implants in each group met the success criteria, and the success rate was 100%. Conclusion Two surface-treated implants placed in the posterior maxilla with greater than 4 mm alveolar bone height exhibited successful one-year treatment outcomes if a primary stability of 65 or higher ISQ was obtained and a 3-month early loading protocol was applied.

Endovascular therapy of critical limb ischemia is indicated in high risk patients, especially the diabetics. The ipsilateral antegrade femoral approach is the most common access site. When this approach fails, the retrograde pedal artery percutaneous approach can be considered. A 51-year-old diabetic male patient was presented with severe rest pain and gangrene on his right 4th toe. Computed tomography angiography showed multilevel calcific arterial occlusive disease, involving the popliteal and proximal anterior tibial arteries. Below knee angioplasty and stenting of the right leg was done through ipsilateral antegrade femoral approach and retrograde pedal artery approach. The C-arm guided retrograde pedal approach for calcific artery was useful for recanalization of the occluded anterior tibial artery when antegrade approach failed.
Angiography ; Angioplasty ; Arterial Occlusive Diseases ; Arteries ; Diabetic Foot ; Extremities ; Gangrene ; Humans ; Ischemia ; Knee ; Leg ; Male ; Middle Aged ; Peripheral Arterial Disease ; Stents ; Tibial Arteries ; Toes