Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p<0.001). The mean MLD within stent increased 14%, from 2.91+/-0.39 mm at the nominal balloon inflation (inflation pressure=7 atm) to 3.37+/-0.29 mm at high pressure balloon inflation (inflation pressure <0A65B>12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.
Acidosis ; Acute Kidney Injury ; Angioplasty, Balloon ; Arteries ; Aspirin ; Constriction, Pathologic ; Coronary Vessels* ; Hemorrhage ; Heparin ; Humans ; Inflation, Economic ; Platelet Aggregation Inhibitors* ; Stents* ; Thrombosis ; Ultrasonography ; Warfarin

The purpose of this study was to investigate effects of nutrition education program and pamphlet for the lower grades elementary students focused on individual daily needed food exchange units using Food Exchange System. Program consisted of four lessons (40 min/lesson), "5 major nutrients & function", "6 food group and sources", "daily needed food exchange units for normal body weight", and "smart snack choice and exercise". Pamphlet as activity book was developed for the program. The subjects were 3rd grade elementary students (educated group, 31 vs. non-educated group, 31). Educated group were lessoned as group and/or individual. We examined the differences in nutrition knowledge, dietary attitudes, dietary intakes and satisfaction of the program and pamphlet. In educated group, there were positive improvements on nutrition knowledge score "function and foods of 5 nutrients" and on dietary attitudes "type of breakfast and snacks". In the evaluation of dietary intakes according to KDRI, there were positive improvements on intakes level of riboflavin, vit. C, folate, Ca, P, Fe and Zn in educated group. In satisfaction with the program and pamphlet, contents, font size, visual, figure, difficulty and program curriculum were over 2.90/3.0. It showed that the developed nutrition education program and pamphlet focused on individual daily needed food exchange units using Food Exchange System improved nutrition knowledge, dietary attitudes and nutrients intake level in the lower grades elementary students.
Breakfast ; Curriculum ; Folic Acid ; Humans ; Pamphlets ; Riboflavin ; Snacks

While there is a high prevalence of patent foramen ovale in adults, paradoxical embolism via a patent foramen ovale is rare. Previous echocardiographic studies indicated that paradoxical embolism might only occur in patients with high-risk features of patent foramen ovale (i.e., large defect size, presence of a Eustachian valve, and high right atrial pressure). Here, we present a case of patent foramen ovale with high-risk CT features for paradoxical embolism.

While there is a high prevalence of patent foramen ovale in adults, paradoxical embolism via a patent foramen ovale is rare. Previous echocardiographic studies indicated that paradoxical embolism might only occur in patients with high-risk features of patent foramen ovale (i.e., large defect size, presence of a Eustachian valve, and high right atrial pressure). Here, we present a case of patent foramen ovale with high-risk CT features for paradoxical embolism.

BACKGROUND AND OBJECTIVES: Primary percutaneous coronary intervention (PCI) has been reported to be effective reperfusion therapy for acute myocardial infarction (AMI). In the very thrombotic environment of AMI, primary PCI, with heparin-coated stents, has been known to reduce the early reocclusion of the stented vessel by preventing thrombosis. However, little data exist regarding the long-term clinical outcomes. The aim of our study was to evaluate the safety, feasibility and long-term efficacy of heparin-coated stents in AMI. SUBJECTS AND METHODS: Between January 1998 and July 2002, primary PCI with heparin-coated stents was performed in 132 consecutive patients (98 males, with a mean age of 56.3+/-0.7 years) admitted with the diagnosis of AMI within 12 hours from the onset of the chest pain. Major adverse cardiac events (MACE), including death, MI, TLR (target lesion revascularization) and CABG, were recorded during hospitalization and the follow-up period. Angiograms were obtained at the baseline, after stent implantation and at 6 months following implantation. RESULTS: The angiographic and procedure success rate was 96.2%. During hospitalization, there was no evidence of reocclusion of stented vessel, but 1 patient underwent a repeat PCI due to dissection. There were no bleeding complications. A six-month angiographic follow-up was completed in 47.2% of eligible patients and binary restenosis was present in 20.1%. During the long-term clinical follow-up (mean follow-up period 37.2+/-7.2 months), there were 12 deaths, 1 myocardial infarction and 18 TLR. The MACE free survival rate was 76.5%. CONCLUSION: Primary PCI, with heparin-coated stents, shows favorable long-term clinical outcomes.
Chest Pain ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Hospitalization ; Humans ; Male ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Reperfusion ; Stents* ; Survival Rate ; Thrombosis

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.
Angioplasty ; Angioplasty, Balloon ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Ischemic Attack, Transient ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Stents* ; Stroke ; Takayasu Arteritis ; Thrombosis ; Transplants

BACKGROUND: Diastolic dysfuction can be assessed by Doppler echocardiography of mitral inflow. Multiple factors including atrioventricular (AV) delay affect the mitral inflow Doppler indexes. This study was designed to assess the changes of mitral inflow patterns after successful radiofrequency catheter ablation (RFCA) of accessory pathway associated with a short AV interval during pre-excitation in patients with WPW syndrome. METHOD: Echocardiogram, ECG and BP were recorded before and after RFCA for treatment of accessory pathway in 15 patients with WPW syndrome (mean age : 39.7+/-14.6). Doppler indexes including E wave velocity and its velocity time integral (EVTI) ,A wave velocity and its VTI (AVTI), deceleration time (DT), isovolumic relaxation time (IVRT), atrial filling fraction (AFF)and total mitral inflow VTI were measured. RESULTS: 1) PR interval prolonged 94+/-18msec to 174+/-34msec (p<0.001) without significant increment of heart rate and blood pressure after successful RFCA. 2) E/A ratio decreased from 1.29+/-0.58 to 1.1+/-0.53 (<0.001) but E wave velocity, DT and IVRT were not changed significantly after RFCA. 3) A wave velocity and AFF was 55.8+/-17.4msec and 0.35+/-0.08 and increased to 61.8+/-19.9msec and 0.42+/-0.1, respectively after RFCA (p<0.05). 4) Total mitral inflow VTI was 13.6+/-3.5cm and 14.9+/-3.6cm before and after RFCA, respectively (p<0.05) CONCLUSION: These results suggested that normalization of the PR interval after RFCA in patients with WPW syndrome had beneficial hemodynamic effects on the stroke volume by changing mitral inflow Doppler indexes. Therefore, the effect of AV delay is an another parameter to consider when evaluating Doppler indexes of LV filling.
Blood Pressure ; Catheter Ablation ; Deceleration ; Echocardiography, Doppler ; Electrocardiography ; Heart Rate ; Hemodynamics ; Humans ; Relaxation ; Stroke Volume ; Wolff-Parkinson-White Syndrome*

BACKGROUND: Intracoronary stenting in large coronary artery with diameters >3 mm has been shown to be beneficial in the treatment of acute or threatened closures complicating balloon angioplasty and in the prevention of restenosis. However, whether equally favorable results are afforded by stent placement in small vessels (<3 mm) remains unclear. Accordingly, we evaluated the safety and feasibility of intracoronary stenting in native coronary vessels less than 2.75 mm in size. METHODS: Between January 1997 and July 1998, seventy eight patients with 81 lesions were treated with 83 stents, regardless of clinical setting. The angiographic criteria for enrollment included at least 70% stenosis and a vessel that reference diameter was less than 2.75 mm. Every patients received aspirin (300 mg qd, indefinitely) and ticlopidine (250 mg bid, one month) and was given a bolus dose of 10,000 U heparin during procedure. RESULTS: Angiographic success was achieved in 80 of 81 attempts (98%). There was one in-hospital death because of pump failure in AMI patient. There was no acute stent thrombosis. At 6 month follow-up, event free survival was achieved in 90% of patients and angiographic restenosis was found in 28% of patients (9/32). CONCLUSION: The present observational study demonstrates that angiography-guided stent placement in coronary artery < 2.75 mm in diameter is safe and effective in conjunction with current stent deplyment technique and antiplatelet protocol.
Angioplasty, Balloon ; Aspirin ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Disease-Free Survival ; Follow-Up Studies* ; Heparin ; Humans ; Observational Study ; Stents* ; Thrombosis ; Ticlopidine

The dose-response for glycopyrrolate and heart rate in anesthetized children has not heen defined. We determined the dose-response for glyeopyrrolate and heart rate in 50 children, ASA physical status l and 2, anesthetized with halothane and nitrous oxide. Anesthesia was induced with 60-70% nitrous oxide in oxygen and halothane(1.5-2.0 vo1%). After induction of aneethesia, glycopyrrolate in a dose of 4, 6, 8, 12 or 16ug Xkg(-1) was administered by rapid infusion to each subject. The effects of glycopyrrolate on heart rate, heart rhythm and systolic blood pressure were compared among dosage groups, and dose-response curve for peak heart rate was constructed, Glycopyrrolate increased the heart rate in a dose-related manner upto 12 ug X kg(-1) except 16 ugX kg(-1). Fifty percent maximal response corresponded to 6.1 ug X kg(-1), and 95% maximal response corresponded to 11.1 ug X kg(-1) . None of the patients had nonsinus rhythm after glycopyrrolate injection. Except for glycopyrrolate given at 4 ug x kg(-1), the systolic blood pressure increased significantly after all other doses. Glycopyrrolate in doses greater than or equal to 6 ug X kg(-1) increased the heart rate and systolic blood pressure in children anesthetized with halothane and nitrous oxide.
Anesthesia ; Anesthetics ; Blood Pressure ; Child* ; Glycopyrrolate ; Halothane* ; Heart Rate* ; Heart* ; Humans ; Nitrous Oxide* ; Oxygen

PURPOSE: This study examined the effects of backward walking training with task orientation on the functional walking ability of children with cerebral palsy.METHODS: This study was a single-blinded, randomized controlled trial with a crossover design conducted at a single rehabilitation facility with cross-over to the other intervention arm following a two-week break. For a total of 12 children with spastic hemiplegia cerebral palsy, the forward walking training group (n=6) underwent training three times a week for three weeks, 40 minutes a day, and the backward walking training group (n=6) was also trained under the same conditions. To identify the functional walking ability, variables, such as the walking speed, stride length, and step length, were measured using a walk analyzer (OptoGait, Microgate S.r.l, Italy).RESULTS: Both groups showed significant increases in walking speed, stride length, and step length (p<0.01). The backward walking group showed more significant improvement in the walking speed from pre- to post-test (p<0.05). The gait characteristics were similar in the two groups (stride length and step length) but the walking speed in the backward walking group showed a mean difference between the positive effects higher than the forward walking group.CONCLUSION: Task-oriented backward walking training, which was conducted on the ground, may be a more effective treatment approach for improving the walking functions of spastic hemiplegia children than forward walk training.
Arm ; Cerebral Palsy ; Child ; Cross-Over Studies ; Gait ; Hemiplegia ; Humans ; Muscle Spasticity ; Rehabilitation ; Walking