After coronary stent implantation, neointima formation resembles the wound healing process as it involves the sequential processes of inflammation, granulation, and remodeling. Because antiproliferative drugs and polymers of drug-eluting stents (DESs) delay vascular healing compared with bare metal stents, fibrin deposition can remain long after stent implantation, or inflammation can be excessive. Delayed vascular healing can be associated with adverse clinical outcomes including DES thrombosis or restenosis, and poor endothelization of DES neointima can accelerate neoatherosclerotic change inside the neointima, further contributing to luminal restenosis or neointimal instability. Despite the lack of correlation between pathologic and optical coherence tomography (OCT) findings, OCT assessments of neointima under various circumstances can reveal vascular responses to stent therapy. Homogeneous, heterogeneous, and layered neointima patterns can be recognized by OCT and can change with time. Homogeneous neointima might be associated with better clinical outcomes after DES implantation, whereas non-homogeneous neointima or neoatherosclerotic change can be associated with poorer clinical outcomes. However, limited data are currently available, and further studies are required to comprehensively address these questions.
Coronary Artery Disease ; Drug-Eluting Stents* ; Fibrin ; Inflammation ; Neointima* ; Phenobarbital ; Polymers ; Stents ; Thrombosis ; Tomography, Optical Coherence ; Wound Healing

BACKGROUND: The purpose of this study was to investigate the mechanism of endothelium-dependent and independent responses to endothelins (ETs) in porcine coronary artery. METHODS: The vascular rings of left anterior descending artery or left circumflex artery from 7 pigs were suspended in conventional organ chambers for the measurement of isometric force. To evaluate relaxation responses, vascular rings with endothelium were exposed to ET-1 and ET-3. To evaluate contraction responses, vascular rings with and without endothelium were exposed to ET-1 and ET-3 in the presence or absence of BQ 123 (ET(A) receptor antagonist) or TAK-044 (ET(A) and ET(B) receptor antagonist). RESULTS: Transient relaxation responses of vascular rings occurred after exposure of ET-1 and ET-3. These transient responses disappeared after preincubation with N-nitro-L arginine. There was an increased contractions of vascular rings according to increasing concentration of ET-1 and ET-3. The initial responses were enhanced in vascular rings without endothelium in ET-1 and ET-3. In vascular rings with endothelium, the contraction responses were more reduced in vascular rings with preincubation of BQ 123 than in vascular rings without BQ 123 in ET-1. In vascular rings without endothelium, the contraction responses were more reduced in vascular rings with preincubation of TAK-044 than in vascular rings without TAK-044 in ET-1. CONCLUSION: ET(B) receptor on the endothelium might mediate the transient vasodilator responses to ET-1 and ET-3 through release of nitric oxide in porcine coronary artery. ET(A) and ET(B) receptor on vascular smooth muscle cells might mediate vasoconstrictor responses to ETs.
Arginine ; Arteries ; Coronary Vessels* ; Endothelins* ; Endothelium ; Muscle, Smooth, Vascular ; Nitric Oxide ; Receptors, Endothelin ; Relaxation ; Swine

No abstract available.
Tuberculosis, Miliary*

Interest in the prevalence of patent foramen ovale(PFO) and its relation to embolic stroke has increased with the sophistication of methods for noninvasive cardiac assessment. The effect of foramen ovale closure on the risk for subsequent strokes is promised. A 22-year old woman was presented with sudden onset of cerebral infarct. She had a patent formen ovale, and right to left shunt during the Valsalva maneuver, which was diagnosed by transesophageal contrast echocardiography. Transcatheter closure of PFO was performed with Rashkind PDA umbrella under the guidance of transesophageal echocardiography. Transcatheter closure of PFO can be accomplised with little morbidity and may reduce the risk of embolic episode.
Echocardiography ; Echocardiography, Transesophageal* ; Female ; Foramen Ovale ; Foramen Ovale, Patent* ; Humans ; Prevalence ; Stroke* ; Valsalva Maneuver ; Young Adult

BACKGROUND: It is well known that atrial fibrillation is common cardiac arrythmia in old age and poses a definitive risk factor of cerebral infarction. Therefore, effective treatment of atrial fibrillation is very important in the prevention of cerebral infarction. However, oral anticoagulant medication for the prevention of embolic ischemic stroke may be dangerous due to cerebral hemorrhage side effects. METHODS: This is a controlled case study designed to identify the risk factors in a large numbers of stroke and atrial fibrillation patients and to assess those patients with atrial fibrillation as a high risk group for cerebral infarction. All patient discharged from Chonnam National University Hospital were identified over a 42 month period who met our case standards of atrial fibrillation and ischemic stroke (n=62), and compared them with the control groups who were discharged with atrial fibrillation without stroke(n=68). We excluded the atrial fibrillation due to valvular heart disease, ischemic heart disease and congestive heart failure during the selection of subjects. RESULTS: Subjects and the controls were characteristically similar with common past medical histories of diabets, smoking, and hyperlipidemia. Sex, familial history, left ventricular hypertrophy in 2D-echocardiogram were also similar in both groups, however differences did exist. Subjects were significantly older than controls(68.9 : 63.9, p<0.001) and more likely to have a history of hypertension(56.5% : 23.5%, p<0.001) and left atrial enlargement(>40mm)(52.6% : 29.0%, p<0.001). Each of these 3 factors were assinged a measure of 1 point as a risk score, ischemic embolic stroke was found in 4 out of 28 patients(14.3%) with a risk score of 0, in 16 out of 39 patients(41.0%) with a risk score of 1, in 29 out of 41 patients(70.7%) with a risk score of 2, in 8 out of 11 patients(72.7%) with a risk score of 3. CONCLUSIONS: Based on the above results, a subject having more than two risk factors should be regarded as a high risk group for cerebral infarction and the long term anticoagulant therapy for the prevention of stroke may also be necessary even though some complications are present.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Cerebral Hemorrhage ; Cerebral Infarction* ; Heart Failure ; Heart Valve Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Hypertrophy, Left Ventricular ; Jeollanam-do ; Myocardial Ischemia ; Patient Selection ; Risk Factors* ; Smoke ; Smoking ; Stroke

Sneddon's syndrome consists of livedo reticularis and ischemic cerebrovascular disease, which was reported by Sneddon in 1965. Althrough the etiology of it is not clear, this syndrome appears frequantly in patient with antiphospholipid antibody or early stage of Systemic Lupus Erythematosus. We report a 32-year-old female patient who had been suffered from livedo reticularis and premature cerebral infarction. VDRL was false positive for over 5 years. These findings were compatible with Sneddon's syndrome.
Adult ; Antibodies, Antiphospholipid ; Cerebral Infarction ; Female ; Humans ; Livedo Reticularis ; Lupus Erythematosus, Systemic

Optical coherence tomography (OCT) has been recently applied to investigate coronary artery disease in interventional cardiology. Compared to intravascular ultrasound, OCT is able to visualize various vascular structures more clearly with higher resolution. Several validation studies have shown that OCT is more accurate in evaluating neointimal tissue after coronary stent implantation than intravascular ultrasound. Novel findings on OCT evaluation include the detection of strut coverage and the characterization of neointimal tissue in an in-vivo setting. In a previous study, neointimal healing of stent strut was pathologically the most important factor associated with stent thrombosis, a fatal complication, in patients treated with drug-eluting stent (DES). Recently, OCT-defined coverage of a stent strut was proposed to be related with clinical safety in DES-treated patients. Neoatherosclerosis is an atheromatous change of neointimal tissue within the stented segment. Clinical studies using OCT revealed neoatherosclerosis contributed to late-phase luminal narrowing after stent implantation. Like de novo native coronary lesions, the clinical presentation of OCT-derived neoatherosclerosis varied from stable angina to acute coronary syndrome including late stent thrombosis. Thus, early identification of neoatherosclerosis with OCT may predict clinical deterioration in patients treated with coronary stent. Additionally, intravascular OCT evaluation provides additive information about the performance of coronary stent. In the near future, new advances in OCT technology will help reduce complications with stent therapy and accelerating in the study of interventional cardiology.
Atherosclerosis/diagnosis/pathology/ultrasonography ; Coronary Artery Disease/*diagnosis/pathology/ultrasonography ; Humans ; Postoperative Complications/diagnosis/pathology/ultrasonography ; Stents/*adverse effects ; Tomography, Optical Coherence/*methods ; Ultrasonography, Interventional

OBJECTIVE: We report a case of Churg-Strauss syndrome (CSS) which accompanied a mononeuritis multiplex. CASE SUMMARY: A 46-year-old woman began to suffer from an allergic rhinitis since 1985, and was diagnosed as a bronchial asthma in 1995. She also complained numbness of the upper and lower extremities, which eventually lead to a weakness and edema of both upper and lower extremities. Electrophysiologic study findings were compatible with a mononeuritis multiplex. The skin biopsy revealed a necrosis of the vessels with infiltration of a large number of neutrocytes and lymphocytes. CONCLUSION: Based on the patient's clinical characteristic, skin biopsy findings and electrophysiologic study findings, we have concluded that the case fit well for CSS.
Asthma ; Biopsy ; Churg-Strauss Syndrome* ; Edema ; Female ; Humans ; Hypesthesia ; Lower Extremity ; Lymphocytes ; Middle Aged ; Mononeuropathies* ; Necrosis ; Rhinitis ; Skin

OBJECTIVE: The purpose of this study is to prove protective action of melatonin on the development of neuropathy in diabetic rat. METHOD: The experimental rats (Sprague-Dawley) were divided into 3 groups: Group 1, streptozotocin-induced diabetic rats with trial of melatonin; Group 2, streptozotocin-induced diabetic rats without trial of melatonin; Group 3, normal control. Streptozotocin was injected intraperitoneally in group 1 and 2. Melatonin was administered per orally in group 1 from 1 week after the injection of streptozotocin. The melatonin effect on diabetic neuropathy was evaluated by the measurement of conduction velocities and amplitudes of rat tail mixed nerve action potentials. The electrophysiologic examinations were performed before and 2, 4, and 6 weeks after administration of streptozotocin. RESULTS: The rat tail mixed nerve conduction velocities were decreased at 4 weeks in group 1 and 2, and showed significant improvement at 6 weeks in group 1 as compared with those of group 2 (p<0.05). The amplitudes of the compound nerve action potentials did not show difference before and after streptozotocin and melatonin trials, neither among groups. CONCLUSION: In this experimental study, we observed the inhibitory effect of melatonin on the progression of polyneuropathy in early stage of diabetic rat. For the clinical application to human beings, further study is required.
Action Potentials ; Animals ; Diabetes Mellitus ; Diabetic Neuropathies ; Humans ; Melatonin* ; Neural Conduction ; Polyneuropathies ; Rats* ; Streptozocin ; Tail

PURPOSE: We evaluated the effectiveness and safety of 18G biopsy gun with US guidence in the transplanted kidneys. MATERIALS AND METHODS: We performed 200 US-guided percutaneous biopsies using 18G biopsy gun. Diagnostic efficacy and complication of the biopsy in these patients were analyzed. RESULTS: Biopsy specimens were adequate for histologic diagnoses in 193 patients(96.5%). The mean of the biopsy frequency was 3, the mean of total glomerular number was 21.64 and the mean glomerular number per one biopsy was 6.93. Major complications occured in 3 (1.5%) of the 200 biopsies; hematuria developed in two patients, AV fistula in one. These complications were successfully controlled either by only transfusion or by coil embolization. There were no statistical differences in blood pressure, hemoglobin, BUN/Cr between pre- and post-renal biopsies. CONCLUSION: US-guided percutaneous biopsy of renal allograft with 18G biopsy gun is simple, safe, and accurate method in evaluating the renal allograft dysfunction.
Allografts ; Biopsy* ; Blood Pressure ; Diagnosis ; Embolization, Therapeutic ; Fistula ; Hematuria ; Humans ; Kidney