Acute coronary syndrome (ACS) represents a broad spectrum of ischemic myocardial events, including unstable angina, non-ST elevation myocardial infarction, and acute ST elevation myocardial infarction, which are associated with high morbidity and mortality. Early diagnosis and risk stratification are essential for initiation of optimal medical and invasive management. Randomized clinical trials over the past decade have revolutionized the care of patients with ACS. Therapeutic measures consist of administration of aggressive antiplatelet, antithrombotic, and antiischemic agents. In addition, patients with high-risk features, notably positive troponin, ST segment changes, and diabetes, benefit from early invasive intervention as compared to conservative strategies. Lifestyle interventions, modification of risk factor profile, and long-term medical treatment are of pivotal importance in reducing the long-term risk of recurrence.
Acute Coronary Syndrome ; Angina, Unstable ; Anticoagulants ; Early Diagnosis ; Humans ; Life Style ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Recurrence ; Risk Factors ; Secondary Prevention ; Troponin

It is. commonly assumed that nasorespiratory function can exert a dramatic effect upon the development of the dentofacial complex. Specially, it has been stated that chronic nasal obstruction leads to mouth breathing, which causes altered tongue and mandibular positions. If this occurs during a period of active growth, :the .outcome is development of the "adenoid facies". Such patients characteristically: manifest a vertically long lower third facial height, narrow alar bases, lip incompetence, a long and narrow maxillary arch and a greater than normal mandibular plane angle. But several authors have reported that so-called adenoid facies is not always associated with adenoids and mouth breathing, and that a particular type of dentition is not alwarys found in mouth breathers with or without adenoids. Some authors have believed adenoids lead to mouth breathing in cases with particular facial characteristics and types of dentition. We assumed that the ability to adapt to individual's neuromuscular complex is various. So, we compared the difference of influence of mouth breathing between childrens who have different facial types. This study included 60 patients and they were divided into three groups by Rickett's facial type. Their dentition and tongue position were compared. The results are as follows. 1. There is a significant difference in arch width of upper molars between different facial types. Especially dolichofacial type patients have narrowest arch width. 2. There is a significant difference in tongue position between different facial types. Especially dolichofacial type patients have lowest positioned tongue.
Adenoids ; Child ; Dentition* ; Facies ; Humans ; Lip ; Molar ; Mouth ; Mouth Breathing ; Nasal Obstruction ; Respiration* ; Tongue

BACKGROUND: Adaptive remodeling of the wall of diseased arterial segments occurs to compensate for the accumulation of atherosclerotic plaque. Histopathologic studies and intraoperative high-frequency epicardial coronary ultrasound imaging as well as intracoronary ultrasound imaging have shown that human coronary arteries enlarge in parallel with the formation of atherosclerotic plaque. Therefore, the lumen area is preserved until the progressive accumulation of plaque exceeds the compensatory mechanisms of the vessel. In 1995, however, Pastercamp et al. reported that arterial wall constriction (shrinkage) or inadequate enlargement may be a different mechanism associated with the development of severe arterial lumen narrowing in addition to plaque proliferation. The aim of this study is to examine what extent of de novo native coronary arterial stenosis is accompanied by compensatory enlargement and to find the predictors of inadequate remodeling with intravascualr ultrasound. METHODS: Fifty eight patients were enrolled from February 1997 through October 1997. Patients who had the lesion of more than 50% stenosis of minimal luminal diameter in coronary angiography were indicated. The lesion which was located in the ostium or was very tortuous or angulated was excluded. The lesion which had the history of balloon angioplasty or stent insertion was also excluded. We used 20 MHz endosonic intravascular ultrasound catheter. We measured EEM area (External Elastic Membrane area), lumen area and plaque plus media area and analysed plaque characteristics. RESULTS: 1) Fifty-eight consecutive patients (43 men, 15 women; mean age 55.4 years, range 33 to 78) who had not undergone previous catheter intervention were studied with a single intravascular ultrasound system. 2) Among 58 patients, 20 patients (35%) had acute myocardial infarction, 30 patients (52%) unstable angina, 6 patients (10%) stable angina and 2 patients (3%) old myocardial infarction. Lesions were located at the left anterior descending arteries in 29 patients (50%), right coronary arteries in 21 patients (36%) and left circumflex coronary artery in 8 patients (14%). 3) Compensatory enlargement was observed in 19 (32%) of 58 lesions and inadequate compensatory enlargement in 39 (68%). 4) EEM and plaque areas at lesion site of compensatory enlargement group were significantly larger than those of inadequate enlargement group (p<0.05). 5) Risk factors for coronary arterial disease including diabetes mellitus, hypertension, hypercholesterolemia (serum cholesterol<0A65B>240 mg/dl), smokings and plaque characteristics were not statistically related with inadequate enlargement. Although there was no statistical significance, there was a tendency of inadequate enlargement in patients with diabetes mellitus and calcified plaque. 6) The only predictor of inadequate remodeling was the postmenopausal female (p<0.05). CONCLUSION: Adaptive compensatory coronary arterial remodeling was occured less frequently in patients with acute coronary syndromes than in patients with stable angina. The only statistically significant predictor of adaptive compensatory coronary arterial remodeling was postmenopausal women. Inadequate compensatory coronary arterial remodeling was occured more frequently in patients with diabetes mellitus or calcified plaque but without statistical significance.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Catheters ; Constriction ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Membranes ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Risk Factors ; Smoke ; Stents ; Ultrasonics* ; Ultrasonography

BACKGROUND AND OBJECTIVES: The prognostic value of biochemical markers and the resolution of ST-segment elevation on electrocardiogram are well established. However, how a combination of these two tools affects the evaluation of risk stratification has not yet been evaluated. SUBJECTS AND METHODS: Between January 2006 and June 2008, 178 consecutive patients treated with primary percutaneous coronary interventions after ST-segment elevation myocardial infarctions (STEMI) were analyzed at two coronary care units. Patients were divided into the following three groups according to ST-segment resolution: complete (> or =70% depression of the elevated ST-segment, n=63), partial (30% to 70%, n=90), and incomplete (<30%, n=25). Demographic data, including history, electrocardiography, biochemical markers, initial ejection fraction, and angiographic findings were also evaluated. RESULTS: There were 7 deaths, 3 repeated myocardial infarctions, and 17 readmissions for worsening heart failure during six months of follow-up. In a multivariate analysis to predict clinical outcomes, ejection fraction {hazard ratio (HR): 0.83 (0.76-0.91), p<0.01}, high-sensitivity C-reactive protein {HR: 1.15 (1.05-1.26), p<0.05}, and the degree of ST-segment resolution {HR: 0.96 (0.93-0.09), p<0.05} were independently associated with clinical outcomes. According to the Cox-proportional hazards model, the addition of ST-segment resolution markedly improved the prognostic utility of the model containing biochemical markers and ejection fraction. CONCLUSION: Assessment of biomarkers upon admission and ST-segment resolution are strong predictors of clinical outcomes. The combination of these data provides additive information about prognosis at an early point in the disease progression and further improves risk stratification for STEMI.
Biomarkers ; C-Reactive Protein ; Coronary Care Units ; Depression ; Disease Progression ; Electrocardiography ; Follow-Up Studies ; Heart Failure ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Proportional Hazards Models

BACKGROUND: The clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. The use of high pressure balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. Therefore, we evaluated the effect of anticoagulation of subacute thrombosis sfter stenting retrospectively on a consecutive series of patients who received palmaz-Schatz coronary stents with high pressure balloon dilatation. METHOD: From March 1995 to August 1995, 62 patients underwent Palmaz-Schatz coronary stent implantation. After deploying stents successfully, high pressure overdilatation of the stents was performed in all patients. According to post-stent anticoagulation, 32 patients received aspirin 200 mg/day, ticlopidine 500 mg/day and warfarin for two months, 30 patients received aspirin and ticlopidine. RESULTS: The clinical or angiographic variables were not significantly different between the two groups. There was no acute or subacute thrombosis in the two groups. The hospital stay after stenting was significantly shorter in the patients without antcoagulation than in patients with anticoagulation. CONCLUSION: The Palmaz-Schatz stent can be safely implanted without anticoagulation provided that stent expansion is daequate by the use high pressure balloon dilatation This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.
Aspirin ; Dilatation* ; Humans ; Length of Stay ; Retrospective Studies ; Stents* ; Thrombosis ; Ticlopidine ; Ultrasonography ; Warfarin

BACKGROUND AND OBJECTIVES: QT dispersion (QTd) represents the inhomogeneity of ventricular repolarization and has been suggested to predict ventricular arrhythmia in patients with coronary artery disease (CAD). This study investigates the short-term effect of percutaneous transluminal coronary angioplasty (PTCA) on QTd in patients with CAD and no history of previous myocardial infarct. MATERIALS AND METHODS: In 84 angina patients (65 men and 19 women, mean age of 58.3+/-9.0 yeras) who underwent successful PTCA of single coronary artery, ECG was checked in baseline, immediate, 1day and 1 month after PTCA. QTd and corrected QTd (c-QTd) were measured in these ECGs by digitizer. RESULTS: PTCA was performed at left anterior descending artery (LAD) in 56, left circumflex artery (LCx) in 12 and right coronary artery (RCA) in 16 patients. Mean and standard error of QTd (c-QTd) at baseline, immediate, 1day and 1month after PTCA was 51.3+/-4.2 (50.7+/-4.1), 54.2+/-4.5 (52.8+/-4.5), 47.7+/-4.3 (48.5+/-4.8) and 36.3+/-4.5 (37.5+/-4.6)msec, respectively. QTd and c-QTd significantly decreased at 1 month following PTCA. The difference was more prominent in pateints with LAD lesion than LCx or RCA lesion and independent of gender, severity of stenosis and use of beta-blockers. CONCLUSION: QTd decreases in CAD patients with no history of myocardial infarct at 1 month following successful PTCA. This may facilitate a favorable recovery from inhomogenous repolarization. These findings call for long-term follow-up of QTd and the incidence of ventricular tachyarrhythmias and sudden death following successful PTCA.
Angioplasty, Balloon, Coronary ; Arrhythmias, Cardiac ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Death, Sudden ; Electrocardiography ; Female ; Humans ; Incidence ; Male ; Myocardial Infarction ; Tachycardia

No abstract available.
Disease Outbreaks* ; Epidemiology* ; Foodborne Diseases ; Japan* ; Korea* ; Mortality

BACKGROUND AND OBJECTIVES: We investigated whether prehypertensives (PHs) exhibit more prevalent electrocardiographic and echocardiographic left ventricular hypertrophy (ECG LVH) and if they are are more associated with impaired left ventricular (LV) diastolic function than are normotensives (NTs). SUBJECTS AND METHODS: A total of 608 subjects> or = 40 years of age with normal BP (SBP<120 mmHg and DBP<80 mmHg, n=335) and PH (n=273) and who were without a history of hypertension, diabetes and any other known cardiovascular diseases underwent blood sampling for obtaining the lipid profile, and they also underwent 12-lead electrocardiography and echocardiography. RESULTS: Compared with the NTs, the PHs had significantly higher Sokolow-Lyon and Cornell voltage for ECG LVH, and they ahd a higher prevalence of ECG LVH (men: 16.9% vs 5.9%, women: 2.0% vs 1.0%, respectively). The PHs had a more increased left ventricular mass index (LVMI, Men: 118.1+/-24.4 g/m2 vs 102.0+/-19.1 g/m2, p=0.02; Women: 117.5+/-26.4 g/m2 vs 101.9+/-30.7 g/m2, p=0.02) and a more decreased LV diastolic function (E/A, Men: 1.14+/-0.6 vs 1.30+/-0.4, p=0.03; Wemen: 1.11+/-0.6 vs 1.25+/-0.5, p=0.03) on echocardiography than the NTs. CONCLUSION: The PHs were associated with a higher prevalence of ECG LVH and a more increased LVMI on echocardiography than that of the NTs. Therefore, we should pay earlier attention to diagnose and screen the pre-hypertensive group.
Cardiovascular Diseases ; Echocardiography ; Electrocardiography ; Female ; Humans ; Hydrogen-Ion Concentration ; Hypertension ; Hypertrophy, Left Ventricular* ; Male ; Prevalence

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*

BACKGROUND: The several kinds of coronary stents have proven successful in their role to treat acute or subacute closures after balloon angioplasty as well as to reduce the restenosis rate in de novo lesions. However, investigations continue in order to develop an ideal stent with a strong, highly flexible, radial force, especially useful in cases of tortuous vessels, lesions at bends, and lesions distal to previously deployed stents. The NIR stent is a recently developed balloon-expandable, stainless-steel, slotted tube stent; it is designed for improved flexibility with a higher radial force when compared with the traditional Palmaz-Schatz stent. We report the immediate results of our experience with the NIR stent. The purpose of the present study was to assess the feasibility, safety and efficacy of the deployment of manually crimped NIR stents in patients with complex coronary anatomy as well as the clinical outcomes within the first month. METHODS: Between January and July 1997, 143 NIR stents were implanted in the coronary arteries of 124 patients (male 76%, mean age 56+/-10 years). Sixty-one patients had UAP, 43 had SA, and 20 patients had AMI. RESULTS: 1)Indications of stenting were de novo lesions in 123 (95%) and restenosis lesion in 6 (5%). 2)Frequency of used stent length was 16mm in 65 cases (46%), 32mm in 60 cases (42%), 25 mm in 12 cases (8%), and 9mm in 6 cases (4%). 3)Single stents were implanted in 115 (89%) lesions, and overlapping stenting with 2nd NIR stents in 14 (11%) lesions. 4)Procedural success rate (defined as the angiographically residual stenosis of <30% immediately after the procedure with no major clinical events within 4 weeks after the procedure) was 95.2% (118/124 pts). Angiographic success rate (defined as a residual stenosis of <30% without major dissection) was 96.1% (124/129 lesion). The procedural success rate and the angiographic success rate in calcified lesions and/or thrombi containing lesions were 100%. The procedural success rate and the angiographic success rate in cases of tortuous proximal vessels to the lesion were 91% and 91%, respectively. The procedural success rate and the angiographic success rate in more than 45 degrees angulated lesions were 98% and 94%, respectively. 5)The mean lumen diameter of target lesions was increased from 0.6+/-0.4mm to 3.1+/-0.5mm (p<0.001) after stent implantation. The percent of diameter stenosis was decreased from 82+/-12% to -1+/-13% (p<0.001) after stent implantation. The mean diameter of the reference artery was 3.1+/-0.6mm. 6)Incidence of peristent dissection after stenting was 6.2% (8/129 lesion). 7)The rate of stenting failure was 4.8% (6 pts). There were 2 cases of stent migration, 2 cases of failure to cross the lesion and 2 cases of procedure-related emergency CABG. CONCLUSION: There is a higher tendency for stent migration with manually crinped stents compared with that of premounted stents. However, coronary stenting with manually-crimped NIR stents can be safely performed and may be particularly useful in patients with unfavorable clinical and angiographic characteristics for percutaneous coronary intervention. Follow-up data is needed to assess long term patency of this stent.
Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Decompression Sickness ; Emergencies ; Follow-Up Studies ; Humans ; Percutaneous Coronary Intervention ; Pliability ; Stents*