It is currently necessary to manage chronic ischemic foot gangrene because the rate of hospitalization and operations is increasing as a result of diet change and the growth of an aging population. Chronic ischemic foot gangrene is caused by Buerger`s disease, atherosclerosis and particularly, diabetes. In this study, we used the Wagner ischemic index with Doppler flowmeter and Wagner classification on 62 patients over 8 years from 1991 to 1998 as an index for treatment and prognosis. We measured the systolic pressure to determine the ischemic index, and according to Wagner the blood flow was inadequate in cases of diabetic foot gangrene and nondiabetic foot gangrene when it was below 0.45 and 0.35, respectively. According to the observation of clinical symptoms, we divided the cases by Wagner classification. Based on the above data, we performed conservative treatment, skin graft, local flap, superficial sural arterial island flap and amputation. We then followed up the patients and observed the treatment results. We concluded that the Wagner ischemic index with Doppler flowmeter and Wagner classification was useful in determining, selecting, and predicting the rate of survival or death as a result of amputation and graft when a surgical operation is performed.
Aging ; Amputation ; Atherosclerosis ; Blood Pressure ; Classification* ; Diabetic Foot ; Diet ; Flowmeters* ; Foot Ulcer* ; Foot* ; Gangrene ; Hospitalization ; Humans ; Prognosis ; Skin ; Transplants

BACKGROUND: The endothelium is an important regulator of vascular tone via release of relaxing and constricting substances. The regulatory effect of the endothelium has been shown to be impaired in atherosclerotic arteries in human and animal models of hypertension. But there are some debates on extent and developing time of endothelium dysfunction in patients with hypertension, and the determining factors for endothelium dysfunction also were not defined. The objects of this study are to determine whether endothelial function is impaired in coronary and peripheral arteries, and to investigate the predicting factors for endothelial dysfunction in patients with essential hypertension. METHODS: The study patients comprised 14 patients with essential hypertension(M : 7, Mean age : 50+/-2 year) and 6 normal control (M :2, Mean age : 45+/-4 year). We assessed the vasomotor response to acetylcholine and nitroglycerin by change of arterial diameter during the infusion of acetylcholine, from 10(-9M) to 10(-6M) in coronary artery and 7.5, 15, and 25ug/min in left superficial femoral artery, and on intracoronary injection of 200ug nitroglycerin after acetylcholine infusion. RESULTS: 1) There were no significant differences in sex, age, body mass index and ventricular mass index, except systolic(174+/-5 vs 118+/-7mmHg, p<0.001) and distolic blood pressure(106+/-5 vs 75+/-5mmHg,p<0.001) between patients with hypertension and normal control. 2) There were no significant differences in laboratory date of total cholesterol, HDL-cho-lesterol, lipoprotein(a), microaluminuria and von-Willebrand Factor but Fibrinogen level was raised significantly in patients with hypertension than normal control(299+/-26 vs 192+/-23ng/dl, p=0.04). 3) The vasoconstrictor response to acetylcholine, 10-8 to 10-6 M concentration, at proximal, mid, and distal left anterior descending coronary artery were increased significantly in hypertensive patients than normal control(p<0.05). At rest superficial femoral artery, the vasodilator response to acetylcholine, only 25ug/min, was decreased in patients with hypertension(p<0.05). There was no signficant difference in the vasodilator response to nitroglycerin at coronary artery between two groups but in superficial femoral artery, the vasodilator response to nitroglycerin was decreased significantly in hypertensive patients(p<0.05). CONCLUSIONS: The results of this study suggest that endothelium dependent vascular relaxation is impaired in both coronary and superificial femoral artery and it remained to be investigated the predicting factors for endothelial dysfunction in patients with essential hypertension.
Acetylcholine ; Arteries ; Body Mass Index ; Cholesterol ; Coronary Vessels ; Endothelium ; Femoral Artery ; Fibrinogen ; Humans ; Hypertension* ; Lipoprotein(a) ; Models, Animal ; Nitroglycerin ; Relaxation

BACKGROUND: Eisenmenger syndrome is a complication of heart dease with left-to-right shunt in which the pulmonary arterial pressure is increased due to increased pulmonary vascular resistance and the shunt directions becomes bidirectional or reversed at the level of atria, ventricies, or great arteries. Corrective surgery is impossible unless there is substantial reactive change pulmonary vascular resistance. METHOD: To identify clinical and hemodynamic features and observe natural history of adult patients with Eisenmenger syndrome, a retrospective clinical study was done on 61 patients(male:female=39:22) with Eisenmenger syndrome who were admitted to Seoul National University Hospital from September, 1979 to A piril, 1989, and were confirmed after cardiac catheterization and angiography. RESULTS: VSD was most freguent underlying defect(31 cases, 51%), followed by PDA(12 cases, 20%), ASD(9 cases,15%) and Combined lesion(9 cases, 15%). The average age was 27.3 years with the peak incidence in third decades. Effort intolerance(96.7%), palpitation(75.4%), hemoptysis(19.7%), and syncope(8.2%) were common symptoms, and cyanosis(62.3%), clubbing(63.9%) and increased heart sound were freguently(86.9%) observed. The mean pressure of the pulmonary artery and the total pulmonary vascular resistance were markedly elevated with the mean value of 76.7+/-14.2mmgHg and 29.3+/-12.HU respectively, 4 of the 19 patients who were given 100% oxygen inhalation showed reversibility of the pulmonary vascular resistance. During follow up(mean:40+/-29 months), Complications include infective endocarditis(1 case), brain abcess(2 case), atrial fibrillation(3 case), acute renal failure(1 case) and gout(2 case). 6 patients(10%) died during medical follow-up period(mean:40+/-29 months). Congestive heart failure and pulmonary infarction after cardiac catheterization including one postoprative death were causes of death. CONCLUSION: VSD, ASD, and PDA were common underlying defects of adult Eisenmenger syndrome. Complication was not uncommon and the common cause of death was congestive failure. The prognosis of the patients with Eisenmenger syndrome may not be so dismal as has been thought, though the exact survival to be determined.
Adult* ; Angiography ; Arterial Pressure ; Arteries ; Brain ; Cardiac Catheterization ; Cardiac Catheters ; Cause of Death ; Eisenmenger Complex* ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Sounds ; Hemodynamics ; Humans ; Incidence ; Inhalation ; Natural History* ; Oxygen ; Prognosis ; Pulmonary Artery ; Pulmonary Infarction ; Retrospective Studies ; Seoul ; Vascular Resistance

BACKGROUND AND OBJECTIVES: Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review. SUBJECTS AND METHODS: A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively. RESULTS: Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest. CONCLUSION: This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.
Chest Pain ; Dyspnea ; Embolism ; Foramen Ovale, Patent* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Pulmonary Embolism ; Retrospective Studies ; Shock ; Stroke ; Syncope ; Thrombosis*

The association between nephrotic syndrome and intravascular coagulation has been known for more than a century, but it was not until 1948 that a thrombotic diathesis in nephrotic patients was proposed. The prevalence of thrmbo-embolic complications is much higher in adult patients. Deep vein thrombosis of the leg is the most common complications in nephrotic adult and was responsible for one-third of the thrombo-embolic complications of nephrotic children. Arterial thrombosis occurs less frequently and is seen primarily in childern. We present a case of acute anterior myocardial infarction in a young man with nephrotic syndrome, secondary to minimal change glomerulonephritis, in which thrombosis of the proximal left anterior descanding artery was the actual cause of acute myocardial infarction.
Adult ; Arteries ; Child ; Disease Susceptibility ; Humans ; Leg ; Myocardial Infarction* ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Prevalence ; Thrombosis ; Venous Thrombosis

BACKGROUND: Atrioventricular reentry is the most common cause of supraventricular tachycardia in Korea. Radiofrequency catheter ablation(RFCA) is now accepted to be the safe and effective treatment modality for the elimination ofr accessory pathway conduction in patient with atrioventricualr reentrant tachycardia(AVRT). METHODS: To evaluate the clinical usefulness of RFCA for the treatment of AVRT, this study was conducted in 109 patients(male 68, female 41) with atrioventricular accessory pathway and documented AVRT after electrophysiologic study. RESULTS: A total of 112 accessory pathways were identified in 109 patients. The mean power outputs of the successful ablations at the atrial side of the annulus were higher than those at the ventricular side(34.0+/-8.9W versus 20.0+/-7.6W, p<0.01), but the maximum temperatures were lower at the atrial side of the annulus than those at the ventricular side (66.4+/-14.0degrees C versus 77.2+/-6.4degrees C, p<0.01). Accessory pathway conduction was eliminated in 102 of 112 pathways successfully(success rate 91v). There were 4 nonfatal complications(3.7%). 3 patients with hemopericardium and 1 with femoral artery thrombus, during or after ablation porcedures. Recurrences of AV reentrant tachycardia or delta wave on the electrocardiogram occured in 5 patients, and 4 of them had successful second procedures. There were no late complications during a mean follow-up period of 13+/-5 months. CONCLUSION: RFCA is highly effective and safe treatment modality in ablation accessory pathway conduction.
Catheter Ablation* ; Catheters ; Electrocardiography ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Korea ; Pericardial Effusion ; Recurrence ; Tachycardia* ; Tachycardia, Supraventricular ; Thrombosis

BACKGROUND: Combination chemotherapy including platinum is based on treatment of advanced non-small cell lung cancer (NSCLC). But combination chemotherapy is not tolerable in elderly patients. Paclitaxel is one of the most active single chemotherapeutic agent in advanced NSCLC. We evaluated the efficacy and safety of single paclitaxel chemotherapy in elderly with advanced NSCLC. METHODS: From September 2002 to May 2004, a total 24 patients aged 70 years and older with advanced NSCLC were enrolled in this study. Treatment was consisted with paclitaxel 135 mg/m2 intravenously for 3hrs on day 1. Chemotherapy repeated every three weeks until disease progression or severe toxicity developed. RESULTS: Of the 24 patents, only 18 patient can be evaluated and 4 partial remission, 11 stable diseases and 3 progressive diseases were observed. Based on an intent-to-treatment analysis, The overall response rate was 17%. The estimated median survival and median time to progression were 44 weeks and 18 weeks, respectively. The major toxicity were grade 3 or 4 neutropenia (6%). Other toxicity were myalgia, neuropathy, nausea and oral mucositis, but all of them were usually mild (grade 1, 2) and recovered spontaneously. There were no treatment- related deaths. CONCLUSIONS: This single low dose paclitaxel chemotherapy is highly tolarable with activity comparable to that of conventional dose regimens especially in elderly advanced non-small cell lung cancer.
Aged* ; Carcinoma, Non-Small-Cell Lung ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination ; Humans ; Myalgia ; Nausea ; Neutropenia ; Paclitaxel* ; Platinum ; Stomatitis

BACKGROUND AND OBJECTIVES: Efonidipine hydrochloride, an L- and T-type dual calcium channel blocker, is suggested to have a heart rate (HR)-slowing action in addition to a blood pressure (BP)-lowering effect. The aim of this study was to determine the effect of efonidipine on HR and BP in patients with mild-to-moderate hypertension. SUBJECTS AND METHODS: In a multi-center, prospective, open-labeled, single-armed study, we enrolled 53 patients who had mild-to-moderate hypertension {sitting diastolic BP (SiDBP) 90-110 mmHg}. After a 2-week washout, eligible patients were treated with efonidipine (40 mg once daily for 12 weeks). The primary end point was the change in HR from baseline to week 12. The secondary end-point included the change in trough sitting BP and 24-hour mean BP between baseline and week 12. Laboratory and clinical adverse events were monitored at each study visit (4, 8, and 12 weeks). RESULTS: Fifty-two patients were included in the intention-to-treat analysis. After 12 weeks of treatment with efonidipine, the resting HR decreased significantly from baseline to week 12 {from 81.5+/-5.3 to 71.8+/-9.9 beats/minute (difference, -9.9+/-9.0 beats/minute), p<0.0001}. The trough BP {sitting systolic blood pressure (SiSBP) and SiDBP} and 24-hour mean BP also decreased significantly (SiSBP: from 144.6+/-8.2 to 132.9+/-13.5 mmHg, p<0.0001; SiDBP: from 96.9+/-5.4 to 88.3+/-8.6 mmHg, p<0.0001, 24-hour mean systolic BP: from 140.4+/-13.5 to 133.8+/-11.6 mmHg, p<0.0001; 24-hour mean diastolic BP: from 91.7+/-8.7 to 87.5+/-9.5 mmHg, p<0.0001). CONCLUSION: Efonidipine was effective in controlling both HR and BP in patients with mild-to-moderate hypertension.
Blood Pressure ; Calcium ; Calcium Channel Blockers ; Calcium Channels ; Dihydropyridines ; Heart ; Heart Rate ; Humans ; Hypertension ; Nitrophenols ; Organophosphorus Compounds ; Prospective Studies

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.
Aged ; Angioplasty, Balloon, Coronary/*methods ; Coronary Stenosis/surgery/*therapy ; Death, Sudden, Cardiac/etiology ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Thrombosis/etiology

The optimal dose of beta blockers after acute myocardial infarction (MI) remains uncertain. We evaluated the effectiveness of low-dose nebivolol, a beta1 blocker and a vasodilator, in patients with acute MI. A total of 625 patients with acute MI from 14 teaching hospitals in Korea were divided into 2 groups according to the dose of nebivolol (nebistol®, Elyson Pharmaceutical Co., Ltd., Seoul, Korea): low-dose group (1.25 mg daily, n=219) and usual- to high-dose group (≥2.5 mg daily, n=406). The primary endpoints were major adverse cardiac and cerebrovascular events (MACCE, composite of death from any cause, non-fatal MI, stroke, repeat revascularization, rehospitalization for unstable angina or heart failure) at 12 months. After adjustment using inverse probability of treatment weighting, the rates of MACCE were not different between the low-dose and the usual- to high-dose groups (2.8% and 3.1%, respectively; hazard ratio: 0.92, 95% confidence interval: 0.38 to 2.24, p=0.860). The low-dose nebivolol group showed higher rates of MI than the usual- to high-dose group (1.2% and 0%, p=0.008). The 2 groups had similar rates of death from any cause (1.1% and 0.3%, p=0.273), stroke (0.4% and 1.1%, p=0.384), repeat PCI (1.2% and 0.8%, p=0.428), rehospitalization for unstable angina (1.2% and 1.0%, p=0.743) and for heart failure (0.6% and 0.7%, p=0.832). In patients with acute MI, the rates of MACCE for low-dose and usual- to high-dose nebivolol were not significantly different at 12-month follow-up.