Purpose: To compare the effectiveness of warm saline and anti-fog solution for preventing fogging of a non-contact wide-field viewing system during vitrectomy. Methods: Five liters of water at 36°C were placed in a transparent container. The fogging areas of wide-field lenses were microscopically measured. We created three groups: lenses soaked in normal saline at 25°C for 1 minute (control), lenses soaked in normal saline at 50°C for 1 minute (warm saline), and lenses that were wiped with a sponge soaked in anti-fog solution (ULTRASTOP pro med. Solution, Sigmapharm, Vienna, Austria) after prior soaking in normal saline at 25°C for 1 minute (anti-fog). Images of fogged areas were acquired at 10 seconds and 1, 3, and 5 minutes. Extent of fogged areas and central lens invasion were determined. All experiments were repeated 10 times. Results: In the control group, the entire areas were always completely fogged. The average fog coverage values were 4.34 ± 1.28, 6.30 ± 1.38, 56.00 ± 25.01, and 93.81 ± 5.88% at 10 seconds and 1, 3, and 5 minutes in the warm saline group and 4.74 ± 0.57, 7.35 ± 0.96, 10.13 ± 1.09, and 11.74 ± 1.74% in the anti-fog group, respectively. There were significant differences at 3 and 5 minutes (p = 0.029, p = 0.012). Fogging of the central lens was detected in 8 tests after 3 minutes and all 10 tests after 5 minutes in the warm saline group, but no fogging was detected in the anti-fog group. Conclusions Application of an anti-fog solution to a wide-field viewing lens prevents lens fogging during vitrectomy.

A 43-year-old male presented with effort angina. Ammonia positron emission tomography (PET) revealed reversible perfusion defect in left anterior descending artery (LAD) and left circumflex artery (LCX) territories with decreased coronary flow reserve. Coronary angiogram showed significant stenosis in proximal LAD and intermediate diffuse stenosis in LCX and right coronary artery (RCA). Fractional flow reserve (FFR) showed similar results with ammonia PET. After percutaneous coronary intervention for LAD and LCX, flow and pressure checked by PET and FFR showed improvement. Simultaneously use of ammonia PET and FFR could be useful for determining ischemia-inducible lesion especially in diffuse intermediate lesion with discrepancy between functional studies.
Adult ; Ammonia ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Male ; Percutaneous Coronary Intervention* ; Perfusion ; Positron-Emission Tomography*

BACKGROUND AND OBJECTIVES: Systemic activation of the inflammatory system after aortic injury may play a role in the development of complications. The aim of this study was to determine the significance of the inflammatory markers for the mortality of patients suffering with medically treated type B acute aortic syndrome (AAS). SUBJECTS AND METHODS: We analyzed a total of 81 patients who were admitted with AAS within 24 hours from the onset of the symptoms and who were medically treated between January 2000 and December 2004. The patients were divided into two groups: the moribund patients who died within 2 weeks (group I: n=8, mean age: 64.0+/-11.0 years) and the patients who survived over 2 weeks (group II: n=73, mean age: 62.6+/-13.7 years). The serum high-sensitivity C-reactive protein (hsCRP) levels, the white blood cell (WBC) and monocyte counts, and the plasma D-dimer levels were measured on admission. RESULTS: The baseline clinical characteristics were not different between the two groups. The major causes of in-hospital death in group I were extensions or rupture of type B dissection (6 cases) and acute renal failure (2 cases). The multivariate analysis demonstrated that a high monocyte count (>1,250/mm3), and high levels of hsCRP (>11 mg/dL) and D-dimer (>1.2 mg/dL) were independent determinants of the short-term mortality (OR=6.39, 6.14 and 9.00; 95% CI=1.19 to 34.1, 1.14 to 32.9 and 1.20 to 67.4; p=0.02, 0.04 and 0.03, respectively). CONCLUSION: Systemic activation of the inflammatory system in type B AAS patients may be one of the important factors associated with the development of short-term mortality.
Acute Kidney Injury ; C-Reactive Protein ; Humans ; Inflammation ; Leukocytes ; Monocytes ; Mortality* ; Multivariate Analysis ; Plasma ; Prognosis ; Rupture

Stent thrombosis is a fatal complication in patients who have undergone percutaneous coronary intervention, and discontinuation of anti-platelet agent is a major risk factor of stent thrombosis. We report a rare case of very late stent thrombosis (VLST) following discontinuation of anti-platelet agents in a patient who experienced acute myocardial infarction and essential thrombocytosis. She had undergone implantation of a drug eluting stent (DES) and a bare metal stent (BMS) two and half years prior to her presentation. VLST developed in DES, not in BMS, following interruption of anti-platelet therapy.
Drug-Eluting Stents ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Risk Factors ; Stents ; Thrombocythemia, Essential ; Thrombocytosis ; Thrombosis

Factor XI deficiency is a very rare congenital coagulation disorder. Bleeding complications should be considered when treating a patient with unstable angina and congenital coagulation disorder during and after percutaneous coronary intervention (PCI). Thrombotic complications can develop after fresh frozen plasma (FFP) transfusion and drug-eluting stent (DES) implantation. We report here on the successful management of a patient having unstable angina with factor XI deficiency, and this patient was treated with PCI under intravascular guidance and with the aid of FFP and hemostatic devices.
Angina, Unstable* ; Angioplasty ; Drug-Eluting Stents ; Factor XI Deficiency* ; Factor XI* ; Hemorrhage ; Humans ; Percutaneous Coronary Intervention* ; Plasma

BACKGROUND AND OBJECTIVES: alpha-Lipoic acid (ALA) is known to improve endothelial function in patients with diabetes. However, the effect of ALA on endothelial function in hypertensive patients is unknown. The aim of this study was to investigate whether ALA improves endothelial function in diabetic and hypertensive patients. SUBJECTS AND METHODS: This study included 40 patients who were treated with ALA (Group I: 20 diabetic patients, 54.9+/-10.2 years, Group II: 20 hypertensive patients, 56.5+/-9.0 years). ALA was administered in 600 mg/day doses during the first four weeks, and 1,200 mg/day doses during the second four weeks. Clinical characteristics and endothelial function were assessed at baseline, 4 weeks and 8 weeks after ALA administration. Evaluation of patients included: assessment of the brachial artery for flow mediated vasodilation (FMD) and the inflammatory marker (high sensitive CRP: hsCRP). RESULTS: Clinical characteristics (body mass index, total cholesterol/HDL-cholesterol and hsCRP) were unchanged in each group. However, FMD was significantly improved at 8 weeks after ALA therapy in both groups. Group I-baseline: 4 weeks : 8 weeks = 4.1+/-3.3 : 6.5+/-2.2 : 8.0+/-2.7, Group II-baseline: 4 weeks : 8 weeks = 5.5+/-3.7 : 7.4+/-3.3 : 9.3+/-2.7, p<0.05. The level of fibrinogen was observed to have an inverse correlation with FMD at 8 weeks after ALA therapy in Group I (p<0.05). CONCLUSION: ALA improves endothelial function in both diabetic and hypertensive patients.
Brachial Artery ; Fibrinogen ; Humans ; Hypertension ; Thioctic Acid ; Vasodilation

BACKGROUND AND OBJECTIVES: alpha-Lipoic acid (ALA) is known to improve endothelial function in patients with diabetes. However, the effect of ALA on endothelial function in hypertensive patients is unknown. The aim of this study was to investigate whether ALA improves endothelial function in diabetic and hypertensive patients. SUBJECTS AND METHODS: This study included 40 patients who were treated with ALA (Group I: 20 diabetic patients, 54.9+/-10.2 years, Group II: 20 hypertensive patients, 56.5+/-9.0 years). ALA was administered in 600 mg/day doses during the first four weeks, and 1,200 mg/day doses during the second four weeks. Clinical characteristics and endothelial function were assessed at baseline, 4 weeks and 8 weeks after ALA administration. Evaluation of patients included: assessment of the brachial artery for flow mediated vasodilation (FMD) and the inflammatory marker (high sensitive CRP: hsCRP). RESULTS: Clinical characteristics (body mass index, total cholesterol/HDL-cholesterol and hsCRP) were unchanged in each group. However, FMD was significantly improved at 8 weeks after ALA therapy in both groups. Group I-baseline: 4 weeks : 8 weeks = 4.1+/-3.3 : 6.5+/-2.2 : 8.0+/-2.7, Group II-baseline: 4 weeks : 8 weeks = 5.5+/-3.7 : 7.4+/-3.3 : 9.3+/-2.7, p<0.05. The level of fibrinogen was observed to have an inverse correlation with FMD at 8 weeks after ALA therapy in Group I (p<0.05). CONCLUSION: ALA improves endothelial function in both diabetic and hypertensive patients.
Brachial Artery ; Fibrinogen ; Humans ; Hypertension ; Thioctic Acid ; Vasodilation

The aim of this study was to examine the anti-inflammatory effect of abciximab-coated stent in a porcine coronary overstretch restenosis model. Ten abciximab-coated stents, ten sirolimus-eluting stents (SES), and ten paclitaxel-eluting stents (PES) were deployed with oversizing (stent/artery ratio 1.3:1) in porcine coronary arteries, and histopathologic analysis was done at 28 days after stenting. There were no significant differences in the neointima area normalized to injury score and inflammation score among the three stent groups (1.58+/-0.43 mm2, 1.57+/-0.39 mm2 in abciximab-coated stent group vs. 1.69+/-0.57 mm2, 1.72+/-0.49 mm2 in the SES group vs. 1.92+/-0.86 mm2, 1.79+/-0.87 mm2 in the PES group, respectively). In the neointima, most inflammatory cells were lymphohistiocytes. Significant positive correlations were found between the extent of inflammatory reaction and the neointima area (r=0.567, p<0.001) and percent area stenosis (r=0.587, p<0.001). Significant correlations were found between the injury score and neointimal area (r=0.645, p<0.001), between the injury score and the inflammation score (r=0.837, p<0.001), and between the inflammation score and neointimal area (r=0.536, p=0.001). There was no significant difference in the inflammatory cell counts normalized to injury score among the three stent groups (75.5+/-23.1/microliter in abciximabcoated stent group vs. 78.8+/-33.2/microliter in the SES group vs. 130.3+/-46.9/microliter in the PES group). Abciximab-coated stent showed comparable inhibition of inflammatory cell infiltration and neointimal hyperplasia with other drug-eluting stents in a porcine coronary restenosis model.
Animals ; Anti-Bacterial Agents/administration & dosage ; Anti-Inflammatory Agents/*pharmacology ; Antibodies, Monoclonal/administration & dosage/*pharmacology ; Arteries/injuries/pathology ; Constriction, Pathologic ; Coronary Restenosis/*therapy ; Disease Models, Animal ; *Drug-Eluting Stents ; Female ; Hyperplasia ; Immunoglobulin Fab Fragments/administration & dosage/*pharmacology ; Inflammation ; Paclitaxel/administration & dosage ; Sirolimus/administration & dosage ; Swine ; Tunica Intima/pathology

BACKGROUND AND OBJECTIVES: Angiotensin II type 1 receptor blocker (ARB) has been to attenuate neointimal formation and vascular smooth muscle cell proliferation, with decreased inflammation. Recent studies have demonstrated that statins may contribute to the beneficial effects of ARB toward vascular diseases. The aim of this study was to evaluate the beneficial effects of the combination therapy of ARB and statin compared to that of angiotensin converting enzyme (ACE) inhibitor and statin in acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: 396 patients with ACS, who underwent PCI between June 2002 and December 2003, were divided into two groups: the ARB and simvastatin (n=188, 61.2+/-10.3 years, male 72%) and ACE inhibitor and simvastatin groups (n=208, 60.9+/-10.6 years, male 66%). The major adverse cardiovascular events, including restenosis and repeat PCI, between the two groups were compared. RESULTS: At 6-month after PCI, the levels of total cholesterol, triglyceride and low-density lipoprotein cholesterol were significantly decreased and that of high-density lipoprotein cholesterol significantly increased, and the levels of high-sensitivity C-reactive protein, fibrinogen, white blood cell and monocyte significantly decreased in both groups. A quantitative coronary angiography analysis of stented coronary segments disclosed no differences in the minimum lumen diameter and stent length. At the 6-month follow-up angiogram, there were no significant differences in the incidence of restenosis and repeat PCI, and there was also no difference in late loss between the two groups (ARB and statin group: 20%, 18%, 0.78+/-0.38 mm vs. ACE inhibitor and statin group: 22%, 20%, 0.81+/-0.44 mm). There were no significant differences in the incidence of cardiac deaths, myocardial infarctions, cerebrovascular accidents and bypass grafts at the 1-year clinical follow-up between the two groups. The event-free survival rates at 1 year were 81 and 79% in the ARB and statin and the ACE inhibitor and statin groups, respectively. There were no differences in the late loss and major adverse cardiac events according to the used ARBs or ACE inhibitors. CONCLUSION: The combination therapy of ARB with statin might not show more beneficial effects compared to ACE inhibitor with statin in ACS patients having undergone PCI.
Acute Coronary Syndrome ; Angiotensin II* ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins* ; C-Reactive Protein ; Cell Proliferation ; Cholesterol ; Coronary Angiography ; Death ; Disease-Free Survival ; Fibrinogen ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Inflammation ; Leukocytes ; Lipoproteins ; Male ; Monocytes ; Muscle, Smooth, Vascular ; Myocardial Infarction ; Peptidyl-Dipeptidase A ; Percutaneous Coronary Intervention* ; Receptor, Angiotensin, Type 1* ; Simvastatin* ; Stents ; Stroke ; Transplants ; Triglycerides ; Vascular Diseases

BACKGROUND AND OBJECTIVES: Hyperglycemia on hospital admission is a known important risk factor in patients with acute myocardial infarction. The purpose of this study was to investigate the relation between the level of hemoglobin A1c (HbA1c) and major adverse cardiac events (MACE) in non-diabetic acute myocardial infarction patients who underwent primary percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: Of the 105 acute myocardial infarction patients who underwent primary PCI between January 2002 and December 2002, 68 non diabetic patients were analyzed. The patients were divided into two groups: group I (n=46, 58.7+/-12.5 years, 37 male) with low levels of HbA1c (<6%) and group II (n=22, 64.6+/-13.1 years, 18 male) with elevated levels of HbA1c (6% to 7%). MACE was observed during the six-month clinical follow-up. RESULTS: There were no differences in the risk factors for atherosclerosis and angiographic characteristics between the two groups. Group II had a significantly higher rate of MACE (13% vs. 36%, p=0.026) compared to Group I. Logistic regression analysis disclosed that an elevated level of HbA1c, between 6 and 7%, was a significant independent predictor of MACE. CONCLUSION: An elevated level of HbA1c is a significant prognostic factor in non-diabetic acute myocardial infarction patients after primary PCI.
Angioplasty ; Atherosclerosis ; Diabetes Mellitus ; Follow-Up Studies ; Humans ; Hyperglycemia ; Logistic Models ; Myocardial Infarction* ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors