Acute aortic dissection is the most common catastrophic illness of the aorta. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode, but survival may be significantly improved by the timely institution of diagnostic modalities and appropriate medical and surgical therapy. But, approximately 10-20% of patients with acute aortic dissection present with a clinical picture of acute myocardial infarction. This sometimes can not only delay the diagnosis and adequate treatment of acute aortic dissection but also inappropriately treat with thrombolytic agents and anticoagulants which result in rapid deterioration of clinical condition of patient. We report a case of acute aortic dissection with dynamic ST changes in electrocardiogram which resulted in delay of accurate diagnosis and adequate treatment of acute aortic dissection.
Anticoagulants ; Aorta ; Catastrophic Illness ; Diagnosis ; Electrocardiography* ; Fibrinolytic Agents ; Humans ; Myocardial Infarction

BACKGROUND: Several stents are now available for the treatment of failed or suboptimal angioplasty. However, one of the limitations of stents is difficult to deploy especially in tortuous vessels, lesions at a bend, and distal to previously deployed stents. The AVE Micro-II stent has a very low profile(1.65mm), optimum radio-opacity, and highly flexible properties. It is mounted on a semi-compliant balloon with a monorail delivery system. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report clinical outcomes and angiographic follow up results of AVE Micro-II stent. METHODS: Between January 1996 and September 1996, 77 patients were stented with the AVE Micro-II stent. Six-months follow-up angiogram was performed in 57 patients(64 lesions, follow-up rate : 74%). RESULTS: The overall angiographic restenosis rate was 26.6%. By univariable analysis, the rate of restenosis was significantly higher for stents in angulated lesions, in smaller post-stent luminal diameter, in the left anterior descending artery lesion than the right coronary artery, in ostial lesion(p=0.02), in peristent dissecting lesions(p=0.02), in tortuous proximal vessels(p=0.03). Stenting of angulated lesions(p=0.0001, Odds ratio=54.64), small post-stent luminal diameter(p=0.01, Odds ratio=5.46), and the left anterior descending artery than the right coronary artery(p=0.03, Odds ratio=17.2) were the strong independent predictors of restenosis in a multiple logistic regression analysis. Event-free survival(freedom from death, myocardial infarction or revascularization) was 80.7% at 6 months. CONCLUSIONS: 1) The AVE Micro-II stent can be placed safely and efficiently. 2) The angiographic restenosis rate was 26.6%, and 80.7% of patients remained free of cardiovascular events at 6 months. 3) Stenting of angulated lesions, small post-stent luminal diameter, and the left anterior descending artery than the right coronary artery are associated with higher rates of restenosis.
Angioplasty ; Arteries ; Coronary Vessels ; Disease-Free Survival ; Follow-Up Studies* ; Humans ; Logistic Models ; Myocardial Infarction ; Phenobarbital ; Stents*

BACKGROUND: Despite of the first coronary wallstent implantation ushered in the new era in interventional cardiology with the purpose of circumventing the two major limitation of coronary balloon angioplasty, early acute occlusion and late restenosis, however, previous investigators suggested the high rate of subacute occlusion after original wallstent implantation. Recently the low incidence of the subacute closure and restenosis rate with the newely modified less shortening coronary wallstent in native coronary artery and in aortocoronary vein grafts were reported. In this study we report the acute and 6 months follow up results with less shortening coronary wall stent in 32 patients. METHODS: Thirty two patients were enrolled from March 1996 through February 1997 at the Yonsei cardiovascular center of Yonsei University. The specific angiographic criteria for enrollment included at least 70% stenosis and a lesion that was 20mm or more in length and a vessel diameter of at least 2.5mm. Enteric coated aspirin(100mg daily) and ticlopidine(500mg daily) at least 3 days before the procedure and received continuous infusion of 24,000U of heparin for 1day after the procedure. Angiography was performed in two orthogonal views at pre, post procedure and 6months later. Quantitative analysis was performed with the use of the electronic caliper comparing to the empty catheter. All continuous variables were expressed as mean SD and analyzed with the t-test. Differences between groups were analyzed with Chi-square analysis and Fishers Exact test where appropriate. RESULTS: The newly modified Coronary Less Shortening Wallstents were successfully implanted in all the 35 diffuse coronary lesions(more than 20mm in length) of the 32 patients, including 15 pts of acute myocardial infarction, 14 pts of unstable angina, and 3 pts of stable angina. Average 6 months follow up angiography was performed in 26 patients. Immediate angiographic results with Less Shortening Wallstent comparing with 6 months follow up were 3.0+/-0.4mm and 1.7+/-0.9mm in minimal luminal diameter(MLD), 5.1+/-9.1% and 46.8+/-25.8% in diameter stenosis(DS). During the in-hospital phase, no major cardiac event occurred except 2 cases of transmural myocardial infarction, including one of stent thrombosis(3.1%) and one of side branch occlusion, despite of inclusion of 7 cases of threatened occlusion in the long lesion. The restenosis rate at follow up angiography was 30.7%(8/26 pts). The restenosis rate was higher in patients with stent insertion into right coronary artery or adjuvant high pressure oversize ballooning after stent insertion but not statistically significant. CONCLUSIONS: The results of this study suggested that new Less Shortening Wallstent might reduce the requirement of multiple stent in the long lesion and a lower rate of subacute thrombotic occlusion in comparison to the reports with its prototype. Restenosis rate was not significantly different from other types of stents. Althouth the restenosis rate was high in patients with stent insertion, there was no statistical significance probably due to small sample size. But further large scale long term follow-up study is needed to evaluate the role of new Less Shortening Wallstent.
Angina, Stable ; Angina, Unstable ; Angiography ; Angioplasty, Balloon, Coronary ; Cardiology ; Catheters ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Follow-Up Studies* ; Heparin ; Humans ; Incidence ; Myocardial Infarction ; Phenobarbital ; Research Personnel ; Sample Size ; Stents ; Transplants ; Veins

OBJECTIVES: The acute diarrhea is a common complaint among immunocompromised hosts, and may cause life threatening event. The infectious etiologies vary depending on virus, bacteria, and parasites. The most common etiology of acute gastroenteritis is known as enteric virus in Korea. But there are few studies about the infectious etiology of acute gastroenteritis in immunocompromised hosts. The aim of this study was to investigate the infectious etiologies of acute diarrhea in immunocompromised hosts. METHODS: Seventy three patients were enrolled prospectively in a university hospital from January 2013 to July 2014. Immunocompromised hosts included above 65-year-old people, patients with chronic diseases, solid organ or stem cell transplants, solid organ malignancies, hematologic malignancies, immunosuppressive or steroid taking patients. The clinical data were collected and stool samples collected during diarrhea were undergone laboratory analysis for enteric viruses and bacterial enteropathogens including Salmonella spp., Shigella spp., and Clostridium difficile. RESULTS: Fifty five patients were analyzed as follows : above 65 year-old people were 36 cases (66%), previous antibiotic usage was 22 cases (41.5%). 44 cases (81.1%) were admitted to general ward whereas 9 cases to ICU (17%). 41 cases (73.6%) were treated with antibiotics. Positive C. difficile toxin assays were 6 cases (11.9%). Other infectious etiologies were not found. CONCLUSIONS: C. difficile infection was more common infectious etiology while enteric viruses and other bacteria are not associated with acute diarrhea among immunocompromised hosts in this study. So C. difficile infection must be considered preferentially in immunocompromised hosts with acute diarrhea.
Aged ; Anti-Bacterial Agents ; Bacteria ; Chronic Disease ; Clostridium difficile ; Diarrhea* ; Gastroenteritis ; Hematologic Neoplasms ; Humans ; Immunocompromised Host* ; Korea ; Parasites ; Patients' Rooms ; Prospective Studies ; Salmonella ; Shigella ; Stem Cells

BACKGROUND: Coronary stenting is known to reduce the rates of restenosis in focal lesions, but the efficacy of stents for long lesions have not been thoroughly defined. To evaluate the immediate and follow-up results of three different types of stents in lesions longer than 20mm, consecutive series of patients (pts) were reviewed. METHODS: Between February 1996 and January 1997, 123 patients (male 68.3%, mean age 57+/-10 years) with a total of 130 lesions underwent long stent : stenting. Excluding multiple stents and unplanned use for acute closure fifty-three pts (56 lesions) were treated with the Microstent II (M-II):30 pts (31 lesions) received the Less Shortening Wallstent (WA):and 40 pts (43 lesions) were treated by the Gianturco-Roubin II stent (GR-II). RESULTS: With the clinical success defined as <30% residual stenosis without death, CABG, Q-wave MI was achieved in 93% with the M-II, 94% with the WA and 95% with the GR-II. Stent thrombosis occurred 0% in M-II, 1.5% in WA and 2.3% in GR-II. Clinical success and stent thrombosis rates were not different between the three types of stents. Follow-up (FU) quantitative angiography was obtained from 34 pts (64%) in M-II, 25 lesions (83%) in WA and 26 pts (65%) in GR-II after 6 months. Restenosis rate defined as <0A65B>50% diameter stenosis at FU was 26% in M-II, 32% in WA and 38% in GR-II:there was no significant difference between the three stents. Target lesion revascularization (TLR) defined as CABG or target lesion PTCA at FU was 17.6% in M-II, 12% in WA and 23.1% in GR-II. Restenosis rate correlated closely with lesion length (p-value-0.03, Odds ratio-1.096) and small post-stent luminal diameter (p-value-0.002, Odds ratio-0.063) in a mu-ltivariable analysis. CONCLUSION: Coronary stenting for long lesions can be safely performed with acceptable complication rates using any of the three types of stents. Restenosis and late outcome was not related to type of stent.
Angiography ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis

BACKGROUND: Even after efficacious thrombolytic therapy in patients with acute myocardial infarction, ang-iographic studies demonstrated significant thrombotic remnants in many patients which makes it difficult to identify the morphological characteristics of the pure underlying plaque of the lesion. The purpose of the current study is to assess the morphological characteristics and calcification of the plaque, and the thrombi remnants in the occluded segments of infarct-related artery in acute myocardial infarction by intravascular ultrasound (IVUS). METHODS: Coronary angiography and IVUS studies for the infarct-related arteries were performed at about 6 days after the onset of chest pain in 22 patients (male 19 patients) with acute myocardial infarction (AMI). Fifteen patients had been treated with thrombolytics, and all patients received an intravenous infusion of heparin and oral aspirin. RESULTS: 1) Coronary angiography demonstrated total occlusion in 2 cases, and angiographic % diameter stenosis was 74.5+/-18.1%. 2) IVUS identified the soft plaque in 10 cases (45.5%) and the hard plaque with or without calcification (54.5%). Plaque rupture was observed in 4 cases, and in one case, slight depression of a part of the plaque without definite rupture suggestive of the plaque erosion was noted. Intraluminal echogenic material suggesting thrombi was documented in 8 (36.4%). 3) % Diameter and % luminal cross-sectional area stenosis on IVUS was 49.0+/-19.6% and 71.6+/-15.3%, respectively. The eccentricity index of the plaque was 3.1+/-1.7. 4) There was no complication during IVUS studies. CONCLUSIONS: IVUS studies in AMI were safe and feasible for identification of the morphological characteristics of the plaque like as plaque rupture and calcification, and presence of thrombi remnants, and it would contribute to decision making as regards the therapeutic measures according to the characteristics of the lesion.
Arteries ; Aspirin ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Decision Making ; Depression ; Heparin ; Humans ; Infusions, Intravenous ; Myocardial Infarction* ; Phenobarbital ; Rupture ; Thrombolytic Therapy ; Thrombosis ; Ultrasonography*

Deep vein thrombosis is a predisposing condition for pulmonary embolism, which can be fatal. Usually, deep vein thrombosis is found in the lower extremities, but it can also occur in the upper extremities. The prevalence of upper extremity deep vein thrombosis appears to be increasing, particularly due to the increased use of indwelling central venous catheters. Pulmonary embolism is present in up to one-third of patients with upper extremity deep vein thrombosis. Upper extremity deep vein thrombosis is an increasingly important clinical entity, with the potential for considerable morbidity. Here, we report a case of upper extremity deep vein thrombosis and pulmonary embolism in a severely obese man who was successfully treated with anticoagulants.
Anticoagulants ; Central Venous Catheters ; Humans ; Lower Extremity ; Prevalence ; Pulmonary Embolism* ; Thoracic Outlet Syndrome ; Upper Extremity Deep Vein Thrombosis* ; Upper Extremity* ; Venous Thrombosis

BACKGROUND: Abdominal pain is a common complaint seen at emergency centers. Various diseases can cause abdomin al pain making it difficult to make a correct diagnosis. In the elderly, however, the consequences of an incorrect or delayed diagnosis can be more critical. We investigated the accuracy of initial diagnoses in the emergency center and analyzed the associations among medical factors including age. METHODS: We compared the ICD 10 codes of initial diagnoses to the codes of final diagnoses, defined the 'degree of agreement' using a 5 point scale, and classified patients into 'high degree of agreement' or 'low degree of agreement' groups. According to the severity of illness, we classified patients as 'admission' or 'out patient follow up'. According to their illness, we classified them as 'surgical' or 'medical'. According to age, we classified them as 'elderly' or 'adult'. Finally, we analyzed the statistical significance of each association. RESULTS: Overall, admitted patients and surgical diagnoses had higher degrees of agreement. 'Elderly' patients had no significant difference in 'degree of agreement' from 'adult' patients. CONCLUSION: Among patients presenting with acute abdominal pain to the emergency center, the degree of agreement between initial diagnosis and final diagnosis is dependent on the diagnostic characteristics of the disease, and not on the age of the patients. Further studies on the diagnostic accuracy of individual diseases are needed. Additional diagnosis associated variables, for example comorbidity and prognosis, needs to be studied regarding relationship to diagnostic accuracy.
Abdominal Pain ; Aged ; Comorbidity ; Delayed Diagnosis ; Emergencies ; Humans ; Prognosis

Spontaneous spinal epidural hematomas (SSEH) are rare, accounting for less than 1% of all spinal epidural lesions. The potential causes include coagulopathies, antithrombotic drugs, hypertension, increased venous pressure, and vascular malformations. A SSEH causes severe neurological deficits unless treated in a timely manner. As the number of patients who are diagnosed with ischemic heart disease and treated using percutaneous coronary intervention (PCI) increases, the prescription of dual antiplatelet agents is also increasing. We report a case of SSEH caused by dual antiplatelet agent therapy in a patient who had undergone PCI.
Accounting ; Aspirin ; Hematoma, Epidural, Spinal ; Humans ; Hypertension ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Prescriptions ; Ticlopidine ; Vascular Malformations ; Venous Pressure

We report a case of successfully treated acute fulminant myocarditis induced by ulcerative colitis with extracorporeal life support and infliximab. Myocarditis is a rare but crucial complication during an exacerbation of inflammatory bowel disease. In our case, we applied extracorporeal membrane oxygenation (ECMO) for cardiac rest under impression of acute myocarditis associated with ulcerative colitis, and added infliximab for uncontrolled inflammation by corticosteroid. As a result, our patient was completely recovered with successful weaning of ECMO.
Colitis, Ulcerative* ; Extracorporeal Membrane Oxygenation ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Infliximab* ; Myocarditis* ; Ulcer* ; Weaning