Resistance to heparin therapy during cadiopulmonary bypass(CPB) is infrequent but can result in potentially life-threatening event. The precise etiology of the heparin resistance remains unknown. Clearly, the most predictive risk factor is a history of previous heparin exposure. Assessment of the clinical heparin effect, by determination of the activated clotting time(ACT), identifies those patients with heparin resistance. The potential risk of suboptimal anticoagulation is circumvented by the administration of additional heparin. High dose aprotinin suppress the activation of intrinsic coagulation pathway through surface activators inhibition, as documented by increases in the ACTs during CPB. Such effect of aprotinin on ACT, which can allow heparin-resistant patients to overestimate heparinization. We report a case of pump failure due to inappropriate heparinization in heparin-resistant patient.
Aprotinin ; Cardiopulmonary Bypass ; Heart ; Heparin* ; Humans ; Risk Factors

BACKGROUND: Monitoring of cellular function during acute reduction of oxygen delivery(DO2) remains controversial. Increases of arteriovenous difference in PCO2(AVPCO2) and in pH(AVpH) have been alleged to reflect development of tissue hypoxia in shock status associated with low cardiac output. Method: 6 anesthetized and mechanically ventilated pigs were bled via Swan-Ganz catheter by 10% of total estimated blood volume. In each pig, we measured the hemodynamic parameters, arterial and mixed venous blood gas analysis data and calculated O2-derived parameters during gradual blood loss from 10% to 50%. RESULT: As blood loss increased, DO2 declined from 521+/- 108 ml/min to 178+/- 125 ml/min but O2 extraction ratio(14+/- 4% to 47+/- 33%) increased. After 30% blood loss, O2 consumption decreased from 121 +/-48 ml/min to 79+/- 58 ml/min progressively but lactate level markedly increased from 22.0 +/-5.5 mg/dl to 52.7+/- 21.8 mg/dl. As DO2 decreased, AVPCO2 and AVpH( -11+/- 2 mmHg to - 27+/- 11 mmHg, 0.03+/- 0.02 to 0.11 0.04 respectively) rose, and these increases were especially more prominent after DO2 value at 30% blood loss than before(p<0.05). CONCLUSION: We demonstrated that the increases of AVPCO2 and AVpH can be reliable parameters of tissue hypoxia during gradual blood loss.
Anoxia* ; Blood Gas Analysis ; Blood Volume ; Cardiac Output, Low ; Catheters ; Hemodynamics ; Hemorrhage* ; Hydrogen-Ion Concentration* ; Lactic Acid ; Oxygen ; Shock ; Swine*

OBJECTIVE: GnRH-agonist (GnRH-Ag) used in controlled ovarian hyperstimulation (COH) for IVF-ET has been known to affect directly on apoptosis of human ovarian cells, but its mechanism is not clearly understood. Therefore, the purpose of the present study was to investigate whether caspase-3 and -9 activation and poly-(ADP-ribose)-polymerase (PARP) cleavage are involved in the mechanism(s) by which GnRH-Ag induces apoptosis in human granulosa-luteal cells. METHODS: Human granulosa-luteal cells collected from IVF-ET patients were cultured and treated with 10(-6) M GnRH-Ag or saline as a control. To access apoptosis in the cells, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-digoxigenin nick end-labeling (TUNEL) assay and DNA fragmentation analysis were preformed 24 h after the treatment. Activity of caspase-3 and -9 in the cells was examined by using a fluorogenic substrate. Caspase-3 and -9 activation and poly (ADP-ribose) polymerase (PARP) cleavage were analyzed by Western blotting. RESULTS: DNA fragmentation in the cells increased in the higher concentration over 10(-6) M GnRH-Ag. In the result of TUNEL assay, the rate of apoptotic cells in GnRH-Ag treatment increased significantly compared with that of saline treatment (p<0.05). The activity of caspase-3 and -9 investigated by using a fluorogenic substrate increased only in the apoptotic cells. In Western blot analysis, the cells treated with GnRH-Ag revealed an increase in active forms of caspase-3 and -9 compared with those of the saline treatment. In addition, cleavage of PARP also increased in the cells treated with GnRH-Ag. CONCLUSION: These results suggest that activation of caspase-3 and -9 and cleavage of PARP might be involved in apoptosis of human granulosa-luteal cells induced by GnRH-Ag.
Apoptosis* ; Blotting, Western ; Caspase 3* ; DNA Fragmentation ; DNA Nucleotidylexotransferase ; Female ; Fluorescent Dyes ; Humans* ; In Situ Nick-End Labeling ; Luteal Cells*

Progressive multifocal leukoencephalopathy (PML) is a very rare and often fatal demyelinating disease of central nervous system (CNS), which mostly occurs in patients with immunosuppression such as acquired immunodeficiency syndrome (AIDS) patients, transplant patients and patients receiving chemotherapy. PML usually manifests with acute or subacute neurologic deficit. and its late diagnosis may lead death or significant permanent disability. We report a 33-year old man diagnosed with PML in AIDS, who initially presented with gradual onset of dementia. Most symptoms of PML were progressed rapidly for several months, and characterized by focal neurological symptoms. On the other hand, we were experienced in patients without focal neurological symptoms and ongoing overall cognitive decline slowly. Patients with immunosuppression can be presented in a variety of neurological symptoms, detailed examinations for cognitive functions were needed in early stage of the disease.
Acquired Immunodeficiency Syndrome* ; Adult ; Central Nervous System ; Delayed Diagnosis ; Dementia* ; Demyelinating Diseases ; Drug Therapy ; Hand ; Humans ; Immunosuppression ; Leukoencephalopathy, Progressive Multifocal* ; Neurologic Manifestations

An intrathyroid thyroglossal duct cyst (TGDC) presented as an anterior neck mass in a 62-year-old male without history of prior thyroid disease or infection. This cyst was clinically indistinguishable from a thyroid nodule. In addition to that, fine needle aspiration cytology revealed normal–looking squamous cells. Diagnosis, work-up, management approach, and treatment of intrathyroid TGDC are discussed as well as distinguishing features between intrathyrod TGDC with tract and without tract. This is the very rare case of intrathyroid TGDC in Korean population and the possibility of intrathyroid TGDC should remain in the differential diagnosis of thyroid nodule.
Biopsy, Fine-Needle ; Diagnosis ; Diagnosis, Differential ; Epithelial Cells ; Humans ; Male ; Middle Aged ; Neck ; Thyroglossal Cyst ; Thyroid Diseases ; Thyroid Gland ; Thyroid Nodule

BACKGROUND: Coronary sinus(CS) electrode catheter has been used ad a very useful mapping and guiding tool in catheter ablation of the left-side atrioventricular pathway(AP). Recently, it was reporter that single catheter approach of catheter ablation of the manifest left-side AP was feaside with a comparable success rate but shorter fluoroscopy time, compared with the standard approach. This study was performed to evaluate the role of CS electrode catheter in catheter avlation of the lefr-side AP. SUBJECTS AND METHODS: Sixty-five consecutive patients(43 men, 22 women) with a single left-side AP were included in this study. The first 32 patients underwent catheter ablation with an eletrode catheter in CS(CS+ group: 19 men, 13 women: 42.3+/- 14.6 years) and the later 33 patients with no electrode catheter in CS(CS- group: 24 men, 9 women: 38.8+/- 14.1 years). APs were localized by mapping the CS in CS+ group or by mapping the mitral valve annulus in CS- group with a 4mm-tipped deflectable catheter(7F, Webster or EPT). Radiofrequency energy(RF) was delivered unipolarly at a fixed power of 30-50 volts or 30-60 seconds. AP location, succes rate, number of RF applications, fluoroscopy time, and complications were compared between 2 group. RESULTS: APs were located at the left posteroseptal wall in 2(6.2%), left posterior wall in 5(15.5%), left posterolateral wall in 3(9.3%), left lateral wall in 18(56.3%), left anterolateral wall in 4(12.5%) in CS+ group. In CS- group, there were 6(18.2%) left posteroseptal, 2(6.1%) left posterior, 5(15.2%) left posterolateral, 12(36.4%) left lateral, 8(24.2%) left anterolateral AP with no significant difference in the distribution of the APs between 2 groups. The proportions of concealed and manifest APs wrer similar in 2 groups(17/15 vs. 19/14). Twenty-eight(87.5%) of 32 APs in CS+ group and 30(90.9%) of 33 APs in CS- group were successfully ablated showing no signigicant difference in the succes rates between 2 groups. The numbers of RF applications to ablate the APs were similar between 2 groups(3.9+/-3.4 vs. 3.5+/-2.9). Total fluoroscopy times wrer also similar between 2 groups(54.3+/-33.5 minutes vs. 47.2+/-21.4 minutes). There were no major conplications in both groups. CONCLUSIONS: Radiofrequency catheter ablation of the left-side APs may be successfully performed without using a CS electrode catheter as a guide in diagmosing and localizing left-side APs.
Catheter Ablation* ; Catheters* ; Coronary Sinus* ; Electrodes* ; Female ; Fluoroscopy ; Humans ; Male ; Mitral Valve

BACKGROUND: Coronary stent is known as an effective treatment in the intimal dissection after angioplasty and the prevention of restenosis. However, in-stent restenosis still remains a major concern in clinical stenting. METHOD: The Microstents were placed in 151 patients from May '96 to Aug '97 and performed follow-up coronary angiograms in 49 (32.5%) patients. To identify the clinical, angiographic and procedure-related variables that predict late restenosis within the stented artery, 49 patients (58+/-8 year:38 M, 11 F) were studied. Indications for stenting were 25 de novo (52.8%), 9 restenotic (18.7%), 8 suboptimal PTCA (16.7%) and 6 bail-out lesions (12.6%). All patients were treated with aspirin and ticlopidine for one month after stenting. The follow-up angiograms were obtained at 5+/-3 months and variables of 13 patients with restenosis were compared with those of 36 patients without restenosis. RESULTS: The in-stent restenosis rate was 26.5%. Univariate logistic regression analysis was used to determine how in-stent restenosis was influenced. Clinical diagnosis, presence of risk factors, lipid profiles, numbers of involved vessels, target arteries, lesion length, lesion types, stent length, maximal inflation pressure, predilation balloon size, reference vascular diameter, minimal luminal diameter, and stent to artery diameter ratio were analyzed. Among these variables, only lesion length before stent implantation was a predictor for in-stent restenosis (19.9+/-11.1 mm vs. 10.9+/-7.3 mm, p=.017). CONCLUSION: Lesion length before Microstent II implantation is the single predictor of late in-stent restenosis.
Angioplasty ; Arteries ; Aspirin ; Diagnosis ; Follow-Up Studies ; Humans ; Inflation, Economic ; Logistic Models ; Phenobarbital ; Risk Factors ; Stents ; Ticlopidine

BACKGROUND: The prevalence of ischemic heart diseases (IHD) has increased remarkably during the past 10 years in Korea. Because only few reports on risk factors of IHD in Korean women exist, the aim of this study was to determine the clinical characteristics (including risk factors) of IHD in Korean women. METHODS: Fifty-six female patients and 122 (out of 655) of male patients with significant coronary artery stenosis were included in this study. There were 12 cases of angina pectoris and 35 cases of myocardial infarction in the 56 female patients. There were 54 cases of angina pectoris and 68 cases of myocardial infarction in the 122 male patients. Age and sexdistributions, risk factors of atherosclerosis, and coronary angiographic findings were compared between the female and male patients. RESULTS: The female patients were older than the male patients (63+/-8 years vs. 58+/-4 years, p<0.01). The proportion of patients older than 60 was higher in women than men (70% vs. 48%, p<0.01). The number of risk factors was 1.17 in women and 1.27 in men, and the proportion of patients with multiple risk factors (> or = 2) was greater in men than in women (43% vs. 25%, p<0.05). Hypertension was more prevalent (66% vs. 11%, p<0.001) and smoking was less (65% vs. 11%, p<0.001) in women than men. After age adjustment, hypertension was more frequent in women, and smoking was more in men (p=0.001). On coronary angiograms there were no difference in the morphology of coronary artery stenosis, the distribution of culprit vessels, and the number of vessels involved between women and men, In terms of therapeutic modalities, there were no differences between women and men in our study. CONCLUSIONS: In Koean women with IHD, hypertension is more common and smoking is less common. However, coronary artery lesion morphology and distribution are comparable between women and men.
Angina Pectoris ; Atherosclerosis ; Coronary Stenosis ; Coronary Vessels ; Female ; Humans ; Hypertension ; Korea* ; Male ; Myocardial Infarction ; Myocardial Ischemia* ; Prevalence ; Risk Factors ; Smoke ; Smoking

PURPOSE: Concurrent chemoradiation (CRT) with 3-weekly doses of cisplatin is a standard treatment for loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). However, treatment with 3-weekly doses of cisplatin is often associated with several adverse events. Therefore, we conducted this retrospective analysis to determine the efficacy and tolerance of CRT with a low weekly dose of cisplatin in stage IV HNSCC patients. MATERIALS AND METHODS: Medical records of patients who were diagnosed with stage IV HNSCC and received concurrent CRT were analyzed. All patients were treated weekly with cisplatin at 20-30 mg/m2 until radiotherapy was completed. RESULTS: A total of 35 patients were reviewed. Median follow up was 10.7 months (range, 1.7 to 90.5 months), the median radiation dose was 7,040 cGy, and the median dose of cisplatin received was 157 mg/m2. Eleven patients received docetaxel combination chemotherapy. Overall, 25 patients (71.4%) achieved complete response (CR), eight (22.9%) showed partial response. The median overall survival was 42.7 months, the 3-year survival rate was 51.2% and the 3 year disease-free survival rate was 72.8%. Overall survival was improved in patients who achieved CR relative to others (59.7 months vs. 13.4 months; p=0.008). There were significant differences in survival between patients who received docetaxel combination and cisplatin alone (51.8 months vs. 7.9 months; p=0.009). Grade 3-4 adverse events included stomatitis (82.9%), dermatitis (22.9%), infection (11.4%), dysphagia (8.6%), and neutropenia (5.7%). CONCLUSION: CRT with low dose weekly cisplatin is likely effective and tolerable, even in patients with locally advanced-stage IV HNSCC.
Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Cisplatin* ; Deglutition Disorders ; Dermatitis ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Head and Neck Neoplasms ; Head* ; Humans ; Medical Records ; Neck* ; Neutropenia ; Radiotherapy ; Retrospective Studies ; Stomatitis ; Survival Rate

BACKGROUND: One of most important mechanisms of coronary stent restenosis is neointimal hyperplasia. Although the process of neointima formation is not fully understood, a special role has been advocated for adherent platelets. Previous studies have shown a clear benefit with combined antiplatelet therapy such as aspirin plus ticlopidine in reducing the rate of thrombotic occlusions of stented vessels. The purpose of this study was to evaluate the effects of duration of antiplatelet regimens on coronary stent restenosis. METHODS: After successful placement of coronary artery stents in 222 patients, we performed follow-up coronary angiograms in 99 patients (42.3%). Forty-six patients were randomly assi-gned to receive aspirin and ticlopidine for four weeks (Group I: 54+/-9 years: M 38, F 8) and 48 patients for 6 months (Group II: 58+/-8 years: M 38, F 10). RESULTS: There were no significant differences in clinical and procedural variables or coronary lesion characteristics before and after stenting. At 6 months after stenting, minimal luminal diameter was 2.16+/-0.93mm in Group I and 2.04+/-1.07mm in Group II (p-0.57). Late lumen loss was 0.80+/-1.07mm in Group I and 0.92+/-1.11mm (p-0.58) in Group II. The stent restenosis rate of Group I at 28.3% and that of Group II at 29.2% were not statistically significant between the two groups (p-0.92). CONCLUSIONS: The therapeutic duration of combined antiplatelet regimen with aspirin and ticlopidine after coronary stent does not affect stent restenosis rate.
Aspirin* ; Coronary Vessels ; Follow-Up Studies ; Humans ; Hyperplasia ; Neointima ; Phenobarbital ; Stents* ; Ticlopidine*