PURPOSE: Percutaneous closure with occluding coils has been recently described as a method of nonsurgical treatment of the small patent ductus arteriosus (PDA). The snare-assisted technique or detachable coil has been newly developed, improving coil delivery and eliminating the incidence of coil embolization. This method is also applicable to residual PDA following surgical ligation or device implantation. The study purpose is to discuss our experience with percutaneous closure of the small patent ductus arteriosus by occluding coils. METHODS: Between February 1995 and September 1996, 41 patients underwent coil occlusion. Thirty-one patients had native PDAs and 10 residual PDAs. Mean age was 5.0 +/- 3.2 years (1.5 to 14.0 years), and mean body weight 18.0 +/- 7.2kg (8.7 to 45kg). Mean ductal diameter was 1.9 +/- 0.6mm (1.0 to 3.5mm). Occlusion was performed by using the snare technique in 34 patients and by using a detachable coil in 6 patients. Follow-up was done at week 1, 3, 6, and a 12-month postprocedure was dont by echocardiography. RESULTS: Of the 41 patients with successful coil implantation, 32 patients (78%) had no residual shunting, 8 trace residual shunting, and 1 small residual shunting shown by angiogram immediately after coil embolization. All the patients except for one were followed up for 6.5 +/- 4.5 months (1 day to 12 months). Complete closure was confirmed in 38 patients (95%) at 6 months after implantation (34/40 at 1 month, 37/40 at 3 months, 38/40 at 6 months). There were no significant complications. CONCLUSION: Percutaneous occlusion of PDA can be safely and effectively performed in patients with small PDA, irrespective of native or residual nature, by using the snare technique or a detachable coil.
Body Weight ; Ductus Arteriosus, Patent* ; Echocardiography ; Embolization, Therapeutic* ; Follow-Up Studies ; Humans ; Incidence ; Ligation ; SNARE Proteins

BACKGROUND AND OBJECTIVES: Chemokines are effective leukocyte chemoattractants and may play an important role in mediating eosinophil recruitment in various allergic conditions in human. Eotaxin is an eosinophil-specific chemokine associated with the recruitment of eosinophils to the site of allergic inflammation. However, it is not yet known as to whether or not RANTES is associated with selective tissue eosinophilia. The aim of this study is to understand the events involved in selective eosinophil migration into inflammatory sites. MATERIALS AND METHODS: We performed the quantitative analysis of RANTES and eotaxin mRNA expression levels in TDI-induced nasal hyper-reactive rats. Expression levels of RANTES and eotaxin mRNA from inferior turbinate mucosa were examined using competitive PCR in 35 experimental rats and 5 control rats compared with infiltrated eosinophil counts. RESULTS: The quantity of RANTES mRNA increased 3 folds 2 day after provocation, and the infiltrating eosinophils were correlated with the expression levels of RANTES mRNA (p<0.01). The quantity of eotaxin mRNA increased 15 folds 1 day after provocation. These results suggest that RANTES and eotaxin play a role in controlling antigen-induced eosinophil recruitment into the tissue. Eotaxin is a more potent and selective chemoattractant for eosinophils than infiltrating eosinophils, and were correlated with the expression levels of eotaxin mRNA (p<0.01). CONCLUSIONS: Further investigations for chemokine receptor related to eosinophils will provide better understanding of the mechanism involved in selective tissue eosinophilia.
Animals ; Chemokine CCL5* ; Chemokines ; Chemokines, CC* ; Chemotactic Factors ; Eosinophilia ; Eosinophils ; Humans ; Inflammation ; Leukocytes ; Mucous Membrane ; Negotiating ; Polymerase Chain Reaction* ; Rats* ; RNA, Messenger* ; Turbinates

Isolated noncompaction of the left ventricular myocardium is a rare cardiac disorder due to an arrest in myocardial morphogenesis. It is characterized by prominent and excessive trabeculation in a ventricular wall segment, with deep intertrabecular spaces perfused from the ventricular cavity. Echocardiographic findings are important clues for the diagnosis. Clinical symptoms include signs of left ventricular systolic dysfunction even to the point of heart failure, ventricular arrhythmias, and embolic events. We describe two cases of isolated noncompaction of the myocardium, with ventricular tachycardia in one, and chest pain due to microvascular dysfunction in the other.
Adult* ; Arrhythmias, Cardiac ; Chest Pain ; Diagnosis ; Echocardiography ; Heart Failure ; Humans ; Morphogenesis ; Myocardium* ; Tachycardia, Ventricular

Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.
Adult ; Allografts ; Antibodies ; Antibody Formation ; Hepatitis B Surface Antigens ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoglobulins ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Male ; Mortality ; Plasmapheresis ; Rituximab ; Tissue Donors

Intrathoracic omental herniation through the esophageal hiatus is extremely rare. Here, we report a case of a 57-year-old male with continuous ambulatory peritoneal dialysis (CAPD) who was admitted to our hospital after experiencing nausea and abdominal discomfort for 3 days. Computed tomography (CT) revealed a fatty mass, extended continuously through the esophageal hiatus into the thoracic cavity. Laparoscopic surgery revealed an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines. Peritoneal dialysis was resumed six weeks later. This is a report of omental herniation through the esophageal hiatus in a patient with CAPD.
Hernia ; Humans ; Intestines ; Laparoscopy ; Male ; Middle Aged ; Nausea ; Omentum ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Stomach ; Thoracic Cavity

BACKGROUND: Although nutritional problems associated with dialysis are well described, nutritional problems after renal transplantation have received little attention. Nutrition interventions play an important role in prevention and management of common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. METHODS: Sixty-four kidney transplant recipients who received post-transplant management at our hospital replied to the questionnaire. The questionnaire included 102 questions on the amount and types of Korean foods that they consumed last week. Nutritional elements of diet in renal transplant patients who consume Korean food were analyzed on the basis of the survey. RESULTS: The mean energy and protein of daily intake were 2,088+/-1,016 kcal and 75.5+/-38.2 g. Patients' diets were generally sufficient, but characterized by deficiencies in vitamin B2, vitamin D, niacin, calcium, and magnesium intake. CONCLUSIONS: Dietary advice is required with regard to intake of some nutritional elements for kidney transplant recipients who consume Korean foods. Their main nutritional problem is obesity after transplantation. Attention should be paid to prevention of nutritional imbalance.
Calcium ; Cardiovascular Diseases ; Dialysis ; Diet ; Humans ; Hypertension ; Kidney Transplantation ; Kidney* ; Magnesium ; Niacin ; Obesity ; Surveys and Questionnaires ; Riboflavin ; Transplantation ; Vitamin D

BACKGROUND: To evaluate metabolic effects of testosterone on whole bodily systems, non-scrotal testosterone transdermal patch was given to middle aged men. METHODS: Sixteen impotent patients with serum testosterone levels between 300 and 500 ng/dL, were recruited for 6 month of treatment with non-scrotal testosterone transdermal delivery system, and six patients dropped during the study. All patients have a non-organic impotence (mean age:48 +/- 7). After 1 month placebo patch running period, patients were given 1 or 2 patches. The parameters were evaluated at each stage; before treatment, after placebo patch, and after testosterone patch for 3 months and 6 months. The evaluation parameters included body weight, blood pressure, heart rate, body mass index (BMI), body fat, haemoglobin, haematocrit, RBC, lipid profiles, Prostatic Specific Antigen (PSA), Transrectal Ultrasonography (TRUS), International Prostatic Symptom Score (IPSS), bone markers such as osteocalcin and Deoxypyridinoline (dPyr), Bone Mineral Density (BMD), psychological evaluation with Questionnaire and hormones such as cortisol, Dehydroepiandrosterone sulfate (DHEA-S), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), prolactin, testosterone and Sex Hormone Binding Globulin (SHBG). Sexual functions were evaluated by means of sexual Questionnaire which has grade systems (high grade means good response) on each domain. RESULTS: Hormonal, hematopoietic, lipid and prostatic parametem were not changed with statistical insignificance. There were no significant changes in BMD. But mean osteocalcin values increased about 31.5% (p<0.05). Bone resorption marker, D-Pyr values were also decreased significantly about 18.6% after 4 montbs treatment, but such changes were not shown after 6 months. Tendencies of improvement in all domains of Sexual Questionnaire were noticed, even though they were not statistically significant except in frequency of coitus and satisfaction with ejaculation (p<0.05), CONCLUSION: Decreased bone resorption was noticed while persistent increased bone formation occurred after 4 months treatment of testosterone. Testosterone supplementation has a beneficial effects on mood and sexual function in the impotent patients with lower borderline testosterone level. And it can be concluded that 6 months testosterone treatment dose not produce any adverse reactions on bodily system.
Adipose Tissue ; Blood Pressure ; Body Mass Index ; Body Weight ; Bone Density ; Bone Resorption ; Coitus ; Dehydroepiandrosterone Sulfate ; Ejaculation ; Erectile Dysfunction ; Follicle Stimulating Hormone ; Heart Rate ; Humans ; Hydrocortisone ; Luteinizing Hormone ; Male* ; Middle Aged* ; Osteocalcin ; Osteogenesis ; Prolactin ; Surveys and Questionnaires ; Running ; Sex Hormone-Binding Globulin ; Testosterone* ; Transdermal Patch* ; Ultrasonography

BACKGROUND AND OBJECTIVES: It has been reported that intracoronary radiation therapy (ICRT) using a Ho-166 coated balloon inhibits restenosis of porcine coronary arteries. However, the consequences of ICRT on coronary artery endothelial function are unknown. The aim of this study is to investigate the effects of ICRT using a Ho-166 balloon on coronary artery endothelial function and vasomotor reactivity. MATERIALS AND METHODS: Female pigs (25-35 kg) were orally premedicated daily with aspirin (100 mg) and ticlopidine (250 mg) for the duration of the study. Under sterile conditions with local anesthesia of the skin provided by 2% lidocaine, an arteriotomy of the left carotid artery was performed, an 8 Fr sheath was inserted, and intraarterial heparin sodium (10,000 IU) was injected. Under fluoroscopic guidance, the coronary artery main branch was selected through an 8 Fr guiding catheter for coronary artery overdilation injury (balloon to artery ratio, 1.3:1) and ICRT. A Ho-166 coated balloon prepared to deliver 20 Gy at a depth of 2 mm from the balloon surface was used for ICRT. The coronary artery main branch in each pig was randomly assigned to either balloon injury (Group I) or balloon injury plus ICRT (Group II). Coronary artery segments were taken from the animals at 0 week (n=8), 4 weeks (n=6) and 8 weeks (n=8) after the intervention. Data in each group denote the relative ratio compared to non-injured coronary artery and are expressed as mean +/- standard error of mean. RESULTS: The degree of KCl-induced contractile response (g) was not different between the two groups at 0 and 4 weeks, but was significantly decreased in group II compared to group I at 8 weeks (I:1.04+/-0.06, II:0.79+/-0.07, p=0.014). In rings precontracted with prostaglandin F 2alpha (PGF 2alpha), the degree of NO-dependent relaxation (%) induced with substance P was significantly decreased in group II compared to group I at 0 week (I:0.93+/-0.33, II:0.47+/-0.31, p=0.03), but the difference between the two groups was not significant at 4 and 8 weeks. In rings precontracted with PGF 2alpha and LAME in the presence of indomethacin, the degree of EDHF-induced relaxation (%) using substance P was not different between the two groups at 0, 4 and 8 weeks; nor was the degree of sodium nitroprusside-induced endothelium independent relaxation (%) in depolarized conditions with PGF 2alpha. CONCLUSION: Endothelial function of the porcine coronary artery is only transiently impaired after ICRT using a Ho-166 coated balloon. Therefore this therapy can be used as an effective method to prevent restenosis after percutaneous coronary intervention.
Anesthesia, Local ; Angioplasty ; Animals ; Arteries ; Aspirin ; Carotid Arteries ; Catheters ; Coronary Restenosis ; Coronary Vessels ; Endothelium ; Female ; Heparin ; Humans ; Indomethacin ; Lidocaine ; Percutaneous Coronary Intervention ; Prostaglandins F ; Relaxation ; Skin ; Sodium ; Substance P ; Swine ; Ticlopidine

BACKGROUND: Previously we reported the inhibition of coronary restenosis with Abciximab (ReoPro(R))-coated stent in a porcine model. ReoPro(R) inhibits platelet aggregation, the proliferation of vascular smooth muscle cells and inflammatory reaction. METHODS: We performed a prospective randomized trial to compare two types of stents for the revascularization in native coronary artery. The primary effective end points were major adverse coronary events (MACE): cardiac death, acute myocardial infarction, target vessel revascularization (TVR), restenosis at 6-month clinical and angiographic follow-up. RESULTS: One hundred fifty-five patients were enrolled between Aug, 2001 and Jun, 2003. Mean ages (56.0 +/- 10.0 vs. 56.9 +/- 10.8 years), baseline diameter stenosis and minimal luminal diameter were not different between the two groups. There was one myocardial infarction and revascularization during hospital stay in control stent group. During clinical follow-up, there were two myocardial infarctions in control group. Follow-up coronary angiogram was done 62.3% (48/77) in coated and 65.4% (51/78) in control groups. Diameter stenosis and late loss were significantly less in the ReoPro(R)-coated stent group compared with controls (16.4 +/- 5.8% vs. 34.3 +/- 6.1%, p=0.009; and 0.33 +/- 0.28 mm vs. 0.88 +/- 0.41 mm; p=0.002). The restenosis and TVR rates of ReoPro-coated stent were relatively lower compared with control stent [14.6% (7/48) vs. 29.4% (15/51), p=0.062; and 9.2% (7/76) vs. 14.7% (11/75); p=0.327]. CONCLUSION: A ReoPro(R)-coated stent is safe and may be effective in the prevention of coronary restenosis.
Blood Platelets* ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Restenosis ; Coronary Vessels* ; Death ; Follow-Up Studies ; Glycoproteins* ; Humans ; Length of Stay ; Muscle, Smooth, Vascular ; Myocardial Infarction ; Phenobarbital ; Platelet Aggregation ; Prospective Studies ; Stents*

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the usefulness of cardiac troponin as a marker for the detection of minor myocardial injury following percutaneous coronary interverntion (PCI). SUBJECTS AND METHODS: In 79 patients who underwent successful PCI under the diagnosis of stable angina, serum creatinine kinase MB isoenzyme (CK-MB), cardiac troponin T (cTnT), and cardiac troponin I (cTnI) were measured before and at 6, 12 and 24 hours after PCI, and the angiographic findings and procedural characteristics of PCI were compared between the elevated and the normal enzyme groups. RESULTS: Abnormal values of one or more markers following PCI were observed in 17 patients (22%) ; 11 after stenting and 6 after balloon angioplasty alone. The frequency of abnormal cTnI levels was 19% and was significantly higher than that of CK-MB (6%, p < 0.01). No significant differences in target vessel number, target artery, ACC/AHA type, TIMI flow, stenting, time and number of ballooning, maximal inflation pressure or balloon diameter and length were observed between the two groups. Small side branch occlusions developed in 23% of the elevated enzyme group and in 3% of the normal enzyme group. CONCLUSION: Minor myocardial injury can be detected by cTnI and is observed frequently in patients with stable angina following PCI. A small side branch occlusion is related with elevated cTnI.
Angina Pectoris ; Angina, Stable ; Angioplasty, Balloon ; Arteries ; Coronary Disease ; Creatinine ; Diagnosis ; Humans ; Inflation, Economic ; Percutaneous Coronary Intervention* ; Phosphotransferases ; Stents ; Troponin I ; Troponin T ; Troponin*