BACKGROUND: Carotid artery stenosis is not infrequently associated with coronary artery disease. However, the technique performing selective carotid angiography is not established during right transradial coronary angiography. We investigated the reliability and safety of selective carotid angiography from the right transradial approach. MATERIALS AND METHODS: Following right transradial coronary angiography, selective carotid angio-graphy was performed using a 5 Fr Simmons-2 catheter in 103 patients (59+/-8 years [range, 18-80], 78 males). Ninety five (92%) patients had significant coronary artery disease. Subclavian and innominate arteries were moderately tortuous in 25 (24%) patients and aortic arch was elongated, more vertically oriented in 20 (19%). After forming a loop in ascending (n=65, 63%) or descending (n=38, 37%) aorta, the catheter was withdrawn and rotated counterclockwise to engage its tip in left carotid artery and innominate artery subsequently. After the catheter tip was adjusted at each ostia of carotid arteries, contrast material was delivered. In 63 (61%) patients, the procedures were performed on outpatient basis. RESULTS: Bilateral selective carotid angiography was successfully performed in 101 (98%) patients. In two patients with severely tortuous subclavian artery, the catheter was not engaged selectively in left carotid artery. The image quality of the angiograms performed by manual injection was determined satisfactory. Significant carotid stenosis was found in 17 (17%) patients. There were no complications, including thromboembolism and arterial dissection. CONCLUSION: Selective carotid angiography can be performed reliably and safely using a 5 Fr Simmons catheter from the right transradial approach. This technique is useful for evaluation of isolated or associated carotid artery stenosis from the right transradial approach.
Angiography* ; Aorta ; Aorta, Thoracic ; Brachiocephalic Trunk ; Carotid Arteries ; Carotid Stenosis ; Catheters ; Coronary Angiography ; Coronary Artery Disease ; Humans ; Outpatients ; Radial Artery ; Subclavian Artery ; Thromboembolism

BACKGROUND: Transradial coronary intervention was introduced recently. It has less bleeding and vascular complications and advantage of early ambulation. METHODS: We compared 142 transradial coronary interventions (101 stents, 56 balloon angioplasty and 18 rotablation) with 120 transfemoral interventions in 230 patients from January to August 1998. RESULTS: Overall success rate was not different between two approaches (92% vs 89%), but smaller sized sheath and less amount of contrast agent were required in transradial interventions compared to transfemoral interventions. Conventional guiding catheters which are used in transfemoral approach were used in most cases (94%) of transradial interventions. Judkins left 3.5 (in stead of JL4.0 in femoral approach) and Judkins right 4.0 were the most frequently used guiding catheters in transradial approach. Stent implantation was successfully done in 99 out of 101 lesions (98%) in transradial intervention and 76 out of 78 lesions (97%) in transfemoral intervention. Rotational atherectomy and primary balloon angioplasty or stenting were done successfully in 10 - 20% of the patients in both groups. All procedures were done successfully without any major procedure-related complications (myocardial infarction, death, bypass surgery) or major vascular complications in both groups. During the clinical follow-up of transradial group, punctured arteries showed 10% incidence of radial artery pulse weakness with 3% of pulse loss. CONCLUSION: Transradial approach is useful another feasible route for coronary interventions. The feasibility of primary balloon angioplasty or stenting and rotational atherectomy by transradial approach should be evaluated in the future.
Angioplasty, Balloon ; Arteries ; Atherectomy, Coronary ; Catheters ; Coronary Artery Disease* ; Coronary Vessels* ; Early Ambulation ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Infarction ; Radial Artery ; Stents

We report a case of tuberculosis verrucosa cutis in a 34-year-old male patient who presented with asymptomatic verrucous plaque over the right buttock, right inner thigh and right inguinal area. The Mantoux test revealed a strong positive reaction. The histologic picture consists of hyperkeratosis, acanthosis and papillomatosis overlying an inflammatory infiltrate in the upper dermis. Tuberculoid granulomas without caseation necrosis are seen in the dermis. Tubercle hacilli were not demonstrated. The patient was treated with INAH, Rifampicin and Ethambutol for 6 months. To date, the skin lesions have markedly improved.
Adult ; Buttocks ; Dermis ; Ethambutol ; Granuloma ; Humans ; Male ; Necrosis ; Papilloma ; Rifampin ; Skin ; Thigh ; Tuberculosis*

BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.
Anesthesia* ; Animals ; Arrhythmias, Cardiac ; Dogs* ; Epinephrine* ; Halothane* ; Hemostasis ; Myocardium ; Ventricular Premature Complexes

We evaluated the therapeutic effect of potassium iodide in fourteen patients with erythema nodosum. The results were as follows: 1) All patients were given a saturated solution of potassium iodide, 600 to 900 mg orall y a day for 3 days to 5 weeks. 2) Three patients were observed initial days, two patients within 9 days. 3) There were no correlations between therapeutic effect of potassium iodide. 4) Specific side effects were not found during the treatment with potassium iodide.
Erythema Nodosum* ; Erythema* ; Humans ; Potassium Iodide* ; Potassium*

Interferon preparations, in addition to their antiviral properties, may inhibit cell growth and multiplication, enhance the expression of cell surface antigens and influence some functions of T-1ymphocytes, macrophages and natural killer cells. The study was performed in order to investigate the cytolytic effect, antiproli ferative effect and HLA antigen expression effect of the gamma-interferon(IFN- r ) on human melanoma cell line A-375. the cytolytic activities were checked by 'Cr release assay, the antiproliferative activities were analyzed by the 'H-thymidine uptake test and HLA antigen expressions were observed by the indirect imrnuno fluor esent method. The results were as follows : 1. The cytolytic effect of the peripheral rnononuclea.r cells treated with INF- on A 375 human melanoma cell line was increased to 31.4%, 36.5%, 33.9%, 53.9 %, 13.9% respectively in the experiment 1, 2, 3, 4, 5 as compared to control group (-11.4%, 3.6%, 18.5%, 35.5%, 6.7% respectively). 2. 1ri the dose response check of the peripheral mononuclear cells treated with INF r to A 375, the cytolytic effect was definitely observed at 200U/ml concentration of the INF r and maximal effect was observed at 500U/ml concentration. 3. The IIUF r treated natural killer cells did not show any significant increase in cytolytie activity as compared to that of untreated natural killer cell and the same results were obtained with monocytes. This cytolytic activity was significantly increased when INF-r treated natural killer cells were co-culturd with monoeytes. 4. The cyaolytjc activity of natural killer cells was increased at the same degree when using culture supernant of INF- treated monocytes as in the case of using
Antigens, Surface ; Cell Line ; Humans* ; Interferons* ; Killer Cells, Natural ; Macrophages ; Melanoma* ; Monocytes

Immunohistochemical staining was performed in 20 skin granulomas of 16 patients with leprosy using antisera against lysozyme and S-100 protein. In lepromatous leprosy, lysozyme positive cells and S-100 protein positive cells were rarely found in the dermis. However, the histoid leprosy specimen had large numbers of lysozyrne positive cells and S-100 protein positive cells in granuloma. In borderline group, lysozyme positive cells and S-l00 protein positive cells were found in the dermis. S-100 protein positive cells were diffusely distributed throughuut the granuloma in borderline lepromatous leprosy, while they were often found in lymphocytic mantle in borderline tuberculoid leprosy. In tuberculoid leprosy, lysozymal staining was encouritered in epitheloid cells and giant cells, but S-100 protein positive cells were predominantly found encircling granuloma. In the epidermis, great numbers of S-l00 protein positive cells were found in tuberculoid leprosy than in lepromatous leprosy.
Dermis ; Epidermis ; Giant Cells ; Granuloma ; Humans ; Immune Sera ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Leprosy, Tuberculoid ; Muramidase* ; S100 Proteins ; Skin

Recently spondylolysis and spondylolisthesis have become major causes of low back pain in the orthopaedic field and numerous methods have been designed for its treatment. The authors used the LSDS with posterolateral fusion for 12 cases of spondylolisthesis and spondylolysis having low back pain and tenderness, which were operated on during the 4 years from Jan. 1983 to Jan. 1986 at Wallace Memorial Baptist Hospital. The advantages of LSDS with posterolateral fusion are as follows. l. In the case of distraction spondylodesis of interspinous process between L4 and Sl; A. the diameter of intervertebral formaina as well as of the whole spinal canal is widened. B. decompression is accomplished. C. the mechanical stress on the posterior columns of vertebral arch is lessened because the plumb line is anteriorly transferred. 2. Technique of LSDS; the knee-elbow position has the advantages of maximal kyphosis together with expansion of the space between the vertebral arches, as well as a reduction in the tendency to bleed because the blood collects in the abdominal vessels. 3. Internal fixation of grafted bone is not necessary. 4. A large surface area for unit mass of graft is in contact with blood supply. 5. Hypertrophy or displacement of graft can not encroach upon the epidural space; as may occur in certain circumstances following posterior fusion. The results of treatment are follows; l. In the case of improvement of symptoms after facet infiltration and knee-elbow position, satisfa- ctory results after LSDS were obtained. 2. The progression of slipping was not occurred after LSDS. 3. In increased lumbar lordosis, we have noted the instability especially with the changes from the mean values in Fergusons angles. 4. In the slip angle, there is some tendency to the lumbosacral instability correlating with the in- crease in the body weight. 5. We have also noted that the functional result was not closely related with degree of displacement.
Animals ; Body Weight ; Decompression ; Epidural Space ; Hypertrophy ; Kyphosis ; Lordosis ; Low Back Pain ; Lysergic Acid Diethylamide ; Protestantism ; Spinal Canal ; Spinal Fusion ; Spondylolisthesis ; Spondylolysis ; Stress, Mechanical ; Transplants

The increased knowledge of the cutaneous circulation of the body and refinements in surgical technique have provided the basis for the successful microvascular transfer of various muscle, skin and myocutaneous free flap. We have found the tensor fascia lata(TFL) inyocutaneous flap to be reliable one and its transfer as a free flap. The TFL myocutaneous free flap was first introduced by Hill et al in 1978 and our two cases report were first introduced in Korea. Two cases of microvascular TFL myocutaneous free flap transfer were performed at the department of Orthopaedic Surgery of Hanyang University Hospital and satisfactory result was obtained from the one of those.
Fascia Lata ; Fascia ; Free Tissue Flaps ; Korea ; Skin

A analysis was performed on 1716 pediatric surgical patients, who were supposed to receive elective operations at Seoul National University Childrens Hospital from March 2, 1991 to June 29, 1991. The results can be summarized as follows; 1) Overall cancelled ratio was 19.6%. 2) Departmental distribution of delayed/cancelled elective operations, Plastic surgery 27.0%, pediatric surgery 26.1%, neurosurgery 20.3%, cardiothoracic surgery 18.1%, orthopedic surgery 18.0%, ENT 15.6 ophthalmology 13.9% and urology 13.8%. 3) Major causes of delay/cancellation of elective operatios; Abnormal history and physical examination 54.3 , non-medical 35.0% and abnormal laboratory data only 10.7%. 4) Detailed causative factors of delay/cancellation of elective operations, URI 30.6%, notadmitted 27.9%, heavy schedule 5.9%, abnormal LFT 5.3%, FUO 4.2%, abnormal PTT/PT 2.4%, arrhythmia and cardiac disease 2.4% and further diagnostic evaluation needed 1.8%.
Appointments and Schedules ; Arrhythmias, Cardiac ; Child ; Heart Diseases ; Humans ; Neurosurgery ; Ophthalmology ; Orthopedics ; Physical Examination ; Seoul ; Surgery, Plastic ; Urology