BACKGROUND: Plaque compression (and/or redistribution) and vessel expansion are important mechanisms of percutaneous coroanry balloon angioplasty. We investigated the mechanisms of balloon angioplasty according to plaque characteristics by intravascular ultrasound and assessed the time-sequencing morphometric changes of target vessel after balloon dilation without catheter change using intravascular ultrasound balloon catheter. METHOD: We studied balloon angioplasty in 10 patients (eight male, average age of 55.3 years). Quantitative coronary angiography and intravascular ultrasound images were attained at baseline and at timed intervals of 0sec, 60sec and 180sec post-balloon angioplasty. The following categories were attained : reference diameter, minimal lumen diameter, cross sectional area (CSA) of lumen (L), external elastic membrane (EEM), and plaque + media (P+M). We also assessed the plaque morphology of target lesion and classified them into two groups according to intravascular ultrasound imaging : a soft plaque group versus a group characterized by fibrous and/or mildly calcified plaque. RESULTS: The proportions of plaque compression in the total luminal gain were 80% in the soft plaque group and 70% in the other ; the absolute amount of plaque compression was 26.9% in soft plaque and 24.0% in the other group. The time sequencing changes of target lesion EEM CSA of both group were 14.4+/-2.9mm2, 14.3+/-3.8mm2 (baseline) 15.1+/-2.5mm2, 15.4+/-3.7mm2 (immediate) 15.0+/-2.8mm2, 14.5+/-3.9mm2 (180sec), those of P+M CSA (target lesion) were 10.4+/-3.3mm2, 10.7+/-2.4mm2 (baseline) 7.6+/-2.7mm2, 8.1+/-2.4mm2 (immediate) 7.9+/-2.9mm2, 8.5+/-3.4mm2 (180sec). Target lesion lumen CSA were 4.0+/-1.1mm2, 3.6+/-2.0mm2 (baseline) 7.5+/-1.1mm2, 7.3+/-3.2mm2 (immediate) 7.1+/-1.3mm2, 6.0+/-1.7mm2 (180sec) respectively. CONCLUSION: Plaque compression (and/or redistribution) is the predominant mechanism of luminal gain in both groups. The absolute amounts of P+M CSA changes and time sequencing increment of target lesion were similar in both groups. In the non-soft group, the immediate increment and time sequencing reduction of EEM CSA in target lesion were greater than those of the soft plaque group.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Catheters ; Coronary Angiography ; Humans ; Male ; Membranes ; Phenobarbital ; Ultrasonography

BACKGROUND: renal artery stenosis (RAS) is a major cause of renovascular hypertension and renal function due to ischemic atrophy of kidney. There are several methods to treat the RAS, including are surgery, percutaneous transluminal renal angioplasty, and medical treatment. The purpose of this study is to evaluate the usefulness, safety, and efficacy of percutaneous transluminal stent deployment in RAS. METHOD: From January 1995 to July 1996, 17 patients underwent renal stent implantation due to renal artery stenosis (11 male, 6 female). the mean age was 49 years old, one patient had both renal artery stenosis and total lesions were 18. The causes of renal artery stenosis were atherosclerosis in 12, fibromuscular dysplasia in 2, Takayasu's disease in 2, and autoimmune disease (Bechet's) in one case. Renal artery stenting was performed via femoral artery in 12 lesions and brachial artery in 6 lesions. Follow up was performed by renogram, renal angiogram, and clinical examination. RESULT: the degree of renal artery stenosis was 83% (70-95%). the lesion sites were 12 ostial and 6 non-ostial lesions. The used renal stents were Palmaz-biliary stent in 17 lesions and Micro-2 stent in one lesions. All stents were implanted successfully and there was no residual stenosis in all patients except one case showed 20% residual stenosis due to huge renal artery size. The transstenotic pressure gradients after renal artery stenting was decreased markedly from 74mmHg to 2mmHg. There no serious complications such as a death, emergency surgery, or nephrectomy. There were two minor complications which were one case of pyelonephritis and one case of inguinal hematoma. After stenting, blood pressure was decreased partially in 13 patients and completely in 2 cases. CONCLUSION: Renal artery stenting appears to be safe and feasible and the alternative treatment modality to surgery for renal artery stenosis.
Angioplasty ; Atherosclerosis ; Atrophy ; Autoimmune Diseases ; Blood Pressure ; Brachial Artery ; Constriction, Pathologic ; Emergencies ; Femoral Artery ; Fibromuscular Dysplasia ; Follow-Up Studies ; Hematoma ; Humans ; Hypertension, Renovascular ; Kidney ; Male ; Middle Aged ; Nephrectomy ; Pyelonephritis ; Renal Artery Obstruction* ; Renal Artery* ; Stents*

No abstract available.
Child* ; Humans ; Purpura, Thrombocytopenic, Idiopathic*

No abstract available.
Fibroma

We studied the angiographic findings in 65 patients wtih congenital pulmonary atresia, ages 4 days to 14 years(mean 3.3 yrs), form 1981 to 1986 at Severance Hospital Yonsei University. 1. 6 had pulmonary atresia with anintact interventricular septum, 38 had it with cardiac anomaly Renodynamically simulating TOF, and 21 associatedwith more complicated cardiac anomalies. 2. In the group with an intact ventricular septum, 5 showed confluentintrapericardial pulmonary artery, all segmental pulmonary arteries connceted to intrapericardial pulmoanryartery. 3. In the group simulating TOF, aorta arose from RV with or without overriding in 35. In 27 patients withconfluent intrapericardial pulmonary artery, 23 had more than 10 segmental pulmoanry arteries connceted tointrapericardial artery and 5 had severely hypoplastic hilar pulmonary arteries. In 11 with nonconfluentintrapericardial pulmonary artery, 4 had more than 10 segmental pulmonary arteries connected to central pulmonaryartery and 9 had severely hypoplastic hilar pulmonary arteries. 4. In the group associated with more complicatedcardiac anomaly, included 8 patients with atrioventricular discordance, 7 with univentricular heart and 6 withtricuspid atresia. In 17 patients with confluent intrapericardial artery, 16 had more than 10 segmental pulmoanryarteries conncected to intrapeircardial artery, one showed severe hypoplasia of hilar pulmonary arteries. Inanother 4 with nonconfluence, no one showed more than 10 segmental arteries conncted to intraperdicardial or hilarpulmonary artery.
Aorta ; Arteries ; Heart ; Humans ; Pulmonary Artery ; Pulmonary Atresia ; Ventricular Septum

The importance of the preoperative intraocular pressure cannot be overemphasized for cataract operation. We compared the preoperative intraocular pressure between the conventional retrobulbar anesthesia technique and the pin point anesthesia technique with different anesthetic dosage using tono-pen in 23 patients(41 eyes) divided into 4 groups. In the 1st group(10 eyes), after conventional retrobulbar injection was performed using 3ml of 2% lidocaine, digital massage was done for 10 minutes. In 2nd group(13 eyes), 2% lidocaine 1.0ml was injected into subtenon's space(true muscle cone) through the small hole in the superior temporal quadrant 8mm posterior to limbus using specially designed blunt, curved cannula without any method to decrease the intraocular pressure (pin point anesthesia). In the 3rd group(13 eyes), and 4th group(5 eyes), same procedure was performed as 2nd group using 0.75ml and 0.50ml of 2% lidocaine respectively. As a results, in 1st group, average intraocular pressure was decreased around 5.6mm Hg after digital massage. In the 2nd, 3rd, and 4th group, preoperative intraocular pressure increased by 2.2, 0.8, and 0.5mmHg. As comparison of three group of the pin point anesthesia, in the 2nd group, sometimes there were mild chemosis, in the 4th group, often discomfort, in contrast, in 3rd group there were no chemosis, pain or discomfort. As a conclusion we want to recommend a pin poit anesthesia using 0.75ml of 2% lidocaine for the routine cataract operation.
Anesthesia* ; Cataract ; Catheters ; Intraocular Pressure* ; Lidocaine ; Massage

Surgical revascularization is very effective for the relief of chest pain, improvement of exercise tolerance and ventricular performance in certain ischemic heart diseases. Bypass graft angiography and native coronary angiography after coronary artery bypass graft(CABG) were required for the evaluation of graft patency, progression of the native coronary artery disease and to predict the prognosis of the patients after CABG. The cases included in this study involved 15 patients who underwent selective bypass graft angiography among 102 CABG cases. Thirty eight sites were bypassed by saphenous vein and two sites by internal mammary artery. The results were as follows: 1) The overall patency rate of the saphenous vein bypass graft was 76.3% and the two sites of the internal mammary artery bypass graft were both patent. 2) The patency rate of direct anastomosis was 86.2% and of sequential anastomosis, 44.4%. 3) In eight patients who underwent native coronary angiography, five patients showed progression of grafted coronary artery disease. Among them, two patients had accompanying progression of coronary artery disease in non-grafted vessels. 4) Follow up treadmill test performed in six patients showed improvement of exercise tolerance in all patients. 5) There was some increase in the ejection fraction of the left ventricle after CABG in six patients who received follow up left ventriculography.
Angiography* ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Exercise Test ; Exercise Tolerance ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mammary Arteries ; Myocardial Ischemia ; Prognosis ; Saphenous Vein ; Transplants*

The purpose of this study is to evaluate histologically the resorption and tissue response of various resorbable collagen membranes used for guided tissue regeneration and guided bone regeneration, using a subcutaneous model on the dorsal surface of the rat. In this study, 10 Sprague-Dawley male rats (mean BW 150gm) were used and the commercially available materials included acellular dermal matrix allograft, porcine collagen membrane, freeze-dried bovine dura mater. Animals were sacrificed at 2, 6 and 8 weeks after implantation of various resorbable collagen membranes. Specimens were prepared with Hematoxylin-Eosin stain for light microscopic evaluation. The results of this study were as follows: 1. Resorption : Inner portion of porcine collagen membrane was resorbed a lot at 6 weeks, but its function was being kept for infiltration of another tissues were not observed. Freeze-dried bovine dura mater and acellular dermal allograft were rarely resorbed and kept their structure of outer portion for 8 weeks. 2. Inflammatory reactions : Inflammatory reaction was so mild and foreign body reaction didn't happen in all of resorbable collagen membranes, which showed their biocompatibility. 3. In all of resorbable collagen membranes, multinucleated giant cells by foreign body reactions were not observed. Barrier membranes have to maintain their function for 4-6 weeks in guided tissue regeneration and at least 8 weeks in guided bone regeneration. According to present study, we can find all of the resorbable collagen membranes kept their function and structure for 8 weeks and were rarely resorbed. Foreign body reaction didn't happen and inflammatory reaction was so mild histologically. Therefore, all of collagen membranes used in this experiment were considered proper resorbable membranes for guided tissue regeneration and guided bone regeneration.
Acellular Dermis ; Allografts ; Animals ; Bone Regeneration ; Collagen ; Dura Mater ; Foreign Bodies ; Foreign-Body Reaction ; Giant Cells ; Guided Tissue Regeneration ; Humans ; Male ; Membranes* ; Rats* ; Rats, Sprague-Dawley

BACKGROUND: Clonidine premedication has many beneficial effects in patients undergoing CABG surgery. Amrinone, having the ability to increase cardiac performance without increasing myocardial O2 consumption, is a valuable drug in postoperative management after cardiopulmonary bypass (CPB). The use of amrinone with a catecholamine is also important clinically because the cathecholamines support perfusion pressure and the combined use exerts synergistic or additive effects. We performed this study to examine whether clonidine premedication could change the amount of dopamine used concomitantly with amrinone for management after CPB. METHODS: Nineteen patients for elective CABG were allocated to two groups according to their premedication; a placebo (Group 1, n = 13) or clonidine 4 microgram/kg p.o. (Group 2, n = 6). All patients arrived in the operating room with infusion of isosorbide dinitrate (ID). Anesthesia was performed with standard techniques. Before initiation of CPB, significant lowering of BP or HR was treated with phenylephrine or atropine respectively. Amrinone was given bolus (0.75 mg/kg) and infusion (10 microgram/ kg/min) was begun instead of ID at the release of aortic cross-clamp. Dopamine infusion (3 microgram/kg/min) was started at 35degree C (rectal) and its rate was adjusted for maintaining acceptable hemodynamics. We compared the amount of infused dopamine within 90 mins after CPB between the two groups. We also compared systolic BP, HR and CVP before induction, 10 mins after induction and 60 mins after CPB. RESULTS: Systolic BP and HR before induction and HR 10 mins after induction were significantly lower in Group 2 (P < 0.05), but they were all within normal range. The proportion of patients who needed phenylephrine or atropine before CPB was not significantly different in the two groups. The amount of infused dopamine was significantly larger in Group 2 (P < 0.05). Hemodynamics were acceptable after CPB although HR 60 min after CPB was significantly lower within the normal range in Group 2 (P < 0.05). Weaning time from CPB was not significantly different in the two groups. No significant adverse effect was observed throughout this study. CONCLUSIONS: Clonidine, used as premedication, increases the need of catecholamine which is concomitantly administered with amrinone for weaning from CPB. But this method provides clinically effective result without jeopardizing hemodynamics in CABG.
Amrinone* ; Anesthesia ; Atropine ; Cardiopulmonary Bypass ; Clonidine* ; Coronary Artery Bypass* ; Coronary Vessels* ; Dopamine* ; Hemodynamics ; Humans ; Isosorbide Dinitrate ; Operating Rooms ; Perfusion ; Phenylephrine ; Premedication ; Reference Values ; Weaning

BACKGROUND: There are many reports about the correlation between cardiovascular disorders and estrogen deficiency in postmenopausal women. The purpose of current study is to know that postmenopausal estrogen therapy may affect the lipid metabolism and endogenous fibrinolytic system and exercise tolerance. METHOD: We investigated the relation of estrogen treatment (srogen 0.625 mg/day) to serum lipid levels, angiotensin converting enzyme activity, plasminogen activator inhibitor-1 and parameters of treadmill test in 22 postmenopausal women of normal coronary artery with abnormal exercise test complained with chest pain accompanied by postmenopausal symptoms. RESULTS: Estrogen treatment significantly elevated the serum HDL-cholesterol level (42.8 to 50.1 mg/dl, p<0.05) and reduced the PAI-1 level (16.2 to 10.4 ng/dl, p<0.01) without considerable side effects. During the exercise test, the positivity appearance time and total exercise duration is significantly increased after estrogen treatment. CONCLUSION: The postmenopausal use of estrogen favorably changed the lipid level, fibrinolytic system and might improve the microcirculation which may protect against the ischemic heart disease risk without significant side effects.
Chest Pain ; Coronary Vessels ; Estrogens* ; Exercise Test ; Exercise Tolerance ; Female ; Humans ; Lipid Metabolism ; Microcirculation ; Myocardial Ischemia ; Peptidyl-Dipeptidase A ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Postmenopause