Alcohol has extensive effects on sleep and daytime sleepiness. Alcohol has a sleep inducing effect and the effect of increased non-REM sleep and suppressed REM sleep during the first half portion of night sleep, but alcohol induces the effect of decreased non-REM sleep and increased light sleep and frequent awakenings and REM rebound during the second half portion of night sleep. Alcohol provokes chronobiological change such as the changes of amplitude or the phase shifts of hormones or core body temperature. The sleep disruption resulting from alcohol drinking may lead to daytime fatigue and sleepiness. The elderly are at particular in the increased risk of alcohol-related sleep disorders because they achieve higher levels of alcohol in the blood and brain than do younger adults after consuming an equivalent dose. Bedtime alcohol consumption among older adults may lead to unsteadiness if walking is attempted during the night, with increased risk of falls and injuries. Continued alcohol use for sleep induction often induces aggravation of insomnia, alcoholism or sleep related breathing disorders such as obstructive sleep apnea. Alcohol should not be used as substitution of sleep pill because of the dependence and tolerance for sleep inducing effect, and the sleep disruption produced by alcohol withdrawal.
Adult ; Aged ; Alcohol Drinking ; Alcoholism ; Body Temperature ; Brain ; Fatigue ; Humans ; Respiration ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sleep, REM ; Walking

Successful percutaneous transluminal angioplasty (PTA) of an internal mammary artery graft was performed in a 40 year old male patient who had recurrent angina soon after bypass surgery. Coronary angiography showed total occlusion of proximal portion of the left anterior descending artery and normal right coronary artery. Angiography of the left internal mammary artery graft revealed a tight stenosis (90% diameter narrowing) in the mammary artery at its insection into the left anterior descending artery.Angiography after the angioplasty demonstrated a widely patent graft (residual stenosis 10%) and translesional pressure gradient was 10 mmHg.
Adult ; Angiography ; Angioplasty* ; Arteries ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Vessels ; Humans ; Insects ; Male ; Mammary Arteries* ; Transplants*

Myocardial infarction is almost regularly associated with severe and widespread obstructive coronary artery disease. Recently, there have been some reports of myocardial infarction with normal of near normal coronary arteries on cineangiography. The following report concerns 6 cases (4% of a series of 142 consecutively studied patients with myocardial infarction) of myocardial infarction proved on clinical grounds with normal or near normal coronary arteries at coronary angiography obtained several months later. The clinical data was shown in Table 1 and Table 2. All 6 patients were male. Three were in the fifth, two in the sixth, and one in the seventh decade. Multiple risk factors were present in only one patient. Areas of localized dyskinesia or hypokinesia were demonstrated in five on the left ventricular cineangiography. The left ventricular end-diastolic pressure was greater than 12 mmHg in all 6 patients. One patient had hypertrophic cardiomyopathy and the remaining 5 patients had no underlying heart diseases. One patient had moderate congestive heart tailure. It is possible that prolonged, localized coronary artery spasm or platelet thrombi that subsequently resolved are a part of the pathogenic mechanism.
Blood Platelets ; Cardiomyopathy, Hypertrophic ; Cineangiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Dyskinesias ; Estrogens, Conjugated (USP) ; Heart ; Heart Diseases ; Humans ; Hypokinesia ; Male ; Myocardial Infarction* ; Risk Factors ; Spasm

Conventional dual chamber pacing (DDD) preserves atrioventricular synchrony but depend on appropriate sinus node function to achieve physiological heart rate with exercise by atrial tracking. Other indirect indicators of metabolic demand have been used to modulate pacing rate increases with exercise including sensing of pH, respiratory rate, ventricular repolarization and oxygen saturation. The activity sensing approach is unique in that noise generated by activity modulates the response and empirical programming of the unit allows for attaining the desired rate for a given level of activity. Physiologic rate increases can be obtained in patients with sinus node dysfunction or even atrial fibrillation. The lead can either be positoned in the atria for patients without atrial fibrillation or AV conduction disturbance or in the ventricle. We present two cases of rate responsive pacing using the Activitrax.
Atrial Fibrillation ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Noise ; Oxygen ; Respiratory Rate ; Sick Sinus Syndrome ; Sinoatrial Node

Coronary arterivenous fistula(CAVF) is an uncommon congenital coronary anomaly-Bilateral CAVFs that originate from both coronary arteries are very rare. Coronary arteriography performed in recent years has clarified the incidence and various features of this lesion. Baim et al.1) reported that only 5% of the coronary artery fistulas arose from bilateral coronary arteries. In this report, we present a case of bilateral coronary artery pulmonary artery fistulas associated with atypical chest pain.
Angiography ; Arteries* ; Chest Pain ; Coronary Vessels ; Fistula* ; Incidence ; Pulmonary Artery

Balloon angioplasty of stenosis involving a bifurcation of coronary arteries carries a significant risk of iatrogenic permanent occlusion of one of the adjacent branches. In order to prevent this complication, kissing balloon technique, inhitially, used for aortoplasty in Leriche synrome, was introduced into coronary angioplasty. Alternatively Oesterle described the single-guide, two-wire technique which is less traumatic with nearly equal outcomes. Among 200 coronary angioplasty cases done in our laboratory, 3 cases of unstable angina pectoris with stenosis involving major bifurcation sites were encountered. In 2 cases with stenosis involving left anterior descending artery and diagonal branch, kissing balloon technique was performed. Single-guide, two-wire technique was performed in remaining 1 case with stenosis of posterior descending and posterior lateral branchs. The outcome were successful without major complications.
Angina, Unstable ; Angioplasty* ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Vessels

Percutaneous mitral ballon vavuloplasty(PMV) using the double-ballon technique was performal in a 48 year old female patient with recurrent mitral stenosis 16 years after surgical open mitral commissurotomy. PMV resulted in an increase in mitral valve area by Gorlin's method from 0.9 to 2.2 cm2, a decrease in mean mitral diastolic pressure gradient from 30 to 17 mmHg, and an increase in cardiac output from 4.7 to 5.5 L/min. There was no evidene of significant left to right shunt through the atrial septal punture site PMV. After PMV minimal grade 1 mitral regurgutation developed. Mitral ballon valvuloplasty can be performed effectively and safely in selected patients with restenosis after surgical commissurotomy.
Blood Pressure ; Cardiac Output ; Female ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Stenosis

To determine factors involved in left ventricular aneurysm formation after transmural anterior myocardial infarction, 74 patients with a first myocardial infarction who underwent cardiac catheterization within 6 weeks of infarction were evaluated.Patients were divided into four groups depending on the status of the left anterioe descending artery(LAD) and the presence Group I(n=15);aneurysm with occluded LAD, Group II(n=16);no aneusrysm and occluded LAD, Group III(n=18);aneusrysm and patent LAD, and Group IV(n=25);no aneusrsm with patent LAD. Neither age, sex nor risk factors for coronary disease correlated with aneusrysm formation,but the duration of chest pain in patients with previous angina was significantly longer in group II(no aneusrysm with occluded LAD) compared with other groups(P<0.01). Single vessel disease was more commom in Group I and III(aneusrysm) compared with II and IV(no aneusrysm)(P<0.06). Collateral blood supply was more frequently observed in Group I and II(occluded LAD) compared with Group III and IV(patent LAD)(P<0.01) and was slightly less in Group I(aneusrysm) compared with Group II(no aneusrym)(P<0.07). Delta area decreasing rate of the left ventricle was significantly lower in Group I and III(aneusrysm)compared with Group II and IV(no aneusrysm)(P<0.01). Single vessel disease in assocition with poor collateral circulation tends to be a determinant of left ventricular aneusrysm formation after anterior myocardial infarction.
Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Collateral Circulation ; Coronary Disease ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction* ; Risk Factors

BACKGROUND: Total obstruction of the left main coronary artery is a common cause of sudden death but is rarely seen in patients who survive to undergo diagnostic evaluation or treatment. METHODS: During twenty six-year period, we encountered 5 patients with chronic total obstruction of the left main coronary artery out of about 4,000 patients who underwent coronary angiography. RESULTS: All patients have undergone coronary bypass surgery. These patients present with increasingly severe angina. A right dominat coronary anatomy is always found, usually with well-developed right-to-left collaterals. Left ventricular function was severely impaired in two patients out of five patients. CONCLUSIONS: The results of surgical revascularization in our patients and others described in the literature can support the safety and efficacy of this approach.
Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Humans ; Ventricular Function, Left

Tuberculosis of the duodenum is rare event in patients with pulmonary or intestinal tuberculoais. It is very difficult to diagnose duodenal tuberculosis because of inconaiatent symptoms and nonspecific duodenal lesioa. Although fiberoptic endoscopy has been used, there is the limitation of fiberoptic endoscopy ia diagnosingthis disease and the diagnoais require laparotomy with biopsy. Recently we experienced a case of duodenal tuberculosis with duodenoscopic findings of the submucosal tumor of duaidenum. We report a case with review of literatures.
Biopsy ; Duodenum* ; Endoscopy ; Humans ; Laparotomy ; Tuberculosis*