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

Perforation of the interventricular septum complicating acute myocardial infarction is uncommon. The condition was first described anatomically by Latham in 1845 and the first antemortem diagnosis was made by Brunn in 1923. In both cases, bedside catheterization utilizing a flow directed catheter detected a step up of O2 saturation at the ventricular level, compatible with ventricular septal defect, and two dimensional echocardiogram allowed direct visualization and localization of the postmyocardial infarction VSD. Finally cineventriculogram confirmed them.
Catheterization ; Catheters ; Diagnosis ; Heart Septal Defects, Ventricular ; Infarction* ; Myocardial Infarction

PURPOSE: An adequate pain control is one of important factors for obtaining good outcomes in the ambulatory basis of hemorrhoidectomy. There have been many methods for pain control after hemorrhoidectomy such as narcotics, various kinds of analgesics, etc. The aim of this study is to compare intraoperative internal anal sphincter injection of Ketorolac tromethamine and other two conventional methods for pain control. METHODS: A total of 56 patients with hemorrhoid grade III or IV underwent surgery between May and October 1999, and prospectively assigned to three groups in the consecutive order. The group was divided in Group 1: [Ketorolac tromethamine (Tarasyn) 60 mg intrasphincteric injection intraoperatively and 30 mg IM/prn?10 mg po/6hrs], Group 2: [No intraoperative injection and maintain pain control with Tarasyn 30 mg IM/prn/10 mg po/6hrs], and Group 3: [No intraoperative injection and maintain pain control with Pethidine (Demerol) 50 mg IM/prn and Ibuprofen 400 mg/Paracetamol 500 mg/Codeine 20 mg (Myprodol) po/8hrs]. The post operative data and pain scoring was performed on the questionnaire with Point box scale (BS-11) and Behavioral rating scale (BRS-6) each 24 hours during 5 days after surgery. RESULTS: There are 22 patients in the Group 1, 16 in the Group 2 and 18 patients in the Group 3. The median age of the Group 1 is 42.5, Group 2, 44.5 and Group 3, 45 years. The pain score on the first day after surgery in group 1 was significantly lower than group 2 (p<0.05) in the both pain scoring scale but was no differences between group 1 and 3. On the fifth day after surgery group 3 was significantly lower than both group 1 and 2 in the point box scale (p<0.05). The urinary retention rate and the day of first bowel movement after surgery show no differences among three groups (p>0.05). CONCLUSIONS: Intraoperative internal anal sphincter injection of Ketorolac tromethamine shows a better pain control than conventional methods in early postoperative period. Therefore it might be helpful for patients to go home on the day after surgery, and strong pain killer to control pain after discharge will be needed.
Anal Canal* ; Analgesics ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Ibuprofen ; Ketorolac Tromethamine* ; Ketorolac* ; Meperidine ; Narcotics ; Postoperative Period ; Prospective Studies ; Surveys and Questionnaires ; Tromethamine ; Urinary Retention

PURPOSE: To investigate the effects of varying the time of Mitomycin-C (MMC) subconjunctival injection before, during and after operation. METHOD: We divided rabbits into 3 groups according to injection time. Subconjunctival injections of 0.01% MMC 0.05 ml were given to the preoperative group at 6, 12 and 24 hours before operation, and to the postoperative group at 6, 12 and 24 hours after operation. The control group was given the injections during operation. Bleb formation and histologic analyses were studied for 4 weeks after operation. RESULTS For gross findings, the blebs of the preoperative and control groups were seen on the fourth day and completely formed at one week after operation, and were larger than those of the postoperative group. On the other hand, the blebs of the postoperative group were seen to have poor formation, displaying hypervascularity on the fourth day and disappearing one week after operation. For histologic findings, the proliferation of collagen fibers and the undifferentiation of fibroblasts observed in the preoperative and control groups were almost identical. But, the proliferation of collagen fibers and well-differentiated fibroblasts were seen to increase in the postoperative group, so aqueous flow was obstructed at week 3. CONCLUSIONS: Subconjunctival injections within 24 hours before or during glaucoma filtration surgery were better for bleb formation and preservation than those administerd after surgery.
Blister ; Collagen ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Hand ; Mitomycin* ; Rabbits*

PURPOSE: To investigate the effects of varying the time of Mitomycin-C (MMC) subconjunctival injection before, during and after operation. METHOD: We divided rabbits into 3 groups according to injection time. Subconjunctival injections of 0.01% MMC 0.05 ml were given to the preoperative group at 6, 12 and 24 hours before operation, and to the postoperative group at 6, 12 and 24 hours after operation. The control group was given the injections during operation. Bleb formation and histologic analyses were studied for 4 weeks after operation. RESULTS For gross findings, the blebs of the preoperative and control groups were seen on the fourth day and completely formed at one week after operation, and were larger than those of the postoperative group. On the other hand, the blebs of the postoperative group were seen to have poor formation, displaying hypervascularity on the fourth day and disappearing one week after operation. For histologic findings, the proliferation of collagen fibers and the undifferentiation of fibroblasts observed in the preoperative and control groups were almost identical. But, the proliferation of collagen fibers and well-differentiated fibroblasts were seen to increase in the postoperative group, so aqueous flow was obstructed at week 3. CONCLUSIONS: Subconjunctival injections within 24 hours before or during glaucoma filtration surgery were better for bleb formation and preservation than those administerd after surgery.
Blister ; Collagen ; Fibroblasts ; Filtering Surgery* ; Filtration* ; Glaucoma* ; Hand ; Mitomycin* ; Rabbits*

We studied the incidence of spontaneous infarct related artery recanalization and it's effect on LV function in 120 patients with acute myocardial infarction by angiography within 1 month after onset of acute MI between Nov. 1983 to Sep. 1988. The total occlusion rate of the infarct related artery in 34 cases catheterized from 1st day to 7th day was 55.8%, that of 33 cases from 8th day to 14th day 51.5%, that of 32 cases from 15th day to 21th day 40.7% and that of 21 cases from 21th day to 30th day was 47.7%. These results suggest that spontaneous recanalization of infarct related artery has mainly occurred within 24 hours after acute MI. LV ejection fraction among those patients who showed spontaneous recanalization(n=59) was not significantly superior to those with persistent occlusion of the infarct related artery. Both anterior and inferior MI patients showed no difference in LV function as regard to whether they showed recanalization or persistent occlusion. Although early spontaneous reperfusion of the infarct related artery is not uncommon in acute MI, LV function was not influnced by the spontaneous recanalization at least until 1 month after MI.
Angiography ; Arteries ; Catheters ; Humans ; Incidence ; Myocardial Infarction* ; Reperfusion ; Ventricular Function, Left*

Two-dimensional and Doppler echocardiographic examination were obtained in 31 patients both immediately and 2 to 5 months(mean3.1+/-1.8) after balloon dilation. Mitral valve area by planimetry immediately after valvuloplasty measured 1.8+/-0.3cm2 and 1.7+/-0.3cm2 at 2-5 months follow-up, but the difference was satistically insignificant. More than 15% decrease of the mitral valve area at follow-up was noticed in 10 patients(32%), but the valve area at follow-up was >1.5cm2 in all patients. Left atrial size(antero-posterior diameter) and volume by 2-dimensional echocardiography decreased more remarkably from 4.4+/-0.7cm, 82+/-42cm3 immediatly after vavuloplasty to 4.2+/-0.7cm, 68+/-26cm2 at follow-up respectively but there was no statistical significance. Mitral regurgitation graded by pulsed Doppler ultrasound decreased from 1.6+/-0.7 immediatly after valvuloplasty to 1.3+/-0.5(p<0.09) at follow-up, but there was no significant change in peak E velocity, EF slope, fractional shortening and ejection fraction. Symptomatic improvement at follow-up occured in all but one patient. Thus, 2 to 5 months after balloon mitral valvuloplasty there was no significantly after valvuloplasty decreased slightly at follow-up.
Echocardiography* ; Follow-Up Studies* ; Humans ; Mitral Valve Insufficiency ; Mitral Valve* ; Ultrasonography

Eleven patients with acute myocardial infarction were treated with recombinant tissue-type plasminogen acrivator(rt-PA). The incidence of coronary thrombolysis, reocclusion and effect on the fibrinolytic system were studied. Dose of 1.25mg/kg up to 100mg of rt-PA was given intravenously for3 hours. Six of 7 patients(85.7%) on whom coronary angiography was performed within 90 min of initiation of therapy showed recanalization of the infarct-related artery and two of 3 patients at 24hrs. Reocclusion was demonstrated in one of 7 patients on whom repeat coronary angioplasty was performed at 15+/-5days. Blood fibrinogen level was higher than 100mg/dl after rt-PA infusion. One patients died during left ventriculography and there were no major bleeding complications. Thus intravenous rt-PA achieves high rate of recanalization without eliciting clinically significant fibrinogenolysis.
Angioplasty ; Arteries ; Coronary Angiography ; Fibrinogen ; Hemorrhage ; Humans ; Incidence ; Myocardial Infarction ; Plasminogen*

Certain angiographic patterns outlining the morphologic characteristics of vessels and defining the lesion-specific characteristics have recently been shown to greatly influence the likelihood of a successful dilation. In 1988, ACC/AHA Subcommitte on percutaneous transluminal coronary angioplasty proposed the lesion-specific classification as a guide for estimating the likelihood of a successful procedure as well as the the likelihood of developing abrupt vessel closure. To determine the lesion-specific predictors for successful dilation and complications after percutaneous transluminal coronary angioplasty, nine angiographic charateristics of 200 lesions in 164 patients who underwent coronary angiplasty between May, 1983 and September, 1989 were analyzed. 1) Successful dilation, defined as a reduction in stenosis diameter to less than 50% without acute myocardial infarction or emergency coronary artery bypass graft, occurred in 175 of 212 lesions(82.5%). 2) Successful dilation occurred in 13 of 15 type A lesions(86.6%), 148 of 178 type B lesions(83.1%) and 3 of 7 type C lesions(42.8%)(p<0.05 for A or B vs C). 3) Acute closure syndrome occurred in none of type A lesions, 6 of type B lesions(3.4%), 2 of type C lesions(28.5%)(p<0.005 for A or B vs C). 4) multivariate analysis showed that lesion-specific characteristic predictors for successful dilation were length of lesion(p<0.05) and accessibility(p<0.05) ; for ischemic events were major branch involvement(p<0.05) and eccentricity(p<0.05); for acute closure syndrome were accessibility(p<0.05) and eccentricity(p<0.05). 5) Procedural predictors for ischemic events were coronary artery dissection(p<0.01), post-PTCA diameter stenosis(p<0.05) and balloon/artery diameter ratio(p<0.01) ; For acute closure syndrome was coronary artery dissection(p<0.005). In this analysis, we found that angiographic lesion-specific characteristics related very importantly to procedural success and were able to define three major independent lesionspecific risk factors whose presence beforehand decreased the likelihood of successful dilation and increased the likelihood of acute closure. In the absence of any of these risk factors, the risk of acute closure is very small. Thus, identification of these factors and their associate risk should improve patients selection and better define the role of coronary angioplasty in the management fo patients with coronary artery disease.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Classification ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Emergencies ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Risk Factors ; Transplants