BACKGROUND: Improvements in catheter equipments and increasing experience of the operators have brought about a broadening of the indications and applications of percutaneous transluminal coronary angioplasty(PTCA). In particular, coronary angioplasty has been employed in total occlusions.We evaluated the initial success rate and safety of PTCA total occulsive coronary artery disease. METHODS: To assess the success rate and safety of PTCA total coronary artery occlusion, the data of 24 patients(male 19, female 5, mean age 55+/-9 years), in whom PTCA for total occlusion were performed, were examined. RESULTS: Primary success rate of procedure was 66.7%(16 out of 24 lesions).The success rate according to the duration of total occlusions was 8 out of 11(72.7%) with occlusions<4 weeks duration and 3 out of 7(42.9%) with occlusions>4 weeks duration(p=0.07). There was no difference in success rate according to vassel dilate(left anterior descending 75.0%, right coronary 44.4%) and length of occluded lesion(0.93%+/-0.47%cm, p=0.35). Eight procedural failures included inability to cross the lesion with a guide wire in 6 and inability to dilate the lesion in 2, but there was no emergency coronary bypass surgery or cardiac death. CONCLUSION: Even though the recanalization of occluded coronary arteries has a lower initial success rate than angioplasty for stenotic arteries, PTCA in total occlusion can be performed as a safe and effective therapeutic modality in selective patients.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Catheters ; Coronary Artery Disease ; Coronary Vessels* ; Death ; Emergencies ; Female ; Humans

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) have been broaden recent years. We evaluated the initial success rate and safety of PTCA in mulitiple lesions and vessels. METHODS: To assess the success rate and safety of PTCA In mulitiple lesions and vessels, the data of 60 lesions from 28 patients(male 23, female 5, mean age 56+/-12 years), in whom PTCA for multiple lesions and vessels were performed, were examined. Initial results and complications were compared in 37 lesions undergoing multivessel and 23 lesions undergoing multilesion PTCA. RESULTS: Overall primary success rate of procedure was 82%(49 out of 60 lesions). Angioplasty was attempted in mean 2.1 stenotic lesions per patient. Primary success rate per lesion was 84%(31 of 37) among those who underwent multivessel and 78%(18 of 23) among those who underwent multilesion PTCA(p>0.05). Success rate according to the combination of dilated vessels was 85.7%(12 of 14) in left anterior descending(LAD) and left circumflex(LCX), 83.3%(10 of 12) in LAD and right coronary artery(RCA), 100.0%(4 of 4) in LAD and diagonal branch, RCA and LCX in 75.0%(3 of 4), and 66.7%(2 of 3) in LAD, LCX and diagonal branch. Eleven failures(18.3%) included inability to pass the guide wire cross the lesion or inability to locate the balloon catheter in 5(8,3%), abrupt closure in 2(3,3%), coronary spasm in 1(1.7%) and major branch occlusion in 3(5.0%), but there was no emergency coronary bypass surgery or cardiac death. CONCLUSION: Coronary angioplasty in selected patients with multivessel and multilesion coronary artery disease might be useful and have relatively good initial results, but the long-term efficacies with other forms of treatment must be evaluated prospectively.
Angioplasty* ; Catheters ; Coronary Artery Disease ; Death ; Emergencies ; Female ; Humans ; Spasm

This study was done to determine the value of thallium-201 stress myocardial perfusion scanning for identifying disease in the individual coronary arteries. Segement analysis of rest and stress myocardial perfusion scanning was performed in 65 subjects who underwent coronary arteriography. Anterolateral wall detects had a sensitivity of 70%, a spectivity of 92%, and a predicitive accuracy of 93.3% for identifying left anterior descending(LAD) coronary artery disease(CAD). Anteroseptal wall defects had a sensitivy of 62.5%, a specificity of 80%, and a predictive accuracy of 83.3% for identifying LAD CAD. Septal wall defects had a sensitivity of 67.5%, a specificity of 92%, and a predictive accuracy of 94.4% for identifying LAD CAD. Inferior wall defects had a sensitivity of 65.4%, a specificity of 89.7%, and a predictive accuracy of 80.9% for identifying right CAD. Posterolateral wall defects had a identifying left circumflex CAD. Thus, although senmental analysis of stress myocardial perfusin scanning can identify LAD CAD with high sensitivity and specificity, only moderate sensitivity and specificity are achieved in identifying right CAD or left circumflex CAD. But stress myocardial perfusion scanning has tendency to identify the most severely ischemic area, use of segmental analysis may be of benefit in the evaluation of patients with ischemic heart disease before or after coronary artery bypass graft and percutaneous transluminal coronary angioplasty.
Angiography ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Myocardial Ischemia ; Perfusion* ; Sensitivity and Specificity ; Transplants

A 6-year old girl was diagnosed as atrophoderma vermiculatum on face, especially on cheek and preauricular area, and dorsum of both hands. She had suffered from congenital heart disease which was diagnosed as ventricular septal defect by cardiac: catheterization and cineangiography in final. Three months after patch repair of ventricular septal defect, no further new skin lesion developed. But reticulate skin atrophy was remained.
Atrophy ; Catheterization ; Catheters ; Cheek ; Child ; Cineangiography ; Female ; Hand ; Heart Defects, Congenital* ; Heart Septal Defects, Ventricular ; Humans ; Skin

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

Recent studies showed effective early recannalization of infarct-related artery achieved by intravanous urokinase, but dosage of urokinase is still arbitary. Thirty-five patients with acute trasmural myocardial infarction were treated with intraveous urokinase from April 1984 to October 1988. The incidence of coronary thrombolysis, left ventricula function and effect on fibrinolytic system were investigated. Inital 18 patients recieved 0.5 to 2.0 million unitis of urokinase and remaining 17 patients received 3 million units of urokinase intravenously for 1 hour. Thirteen of 17 patients(76.4%) with 3 million units but only four of 18 patients(22.2%) with 0.5 to 2.0 million units showed patent infarct-related coronary artery. Left ventricular function was significantly better in patients with patent infarct-related coronary artery, and the difference was marked in anterior myocardial infarction. There were three local bleeding at puncture site in 3 million units group, one of which required transfusion. Thus, intravenous infusion of 3 million units of urokinase provide rapid reperfusion of infarct-related coronary arterty and myocardial salvage is more lkiely to occur.
Arteries ; Coronary Vessels ; Hemorrhage ; Humans ; Incidence ; Infusions, Intravenous ; Myocardial Infarction* ; Punctures ; Reperfusion ; Urokinase-Type Plasminogen Activator* ; Ventricular Function, Left

PURPOSE: We investigated the mRNA levels of peroxisome proliferator-activated receptor (PPAR)-alpha, PPAR-gamma, adipokines, and cytokines in the lung tissue of lean and obese mice with and without ovalbumin (OVA) challenge, and the effect of rosiglitazone, a PPAR-gamma agonist. METHODS: We developed 6 mice models: OVA-challenged lean mice with and without rosiglitazone; obese mice with and without rosiglitazone; and OVA-challenged obese mice with and without rosiglitazone. We performed real-time polymerase chain reaction for leptin, leptin receptor, adiponectin, vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta, PPAR-alpha and PPAR-gamma from the lung tissue and determined the cell counts and cytokine levels in the bronchoalveolar lavage fluid. RESULTS: Mice with OVA challenge showed airway hyperresponsiveness. The lung mRNA levels of PPARalpha and PPAR-gamma increased significantly in obese mice with OVA challenge compared to that in other types of mice and decreased after rosiglitazone administeration. Leptin and leptin receptor expression increased in obese mice with and without OVA challenge and decreased following rosiglitazone treatment. Adiponectin mRNA level increased in lean mice with OVA challenge. Lung VEGF, TNF-alpha, and TGF-beta mRNA levels increased in obese mice with and without OVA challenge compared to that in the control mice. However, rosiglitazone reduced only TGF-beta expression in obese mice, and even augmented VEGF expression in all types of mice. Rosiglitazone treatment did not reduce airway responsiveness, but increased neutrophils and macrophages in the bronchoalveolar lavage fluid. CONCLUSION: PPAR-alpha and PPAR-gamma expressions were upregulated in the lung tissue of OVA-challenged obese mice however, rosiglitazone treatment did not downregulate airway inflammation in these mice.
Adipokines ; Adiponectin ; Animals ; Bronchoalveolar Lavage ; Cell Count ; Cytokines ; Inflammation ; Leptin ; Lung ; Macrophages ; Mice ; Mice, Obese ; Neutrophils ; Obesity ; Ovalbumin ; Ovum ; Peroxisome Proliferator-Activated Receptors ; Peroxisomes ; PPAR alpha ; Real-Time Polymerase Chain Reaction ; Receptors, Leptin ; RNA, Messenger ; Thiazolidinediones ; Transforming Growth Factor beta ; Transforming Growth Factors ; Tumor Necrosis Factor-alpha ; Vascular Endothelial Growth Factor A

To evaluate the diagnostic value of thallium-201 stress myocardial scintigraphic imaging and stress electrocardiography, sensitity, specificity and predicitive value of thallium-201 stress myocardial scintigraphic imaging were compared to simultaneously recorded 12 lead electrocardiography in 17 normal subjects and 30 patients with coronary artery disease who proved by coronary arteriography. The following results were obtained. 1) The mean age was 49.5+/-10.7 years(mean+/-SD)in subjects with normal coronary arteries and 53.1+/-8.8 years in patients with stenotic coronary arteries. 2) Fourteen patients had one-vessel disease, 10 two-vessel disease and 6 three-vessel disease. 3) Sensitivity of thallium myocardial scintigraphic imaging was higher than that of stress electrocardiography(86.7% vs 76.7%). 4) Specificity of both tests was same(70.6% vs 70.6%). 5) Sensitivity of thllium-201 stress myocardial scintigraphic imaging and stress electrocardigraphy in relation to the extent of coronary artery disease showed 78.6% vs 64.3% in one vessel disease, 90% vs 80% in two-vessel disease and 100% vs 100% in three-vessel disease. 6) Predictive value of thallium-201 stress myocardial scintigraphic imaging and stress electrocardiography revealed 83.9% vs 82% in the postive test and 75% vs 63.2% in the negative test. In conclusion, even though thallium-201 stress myocardial scintigraphic imaging was superior to stress electrocardiography in diagnosing coronary artery disease, scintigraphic defects were noted in 5 subjects with normal coronary arteries which could mislead to erroneous diagnosis of coronary artery disease. This point should be taken into consideration in the interpretation of thallium-201 stress myocardial scintigraphic imaging.
Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Electrocardiography* ; Humans ; Sensitivity and Specificity ; Thallium

We studied 70 cases of transmural myocardial infarction with first attack to look into the coronary anatomy of the infarct-related artery in the time course of infarction and evaluate the left ventricular wall motion according to patency of the infarct-related artery. The following result were obtained. 1) Among 70 cases with transmural myocardial infarction, 47(67.1%) had anterior infarction and 23 (32.9%) inferior infarction. Mean age of the total cases was 52.1+/-10.6 and M:F ratio was 7.8:1. 2) 28 cases were single vessel disease(40.0%), 19 cases were two vessel disease(27.1%), 18 cases werew three vessel disease(25.8%) and 5 cases had insignificant coronary stenosis (7.3%) with 4 cases of normal coronary artery. 3) The total occlusion rate of the infarct-related artery in 70 cases was 48.6%. The total occlusion rate of the 8 cases catheterized within 1 day was 87.5%, that of the 17 cases from 2nd to 15th day 52.9% that of the 23 cases from 16th day to 2nd month 39.1%, that of the 15 cases from 3rd to 12th month 40.0% and that 7 cases from 2nd and 6th year 42.8%. These results suggest that the natural resolution of the infarct-related artery has almost happened within 2 weeks. 4) The left ventricular ejection fraction was higher and the left ventricular end-diastolic pressure was lower in the group with incomplete occulsion of infarct-related artery than in those with complete occulsion, and left ventricular wall motion was better in the group with incomplete occulsion of the infarct-related artery than in those with complete occulsion.
Arteries* ; Catheters ; Coronary Stenosis ; Coronary Vessels ; Infarction ; Myocardial Infarction* ; Stroke Volume

PURPOSE: Viral infection is the most common aggravating factor for childhood asthma. Asthma may be a risk factor for severe respiratory symptoms in children with lower respiratory tract infections of viral etiology. Influenza A infection enhances Th2-polarization to house dust mites during the acute phase and leads to lung dysfunction in a mouse model. However, there are no data on the relationship between atopic sensitization and H1N1 (Influenza A) infection in humans. To investigate whether atopic sensitization is associated with the severity of H1N1 pneumonia, we compared clinical features and the atopic sensitization rate between children with and without H1N1 infection. METHODS: Using reverse transcription-polymerase chain reactions, we investigated H1N1 virus infection in 214 children who were hospitalized with high fever and respiratory symptoms from September 2009 to February 2010. We also performed immunoassays for total and specific IgEs to six common aeroallergens. Atopy was defined as positivity for more than one specific IgE. The clinical severity of pneumonia was evaluated based on intensive care unit admission, oxygen therapy, steroid therapy, and atelectasis. RESULTS: There were 70 H1N1-positive children, 42.9% of whom had pneumonia. Children with H1N1 infection were older and had a higher prevalence of atopic sensitization and pneumonia compared with H1N1-negative children. The rate of atelectasis was higher in children with H1N1 pneumonia than in children with non-H1N1 pneumonia. Among children with H1N1 viral infection, those with atopic sensitization had a higher prevalence of intensive care unit admission and oxygen therapy, and a longer duration of hospitalization than non-atopic children. There were no differences between atopic and non-atopic children without H1N1 viral infection. CONCLUSIONS: The prevalence of H1N1-induced severe lower respiratory tract diseases is higher in children with atopic sensitization.
Animals ; Asthma ; Child ; Fever ; Hospitalization ; Humans ; Immunoassay ; Immunoglobulin E ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Intensive Care Units ; Lung ; Mice ; Oxygen ; Pneumonia ; Prevalence ; Pulmonary Atelectasis ; Pyroglyphidae ; Respiratory System ; Respiratory Tract Diseases ; Respiratory Tract Infections ; Risk Factors