Adrenal Cortex Hormones* ; Prospective Studies* ; Stents*

BACKGROUND AND OBJECTIVES: Many studies have shown that coronary artery bypass graft (CABG) surgery prolongs the life of patients with left main coronary artery disease (LMCD). Recently, percutaneous coronary intervention (PCI) has been applied to treat LMCD, with good clinical results. However, a significant portion of patients decline any revascularization therapy, so receive medical treatment only. The aim of this study was to evaluate the long term clinical outcome in these patients with LMCD, according to the treatment strategies. SUBJECTS AND MEHTODS: The clinical outcomes of 281 consecutive patients, with significant LMCD, between January 1997 and December 2000, were evaluated. The patients were divided into three groups, according to their initial treatment strategies;1) CABG, 2) PCI and 3) medical treatment. The mean follow-up duration was 37.4+/-14.9 months. RESULTS: The 1- and 3-year survival rates in the CABG group (97.4+/-1.5% and 95.6+/-1.9%) were significantly higher than those of the medical group (89.8+/-3.9% and 76.1+/-5.9%;p=0.03). The survival rates in the PCI group (one year and 3-year survival rate, 98.1+/-1.3% and 93.8+/-2.5%) were similar to those of the CABG group (p=0.93). The incidence of 3-year MACE in the medical group (40.7%) was higher than those of the CABG (10.5%, p<0.001) and PCI groups (20.4%, p=0.007). There was no significant difference between the CABG and PCI groups (p=0.06). CONCLUSION: In patients with LMCD, a CABG remains the standard therapy for prolonging survival and lowering the incidence of MACE. PCI offers similar survival benefits in selected patients. Medical treatment is associated with a significantly higher mortality and MACE. Active revascularization therapy should be the treatment of choice for the patients with LMCD.
Angioplasty ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Disease* ; Follow-Up Studies* ; Humans ; Incidence ; Mortality ; Percutaneous Coronary Intervention ; Survival Rate ; Transplants

Epidermal keratinocytes are important sources of a wide variety of cytokines that include the endothelin-1 (ET-1). Glucocorticoids have been shown to inhibit the production of several cytokines. However, their effect on ET-1 synthesis by keratinocytes is still unknown. It has been reported that ultraviolet B (UVB) irradiation stimulates both the synthesis and release of ET-1 and it was observed that ET-1 secretion by HaCat cells increased with increasing UVB exposure. In this study, the effects of glucocorticoid on ET-1 production were evaluated using cultured HaCat keratinocytes. The results showed that dexamethasone suppressed basal re-lease of ET-1. In addition, it strongly inhibited the UVB-mediated augmentation of ET-1 production. Furthermore, lincomycin slightly enhanced the inhibitory effect of dexamethasone on ET-1 synthesis.
Cytokines ; Dexamethasone* ; Endothelin-1 ; Glucocorticoids ; Keratinocytes* ; Lincomycin

No abstract available.
Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Vulva*

To assess the efficacy of 2 different mitral balloon valvotomy (PMV) techniques, PMV was performed using Inoue balloon (I) in 35 pts and double balloon (D) in 33 pts with mitral stenosis (male 27, female 41, mean age 42+/-12 years). The success rate of PMV was 89%(31/35 pts) in I group and 97%(33/33 pts) in D group. Mitral valve area after dilation increased equally effectively in both groups (I and D) from 0.9+/-0.2 and 0.8+/-0.2 to 1.9+/-0.2 and 1.9+/-0.3cm2 respectively (p<0.0001). There were no differences in degree of improvement of cardiac output, mitral gradient, left atrial pressure, pulmonary artery pressure and various doppler echocardiographic findings in both groups, but EF slope was more improved from 13+/-7 to 48+/-16 mm/sec in D group than those (from 15+/-6 to 39+/-15mm/sec) of I group. Increments of long and short diameters of mitral valve orifice by 2D-echocardiogram were 1.1+/-0.6 and 0.3+/-0.3cm in D group and 0.9+/-0.5, 0.4+/-0.3cm in I group. The ratio of long and short diameter increase was significantly larger in D than that of I group (long/short 2.8+/-0.7 vs 2.4+/-0.7, p<0.05) and short diameter of orifice after dilation was more improved in I than that of D group (1.1+/-0.2 vs 1.0+/-0.2cm p<0.05). Complications included deflation failure of Inoue balloon in 2, and cerebral embolic episode in 1 (D). Incidence of increased mitral regurgitation was 50% in D and 45% in I, development of ASD (Qp/Qs>1.2) was 20% in D, 13% in I group respectively and mean amount of left to right shunt (Qp/Qs) was 1.7+/-0.3 in D and 1.5+/-0.1 in I group. Total procedure and fluoroscopic time were 84+/-24 and 25+/-11 min. in D and 56+/-20 and 16+/-6 min. In I, which had statistically significant differences (p<0.002). Thus we concluded PMV using Inoue or double balloons was equally effective in selected patients. Total procedure and fluoroscopic time of Inoue balloon technique were significantly shorter than those of double balloons. Double balloon technique had more tendency of longitudinal splitting of the commissures.
Atrial Pressure ; Balloon Valvuloplasty* ; Cardiac Output ; Echocardiography ; Female ; Follow-Up Studies* ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Pulmonary Artery

No abstract available.
Histamine* ; Pruritus*

BACKGROUND: The purpose of this study was to investigate the mechanism of endothelium-dependent and independent responses to endothelins (ETs) in porcine coronary artery. METHODS: The vascular rings of left anterior descending artery or left circumflex artery from 7 pigs were suspended in conventional organ chambers for the measurement of isometric force. To evaluate relaxation responses, vascular rings with endothelium were exposed to ET-1 and ET-3. To evaluate contraction responses, vascular rings with and without endothelium were exposed to ET-1 and ET-3 in the presence or absence of BQ 123 (ET(A) receptor antagonist) or TAK-044 (ET(A) and ET(B) receptor antagonist). RESULTS: Transient relaxation responses of vascular rings occurred after exposure of ET-1 and ET-3. These transient responses disappeared after preincubation with N-nitro-L arginine. There was an increased contractions of vascular rings according to increasing concentration of ET-1 and ET-3. The initial responses were enhanced in vascular rings without endothelium in ET-1 and ET-3. In vascular rings with endothelium, the contraction responses were more reduced in vascular rings with preincubation of BQ 123 than in vascular rings without BQ 123 in ET-1. In vascular rings without endothelium, the contraction responses were more reduced in vascular rings with preincubation of TAK-044 than in vascular rings without TAK-044 in ET-1. CONCLUSION: ET(B) receptor on the endothelium might mediate the transient vasodilator responses to ET-1 and ET-3 through release of nitric oxide in porcine coronary artery. ET(A) and ET(B) receptor on vascular smooth muscle cells might mediate vasoconstrictor responses to ETs.
Arginine ; Arteries ; Coronary Vessels* ; Endothelins* ; Endothelium ; Muscle, Smooth, Vascular ; Nitric Oxide ; Receptors, Endothelin ; Relaxation ; Swine

Nevus flammeus is a benign but cosmetically devascating congenital inalformation involving mature capillaries. The copper vapor laser is a therapeutic device which had been newly applied to this. Yellow copper vapor light is absorbed by the intraluminal oxyhemoglobulin mo ecules, leading to the destruction of blood vessels. This study was undertaken to evaluate the histobigic findings in a patient with nevus flammeus according to the sequential time after copper vapor laser therapy. The results were as followed, One hour after treatment, nonspecific damages to the epidermis and upper part of the dermis were observed. The specific damage to the vessels which showed thrombi formations and partial disruption of the vessel walls was prominent. One cay after treatment, degeneration of the epidermis and sepaiation of the dermoepidermal junction were apparent. Three days after treatment, extravasations of a small amount of erythrocytes and inflanimatory cell infiltrations were present, especially around the vessels. Seven days after treatment, the capillaries showed a deposition of fiorinoid material around themselves. Partial disappearance of the vessel walls was seen. There was hisi ologic evidence of the replacement of abnormal ectatic vessels by normal appearing vessels with small uminal diameters, surrounded by endothelial cells.
Blood Vessels ; Capillaries ; Copper* ; Dermis ; Endothelial Cells ; Epidermis ; Erythrocytes ; Humans ; Lasers, Gas* ; Nevus* ; Port-Wine Stain*

No abstract available.

Because of the frequent misdiagnosis of the carpal injury, the orthopedic surgeon must know the mechanism of injury and exact radiological interpretation. We had encountered 114 cases of carpal injury, in which carpal fracture, carpal dislocation and instability were analysed by radiological examination. The following results were obtained: 1. In 75 carpal bone fractures, the most common fracture was scaphoid fracture (64 cases), the next com- mon one was triangular fracture (4 cases). 2. Among the 64 scaphoid fractures, the waist portion was the most frequent site (45 cases) and the least was tubercle fracture (2 cases). 3. Of the carpal bone fractures, the fresh fracture was 48 cases (64%) and old one was 27 cases (36%), these showed sclerosis, cystic change, and degenerative change in radiological examination. 4. In 14 carpal dislocations, perilunar dislocation was 2.5 times move common than lunate dislocation, and the trans-scaphoid perilunar dislocation was the most common dislocation. 5. Carpal instability was 25 cases. These were dorsiflexion instability, navicular rotary subluxation, and pal- mar-flexion instability. The most common instability was dorsiflexion instability.
Carpal Bones ; Classification ; Diagnostic Errors ; Dislocations ; Incidence ; Orthopedics ; Sclerosis ; Wrist