BACKGROUND: With the recent development in arterial reconstructive procedure such as percutaneous transluminal coronary angioplasty or atherectomy, the incidence of vascular complications involving femoral artery is increasing due to greater use of larger percutaneous instruments(including arterial sheath) and periprocedural anticoagulant therapy. Femoral pseudoaneurysm requires rapid diagnosis and management to prevent limb ischemia, worsening of the arterial injury or repair of the arterial defect. Recently, accurate diagnosis of these injuries can be made nonivasively with duplex sonography and Doppler color flow imaging, and nonsurgical treatment may be possible by using external compression guided by ultrasound even in patients requiring prolonged anticoagulant therapy. METHOD: Three patients, one undergoing coronary angiography and two undergoing percutaneous transluminal coronary angioplasty, developed expansile groin masses at the vascular access sites diagnosed as femoral artery pseudoaneurysm s by Doppler ultrasound. All patients were hypertensives, taking aspirin and two patients who underwent PTCA received intravenous heparin after procedure. After diagnosis of femoral pseudoaneurysm, all patients underwent mechanical(C-clamp) external compression guided by ultrasound for 3 hours. RESULT: Follow up color flow scans were obtained after 24 hours and in one patients, blood flow in the tract was eliminated but persistent blood flow was observed in two patients who underwent PTCA. Before closure of pseudoaneurysm, one patient needed another 6 hours of ultrasound guided compression and the other needed more 12 hours. All patients were discharged without complication or recurrence of pseudoaneurysm. CONCLUSION: These cases suggest that nonsurgical closure of femoral pseudoaneurysms is feasible even in patients requiring prolonged antiplatelet and anticoagulant therapy.
Aneurysm, False* ; Angioplasty, Balloon, Coronary ; Aspirin ; Atherectomy ; Cardiac Catheterization* ; Cardiac Catheters* ; Coronary Angiography ; Diagnosis ; Extremities ; Femoral Artery ; Follow-Up Studies ; Groin ; Heparin ; Humans ; Incidence ; Ischemia ; Recurrence ; Ultrasonography

PURPOSE OF REVIEW: Rheumatoid arthritis (RA) is characterized by a chronic T-cell response that has escaped normal control mechanisms. This review summarizes recent insights in pathways that are functional in RA and that favor continuous and pathogenic T-cell activation. RECENT FINDINGS: T-cell activation is ultimately determined by positive signals from costimulatory molecules and negative signals from regulatory T cells. Blockade of the classic costimulatory pathway, CD28-CD80 or CD86, is beneficial in RA. Additional pathways that predominantly control the activation of memory and effector T cells are functionally important in synovial inflammation. Some of these costimulatory molecules(such as stimulatory killer cell immunoglobulin-like receptors and NKG2D) appear to be relatively specific for RA and not to play a role in normal immune responses. In addition to this predominance of positive signals, age-disproportionate decline in thymic activity in RA may lead to a diminution of regulatory T cells and loss of their negative signals. SUMMARY: The successful treatment trial of RA with CTLA-4Ig clearly documents the importance of T-cell costimulation in RA disease activity. Novel costimulatory pathways may be of even greater significance than CD28 in RA and may represent promising new therapeutic targets. The finding of reduced thymic activity in RA is exciting and will stimulate further studies of T-cell homeostasis and the function of regulatory cells.
Arthritis, Rheumatoid* ; Autoimmunity ; Homeostasis ; Inflammation ; Lymphocytes* ; Memory ; Receptors, KIR ; T-Lymphocytes ; T-Lymphocytes, Regulatory ; United Nations

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

Beh et's syndrome is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Vascular complications consist of venous thromboembolism, arterial aneurysms and occlusions, and they develop in about 25% of patients. Weakening of the aortic wall may lead to aneurysms that may rupture and cause life-threatening hemorrhage, but nothing in the surgical and nonsurgical techniques proposed for the treatment for aneurysms in Beh et's syndrome has proved to be satisfactory. The traditional treatment for thoracic aotic aneurysms is the surgical replacement of a prosthetic graft. Although advances in the operative care of patients with thoracic aortic aneurysms have been achieved, the associated morbidity and mortality are considerable, especially in those with coexisting conditions such as advanced age, coronary artery disease and heart failure. Currently, transluminally placed endovascular stent-grafts offer an alternative approach to treatment that is potentially less invasive with a lower risk. We report a 37-year-old male patient with thoracic aortic aneurysm associated with Beh et's syndrome. Transluminal endovascular stent-graft placement was attempted : the stent-graft was introduced through a 22-Fr sheath using a common femoral artery cut down and expanded to 25-30 mm in diamter. There was increased thrombosis of the aneurysm on a follow-up imaging study, and the patient was discharged without complications.
Adult ; Aneurysm ; Angioplasty ; Aortic Aneurysm, Thoracic* ; Behcet Syndrome* ; Coronary Artery Disease ; Femoral Artery ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mortality ; Rupture ; Thrombosis ; Transplants ; Ulcer ; Venous Thromboembolism

Beh et's syndrome is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Vascular complications consist of venous thromboembolism, arterial aneurysms and occlusions, and they develop in about 25% of patients. Weakening of the aortic wall may lead to aneurysms that may rupture and cause life-threatening hemorrhage, but nothing in the surgical and nonsurgical techniques proposed for the treatment for aneurysms in Beh et's syndrome has proved to be satisfactory. The traditional treatment for thoracic aotic aneurysms is the surgical replacement of a prosthetic graft. Although advances in the operative care of patients with thoracic aortic aneurysms have been achieved, the associated morbidity and mortality are considerable, especially in those with coexisting conditions such as advanced age, coronary artery disease and heart failure. Currently, transluminally placed endovascular stent-grafts offer an alternative approach to treatment that is potentially less invasive with a lower risk. We report a 37-year-old male patient with thoracic aortic aneurysm associated with Beh et's syndrome. Transluminal endovascular stent-graft placement was attempted : the stent-graft was introduced through a 22-Fr sheath using a common femoral artery cut down and expanded to 25-30 mm in diamter. There was increased thrombosis of the aneurysm on a follow-up imaging study, and the patient was discharged without complications.
Adult ; Aneurysm ; Angioplasty ; Aortic Aneurysm, Thoracic* ; Behcet Syndrome* ; Coronary Artery Disease ; Femoral Artery ; Follow-Up Studies ; Heart Failure ; Hemorrhage ; Humans ; Male ; Mortality ; Rupture ; Thrombosis ; Transplants ; Ulcer ; Venous Thromboembolism

No abstract available.
Chemoradiotherapy ; Humans ; Hysterectomy ; Uterine Cervical Neoplasms

Myocardial bridging is defined as a condition where a segment of a major epicardial coronary artery running intramurally through the myocardium. Although this abnormality is usually regarded as an incidental finding at angiography, it has been associated with myocardial ischemia, infarction, and sudden death. Standard treatment involves beta-adrenergic receptor blockers, surgery with dissection of the overlying muscle fibers, or coronary artery bypass grafting. A few cases of the intracoronary stent implantation have been reported as an alternative treatment in individual patients with myocardial bridging. We report a case of intracoronary stenting in a severe systolic narrowing at the middle segment of the left anterior descending artery in a patient complaining of recurrent chest pain despite medical treatment.
Angiography ; Arteries ; Chest Pain ; Coronary Artery Bypass ; Coronary Vessels ; Death, Sudden ; Humans ; Incidental Findings ; Infarction ; Myocardial Bridging* ; Myocardial Ischemia* ; Myocardium ; Running ; Stents*

Communication between coronary arteries and cardiac chambers or large vessels is unusual type of congenital malformation. Aneurysmal formation of a coronary arteriovenous fistula is even rare. We report a case of 83-year-old women with giant aneurysm of the coronary arteriovenous fistula from the left anterior descending coronary artery treated by percutaneous deployment of embolization coil.
Aged, 80 and over ; Aneurysm* ; Arteriovenous Fistula* ; Coronary Vessels ; Embolization, Therapeutic ; Female ; Humans

BACKGROUND: The Rheumatoid Factor (RF) is the only serological marker in the diagnosis of rheumatoid arthritis (RA), but its sensitivity and specificity are not satisfactory for the diagnosis of RA. Therefore, we investigated the diagnostic performance of a new anti-cyclic citrullinated peptide antibodies test (anti-CCP) by the enzyme-linked immunosorbent assay (ELISA) in RA. METHODS: A cyclic peptide variant that contains citrulline was used as an antigenic substrate in ELISA. We performed the RF and anti-CCP in 324 RA patients, 251 non-RA patients (rheumatic diseases other than RA), and 286 normal individuals. Diagnostic performances such as sensitivity and specificity were evaluated by the receiver-operator characteristics (ROC) curve at optimal cut-off values. The optimal cut-off values were determined at the maximal point of the area under the curve. RESULTS: The sensitivity and specificity of anti-CCP were 72.8% and 92% at 3.8 U/mL. The sensitivity and specificity of RF were 80.6% and 78.5% at 9 U/mL. The sensitivity and specificity of anti-CCP and RF were 67%, 95.2% and 63.3%, 90% at 8.4 U/mL, 20 U/mL, respectively. A combination of anti-CCP with RF increased the sensitivity and specificity to 79.3%, 96.4%, respectively. Anti-CCP was positive in 23.8% among 63 sero-negative RA patients. CONCLUSIONS: We considered that the anti-CCP might be useful as another new serological marker for the diagnosis of a RA combination with RF, or not, because the anti-CCP has a higher diagnostic specificity than the RF and was an easy, convenient ELISA method in performance.
Antibodies* ; Arthritis, Rheumatoid* ; Citrulline ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Humans ; Rheumatoid Factor ; Sensitivity and Specificity