Since the introduction of percutaneous balloon angioplasty by Gruentzig in 1979, percutaneous coronary intervention (PCI) has become the main treatment modality for the management of coronary heart disease. More than 1,000,000 PCI procedures are performed annually worldwide. With the advent of new therapeutic technologies, the indications for PCI have markedly expanded. Nowadays, improvements in balloon technology, popular use of coronary stent, and the proper administration of antiplatelet agents including GPIIbIIIa inhibitors have influenced the acute procedural outcomes. This technological and procedural advance in PCI has resulted in angiographic success rates of 96 to 99%, with Q-wave MI rates of 1 to 3%, emergency coronary bypass surgery rates of 0.2 to 3%, and unadjusted in-hospital mortality rates of 0.5~1.4%. However, despite the marked improvements in the acute outcome of PCI, long-term results including the restenosis rate are less impressive. The restenosis rate following balloon angioplasty reaches 30~40%, and is higher in certain clinical and angiographic subsets. The recent introduction of intracoronary stent and brachytherapy (intracoronary lesional ionizing radiation therapy) has a favorable impact on the restenosis precess including elastic recoil and intimal hyperplasia. Intracoronary stents decreased elastic recoil and remodeling and intracoronary radiation reduced intimal hyperplasia. Several randomized clinical trials to assess the efficacy of stents and intracoronary brachytherapy are ongoing with impressive results. In 2001, a breakthrough has been made in the prevention and the treatment of restenosis with the advent of a drug-eluting stent. Balloon-expandable stents coated with rapamycin or paclitaxol showed nearly 0% restenosis rate at 6-month follow-up. We might expect to solve restenosis completely in a very near future.
Angioplasty, Balloon ; Brachytherapy ; Coronary Disease ; Drug-Eluting Stents ; Emergencies ; Follow-Up Studies ; Hospital Mortality ; Hyperplasia ; Percutaneous Coronary Intervention* ; Platelet Aggregation Inhibitors ; Radiation, Ionizing ; Sirolimus ; Stents

No abstract available.
Foot*

No abstract available.
Coronary Artery Disease* ; Coronary Vessels*

BACKGROUND: It is now well established that hypercholesterolemia is an important cause of coronary heart disease, and clinical intervention studies have demonstrated the therapeutic value of correcting hypercholesterolemia. One of lipoprotein, lipoprotein(a) [LP(a)] contains one(or two) molecule of apo(a) linked to apo B100 by a disulphied bridge, is associated with an increased risk of coronary heart disease. NIDDM patients have a two-to fourfold increased risk of coronary heart disease relative to nondiabetic subjects. This excess risk is explained only partially by increased levels of standard risk factors. This study was conducted to assess the relatioship between serum Lp(a) levels and coronary heart disease. Furthermore, whether the Lp(a) level was related with NIDDM or not. METHODS: Total 83 subjects undergoing coronary angiography were evaluated on clinical risk factors and lipid profies with Lp(a). Among them, 24 subjects had normal coronary artery, while the others revealed significant stenosis of coronary arteries more than 50%. RESULTS: The serum Lp(a) levels of the CHD group were significantly higher than control group(37.4 +/- 31.8mg/dl vs 22.6 +/- 12.9mg/dl). Other lipids profile were not significantly dfferent between two groups. Serum Lp(a) levels had no relations to fasting blood sugar level. Multivariate logistic regression analysis of lipid parameters revealed that cholesterol, LDL-cholesterol, and Lp(a) were best discriminator among risk factors for coronary heart disease. But in our study, the serum cholesterol and LDL-cholesterol levels were within normal range. CONCLUSION: This study suggested that Lp(a) level was a significant independent risk factor for coronary heart disease whether there was fasting hyperglycemia or not.
Blood Glucose ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease* ; Coronary Vessels ; Diabetes Mellitus, Type 2* ; Fasting ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Clinical Trial ; Lipoprotein(a)* ; Lipoproteins ; Logistic Models ; Reference Values ; Risk Factors*

The pathophysiology of functional gastrointestinal disorder(FGID) is not completely understood, but the importance of the 'Brain-Gut Axis(BGA)' model in FGID is being increasingly recognized. The BGA model is a bidirectional, hard-wired and homeostatic relationship between the central nervous system(CNS) and the enteric nervous system(ENS) via neural, neurohormonal and neuroimmunological pathways. In addition, the BGA model would provide a rationale for the use of psychotropics on FGID. The authors experienced two cases in which duloxetine, a serotonin-norepinephrine reuptake inhibitor, was effective in relieving FGID symptoms as well as psychiatric symptoms such as depression and hypochondriacal anxiety. Therefore we discuss the vignettes from the perspective of BGA theory. Duloxetine showed efficacy in these two patients by reducing visceral hypersensivity (bottom-up regulation) and by relieving depression and anxiety(top-down regulation).
Anxiety ; Depression ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome ; Thiophenes

The increase of health care expenditures is an important problem in the almost countries. Also, suppression of the health care expenditures is an important problem in the health field of Korea since the national health insurance for total people in 1989. Thus, it is very important to grasp the change of the health care expenditures of family and proportions of the health care expenditures to total expenditures of family, because they are the basis of national health care expenditures in Korea. While the health care expenditures of urban family were increased during 1980-1993 by 12.8% annually, the total expenditures of urban family were increased by 14.8% annually. consequently, the proportions of health care expenditures to total expenditures were decreased from 5.98% to 4.76%. The proportions of health care expenditure for 3 years to come were predicted to 4.75% in 1994, 4.67% in 1995, and 4.63% in 1996 by the time-series ana]ysis. That is, it was predicted that they would be decreasing slowly. The product elasticity of health care expenditure was less than 1 in the multiple regression analysis, so the health care is normal good rather than superior good. Therefore, it seems that the household economy is able to bear the expense pursuing the improvement of quality of health care by actualizing the medical insurance fee.
Delivery of Health Care* ; Elasticity ; Family Characteristics ; Fees and Charges ; Hand Strength ; Health Expenditures* ; Humans ; Insurance ; Korea ; National Health Programs ; Quality of Health Care

BACKGROUND: Despite general agreement as to the safety and immediate success of percutaneous iliac angioplasty, its long-term efficacy remains subjects to debate and percutaneous transluminal angioplasty(PTA) induced dissection in the iliac artery may also lead to urgent surgery although frequency of this complication is not clearly stated in the literature. The relatively early result with the use of the Palmaz balloon-expandable intraluminal stent(BEIS) for treating atherosclerotic iliac artery and PTA-induced iliac artery dissections strongly suggest that Palmaz BEIS has its important role for limitations of PTA.It is generally accepted that indications for stent placement are (a) inadequate immediate postangioplasty response (b) restenosis after previous iliac balloon angioplasty, and (c) total iliac artery occlusion. METHODS: We report the successful implantation of Palmaz BEIS at right common iliac artery in a patients suffered from severe claudication. Previously the patients received PTA two times. First PTA resulted in intimal dissection and restenosis occurred after successful second PTA. RESULTS: After successful implantation of Palmaz BEIS, pressure gradients across the lesion and blood flow pattern were nearly normalized. The patients was discharged without symptom and was in good condition after 4 months follow-up. CONCLUSION: According to our this limited experience and other reports, stent placement in valuable adjunct in the management of iliac artery disease.
Angioplasty ; Angioplasty, Balloon ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Iliac Artery* ; Stents*

No abstract available.
Evoked Potentials, Auditory, Brain Stem* ; Rabbits*

Objective: This study identified the incidence and risk factors for headache attributed to acute pyelonephritis. Methods: The inclusion criteria were patients who were admitted with acute pyelonephritis at our hospital and ≥ 18 years of age. The following exclusion criteria were used: 1) patients who could not express their headache because of mental deterioration, 2) the presence of meningitis or meningoencephalitis, or 3) structural lesions on brain computed tomography or magnetic resonance images that could cause headache. The primary outcome was headache attributed to acute pyelonephritis as a dependent variable. The differences were analyzed using demographic and laboratory profiles as independent variables. Additionally, correlation analysis was performedbetweenseverity of headache using VAS score and demographic and laboratory profiles including age, WBC, and CRP. Results: A total of 479 patients met the inclusion criteria for this study, and 97 patients developed headache attributed to acute pyelonephritis. Patients with headache were younger and more likely to be female, and had a lower incidence of diabetes than those without headache. However, laboratory profiles that reflected the severity of acute pyelonephritis were not predictive factors for headache. Multiple logistic regression analysis demonstrated that young age and non-diabetes were independently significant variables for the prediction of headache attributed to acute pyelonephritis. In addition, the VAS score was found to be negative correlated with age, whereas it was not correlated with WBC and CRP. Conclusions: We determined that headache attributed to acute pyelonephritis was relatively common, and it was related to demographic characteristics but not acute pyelonephritis severity.
Pyelonephritis ; Headache

We expierienced five cases of bilateral inferior vena cava for recent one year. We evaluated the CT findings of the cases and of dilated veins located in the left retroperitoneum (seven left gonadal, seven inferior mesenteric, and two left ascending lumber veins)in the viewpoints of the size, location and relation with the surrounding structures. Bilateral inferior vena cava (IVC) may be asymmetric and the left IYC may be smaller than other retroperitoneal veins with a round contour. The left lYC was located anterior to the spinal body and corresponded with contralateral vena cava in the anteroposterior plane. The gonadal vein was located anterior or anterolateral side of the psoas and always crossed the ureter. Most of the inferior mesenteric vein showed similar location to the opposite site of the vena cava in the anterolateral side of the psoas muscle, medial to the left ureter without crossing. The left ascending lumbar vein was similarly located to the left vena cava but dilated in a short segment. It is required to trace the vessel upward and downward and observe its continuity for correct differentiation. If it is impossible, some differential points suggested in the results of our study will be helpful for distinguishing them.
Gonads ; Mesenteric Veins ; Psoas Muscles ; Ureter ; Veins* ; Vena Cava, Inferior