No abstract available.
Humans

BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

No abstract available.
Humans ; Stomach Neoplasms*

BACKGROUND: The detection of specific autoantibodies in the sera of patients with systemic rheumatic diseases plays a key role in the differential diagnosis. Enzyme-linked immunosorbent assays (ELISA) is known as sensitive and semiquantitative method to detect autoantibodies and ELISA kits using a recombinant fusion protein as antigen have been developed. So, various commercial ELISA have recently become available in a diagnostic laboratory. We investigated the clinical value of antinuclear autoantibodies using commercial ELISA kits. METHODS: The serum of 90 patients were tested for autoantibodies to SSA/Ro, SSB/La, nRNP/Sm and Sm antigens by ELISA using four commercial kits, EL-ANA(TM) (TheraTest, IL, USA), DIASTAT(TM)(SHIELD, DUNDEE, UK), QUANTALit(TM) (INOVA, CA, USA), Varelisa(TM) (elias, WI, USA). We evaluated the clinical usefulness of panel test of Varelisa(TM) in the diagnosis of systemic rheumatic diseases. RESULTS: The concordance rates of four ELISA kits for autoantibodies to SSA/Ro, SSB/La, RNP/Sm and Sm antigens were 83.6%, 74.5%, 87.5% and 80.0%, respectively. Using panel test of Varelisa(TM), positive rates of autoantibodies to Ul-snRNP, nRNP/Sm, Sm, SSA/Ro, SSB/La, Scl-70, CENP and Jo-1 antigens in SLE were 30.0, 40.0, 33.3, 46.7, 20.0, 20.0, 10.0, and 0%, respectively. Of 30 patients with SLE, 16 (53.3%) were positive for 2 or more antibodies. CONCLUSIONS: EL-ANA(TM), QUANTALite(TM) and Varelisa(TM) show more positive rates than DIASTAT(TM). The difference in the positive rates among four commercial ELISA kits may come from the different antigen sources. The panel test of 8 autoantibodies using Varelisa(TM) ELISA kit offers discriminative power and enhances the specificity of the assay in patients who lack clear evidence of clinically definite autoimmune disease.
Antibodies ; Autoantibodies* ; Autoimmune Diseases ; Diagnosis ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay* ; Histidine-tRNA Ligase ; Humans ; Rheumatic Diseases ; Sensitivity and Specificity ; Staphylococcal Protein A

No abstract available.
Echocardiography, Transesophageal* ; Foramen Ovale, Patent*

BACKGROUND: The Fas/Fas ligand (FasL) system plays an important role in apoptosis by involvement in various immunologic functions, especially the removal of autoreactive and activated T-cells. sFas is a variant of the Fas receptor molecule, which lacks the transmembrane domain by alternative splicing of Fas mRNA and has an inhibitory effect in apoptosis by inhibition of the Fas/FasL pathway. sFasL is a coverted form of FasL by metalloproteinase and is increased in various malignant and autoimmune diseases. In this study, we investigated the expression of sFas and sFasL in systemic lupus erythematosus (SLE) and evaluated their usefulness as markers of disease activity. MATERIALS AND METHODS: The concentration of sFas and sFasL in sera from 43 patients with SLE, 17 with rheumatoid arthritis (RA) and 15 normal healthy persons were measured using sFas (S) ELISA Kit and sFas Ligand ELISA Kit (MBL Co., LTD., Nagoya, Japan), respectively. Twenty of 43 SLE sera were paired samples of 10 patients obtained on admission and discharge. RESULTS: The concentration of sFas in SLE (3.12 +/- 2.28 ng/mL) was significantly higher than in RA (2.23 +/- 0.37 ng/mL) and in the normal control (2.12 +/- 0.33 ng/mL). In particular, the concentration of sFas in sera on admission (4.35 +/- 3.68 ng/mL) was significantly higher than in the sera on discharge (2.89 +/- 0.66 ng/mL), but, the concentration of sFasL among the 3 groups was not statistically different. CONCLUSIONS: These results suggest that apoptosis is involved in the pathogenesis of SLE and sFas might be a useful marker as a predictor of disease activity. Further study on the correlation between sFas and other disease activity markers, such as CRP, CH50, CD4 cell count and autoantibody titer is needed. Also, the evalution of sFas as a predictor of disease progression on follow-up studies of these patients is needed.
Alternative Splicing ; Antigens, CD95 ; Apoptosis ; Arthritis, Rheumatoid ; Autoimmune Diseases ; CD4 Lymphocyte Count ; Disease Progression ; Enzyme-Linked Immunosorbent Assay ; Fas Ligand Protein* ; Follow-Up Studies ; Humans ; Lupus Erythematosus, Systemic* ; RNA, Messenger ; T-Lymphocytes

Two patients, bulging fetal membrane accompanied with cervical dilatation & effacement in the late second-trimester, were treated by modified Shirodkar method. Pregnancies were prolonged effectively and viable fetuses were delivered in both cases. Our cases may help make objective decision prior to attempting cerclage placement when cervix is markedly dilated and something should be done to save pregnancy.
Cervix Uteri ; Extraembryonic Membranes* ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Uterine Cervical Incompetence*

PURPOSE: To analyze the predictors of the antimuscarinic treatment response for female patients with an overactive bladder (OAB). MATERIALS AND METHODS: Eighty women diagnosed with an OAB, who had also undergone 3 months of treatment with propiverine hydrochloride (20mg/day), were enrolled. All patients were assessed by history taking, physical examination, urinalysis, frequency/volume charts and urodynamic study (UDS) prior to treatment; frequency/volume charts and a patients' satisfaction were analyzed 3 months after treatment. Patients were divided into satisfied, moderate and unsatisfied groups according to their subjective satisfaction. RESULTS: Subgroups according to the patients' subjective satisfaction included 57, 14 and 9 patients for satisfied, moderate and unsatisfied group, respectively. In the UDS, detrusor overactivity was noted in 15 patients of the satisfied group, 2 of the moderate group, but none of the unsatisfied group. Maximum detrusor pressure and detrusor pressure at maximum flow were higher in the unsatisfied group. The incidence of bladder outlet obstruction (BOO) was higher in the moderate and unsatisfied groups. In pre-treatment frequency/volume chart, the frequency of urge symptom was significantly increased in the satisfied group. Comparing the pre- and post-treatment frequency/volume charts revealed that the satisfied and moderate groups showed decreased frequency and nocturia, and increased functional bladder capacity compared to unsatisfied group after treatment. CONCLUSIONS: The efficacy of antimuscarinic treatment in female OAB could be associated with the frequency of urge symptom, detrusor overactivity and BOO; an UDS may aid in predicting the efficacy of antimuscarinic treatment.
Female* ; Humans ; Incidence ; Muscarinic Antagonists ; Nocturia ; Physical Examination ; Urinalysis ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Bladder, Overactive* ; Urodynamics

Forty year old woman with dysphagia underwent surgical correction of complete vascular ring formed by right aortic arch, Kommerell's diverticulum and ligamentum arteriosum. Operation consisted of ligamentum division, reduction diverticuloplasty and posterior diverticulopexy via left posterolateral thoracotomy. Dysphagia was relieved postoperatively, and concentic narrowing of esophagus in the level of aortic arch disappeared on postoperative esophagography.
Aorta, Thoracic ; Deglutition Disorders ; Diverticulum* ; Esophagus ; Female ; Humans ; Thoracotomy

Injury of the ankle ligaments is one of the most common sports-related injuries. Although there are some debates as to the best initial treatment for an acute tear of a lateral ligament, persistent functional instability of the ankle develops in approximately 20% of patients regardless of the type of initial treatment. In these patients, late reconstruction of the lateral ankle ligaments may become necessary. Among 13 cases which have been operated with Larsen procedure using peroneus brevis tendon from March 1991 to February 1993, the 11 cases followed up over 1 year were examined clinically and radiologically. We introduced the clinical analysis and results with the brief review of the literatures. 1. The indication of surgical treatment was the ankle instability which had differences over 10° in talar tilting angle or over 3mm in anterior displacement compared wit the uninjured site. 2. The postoperative results were 5 cases in excellent and 4 in good. 3. The Larsen procedure was considered a good method to anatomically and simply stabilize both the ankle and subtalar joint and to fix tendon depending on the type of instability.
Ankle ; Collateral Ligaments ; Humans ; Ligaments ; Methods ; Subtalar Joint ; Tears ; Tendons