No abstract available.
Amphibians* ; HIV* ; Humans* ; Oocytes*

The incidence of coronary artery diseases in elderly patients has been increased in Korea. Coronary intervention may be one of the effective therapeutic modalities in elderly patients instead of coronary bypass surgery. We hereby report a case of coronary stenting in a 93 year-old male patient with unstable angina. He had a long segmental diffuse stenosis over middle left anterior descending coronary artery, which was treated successfully by long MicroStent II. He has no cardiovascular event or target vessel revascularization on two-year clinical follow-up.
Aged ; Angina, Unstable ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Stents*

Congenital coronary arteriovenous fistulas represent abnormal communication between coronary arteries and any cardiac chambers, pulmonary artery, coronary sinus, superior vena cava or pulmonary vein. A 60 year-old male patient presented with severe effort-induced chest pain radiating to left arm. Resting electrocardiogram was normal and anterior ischemia was demonstrated on stress myocardial SPECT. Coronary angiogram reve-aled very long and tortuous coronary arteriovenous fistulas originated from the left circumflex and right coronary artery, which drained into intercostal arteries. Proximal segment of left anterior descending artery stenosed about 50%. Both coronary artery fistulas were ligated and left internal mammary artery was grafted into left anterior descending artery. After surgical correction he has no cardiovascular events on 7-month clinical follow-up.
Arm ; Arteries ; Arteriovenous Fistula* ; Chest Pain ; Coronary Sinus ; Coronary Vessels ; Electrocardiography ; Fistula ; Follow-Up Studies ; Humans ; Ischemia ; Male ; Mammary Arteries ; Middle Aged ; Pulmonary Artery ; Pulmonary Veins ; Tomography, Emission-Computed, Single-Photon ; Transplants ; Vena Cava, Superior

OBJECTIVE: The goal of this study was to assess the effect of high-dose simvastatin on cerebral vasospasm and its clinical outcome after aneurysmal subarachnoid hemorrhage (SAH) in Korean patients. METHODS: This study was designed as a prospective observational cohort study. Its subjects were aneurysmal SAH patients who had undergone aneurysm clipping or coiling. They were assigned to 1 of 3 groups : the 20 mg, 40 mg, and 80 mg simvastatin groups. The primary end-point was the occurrence of symptomatic vasospasm. The clinical outcome was assessed with the modified Rankin Scale (mRS) score after 1 month and 3 months. The risk factors of the development of vasospasm were assessed by logistic regression analysis. RESULTS: Ninety nine patients with aneurysmal SAH were treated and screened. They were sequentially assigned to the 20 mg (n=22), 40 mg (n=34), and 80 mg (n=31) simvastatin groups. Symptomatic vasospasm occurred in 36.4% of the 20 mg group, 8.8% of the 40 mg group, and 3.2% of the 80 mg group (p=0.003). The multiple logistic regression analysis showed that poor Hunt-Hess grades (OR=5.4 and 95% CI=1.09-26.62) and high-dose (80 mg) simvastatin (OR=0.09 and 95% CI=0.1-0.85) were independent factors of symptomatic vasospasm. The clinical outcomes did not show a significant difference among the three groups. CONCLUSION: This study demonstrated that 80 mg simvastatin treatment was effective in preventing cerebral vasospasm after aneurysmal SAH, but did not improve the clinical outcome in Korean patients.
Aneurysm* ; Cohort Studies* ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Logistic Models ; Prospective Studies* ; Risk Factors ; Simvastatin* ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial*

Antiphospholipid antibody syndrome (APS) is defined as the presence of lupus anticoagulant antibody or anticardiolipin antibody with vascular thrombosis or pregnancy complications. APS can be associated with autoimmune disease or infectious disease. APS has also been reported in conjunction with variety of solid and hematologic malignancies. There were some reports on APS which were accompanied by hematologic malignancy, but there was no report with solid malignancy in Korea. We experienced one case of secondary APS, which was diagnosed during pre-operative evaluation of thyroid cancer. This patient had prolonged aPTT (activate partial thromboplastin time) and decreased coagulation factors which were regarded as hemophilia at first. Although the precise mechanism of the relationship between APS and cancer has not been proven thoroughly, APS can be accompanied by various malignancies. So proper screening and early detection of malignancies in APS patients are recommended.
Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome ; Autoimmune Diseases ; Blood Coagulation Factors ; Communicable Diseases ; Hematologic Neoplasms ; Hemophilia A ; Humans ; Korea ; Lupus Coagulation Inhibitor ; Mass Screening ; Pregnancy Complications ; Thromboplastin ; Thrombosis ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND: The most important acute complication of percutaneous transluminal coronary angioplasty (PTCA) is abrupt closure by dissection and thrombus, which account for the majority of deaths and emergency coronary artery bypass procedures associated with PTCA. We sought to determine the relationship between clinical, angiographic characteristics and abrupt thrombotic closure related to coronary intervention. METHODS: One hundred thirty two patients (61.6+/-8.0 year, 98 male) underwent PTCA or stenting under the diagnosis of acute myocardial infarction were analyzed at Chonnam University Hospital between Jan '97 and Jun '98. Patients were divided into two groups, one, 14 patients (Group A, 61.7+/-8.0 year, 9 male), who developed thrombotic occlusion, and the other, 118 patients (Group B, 61.5+/-8.0 year, 89 male) who did not develop abrupt closure related to the coronary intervention. RESULT: There were no significant differences in age, sex, risk factors, activated partial thromboplastin time, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, location of lesion, branch involvement, lesion severity, AHA/ACC morphology between two groups. The incidence of intra-coronary thrombus was greater in Group A than in Group B (44% vs. 2%, p=0.025). Acute thrombotic occlusion related to the coronary interventions developed more frequently in the lesions within two days after the symptomatic onset (55% vs. 19%, p=0.035) and in the right coronary artery (RCA) lesions (55% vs. 24%, p=0.041). CONCLUSION: Predictors of abrupt thrombotic occlusion during coronary intervention in patients with acute myocardial infarction are intracoronary thrombus, earlier intervenion within 2 days after onset of aucte myocardial infarction and RCA lesion.
Angioplasty, Balloon, Coronary ; Blood Sedimentation ; C-Reactive Protein ; Coronary Artery Bypass ; Coronary Vessels ; Diagnosis ; Emergencies ; Fibrinogen ; Humans ; Incidence ; Jeollanam-do ; Myocardial Infarction* ; Partial Thromboplastin Time ; Risk Factors ; Stents ; Thrombosis

BACKGROUND AND OBJECTIVES: Angiotensin converting enzyme inhibitor (ACEI) is known to be effective in the prevention of left ventricular failure (LVF) after acute myocardial infarction. The aim of this study was to investigate the efficacy of an ACEI, Cilazapril, on left ventricular remodeling in patients with ischemic LVF, who underwent coronary interventions. MATERIALS AND METHODS: Cilazapril, 2.5 - 5.0 mg per day was administ-ered 12 weeks after coronary interventions in 25 patients (18 M, 7 F, 61.5+/-9 years) with impaired LV function (ejection fraction< or = 50%). Fifteen patients (9 M, 6 F, 59.4+/-7 years) without ACEI were compared by clinical examinations, blood chemistry, electrocardiogram and echocardiogram with Cilzapril group at 2, 4, 8 and 12 weeks after intervention. RESULTS: Blood pressure and heart rate were not changed after Cilazapril. LV end-diastolic volume (LVEDV) decreased from 153.1+/-38.7 to 135.6+/-25.5 ml and end-systolic volume from 84.9+/-34.7 to 72.6+/-25.1 ml after 12-week Cilazapril p=0.003, p=0.001. Ejection fraction (EF) was increased from 44.4+/-3.2 to 52.4+/-2.8% after 12 weeks of Cilazapril p=0.034. In control group, LVEDV was changed from 152.7+/-44.6 to 143.6+/-28.7 ml, which failed to show significant reduction. Side effects of Cilazapril were 3 dry cough (3/25, 12%) and 1 facial edema, 1 hypotension and 1 dizziness. CONCLUSION: Cilazapril is a beneficial adjunctive therapeutic agent in patients with ischemic left ventricular failure for the prevention of ventricular dilatation, especially after coronary intervention.
Blood Pressure ; Chemistry ; Cilazapril* ; Cough ; Dilatation ; Dizziness ; Edema ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Hypotension ; Myocardial Infarction ; Peptidyl-Dipeptidase A ; Ventricular Remodeling*

PURPOSE: To evaluate the usefulness of percutaneous transhepatic biliary drainage (PTBD) tract dilatation using a Nipro set. MATERIALS AND METHODS: We dilated 28 percutaneous biliary drainage tracts up to 18F ; 26 procedures involved PTBD, and two, cholecystostomy. A Nipro set was used for dilatation, the purposes of which were stone removal (n=18) and choledochoscopic biposy (n=10). For dilatation, local anesthesia was used in all cases. RESULTS: In all patients, tract dilatation was successful. In 21 of 28 cases, dilatation of the right PTBD tract was involved, and in five of 28, dilatation of the left tract. In two cases, tract dilatation was done in cholecystostomy tracts. Complications encountered were pain (n=17), bradycardia (n=2), hemobilia (n=2), bleeding (n=1)and fever (n=1). CONCLUSION: In choledocoscopy, tract dilatation using a Nipro set is safe and simple.
Anesthesia, Local ; Biliary Tract* ; Bradycardia ; Cholecystostomy ; Dilatation* ; Drainage ; Fever ; Hemobilia ; Hemorrhage ; Humans

PURPOSE: To evaluate the diagnostic efficacy of gastric air filling during DSA-hepatic arteriography of the left lobe in overcoming the pitfalls caused by accessory left gastric artery and left hepatic artery from left gastric artery. MATERIALS AND METHODS: In a prospective study, standard hepatic arteriogram and hepatic arteriogram after ingestion of an effervescent agent were performed in 22 patients with anatomic variation of the celiac axis. The anatomic variations were accessory left gastric artery in 15 patients and left hepatic arteryfrom left gastric artery in seven. RESULTS: Hepatic arteriogram after ingestion of an effervescent agent was excellent in differentiating nodular stomach staining from hepatic tumor staining in the left hepatic lobe in patients with accessory left gastric artery, and for evaluation of the left hepatic lobe when this was obscured by stomach staining. CONCLUSION: Hepatic arteriogram after ingestion of an effervescent agent is a simple and safe method for overcoming angiographic pitfalls due to anatomic variation.
Anatomic Variation ; Angiography* ; Angiography, Digital Subtraction ; Arteries ; Axis, Cervical Vertebra ; Eating ; Hepatic Artery ; Humans ; Prospective Studies ; Stomach

OBJECTIVE: Brief epidodes of ischemia have been shown to make the heart more resistant to subsequent ischemia in animal studies(known as ischemic preconditioning, IP). This phenomenon was tested in patients undergoing percutaneous transluminal coronary angioplasty(PTCA). METHODS: Thirteen patients who had significant epicardial coronary stenosis without myocardial infarction, ventricular hypertrophy or conduction defect, received two to four 2-min balloon inflations separated by 5 min of reperfusion. Surface electrocardiogram(S-ECG) and intracoronary electrocardiogram (IC-ECG) from an angioplasty guide wire were recorded before and after balloon inflation. RESULTS: The changes of ST segment were observed in 13 out of 15 lesions on IC-ECG and 7 on S-ECG. The maximal ST changes on IC-ECG and S-ECG were 20.2+/-13.7mm and 1.21.5mm respectively(p<0.01). The time to beginning of ST segment change after balloon inflation were 10.1+/-12.6 seconds and 63.3+/-14.2 seconds on IC-ECG and S-ECG, respectively(p<0.01). The maximal changes of ST segment on IC-ECG during the second inflation were significantly lower than that during the first(20.2+/-13.7 vs 16.312.3mm, p<0.05). However, changes of R wave, T wave and QT interval were not significantly different between two inflations. The recovery time to baseling ECG after initiation of reperfusion were 50.2+/-41.7 seconds and 38.5+/-29.6 seconds for the first inflation and the second, respectively(P<0.05). CONCLUSION: These results suggest that IC-ECG is more sensitive and reliable than S-ECG in detection of myocardial ischemia and that IP may occur during PTCA since ST segment shift is decreased and is normalized earlier at the second balloon inflation compared with the first.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Animals ; Coronary Stenosis ; Electrocardiography* ; Heart ; Humans ; Hypertrophy ; Inflation, Economic ; Ischemia ; Ischemic Preconditioning ; Myocardial Infarction ; Myocardial Ischemia ; Reperfusion