OBJECTIVES: This study evaluates the change of the left atrial appendage function before and after electrical cardioversion to understand the mechanism involved in systemic thromboembolism of atrial fibrillation. BACKGROUND: Systemic thromboembolism associated with electrical cardioversion of atrial fibrillation is thought to originate from the left atrium or left atrial appendage, or both.However, the mechanism involved is poorly understood. METHOD: We studied left atrial appendage function funcction with transesophageal echocardiography in 15 patients with atrial fibrillation before and after successful electrical cardioversion. We measured left atrial appendage emptying and filling velocities and left atrial appendage areas. Also we analysed the characteristic Dopper flow pattern of LAA. RESULT: Left atrial appendage emptying velocities before cardioversion were greater in patients without(32.0+/-13.2cm/sec) than in those with(21.4+/-7.6cm/sec) spontaneous echo contrast(SEC). Furthermore emptying velocities after cardioversion were significantly reduced group with (21.4+/-7.6 vs 12.2+/-9.6, p<0.05) and the groupwithout(32.0+/-13.2 vs 18.1+/-10.2, p<0.05)SEC. CONCLUSION: After electrical cardioversion for atrial fibrillation left atrial appendage function is impaired. These observations suggest that stunned left atrial appendage after cardioversion may predispose to thrombus formation, which may play a role in the mechanism involved in the occurrence of thromboembolism after cardioversion.
Atrial Appendage* ; Atrial Fibrillation* ; Echocardiography, Transesophageal* ; Electric Countershock* ; Heart Atria ; Humans ; Thromboembolism ; Thrombosis

A 36-year-old woman was presented with extensive anterior wall myocardial infarction. We tried to perform direct coronary angiography for the purpose of primary stenting. However, coronary angiogram revealed normal coronary arteries without intracoronary thrombi. We continued further evaluations to find out the cause of normal coronary myocardial infarction. The findings of severe hypertensive retinopathy and concentric left ventricular hypertrophy suggested that she had secondary hypertension. The detailed history, laboratory and radiological findings revealed the pheochromocytoma. The tumor was successfully removed by operation.
Adult ; Anterior Wall Myocardial Infarction ; Coronary Angiography ; Coronary Vessels ; Female ; Humans ; Hypertension ; Hypertensive Retinopathy ; Hypertrophy, Left Ventricular ; Myocardial Infarction* ; Pheochromocytoma* ; Stents

BACKGROUNG AND OBJECTIVES: Diabetes mellitus is a significant risk factor for adverse outcome after PTCA, which is associated with an increased late mortality and target lesion revascularization (TLR) rates. The beneficial role of coronary stenting on the clinical and angiographic outcomes of diabetic patients is not clearly defined. The aim of this study was to evaluate the early and mid-term outcomes in diabetic patients undergoing elective stenting of native coronary lesions compared with those in non-diabetic patients. MATERIALS AND METHODS: Between July 1997 and June 1998, coronary stenting was performed on 46 lesions in 38 diabetic patients and 126 lesions in 117 non-diabetic patients. Follow-up angiography at mean day of 189+/-45 was performed in 58.7% (91 patients) and analysed by quantitative coronary angiography (QCA). RESULTS: There was a higher incidence of multi-vessel disease in diabetic patients than non-diabetic patients but not statistically significant (71.1% vs 51.3%, p=0.106). There were no differences in major procedural complications and in-hospital events (myocardial infarction, angina and death) in diabetics and non-diabetics. During the follow-up, the incidence of target lesion revascularizton (TLR) and cardiac event free survival did not differ between two groups. CONCLUSION: Coronary stenting in diabetics resulted in a low rate of immediate procedural com-plications and early major adverse cardiac event (MACE), similar to non-diabetics. There were no differences in the mid-term clinical and angiographic outcomes in diabetics and non-diabetics.
Angiography ; Coronary Angiography ; Diabetes Mellitus ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Infarction ; Mortality ; Risk Factors ; Stents*

BACKGROUNG AND OBJECTIVES: It was reported that low molecular weight heparin (LMWH) was more effective than unfractionated heparin in patients with acute coronary syndrome. Recent studies have shown that the pathophysiology of restenosis in stented lesions was different from those of nonstented lesions. Treatment strategies designed to limit cellular proliferation that were ineffective in nonstented lesions may be efficacious in reducing in-stent restenosis. This study was aimed to compare the clinical and angiographic results of LMWH (nadroparin) after coronary stenting with those of conventional ticlopidine regimen. MATERIALS AND METHODS: Patients were eligible for inclusion if they had angina and/or objective evidence of myocardial ischemia, and a significant (>50%) stenosis that was documented on a recent coronary angiogram. After stenting, prospective randomized comparison study was performed. Patients were randomly assigned to either nadroparin (200 IU/kg, sc, bid) or ticlopidine (250 mg bid) plus aspirin (200 mg qd) treatment groups. Repeat coronary angiography (KERN=*)was performed at 236+/-90days after stenting, and quantitative coronary angiographic analysis (QCA) was done. RESULTS: Intracoronary stent implantation was performed in eighty five lesions in eighty one patients (ticlopidine:40, nadroparin:41). There was no significant difference in any baseline clinical/angiographic variables between the two treatment groups. There were no subacute stent thrombosis, infarction and death in both groups. Six-month event-free survival was 36 (90%) in the ticlopidine group and 35 (85.4%) in the nadroparin group. Follow-up quantitative angiographic data such as late loss (1.35+/-0.70 vs 1.32+/-0.69), loss index (0.53+/-0.70 vs 0.56+/-0.23) and restenosis rate (36% vs 25.8%) were not different between ticlopidine and nadroparin groups. CONCLUSION: Effects of nadroparin were not different from those with ticlopidine therapy in the prevention of restenosis and subacute stent thorombosis after coronary stenting. Clinical outcomes between two strategies were similar. Low molecular weight heparin may be an alternative to ticlopidine in patients that ticlopidine cannot be administered because of severe adverse effects.
Acute Coronary Syndrome ; Aspirin ; Cell Proliferation ; Constriction, Pathologic ; Coronary Angiography ; Disease-Free Survival ; Follow-Up Studies ; Heparin ; Heparin, Low-Molecular-Weight ; Humans ; Infarction ; Myocardial Ischemia ; Nadroparin* ; Prospective Studies ; Stents* ; Thrombosis ; Ticlopidine*

BACKGROUND AND OBJECTIVES: The goal of this study was to examine the safety and feasibility of a primary (direct) stenting in acute myocardial infarction (AMI). In the treatment of AMI, Percutaneous transluminal coronary angioplasty (PTCA) has documented superior reperfusion rate and improved clinical outcomes than thrombolytic therapy. However, there are several limitations of PTCA, such as recurrent ischemia in 10 to 15%, reinfarction in 3 to 5% and restenosis in 30 to 50% of patients. There are several reports that, compared with PTCA, the implantation of coronary stent has been shown to reduce angiographic restenosis and improve late clinical outcomes. But in general, stenting has been contraindicated in thrombus containing lesion due to the risk of subacute thrombosis. With advance in technique and the recognition of the importance of adequate platelet inhibition, the incidence of subacute thrombosis has fallen in patients with acute coronary syndrome and thrombus laden lesion. Methods and Results: In our study, primary stenting was performed in 42 patients of AMI. There are 6 cases (22.5%) target lesion restenosis during the follow up coronary angiography (150+/-86day) and no in-hospital death. Three cases (7.1%) of them require revascularization including two re-PCTA and a coronary artery bypass graft for the recurrent ischemic symptoms. There were no reinfarction and death after discharge. Six-months event free survival reate was 85.7%. CONCLUSION: Primary stenting is safe and feasible in the majority of patients with AMI and results in excellent mid-term outcomes compared with PTCA.
Acute Coronary Syndrome ; Angioplasty, Balloon, Coronary ; Blood Platelets ; Coronary Angiography ; Coronary Artery Bypass ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Ischemia ; Myocardial Infarction* ; Reperfusion ; Stents* ; Thrombolytic Therapy ; Thrombosis ; Transplants

Phakomatosis pigmentova.scularis is a disease complex with dermal melanocyto sis such as nevus of Ota, nevus of Ito, or Mongolian spots and extensive hemangiomatous change such as nevus flammeus, which are associated with systemic organ involvement. We report a 23-year-old female, who showed bilateral nevus of Ota and nevus of Ito with widespread nevus flammeus and Mongolian spots since birth. She was also associated with megalocornea due to congenitol glaucoma and cataract.
Cataract ; Female ; Glaucoma ; Humans ; Mongolian Spot ; Neurocutaneous Syndromes* ; Nevus ; Nevus of Ota ; Parturition ; Port-Wine Stain ; Young Adult

Acute arterial occlusion of the extremity may result from obstruction of an artery by embolism or by thrombosis in situ. This results in the sudden cessation of blood flow to an extremity. So immediate managements are required to prevent propagation of the clot and to restore blood flow to the ischemic extremity promptly. We report a case of a acute arterial occlusion which was developed during prolonged fasting. A 59-year-old male was transferred due to severe ischemic pain, coldness and loss of pulse in left lower extremity during fast. The arteriogram shows a complete obstruction of external iliac artery and non-visualization of femoral artery and popliteotibial artery in the left lower extremity. Selective intra-arterial urokinase thrombolytic therapy and percutaneous transluminal angioplasty resulted in recannulation of obstructed artery and relief of symptoms.
Angioplasty ; Arteries ; Embolism ; Extremities ; Fasting* ; Femoral Artery ; Humans ; Iliac Artery ; Lower Extremity* ; Male ; Middle Aged ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

Human Adjuvant Disease(HAD) is a connective tissue disease occuring after cosmetic surgery with a foreign substance. It was first reported by Miyoshi in 1964. There have been specific connective disorders such as systemic lupus erythematosus, rheumatoid arthritis, progressive systemic sclerosis and mixed connective tissue disease. Scleroderma is the single most commonly reported disease. A 55-year-old woman was seen for evaluation of dypnea. Four years previously, she underwent cosmetic surgery with silicone injected directly into eyelid, forehead, both hand and monspubis. The patient presented the classic feature of systemic sclerosis and pericardial effusion. Following pericardiocentesis, she felt somewhat better and became less dyspneic. Seventeen days later, however, she progressively deteriorated and died in spite of intensive medical therapy and supportive care.
Arthritis, Rheumatoid ; Connective Tissue Diseases ; Eyelids ; Female ; Forehead ; Hand ; Humans ; Lupus Erythematosus, Systemic ; Middle Aged ; Mixed Connective Tissue Disease ; Pericardial Effusion ; Pericardiocentesis ; Scleroderma, Diffuse ; Scleroderma, Systemic ; Sclerosis* ; Silicone Gels* ; Surgery, Plastic*

PURPOSE: To evaluate criteria for differentiating benign versus malignant solitary pulmonary nodules (SPNs) by analyzing their morphology and perinodular parenchymal changes on CT/HRCT. MATERIALS AND METHODS: We retrospectively reviewed the CT/HRCT in 99 patients with SPN. Sixty two cases were proved by surgery, PCNA, clinical follow up and etc. Thirty seven cases were diagnosed by typical benign calcification. We defined SPN as a discrete, single lesion in the lung with margins that are sharp enough to permit measurement of diameter. We excluded lesions more than 4cm in diameter and lesions with cavity from our study protocol. The study included 41 malignant nodules and 58 benign nodules. RESULTS: Mean diameter of malignant nodule was 2.9cm, benign nodule was 2.2cm. Peripheral location of nodule was 28 in malignant nodules, 50 in benign nodules. Typical benign calcification was observed in 37 tuberculoma and three hamartoma. Lobulated margin was noted in 32 malignant nodules and 14 benign nodules. Spiculated margin was observed in 17 malignant nodules and 20 benign nodules. Low attenuation within the nodule was observed in 14 malignant nodules and 12 benign nodules. Pleural tail was observed in 14 malignant nodules and 31 benign nodules. Air bronchogram was noted in 18 malignant nodules and 4 benign nodules. Juxta nodular tuberculosis was observed in 6 malignant nodules and 29 benign nodules. CONCLUSION: Malignant nodules were larger than benign nodules and more commonly demonstrated a Iobulated contour and air bronchogram (p<0.05). Benign nodules more commonly demonstrated low density in the nodule and associated with juxta nodular tuberculosis and peripheral location (p<0.05). Spiculated margin and pleural tail were not helpful to differentiate benign from malignant nodule.
Follow-Up Studies ; Hamartoma ; Humans ; Lung ; Proliferating Cell Nuclear Antigen ; Retrospective Studies ; Solitary Pulmonary Nodule* ; Tuberculoma ; Tuberculosis

PURPOSE: To evaluate criteria for differentiating benign versus malignant solitary pulmonary nodules (SPNs) by analyzing their morphology and perinodular parenchymal changes on CT/HRCT. MATERIALS AND METHODS: We retrospectively reviewed the CT/HRCT in 99 patients with SPN. Sixty two cases were proved by surgery, PCNA, clinical follow up and etc. Thirty seven cases were diagnosed by typical benign calcification. We defined SPN as a discrete, single lesion in the lung with margins that are sharp enough to permit measurement of diameter. We excluded lesions more than 4cm in diameter and lesions with cavity from our study protocol. The study included 41 malignant nodules and 58 benign nodules. RESULTS: Mean diameter of malignant nodule was 2.9cm, benign nodule was 2.2cm. Peripheral location of nodule was 28 in malignant nodules, 50 in benign nodules. Typical benign calcification was observed in 37 tuberculoma and three hamartoma. Lobulated margin was noted in 32 malignant nodules and 14 benign nodules. Spiculated margin was observed in 17 malignant nodules and 20 benign nodules. Low attenuation within the nodule was observed in 14 malignant nodules and 12 benign nodules. Pleural tail was observed in 14 malignant nodules and 31 benign nodules. Air bronchogram was noted in 18 malignant nodules and 4 benign nodules. Juxta nodular tuberculosis was observed in 6 malignant nodules and 29 benign nodules. CONCLUSION: Malignant nodules were larger than benign nodules and more commonly demonstrated a Iobulated contour and air bronchogram (p<0.05). Benign nodules more commonly demonstrated low density in the nodule and associated with juxta nodular tuberculosis and peripheral location (p<0.05). Spiculated margin and pleural tail were not helpful to differentiate benign from malignant nodule.
Follow-Up Studies ; Hamartoma ; Humans ; Lung ; Proliferating Cell Nuclear Antigen ; Retrospective Studies ; Solitary Pulmonary Nodule* ; Tuberculoma ; Tuberculosis