We report the implantation of a balloon-expandable intravascular stent at proximal left anterior decending artery in a patients suffered from Canakian functional class III angina for 8 years. The patient received 3 times percutaneous transluminal coronary angioplasty at proximal left anterior descending and circumflex artery without benefits. Repeated angiography revealed restenosis at proximal left anterior descending artery. Atherectomy was tried with transluminal extraction catheter(TEC) with luminal dissection and coronary bypass graft followed. occluded vein grafts were defined by follow-up angiography and chest pain recurred. No residual stenosis or thrombosis was documented in 24 hour follow-up angiography and the patient was discharged without symptom at 10 days after stenting.
Angiography ; Angioplasty, Balloon, Coronary ; Arteries ; Atherectomy ; Chest Pain ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis ; Transplants ; Veins

No abstract available.
Decompression* ; Facial Nerve* ; Recovery of Function*

Because of congenital deficiency of the superior sacral facet of S1 or the arch of L5 in dysplastic spondylolisthesis, progression of slippage may occur even in the presence of a posterior solid arthrodesis, especially in the patients with high degree of slippage and lumbosacral kyphsis. Therefore, the anterior interbody fusion may be necessary additionally. But the operation is very difficult because of a little supporting structure anteriorly for bone grafting. We have a case of dysplastic spondylolisthesis which showed progressive slippage even though solid posterolateral fusion. On which case we performed additional anterior interbody fsuion by the technique of anterior open wedge osteotomy on the superior dome of sacrum to support the L5 on S1. And this is the case report of the result.
Arthrodesis ; Bone Transplantation ; Humans ; Osteotomy ; Sacrum ; Spondylolisthesis

A case of alopecia universalis in a 45-year-old male was reported. The hair loss initiated on the eyebrows and progressed to the whole body, but the scalp hairs were well preserved. Histopathologic features of eyebrows were compatible findings with alopecia areata. This is a unique case of alopecia universalis without any involvement of scalp hairs.
Alopecia/*pathology ; Case Report ; Extremities ; Eyebrows/pathology ; Genitalia, Male ; Hair/*pathology ; Human ; Male ; Middle Age ; Scalp/*pathology ; Skin/pathology

We evaluated the hypolipidemic effect and adverse reaction of Lovastatin, HMG-CoA reductase inhibitor 20 to 40mg once-daily in the evening, in 20 patients with primary hypercholesterolemia for 12 weeks and the following results were obtained. 1) Lovastatin significantly reduced the total cholesterol(from 264.8+/-12.9mg/dl to 195.3+/-31.3mg/dl) by 26.3%, TG(from 191.1+/-41.5mg/dl to 156.2+/-52.9mg/dl) by 18.3%, LDL-C(from 177.0+/-12.4mg/dl to 121.3+/-19.6mg/dl) by 31.5% and increased th HDL-C (from 39.8+/-4.2mg/dl to 41.6+/-5.0mg/dl) by 4.5% at the end of 12th week. 2) The adverse reaction during the period of study were limited to diarrhea and nausea in one patient, dryness of skin and itching in one patient, and no patients was withdrawn form therapy. In this study, Lovastatin was well toterated and effective agent for the treatment of hypercholesterolemia without serious side effects.
Diarrhea ; Humans ; Hypercholesterolemia* ; Lovastatin ; Nausea ; Oxidoreductases ; Pruritus ; Skin

BACKGROUND: Left atrial thrombus(LAT) has long been recognized as a complication of mitral stenosis(MS).The transesophageal echocardiographic approach readily visualize LAT. We evaluated the risk factors for left atrial thrombus in patients with MS using transthoracic(TTE) and transesophageal echocardiography(TEE). METHODS AND RESULTS: One hundred and forty-three(patients) who had moderate to severe MS were consecutively studied with TTE and TEE. They were 43 males(30%) and 100 females(70%).The mean age was 44+/-11 years(range 21-70). Twenty-five patients had at least one episode of embolic events. Ninety-six patients were in atrial fibrillation(AF). LAT was detected in 30 pts(21%) : 16 had thrombus confined to the LA appenge(LAA), 14 to true LA cavity and/or LAA. TTE variables were compared between LAT group and non-LAT group. Univariate predictors of LAT were mitral valve area(MVA)(0.78+/-0.22cm2 vs 1.05+/-0.32cm2, p=0.001), pressure half time(353+/-88ms vs 258+/-118ms, p=0.002). LV ejection fraction(EF)(55+/-11% vs 62+/-8%,p=0.008), LA size (58+/-11mm vs 52+/-7mm, p=0.033) and AF(p=0.001). Stepwise logistic regression analysis revealed significant independent predictors of LAT to be AF(p=0.02), MVA(p=0.02) and EF(p=0.03). CONCLUSION: Left atrial thrombus was not uncommon in patients with rheumatic mitral stenosis. Small mitral valve area and reduced ejection fraction of left ventricle appear to be significant predictors of LAT in mitral stenosis with atrial fibrillation.
Atrial Fibrillation ; Echocardiography* ; Heart Ventricles ; Humans ; Logistic Models ; Mitral Valve ; Mitral Valve Stenosis* ; Risk Factors ; Thrombosis*

BACKGROUND: Since the nonsurgical treatment of mitral stenosis using a single balloon has been introduced by Inoue et al. in 1984. percutaneous mitral valvuloplasty has became an accepted therapeutic modality for selected patients with mitral stenosis. Zeibag et al. demonstrated the double balloon technique showed a better outcome than the single balloon in obtainning the optimal mitral valve area. On the other hand, there are several reports that single balloon technique was comparable with the double balloon technique. Therefore, there are still controversies in efficacy, benefit and complications between balloon techniques. METHOD: To compare the efficacy and complications of percutaneous mitral valvuloplasty with the double balloon or the Inoue balloon technique, 40 patients were studied consecutively by random method in selecting the balloon technique. RESULTS: In all cases, percutaneous mitral valvulopasty was performed successfully. Optimal outcome defined as mitral valve area larger than 1.5cm2 was obtained in 12 cases out of 16(75%) in double balloon group and 15 out of 24(63%) in Inoue balloon group(p=NS). Mitral valve area was significantly increased after valvulopasty in both technique but there was no different between both groups(Mean+/-SD ; 0.9+/-0.3 to 1.7+/-0.2 vs 0.9+/-0.2 to 1.9+/-0.2cm2). There were also hemodynamic improvement significantly in mean mitral gradient(MG). pulmonary artery pressure (PAP) and left atrial pressure(LAP) after PMV but there were no difference between groups (18+/-8 to 7+/-2 vs 21+/-13 to 9+/-4 mmHg for MG. 29+/-12 to 22+/-9 vs 28+/-9 to 18+/-5mmHg for PAP and 22+/-8 to 11+/-5 vs 21+/-6 to 11+/-4 for LAP respectively). Mitral requrgitation greater than grade 2 occurred in 2 cases of the double balloon group and one case of the Inoue balloon group(p=NS). New development of atrial shunt was found in 3 cases in both groups. CONCLUSIONS: The double and Inoue balloon techniques were quite comparable in immediate outcome and complications.
Hand ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Prospective Studies* ; Pulmonary Artery

A case of a 39-year-old woman with corrected transposition of the great vessels without significant intracardiac anomaly or coronary disease is reported. The clinical diagnosis of coronary arterial disese was supported in this patient by electrocardiographic changes of probable old anteroseptal myocardial infarction. Coronary arteriographic study showed the morphologic left coronary artery supplied the right-sided ventricle, and the right coronary artery supplied the left-sided ventricle, and the right coronary artery supplied the left-sided ventricle. Although the condition is theoretically compatible with a normal life span, few patient with this lesion survive past 40 years of age because of the subsequent heart block or functioning as a systemic ventricle.
Adult* ; Anterior Wall Myocardial Infarction ; Coronary Angiography* ; Coronary Disease ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Female ; Heart Block ; Humans

The exercise ECG gives a valuable indirect evidence of insufficient myocardial perfusion during stress, but it has been impossible with ECG data alone to localize the site or sites of partial or complete arterial occlusion. The coronary angiography has proved to be valvuable as a technique for identifying anatomical lesions. However, arteriography alone dose not provide evaluation of the underlying myocardium. The two tests are complementary, one supplying indirect physiologic data and the other providing anatomical licalization of obstruction. The author reviewd 58 patients out of 86 patients who performed treadmill test and coronary angiography at the cardiac laboratory of Yonsei University Severance Hospital from January, 1981 through December, 1983. The following results were obtained. 1) Among the 58 patients in this study, 33 had negative exercise test and 25 had positive test. 2) Among the 14 patients who ended exercise test due to chest pain,2patients had negative exercise test. Coronary angiography on all the 14 patients showed significalt coronary artery stenosis. 3) With this multigraded treadmill test, the sensitivity was 68.8% and spedccificity was 88.7%. 4) The appreance of ischemic change during the early stage of exercise, the deeper ST segment depression and the downsloping ST segment have the higest specificity as indicators of coronary artery disease. 5) Four patients showed ST segment elevation in the exercise ECG, and their coronary angiogram showed 1-vessel disease in 1 patientts, 2-vessel dosease in 2 and 3-vessel disease in 3. All of them had multiple stenosis or complete obstruction of the left anterior descending artery on coronary angiogram and ventricualar dyskinesia on the left ventriculogram.
Angiography ; Arteries ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Depression ; Dyskinesias ; Electrocardiography ; Exercise Test* ; Humans ; Myocardium ; Perfusion ; Sensitivity and Specificity ; Thorax

We report a case of erythema nodosurn associated with ulcerative colitis which occurred in a 13-year-old girl who showed well demarcated, painful, erythematous nodules and plaques on both upper and lower extremities. The patient also experienced frequent intermittent abdominal pain and bloody stools for about 1 year. Laboratory findings revealed polymorphonuclear leukocytosis and occult blood in the stool. Findings of sigmoidoscopy, barium enema, and rectal biopsy were consistent. with ulcerative colitis. A skin biopsy from the lesion on the right shin revealed a moderate inflammatory cell infiltrate in the septa of the subcutaneous fat layer, composed chiefly of lymphohistiocytes and a few epitheloid cells. The symptoms and signs responded well to orally administered prednisolone and sulfasalazine.
Abdominal Pain ; Adolescent ; Barium ; Biopsy ; Colitis, Ulcerative* ; Enema ; Erythema Nodosum* ; Erythema* ; Female ; Humans ; Leukocytosis ; Lower Extremity ; Occult Blood ; Prednisolone ; Sigmoidoscopy ; Skin ; Subcutaneous Fat ; Sulfasalazine ; Ulcer*