"Dual LAD" was defined as the early bifurcation of the proximal LAD into two vessels : a short LAD which remained in the anterior interventricular sulcus and does not reach the apex, and a long LAD which leaves the anterior interventricular sulcus only to return to the distal sulcus and continue to the apex. Recognition of "Dual LAD" is essential to prevent errors of interpretation of the coronary arteriogram and for planning of optimal surgical therapy. We report 2 cases of "Dual LAD" with the review of the literatures.
Coronary Vessels*

Patients with hypertrophic cardiography often complain of chest pain and have electrocardioagrams suggesting myocardial damage or ischemia. Some of three patients have associated coronary arterial atherosclerosis. Transmural myocardial infarction may occur in patients with hypertrophic cardiomyopathy in the absence of significant atherosclerosis of the extramural coronary arteries, about which several pathophysiologic exlpanations were discussed. Presented here, a case of 49-year-old man with hypertrophic cardiomyopathy accompanied with myocardial infarction and angiographically normal coronary arteries is reported. Asymmetric septal hypertrophy, characteristic morphologic abnormality of hypertrophic cardiomyopathy, was progressed to dilated cardiomyopathy after the occurrence myocardial infarction.
Atherosclerosis ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic* ; Chest Pain ; Coronary Vessels ; Humans ; Ischemia ; Middle Aged ; Myocardial Infarction*

We studied 70 cases of transmural myocardial infarction with first attack to look into the coronary anatomy of the infarct-related artery in the time course of infarction and evaluate the left ventricular wall motion according to patency of the infarct-related artery. The following result were obtained. 1) Among 70 cases with transmural myocardial infarction, 47(67.1%) had anterior infarction and 23 (32.9%) inferior infarction. Mean age of the total cases was 52.1+/-10.6 and M:F ratio was 7.8:1. 2) 28 cases were single vessel disease(40.0%), 19 cases were two vessel disease(27.1%), 18 cases werew three vessel disease(25.8%) and 5 cases had insignificant coronary stenosis (7.3%) with 4 cases of normal coronary artery. 3) The total occlusion rate of the infarct-related artery in 70 cases was 48.6%. The total occlusion rate of the 8 cases catheterized within 1 day was 87.5%, that of the 17 cases from 2nd to 15th day 52.9% that of the 23 cases from 16th day to 2nd month 39.1%, that of the 15 cases from 3rd to 12th month 40.0% and that 7 cases from 2nd and 6th year 42.8%. These results suggest that the natural resolution of the infarct-related artery has almost happened within 2 weeks. 4) The left ventricular ejection fraction was higher and the left ventricular end-diastolic pressure was lower in the group with incomplete occulsion of infarct-related artery than in those with complete occulsion, and left ventricular wall motion was better in the group with incomplete occulsion of the infarct-related artery than in those with complete occulsion.
Arteries* ; Catheters ; Coronary Stenosis ; Coronary Vessels ; Infarction ; Myocardial Infarction* ; Stroke Volume

We report a case of laparoendoscopic single-site surgery (LESS) for a symptomatic left seminal vesicular cyst and ipsilateral renal agenesis. A 49-year-old man presented with a 1-year history of severe irritation upon voiding and intractable, recurrent hematospermia. A computed tomography scan showed a 68x41x38 mm sized left seminal vesicular cyst with ipsilateral renal agenesis. LESS was performed successfully to treat the seminal vesicle cyst. The total operative time was 125 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day.
Congenital Abnormalities ; Hemospermia ; Humans ; Kidney ; Kidney Diseases ; Laparoscopy ; Middle Aged ; Operative Time ; Seminal Vesicles ; Surgical Procedures, Minimally Invasive

Since the introduction of PTCA by Gruntzig in 1977, this is now widely used in some subsets of patients with coronary artery disease and is an effective alternative to surgery for many patients. In the 3 years from June 1983 to June 1985, PTCA was attempted in 33 patients with coronary artery disease at the Severance Hospital. There were 26 men and 7 women, whose mean age was 51 years(31-68year). Seven patients had a previous myocardial infarction. Thirty one of 33 patiens presented with chest pain. Twenty four patients had unstable angina and 7 stable angina. the median duration of angina was 5 months(1-120months). 29 had one vessel disease. One had left main disease, 1 two-and 2 three-vessel disease. PTCA was attempted on lesions located in the left anterior descending artery in 26 patients, right coronary artery in1. Successful dilation(stenosis opened by 20% or more of the normal luminal diameter)was achieved in 24 patients(73%). Seventy seven of the stenosis of the LAD and 75% of the RCA was succesfully dilated, whereas PTCA was failed in all 2 patients with a stenosis of the LCX. One patients with a stenosis of the left main artery was succesfully dilated. The mean degree of stenosis was reduced from 77+/-2% to 34+/-2%(P<0.001). The mean pressure gradient was diminished from 53+/-8mmHg to 18+/-6mmHg(P<0.001). Acute coronary occlusion occured in 4 patients(12%). Three of them developed acute myocardial infarction. Emergency coronary bypass operation was done in 2 patients, but one died on the day of operation. Follow-up clinical assessment in the hospital after successful angioplasty indicated freedom from angina in the most of successfully dilated patietns. Eleven patients who underwent successful dilation had basesline and follow-up(within 2 weeks after PTCA) transmill tests. Nine of 11 patients with a positive treadmill test before PTCA obtained negative results after successful angioplasty. Mean exercise duration increased from 316+/-46sec to 601+/-34sec(P<0.001). Eight patients have developed recurrence of angina(recurrence rate;33%) during follow-up period of 3 to 36 months(medial;10 months). In 6 of these cases, restenosis has been documented angiographically within 3 months of dilatation. Four asymptomatic patients have had follow-up angiography. In all patients, the dilated segments was unchanged or improved. Repeat PTCA was attempted in 5 patients with a success rate of 80% without any complications. This initial expierence with PTCA indicates that it is an effective method of relieving coronary stenosis and ischemic symptoms in selected patients. But it carries an inherent risk of serious complications. Also restenosis is a persistent problem with PTCA. Repeat PTCA can be done with a high success and a low complication rate.
Angina, Stable ; Angina, Unstable ; Angiography ; Angioplasty ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Occlusion ; Coronary Stenosis* ; Coronary Vessels* ; Dilatation ; Emergencies ; Exercise Test ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Myocardial Infarction ; Phenobarbital ; Recurrence

Since recognition of coronary arterial clloateral circulation in living patients has been made possible by coronary arteriography, controversy has existed about the functional importance of these vessel and their ability to protect the myocardium against ischemia. The coronary arteriograms and left ventriculograms of 279 consecutive patients were reviewed. All had at least 50% diameter reduction of 1 or more major coronary arteries. In 94 patients(111 arteries), at least 1 major branch was totally occluded. Collateral circulation was seen in 85 of 111(76.6%) totally occlued arteries versus 22 of 107(20.6%) with > or =90% but <100% stenosis(P<0.01). No artery with <90% stenosis(254 arteries) recieved angiographically detectable collateral vessels. An analysis was made of the relation between left ventricular segmental wall motion and the quality of collateral circulation in 68 totally occluded arteries among 60 patients with myocardial infarction(Group 1) and in 43 totally occluded arteries among 34 patients without prior myocardial infarction(Group 2). Good collateral vessels went to 62.8% of Group 2, but 38.8% of Group 1(P<0.05). LV contraction was abnormal in all Group 1 patients with good collateral circulation. Of 27 with good collateral circulation in Group 2, LV contraction was normal in 59.3% and abnormal in 40.7%. But there was no statistically significant difference between the effect of good or poor collateral circulation in LV wall motion in each Group. Also we have studied the frequency of collateral circulation appearance in 34 patients, in whom the date of symptom onset of transmural infarction was definitely documented. The presence of collateral vessels was significantly higher in the patients studied 1-15 day period after symptom onset vs those studied within 1 day(77.8% vs 14.3%, P<0.05). but there was no significant differance in the apperance of collaterals in the patients studied in the 1-15 day vs the 15 day-2 month, and vs the 2-36 month period(77.85, 66.7% and 66.7%, NS). These observation indicate that collateral circulation cannot be seen angiographically unless there is total or near-total occlusion, and that the pressence of good collaterals may play a patrial role in preserving myocardial function and preventing myocardial infarction. The development of collaterals in myocardial infarction seems to be occurred within 15 days after the symptom onset of transmural infarction. But any benefits can not be expected from newly developed collateral circulation after myocardial infarction.
Angiography ; Arteries ; Collateral Circulation* ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Infarction ; Ischemia ; Myocardial Infarction ; Myocardium

To determine the long-term results after PMV, the incidence of restenosis and analysis the factors predicting restenosis, 108 patients were studied at pre-, post-PMV, after 3 months and 1 year (13+/-4 months) with echocardiography. 1) Restenosis was demonstrated in 25 of 108 patients(23%) at 1 year follow-up. 2) Descriminant analysis showed echocardiographic score and mitral valve area before PMV as predictors of restenosis. 3) There were significant decreament of mitral valve area from 1.8+/-0.4cm2 (after PMV) to 1.5+/-0.3 cm2 at 3 months follow-up and further stenosis (1.2+/-0.3 cm2) at long-term follow-up in group with restenosis. In contrast, in group without restenosis, mitral valve area after PMV was 1.8+/-0.3cm2, aat 3 months follow-up was 1.8+/-0.3cm2 and at long term follow-up was 1.8+/-0.4cm2. 4) There was higher restenosis rate in group with Inoue balloon (47%) than group with double balloon (18%) despite of large EBDA/BSA.
Constriction, Pathologic ; Echocardiography ; Follow-Up Studies* ; Humans ; Incidence ; Mitral Valve

OBJECTIVES: The purpose of this study was to examine whether Symptom Management Module-Korean Brief Version(SMM-B) is effective as a psychosocial treatment of the inpatients with chronic schizophrenia. We also questioned which of demographic and clinical characteristics could be predictors of differential treatment response. METHODS: The subjects were composed of 30 inpatients with chronic schizophrenia, who were trained with weekly session of SMM-B for 5 weeks. Before and after the training, the level of psychopathology, knowledge about schizophrenia were assessed as dependent variables by using Clinical Global Impression(CGI) and Scale to Assess Unawareness of Mental Disorder(SUMD). RESULTS: Overall, patients showed improvement over the treatment period on psychopathology as well as knowledge about psychosis. Total scores of SUMD were changed from 16.9+/-4.0 before training to 12.9+/-4.2 after training(p<0.01) and scores of CGI were improved from 3.7+/-0.9 to 2.8+/-0.8 (p<0.01). However age, gender, years of education, age of onset, duration of illness, duration of admission, numbers of psychiatric admission, and clinical status evaluated by CGI were not correlated with un-awareness of psychosis. CONCLUSION: These results suggest that SMM-B could be a reliable method to improve self-awareness of psychosis in patients with chronic schizophrenia and one of important elements in rehabilitation.
Age of Onset ; Education ; Humans ; Inpatients* ; Psychopathology ; Psychotic Disorders ; Rehabilitation ; Schizophrenia*

Mitral stenosis is characterized by chronic pulmonary arterial hypertension. Although it is well recognized that right ventricle can be affected by pressure-overload in patients with mitral stenosis, the study for effects on right ventricular function after relief of pressure overload was difficult after open heart surgery due to paradoxical septal motion and scarring change of pericardium. Recently, percutaneous mitral valvuloplasty(PMV) has been used in patients with mitral stenosis as an alternative to surgical mitral commissurotomy. The present study was designed to demonstrate the difference of right ventricle between normal subjects and patients with mitral stenosis, as well as to investigate the changes of right ventricle before and after PMV with Doppler- echocardiography and isovolumic indices. The results were summarized as follows : 1) Right ventricular emptying fraction which was assumed to be proportional to right ventricular ejection fraction was depressed significantly in patients with mitral stenosis than those of normal subjects. However, there were no sighificant differences in Vpm between the two groups. 2) Right atrial and ventricular areas of patients with mitral stenosis were enlarged significantly than those of normal subjects. Right ventricular diastolic function measured by transtricuspid pulsed Doppler showed relaxation abnormality pattern in patients with mitral stenosis. 3) Enlarged right atrium and ventricular area were decreased significantly after PMV. Depressed right ventricular sytolic and diastolic function were recovered after relief of pressure-overload by PMV. However, there were no significant changes in Vpm after PMV. 4) Right ventricular emptying fraction was inversely correlated with mean pulmonary artery pressure and right ventricular end-diastolic area. Discriminant factor between group with right ventricular diastolic dysfunction and group without diastolic dysfunction was pulmonary vascular resistance. In conclusion, there were right ventricular systolic and diastolic dysfunction without abnormal right ventricular contractility in patients with mitral stenosis, moderate pulmonary hypertension and normal sinus rhythm, and these functional abnormalities were largery reversible after relief of pressure-overload on the right ventricle by PMV.
Cicatrix ; Echocardiography ; Heart Atria ; Heart Ventricles ; Humans ; Hypertension ; Hypertension, Pulmonary ; Mitral Valve Stenosis* ; Pericardium ; Pulmonary Artery ; Relaxation ; Stroke Volume ; Thoracic Surgery ; Vascular Resistance ; Ventricular Function, Right*

BACKGROUND: The role of coronary collateral circulation has been a subject of great interest and controversy. The functional significance of collateral circulation was evaluated in 125 patients with total coronary occlusion of left anterior descending artery(LAD) or right coronary artery(RCA). METHOD: Patients were classified into two groups. Group 1:patients with angina pectoris(AP), Group 2:patients with a first transmural myocardial infarction(MI) within 3 months of symptom onset, Clinical variables, resting and exercise electrocardiogram(EKG) were analyzed with angiographic findings. Collateral fillings were graded from 0 to 3 : 0=none ; 1=filling of side branches only ; 2=partial filling of the epicardial segment ; 3=complete filling of epicardial segment. The wall motion of each segment was scored from 1 to 5:1=normal ; 2=mild to moderate hypokinesia ; 3=severe hypokinesia ; 4=akinesia ; 5=dyskinesia. The score of the 5 segments were added to yield a total LV score. RESULT: There is a higher prevalence of good collaterals and multivessel disease in group 1 than in group 2(83% vs 53%, 54% vs 30%, respectively, p<0.05). The left ventricular ejection fraction(LVEF), left ventricular end-diastolic pressure(LVEDP) and segmental wall motion score were significantly better in group 1 than group 2(68.9+/-13.4% vs 50.5+/-12.6%, 15.0+/-7.3 vs 20.3+/-8.8mmHg, 6.5+/-2.2 vs 9.6+/-2.3, respectively, p<0.05). In spite of total coronary occlusion, 61% of AP patients had normal resting EKG but 96% of patients who underwent treadmill test proved to be positive. The proportions of well-developed collaterals in 3 groups divided according to the interval between onset of MI and angiography(within 1 day, 2 to 14 days, 15 days to 3 months)were 13%, 54% and 60%. There were no significant difference in LVEF, segmental wall motion score and LVEDP in MI patients with poorly-developed collaterals and well-developed collaterals(49.1+/-15.7 vs 46.4+/-10.1%, 11.1+/-2.2 vs 10.9+/-1.4 and 24.3+/-9.7 vs 20.3+/-7.0mmHg, p=NS). The degree of collateral development is higher in MI with RCA occlusion compared with that of LAD occlusion(1.1+/-1.0 vs 2.0+/-1.0, p<0.05). CONCLUSION: Collateral circulation can prevent myocardial ischemia and preserve myocardial function in a significant number of patients with AP but do not provide protection against exercise-induced myocardial ischemia in a majority of patients with AP. Well-developed collaterals are uncommonly present within 1 day after MI, but subsequently develop and are generally demonstrable after 2 weeks. Collateral vessels in patients with MI have no beneficial effects on preserving myocardial function.
Collateral Circulation* ; Coronary Occlusion* ; Electrocardiography ; Exercise Test ; Humans ; Hypokinesia ; Myocardial Ischemia ; Prevalence