"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*

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

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 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

The effect of oral nicorandil were evaluated by a 9-day double-blind cross-over protocol on 16 subjects with angina pectoris referred to our cardiology clinic from June '84 through September '85. total daily doses were 15-45mg. The effects were measured by 3 seperate treadmill exercise EKG tests and symptom reviews on each patient. The following results were obtained. 1) The mean age of the patients was 57.4+/-7.2 years. These were 14 male and 2 female patients. 2) Resting heart rate on nicorandil was 73.6+/-14.0 beats/min and 70.5+/-14.0 beats/min in placebo(P<0.05). There were no significant effects of nicorandil on resting blood pressure and heart rate-blood pressure product. 3) Peak exercise heart rate was 126.4+/-22.5 beats/min on nicorandil and 121.8+/-21.4 beats/min on placebo(P<0.05). There were no significant effects of nicorandil on blood pressure after exercise and peak heart rate-blood pressure product(x10(-3)) after nocorandil was 20.2+/-5.0 and 18.9+/-4.6 on placebo(P>0.05). 4) Exercise duration was 485.8+/-107.7 sec on nicorandil and 423.3+/-101.9 sec on placebo(P<0.001). 5) The exercise duration was prolonged in 11 cases(68.7%), showed on change in 2 cases(12.5%), and shortened in 3(18.8%). 6) There were attacks of chest pain during placebo period in 2 cases, but none developed during nicorandil period. 7) Headache was noted in 2 patients, and in one of them, it was so severe as to discontinue nicorandil stydy. No other side effects were noted. In conclusion, additional therapeutic benefit can be obtained by nicorandil in patients with severe angina in spite of conventional antianginal agents already being administered.
Angina Pectoris* ; Blood Pressure ; Cardiology ; Chest Pain ; Cross-Over Studies* ; Electrocardiography ; Female ; Headache ; Heart ; Heart Rate ; Humans ; Male ; Nicorandil*

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

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

Previous studies showed that in patients with coronary artery disease(CAD), the ejection fraction(EF) response to exercise was often abnormal. Therefore, the fact that EF at rest might be infulence by extent of CAD was implied. So, we studied the relationship between the extent of CAD and the left ventricular function with LVEDP and LVEF measured by area-laength method in 168 patients with significant CAD without myocardial infarction and 111 cases with myocardial infarction. The results are as follows: 1) In 168 cases with significant CAD without myocardial infarction, LVEF in 87 cases with single vessel involvement is significantly higher than in 81 cases with multi-vessel involvement(76.4+/-10.0, 71.3+/-14.9), but LVEF in both group are within normal limits of ours(75.1+/-18.8). LVEDP has no difference between groups. 2) In 111 cases with myocardial infarction, there are no significant difference in LVEDP and LVEF between single vessel group and multi vessel group. But LVEF in both group are significantly lower than normal range of ours. In conclusion, LVEF in the group without myocardial infartion was infulenced by the extent of CAD. But LVEF in the group with myocardial infarction may be influenced by not only the extent of CAD but also infarction site, duration after infarction and collerteral vessels.
Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Infarction ; Myocardial Infarction* ; Reference Values ; Ventricular Function, Left*

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

PURPOSE: Percutaneous nephrolithotomy (PCNL) is conventionally conducted in the prone position. However, the prone position increases anesthesia-related morbidity and position changes lengthen the operation time. We report perioperative outcomes and the learning curve for flank PCNL on the basis of a single surgeon's experience. MATERIALS AND METHODS: This study investigated 53 cases of flank PCNL performed for renal stones at our institution from April 2008 to September 2010. We compared mean operative time, stone-free rate, drop in hemoglobin level, length of hospital stay, complications, and need for additional procedures after the surgery. The 53 cases were divided into three groups by case number to compare therapeutic effect, stability, and the learning curve for flank position PCNL. RESULTS: The mean operation time for the 53 patients was 97.3+/-43.1 minutes. The mean operation time gradually decreased as the surgeon accumulated experience. From the 36th case, the mean operation time showed a statistically significant decrease to 72.2+/-24.1 minutes (p=0.003). The overall stone-free rate was 64.2% for all procedures (range, 61.1-76.5%). There were no significant differences in the drop in hemoglobin level, stone-free rate, re-treatment, hospital stay, or complication rate. There was no injury to the bowel or renal vessels, and no other major complications occurred. CONCLUSIONS: Flank PCNL can be used to remove renal stones effectively while overcoming the disadvantages of the existing prone position PCNL. After 36 cases, the learning curve showed acquisition of surgical competence. The clinical experience reported here suggests that flank PCNL is a safe and feasible technique.
Hemoglobins ; Humans ; Kidney ; Kidney Calculi ; Learning ; Learning Curve ; Length of Stay ; Mental Competency ; Nephrostomy, Percutaneous ; Operative Time ; Prone Position