Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p<0.001). The mean MLD within stent increased 14%, from 2.91+/-0.39 mm at the nominal balloon inflation (inflation pressure=7 atm) to 3.37+/-0.29 mm at high pressure balloon inflation (inflation pressure <0A65B>12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.
Acidosis ; Acute Kidney Injury ; Angioplasty, Balloon ; Arteries ; Aspirin ; Constriction, Pathologic ; Coronary Vessels* ; Hemorrhage ; Heparin ; Humans ; Inflation, Economic ; Platelet Aggregation Inhibitors* ; Stents* ; Thrombosis ; Ultrasonography ; Warfarin

No abstract available.
Hemolytic-Uremic Syndrome* ; Postpartum Period*

We report a first case of meningitis due to listeria monocytogenes after cardiac transplantation in Korea. This patient is a 40-year-old man with Dilated cardiomyopathy, he presented with intermittent dyspnea and abdominal distension for about 1 year. After cardiac transplantation, he was treated with azathioprine, cyclosporine and prednisolone for graft rejection. He was presented with intermittent fever, headache and lethargy for about 10days after cardiac transplantation. Listeria monocytogenes was isolated from blood culture and CSF culture. He was treated with intravenous penicillin G for 10days successfully and changed with ampicillin for 10days, took oral ampicillin for 10days without any complication after discharge.
Adult ; Ampicillin ; Azathioprine ; Cardiomyopathy, Dilated ; Cyclosporine ; Dyspnea ; Fever ; Graft Rejection ; Headache ; Heart Transplantation* ; Heart* ; Humans ; Korea ; Lethargy ; Listeria monocytogenes* ; Listeria* ; Meningitis* ; Penicillin G ; Prednisolone

The end-stage dilated cardiomyopathy is usually treated with cardiac transplantation although some limited success have also been obtained in selected patients using dynamic cardiomyoplasty or medical assist devices. Recently, a new surgical alternatives, called partial left ventriculectomy (PLV) was introduced by Randas J. V Batista in 1995. A 40-year-old man who had end-stage dilated cardiomyopathy refractory to optimal doses of medicines underwent partial left ventriculectomy (Batista's operation), which reduces ventricular volume to improve left ventricular function. The left ventricular ejection fraction increased from 20 % to 58 % at 4 month after operation.
Adult ; Cardiomyopathy, Dilated* ; Cardiomyoplasty ; Heart Transplantation ; Humans ; Stroke Volume ; Ventricular Function, Left

Post-thoracotomy syndrome is a condition characterized by pain that continues for more than 2 months after a thoracotomic procedure. Some patients suffer from devastating chest pain despite receiving multimodal treatment such as analgesics, antidepressants, anticonvulsants and nerve blockers. Spinal cord stimulation has been reported to be a promising relief for the intractable neuropathic pain. A 60-year-old man who had been suffering from post-thoracotomy pain for 20 years showed relief of pain after spinal cord stimulation. Spinal cord stimulation thus seems to be a viable option for patients who do not respond to conventional pain management therapy.
Analgesics ; Anticonvulsants ; Antidepressive Agents ; Chest Pain ; Combined Modality Therapy ; Humans ; Middle Aged ; Nerve Block ; Neuralgia ; Pain Management ; Spinal Cord ; Spinal Cord Stimulation ; Stress, Psychological

Gout attacks are often accompanied by systemic inflammatory response. The aim of the retrospective study was to compare gout patients in different age groups in terms of their clinical features at gout attacks. Patients, who were treated for gout attack in two tertiary medical centers between January 2000 and April 2014, were divided into young (≤ 50 years), middle-aged, and elderly (> 65 years) groups. Patients in three age groups were compared in terms of presence of fever (> 37.8°C), C-reactive protein (CRP) levels, and erythrocyte sedimentation ratio (ESR) at the gout attacks. Monocytes, which were isolated from 10 consecutive patients who previously experienced gout attacks, were stimulated with monosodium urate (MSU) crystals and cytokine production was measured by flow cytometry. Among 254 patients analyzed in this study, 48 were young, 65 were middle-aged, and 141 were elderly. The elderly patients were more likely to have fever (51.1%) during the attack than the young (20.8%) and middle-aged (30.8%) patients (P < 0.001 by χ² test). They were also more likely to have higher ESR and CRP levels than the young patients (P = 0.002 for ESR, P < 0.001 for CRP). Patients' age correlated significantly with CRP and ESR levels (both P < 0.001). After stimulation with MSU, the production of interleukin-1β by monocytes increased with patients' age (r = 0.670, P = 0.03). In conclusion, gout attacks in elderly patients are associated with fever and higher ESR and CRP levels, often resembling a septic arthritis.
Aged* ; Aging ; Arthritis, Infectious ; Blood Sedimentation ; C-Reactive Protein ; Fever ; Flow Cytometry ; Gout* ; Humans ; Inflammation ; Monocytes ; Retrospective Studies ; Uric Acid

CAAT/enhancer-binding protein-beta (C/EBPβ) is a transcription factor that regulates interleukin-1β (IL-1β)-induced catabolic pathways, including the expression of matrix metalloproteinases (MMPs), in chondrocytes. We previously reported that suppressor of cytokine signaling 1 (SOCS1) inhibits IL-1β signaling in chondrocytes. However, the effect of SOCS1 on C/EBPβ has not been explored. To investigate the interaction between SOCS1 and C/EBPβ, we established human SW1353 cells with overexpression or knockdown of SOCS1 or C/EBPβ. Both SOCS1 and C/EBPβ were involved in transcription of MMP-3 and MMP-13. When stimulated with IL-1β, C/EBPβ levels were significantly increased by SOCS1 knockdown and decreased by SOCS1 overexpression. A similar change in IL-1β-induced C/EBPβ expression was observed in SOCS1-transfected human articular chondrocytes. However, C/EBPβ overexpression or knockdown did not change the levels of IL-1β-induced SOCS1. SOCS1 regulated the levels of C/EBPβ mRNA by ubiquitination of C/EBPβ as well as transcriptional regulation. Furthermore, it suppressed the phosphorylation of cAMP response element-binding protein (CREB), an active transcription factor of C/EBPβ. In addition, p38 mitogen-activated protein kinases, a target of SOCS1, was involved in CREB phosphorylation. The chromatin immunoprecipitation assay confirmed that SOCS1 overexpression led to reduced binding of C/EBPβ to the MMP-13 promoter. Taken together, our results demonstrate that SOCS1 downregulates the p38-CREB-C/EBPβ pathway resulting in increased expression of MMPs in chondrocytes.
Chondrocytes* ; Chromatin Immunoprecipitation ; Cyclic AMP Response Element-Binding Protein ; Humans* ; Matrix Metalloproteinases ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; RNA, Messenger ; Transcription Factors ; Ubiquitin ; Ubiquitination

BACKGROUND: It is uncommon for patients who have received a permanent implant to remove the spinal cord stimulator (SCS) after discontinuation of medication in complex regional pain syndrome (CRPS) due to their completely painless state. This study evaluated CRPS patients who successfully removed their SCSs. METHODS: This 10-year retrospective study was performed on patients who had received the permanent implantation of an SCS and had removed it 6 months after discontinuation of stimulation, while halting all medications for neuropathic pain. Age, sex, duration of implantation, site and type of CRPS, and their return to work were compared between the removal and non-removal groups. RESULTS: Five (12.5%, M/F = 4/1) of 40 patients (M/F = 33/7) successfully removed the permanent implant. The mean age was younger in the removal group (27.2 ± 6.4 vs. 43.5 ± 10.7 years, P < 0.01). The mean duration of implantation in the removal group was 34.4 ± 18.2 months. Two of 15 patients (13.3%) and 3 of 25 patients (12%) who had upper and lower extremity pain, respectively, had removed the implant. The implants could be removed in 5 of 27 patients (18.5%) with CRPS type 1 (P < 0.01). All 5 patients (100%) who removed their SCS returned to work, while only 5 of 35 (14.3%) in the non-removal group did (P < 0.01). CONCLUSIONS: Even though this study had limited data, younger patients with CRPS type 1 could remove their SCSs within a 5-year period and return to work with complete pain relief.
Age Factors ; Device Removal ; Extremities ; Humans ; Lower Extremity ; Neuralgia ; Retrospective Studies ; Return to Work ; Spinal Cord Stimulation ; Spinal Cord

A clinical and statistical observation was made on out-patients and in-patients admitted to the Department of Urology, Seoul National University Hospital for the past 24 years from 1954 to 1977. The observations were summarized as follows. 1. During the period, the total number of out-patients was 63,438 and that of in-patients, 6,028. 2. In the out-patients, lower urinary tract infections such as urethritis and prostatitis were the most common diseases regardless of the time period. 3. In the in-patient, the frequency of the disease has been changed with the lapse of time in the order of the occurrence. The interesting changes of the disease order related to the time period were noted as follows. 1954-1960 : genitourinary tuberculosis, urolithiasis, tumor, injury and congenital anomaly. 1961-1970 : urolitiasis, tumor, genitourinary tuberculosis, injury, infection and congenital anomaly. 1971-1977 : tumor. urolithiasis, genitourinary tuberculosis, congenital anomaly, injury and infection. 4. In 1977, 10 major diseases were tumor, ureteral stone, infertility, renal tuberculosis, B. P. H. hypospadias, varicocele, renal stone, scrotal injury and renal tumor 5. Major operations were performed on 4,122 cases during the period. Nephrectomy and ureterolithotomy were the most common operations. Recently, total cystectomy with ileal loop diversion, transurethral procedure and vasovasostomy, which require more skillful techniques, are increasing in number.
Cystectomy ; Female ; Humans ; Hypospadias ; Infertility ; Male ; Nephrectomy ; Outpatients ; Prostatitis ; Seoul* ; Tuberculosis ; Tuberculosis, Renal ; Ureter ; Urethritis ; Urinary Tract Infections ; Urolithiasis ; Urology* ; Varicocele ; Vasovasostomy

Recent changes in healthcare systems have changed the epidemiologic paradigms in many infectious fields including bloodstream infection (BSI). We compared clinical characteristics of community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA) BSI. We performed a prospective nationwide multicenter surveillance study from 9 university hospitals in Korea. Total 1,605 blood isolates were collected from 2006 to 2007, and 1,144 isolates were considered true pathogens. HA-BSI accounted for 48.8%, CA-BSI for 33.2%, and HCA-BSI for 18.0%. HA-BSI and HCA-BSI were more likely to have severe comorbidities. Escherichia coli was the most common isolate in CA-BSI (47.1%) and HCA-BSI (27.2%). In contrast, Staphylococcus aureus (15.2%), coagulase-negative Staphylococcus (15.1%) were the common isolates in HA-BSI. The rate of appropriate empiric antimicrobial therapy was the highest in CA-BSI (89.0%) followed by HCA-BSI (76.4%), and HA-BSI (75.0%). The 30-day mortality rate was the highest in HA-BSI (23.0%) followed by HCA-BSI (18.4%), and CA-BSI (10.2%). High Pitt score and inappropriate empirical antibiotic therapy were the independent risk factors for mortality by multivariate analysis. In conclusion, the present data suggest that clinical features, outcome, and microbiologic features of causative pathogens vary by origin of BSI. Especially, HCA-BSI shows unique clinical characteristics, which should be considered a distinct category for more appropriate antibiotic treatment.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/drug therapy/*epidemiology/microbiology/mortality ; Community-Acquired Infections/drug therapy/*epidemiology/microbiology/mortality ; Cross Infection/drug therapy/*epidemiology/microbiology/mortality ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Treatment Outcome ; Young Adult