No abstract available.

This was designed to assess the outcomes of side branch (SB) stenosis after implantation of three drug-eluting stents (DES). From 2,645 patients in the ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary Lesions) Trial, 788 patients had 923 bifurcation lesions with SB > or = 1.5 mm were included. SB was treated in 150 lesions, including 35 (3.8%) receiving SB stenting. Of untreated SB with baseline stenosis < 50%, the incidences of periprocedural SB compromise was similar in the zotarolimus (15.8%), sirolimus (17.2%), and paclitaxel (16.6%) stent groups (P = 0.92). At follow-up angiography, delayed SB compromise occurred in 13.9%, 3.2%, and 9.4% (P = 0.010) of these groups. When classified into four groups (< 50%, 50%-70%, 70%-99%, and 100%), 9.0% of untreated SB were worsened, whereas improvement and stationary were observed in 9.6% and 81.4%. In a multivariable logistic regression model, main branch (MB) stenosis at follow-up (%) was the only independent predictor of SB stenosis worsening (odds ratio, 1.03; 95% confidence interval, 1.01-1.04; P < 0.001). After MB stenting in bifurcation lesions, a minority of SB appears to worsen. DES with strong anti-restenotic efficacy may help maintain SB patency.
Acute Disease ; Aged ; Blood Vessels/physiopathology ; Cardiovascular Agents/*therapeutic use ; Coronary Angiography ; Coronary Stenosis/*drug therapy/physiopathology/radiography ; Drug-Eluting Stents/*adverse effects ; Female ; Follow-Up Studies ; Humans ; Logistic Models ; Male ; Middle Aged ; Myocardial Infarction/etiology/radiography ; Myocardial Revascularization ; Odds Ratio ; Paclitaxel/*therapeutic use ; Predictive Value of Tests ; Sirolimus/*analogs & derivatives/*therapeutic use ; Thrombosis/etiology ; Treatment Outcome

Stenosis of the subclavian vein after cannulation occurs in 15-50% of chronic hemodialysis patients, and impedes the placement of an arteriovenous fistula in the ipsilateral arm. Its natural history and pathogenic mechanism are not well established yet. To investigate the clinical characteristics of the patients and therapeutic effect of percutaneous angioplasty and stenting, 10 consecutive chronic hemodialysis patients(3 men and 7 women; mean 55 year old) from March 1999 to February 2001 who showed subclavian vein stenosis and were treated with above percutaneous procedure were included in this study. The patients were followed for median 15.8(9.3-23.7) months after stenting. The causes of chronic renal failure were hypertension in four, diabetes mellitus in four, and unknown in two patients. Edema was noted on left upper extremity in nine and right in one patient. All cases of stenosis of central vein were found in ipsilateral side. Duration from beginning of hemodialysis to angioplasty and stenting was median 28(0.5-180) months. Duration for keeping subclavian vein catheter was median 35(13-65) days and duration for arteriovenous fistula in ipsilateral arm was median 15.1(1.1-120) months before stenting. All patients were performed stenting successfully and edema of upper extremities began to decreased immediately after the procedure. Involved stenosis lesions were noted on left bracheocephalic vein in seven, left subclavian vein in two, and right bracheocephalic vein in one patient. Restenosis after the procedure occurred in three patients in 1 year after stenting, and percutaneous balloon angioplasty(198, 256, 276 days after initial stenting) was performed again successfully. There was no severe complication during the procedure in all patients. In conclusion, we speculate that percutaneous angioplasty and stenting is a safe and effective therapeutic modality in chronic hemodialysis patients with central vein stenosis.
Angioplasty* ; Angioplasty, Balloon ; Arm ; Arteriovenous Fistula ; Catheterization ; Catheters ; Constriction, Pathologic* ; Diabetes Mellitus ; Edema ; Female ; Humans ; Hypertension ; Kidney Failure, Chronic ; Male ; Natural History ; Renal Dialysis* ; Stents* ; Subclavian Vein ; Upper Extremity ; Veins

BACKGROUND: We addressed the problem of the circadian changes in neural control of the circulation in ambulant hypertensive subjects. With spectral analysis of heart rate variability the tonic sympathetic and vagal activities and their changes are respectively assessed by the power of 0.050 - 0.015Hz(low frequency, LF) and 0.150 - 0.350Hz(respiratory linked, high frequency, HF) components of the spectrum of the beat by beat variability of RR interval. METHODS: Heart rate variability(HRV) and its circadian rhythm were evaluated in 15 patients with hypertension. By using 24-h Holter monitoring, HRV and its spectral components were measured. Finding were compared with 15 age-matched normal controls. RESULTS: The 24-hour plot of the SDs revealed that heart rate variability was significantly lower in the hypertensive patients, and the differences reached statistical significance during hours 2, 3, 9, 13, 16, 18, 19, and 23(p<0.05). Spectral analysis showed that power in the high-frequency range(0.150 to 0.350Hz) was lower among the hypertensive patients than among the normal controls during 22 of 24 hours but that the difference was statistically significant only during 2 hours(p<0.05). Power in the low frequency range(0.050 to 0.150Hz) was low at night, increased in the morning, and high during the day among controls ; this circadian rhythm was absent among hypertensive patients. CONCLUSIONS: Among hypertensive patients, HRV is decreased with a partial withdrawal of parasympathetic tone, and the circadian rhythm of sympathetic/parasympathetic tone is altered.
Circadian Rhythm ; Electrocardiography, Ambulatory ; Heart Rate ; Humans ; Hypertension

Adrenal medullary hyperplasia is an increase in the mass of the adrenal medullary cells. We report a case of a 38-year-old man presenting with pheochromocytoma-like symptoms who was preoperatively misdiagnosed with pheochromocytoma. Hypertension was associated with an intracranial hemorrhage evident in a brain computed tomography scan, in which no obvious pituitary gland enlargement was detected. An abdominopelvic CT revealed a solitary tumor in the right adrenal gland with no obvious enlargement of the contralateral adrenal gland or sympathetic chains. Lab results showed increased levels of urinary metanephrines. Based on clinical data, the patient underwent a laparoscopic right adrenalectomy bases on a diagnosis of pheochromocytoma. The patient was finally diagnosed with adrenal medullary hyperplasia with coexisting ipsilateral non-functioning adrenal cortical adenoma. Postoperatively, blood pressure and lab results were maintained in the normal range and the patient was symptomatically free during the follow-up period.
Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma* ; Adult ; Blood Pressure ; Brain ; Diagnosis ; Follow-Up Studies ; Humans ; Hyperplasia* ; Hypertension ; Intracranial Hemorrhages ; Pheochromocytoma ; Pituitary Gland ; Reference Values

The basic laboratory test for diagnosis of hematological diseases most widely used is microscopic examination of blood smear slides. The purpose of development of integrated hematological management program of microscopic examination is to improve effectiveness of microscopic examination of blood smear slides and to offer references consistent and easy to use. The lists of various blood cells and hematological diseases were prepared, and 2,589 microscopic photo slides were made corresponding to these lists. The images made of microscopic photo slides were developed through multimedia PC and slide scanner. Thirty-seven references always used for hernatological diagnosis were arranged in the form of tables and figures. With integration of these images and references, an application software consists of functions such as reports of peripheral blood cell morphology and bone marrow examination, stepwise learning of diagnostic procedures, finding hematology atlas and references, and reports of other special hematology laboratory tests was developed. The development tool was Visual FoxPro (version 5 .Oa, Microsoft, USA). Internet hematology atlas contained in the homepage of Department of Clinical Pathology of Seoul National University Hospital were also prepared. The contents developed in this study may be a good guideline for diagnosis of hematological diseases. As a good supporting material, hematology atlas, references and internet homepage will be basic study materials that will help medical students and clinicians understand the workflow of hematological diagnosis.
Blood Cells ; Bone Marrow Examination ; Diagnosis ; Education ; Hematologic Diseases ; Hematology* ; Humans ; Internet ; Learning ; Multimedia* ; Pathology, Clinical ; Seoul ; Students, Medical

Biliary plastic stent induced life-threatening hemobilia is very rare. In this case, hemobilia seriously worsened following removal of a biliary stent, which had been placed for treatment of a postoperative bile leak in a patient who had undergone lateral liver segmentectomy for abdominal trauma. Following placement of the biliary stent, the bile leak improved, but hemobilia and cholangitis developed five days later. To manage the stent malfunction, we removed the biliary stent. However, life-threatening hemobilia developed immediately after removal. Endoscopic hemostasis was impossible; therefore, emergency angiographic embolization and stent graft were performed successfully. In such cases, angiographic embolization and stent-graft placement are effective diagnostic and therapeutic alternatives. When a patient develops hemobilia or cholangitis after biliary stent placement, endoscopists should pay special attention to remove the stent, which might exacerbate hemobilia.
Angiography ; Bile* ; Blood Vessel Prosthesis ; Cholangitis ; Emergencies ; Hemobilia* ; Hemostasis, Endoscopic ; Humans ; Liver ; Mastectomy, Segmental ; Plastics ; Stents*

PURPOSE: Visceral fat (VF) is closely associated with many metabolic risk factors and is also known to be a strong predictive factor for severe metabolic complications in adults. But there are only a few studies concerning the association of VF and risk factors for metabolic syndrome (MS) in children and adolescents. In our study, we emphasized the association of VF [measured by VF computed tomography (VFCT)] and risk factors for metabolic syndrome in children and adolescents. MATERIALS AND METHODS: The subjects were outpatients aged 6 to 18 years who underwent VFCT in the family medicine of The Catholic University of Korea from January 2005 to August 2009. There were 82 patients in total (42 children, 40 adolescents). Height, weight, blood pressure (BP), blood tests, body composition analysis and VF were measured. The three groups were also classified by metabolic score. RESULTS: In children, only high density lipoprotein cholesterol (HDL-C) showed a statistically significant difference, while in adolescents, triglyceride, HDL-C, BP, body mass index (BMI), waist circumference (WC) and VFA showed statistically significant differences. In terms of VFA, fasting glucose, BP, BMI, basal metabolic rate (BMR) and WC showed statistically significant differences. BMI showed a statistically significant difference in terms of BP, BMR, WC, VFA and HDL-C. CONCLUSION: There is a need to acknowledge the statistically significant associations of VF and risk factors for MS in children and adolescents. Screening tests for BP, cholesterol, fasting glucose and WC should be given in clinics for children and adolescents so that MS can be detected and its risk factors treated early.
Adolescent ; Body Mass Index ; Child ; Female ; Humans ; Intra-Abdominal Fat/*physiology ; Male ; Metabolic Syndrome X/*epidemiology/metabolism/physiopathology ; Risk Factors ; Waist Circumference/physiology

Persistent left superior vena cava is a rare congenital anomaly resulting from the failure of the left cardinal vein to degenerate in utero. This anomaly was discovered in 0.3% of large autopsy examinations. Its most relevant clinical implication is the association with cardiac impulse formation and conduction problems. In the case of DDD pacemaker implantation for this anomaly, skillful manual stylet shaping is required or an active fixation device, for example a screw device for stable positioning of pacemaker leads, is needed. We experienced a case of sick sinus syndrome in a patient with persistent left superior and absent right superior vena cava in 72-year-old man. We successfully implanted a DDD type pacemaker through the left superior vena cava via coronary sinus. This is the first Korean report of a successfully implanted permanent pacemaker in a patient with persistent left superior and absent right superior vena cava.
Aged ; Autopsy ; Coronary Sinus ; Dichlorodiphenyldichloroethane* ; Humans ; Sick Sinus Syndrome ; Veins ; Vena Cava, Superior*

BACKGROUND AND OBJECTIVES: The restrictive filling pattern (RFP) is accepted as a poor prognostic marker in congestive heart failure (CHF) patients. But, recently the RFP has been categorized into various prognosis subgroups by their clinical signs or echocardiographic markers with loading manipulation. But, in critically ill or severe dyspneic patients these loading manipulations are not practical to apply. Therefore, we tried to establish simple, reliable prognostic echocardiographic variables in CHF patients with the RFP. MATERIALS AND METHOD: 40 patients with the RFP were observed for 35+/-19 months after echocardiographic examination. We obtained baseline peak early (E), late (A) mitral inflow velocities, E/A ratio, deceleration time of E velocity (DT), peak early (E'), late (A') diastolic mitral annulus velocities, E'/A' ratio, reversibility of the RFP. The reversibility of RFP was defined as E/A ratio reverse (<1) during the Valsalva's maneuver. With the clinical and survival data during follow up period, we established significant prognostic variables in these patients. RESULTS: In univariate analysis, low systolic blood pressure (p=0.013), low A velocity (p=0.044), low A' velocity (p=0.028) and the irreversibility of RFP (p=0.024) were significant drastic prognosis variables. Especially, patients with A velocity <0.32 m/sec or A' velocity <0.04 m/sec showed significantly higher mortality. CONCLUSION: In CHF patients with the RFP, A velocity and A' velocity are very practical prognostic echocardiographic variables and patients with the low A velocity (<0.32 m/sec) or the low A' velocity (<0.04 m/sec) showed higher mortality rate.
Blood Pressure ; Critical Illness ; Deceleration ; Echocardiography ; Follow-Up Studies ; Heart Failure* ; Heart* ; Humans ; Mortality ; Prognosis* ; Valsalva Maneuver