BACKGROUND/AIMS: Drug-eluting stents (DES) are superior to bare metal stents (BMS) in reducing restenosis rates across a wide range of patients and lesion subsets.This study compared the clinical outcomes of DES versus BMS in patients with large coronary arteries (> or = 3.5 mm). METHODS: The study compared 134 patients (59.9 +/- 10.6 years, 90 men, 44 women) who underwent single vessel angioplasty with DESimplantation in large vessels with 115 patients (60.3 +/- 8.9 years, 82 men, 33 women) who received BMS. The clinical outcomes at 12 months were compared between groups. The study end points were major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and the need for target vessel and target lesion revascularization. RESULTS: The baseline clinical coronary angiography and procedural characteristics were similar in both groups. The duration of dual antiplatelet therapy was longer in the DES group than in the BMS group (240 +/- 2.7 vs. 348 +/- 1.7 days, p = 0.042). During the 12-month clinical follow-up, MACE were observed in 13 patients (11.3%) with BMS and 12 patients (9.0%) with DES (p = 0.486). CONCLUSIONS: For coronary stents implanted in large coronary arteries, DES seems to be more favorable, although no significant differences were observed in the clinical outcomes between DES and BMS during a 1-year clinical follow-up.
Angioplasty ; Arteries ; Coronary Angiography ; Coronary Disease ; Coronary Vessels ; Death ; Drug-Eluting Stents ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Male ; Myocardial Infarction ; Prognosis ; Stents

BACKGROUND/AIMS: In this study, we analysed the changes of matrix metalloproteinase-9 (MMP-9) expression in the gastric antral epithelium in respect to H. pylori eradication. METHODS: Twenty patients with H. pylori-positive chronic gastritis or peptic ulcer were studied. The expression of MMP-9 in the gastric antral biopsy specimens were compared before and after H. pylori eradication using immunohistochemical study. The positive rates and intensity of MMP-9 staining were evaluated at surface mucous cells and pyloric gland cells. RESULTS: The positive rate of MMP-9 staining in antral mucosal epithelial cells of H. pylori chronic gastritis is 63.8%. The positive rates of MMP-9 staining in the surface mucous cells and pyloric gland cells were 75.5% and 52.0% before H. pylori eradication, respectively. On the contrary, the rates were 85.5% and 82.0% after eradication. The MMP-9 overexpression in the pyloric gland cells were noticeably increased after H. pylori eradication. Strong positive staining of MMP-9 was increased significantly after H. pylori eradication in the pyloric gland cells. CONCLUSIONS: These results suggest that MMP-9 over-expression is associated with H. pylori infection as a host inflammatory response. The increased expression after H. pylori eradication indicates that MMP-9 may have a important role in remodeling or early tissue repairing process of gastric mucosa.
Adult ; Aged ; English Abstract ; Female ; Gastric Mucosa/*enzymology ; Gastritis/drug therapy/enzymology/microbiology ; Gelatinase B/*metabolism ; Helicobacter Infections/drug therapy/*enzymology/microbiology ; *Helicobacter pylori ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Peptic Ulcer/drug therapy/enzymology/microbiology ; Pyloric Antrum

Tamoxifen citrate is a non-steroidal agent that has demonstrated estrogen agonist and antagonist properties and has found successful application for all stages, as adjuvant therapy, in the treatment of primary breast cancer. The drug was originally introduced for the treatment of high risk postmenopausal women or for postmenopausal patients with advanced disease. Since then, it was reported that long term treatment schedules could provide maximal benefit in preventing recurrences. Recent analyses of clinical trials have demonstrated an increase of disease-free survival in breast cancer among patients with positive estrogen receptor tumor. Tamoxifen is now recommended for chemoprevention of breast cancer in healthy high risk women. An agonist estrogenic effect upon the endometrium, the so called "paradoxical" effect, is suggested when proliferative changes, such as endometrial hyperplasia, adenocarcinoma, polyps. We report a case of endometrial cancer which developed in premenopausal patients with breast cancer under tamoxifen therapy.
Adenocarcinoma* ; Appointments and Schedules ; Breast Neoplasms ; Chemoprevention ; Disease-Free Survival ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Estrogens ; Female ; Humans ; Polyps ; Recurrence ; Tamoxifen*

Gallbladder carcinoma is an uncommon neoplasm, and hemobilia caused by this disease is rare. We present a case of hemobilia in a patient with gallbladder carcinoma, which was recognized at forward duodenoscopy. A 42-year-old man visited our hospital due to intermmittent right upper quadrant pain. Duodenoscopy revealed blood clots with bile juice around the ampulla of Vater and the second portion of the duodenum. Endoscopic ultrasonography for the gallbladder showed a dumbell-shaped mass with a homogenous internal echogenicity on the body of the gallbladder. MR cholangiography showed a lobulated mass with low-signal intensity in the T1-weighted and T2-weighted images. Subsequently, laparoscopic cholecystectomy with regional lymph node dissection was performed, and adenocarcinoma was confirmed.
Adenocarcinoma ; Adult ; Ampulla of Vater ; Bile ; Cholangiography ; Cholecystectomy, Laparoscopic ; Duodenoscopy ; Duodenum ; Endosonography ; Gallbladder* ; Hemobilia* ; Humans ; Lymph Node Excision

The demand for intravenous sedated upper gastrointestianl endoscopy is currently increasing steeply. Despite this trend, patient status complication due to this procedure is largerly neglected by most physicians. Recently, in three patients, mouthpiece fragment were left within the patients' body after intravenous sedated upper gastrointestinal endoscopy. They were transferred to our institution for the removal of the fragment. The patients complained of an uneasy sensation from within their body, around their necks and chests. After conducting therapeutic endoscopy, the fragment could be located around the distal part of their esophagus and within their stomach. The fragment were removed successfully by using snare in two patients, and by using forceps in another patient.
Eating* ; Endoscopy ; Endoscopy, Gastrointestinal* ; Esophagus ; Humans ; Neck ; Sensation ; SNARE Proteins ; Stomach ; Surgical Instruments ; Thorax

BACKGROUND/AIMS: To determine the treatment modalities and the prognosis of a patient with liver cirrhosis, quantitative estimation of liver function is important. We assessed the Child-Pugh score (CPS), the common method as a severity index for the cirrhosis, the Promthombin, gamma GT, and Apolipoprotein A1 (PGA) index and model for end-stage liver disease (MELD) score. The purpose of this study was to evaluate the correlation between these indices in the patients with cirrhosis only and hepatocellular carcinoma (PHC), according to underlying causes (HBV and alcohol). METHODS: We reviewed medical records of 339 cirrhotic patients with/without hepatocellular carcinoma and divided patient groups by disease and underlying cause: cirrhosis caused by alcohol; LC-Al, cirrhosis caused by HBV; LC-B, hepatocellular carcinoma with cirrhosis caused by alcohol; HCC-Al, hepatocellular carcinoma with cirrhosis caused by HBV; HCC-B. We assessed the CPS, PGA index and MELD score and calculated the correlation coefficient between these scores. RESULTS: Among the total of 339 patients, 201 patients were diagnosed on the liver cirrhosis only, and 138 patients on the hepatocellular carcinoma with cirrhosis. In each groups, mean score values were not significantly different in CPS, PGA index and MELD score. The correlation of CPS, PGA index and MELD score in all groups, except for the correlation of PGA index and MELD score in HCC-Al group, was significantly positive (p<0.05). Compared to correlation coefficients between three indices, the patients with cirrhosis only had higher tendencies than the patients with hepatocellular carcinoma. The patients by HBV had higher tendencies than by alcohol. CONCLUSIONS: The correlations between CPS, PGA index and MELD score showed significantly positive correlations in the patients with liver cirrhosis only and hepatocellular carcinoma with cirrhosis (except in HCC-Al group). The patients with cirrhosis only had higher correlation coefficients than the patients with PHC and the patients by HBV had higher than by alcohol.
Adult ; Aged ; Carcinoma, Hepatocellular/*complications ; Female ; Hepatitis B/*complications ; Humans ; Liver Cirrhosis/*complications ; Liver Cirrhosis, Alcoholic/complications ; Liver Neoplasms/*complications ; Male ; Middle Aged ; Prognosis ; *Severity of Illness Index

BACKGROUND/AIMS: Apolipoprotein E (Apo E) is important in plasma lipid metabolism and is a component of several plasma lipoprotein-lipid particles. Three major Apo E isoforms are encoded by three common allelic forms, epsilon2, epsilon3, and epsilon4 at the APO E locus. The goal of this study was to examine the association between polymorphisms in the apolipoprotein E gene (APOE) and fatty liver disease. METHODS: We examined the distribution of APOE alleles from 116 fatty liver patients and 50 controls in Korea. RESULTS: The frequencies of APOE alleles in fatty liver patients were 6.5% in epsilon2, 85.7% in epsilon3 and 7.8% in epsilon4. The corresponding frequencies in control subjects were 4.0% in epsilon2, 91.0% in epsilon3 and 5.0% in epsilon4. There were no significant differences in the distribution of APOE genotypes between fatty liver patients and controls. APOE epsilon2 and epsilon4 allele frequencies in fatty liver patients were more than those in controls. However, there was no significant differences in APOE epsilon2 and epsilon4 allele frequencies. CONCLUSIONS: These results suggest that APOE alleles seem not to be directly associated with the pathogenesis of fatty liver disease.
Adult ; Aged ; Apolipoproteins E/*genetics ; English Abstract ; Fatty Liver/*genetics ; Female ; Gene Frequency ; Human ; Male ; Middle Aged ; *Polymorphism (Genetics)

Benign intracranial hypertension (BIH) is very rare and its cause is unclear. Raised intracranial pressure in the absence of an intracranial mass or hydrocephalus (BIH or pseudotumor cerebri) has been described in association with many conditions including SLE. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi that are responsible for cerebrospinal fluid (CSF) absorption. The diagnosis of BIH was confirmed by increased intracranial pressure in the absence of any abnormal radiological findings of the brain. We report a young woman with SLE and autoimmune thrombocytopenia complicated by BIH which resolved with corticosteroid therapy and osmotic diuretics.
Absorption ; Antigen-Antibody Complex ; Arachnoid ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Diuretics, Osmotic ; Female ; Humans ; Hydrocephalus ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Pseudotumor Cerebri* ; Purpura, Thrombocytopenic, Idiopathic

Pulmonary arterovenous malformation(PAVM) is an uncommon congenital anomaly. As pulmonary arteriovenous malformation is a direct communication between the Branches of pulmonary artery and vein which originated from the malformation of capillary development major disturbances in gas exchange can result. This malformation results in the several symptoms such as dyspnea hemopyssis cyanosis, and severe neurologic complaints. However, the most of patients are usually asymptomatic. Selective pulmonary angiography is well known the helpful diagnostic method. Recently, therapeutic embolization has been advocated as the treatment of choice for pulmonary arteriovenous malformations. We report a case of multiple pulmonary arteriovenous malformation, which was detected on the simple chest X-ray and snccessfully treated with coil embolization in a 19-year-old asymptomatic woman.
Angiography ; Arteriovenous Malformations* ; Capillaries ; Cyanosis ; Dyspnea ; Embolization, Therapeutic* ; Female ; Humans ; Pulmonary Artery ; Thorax ; Veins ; Young Adult

Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.
Astemizole ; Cimetidine ; Cytochrome P-450 Enzyme System ; Electric Countershock ; Electrocardiography ; Erythromycin ; Female ; Histamine Antagonists ; Humans ; Itraconazole* ; Ketoconazole ; Magnesium Sulfate ; Middle Aged ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*