BACKGROUND AND OBJECTIVES: In a previous study, LB30057 was found to inhibit smooth muscle cell proliferation in a dose dependent manner, and prolonged 1 4-day oral administration of LB30057 is effective in reducing the neointimal hyperplasia in a rat carotid balloon injury model. The prolonged administration of LB30057, an orally active direct thrombin inhibitor, was evaluated and found to be a potential inhibitor of restenosis in a porcine coronary injury model. MATERIALS AND METHODS: An oversized balloon injury and a stent injury were given to the right coronary artery and left anterior descending artery, respectively, in the porcine model. LB30057 (50mg/kg) or a placebo was administrated for 28 days, using an osmotic pump, starting 6 hours prior to the injury until sacrifice on the 28th day. The drug concentration and antithrombotic effects (aPTT, thrombin-anti thrombin complex levels) were measured, and a histo-morphometric analysis performed 28 days later. RESULTS: The drug concentrations were 271+/-1 24 and 67+/-52 ng/mL on days 1 and 28 after injury in the drug group. The TAT (thrombin-antithrombin complex) levels were significantly lower in the drug than the control group on the 2nd and 7th days after injury (p<0.05). There were no significant differences in the injury scores, and the luminal, intimal and medial areas between the two groups. CONCLUSION: Prolonged administration of LB30057, using an osmotic pump, was not effective in reducing the restenosis in our pig coronary injury model.
Administration, Oral ; Animals ; Arteries ; Coronary Disease ; Coronary Restenosis ; Coronary Vessels ; Hyperplasia ; Myocytes, Smooth Muscle ; Phenobarbital ; Rats ; Stents ; Thrombin*

BACKGROUND AND OBJECTIVES: The serum hydroxyproline level (SHL) has been regarded as evidence of collagen breakdown or extra-cellular matrix reorganization. The role of SHL as a diagnostic parameter in acute coronary syndrome, and the SHL changes depending on the left ventricular remodeling after acute myocardial infarction, was evaluated. SUBJECTS AND METHODS: Venous blood samples were obtained from 122 patients with AMI at the time of admission, and on days 7, 21 and 90, and once from 15 patients with stable angina, 15 with unstable angina and 12 healthy subjects. The SHL was measured using the amino acid analysis system (HPLC). The regional wall motion index (RWMI), LVEF and LV dimensions were determined in the early (<1 week) and chronic (3 months) phases using echocardiography. Based on the final angiogram, patients were allocated to the reperfusion (TIMI II-III ; n=103) or non-reperfusion (TIMI 0-I ; n=19) groups. RESULTS: There were significant differences in the SHL among patients with AMI (6.49+/-3.77 microgram/L), unstable angina (2.92+/-1.81 microgram/L), stable angina (2.22+/-1.29 microgram/L) and the normal control groups (2.35+/-0.92 microgram/L). There was no significant difference in the SHL between the reperfusion and non-reperfusion groups on admission (p>0.05). However, there was a significant elevation in the SHL 14 day after AMI in the patients of the non-reperfusion group (4.36+/-1.46, 7.63+/-2.69 microgram/L, p=0.032). After 2 week, there was no significant difference in the SHL. There was a significant relationship between the late left ventricular ejection fraction and the SHL (r=-0.414, p=0.037), but no significant relationship between the other factors and the SHL (p>0.05). CONCLUSION: The serum hydroxyproline levels were significantly increased in patients with acute coronary syndrome, which reflect the early change in left ventricular remodeling in acute myocardial infarction.
Acute Coronary Syndrome* ; Angina, Stable ; Angina, Unstable ; Collagen ; Echocardiography ; Humans ; Hydroxyproline ; Myocardial Infarction ; Reperfusion ; Stroke Volume ; Ventricular Remodeling

OBJECTIVE: To describe the angiographic embolization as a safe and an effective alternative treatment in the management of obstetrical hemorrhage and in preserving fertility. METHODS: Between March 1999 and May 2003, 43 patients at Asan Medical Center underwent angiographic embolization for the management of obstetrical hemorrhage. All cases received arterial embolization because of obstetrical hemorrhage unresponsive to conservative management or prophylaxis for massive obstetrical hemorrhage. Medical records were reviewed and detailed to collect adequate clinical data such as clinical status, underlying conditions, amount of transfusion, embolization sites, materials of embolization, duration of the procedure, complications associated with embolization, hospital stay, and the success rate. Patients were contacted by telephone to obtain long-term outcome for menstruation, desire for conception, and subsequent pregnancies. RESULTS: We have experienced the clinical successful embolization in 37 (86.0%) of 43 patients of obstetrical hemorrhage resulting from various causes. The main cause of hemorrhage was atony of uterus (n=17), followed by abnormal placentation (n=6), genital tract laceration (n=5). The average amount of blood transfusion was 7.0 units (range; 0-36 units). The average length of the time for the procedure was 68.2 minutes (range; 30-150 minutes). The average duration of hospitalization was 6.4 days (range; 3-20 days). The main complication after embolization was numbness and pain on right lower extremities in 5 cases and vessel dissection occurred in 1 case. But there was no major complication related to the procedure. We were able to follow up 28 patients. In all cases menses resumed spontaneously soon after the procedure. Seven cases of long-term follow-up became pregnant, and 3 cases of them completed gestations giving birth to healthy babies. CONCLUSION: The results suggest that angiographic embolization is a relatively noninvasive and highly effective method for the management of obstetrical hemorrhage and a useful technique for preserving fertility.
Blood Transfusion ; Chungcheongnam-do ; Female ; Fertility ; Fertilization ; Follow-Up Studies ; Hemorrhage* ; Hospitalization ; Humans ; Hypesthesia ; Lacerations ; Length of Stay ; Lower Extremity ; Medical Records ; Menstruation ; Parturition ; Placentation ; Pregnancy ; Telephone ; Uterus

Behcet's disease is a disorder of a multisystemic involvement with unknown etiology. Involvement of the cardiovascular system and intestinal tract are rare, but serious complications. We present a case with Behcet's disease demonstrating aneurysm of the abdominal aorta as well as hemorrhagic ileal ulcerative lesions and requiring surgical treatment.
Aneurysm* ; Aorta, Abdominal* ; Aortic Aneurysm ; Behcet Syndrome ; Cardiovascular System ; Ileitis ; Ileum* ; Ulcer*

In antiphospholipid antibody syndrome (APS), multiple thromboses affecting large arteries and veins through the whole body is rare. In this report, a case of a 65 year old women suffering from APS with multiple thromboses of the renal and iliac artery, the infrarenal abdominal aorta, the deep vein, and a pulmonary thromboembolism is presented. The patient was treated successfully with intensive anticoagulation and steroid pulse therapy. There was no evidence of recurrent thrombotic complications during a three year follow-up period with oral warfarin and prednisolone
Aged ; Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome* ; Aorta, Abdominal* ; Arteries ; Female ; Follow-Up Studies ; Humans ; Iliac Artery ; Prednisolone ; Pulmonary Embolism ; Thrombosis* ; Veins ; Warfarin

BACKGROUND: Recent data showed prolonged administration of direct thrombin inhibitor might be needed to counteract the persistent thrombin activity and reduce the neointimal hyperplasia after arterial injury. We hypothesized that prolonged administration of LB30057, orally active direct thrombin inhibitor, might inhibit the vascular smooth muscle cell (SMC) proliferation in vitro and neointimal hyperplasia in rat carotid injury model. METHODS: In phase I, thrombin stimulated [methyl-3H] thymidine uptake was measured after LB30057 administration in cell culture study using rat aortic SMC. In phase II, LB30057 (low-dose: 5mg/kg, bid: mid-dose: 25mg/kg, bid: high-dose: 50mg/kg, bid) or placebo was administrated orally twice a day starting from 30minutes before injury until sacrifice for 14days in separated 2 sets of experiment. The histo-morphometric analysis for lumen area, intimal area, medial area, intima-to-medial ratio was performed. RESULTS: In vitro rat aortic SMC culture study, LB30057 inhibited thrombin-induced thymidine uptake. The mean neointimal area was significantly less in high-dose and mid-dose group than placebo group (high-dose vs. placebo: 0.14+/-0.02mm2 vs. 0.25+/-0.02mm2: mid-dose vs. placebo: 0.16+/-0.02mm2 vs. 0.29+/-0.03mm2, p<0.005) respectively and the mean ratio of neointima to medial area were significantly less in high-dose and mid-dose group than in placebo group (high-dose vs. placebo: 1.20+/-0.57 vs. 1.94+/-0.67, mid-dose vs. placebo: 1.58+/-0.29 vs. 2.39+/-0.27, p<0.05). There was no significant difference in the mean area of internal elastic lamina, external elastic lamina and mean luminal area between groups. In 2nd set experiment, the mean neointimal area (placebo: 0.29+/-0.03mm2, mid-dose: 0.16+/-0.02mm2: p<0.005), the mean area of internal elastic lamina and external elastic lamina were significantly less in mid-dose group than in placebo group. The mean ratio of neointima to medial area was significantly less in mid-dose group(1.58+/-0.29) than in placebo group (2.39+/-0.27) (p<0.05). CONCLUSION: LB30057 inhibits SMC proliferation in a dose dependent manner. Prolonged 14-day oral administration of LB30057 is effective in reducing the neointimal hyperplasia in rat carotid balloon injury model.
Administration, Oral ; Animals ; Cell Culture Techniques ; Cell Proliferation* ; Hyperplasia* ; Muscle, Smooth, Vascular* ; Neointima ; Phenobarbital ; Rats* ; Thrombin* ; Thymidine

BACKGROUND AND OBJECTIVES: Despite the proven benefit of cholesterol- lowering therapy in patients with CAD, there is no consensual opinion on guideline of cholesterol-lowering therapy in patients with CAD in Korea. The aim of this study is to evaluate the risk of CAD according to the cholesterol level and to consider current guideline of cholesterol-lowering therapy for the secondary prevention in patients with CAD. MATERIALS AND METHODS: Consecutive 600 patients were assigned into two groups - coronary artery disease group (364 patients) and normal coronary artery group (236 patients) - depending on the coronary angiographic findings. Lipid profiles (total cholesterol, Triglyceride, HDL-cholesterol, LDL-cholesterol) were obtained and the odd ratio of CAD was evaluated according to the national cholesterol education program treatment guideline (NCEP: LDL cholesterol > or = 130 mg/dl) and the national heath insurance treatment guideline (NHI: total cholesterol > or = 220 mg/dl) by multi-variate logistic regression analysis. RESULTS: According to the NHI and NCEP guideline, the proportion of patients with CAD indicated on cholesterol-lowering therapy were 25%, 36.5% respectively and the odd ratio of CAD was 1.00 (95% CI 0.52 - 1.89, p=0.99), 4.89 (95% CI 2.78 - 8.60, p< 0.01) respectively . CONCLUSIONS: Our data showed that LDL-cholesterol > or = 130 mg/dl only reflected the risk of CAD in both guidelines and more proportion of the patients were indicated on cholesterol-lowering therapy in NCEP guideline than in NHI guideline.
Cholesterol ; Cholesterol, LDL ; Coronary Artery Disease* ; Coronary Vessels* ; Education ; Humans ; Insurance ; Korea ; Logistic Models ; Secondary Prevention ; Triglycerides

Coronary artery perforation is a rare and serious complication in coronary angioplasty. Some patients complicated by coronary perforation may develop cardiac tamponade, which is generally due to massive hemorrhage in the pericardial space between the epicardium and the pericardium. We report a case of coronary artery perforation producing impending tamponade, which was successfully treated by transcatheter embolization of distal circumflex artery using polyvinyl alcohol.
Angioplasty ; Arteries* ; Cardiac Tamponade ; Coronary Vessels ; Hemorrhage ; Humans ; Pericardium ; Polyvinyl Alcohol* ; Polyvinyls*

BACKGROUND AND PURPOSE: The radial artery has currently been regarded as a useful vascular access site for coronary procedures. We want to evaluate the incidence and clinical significance of anomalous branching pattern and tortuosity of radial artery. MATERIALS AND METHOD: From May 1997 to May 1999, retrograde radial artery angiography was performed in 1191 cases. Branching anomaly and tortuosity of upper extremity artery, procedure times and local vascular complications were analyzed. RESULTS: 1) Anomalous radial arterial branching was found in 3.2%. Most common one was high origin of the radial artery (2.4%). 2) Tortuosity of radial artery was found in 4.2%. Most common tortuosity were S shape in 1.8% and omega shape in 1.8% of cases. 3) Cross over to other artery, radial artery occlusion and perforation occurred in 24 cases, 6 cases and 4 cases, respectively. Prolonged procedure times, crossover to other artery and radial artery perforation was related with tortuosity of radial artery, not with anomalous branching. CONCLUSION: The incidence in branching anomaly and tortuosity of radial artery was not frequent in our study. Radial artery tortuosity was associated with old age, prolonged procedure time and radial artery perforation. In selected cases, pre- or intra-procedural angiographic assessment of radial artery might be helpful in performing safe procedure.
Angiography ; Arteries ; Incidence ; Radial Artery* ; Upper Extremity

BACKGROUND AND PURPOSE: Hyperhomocysteinemia is supposed to be a risk factor for vascular occlusive disease. We want to evaluate the relationship between plasma homocysteine and the severity of coronary artery disease (CAD). METHODS: In 121 consecutive patients (men:62%: age:60+/-10 years) undergoing coronary angiography, plasma homocysteine, vitamin B(12), vitamin B(6) and folate levels were measured and angiographic findings were evaluated for the number of diseased vessels (diameter stenosis 50%), severity of stenosis of CAD and extent of CAD. Extent of CAD was defined as an index derived by assigning a score of 0-3 per segment depending on the proportion of lumen length irregularity and dividing the sum by the number of visualized segments. RESULTS: Twenty-two patients had normal coronary artery: 35 patients, minimal CAD (diameter stenosis < 50%): 30 patients, 1 vessel disease (VD): 22 patients, 2VD and 12 patients, 3VD. Homocysteine levels w+re not significantly different between the groups (normal:7.6+/-4.2 mmol/L: minimal CAD:8.4+/-3.1mmol/L: 1VD: 8.0+/-4.8mmol/L: 2VDs: 10.2+/-6.0 mmol/L: 3VDs: 9.2+/-5.3 mmol/L). There was no relation between the stenosis scores of CAD and homocysteine levels (r=0.1). The extent scores of CAD were weakly correlated to the plasma homocysteine levels (r=0.22, p<0.05) and low density lipoprotein (LDL) cholesterol levels (r=0.28, p<0.01), and reversely correlated to high density lipoprotein (HDL) cholesterol levels (r=-0.31, p<0.01). The plasma homocysteine levels were reversely correlated to vitamin B12 (r=-0.27, p<0.01) and folate (r=-0.23, p<0.05) levels. In conclusion, the plasma homocysteine level was weakly but significantly correlated with the extent of CAD, not with the severity of stenosis.
Atherosclerosis ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels ; Folic Acid ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Lipoproteins ; Plasma* ; Risk Factors ; Vitamin B 12 ; Vitamins