OBJECTIVE: To determine the relation between the latency and duration of the cutaneous silent period (CuSP) and ultrasonographic findings of patients with carpal tunnel syndrome (CTS). METHOD: Subjects included 50 hands of 33 patients with CTS with electrophysiologic evidence of CTS and 50 hands of 39 adults with no evidence of CTS. CuSP was measured on abductor pollicis brevis (APB) and adductor digiti minimi (ADM) by stimulation of digit 3. All subjects were examined with ultrasonography (US). Using US, the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve were calculated under carpal tunnel. Analysis of differences between the control group and the CTS group was performed using ANOVA. RESULTS: Differences of CSA, FR, latency, and duration of CuSP in both APB, ADM muscles were observed between the two groups. Correlations were observed in the patient group in latency and duration of the APB muscle and only in duration of the ADM (p=0.048, r=0.159; p=0.035, r=-0.315; p=0.039, r=-0.293) muscle. Correlations were found only in duration of ADM (p=0.011, r=0.358) in the control group with respect to CSA. However, there was no correlation with FR. CONCLUSION: There seems to be a significant correlation between the CSA of the median nerve and the latency and duration of CuSP in patients with CTS. In addition, there seems to be a significant difference of CSA, FR, and latency in both APB and ADM between the two groups. CuSP and CSA might be useful for study that reflects intact small fibers in patients with CTS.
Adult ; Carpal Tunnel Syndrome ; Electromyography ; Hand ; Humans ; Median Nerve ; Muscles

BACKGROUND AND OBJECTIVES: P-wave dispersion (PWD) is a well-known electrophysiologic parameter of atria which are prone to fibrillation. Although paroxysmal atrial fibrillation (PAF) following an acute myocardial infarction (AMI) is not uncommon, the relationship between PWD and PAF following AMI has not been determined. SUBJECTS AND METHODS: We reviewed the electrocardiograms, recorded on admission and every day during hospitalization, of 144 patients with primary anterior AMIs and measured the P-wave duration. The left atrial diameter and left ventricular ejection fraction (LVEF) were evaluated by echocardiography. RESULTS: PAF occurred in 20 patients. The maximum P-wave duration and PWD were found to be significantly higher in patients with PAF than those without PAF (120.1+/-8.6 vs. 109.2+/-12.2 ms, p<0.001; and 68.5+/-11.9 vs. 48.7+/-9.6 ms, p<0.001, respectively). The minimum P-wave duration was significantly lower in patients with PAF than in patients without PAF (51.6+/-13.3 vs. 60.4+/-11.7 ms, respectively, p=0.003). There was no significant difference in the left atrial diameter between patients with PAF and patients without PAF (37.3+/-4.4 vs. 36.8+/-5.1 mm, respectively p=0.652); however, the LVEF was significantly different in the patients who developed PAF compared to those who did not develop PAF (38.5+/-11.4 vs. 45.1+/-8.7%, respectively, p=0.003). CONCLUSION: The maximum P-wave duration and PWD were significant predictive factors of PAF in patients with anterior wall ST elevation AMI based on univariate analysis. On the basis of multivariate analysis, age was an independent predictive parameter for PAF as well.
Atrial Fibrillation ; Echocardiography ; Electrocardiography ; Hospitalization ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Stroke Volume

BACKGROUND AND OBJECTIVES: Triple anti-platelet therapy may produce more potent inhibition of platelet aggregation in patients undergoing coronary stent implantation. We tested whether this effect could be maintained in diabetic patients, where platelet reactivity is increased and the risk of stent thrombosis is higher. SUBJECTS AND METHODS: Fifty five type 2 diabetic patients who had undergone drug-eluting stent (DES) implantation and chronic anti-platelet therapy (>1 month) were stratified according to the status of anti-platelet therapy. Platelet aggregation after adenosine diphosphate (ADP; 10 micronmol/L and 20 micronmol/L) stimulation was compared using light transmittance aggregometry between dual (aspirin plus clopidogrel, n=34) and triple therapy (aspirin, clopidogrel plus cilostazol, n=21) groups. RESULTS: The 2 groups had similar clinical and procedural characteristics. Maximal ADP-induced platelet aggregation was significantly lower in the triple therapy group than the dual therapy group (ADP 10 micronmol/L, 37.1+/-15.4 vs. 28.3+/-11.8, p=0.03; ADP 20 micronmol/L, 63.1+/-15.0 vs. 49.1+/-15.1, p=0.01), but there were no differences in diabetic treatment (oral hypoglycemic agent vs. insulin) or diabetic control {hemoglobin Alc (HbA1c)< or =7 vs. HbA1c >7}. CONCLUSION: Triple anti-platelet therapy showed more potent inhibition of maximal ADP induced platelet aggregation in type 2 diabetic patients receiving chronic anti-platelet therapy. This finding suggests that triple antiplatelet therapy may be more effective in preventing thrombotic complications after DES implantation in type 2 diabetic patients.
Adenosine Diphosphate ; Blood Platelets ; Diabetes Mellitus ; Drug-Eluting Stents ; Humans ; Light ; Platelet Aggregation ; Platelet Aggregation Inhibitors ; Stents ; Tetrazoles ; Thrombosis ; Ticlopidine

Infective endarteritis in the pulmonary artery is unusual. However, congenital heart disease such as patent ductus arteriosus (PDA) could be a predisposing factor of infective endarteritis. We report a patient with PDA complicated by infective endarteritis and large pulmonary artery vegetation. After three weeks of antibiotic treatment, the patient underwent surgical closure of the PDA and removal of the vegetation.
Ductus Arteriosus, Patent ; Endarteritis ; Heart Diseases ; Humans ; Pulmonary Artery

BACKGROUND/AIMS: Although the impact of ST segment elevation in patients with acute myocardial infarction (MI) has been studied, little information is available on the impact of ST segment elevation in the patients with acute MI and left ventricular systolic dysfunction. METHODS: We retrospectively analyzed the baseline clinical and angiographic characteristics and the in-hospital and 1- year clinical outcomes of 117 consecutive patients who were diagnosed with acute MI and who had a left ventricular ejection fraction of less than 40%, and these patients were treated from January 2004 to June 2006 at Busan Paik Hospital. Coronary angiography at the index hospitalization and the major adverse cardiac events (MACEs), including cardiac death, non-fatal reinfarction, target vessel revascularization (TVR), and heart failure, were compared between the 77 patients with ST segment elevation myocardial infarction (STEMI) and the 40 patients with non-ST segment elevation myocardial infarction (NSTEMI). RESULTS: Overall, the baseline clinical characteristics were similar between the two groups. On the coronary angiography, thrombolysis in myocardial infarction 0 flow was more common in the STEMI group as compared to the NSTEMI group (p<0.01) and the NSTEMI group had more frequent multivessel disease compared to the STEMI group (p=0.01). However, the in-hospital cardiac deaths and MACEs were not different on comparison between the two groups (p=0.66, p=0.81, respectively). The one-year cardiac deaths and MACEs were not significantly different on comparison between the two groups (p=0.37, p=0.68, respectively). CONCLUSIONS: This study demonstrated that ST segment elevation had no influence on in-hospital and the long term outcomes of patients with acute MI and left ventricular systolic dysfunction.
Coronary Angiography ; Death ; Glycosaminoglycans ; Heart Failure ; Hospitalization ; Humans ; Myocardial Infarction ; Prognosis ; Retrospective Studies ; Stroke Volume ; Ventricular Dysfunction, Left

Sinus of Valsalva aneurysms are rare cardiac anomalies. They can be congenital or acquired, and mainly involve the right or non-coronary sinuses. Unruptured aneurysms are usually asymptomatic unless they compress other structures or produce thrombi. A sinus of Valsalva aneurysm can also produce myocardial infarction through thrombus formation secondary to the turbulent flow in the Valsalva aneurysm. We report a case of a huge sinus of Valsalva aneurysm involving the noncoronary sinus, which was diagnosed as the presumed source of acute myocardial infarction.
Aneurysm ; Heart Atria ; Myocardial Infarction ; Sinus of Valsalva ; Thrombosis

No abstract available.
Angiography ; Catheters* ; Coronary Vessels* ; Spasm*

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) stenosis is a promising approach during this era of drug-eluting stents. However, there is no available hemodynamic data on these type patients during the performance of LMCA stenting. The purpose of this study was to determine the risk factors affecting hemodynamic stability during LMCA stenting, and to evaluate whether hemodynamic support such as inotropics or intra-aortic balloon pump (IABP) is needed, based on the risk factors. SUBJECTS AND METHODS: From July 2003 to January 2006, we enrolled 92 study patients (Male=55) who had visited Yeungnam University Hospital, Keimyung University Dongsan Hospital and InJe University Baik Hospital in Busan and they were all were diagnosed with angiographically detected unprotected LMCA stenosis. Group 1 (n=69) included those patients who did not need hemodynamic support during PCI. Group 2 (n=23) included patients who needed hemodynamic support during PCI. All patients had stents deployed in the LMCA lesions without hemodynamic support; the clinical, angiographic and procedural outcomes were compared between the two groups after the procedure. RESULTS: The baseline patient characteristics were not statistically different between the two groups. On univariate analysis, Group 2 had more patients diagnosed with acute myocardial infarction (AMI) than Group 1 (40% vs. 15%, respectively, p=0.014). Group 1 had a greater frequency of an increased left ventricular (LV) ejection fraction than Group 2 (60+/-10 vs. 47+/-11, respectively, p=0.01). Regarding the lesion location in the LMCA, Group 2 had relatively more lesions at bifurcated locations than Group 1 (44% vs. 78%, respectively, p=0.004). Group 2 required more complex techniques to repair lesions, such as kissing or crush stenting, than did Group 1 (19% vs. 48%, respectively, p=0.006). Multivariate logistic regression analysis showed that the presence of AMI (Odds Ratio (OR)=3.74, p=0.014), a complex stenting procedure such as kissing or crushing (OR=3.99, p=0.006), a bifurcated lesion (OR=4.58, p=0.004) and poor LV function (OR=9.95, p=0.0001) were independent risk factors for hemodynamic instability during LMCA stenting. CONCLUSION: The most important risk factor for hemodynamic instability during LMCA stenting was LV function. Therefore, preparation for hemodynamic support, including IABP before the procedure, is necessary for the high risk patients.
Busan ; Constriction, Pathologic ; Coronary Vessels ; Drug-Eluting Stents ; Hemodynamics* ; Humans ; Logistic Models ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Risk Factors* ; Stents* ; Ventricular Function

BACKGROUND AND OBJECTIVES: Drug-induced electrocardiographic QT interval prolongation is associated with the occurrence of a potentially lethal form of polymorphic ventricular tachycardia, termed 'torsades de pointes' (TdP). Women are at greater risk for the development of drug-induced TdP. To determine whether this may be the result of gender-specific differences in the effect of quinidine on cardiac repolarization, we compared the degree of quinidine-induced QT interval lengthening in young, healthy volunteers. SUBJECTS AND METHODS: Twelve women and 12 men each received a single intravenous dose of quinidine (4 mg/kg) or placebo in a single-blinded, randomized crossover trial. Total plasma concentrations of quinidine were measured, and QT and corrected QT intervals were analyzed. RESULTS: As expected, the mean QTc interval at baseline was longer for women than for men (443.6+/-26.9 vs 402.1+/-31.3 msec, respectively, p=0.037). The mean value of the maximal DeltaQTc after quinidine infusion was higher in women (134.4+/-46.4 vs 117.5+/-37.7 msec, respectively, p=0.029), and the mean value of the minimal DeltaQTc for 1 hour after quinidine infusion was also higher in the female group (47.6+/-15.7 vs 83.7+/-25.4 msec, p=0.034). However, there were no significant differences in the time courses of the changes in the quinidine-induced QTc and DeltaQTc interval between the two groups (p=0.092, and p=0.305, respectively). CONCLUSION: Quinidine causes greater QT prolongation in women at equivalent serum concentrations. This difference may contribute to the greater incidence of drug-induced TdP observed in women taking quinidine, and has implications for other cardiac and noncardiac drugs that prolong the QTc interval.
Asian Continental Ancestry Group ; Electrocardiography ; Female ; Healthy Volunteers ; Humans ; Incidence ; Male ; Plasma ; Quinidine ; Tachycardia, Ventricular

BACKGROUND AND OBJECTIVES: Cilostazol is an antiplatelet drug with antiproliferative properties when administered after coronary bare metal stent implantation. However, its effect on clinical and angiographic outcomes after sirolimus-eluting stent (SES) implantation in native coronary arteries has not been established. SUBJECTS AND METHODS: Two hundred patients who had undergone successful SES implantation were randomly assigned to receive, in addition to aspirin, 75 mg clopidogrel daily or 100 mg cilostazol twice daily after one month of triple oral therapy (aspirin, clopidogrel, and cilostazol). The medications were continued until the follow-up coronary angiography, which was performed after six months. RESULTS: There were no significant differences in the minimal luminal diameters before and immediately after the coronary intervention, and at the follow-up angiography. The late loss of minimal luminal diameter was 0.26+/-0.40 mm in the cilostazol group and 0.28+/-0.41 mm in the clopidogrel group (p=0.773). Other quantitative coronary angiography variables were also similar in the two groups. Restenosis, determined by quantitative coronary angiography at six months and defined as > or =30% narrowing, occurred in 11.4% of the clopidogrel group and 8.7% of the cilostazol group (p=0.478). However, in-stent restenosis was focal (100% vs 23.1% in the clopidogrel group, p<0.001), and shorter in the cilostazol group (6.26+/-2.42 vs 14.5+/-6.55 mm, p=0.001). CONCLUSION: Cilostazol was not inferior to clopidogrel in terms of clinical anti-coagulation effect, and had an antiproliferative effect in native coronary arteries after SES implantation.
Angiography ; Aspirin ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels* ; Drug-Eluting Stents* ; Follow-Up Studies ; Humans ; Phenobarbital ; Sirolimus ; Stents