BACKGROUND AND OBJECTIVES: We assessed plaque erosion of culprit lesions in patients with acute coronary syndrome in real world practice. SUBJECTS AND METHODS: Culprit lesion plaque rupture or plaque erosion was diagnosed with optical coherence tomography (OCT). Intravascular ultrasound (IVUS) was used to determine arterial remodeling. Positive remodeling was defined as a remodeling index (lesion/reference EEM [external elastic membrane area) >1.05. RESULTS: A total of 90 patients who had plaque rupture showing fibrous-cap discontinuity and ruptured cavity were enrolled. 36 patients showed definite OCT-plaque erosion, while 7 patients had probable OCT-plaque erosion. Overall, 26% (11/43) of definite/probable plaque erosion had non-ST elevation myocardial infarction (NSTEMI) while 35% (15/43) had ST elevation myocardial infarction (STEMI). Conversely, 14.5% (13/90) of plaque rupture had NSTEMI while 71% (64/90) had STEMI (p<0.0001). Among plaque erosion, white thrombus was seen in 55.8% (24/43) of patients and red thrombus in 27.9% (12/43) of patients. Compared to plaque erosion, plaque rupture more often showed positive remodeling (p=0.003) with a larger necrotic core area examined by virtual histology (VH)-IVUS, while negative remodeling was prominent in plaque erosion. Overall, 65% 28/43 of plaque erosions were located in the proximal 30 mm of a culprit vessel-similar to plaque ruptures (72%, 65/90, p=0.29). CONCLUSION: Although most of plaque erosions show nearly normal coronary angiogram, modest plaque burden with negative remodeling and an uncommon fibroatheroma might be the nature of plaque erosion. Multimodality intravascular imaging with OCT and VH-IVUS showed fundamentally different pathoanatomic substrates underlying plaque rupture and erosion.
Acute Coronary Syndrome* ; Humans ; Membranes ; Myocardial Infarction ; Plaque, Atherosclerotic ; Rupture* ; Thrombosis ; Tomography, Optical Coherence ; Ultrasonography

OBJECTIVE: There has been a limited investigation looking into the correlation between pericardial fat and abdominal fat with coronary artery disease (CAD) as measured by coronary computed tomographic angiography (CCTA). We proposed that the volume of pericardial fat is larger in patients with CAD than in patients without CAD, and sought to determine which abdominal adiposity index best correlated with pericardial fat volume. METHODS: Participants were examined using CCTA between October 2007 and January 2008. All participants had no previous history of CAD. Pericardial adipose tissue (PAT) volume, abdominal total adipose tissue volume, abdominal subcutaneous adipose tissue volume, and abdominal visceral adipose tissue (AVAT) volume were measured using CCTA. RESULTS: Fifty patients (26.5%) demonstrated CAD, and 139 patients did not demonstrate CAD by CCTA. PAT volume in patients with CAD was larger than that of patients without CAD (173.2+/-64.2 cm3 vs. 147.6+/-50.4 cm3, p<0.01). However, indices of abdominal adiposity were not significantly different between the two groups. Using multivariable analysis, independent predictors of CAD were PAT volume (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.00-1.02, p=0.04), coronary artery calcium score (OR 1.01, 95% CI 1.00-1.01, p<0.01), and typical chest pain (OR 4.88, 95% CI 1.47-16.21, p=0.01). AVAT volume showed a linear correlation with PAT volume. CONCLUSION: PAT volume was an independent predictor of CAD as measured by CCTA. PAT volume was also well correlated with the AVAT volume among the indices of abdominal adiposity.
Abdominal Fat ; Adipose Tissue ; Adiposity ; Angiography ; Calcium ; Chest Pain ; Coronary Artery Disease* ; Coronary Vessels ; Humans ; Intra-Abdominal Fat ; Subcutaneous Fat, Abdominal

We aimed to investigate that complete revascularization (CR) would be associated with a decreased mortality in patients with multivessel disease (MVD) and reduced left ventricular ejection fraction (LVEF). We enrolled a total of 263 patients with MVD and LVEF <50% who had undergone percutaneous coronary intervention with drug-eluting stent between March 2003 and December 2010. We compared major adverse cardiac and cerebrovascular accident (MACCE) including all-cause death, myocardial infarction, any revascularization, and cerebrovascular accident between CR and incomplete revascularization (IR). CR was achieved in 150 patients. During median follow-up of 40 months, MACCE occurred in 52 (34.7%) patients in the CR group versus 51 (45.1%) patients in the IR group (P=0.06). After a Cox regression model with inverse-probability-of-treatment-weighting using propensity score, the incidence of MACCE of the CR group were lower than those of the IR group (34.7% vs. 45.1%; adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.44-0.95, P=0.03). The rate of all-cause death was significantly lower in patients with CR than in those with IR (adjusted HR, 0.48; 95% CI, 0.29-0.80, P<0.01). In conclusion, the achievement of CR with drug-eluting stent reduces long-term MACCE in patients with MVD and reduced LVEF.
Age Factors ; Aged ; Coronary Artery Disease/*drug therapy/mortality/physiopathology ; Diabetes Mellitus, Type 2/complications ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Percutaneous Coronary Intervention/adverse effects ; Proportional Hazards Models ; Renal Insufficiency, Chronic/complications ; Retrospective Studies ; Sex Factors ; Treatment Outcome ; Ventricular Dysfunction, Left/physiopathology

PURPOSE: This study examined the rate of degeneration of acetabular cartilage by the bipolar head according to time, and also which clinical factors are related to the degeneration of acetabular cartilage. MATERIALS AND METHODS: Among 192 patients (226 hip joints) who received bipolar hemiarthroplasty from August 1996 to August 2002, 61 patients (65 hip joints) were enrolled in this study, who were followed up for more than 2 years and showed no signs of dislocation, infection, or functional problems. A modified form of a computer assisted vector wear analysis program was used to measure the rate of degeneration of the acetabular cartilage. The factors that appeared to affect the rate of acetabular degeneration in the two groups was evaluated. RESULTS: The average linear degenerative change in the acetabular cartilage and the volumetric degenerative change were 0.23 +/- 0.107mm/year and 114 +/- 47.2mm3/year, respectively. The result showed significant differences in activity and HHS between the 2 groups. The HHS showed a reverse relationship with the linear degeneration and volumetric degeneration, and the activity showed a correlation with the linear and volumetric degeneration. CONCLUSION: The acetabular cartilage degenerates faster as the patient' activity increases, and slower with a higher HHS. When surgeons perform hip joint arthroplasty, it is strongly recommended that the life expectancy and the level of activity should be considered when deciding between a hemiarthroplasty and total hip arthroplasty.
Aged ; Arthroplasty, Replacement, Hip/*adverse effects ; Cartilage, Articular/*radiography ; Follow-Up Studies ; Humans ; Middle Aged ; Treatment Outcome

A 27-year-old female visited outpatient clinic for the evaluation of palpitation and dyspnea on exertion. Echocardiographic examination including transthoracic and transesophageal echocardiography revealed coarctation of aorta, bicuspid aortic valve, mitral valve prolapse, and sealed-up ventricular septal defect. Further evaluation with computed tomography angiography revealed another combined congenital anomaly of left isomerism with polysplenism and interrupted inferior vena cava and pulmonary embolism with deep vein thrombosis. After corrective surgery for the coarctation, she received anticoagulation therapy for the treatment and the secondary prevention of pulmonary embolism.
Adult ; Ambulatory Care Facilities ; Angiography ; Aortic Coarctation* ; Aortic Valve ; Bicuspid ; Dyspnea ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Ventricular ; Humans ; Isomerism* ; Mitral Valve Prolapse ; Pulmonary Embolism ; Secondary Prevention ; Vena Cava, Inferior* ; Venous Thrombosis

Epidermolysis bullosa (EB) has three distinctive types, of which junctional EB has been known to be associated with pyloric atresia (PA) usaually. PA is a congenital disease of gastric outlet obstruction, known to occur at a rate of 1 per million live-births. It may occur independently or in combination with other congenital disorders such as EB. Dozens of cases of this combined disease have been reported since 1972 and autosomal recessive patterns have recently been revealed. This, junctional epidermolysis bullosa with pyloric atresia, has poor prognosis. Bullous, erupted cutaneous manifestations have recurrent, persistent characteristics and causes extracutaneous manifestations such as electrolyte imbalance, protein-loosing enteropathy, failure to thrive, and sepsis. In some cases, this syndrome may have obstructive uropathy and give it bad results also. For these reasons, physicians should be careful to avoid minor trauma on the skin and need to make meticulous decisions in operative correction about obstrutive gastrointestinal lesion or uropathy. We report a case of 3-day-old male baby, junctional epidermolysis bullosa with pyloric atresia.
Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Epidermolysis Bullosa ; Epidermolysis Bullosa, Junctional* ; Failure to Thrive ; Gastric Outlet Obstruction ; Humans ; Male ; Prognosis ; Sepsis ; Skin

Vasoactive intestinal peptide(VIP) is a 28-amino acid peptide, which may cause secretory diarrhea by stimulating the production of adenylate cyclase. Neuroendocrine tumors, secreting vasoactive intestinal peptide (VIP), are almost always of a pancreatic in origin. However, a pheochromocytoma may produce several neuropeptides, containing VIP, as they are considered to be neuroendocrine tumors. A 57-year-old woman, who presented with chronic watery diarrhea, hypokalemia, weight loss and a left adrenal mass, is described. Histologically, the tumor was diagnosed as a pheoch-romocytoma, with ganglioneuronal differentiation, and was histochemically confirmed to produce a vasoactive intestinal polypeptide. A left adrenal VIP-producing pheochromocytoma was successfully resected. After surgery, her diarrhea subsided and the electrolytes, affected neuroendocrine hormone levels, blood pressure and blood sugar level were normalized.
Adenylyl Cyclases ; Blood Glucose ; Blood Pressure ; Diarrhea ; Electrolytes ; Female ; Humans ; Hypokalemia ; Middle Aged ; Neuroendocrine Tumors ; Neuropeptides ; Pheochromocytoma* ; Vasoactive Intestinal Peptide* ; Weight Loss

PURPOSE: Completion thyroidectomy is the removal of any thyroid tissue that remains after less than total thyroidectomy. The purpose of the present study is to review the processes and pathologic results leading to completion thyroidectomy, and to determine the degree of increased morbidity with completion thyroidectomy. METHODS: The hospital records of 60 patients treated from January 1981 to December 2000 were retrospectively reviewed. RESULTS: The subjects were 48 women and 12 men with ages ranging from 17 to 72 years (mean 46.3 years). Initial pathologic results were 46 cases of papillary carcinoma (76.6%), 12 of follicular carcinoma (20%), one of medullary carcinoma and one of Hurthle cell carcinoma. Initial operations were lobectomy in 51 cases, bilateral subtotal thyroidectomy in 6 and enucleation in 3. Completion thyroidectomies were performed due to tumor recurrence in 32 cases, confirmed malignancy following permanent sections in 21 and others in 7. Twenty-one of the cases were performed within 6 months after initial operations. Residual or recurrent carcinoma was found in 36 cases of the completion thyroidectomy specimens (60%). Postoperative complications were as follows: transient and permanent recurrent laryngeal nerve palsy occurred in 1 (1.7%) and 2 (3.3%) cases, respectively, transient and permanent hypoparathyroidism occurred separately in 15 (25%) and 4 (6.7%) cases, respectively, and there was one case of hematoma (1.7%) and one of wound infection (1.7%). There was no correlation between complications and the interval between initial surgery and reoperation. CONCLUSION: Completion thyroidectomy could be performed with minimal morbidity and might prevent the development of regional recurrence by eliminating an unsuspected focus of cancer. The surgeon should not feel obligated to perform a total thyroidectomy if the diagnosis of cancer is not secure, because the second stage operation can be performed over a wide time interval, allowing the physician and patient considerable latitude for decision making.
Carcinoma, Medullary ; Carcinoma, Papillary ; Decision Making ; Diagnosis ; Female ; Hematoma ; Hospital Records ; Humans ; Hypoparathyroidism ; Male ; Postoperative Complications ; Recurrence ; Reoperation ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Thyroidectomy* ; Vocal Cord Paralysis ; Wound Infection

No abstract available.
Diskectomy*

No abstract available.
Diskectomy*