ABSTRACT
Background and Objectives@#The purpose of this study was to figure out the clinical effectiveness of the bluetooth wireless streaming when used with a hearing aid during cell phone conversation for hearing-impaired listeners.Subjects and Method Twenty-four adults with hearing loss participated (mild: 3, moderate: 13, moderately severe: 8) in the study. The following three objective tests and one subjective questionnaire were administered to all participants; 1) consonant and Monosyllabic test in an noisy environment, 2) speech recognition test in quiet and noisy conditions, 3) listening effort test, and 4) questionnaire about sound quality and preference. Each objective test was conducted in three different cell phone conversation environments as follows; 1) unaided condition, 2) aided condition, with the bluetooth function off, and 3) aided condition, with the bluetooth function on. @*Results@#In the aided condition with the bluetooth function off, performance on consonant and monosyllabic tests was the lowest (p<0.05). However, when the bluetooth function was turned on, the result showed statistically significant superior performance (p<0.05). For the words and sentences test in noisy conditions, using wireless streaming feature with the hearing aids were beneficial compared to not using the feature (p<0.05). However, no significant difference was found between the bluetooth off and on conditions in quiet conditions. Listening effort was significantly lower in noisy background for aided bluetooth on condition (p<0.05). There was no significant difference in sound quality according to each condition, but the preference of Bluetooth feature was overwhelmingly high. @*Conclusion@#Bluetooth wireless streaming is beneficial during phone conversation in noisy environments for users of hearing aids.
ABSTRACT
BACKGROUND/AIMS: The efficacy of standard triple therapy (STT) in treating Helicobacter pylori infection has decreased. Many investigators have attempted to increase the eradication rate. We investigated the outcomes of concomitant therapy (CT) and STT combined with probiotics (STP) as a first-line treatment for H. pylori infection. METHODS: We reviewed the medical records of 361 patients who received either STP (n=286) or CT (n=75). The STP group received STT combined with a probiotic preparation for 1 week. The CT group received STT and metronidazole for 1 week. RESULTS: The intention-to-treat and per-protocol eradication rates were 83.6% (95% confidence interval [CI], 79.0 to 87.7) and 87.1% (95% CI, 81.2 to 89.7) in the STP group and 86.7% (95% CI, 78.7 to 93.3) and 91.4% (95% CI, 83.6 to 97.1) in the CT group (p=0.512 and p=0.324), respectively. The frequency of adverse effects was higher in the CT group (28.2%) than in the STP group (12.8%) (p=0.002). CONCLUSIONS: STP and CT are encouragingly efficacious as first-line treatments for H. pylori infection. Therefore, adding probiotics to STT may be a feasible option to avoid side effects.
Subject(s)
Humans , Helicobacter pylori , Helicobacter , Medical Records , Metronidazole , Probiotics , Research PersonnelABSTRACT
Bone matrix is properly maintained by osteoclasts and osteoblasts. In the tumor microenvironment, osteoclasts are increasingly differentiated by the various ligands and cytokines secreted from the metastasized cancer cells at the bone metastasis niche. The activated osteoclasts generate osteolytic lesions. For this reason, studies focusing on the differentiation of osteoclasts are important to reduce bone destruction by tumor metastasis. The N-myc downstream-regulated gene 2 (NDRG2) has been known to contribute to the suppression of tumor growth and metastasis, but the precise role of NDRG2 in osteoclast differentiation induced by cancer cells has not been elucidated. In this study, we demonstrate that NDRG2 expression in breast cancer cells has an inhibitory effect on osteoclast differentiation. RAW 264.7 cells, which are monocytic preosteoclast cells, treated with the conditioned media (CM) of murine breast cancer cells (4T1) expressing NDRG2 are less differentiated into the multinucleated osteoclast-like cells than those treated with the CM of 4T1-WT or 4T1-mock cells. Interestingly, 4T1 cells stably expressing NDRG2 showed a decreased mRNA and protein level of intercellular adhesion molecule 1 (ICAM1), which is known to enhance osteoclast maturation. Osteoclast differentiation was also reduced by ICAM1 knockdown in 4T1 cells. In addition, blocking the interaction between soluble ICAM1 and ICAM1 receptors significantly decreased osteoclastogenesis of RAW 264.7 cells in the tumor environment. Collectively, these results suggest that the reduction of ICAM1 expression by NDRG2 in breast cancer cells decreases osteoclast differentiation, and demonstrate that excessive bone resorption could be inhibited via ICAM1 down-regulation by NDRG2 expression.
Subject(s)
Bone Matrix , Bone Resorption , Breast Neoplasms , Breast , Culture Media, Conditioned , Cytokines , Down-Regulation , Intercellular Adhesion Molecule-1 , Ligands , Neoplasm Metastasis , Osteoblasts , Osteoclasts , RNA, Messenger , Tumor MicroenvironmentABSTRACT
BACKGROUND/AIMS: Bismuth-containing quadruple and moxifloxacin-based triple regimens are recommended as second-line therapy for Helicobacter pylori infection. The aim of this study was to compare the efficacy of each regimen. METHODS: From August 2004 to October 2012, a total of 949 patients (mean age, 54.32+/-12.08 years; male, 49.4%) who failed H. pylori eradication with a standard triple regimen were included. Patients treated with a bismuth-containing quadruple regimen for 7 and 14 days were designated as 7-BMT and 14-BMT, respectively, and those treated with a moxifloxacin-based triple regimen for 7 and 14 days were designated as 7-MA and 14-MA, respectively. H. pylori eradication was confirmed using the 13C-urea breath test, rapid urease test or histology. RESULTS: The eradication rates by 7-BMT, 14-BMT, 7-MA, and 14-MA were 66.4% (290/437), 71.1% (113/159), 53.1% (51/96), and 73.5% (189/257), respectively, by intention-to-treat analysis (ITT) and 76.5% (284/371), 83.8% (109/130), 55.6% (50/90), and 80.6% (187/232), respectively, by per-protocol analysis (PP). The eradication rates were higher in 14-BMT than 7-BMT by the ITT and PP analyses (p=0.277 and p=0.082, respectively). The 14-BMT and 14-MA treatments showed similar efficacies by ITT and PP (p=0.583 and p=0.443, respectively). CONCLUSIONS: The 7-BMT, 14-BMT, and 14-MA treatments showed similar and suboptimal efficacies. In both regimens, extending the duration of treatment may be reasonable considering the high level of antibiotic resistance in Korea.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Amoxicillin/administration & dosage , Antacids/administration & dosage , Anti-Infective Agents/administration & dosage , Bismuth/administration & dosage , Drug Administration Schedule , Drug Therapy, Combination/methods , Fluoroquinolones/administration & dosage , Helicobacter Infections/drug therapy , Helicobacter pylori , Intention to Treat Analysis , Metronidazole/administration & dosage , Proton Pump Inhibitors/administration & dosage , Retrospective Studies , Tetracycline/administration & dosage , Treatment OutcomeABSTRACT
Stress cardiomyopathy is characterized by transient systolic dysfunction of the apical and/or mid segment of the left ventricle. The main pathophysiology of stress cardiomyopathy is the excessive release of catecholamine. Opioid withdrawal can initiate a surge of catecholamine and an attack of stress cardiomyopathy. In this case, we report a case of stress cardiomyopathy due to iatrogenic withdrawal from transdermal fentanyl.
Subject(s)
Aged , Humans , Fentanyl , Heart Ventricles , Takotsubo CardiomyopathyABSTRACT
A paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt, and is commonly related to patent foramen ovale (PFO). However, coexisting pulmonary embolisms, deep vein thromboses (DVT), and multipe systemic arterial embolisms, associated with PFO, are rare. Here, we report a patient who had a cryptogenic ischemic stroke, associated with PFO, which is complicated with a massive pulmonary thromboembolism, DVT, and renal infarctions, and subsequently, the patient was treated using a thrombolytic therapy.
Subject(s)
Humans , Embolism , Embolism, Paradoxical , Foramen Ovale, Patent , Infarction , Kidney Diseases , Pulmonary Embolism , Renal Artery , Stroke , Thrombolytic Therapy , Thrombosis , Venous ThrombosisABSTRACT
Coronary artery disease is the most important cause of mortality in patients with systemic lupus erythematous (SLE). After stenting for coronary artery disease in SLE patients similar to non-SLE patients, the risk of stent thrombosis is always present. Although there are reports of stent thrombosis in SLE patients, very late recurrent stent thrombosis is rare. We experienced a case of very late recurrent stent thrombosis (4 times) in a patient with SLE.
Subject(s)
Humans , Coronary Artery Disease , Drug-Eluting Stents , Lupus Erythematosus, Systemic , Stents , ThrombosisABSTRACT
OBJECTIVE: This study was to evaluate the safety of cesarean delivery through transplacental incision in anterior placenta previa and its effect on mother and neonate. METHODS: We examined 74 cases of placenta previa retrospectively who underwent cesarean section from May 2006 to December 2009, in Chungbuk National University Hospital. They were divided into two groups according to the placental incision. Transplacental incision was made in all cases of anterior placenta previa. We compared postoperative maternal hemoglobin change, neonatal hemoglobin and hematocrit, intra and/or postoperative transfusion volume, neonatal intensive care unit (NICU) admission days between the two groups. RESULTS: There were no differences in maternal characteristics, hemoglobin changes, transfusion volume between the two groups. Nor the neonatal hemoglobin and hematocrit level, Apgar score and admission days were different. There was no neonatal acidosis below pH 7.20. CONCLUSION: The cesarean delivery through transplacental incision in anterior placenta previa seems to be safe because it did not increase maternal and fetal blood loss nor NICU admission days.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Acidosis , Apgar Score , Cesarean Section , Fetal Blood , Hematocrit , Hemoglobins , Hydrogen-Ion Concentration , Intensive Care, Neonatal , Mothers , Placenta , Placenta Previa , Retrospective StudiesABSTRACT
OBJECTIVE: This study was performed to compare the pharmacokinetics of methotrexate (MTX) in unruptured ectopic pregnancy according to the injection route. METHODS: Between May 2005 and August 2009, thirty-five patients of unruptured ectopic pregnancy in Chungbuk National University Hospital were treated medically either by intramuscular (IM) or intraamniotic (IA) injection of MTX according to the presence of fetal heart beat. Serum concentration of MTX was measured by fluorescent immunoassay using the blood samples withdrawn serially after its injection. RESULTS: The peak plasma MTX level was achieved at the 30-minute after injection sample in both groups. The mean peak plasma level of MTX in IM group was significantly higher than that of IA in 60-minute (2.296+/-0.64 umol/L vs 1.535+/-0.31 umol/L; p<0.006), 90-minute (1.9+/-0.51 umol/L vs 1.225+/-0.21 umol/L; p<0.002), and 240-minute (1.443+/-0.33 umol/L vs 1.077+/-0.18 umol/L; p<0.011) samples. The mean pretreatment plasma beta-hCG level was significantly higher in IA group, both tubal pregnancy (48,405+/-37,811.7 IU/L vs 18,452.05+/-19,205.34 IU/L; p<0.007) and cervical pregnancy (94,574.2+/-45,037.1 IU/L vs 42,446+/-34,778.12 IU/L; p<0.037), than those of IM group. But neither plasma MTX level nor pretreatment beta-hCG level were related to the treatment outcome. CONCLUSION: The plasma level of MTX increased rapidly in both IM and IA groups; the peak level reached at 30 minutes, and decreased to less than 1 umol/L after 240 minutes. Moreover, it was higher in IM group than IA group. Nevertheless, IA injection may be useful in patients who had high beta-hCG level or fetal heart beat, which are not usually indicated to medical treatment.
Subject(s)
Female , Humans , Pregnancy , Fetal Heart , Immunoassay , Methotrexate , Plasma , Pregnancy, Ectopic , Pregnancy, Tubal , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVES: Angiotensin II receptor blocker (ARB) has emerged as an alternative to angiotensin converting enzyme inhibitor (ACEI) for the treatment of heart failure. This study aimed at comparing the effectiveness and safety of valsartan with ramipril in patients with heart failure, and these patients were hospitalized at Chonnam National University Hospital, Wonkwang University Hospital, Gunsan Medical Center, Presbyterian Medical Center, Seonam University Hospital and Gwangju Christian Hospital. SUBJECTS AND METHODS: Between March 2005 and March 2007, 82 patients (60.5+/-12.4 years, 59 males) who complained of class II to IV dyspnea, according to the New York Heart Association (NYHA) classification, and who had low left ventricular ejection fraction (LVEF) less than 50% were randomly allocated to valsartan or ramipril. After 6 months, the clinical symptoms, vital signs, biochemical tests and echocardiography were compared between the two groups. RESULTS: The NYHA class was improved in both groups (the valsartan group: 2.31+/-0.51 vs. 1.46+/-0.58, p<0.001; the ramipril group: 2.21+/-0.55 vs. 1.61+/-0.50, p<0.001). The incidence of cough, as measured by the cough index, was significantly lower in the valsartan group than in the ramipril group (p=0.045). The LVEF was improved in both groups (the valsartan group: 36.4+/-8.5% vs. 46.9+/-12.9%, p<0.001; the ramipril group: 35.1+/-8.5% vs. 45.3+/-11.2%, p<0.001). The improvements of the left ventricular end-systolic dimension (p=0.754) and end-diastolic dimension (p=0.998) were not different between the two groups. N-terminal Pro-B-type natriuretic peptide level was improved in both groups (the valsartan group: 2619.6+/-4213.5 vs. 995.4+/-2186.0 pg/mL, p=0.012; the ramipril group: 3267.9+/-4320.0 vs. 828.1+/-1232.8 pg/mL, p=0.009), and there was no difference between the groups (p=0.877). CONCLUSION: Both valsartan and ramipril were effective treatments, with relatively low adverse events, in patients with heart failure.
Subject(s)
Humans , Angiotensins , Cough , Dyspnea , Echocardiography , Heart , Heart Failure , Incidence , New York , Peptidyl-Dipeptidase A , Protestantism , Ramipril , Receptors, Angiotensin , Stroke Volume , Tetrazoles , Valine , Ventricular Remodeling , Vital Signs , ValsartanABSTRACT
Floating thrombi in the aortic arch are very rare, and often go under-diagnosed. Herein, a case of an 8-cm long thrombus in the aortic arch is reported. It was a floating, highly mobile thrombus attached to the atherosclerotic plaque in the proximal aortic arch. The patient was a 59-year-old woman with a history of hypertension. The thrombus was operatively removed, with a favorable outcome.
Subject(s)
Female , Humans , Middle Aged , Aorta, Thoracic , Arteriosclerosis , Hypertension , Plaque, Atherosclerotic , ThrombosisABSTRACT
BACKGROUND AND OBJECTIVES: Treating coronary in-stent restenosis (ISR) has become one of the major challenges for the interventional cardiologist. The aim of this study was to determine the feasibility and safety of treating ISR with drug eluting stents (DESs), and we also wanted to determine the effect of DESs on the prevention of recurrent restenosis. SUBJECTS AND METHODS: Eighty patients (age range: 60.9+/-6.4 year-old, males:females=63:17) with 82 ISR lesions that were treated successfully with DES (sirolimus- and paclitaxel-eluting stents) were enrolled in our study. Five patients received 2 stents for a total mean of 1.1+/-0.3 stents per lesion. The major adverse cardiac events (MACEs) during hospitalization, at 30 days and at 6 months after the stenting were analyzed along with the coronary angiographic findings. RESULTS: At the time of DES implantation, the mean number of ISRs was 1.4+/-0.9, and the patterns of ISR according to the Mehran classification were IB in 9 lesions (10.5%), IC in 3 lesions (3.7%), ID in 6 lesions (7.3%), II in 19 lesions (23.2%), III in 30 lesions (36.7%), and IV in 15 lesions (18.3%). The mean stent length was 27.1+/-5.6 mm and the mean acute gain was 2.58+/-0.67 mm. No in-hospital MACE was observed. During the 30-day clinical follow-up, one patient developed acute myocardial infarction due to a subacute stent thrombosis. Forty two patients with 43 lesions underwent a 6-month follow-up coronary angiogram. The mean late loss at 6 months was 0.30+/-0.74 mm. The binary restenosis rate was 9.3% (4/43 lesion). The restenosed lesions were treated by balloon angioplasty in three lesions and by additional DES implantation in one lesion. CONCLUSION: Our results demonstrated that DES was a safe and very effective method for the treatment of ISR.
Subject(s)
Humans , Angioplasty, Balloon , Classification , Coronary Disease , Coronary Restenosis , Drug-Eluting Stents , Follow-Up Studies , Hospitalization , Myocardial Infarction , Stents , ThrombosisABSTRACT
BACKGROUND: Has been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown. METHODS: A total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized. RESULTS: During RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r=0.500, p=0.001), the change of QRS duration post-pacing (r=0.426, p=0.001), and SBP during sinus rhythm (r=0.342, p=0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing. CONCLUSION: Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.
Subject(s)
Female , Humans , Male , Middle Aged , Blood Pressure/physiology , Cardiac Pacing, Artificial , Electrophysiologic Techniques, Cardiac , Heart Ventricles/physiopathology , Hemodynamics/physiology , Tachycardia, Supraventricular/physiopathologyABSTRACT
BACKGROUND: Cardiogenic shock (CS) after acute myocardial infarction (AMI) develops in 5~10% of patients and it is associated with high mortality. The aim of this study is to assess the predictive factors of mortality for patients with AMI and CS. METHODS: Two hundred fifty five AMI patients with CS (the mean age was 66.0 +/- 11.0 years, M: F=156: 99) out of 1, 268 AMI patients who admitted at Chonnam National University Hospital between July 2000 and June 2002 were analyzed according to the clinical characteristics, coronary angiographic findings and MACE during admission and for the 1-year clinical follow-up. RESULTS: Among the enrolled patients, 129 patients survived without MACE (Group I, mean age 64.2 +/- 10.6 years, M: F=76: 53), and 126 patients had MACE (Group II, mean age 68.1 +/- 10.0 years, M: F=80: 46) during admission or during the 1-year follow-up period. There were significant differences in age between the Groups I and II (64.2 +/- 10.6 vs. 68.1 +/- 11.0 years, respectively, p=0.004) and the previous MI history (0 vs. 17.4%, respectively, p< 0.001). The left ventricular ejection fraction (EF) was lower in Group II (Group I vs. II: 49.1 +/- 13.0 vs. 39.1 +/- 12.9%, p< 0.001). The levels of troponin (Tn) I and C-reactive protein (CRP) were higher in Group II (Group I vs. II: 29.2 +/- 7.72 vs. 50.8 +/- 5.17 ng/dL, p=0.017, 3.8 +/- 0.48 vs. 9.9 +/- 1.21 mg/dL, p< 0.001 respectively). Left main stem lesion (LMSL) was more common in Group II than in Group I (0.7% vs. 22.0%, respectively, p=0.004). In-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization. CONCLUSION: Old age, a previous MI history, high Tn and CRP, low EF and LMSL are associated with higher MACE for patients with AMI and CS. Coronary revascularization with TIMI 3 flow lowers the in-hospital mortality.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Hospital Mortality , Korea/epidemiology , Myocardial Infarction/complications , Prognosis , Shock, Cardiogenic/etiologyABSTRACT
BACKGROUND: Epicardial infarct-related artery patency is reliably assessed by the Thrombolysis In Myocardial Infarction flow grade (TFG), and this index is associated with clinical outcomes after fibrinolytics or primary angioplasty in patients with acute myocardial infarction (AMI). The aim of this study was to examine long-term clinical outcomes according to the pre-procedural TFG in AMI after percutaneous coronary intervention (PCI). METHODS: A total of 132 patients with AMI who underwent PCI between July 2001 and December 2001 at Chonnam National University Hospital were divided into two groups according to the pre-procedural TFG: Group I (n=60, 62.7+/-9.2 years, male 66.7%) with TFG 0-1 and Group II (n=72, 61.6+/-11.1 years, male 68.1%) with TFG 2-3. RESULTS: Hypertension was more prevalent in Group I than that in Group II (56.7% vs. 27.8%, p=0.001) and cardiogenic shock on admission was more frequently observed in Group I than that in Group II (20.0% vs. 5.6%, p=0.011). The left ventricular ejection fraction was lower in Group I than that in Group II (42.6+/-10.5% vs. 50.5+/-12.1%, p=0.022). The levels of inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate, fibrinogen, white blood cell and monocyte counts were higher in Group I than in Group II. On diagnostic coronary angiogram, complex lesion was more frequently observed in Group I than that in Group II (53.4% vs. 36.2%, por=0.5 mg/dL, age >or=70 years, triple vessel disease, low pre-interventional TFG (0-1) and post-interventional TFG (0-2). CONCLUSION: Low pre-procedural TFG is associated with hypertension, cardiogenic shock, left ventricular dysfunction, and high mortality, and low event-free survival during one-year clinical follow-up after PCI in AMI.
Subject(s)
Humans , Male , Angioplasty , Arteries , Blood Sedimentation , C-Reactive Protein , Disease-Free Survival , Fibrinogen , Follow-Up Studies , Hypertension , Incidence , Leukocytes , Monocytes , Mortality , Myocardial Infarction , Percutaneous Coronary Intervention , Prognosis , Reperfusion , Shock, Cardiogenic , Stroke Volume , Ventricular Dysfunction, LeftABSTRACT
BACKGROUND: Cardiogenic shock (CS) after acute myocardial infarction (AMI) is developed in 5~10% of patients and associated with high mortality. The aim of this study is to assess the predictive factors of major adverse cardiac events (MACE) in patients with AMI and CS. METHODS: Two hundred fifty five AMI patients with CS (66.0 +/- 11.0 years, M:F=156:99) out of 1,268 AMI patients, who admitted at Chonnam National University Hospital between July 2000 and June 2002, were analyzed according to clinical characteristics, coronary angiographic findings and MACE during admission and 1-year clinical follow-up. RESULTS: Among the enrolled patients, 129 patients survived without MACE (Group I, 64.2 +/- 10.6 years, M:F=76:53) and 126 patients had MACE (Group II, 68.1 +/- 10.0 years, M:F=80:46) during admission and 1-year follow-up period. There were significant differences in age (64.2 +/- 10.6 vs. 68.1 +/- 11.0 years, p=0.004) and previous MI history (0 vs. 17.4%, p<0.001). Left ventricular ejection fraction (EF) was lower in Group II (Group I vs. II: 49.1 +/- 13.0 vs. 39.1 +/- 12.9%, p<0.001). The levels of troponin (Tn) I and C-reactive protein (CRP) were higher in Group II (Group I vs. II: 29.2 +/- 7.72 vs. 50.8 +/- 5.17 ng/dL, p=0.017, 3.8 +/- 0.48 vs. 9.9 +/- 1.21 mg/dL, p<0.001 respectively). Left main stem lesion (LMSL) was more common in Group II than in Group I (0.7% vs. 22.0%, p=0.004). In-hospital death was associated with low Thrombolysis In Myocardial Infarction (TIMI) flow after coronary revascularization. CONCLUSION: Old age, previous MI history, high Tn and CRP, low EF and LMSL are associated with higher MACE in patients with AMI and CS. Coronary revascularization with TIMI 3 flow lowers in-hospital mortality.
Subject(s)
Humans , C-Reactive Protein , Coronary Disease , Follow-Up Studies , Hospital Mortality , Mortality , Myocardial Infarction , Prognosis , Shock , Shock, Cardiogenic , Stroke Volume , TroponinABSTRACT
An isolated coarctation of the lower descending thoracic aorta in adults is a very rare vascular disorder. To the best of our knowledge, the treatment of a coarctation of the descending aorta (middle aortic syndrome) in an adult, using stenting, has never been reported in Korea. A 44 year-old male, suffering from claudication of the both legs for 25 years, was admitted to our hospital. An aortogram revealed a coarctation of the distal thoracic aorta at the T11 level, with a 60 mmHg peak systolic pressure gradient across the lesion. A balloon angioplasty, followed by an 18x40 mm stent implantation, was performed successfully. The peak systolic pressure gradient decreased from 60 mmHg to 15 mmHg. The patient's symptom was relieved after stenting, with no significant adverse events observed during a three-month clinical follow-up.
Subject(s)
Adult , Humans , Male , Angioplasty , Angioplasty, Balloon , Aorta , Aorta, Thoracic , Blood Pressure , Follow-Up Studies , Korea , Leg , StentsABSTRACT
An isolated coarctation of the lower descending thoracic aorta in adults is a very rare vascular disorder. To the best of our knowledge, the treatment of a coarctation of the descending aorta (middle aortic syndrome) in an adult, using stenting, has never been reported in Korea. A 44 year-old male, suffering from claudication of the both legs for 25 years, was admitted to our hospital. An aortogram revealed a coarctation of the distal thoracic aorta at the T11 level, with a 60 mmHg peak systolic pressure gradient across the lesion. A balloon angioplasty, followed by an 18x40 mm stent implantation, was performed successfully. The peak systolic pressure gradient decreased from 60 mmHg to 15 mmHg. The patient's symptom was relieved after stenting, with no significant adverse events observed during a three-month clinical follow-up.
Subject(s)
Adult , Humans , Male , Angioplasty , Angioplasty, Balloon , Aorta , Aorta, Thoracic , Blood Pressure , Follow-Up Studies , Korea , Leg , StentsABSTRACT
BACKGROUND: Sinus node dysfunction (SND) is caused not only by intrinsic sinus node disease, but also by the extrinsic factors. Among the extrinsic factors, autonomic imbalance is most common. Symptomatic SND usually requires permanent pacemaker therapy. However, the clinical characteristics and patient response to medical therapy for hypervagotonic SND have not been properly clarified. MATERIALS AND METHODS: Thirty two patients (14 men, 18 women, 51 +/- 14 years) with hypervagotonic SND were included in this study, but those patients who had taken calcium antagonists, beta-blockers or other antiarrhythmic drugs were excluded. Hypervagotonic SND was diagnosed if the abnormal electrophysiologic properties of the sinus node were normalized after the administration of atropine (0.04 mg/kg). RESULTS: The presenting arrhythmias were 16 cases of sinus bradycardia (50.0%), 12 of sinus pause (37.5%), 3 of sinoatrial block (9.4%) and 1 of tachy-bradycardia (3.1%). Nine (28.1%) patients had hypertension, 7 (21.9%) smoked, 2 (6.3%) had diabetes mellitus, and 1 (3.1%) had hypercholesterolemia. Among the patients, 3 had no remarkable symptoms, 13 had dizziness, 7 had syncope, 3 had weakness and 6 had shortness of breath. Twenty five (78.1%) patients were treated with theophylline, 1 patient with tachy-bradycardia syndrome was treated with digoxin and propafenone, and 6 (18.8%) were treated with no medication. During the 43 +/- 28 month follow-up, 25 patients remained asymptomatic, but 6 who took no medication developed mild dizziness. One patient needed permanent pacemaker implantation owing to recurrent syncope despite of theophylline treatment. CONCLUSION: These results show that hypervagotonic SND has a benign course and most of the patients can be managed safely without implanting a pacemaker. (Ed note: I like the abstract. It is short and direct, as it should be.)
Subject(s)
Female , Humans , Male , Middle Aged , Dizziness/etiology , Dyspnea/etiology , Muscle Weakness/etiology , Sick Sinus Syndrome/complications , Syncope/etiology , Theophylline/therapeutic use , Vasodilator Agents/therapeutic useABSTRACT
BACKGROUND: Atrial fibrillation (AF) is thought to beget AF by shortening atrial refractoriness and reversal of rate adaptation of atrial refractoriness. This phenomenon of electrophysiologic remodeling of the atria during AF has been reported to play a major role in inducibility and stability of AF. METHODS: Thirty-one patients with induced AF lasting >1 second during electrophysiologic study for documented or suspected supraventricular or ventricular tachycardia were included in this study. All the patients had no structural heart disease and history of AF. High right atrium (HRA) burst pacing or extra-stimulation was applied to induce AF. Eleven patients with AF sustained >or=3 min was grouped into Group I and 20 patients with AF <3 min into Group II. P wave duration and amplitude, left atrial (LA) size, atrial refractory period (ARP), intraatrial conduction time (IACT) from HRA electrode catheter to His bundle electrode catheter and characteristics of atrial activities during induced AF were compared between 2 groups. RESULTS: There was no difference in the distribution of underlying cardiac arrhythmias. P wave durations and amplitudes and echocardiographic LA sizes were similar between 2 groups. ARPs and IACTs in group I and II were similar (198.0 +/- 23.9 ms vs. 200.8 +/- 23.0 ms; 38.7 +/- 8.5 ms vs. 38.6 +/- 9.5 ms, respectively). During AF, mean interval of atrial activities in group I was significantly shorter than group II (156.6 +/- 24.2 ms vs. 187.6 +/- 28.0 ms, p<0.01). The degree of irregularity of atrial activities during AF was significantly higher in group I than group II (16.9 +/- 8.7 vs. 9.8 +/- 5.0, p<0.05). The duration of the atrial activities was wider in group I than group II (81.4 +/- 17.5 ms vs. 53.9 +/- 12.4 ms, p<0.001) and the amplitude was lower in group I than group II (56.1 +/- 36.0% vs. 109.0 +/- 51.8%, p<0.05), and the degree of fractionation was greater in group I than group II (4.8 +/- 1.1 vs. 3.2 +/- 0.5, p<0.05). CONCLUSION: These results suggest that shortening of atrial refractoriness and lengthening of local conduction time at the time of or shortly after induction of AF may play a major role in the induction and stabilization of AF.