Activity of Cytokines and Expression of CD62L in Patients with Bronchial Asthma / 결핵

BACKGROUND: The CD4+ T-helper cells comprise functionally distinct subsets of Th1 and Th2 cells that are distinguished on the basis of differential cytokines production. Th1 cells secrete interferon-gamma, lymphotoxin, interleukin-2. Th2 cells produce interleukin-4, interleukin-5, interleukin-10. A previous study shown that Th2 cells and their cytokines increased in patients with atopic asthma. We compared cytokines(IL-4, IFN-gamma) activity and subpopulation of T-lymphocytes in peripheral blood from atopic asthmatics versus non-asthmatics. METHOD: Fifteen patients with atopic asthma(nine men, six women), twelve patients with chronic bronchitis (six men, six women), five healthy persons(three men, two women) were studied. Activity of IL-4, IFN-gamma and T-cell subpopulation in peripheral blood were estimated. RESULTS: Patients had a median age of 55yr. The mean activity of IL-4 of asthmatics was significantly increased(control 0.75+/-1.1pmol/L, atopic asthmatics 3.50+/-0.75pmol/L, chronic bronchitis 2.01+/-1.2pmol/L), but IFN- was not significantly increased. In the T lymphocyte subsets the percent of CD62L+ T-lymphocytes of asthmatics was not significantly increased(control 16.7+/-16.4 %, atopic asthmatics 24.8+/-23.6 %, chronic bronchitis 17.0+/-16.9%). CONCLUSION: In this study elevated production of IL-4 was observed in atopic asthmatics. CD62L+ T-lymphocytes was not increased in atopic asthma.

A Case of Endobronchial Lipoma causing middle lobe syndrome / 결핵

Although lipomas are common benign tumors in humans, endobronchial lipomas are quitely rare. Up to date, about 60 cases have been reported in the English literature. But endobronchial lipomas causing middle lobe syndrome were only 4 cases. These benign slow-growing tumors generally occur in the proximal portion of the lobar or segmental bronchi and originate from fatty tissue that is normally present in the bronchial tree. Smoking or chronic inflammation may be important in the pathogenesis of these tumors. Bronchoscopy is the definite diagnostic tool but, in general, open thoracotomy is required for diagnosis and treatment. Here, we present a case of endobronchial lipoma, with a review of the literature.

A Case of Spontaneous Resolution of Idiopathic Mediastinal Fibrosis / 결핵

Mediastinal fibrosis is pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. Mediastinal fibrosis is local expression of a family of systemic fibrosing syndroms. This can result in compression of adjacent mediastinal structures. Idiopathic fibrosing syndromes include retroperitoneal fibrosis, sclerosing cholangitis of the orbit and fibrosis of the thyroid gland(Riedel's struma). The cause of these disorders is obscure, in some instance there is an underlying malignancy, infection, history of drug ingestion, or trauma with retoperitoneal bleeding. Treatment of mediastinal fibrosis depends on structures involved by the fibrotic process. The disease is self limited in most case or improved by steroids uses. We experienced a case of idopathic solerosing mediastinitis with orbital fibrous dysplasia of unknown cause, which was confirmed by open lung biopsy, so reported it with a review of literature.

Clinical studies of salmeterol / 알레르기

Salmeterol is a long acting, highly selective, beta2-adrenergic agonist. It prevents asthma symptoms in patients with mild or moderate disease and improves nocturnal asthma and sleep quality. We evaluated the bronchodilator and bronchoprotective effect and duration of action of inhaled salmeterol in patients wlth asthma. We compared the bronchodilator and bronchoprotective effects of salmeterol with salbutamol in 34 patients with asthma. Diagnosis of asthma was confirmed with methacholine challenge test or airway reversibility test. We performed the symptom index questionnaire, peak expiratory flow rate, pulmonary function test and methacholine challenge test. Symptom scores were more improved with salmeterol treatment than salbutamol treatment. After salmeterol inhalation, mean FEV1 increased from 1.95L(pre-treatment) to 2.04L(early stage in the treatment), 2.06L(late stage), 2.03L(follow up). There was no difference in FEV1 between early stage and late stage after salmeterol treatment. With salmeterol, there was a significant increases in PC30 on methacholine challenge test ( PC20 4.96 : 16.42). Salmeterol is a potent, long-acting bronchodilator, with a slower onset and longer duration of bronchodilation than salbutamol. It also has bronchoprotective effect and shows low incidence of adverse effects.

The Effect of Vitamin E on the Composition of inflammatory Cells in Alveoli after Paraquat Intoxication in Rats / 결핵

BACKGROUND: Acute pulmonary injury by paraquat are caused by multiple mechanisms including direct injury with oxygen free radicals and several mediators released from inflammatory cells. In order to clarify whether vitamin E could reduce tissue damages induced by intraperitoneal administaration of paraquat and to investigate the pathogenetic mechanisms of paraquat-induced pulmonary injury, vitamin E as a free radical scavenger was administered. METHODS: Rats were divided into three groups (group 1: control, group 2 : paraquat treated group, group 3 : paraquat and vitamin E treated group). Animals were sacrificed on day 1, day 2, day 3, and day 8 after the administration of saline, paraquat, or paraquat/vitamin E. RESULTS: Treatment with vitamin E decreased the death rate of rats treated with paraquat. Comparing with control group (1.37 x 106/ml), mean total cell counts recovered from the lavage fluid from animals treated with paraquat (1.65 x 106/ml) were increased(p=0.06). Magnitudes of increament of the total cell counts on the Day 8 in the vitamin E treated group were smaller than those of the animals treated with paraquat alone. The neutrophils began to appear in significant amounts in the lavage fluid on Day 8 after the administration of paraquat(37.0 + 12.7%). A significant decreasing neutrophil concentration at Day 8 was observed in the paraquat/vitamin E treated group(20.6 + 13.4 %). Histologically the degree of pulmonary fibrosis was most prominent in the paraquat treated group while diffuse alveolar damage was continuously observed in the paraquat/vitamin E treated group and extensive interstitial lymphocytic infiltration was seen in the paraquat/vitamin E treated group. The paraquat/vitamin E treated group showed the less histologic changes. CONCLUISON: In this study vitamin E acting as a scavenger of neutrophil-derived free radicals and suppressant of lipid peroxidation, seemed to be the effective antioxidant in the inhibition of paraquat-induced pulmonary injury.

Bronchial artery Embolization(BAE) for Hemoptysis of Small Amount: A Comparative Study with Conservative Management / 결핵

BACKGROUND: Surgical intervention is known as the principle management for hemoptysis of significant amount But surgical procedure is applicable 13 only small number of patients because of increased mortality in emergency surgery and various functional and structural problems after lung resection. Bronchial artery embolization(BAE) has been used as an alternative interventional technique for immediate control of patients with increased risk for surgery due 19 recurrent or massive hemoptysis. BAE also has limitations such as recurrent bleeding after procedure and its role for the application to small amount of hemoptysis is still not established. METHOD: To evaluate immediate and long term effectiveness of BAE, we analysed 65 patients with hemoptysis according to therapeutic modalities they received ; BAE versus conservative management. RESULTS: The success rate for immediate control of hemoptysis was significantly higher in BAE group with 43 cases(100%) among 43 cases compared with 17 cases(77%) among 22 cases in conservative group (p0.05). The therapeutic response in BAE group was 82%(36/43 cases) and 95%(21/22 cases) in conservative group(p>0.05). According to the amount of hemoptysis, the therapeutic response were seen in 91%(29/32 cases) in less than 100ml and 85%(28/33 cases) in 100~400ml (p>0.05). According to the manifestation of hemoptysis, the therapeutic response in groups of recurrent and nonrecurent were 87%(20/23 cases) and 88%(37/42 cases)(p>0.05). CONCLUSION: The difference of therapeutic response between BAE and conservative group in patients with small amounts of hemoptysis was not found except for immediate control of hemoptysis.

Organophosphorus Intoxication During the Control of Pine Gall Midge / 대한내과학회지

OBJECTIVES: Organophosphates make their clinical effects after absorbed through gastrointestinal tract, lungs and skin. We commonly see the gastrointestinal tract and lung as routes of organophosphates (OP) intoxication, but there have been few reports that said the skin as a route OP intoxication. We have experienced many patients that showed OP intoxication symptoms during or after the control of pine gall midge. So we analyzed the clinical characteristics of the patients and evaluated the route of OP intoxication. METHODS: We analyzed retrospectively 26 cases who were diagnosed as 'OP intoxication after control of pine gall midge' from June 1 1995 to July 31 1996. RESULTS: 1) The mean age of the cases, mean duration of work and mean initial cholinesterase level were 52 years, 11.9 days, 318.2U/L respectively. And the over all ratio of male to female was 11:15. 2) All cases were engaged in drug injection and 7 cases (32%) weared mask. Face and upper body were excluded from protective clothings. 3) The cardinal symptoms were diarrhea and dizziness followed by nausea, vomiting, headache, anorexia, paralysis in order of frequency. 4 Directly contributing factors to symptom onset were rain, excessive sweating due to hot weather and direct contact. 5) Most of cases (92%) were recovered completely. 2 cases died during hospitalization due to acute respiratory failure and sepsis. Mechanical ventilation were applied in 4 cases for mean 12 days. In 2 cases, there were neurobehavioral changes as delayed neurologic sequelae. CONCLUSION: We have concluded that the route of organophosporus intoxication after the control of pine gall midge was skin (transdermal absorption). Sufficient education and protective measures should be done for preventing organophosporus intoxication in the control of pine gall midge.

The Clinical Significance of gamma delta T lymphocytes with pleural tuberculosis / 결핵

BACKGROUND: The changes of the composition in the T-lymphocyte are important as an immunological abnormality in the pathogenesis of tuberculosis. Previously, the second type of TCR dimer(gamma delta T lymphocyte) that did not express CD4 or CD8 molecules was found. In other reports the presence of this type of lymphocytes was increased in the initial stage of tuberculous infections. METHOD: To determine whether there are some differences in the T-lymphocyte subsets in the peripheral blood or pleural effusion among the forty-nine patients were examined T-lymphocyte subset analysis(CD4+T-cell,CD8+ T-cell,gamma delta T-lymphocytes) with anti-Leu4, anti-Leu3a, anti-Leu2a, anti HLA-DR and anti-TCR-gammadelta-1(Becton & Dickinson Co.). RESULTS: The average age of the patients was 50 years old(17-81year). There were 33 males and 16 female patients. patiensts with tuberculosis are 30cases(tuberculous pleurisy 15), lung cancer 12cases(malignant effusion 9) and pneumonia 7cases(parapneumonic effusion 6cases) In T lymphocyte subsets of pleural effusion, helper T lymphocyte(54.6 + 13.8 %) of tuberculous pleurisy was higher than that(36.2 + 25.3 %) of non-tuberculous pleurisy(p= 0.04). The peripheral blood gammadelta T-lymphocytes in tuberculousis was insignificantly higher than non-tuberculous patients(p= 0.24). The peripheral blood gammadelta T-lymphocytes and pleural gammadelta T-lymphocytes in tuberculous pleurisy was insignificantly higher than in non-tuberculous pleurisy(p= 0.16, p= 0.12). CONCLUSION: The percentage of gammadelta T lymphocytes among the total T-lymphocytes is not significantly increased in the peripheral blood or pleural effusion of the pleural tuberculosis. gammadelta T lymphocytes is less useful as a diagnostic method of pleural tuberculosis.

Evaluation of the Solitary Pulmonary Nodule by Spiral Computed Tomography with Contrast Enhancement / 결핵

BACKGROUND: Clinical and Radiographic studies to differentiate benign from malignant pulmonary nodules have previously focused on clinical status and the morphologic and the computed tomographic attenuation characteristics of the lung nodules. Distinctive differences in the vascularity and pathophysiology of malignant versus benign pulmonary nodules were identified. We evaluated the diagnostic method for differentiating malignant from benign solitary pulmonary nodule by contrast enhancement on the spiral CT. METHOD: Sixteen patients with solitary pulmonary nodule were examined(Tuberculoma 8, primary lung cancer 8). Serial thin section on the spiral CT was performed before and after(45second, 2min, 5min) the onset of the injection of 100mL of nonionic contrast material(2mL/sec). RESULTS: There was no difference in size of nodule and pre-contrast CT number (Hounsfield unit) between benign and malignant nodules. At forty-five second after the onset of the injection, malignant neoplasms(19.6+/-7.9 HU) enhanced significantly more than tuberculomas(4.9+/-9.4 HU, p=0.008). At 2 minute and 5 minute after, malignant neoplasms(34.0+/-19.2HU, 340+/-15.4HU) enhanced significantly more than tuberculomas (6.7+/-9.7HU, p=0.007 and 7.7+/-11.5HU, p=0.011). On cut-off value 20HU(contrast enhancement) 2 minute after the injection of contrast media, sensitivity was 87% and specificity was 87%. No correlation between the contrast enhancement and size of the nodules was observed. CONCLUSION: Studies with the use of an intravenously administered noniodinated contrast medium in examining the enhancement properties of lung nodules was performed. The contrast enhancement was useful in differential diagnosis of solitary pulmonary nodules.

Clinical and Immunologic Features of Miliary Tuberculosis withPositive Bone Marrow Study / 결핵

BACKGROUND: Abnormalities of the peripheral blood are frequent and varied in patients with miliary tuberculosis. Anemia,leukopenia, thrombocytopenia, pancytopenia, monocytosis, basophilia, eosinophilia and leukemoid reactions have been reported. These abnormalities are more frequent in patients with positive bone marrow study. In this report, we evaluated clinical, hematological and immunological features in patients with miliary tuberculosis in order to know whether difference is existed between "bone marrow biopsy positive group(pathologically proven to miliary tuberculosis)" and "negative group". METHOD: Clinical evaluation, serum ADA, sIL-2R, and T-lymphocyte subsets were measured in 40 patients with miliary tuberculosis who received bone marrow biopsy. RESULTS: 1) The average age of patients was 39 year-old. There were 23 male and 17 female patients. Associated extrapulmonary tuberculosis are 9 CNS tuberculosis, 6 joint tuberculosis, and 2 tuberculous pleurisy. 2) Sixteen of the 40 patients were positive bone marrow biopsy(60%). 3) Sixteen of the 40 patients(60%) had anemia(ll positive patients: 13 negative patients). Leukopenia occurred in 12 per cent(4:l). Thrombocytopenia was noted in 10%(3:1). 4) The mean value of serum ADA was 83 U/L(90 U/L: 70.6 U/L, p=0.23). 5) The mean activity of Soluble IL-2 receptor was 4,643 pmol/L(6840+/-7446 pmol/L: 1,897 +/- 1,663 pmol/L, p=0.06). 6) In the T lymphocyte subsets, the percent of T-lymphocytes was 64%(62%:73%, p=0.2). In some patients(9), T4 and T8 ratio in BAL fluid(1.97+/-1.2) was higher than that in the peripheral blood(1.16+/-0.5). CONCLUSION: Bone marrow examination are diagnostic in 60% of cases of miliary tuberculosis. Percents of the total T lymphocyte and helper T cell in BAL are more elevated than in peripheral blood. There was no significant difference in peripheral blood abnormalities and marker of T lymphocyte activation between the bone marrow biopsy positive and negative group.

Three cases of primary mediastinal Nonseminomatous germ cell tumors / 결핵

Primary mediastinal nonseminomatous germ cell tumor is extremely rare. Apart from rarity and large size, mediastinal germ cell tumors show striking similarity to testicular tumors in age, incidence, and tumor type. The symptoms associated with these tumors are related mainly to size, invasion of neighboring structures, and distant metastases. Tissue diagnosis is obtained by biopsy of the primary lesion or by biopsy of metastatic sites. Tumors often present with advanced bulky disease, which are unresectable. So these tumors require an aggressive multidisciplinary approach to management. Optimal management includes aggressive surgical debulking and early use of cisplatin-bleomycin-based combination chemotherapy. Serial biomarker measurements permit early recognition of recurrence and improved timing of surgical intervention. The prognosis for mediastinal germ cell tumors is poor, not only because they are far advanced at the time of diagnosis but also because some of the tumors-such as embryonal carcinomas, choriocarcinomas, and endodermal sinus tumors-are very aggressive. In these cases, we present three young male patients with large mass on anterior mediastinum. Tissue diagnosis was obtained by primary lesion biopsy. All patients received surgical debulking and combination chemotherapy and experienced a brief response and eventually had relapses. We report these cases with a review of literatures.

A case of tumorous type of endobronchial tuberculosis simulating bronchial adenoma / 결핵

The tumorous type of endobronchial tuberculosis was reported to be 5 to 10% in the bronchoscopic examination. It was protruding mass that tuberculous mediastinal lymph node ruptured into the bronchial lumen. Generally histologic examination has been performed for purpose of differentiation, because the tumorous type of endobronchial tuberculosis simulate lung cancer in bronchoscopic finding. A case considering operation similar to bronchial adenoma in the bronchoscopic finding was confirmed to endobronchial tuberculosis by positive AFB and disapperance of mass after antituberculosis medication. Case history was presented and reviewed.

The Usefulness in an Automated Kinetic Method in Determining of ADA Activity in Pleural Fluid / 결핵

The determination of ADA(adenosine deaminase) activity in pleural fluid is useful in differental diagnosis of pleural effusion. The conventional method of determining ADA activity used by Giusti was influenced by contamination of ammonia. Additionally, because Giusti's method was mannual method a determining the ADA activities in sample, was not easily automated. In 1993, Oosthuizen HM with collegues developed simple kinetic method for determining ADA activity. It was reliable and suiable method for automation. In this study, we have measured ADA activity in 162 patients with various pleural effusion by Hitachi 747 autoanalyser using the Oosthuizen kinetic method for the purpuse of determination of new diagnostic cut-off value for the tuberculous effusion and evaluation of the correlation between the conventional method and new automated method. This new method of an enzymatic reaction involves 2, 6-dichlorophenolindophenol dye(DICP), adenosine, xanthine oxidase(XO), and nucleoside phosphorylase(NP). The results were as follows: 1) The mean pleural ADA activity of the tuberculous effusion was 52.53 +/-16.43 U/L and significantly higher than that of other groups(p<0.001). If the diagnostic cut-off value of pleural ADA activity for tuberculous effusion is above 30 U/L, the sensitivity is 96% and the specificity is 90%. 2) The mean pleural to serum ADA activity ratio of the tuberculous effusion was 2.29+/-0.96 and it was also significantly higher than that of other pleural groups(p<0.001). If the diagnostic cut-off value of pleural to serum ADA activity ratio is 1.5, the sensitivity is 80% and the specificity is 88% in the diagnosis of tuberculous pleural effusion. 3) The new kinetic method is correlates well to Giuisti's conventional method(r=0.971). In conclusion, the new kinetic method described is easily automated and seems to be suitable for the routine determination of ADA activity.

Transcatheter Arterial Embolization for Hemoptysis / 결핵

BACKGROUND: Transcather arterial embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function such as postpneumonectomy patients and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization and analysed the correlation of the clinical and angiographic characteristics and investigated the clinical course and outcome after arterial embolization in the patients with significant hemoptysis. METHOD: 58 patients with massive or recurrent hemoptysis underwent transcatheter arterial embolization for the treatment of hemoptysis from April 1992 to Sept. 1993. RESULTS: Most common cause of hemoptysis was pulmonary tuberculosis(34 cases, 58.3%). Embolized vessels responsible for hemoptysis were 56 bronchial arteries and 32 nonbronchial systemic arteries. Initial most common angiographic findings were hypervascularity and shunt. Initial success rate of hemoptysis control revealed 81.1%. However, 15 of 58 patients(25.9%) showed recurrence of hemoptysis after transcatheter arterial embolization. The complications(18 cases, 31%) such as chest pain, fever, voiding difficulty, atelectasis, paralytic ileus and unwanted embolization were occured. CONCLUSION: Transcatheter arterial embolization is useful and relatively safe treatment modality for immediate bleeding control of patients with massive hemoptysis or inoperable cases. The further evaluation of the long term results according to the embolized material and underlying pulmonary disease will be required.

A Case of the Bronchial Artery-Pulmonary Vein Malformation / 결핵

The bronchial artery-pulmonary vein malformation should be called the systemic artery-to- pulmonary vein arterioveonus malformation in the lung. Although pulmonary arteriovenous malformation has been well documented in intrapulmonary arteriovenous malformation, the systemic artery-to-pulmonary vein arteriovenous malformation is rare. Most patients with systemic artery-to-pulmonary vein arteriovenous malformation is asymptomatic and the diagnosis of these anomaly may be done by continuous murmur or abnormal chest X-ray on the physical examination. The pathogenesis of this condition is congenital malformation which explains these anastomoses between the pulmonary vein and accessory brochial arteries and acquired malformation which explains development of new blood vessel to supply large enough to cause significant systemic-pulmonary shunts due to inflammation secondary to infection, trauma, or previous surgery. We experienced a case of the bronchial artery-pulmonary vein malformation which was detected on angiography in 20-year-old women whose chief complain is hemoptysis. This massive hemoptysis was controlled by selective brochial artery embolization with Gelfoam and Ivalon particles.

Coronary Artery Calcification Its Incidence and Significance in Patients Detected by Cineangiography

BACKGROUND: The clacification of the wall and narrowing of the lumen of the coronary artery is closely related to the process of atherosclerosis and its severity. Thus, the present study of calcified coronary artery lesions by analysis of cineangiography is attempt to define the incidence and factors to affect the coronary artery calcification. METHODS: Our report concerns a consecutive series of 513 patients who underwent coronary angiography between January 1, 1991 and September 30, 1993. We determined the relationship between the coronary artery calcification and sex, age, risk factors, serum calcium, BUN, creatinine, lesional lumen stenosis and severity of coronary artery disease. RESULTS: Among patients with significant coronary artery disease, 22%(62/282 cases) had the coronary artery calcification by cineangiography. Patients with calcification were older(62+/-8 years) than those without calcification(56+/-10 years)(p=0.0001). The distribution of calcified coronary artery was 35 lesions in LAD, 17 in LCX, 16 in RCA and 4 in LM. The calcification rate was 38%(40/104 cases) for patients with multi-vessel disease, compared to 12%(22/178 case) for those with single vessel disease(p=0.0001). Patients with calcification significantly had the long lesion(22.4+/-13.4mm), compared to those without calcification(18.0+/-11.3mm)(=0.012). Coronary artery calcification was correlated with smoking habits. CONCLUSION: Coronary artery calcification was seen in 22 percent and strongly correlated with age, smoking habits, the severity of disease and length of lesion.

Aneurysm of the Right Coronary Artery with Acute Myocardial Infarction after Blunt Chest Trauma : A Case Report

Despite a large number of automobile accidents, the aneurysm of a coronary artery from blunt chest trauma in a very rare entity. Especially aneurysm of the right coronary artery has been few previously described. A 24-yeal old man sustained blunt chest trauma from steering wheel contact during automobile accident 6 hours after admission, an electrocardiogram revealed complete heart block with ST elevation in lead II, III, and aVF. He needed temporary transvenous cardiac pacing and large amount fluid infusion for treatment of cardiogenic shock from bradycardia and right ventricluar infarction in emergency center. 2-dimensional echocardiogram showed akinetic inferior wall of the left ventricle and dilatation of the right ventricle. Coronary arteriography revealed a saccular aneurysm in the proximal right coronary artery without atherosclerotic change. Size of aneurysm in right coronary artery remained unchanged on repeat coronary arteriogrpahy. His hospital course was uneventful and discharged without any sign of residual ischemia.

The Clinical Significance Of Nailfold Capillary Microscopic Examination In The Patients With Co Ech Tissue Diseases / 대한류마티스학회지

OBJECTIVE: Raynaud's phenomenon is a vascular disorder characterized by reversible spasm of arteries of fingers. It is the first symptom in 70% of partlents with systemic sclerosis. The more systemic involvment the worse prognosis is expected in patients with systemic sclerosis. A more reliable indication of systemic sclerosis is the microvascular involvement by the disease (characteristic patterns of capillary abnormality in the nail-fold). Our puroses were to evaluate the significance of the degree of nailfold capillary abnormlitry in making the diagnosis fo systemic sclerosis, and in determining organ involvement in patients with systemic sclerosis. METHODS: Twenty-six patients with Raynaud's phenomenon whose diagnosis were systemic sclerosis(10 patients), SLE(10 patient), Raynaud's disease(6 patients) were observed for nailfold capillary abnormalities by widefield microscopy. RESULTS: Capillary abnormalities were seen in 100% of the systemic sclerosis (10 patients), 30% of the SLE (3 patients) and 50% of the Raynaud's disease (3 patients). A significant correlation between degree of finger lesions (r=0.718) or organ involvement (X2=20.4, p=0.015) and capillary abnormality class was found although a significant correlation was not found between the duration of the disease and the degree of capillary abnormality in patients with systemic sclerosis (r=0.32). CONCLUSIONS: Nailfold capillary abnormality can easily be observed and could be used as an assistive tools for the diagnosis and prediction of prognosis and extent of organ involvement in patients with Raynaud's phenomenon especially in patients with systemic sclerosis.

Balloon Dilation Angioplasty of Aortic Coarctation in Adult

A 21-year-old woman found to be hypertensive was referred for hypertension. On examination, blood pressure was 170/110mmHg in the right arm, 160/100mmHg in left arm,and 120/70mmHg in legs. A grade 2/6 systolic ejection murmur was present at the left upper sternal border, and a chest x-ray revealed a rib notching on the inferior margin of 4th rib. Two-dimensional echocardiogram showed the coarctation of aorta beyound the origin of the left subclavian artery. Biplane TEE demonstrated a discrete narrowing of the descending aorta at the site of coarctation. The blood pressure was 169/86mmHg in ascending aorta and 118/84mmHg in descending aorta. Aortogram showed a localized coarcted aortic segment of 7mm in diameter and 5mm long just distal to the left subclavian artery. Balloon coarctation angioplasty was performed with 7F 30x15mm pediatric balloon dilatation catheter. Balloon position was confirmed on fluoroscopy by the hourglass appearance of the balloon inflation and thereafter, the balloon was inflated until the waist of the balloon disappeared. After procedure, a pull back pressure tracing across the coarctation of aorta revealed no pressure gradient between ascending and descending aorta with 141/90mmHg. Aortogram showed an increase in diameter of the coarctation of aorta to 18mm with aneurysmal formation. 3 months later, follow up aortogram showed no significant change in diameter of coarctation of aorts or aneurysmal formation. Nonsurgical balloon coarctation angioplasty appears to be an alternative therapy for the coarctation of aorta in adults.

The Factors to Influence on Immediate Elastic Recoil after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: Elastic recoil contributes to the residual lumen reduction immediately after PTCA. We evaluated the factors to influence on immediate elastic recoil after the successful PTCA. METHODS: 88 patients(96 lesions) were studied by quantitative angiography. Angiograms were obtained in two identical near orthogonal projection before PTCA and immediately after the last balloon deflation. RESULTS: Immediately after PTCA, minimal luminal diameter increased from 0.7+/-0.6mm to 1.9+/-0.6mm and percent diameter stenosis was reduced from 77+/-20 to 34+/-21%. The calculated mean elastic recoil was 0.5+/-0.7mm in diameter and % elastic recoils were lesser both in calcified(3+/-23 vs 23+/-24%, p=0.04) and thrombotic(9+/-20 vs 23+/-35%, p=0.02) lesions. The elastic recoil increased significantly according to the inflation diameter of balloon(r=0.32, p<0.01. No significant correlation between the immediate elastic recoil and age, sex, risk factors, eccentricity and lesion length was shown. CONCLUSION: The elastic recoil immediately after a successful PTCA was dependent on the existance of calcium and thrombus on the target lesion and on the balloon size at the maximal inflation.