Effects of High-dose Atorvastatin Pretreatment in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Cardiac Magnetic Resonance Study

It is uncertain that atorvastatin pretreatment can reduce myocardial damage in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). The aim of this study was to investigate the effects of atorvastatin pretreatment on infarct size measured by contrast-enhanced magnetic resonance imaging (CE-MRI) in STEMI patients. Patients undergoing primary PCI for STEMI within 12 hr after symptom onset were randomized to an atorvastatin group (n = 30, 80 mg before PCI and for 5 days after PCI) or a control group (n = 37, 10 mg daily after PCI). The primary end point was infarct size evaluated as the volume of delayed hyperenhancement by CE-MRI within 14 days after the index event. The median infarct size was 19% (IQR 11.1%-31.4%) in the atorvastatin group vs. 16.3% (7.2%-27.2%) in the control group (P = 0.27). The myocardial salvage index (37.1% [26.9%-58.7%] vs. 46.9% [39.9-52.4], P = 0.46) and area of microvascular obstruction (1.1% [0%-2.0%] vs. 0.7% [0%-1.8%], P = 0.37) did not differ significantly between the groups. Frequency of the hemorrhagic and transmural infarctions was not significantly different in the 2 groups. Pretreatment with a high-dose atorvastatin followed by further treatment for 5 days in STEMI patients undergoing primary PCI failed to reduce the extent of myocardial damage or improve myocardial salvage.

Effect of High Dose Rosuvastatin Loading before Primary Percutaneous Coronary Intervention on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: High dose rosuvastatin loading before percutaneous coronary interventions (PCI) reduces the myocardial damage and the incidence of adverse cardiac events in patients with stable angina and acute coronary syndrome. However, no studies are present yet about rosuvastatin loading in patients with ST-segment elevation myocardial infarction (STEMI) in a primary PCI setting. SUBJECTS AND METHODS: A total of 475 patients who underwent primary PCI for STEMI were studied. The study population was divided into two groups with 208 patients in the statin group=40 mg rosuvastatin loading before primary PCI and 267 patients in the control group=no statin pretreatment. At median 3 days after PCI a single-photon emission computed tomography (SPECT) was performed with technetium 99m tetrofosmin For this study were compared infarct size, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and the myocardial blush grade (MBG) between the both groups. RESULTS: Baseline clinical and procedural characteristics were similar between the groups. Infarct size, as assessed by SPECT, was significantly smaller (19.0+/-15.9% vs. 22.9+/-16.5%, p=0.009) in the statin group than in the control group. Patients of the statin group showed a lower corrected TIMI frame count (28.2+/-19.3 vs. 32.6+/-21.4, p=0.020), and higher MBG (2.49+/-0.76 vs. 2.23+/-0.96, p=0.001) than the patients of the control group. The multivariate analysis revealed that rosuvastatin loading {odds ratio (OR) 0.61}, pain to balloon time (OR 2.05), anterior myocardial infarction (OR 3.89) and final the MBG (OR 2.93) were independent predictors of a large infarct size. CONCLUSION: A high dose rosuvastatin loading before the primary PCI reduced the infarct size by microvascular myocardial perfusion improvement.

Esophageal Sinus Formation due to Cyanoacrylate Injection for Esophageal Variceal Ligation-induced Ulcer Bleeding in a Cirrhotic Patient / 대한소화기학회지

Intravariceal injection of N-butyl-2-cyanoacrylate is widely used for the hemostasis of bleeding gastric varices, but not routinely for esophageal variceal hemorrhage because of various complications such as pyrexia, bacteremia, deep ulceration, and pulmonary embolization. We report a rare case of esophageal sinus formation after cyanoacrylate obliteration therapy for uncontrolled bleeding from post-endoscopic variceal ligation (EVL) ulcer. A 50-year-old man with alcoholic liver cirrhosis presented with hematemesis. Emergent esophagogastroscopy revealed bleeding from large esophageal varices with ruptured erosion, and bleeding was initially controlled by EVL, but rebleeding from the post-EVL ulcer occurred at 17th day later. Although we tried again EVL and the injections of 5% ethanolamine oleate at paraesophageal varices, bleeding was not controlled. Therefore, we administered 1 mL cyanoacrylate diluted with lipiodol and bleeding was controlled. Three months after the endoscopic therapy, follow-up endoscopy showed medium to large-sized esophageal varices and sinus at lower esophagus. Barium esophagography revealed an outpouching in esophageal wall and endoscopic ultrasonography demonstrated an ostium with sinus. It is noteworthy that esophageal sinus can be developed as a rare late complication of endoscopic cyanoacrylate obliteration therapy.

A Case of Solitary Fibrous Tumor of Orbit

PURPOSE: A Solitary fibrous tumor is a rare orbital neoplasm derived from mesenchymal cells. The neoplasm should be considered in differential diagnosis of any orbital tumor, and immunohistochemial analysis is important for correct diagnosis. The authors herein describe a case of a solitary fibrous tumor in addition to the findings of a literature review. Solitary fibrous tumors can develop from not only the lacrimal gland, but also orbital soft tissue. Until now, there has been no report of a solitary fibrous tumor arising from orbital soft tissue in Korea. CASE SUMMARY: A 50-year-old man visited our clinic due to a slow progressing mass on the lateral side of the left eye for 1 year. The patient did not suffer from any discomfort or discharge from the mass. Slit lamp and other ocular examinations were unremarkable. Orbital MRI revealed a solid extra-conal enhanced mass that measured 13x11 mm adhering to the lateral wall of the left orbit. Total surgical excision was Performed under local anesthesia and tumor cells showed a strong and diffuse positivity for CD34 by immunohistochemistry. The findings were consistent with the diagnosis of orbital solitary tumor. CONCLUSIONS: The orbital solitary tumor is rare, but it should be considered in the differential diagnosis of any orbital tumor.

Percutaneous Ethanol Injection Therapy for Locally Recurrent Papillary Thyroid Carcinoma

PURPOSE: Percutaneous ethanol injection therapy (PEIT) has been infrequently tried to treat hepatic tumors, thyroid tumors, and primary and secondary hyperparathyroidism. We adopted this technique for treating locally recurrent papillary thyroid carcinomas. The objective of this study is to evaluate the local therapeutic efficacy, side effects and complications of the PEIT for treating locally recurrent papillary thyroid carcinomas. MATHODS: From October 2002 to September 2005, 16 papillary thyroid carcinoma patients (3 males and 13 females) with 24 histologically proven locally recurrent lesions underwent sonography-guided PEIT under local anesthesia when reoperation or other treatments were refused or contraindicated. Of the 24 nodules in 16 patients, 8 recurred in the thyroid bed, 13 recurred in the lateral neck nodes, and 3 recurred in the central neck nodes. Ethanol was injected every 3 months under sonographic guidance. The median follow-up period was 18 months (range: 7~37 months). RESULTS: All the patients tolerated the procedures well with only mild local pain. There were no major complications. Only one patient suffered from a transient vocal cord palsy. A significant decrease of tumor size was observed in all the lesions. The pre-injection diameter of the lesions ranged 5.5 to 25.0 mm (median: 9.9 mm), and this was decreased to 0 to 17 mm (median: 5.3 mm) after PEIT. Of the 4 lesions in 4 patients, the recurrent lesions disappeared completely. CONCLUSION: Our experiences suggest that PEIT appears to be an effective alternative option for treating recurrent lesions of thyroid carcinomas in the properly selected patients. A large prospective study with long-term follow-up is necessary to determine if PEIT has an impact on survival and recurrences.

Inhibitory Effect of Arctium lappa Linne on Compound 48/80-induced Mast Cell Activation and Vascular Permeability / 체질인류학회지

Arctium lappa Linne (AL) has been widely cultivated for a long time as a popular vegetable. The fruit of AL has been used as an antiphlogistic and expectorant in herbal medicine, the crude drug is known as "burdock" in korea. In pharmaceutical field, a few papers recently reported the antiinflammatory, antiviral, and anticancer effects of this extract. However, the antiallergic effect of AL is unknown. The purpose of this study is to investigate the inhibitory effect of AL on compound 48/80-induced mast cell activation. For this, the effects of AL on the degranulation, the histamine release, and the change of the intracellular cAMP (cyclic adenosine-3, 5monophosphate) levels of rat peritoneal mast cells (RPMC) and the influences of AL on the compound 48/80-induced cutaneous reaction were studied. The results were as follows; 1) the compound 48/80-induced mast cell degranulation and histamine release of RPMC was significantly inhibited by pretreatment with AL, 2) the compound 48/80 decreased the cAMP levels of RPMC, but the compound 48/80-induced the cAMP levels of RPMC were significantly increased by pretreatment with AL, 4) AL significantly inhibited compound 48/80-induced vascular permeability of cutaneous tissue. From the above results, it is suggested that AL contains some substances which inhibit the compound 48/80-induced vascular permeability and mast cell activation.

Influence of Various Muscle Relaxants on the Plasma Cholinesterase Activity / 대한마취과학회지

BACKGROUND: The reduction in the plasma cholinesterase (PChE) level results in slow to hydrolysis of succinylcholine (SCC) and mivacurium (MIV). The factors altering the level of the normal enzyme in human could be considered under the several conditions. We investigated in the present study whether the drugs induced decreases in normal PChE activity after administration of various muscle relaxants during anesthesia are evident and how these results should be influenced to the time course of neuromuscular blockade produced by SCC and MIV. METHODS: Young adult patients of ASA class I or II scheduled for elective surgery requiring muscle relaxation were premedicated and anesthesia was maintained with nitrous oxide in oxygen with increment of thiopentone or fentanyl as required. In the neuromuscular monitoring, surface electrodes were applied on the ulnar nerve at wrist. Supramaximal transcutaneous single twitch stimulation (1 Hz) during onset and 0.1 Hz during recovery of neuromuscular blockade induced by various muscle relaxants delivered by a peripheral nerve stimulator was applied. Twitch response of thumb adductor was measured mechanomyographically using 2 kg Load Cell Strain Gauge with thumb piece modification. Recordings were made on a Gould recorder. PChE levels were measured by the modified Garry method after induction of anesthesia and, at 3, 10, 20 and 30 min following administration of 2 x ED95 of pancuronium (PAN), vecuronium (VEC) and atracurium (ATR). Neuromuscular recordings were measured with onset time defined as lag time and manifest time, and recovery time defined as clinical duration, recovery index and total duration. RESULTS: The levels of PChE were significantly reduced after administration of PAN and VEC (p<0.05). Onset times were significantly shorten but recovery time in the group given MIV pretreated by small dose of PAN was significantly prolonged (p<0.05). And there were a evidence to prolong recovery time in the group pretreated by small dose of VEC but not significant. CONCLUSIONS: It is concluded that aminosteroidal derivative neuromuscular blocking agents have presumably evidence induced decreases in PChE activity rather than benzylisoquinolinium derivative neuromuscular blocking agents.