Infected Sclerosing Lipogranuloma after Hernioplasty: Ultrasonographic and MRI Findings

We report the ultrasonographic and MRI findings of an infected sclerosing lipogranuloma after scrotal hernioplasty. Sclerosing lipogranuloma is a rare foreign-body reaction of fat tissue, with most cases being associated with the genital and urinary tracts. To the best of our knowledge, MRI findings in sclerosing lipogranuloma in the scrotal sac have not yet been published and this is possibly the first study to report the case of an infected sclerosing lipogranuloma in the English literature.

Inflammatory Fibroid Polyp of the Appendix: A Case Report

An inflammatory fibroid polyp is a rare benign tumor that can arise throughout the gastrointestinal tract. Most cases are observed in the stomach or ileum, and more rarely in the appendix (< 1%). We report on a case of an inflammatory fibroid polyp of the appendix.

Desmoid-Type Fibromatosis Associated with Silicone Breast Implants

Desmoid-type fibromatosis (extra-abdominal desmoid tumor) arising in the breast is a rare benign disease entity, accounting for 0.2% of all breast tumors. The etiology of mammary fibromatosis is unknown, but has been reported to be associated with genetic factors, hormonal effects, Gardner syndrome, breast trauma or surgery, and breast implants. Fibromatosis associated with breast implants is extremely rare, and only 34 cases have been reported so far. We report the ultrasonographic, computed tomographic, and pathologic findings of breast fibromatosis in a 29-year-old woman, who underwent bilateral augmentation mammoplasty with silicone implants.

HCFC-123-induced toxic hepatitis and death at a Korean fire extinguisher manufacturing facility: a case series

BACKGROUND: Exposure to sustained high concentrations of HCFC-123 is known to be hepatotoxic. We report two simultaneous cases of toxic hepatitis related to exposure to 2,2-dichloro-1,1,1-trifluoroethane (HCFC-123), a common refrigerant, at a Korean fire extinguisher manufacturing facility. CASE PRESENTATION: Patients A and B were men aged 21 and 22 years, respectively, with no notable medical histories. They had recently started working for a manufacturer of fire extinguishers. During the third week of their employment, they visited the emergency center of a general hospital due to fever, lack of appetite, and general weakness. At the time of their visit, they were suspected as having hepatitis due to elevated aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total bilirubin levels and were hospitalized. However, as their condition did not improve, they were moved to a tertiary general hospital. After conservative treatment, one patient improved but the other died from acute hepatic failure. Assessments of the work environment showed that the short-term exposure levels of HCFC-123 for valve assembly processes were as high as 193.4 ppm. A transjugular liver biopsy was performed in patient A; the results indicated drug/toxin-induced liver injury (DILI). Given the lack of a medical history and the occupational exposure to high levels of HCFC-123, a hepatotoxic agent, the toxic hepatitis of the workers was likely related to HCFC-123 exposure. CONCLUSIONS: Work environment assessments have not included this agent. To the best of our knowledge, we are the first to report a case of death related to HCFC-123-induced liver damage. Our findings suggest that exposure standards and limits for HCFC-123 must be developed in Korea; work environments will have to be improved based on such standards.

Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation

OBJECTIVE: Lumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy. METHODS: This study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years. RESULTS: Of the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant. CONCLUSION: There were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.

Clinical Significance of Hyperlactatemia and Acidosis in Patients with Suspected Generalized Convulsion

PURPOSE: To determine the clinical usefulness of lactic acidosis in an evaluation of patients with suspected generalized convulsion. METHODS: This was retrospective cohort study. The correlation between the lactate level and the time to blood gas analysis (ABGA) was analyzed in patients who had a final diagnosis of seizure to exclude the time effect on the spontaneous clearance of lactate. The patient's data in the true seizure group and false seizure group was then compared. The receiver operating characteristics (ROC) curve of lactate, pH and base deficit for diagnosing true seizure was drawn. The sensitivity and specificity of the presence of hyperlactatemia or acidosis for a diagnosis of seizure and predicting epileptiform discharge at electroencephalography (EEG) was analyzed. RESULTS: Of the 173 patients suspected of having generalized convulsion, 136 patients were diagnosed with a true seizure on hospital discharge and patients whose ABGA was performed within 60 minutes after seizure showed a significantly higher arterial lactate level, lower arterial pH and base deficit than the patients whose ABGA was performed after 60 minutes of seizure onset. 62 patients whose ABGA was performed 60 minutes after symptom onset were excluded. Finally, of 111 patients, 89 patients with true seizure showed a significantly higher arterial lactate level, lower arterial pH and base deficit than the 22 patients with false seizure. The ROC curve of lactate, pH and base deficit showed a significant area under the curve for diagnosing true seizure. The presence of hyperlactatemia or acidosis showed high sensitivity for diagnosing true seizure and expecting epileptiform EEG when they were measured with 60 minutes after symptom onset. CONCLUSION: In patients with suspected generalized convulsion, upon presentation to the ED within 60 min of symptom onset, the presence of hyperlactatemia or acidosis increased the likelihood of a true seizure and might be an objective indicator for further evaluations of seizure. On the other hand, normal lactate levels and no acidosis could not exclude a true seizure.

Sacralization of L5 in Radiological Studies of Degenerative Spondylolisthesis at L4-L5

STUDY DESIGN: Radiological analysis. PURPOSE: To investigate sacralization of L5 on radiological studies of degenerative spondylolisthesis at L4-L5. OVERVIEW OF LITERATURE: Degenerative spondylolisthesis commonly develops at L4-L5. Sacralization of L5 is thought to cause stress concentration at this level, which accentuates degenerative changes and promotes development of degenerative spondylolisthesis. However, there has been no study dedicated to determining whether the presence of sacralization at L5 influences the radiological findings in degenerative spondylolisthesis at L4-L5. METHODS: Seventy-eight patients with degenerative spondylolisthesis at L4-L5 were classified into two groups according to the presence of L5 sacralization: with (n=54) and without (n=24). Four radiographic parameters were measured and compared between the two groups: anterior slippage of L4 on L5 (% slip), facet orientation of L4-L5 (degrees), facet osteoarthritis of L4-L5 by Fujiwara's criteria (1~4 grades), and disc degeneration of L4-L5 by Frymoyer's criteria (grades 1~5). RESULTS: There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02+/-6.21 versus 16.65+/-4.87, p=0.809), facet orientation (54.99+/-12.18 versus 56.23+/-4.35, p=0.642), facet osteoarthritis (3.43+/-0.59 versus 3.53+/-0.37, p=0.527), or disc degeneration (4.50+/-0.51 versus 4.35+/-0.61, p=0.340) between the two groups. CONCLUSIONS: Our study shows that the influence of sacralization of L5 on radiological findings in degenerative spondylolisthesis at L4-L5 may be less significant than previously expected. Further studies in large patient groups are needed to clarify the role of L5 sacralization on the development of degenerative spondylolisthesis at L4-L5.

Treatment of Long Tubular Bone Defect of Rabbit Using Autologous Cultured Osteoblasts Mixed with Fibrin / 대한정형외과연구학회지

PURPOSE: The osteogenic potential of autologous cultured osteoblasts mixed with fibrin when transplanted to bone defects was evaluated. MATERALS AND METHODS: Radial shaft defects over 15 mm were made in 30 New Zealand white rabbits. Fifteen rabbits in the control group underwent an iliac bone graft and 15 rabbits in the experimental group underwent an autologous cultured osteoblast injection mixed with fibrin. Both groups were compared radiologically and 5 rabbits in each group were sacrificed for histological evaluation using H-E and Masson's trichrome stains at 3, 6, and 9 weeks. RESULTS: Osteogenesis in the control group progressed more rapidly than in the experimental group. However, at 9 weeks, bone formation in both groups were similar and showed no significant difference in terms of the amount of bone formation and the quality of bone union. CONCLUSION: Autologous cultured osteoblast transplantation mixed with fibrin in bone defects was found to produce bone efficiently.

Calcified Chronic Subdural Hematoma Associated with Intracerebral Hematoma

Calcified chronic subdural hematoma is relatively common, however, its rupture into the subcortical white matter is very rare. A 37-year-old patient with a large, calcified, chronic subdural hematoma which ruptured intracerebrally forming a frontal lobe hemorrhage is reported. Craniotomy for removal of the hematoma and calcification achieved marked reduction in seizure frequency.

The long-term clinical significance of troponin and electrocardiogram in patients with unstable angina / 대한내과학회지

BACKGROUND: The early assessment of cardiac risk is important in patients with unstable angina (UA). The present study investigates the prognostic value capacities of cardiac specific troponin T (cTnT), cardiac specific troponin I (cTnI) and ECG change in Korean patients with UA. METHODS: Two hundred thirty patients (61+/-11 year, male:female=172:58) admitted to Chonnam National University Hospital via emergency room under the diagnosis of UA and underwent diagnostic coronary angiography (CAG) between July 1998 and June 1999, were analyzed according to the ECG findings of ST depression (STD), T wave inversion (TWI), cTnT and cTnI. Clinical characteristics, initial and follow-up CAG findings, and major adverse cardiac events (MACE) within one year were compared. RESULTS: Among the enrolled patients, 164 (71.3%) patients had significant coronary artery stenosis (CAS). During the one-year follow-up period, 40 patients developed MACE : 2 patients died, 7 patients had acute myocardial infarction and 34 patients developed restenosis. Positivity of cTnT and cTnI was associated with presence of CAS (p<0.001) and multi-vessel diseases (p<0.001). Levels of cTnT (5.7+/-8.4 vs 1.6+/-3.1 mg/dL, p<0.001) and cTnI (0.11+/-0.18 vs 0.03+/-0.19 mg/dL, p<0.001) were associated with MACE. The presence of STD was associated with the presence of CAS (p<0.001), multi-vessel diseases (p<0.001), low Thrombolysis In Myocardial Infarction (TIMI) flow (p<0.01), ACC/AHA types (p<0.001) and MACE (p<0.05). TWI was associated with TIMI flow (p<0.05), ACC/AHA types (p<0.001). In the patients with negative cTnT or cTnI, the negative predictive value of MACE within 1 year was 87.1% and 93.4%, respectively. In the absence of STD, that of MACE within 1 year was 87.1%. CONCLUSION: The level of troponin and electrocardiograhic findings are valuable in the early stratification of cardiac risks in Korean patients with UA and the prediction of MACE.

Value of Exercise Treadmill Score for Precdicting the Severity of Coronary Artery Disease / 대한내과학회지

OBJECTIVES: The treadmill exercise eletrocardiography(ECG) is the most commonly used non-invasive method in the evaluation of patients with chest pain. But the accuracy of treadmill exercise ECG in detecting the coronary artery disease(CAD) is still controversial. To improve the accuracy of the treadmill exercise test, exercise treadmill score(ETS) based on exercise duration, degree of ST deviation, and treadmill anginal index during treadmill exercise ECG has been used. METHODS: The authors calculated ETS by simple equation(total exercise duration-5 X maximal ST-segment deviation during or after exercise-4 X treadmill angina index) and analyzed coronary angiograms of 173 patients(mean age '55.5 +/- 8.7, male: female=2.7: 1) who underwent treadmill exercise ECG and coronary angiography in Chonnam University Hospital from January, 1990 through March, 1993. RESULTS: 1) The studied subjects were subdivided into 3groups according to ETS. Group A(high risk, ETSETS>or=11) 71cases(mean age 60.2 +/- 7.4, male: female=3.3:1), group C(low risk, ETS>5) 87cases(mean age 54.8 +/- 9.2, male-female =2.5:1). Clinical diagnoses of the studiedsubjects were 63stable angina, 61unstable angina, 3acute myocardial infarction, and 46 old myocardial infarction. On coronary angiographic findings, 61patients had single vessel disesase, 23patients had two vessel disease and 13patients had three vessel disease. 2) The sensitivity of the treadmill exercise ECG in diagnosing coronary artery disease was 88% and the specificity was 46%. 3) One hundred percent of group A patients had CAD and 54% of them had multivessel disease, 75% of group B had CAD and 27% of them had multivessel disease, and 33% of group C had CAD and 10% of them had multivessel disease. 4) There were no significant differences in the siite of stenotic lesion and degree of stenosis according to ETS in the patients with single vessel disease. 5) There were no significant differences in left ventricular ejection fraction and left ventricular end-diastolic pressure among three groups. CONCLUSION: Exercise treadmill score is useful in predicting the presence and severity of CAD and that low ETS less than -11 may be an indicator of multivessel coronary disease.

2 Cases of Apical Hypertrophic Cardiomyopathy with Left Ventricular Endomyocardial Calcification

Calcification of myocardium is most common in the site of an old infarction or in an aneurysmal wall. In addition, Myocardial calcification may occur in association with endomyocardial fibrosis and hyperparathyroidism, as a result of focal toxic or inflammatory myocardial necrosis, as well as in patients undergoing hemodialysis. Calcium deposits due to parasites and due to neoplastic disease may also be seen, But, left ventricular endomyocardial calcification associated with apical hypertrophic cardiomyopathy is very rare. This report describes 2 cases of apical hypertrophic cardiomyopathy with left ventricular endomyocardial calcification, diagnosed by the echocardiographic, angiographic and histologic findings.

Predictive Factors of Restenosis after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.

Predictive Factors of Restenosis after Percutaneous Transluminal Coronary Angioplasty

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.

Left Ventricular Function in Patients with Angina and Normal Coronary Angiogram

BACKGROUND: Angina with normal coronary angiogram has been called syndrome X or microvascular angina, but pathophysiologic mechanisms for chest patin in this group of patients are not known exactly. To observe the changes of left ventricular function in patients with angina and normal coronary angiogram, the authors analyzed the left ventricular systolic and diastolic function with echocardiogram and cardiac catheterization. METHODS: The authors performed resting and treadmill exercise electrocardiogram, 201TI dipyridamole scan, M-mode and Doppler echocardiogram, cardiac catheterization and coronary angiogram in patients with angina and normal coronary angiogram. The systolic and diastolic left ventricular function indices from M-mode and Doppler echocardiogram, left ventricular catheterization and coronary angiogram were analyzed in 12 patients excluding diabetes, hypertension, cardiomyopathy and esophageal motility disorders among 1626 patients who underwent coronary angiogram between Jan. 1991 and Aug. 1992 in Chonnam University Hospital. RESULTS: 1) Studied subjects were 12 patients, 5 male and 7 female, mean age was 51+/-9.4 year-old. Resting electrocardiograms were normal in 8 cases and ST-T changes in 4 cases. Ischemic ST-T changes were observed in all cases during treadmill exericise test and perfusion defects in 3 cases out of 8 cases during 201TI dipyridamole scan. 2) On echocardiogram, ejection fraction(EF) was 68.9+/-4.5%, fractional shortening(FS) 37.4+/-4.4%, ratio of left atrial to aortic root dimension(LAD/AOD) 1.2+/-0.1, OR slope 3.8+/-0.8c,/sec, mitral valve Doppler E/A velocity ratio[E/A(V)] 0.9+/-0.2, mitral valve Doppler E/A area ratio[E/A(a)]1.3+/-0.3, early diastolic deceleration rate(EDDR) 4.3+/-1.3m/sec2, isovolumic relaxation time(IVRT) 96.2+/-15.7msec, isovolumic contraction time(IVCT) 38.1+/-9.1 msec and aortic valve Doppler peak flow velocity[Ao(V)] 0.8+/-0.2m/sec. EF, FS, IVCT and A(V) were normal. LAD/AOD and IVRT were increased, but E/A(V), E/A(a), OR slope and EDDR were decreased compared to normal subjects. 3) On cardiac catheterization and angiogram, mean left ventricular end-diastolic pressure was 15.3+/-5.1mmHg and ejection fraction by left ventriculogram 78.2+/-7.4%. There was no regional wall motion abnormality. CONCLUSION: Above results suggest that angina with normal coronary angiogram may be associated with impaired left ventricular diastolic function.

Clinical Study for Coronary Artery Stenting

BACKGROUND: Coronary artery stent has been introduced recently to overcome major problems of percutaneous trausluminal coronary angioplasty(PTCA). To evaluate the success rate, complications and predictive factors associated with restenosis in coronary artery stenting, clinical analysis after coronary srtery stent was performed. METHODS: Sixteen patients who underwent coronary artery stent in Chonnam University Hospital beteen Apr. 1992 and Dec. 1993 were observed. The authors analyzed the stent dilivery success, rate complications and restenosis after follow-up coronary angiogram. RESULTS: 1) The palmaz-Schatz stents were implanted in 16 patients(12 male, 4 female, mean age : 53.3 years) and clinical diagnosis of patients were 7 myocardial infarction, 8 unstable angina and one stable angina. Stents were implanted in 10 cases of left anterior descending arteries and 6 cases of right coronary arteries. Three stents were implanted in a patient with long spiral dissection after middle right coronary artery PTCA, single stent was implanted in the other patients. 2) Stent delivery was successful in all cases, but acute stent thrombosis developed just after bail-out procedure for PTCA-induced intimal dissection in myocardial infarction patient who had multivessel lesion and intracoronary thrombus. Subacute stent thrombosis and major bleeding requiring transfusion were not documented. 3) On follow-up coronary angiogram in 10 patients, no restenosis observed in 5 right coronary arterial stents, but restenosis developed in 3 of 5 left anterior descending artery stents. Restenosis was observed in none of 4.0mm stents, two of six 3.5mm stents and one of two 3.0mm stents. 4) Stent restenosis was observed in 3 cases of positive201TI dipyridamole scan which was performed one month after coronary artery stenting. CONCLUSION: Coronary artery stent is a safe and effective in elective procedure. The restenosis rate after intracoronary stent is lower in right coronary artery than left anterior descending artery and larger stent.

Radiofrequency Catheter Ablation of Atrioventricular Accessory Pathways : Factors Influencing the Outcome of Catheter Ablation of Accessory Pathways

BACKGROUND: Catheter ablation of accessory pathways using radiofrequency(RF) energy was recently introduced to cure accessory pathway related tachyarrhythmias. The purpose of the present study was to evaluate the efficacy and safety of radiofrequency catheter ablation of accessory pathways and to determine factors influencing the outcome of catheter ablation. METHODS: Electrophysiology study was performed with standard technique and catheter ablation of accessory pathways using RF and conventional ablation technique. The outcome of RF catheter ablation were evaluated according to the location and the overtness of accessory pathways. Eighty patients(Mean +/-SD age, 36+/-15 years ; 50 male, 30 female)comprising 49(61%) with Wolff-Parkinson-White(WPW) syndrome and 31(39%) with atrioventricular reentry tachycardia(AVRT) using concealed bypass tract underwent RF catheter ablation for total of 85 accessory pathways in the Chonnam University Hospital. Five(6.3%) patients had multiple accessory pathways. RESULTS: Seventy-nine(92.9%) out of 85 pathways and all the pathways in 75(93.8%) out of 80 patients were ablated successfully. The success rate showed no significant difference between patients with overt accessory pathways and patients with concealed accessory pathways(92.0% vs. 93.9%). However, the success rate in right free wall location(72.7% of 11) was significantly lower than that in the other sites (95.9% of 74, p<0.05). More attempts were tried to ablate right-sided accessory pathway than left-sided pathways(6.4+/-24.1 vs. 3.8+/-6.8, p<0.05). Three(3.8%) pathways recurred within 30 minutes after the initial successful ablation. Four(5.1%) pathways recurred from 16 hours to 7 months after completion of the initial successful ablation session during the mean follow-up period of 43+/-24 weeks(range, 2-84 weeks). This late recurrence was more frequent, although statistically insignificant, in right-sided accessory pathways(11.1% vs. 3.3%, p=0.22). All 4 recurrent pathways(1 at the same session, 3 at the repeated sessions) reattempted for ablation were successfully ablated. As procedure-related complications, second degree AV block developed in a patients with mid septal and posteroseptal pahways and hemopericardium in a patients with a left anterolateral pathway. CONCLUSION: RF catheter ablation of atrioventricular accessory pathways is very effective and safe, with a success rate of 93.8% and a complication rate of 2.5%. Right-sided accessory pathways are more difficult to ablate than left-sided accessory pathways, requiring the development of a better technique for right free wall pathways.

The Clinical Effects of Perindopril(Acertil(R)) on Hypertensive Patients

BACKGROUND: Perindopril. a new second-generation angiotensin converting enzyme inhibitor developed by Servier Research, was administered in essential hypertensive patients in order to observe the clinical effects. METHOD: The changes of blood pressure, heart rate, quality of life, clinical laboratory examinations, side effects, electrocardiogram and echocardiographic left ventricular mass were evaluated before and after 4-12mg of perindopril 12 weeks' administration in 25 essential hypertensive patients(mild 10, moderate 8, severe 5, very severe 2 : male 7, female 18 ; mean age 53.1+/-8.9 years). RESULT: 1) After treatment with perindopril alone, blood pressures were lowered markedly in 17(68%), moderately in 5(20%) and mildly in 2(8%) cases. The average of blood pressures of 25 subjects were systolic 173.1+/-22.8mmHg and diastolic 105.9+/-9.5mmHg before treatment, which were lowered to 125.2+/-14.9mmHg and 83.2+/-9.0mmHg respectively after 12 weeks(p<0.0001). 2) Quality of Life improved markedly in 11(44%) and slightly in 9(36%) cases after perindopril administration. 3) On electrocardiographic follow-up study, three out of five left ventricular hypertrophy with strain, seven out of 13 left ventricular hypertrophy, two out of three ST segment and T wave change and two sinus tachycardia were improved. Echocardiographic left ventricular mass was reduced significantly form 249.4+/-72.7g to 202.9 56.3g after 12 weeks perindopril treatment(p<0.0001). 4) Side effects were 5 cases of dry cough and 3 facial flushing. 5) Final Assessment of perindopril effect including hypotensive effect, quality of life, left ventricular mass regression and side effect showed very useful in 16(64%) and useful in 6(24%) out of 25 subjects. CONCLUSION: Perindopril may be an effective initial single antihypertensive agent for the treatment of varying degree of hypertension, especially with left ventricular hypertrophy.

Predictors of Successful Percutaneous Transluminal Coronary Angioplasty in Multivessel Disease

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) was initially applied in patients with proximal, discrete, single vessel disease, but complex multivessel PTCA has become feasible with increased operator experience and instrumental development. The authors analyzed the predictive factors concerning the success rate of multivessel PTCA. METHODS: To evaluate the predictive factors of the successful PTCA in multivessel disease, clinical and angiographic findings of 39 patients (male 31, female 8, age 58.4 9.9) with 84 multiple lesions, who admitted to Chonnam National University Hospital between January 1991 and December 1992, were analyzed. RESULTS: Overall success rate of 84 attempted lesions was 92.9%. Success rate of old aged group 65 years or older was 89.5% and that of below 65 years was 93.8%. Success rate in acute myocardial infarction was 80% and significantly lower than those of old myocardial infarction, unstable and stable angina. Success rate of AHA type C lesion was 75.0% and significantly lower than those of type A(100%), type B1(96.7%) and type B2(95.2%). Success rate according to target vessels was not significantly different. Angiographic findings including calcification, lesion length, angulation, TIMI flow grade, left ventricular function and left ventricular aneurysm didn't affect the success rate of multivessel PTCA significantly. CONCLUSION: Overall success rate of multivessel PTCA was 92.9%. The negative predictive factors affecting the success rate of multivessel PTCA were the acute myocardial infarction out of clinical factors and the AHA type C lesion out of angiographic factors.

Right precordial electrocardiographic and coronary angiographic findings in acute inferior myocardial infarction / 대한내과학회지

No abstract available.