ABSTRACT
BACKGROUND: Limited data are available on the efficacy of statin therapy in stable ischemic heart disease with chronic total occlusion (CTO) without revascularization. We investigated whether statin therapy could be beneficial in stable patients with CTO without revascularization. METHODS: From March 2003 to February 2012, 2,024 patients with at least one CTO were enrolled in a retrospective, single-center registry; 664 of these patients were managed conservatively without an initial revascularization strategy. Among them, we excluded CTO cases involving acute coronary syndrome, in-hospital death or incomplete data and classified 551 patients into statin (n = 369) and non-statin (n = 182) groups according to use of statin at discharge. Propensity score matching analysis was also performed in 148 pairs. The primary outcome was cardiac death. RESULTS: The median overall follow-up duration was 45.7 months (interquartile range: 19.9–70.5 months). Cardiac death occurred in 22 patients (6.0%) in the statin group vs. 24 patients (13.2%) in the non-statin group (P 70 years, renal insufficiency, prior myocardial infarction, left ventricular ejection fraction < 40%, proximal-to-mid CTO location, and no use of statin in CTO patients. CONCLUSION: Statin therapy at discharge may be associated with a reduction in long-term cardiac mortality in stable CTO patients without revascularization.
Subject(s)
Humans , Acute Coronary Syndrome , Death , Follow-Up Studies , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Mortality , Multivariate Analysis , Myocardial Infarction , Myocardial Ischemia , Propensity Score , Renal Insufficiency , Retrospective Studies , Stroke VolumeABSTRACT
BACKGROUND AND OBJECTIVES: Slow coronary flow (SCF) is characterized by delayed contrast dye opacification without significant stenosis of epicardial coronary arteries. However, the pathophysiology and clinical implications of SCF are not fully understood. Some reports have suggested that SCF might be caused by atherosclerosis in the coronary artery microvasculature. Measuring carotid intima-media thickness (IMT) and pulse wave velocity (PWV), which are non-invasive and simple diagnostic tools, was developed to detect subclinical atherosclerosis. Thus, we determined IMT and PWV, and their possible relationship in a SCF group and a normal coronary flow (NCF) group of patients. SUBJECTS AND METHODS: We included 101 patients who complained of chest pain but had a normal coronary angiogram. Thrombolysis in Myocardial Infarction frame count (TIMI frame count, TFC) was evaluated in the left and right coronary arteries. We defined SCF as a TFC of more than 25. Carotid IMT was measured by ultrasonography in both common carotid arteries. PWV was calculated from pulse transit time between the brachial and ankle arteries. RESULTS: Fifteen patients were included in the SCF group and 86 patients in the NCF group. Male patients (n=11, 73.3%) were significantly more common in the SCF group than in the NCF group (n=37, 43.0%, p<0.05). The TFC of the SCF and NCF groups were 28.8+/-3.5 and 15.7+/-4.5, respectively. The carotid IMT in the SCF group increased significantly compared to that in the NCF group (1.2+/-0.3 mm vs. 0.8+/-0.1 mm, p<0.01). However, no significant difference in PWV was observed between the two groups. CONCLUSION: SCF may reflect early atherosclerotic changes in the coronary artery microvasculature.
Subject(s)
Animals , Humans , Male , Ankle , Atherosclerosis , Carotid Artery, Common , Carotid Intima-Media Thickness , Chest Pain , Constriction, Pathologic , Coronary Vessels , Microcirculation , Microvessels , Myocardial Infarction , Pulse Wave AnalysisABSTRACT
Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Aortic Diseases/diagnosis , Cytomegalovirus Infections/complications , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Intestinal Fistula/diagnosis , Intestinal Perforation/diagnosis , Vascular Fistula/diagnosisABSTRACT
Gastrointestinal complications (GI) after thoracoabdominal aortic repair can be classified as biliary disease, heptic dysfunction, pancreatitis, GI bleeding, peptic ulcer disease, bowel ischemia, paralytic ileus, and aortoenteric fistula. Theses complications are associated with high post operative morbidity and mortality. Most of the aortoenteric fistulae after thoracoabdominal aortic surgery are found at the duodenum, near the surgical site. These rare complications are caused by an indirect communication with abdominal aorta that originated from an aneursymal formation ruptured into the duodenum. Such aorto-duodenal fistula formation is considered as a result of inflammatory change from secondary infection near the surgical instruments. Herein, we report two cases of massive upper GI bleeding from aorto-duodenal fistulae and spontaneous lower GI perforation related to cytomegalovirus infection after abdominal aortic aneurysmal repair operations.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Aortic Diseases/diagnosis , Cytomegalovirus Infections/complications , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Intestinal Fistula/diagnosis , Intestinal Perforation/diagnosis , Vascular Fistula/diagnosisABSTRACT
Haemophilus aphrophilus, a fastidious, gram-negative oropharyngeal species grouped as a HACEK organism, is a rare cause of infective endocarditis. Three cases of endocarditis with Haemophilus aphrophilus were reported in Korea, and all of them required valve replacement surgery. We describe a case of native valve infective endocarditis with cerebral embolism and infarction caused by Haemophilus aphrophilus in a 61-year-old woman who was successfully treated with antibiotic therapy for 6 weeks without valve replacement surgery.
Subject(s)
Female , Humans , Middle Aged , Embolism , Endocarditis , Haemophilus , Infarction , Intracranial Embolism , KoreaABSTRACT
Compartment syndrome is rarely associated with non-traumatic rhabdomyolysis. We report the case of a 23-year-old man who developed compartment syndrome associated with rhabdomyolysis caused by prolonged immobilization after antidepressive drug overdose. Elevation of serum creatine phosphokinase and myoglobinuria indicated rhabdomyolysis. Painful swelling of the right buttock and thigh and right lower limb paralysis with sensory and motor deficit were suggestive of gluteal and thigh compartment syndrome with the complication of sciatic nerve injury. The patient received an immediate fasciotomy, medical treatment and rehabilitation. At five months after initial treatment, the patient could walk independently with nearly full recovery of his right lower limb function.
Subject(s)
Humans , Young Adult , Buttocks , Compartment Syndromes , Creatine Kinase , Drug Overdose , Immobilization , Lower Extremity , Myoglobinuria , Paralysis , Rhabdomyolysis , Sciatic Nerve , ThighABSTRACT
Encapsulating peritoneal sclerosis (EPS) is an uncommon but fatal complication of peritoneal dialysis (PD). Recently, there were some reports of advanced EPS cases that were successfully treated by enterolysis although an intestinal perforation or leakage from intestinal anastomosis were associated with a high mortality. We experienced a case of EPS in a 53-year-old man on PD for 3.5 years without a previous history of episode of peritonitis who presented with hemoperitoneum during treatment of peritonitis. EPS was diagnosed radiologically according to typical CT findings; The series of CT scans revealed how to develop in sequence from a very subtle findings to full-blown findings of EPS. Enterolysis was performed because the patient did not respond to conservative management such as cessation of PD with transfer to hemodialysis, nutritional support and steroid therapy. In spite of intestinal perforation during surgery, he was successfully treated with enterolysis. Therefore, we report this case with review of the literature.
Subject(s)
Humans , Middle Aged , Hemoperitoneum , Intestinal Perforation , Nutritional Support , Peritoneal Dialysis , Peritoneal Fibrosis , Peritonitis , Renal Dialysis , SclerosisABSTRACT
Both pyogenic sacroiliitis and iliopsoas muscle abscess are relatively uncommon infectious entities, and their coexistence has been reported in few patients. Its insidious and obscure clinical manifestations can cause the diagnostic delays, resulting in high mortality and morbidity. But, the proper management with appropriate antibiotics and percutaneous drainage of the abscess has showed the satisfactory outcomes in most patients with iliopsoas abscess. In this report, we present a case of 45-year-old male with diabetes mellitus who had an iliopsoas abscess complicated by sacroiliitis.