Acute myocardial infarction with a giant left main aneurysm in atypical Kawasaki disease / 영남의대학술지

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

Acute myocardial infarction with a giant left main aneurysm in atypical Kawasaki disease / 영남의대학술지

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

Ultrasound contrast-enhanced study as an imaging biomarker for anti-cancer drug treatment: preliminary study with paclitaxel in a xenograft mouse tumor model (secondary publication)

PURPOSE: The purpose of this study was to assess tumor angiogenesis using contrast-enhanced ultrasonography (CEUS) of human prostate cancer cells (PC3) that were implanted in mice before and after paclitaxel injection. METHODS: Twelve mice were injected with human PC3. The mice were grouped into two groups; one was the paclitaxel-treated group (n=6) and the other was the control group (n=6). Before administering paclitaxel into the peritoneal cavity, baseline CEUS was performed after the administration of 500 μL (1×108 microbubbles) of contrast agent. The area under the curve (AUC) up to 50 seconds after injection was derived from the time-intensity curves. After injection of paclitaxel or saline, CEUS studies were performed at the 1-week follow-up. Changes in tumor volume and the AUC in both two groups were evaluated. After CEUS, the microvessel density (MVD) was compared between the groups. RESULTS: In the paclitaxel-treated group, the AUC from CEUS showed a significant decrease 1-week after paclitaxel administration (P=0.030), even though the tumor volume showed no significant changes (P=0.116). In the control group, there was no significant decrease of the AUC (P=0.173). Pathologically, there was a significant difference in MVD between both groups (P=0.002). CONCLUSION: The AUC from the time intensity curve derived from CEUS showed an early change in response to the anti-cancer drug treatment that preceded the change in tumor size. The findings of CEUS could serve as an imaging biomarker for assessing tumor responses to anti-cancer drug treatment.

The Correlations of Parameters Using Contrast Enhanced Ultrasonography in the Evaluation of Prostate Cancer Angiogenesis

PURPOSE: The purpose of this study is to investigate the correlations of various kinetic parameters derived from the time intensity curve in a xenograft mouse model injected with a prostate cancer model (PC-3 and LNCaP) using an ultrasound contrast agent with histopathologic parameters. MATERIALS AND METHODS: Twenty nude mice were injected with human prostate cancer cells (15 PC-3 and five LNCaP) on their hind limbs. A bolus of 500 microL (1 x 10(8) microbubbles) of second-generation US contrast agent (SonoVue) was injected into the retroorbital vein. The region of interest was drawn over the entire tumor. The time intensity curve was acquired and then fitted to a gamma variate function. The maximal intensity (A), time to peak (Tp), maximal wash-in rate (washin), washout rate (washout), area under the curve up to 50 sec (AUC50), area under the ascending slope (AUC(in)), and area under the descending slope (AUC(out)) were derived from the parameters of the gamma variate fit. Immunohistochemical staining for VEGF and CD31 was performed. Tumor volume, the area percentage of VEGF stained in a field, and the count of CD31 (microvessel density, MVD) positive vessels showed correlation with the parameters from the time intensity curve. RESULTS: No significant differences were observed between the kinetic and histopathological parameters from each group. MVD showed positive correlation with A (r=0.625, p=0.003), washin (r=0.462, p=0.040), AUC50 (r=0.604, p=0.005), and AUC(out) (r=0.587, p=0.007). Positive correlations were also observed between tumor volume and AUC50 (r=0.481, p=0.032), washin (r=0.662, p=0.001), and AUC(out) (r=0.547, p=0.012). Washout showed negative correlations with MVD (r=-0.454, p=0.044) and tumor volume (r=-0.464, p=0.039). The area percentage of VEGF did not show any correlation with calculated data from the curve. CONCLUSION: MVD showed correlations with several of the kinetic parameters. CE-US has the potential for prediction of tumor vascularity in a prostate cancer animal model.

US Contrast Enhanced Study as an Imaging Biomarker of Anti-cancer Drug Treatment: Preliminary Study with Paclitaxel and a Xenograft Mouse Tumor Model

PURPOSE: We wanted to assess tumor angiogenesis of human prostate cancer cells (PC3) implanted in mice before and after paclitaxel injection via contrast-enhanced ultrasonography (CEUS). MATERIALS AND METHODS: Twelve mice were injected with human prostate cancer cells (PC3) on the back or hind limbs. The mice were grouped into two groups; one was the paclitaxel treated group (n = 6) and the other was the control group, which was treated with normal saline (n = 6). Before injection of paclitaxel into the peritoneal cavity, baseline CEUS was performed by the administration of 500 microl (1x108 microbubbles) of contrast agent. The area under the curve (AUC) up to 50 seconds after contrast injection was derived from the time-intensity curves. After injection of paclitaxel or saline, one week follow up CEUS studies were performed. The changes of the tumor volume and the AUC in both two groups were evaluated. After CEUS, the mice were sacrificed and the microvessel density (MVD) was compared. RESULTS: In the paclitaxel treated group, the AUC from CEUS showed a significant decrease one week after paclitaxel administration (p = 0.03), even though the tumor volume showed no significant changes (p = 0.116). In the control group, there was no significant decrease of the AUC (p = 0.173). Pathologically, there was a significant difference of microvessel density in both groups (p = 0.002). CONCLUSION: The AUC from the time intensity curve derived from CEUS showed early change in response to the anti-cancer drug treatment in advance of a tumor size response. The findings of CEUS could be an imaging biomarker for assessing the tumor response to anti-cancer drug treatment.

Transradial Coronary Intervention: Comparison of the Left and Right Radial Artery Approach

BACKGROUND AND OBJECTIVES: We evaluated the efficacy and safety of the left transradial approach as compared to the right radial approach when performing transradial coronary intervention. SUBJECTS AND METHODS: We performed the transradial coronary intervention in 711 cases via the left approach (Lt. group) and in 614 cases via the right approach (Rt. group) for patients with a normal Allen's test of both arms. We evaluated the procedural success rate, the crossover rate, the puncture time, the total procedural duration, the fluoroscopy time, the amount of contrast agent used and the local vascular complications of both groups. RESULTS: The baseline clinical and angiographic profiles were comparable between both groups. The puncture time, the amount of contrast agent used, choice of the guide catheter and local vascular complications were similar for the two groups. There was no difference in the procedural success rate (Rt. group; 96.4% vs. Lt. group; 96.2%, p=NS). However, there was tendency for a higher success rate via radial access for the Lt. group than for the Rt. group (Rt. group; 91.9% vs. Lt. group; 93.5%, p=0.056). The crossover rate was lower for the Lt. group than for the Rt. group (2.7 % vs. 4.6%, respectively; p=0.04). The total procedural time (32.3+/-15.4. vs. 30.7+/-17.6 min, respectively; p=0.03) and fluoroscopy time (16.9+/-12.6 vs. 13.9+/-7.9 min, respectively; p<0.01) were shorter in the Lt. group. The number of guide catheters used was higher in the Rt. group compared to the Lt. group (1.21+/-0.48 vs. 1.08+/-0.33, respectively; p=0.04). CONCLUSION: The left radial approach may provide increased procedural efficacy for transradial PCI compared to the right radial approach along with similar complications.

Broken Guidewire Fragment in the Radio-brachial Artery During Transradial Sheath Placement: Percutaneous Retrieval via Femoral Approach

A case in which a 0.014" wire was broken during the sheath placement in the radial artery for transradial coronary procedure is described here, and a successful retrieval of it using conventional methods is also described. Through the left femoral artery, the 6 Fr guiding catheter was advanced down to the tip of the broken wire at the brachial artery, and the distal part of the broken guidewire was captivated into the guiding catheter. By inflating the balloon catheter inside of the guiding catheter, seized broken guidewire between the inflated balloon and the guiding catheter was removed successfully by withdrawing the whole system en bloc.

A Diagnostic Value of Ischemia Modified Albumin in Patients with Suspected Acute Coronary Syndrome with Normal EKG and Cardiac Markers

BACKGROUND AND OBJECTIVES: In the early phase of acute chest pain, the diagnosis of acute coronary syndrome (ACS) is often difficult to achieve in an emergency department (ED) due to the non-diagnostic ECG and cardiac markers. Ischemia modified albumin (IMA) has recently been shown to be a sensitive early biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA for the patients with suspected ACS and who have normal ECG/cardiac markers. SUBJECTS AND METHODS: We enrolled 142 consecutive patients who presented to the ED due to suspected ACS, and they had a normal EKG and troponin-I/CK-MB within 5 hours after the onset of their chest pain. The diagnosis of ACS was based upon the clinical findings, the results of serial ECG/troponin and the coronary angiography. The ideal cutoff value of IMA for ACS was calculated by the receiver operator characteristic (ROC) curve analysis. RESULTS: The ACS was diagnosed in 80/142 (56%). The ROC curve area for the IMA test was 0.77 (CI; 0.70-0.85, p<0.01). At a cutoff value of 98.5 U/mL, the sensitivity, specificity and negative predictive values for ACS were 73%, 75% and 75%, respectively. At a cutoff value of 85 U/mL, the sensitivity and specificity and negative predictive values for ACS were 92%, 35% and 95%, respectively. CONCLUSION: IMA might be a useful diagnostic marker of ACS for those patients with normal ECG/cardiac markers and who present within 5 hours after the onset of chest pain.

Feasibility of the Radial Artery as a Vascular Access Route in Performing Primary Percutaneous Coronary Intervention

We aimed to evaluate the feasibility of transradial primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI) by comparing the procedural results and complications with those of transfemoral intervention. From April 1997 to October 2004, we enrolled 352 consecutive cases of STEMI who underwent primary PCI. The femoral route was used in 132 cases (TFI group) and the radial route was used in 220 cases (TRI group). Cases with Killips class IV, a negative Allen test or a non-palpable radial artery were excluded from our study. Baseline clinical and angiographic profiles were comparable in both groups. Vascular access time was 3.8 +/- 3.5 min in the TFI group and 3.6 +/- 3.1 min in the TRI group, and cath room to reperfusion time was 25 +/- 11 min in the TRI group and 26 +/- 13 min in the TRI group. The procedural success rate was 89% in the TFI group and 88% in the TRI group. Crossover occurred in 9 cases (4%) due to approaching vessel tortuosity in the TRI group. Major access site complications occurred in 7 cases (5%) in the TFI group, and there were no complications in the TRI group (p < 0.001). Although radial occlusion occurred in 5 cases of the TRI group, there was no evidence of hand ischemia. The total hospital stay was significantly shorter in TRI group than in TFI group. In conclusion, use of the radial artery might be a potential vascular access route in performing primary PCI in selected cases.

The Clinical Significance of Serum-Hydroxyproline in Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: The serum hydroxyproline level (SHL) has been regarded as evidence of collagen breakdown or extra-cellular matrix reorganization. The role of SHL as a diagnostic parameter in acute coronary syndrome, and the SHL changes depending on the left ventricular remodeling after acute myocardial infarction, was evaluated. SUBJECTS AND METHODS: Venous blood samples were obtained from 122 patients with AMI at the time of admission, and on days 7, 21 and 90, and once from 15 patients with stable angina, 15 with unstable angina and 12 healthy subjects. The SHL was measured using the amino acid analysis system (HPLC). The regional wall motion index (RWMI), LVEF and LV dimensions were determined in the early (0.05). However, there was a significant elevation in the SHL 14 day after AMI in the patients of the non-reperfusion group (4.36+/-1.46, 7.63+/-2.69 microgram/L, p=0.032). After 2 week, there was no significant difference in the SHL. There was a significant relationship between the late left ventricular ejection fraction and the SHL (r=-0.414, p=0.037), but no significant relationship between the other factors and the SHL (p>0.05). CONCLUSION: The serum hydroxyproline levels were significantly increased in patients with acute coronary syndrome, which reflect the early change in left ventricular remodeling in acute myocardial infarction.

A Case of Torsades de Pointes Induced by Complete Atrioventricular Block and Hypokalemia

Torsades de pointes (TdP) is a rare complication of a complete atrioventricular block with QT prolongation. Additional risk factors, such as hypokalemia, may increase the risk of TdP during atrioventricular (AV) block. We experienced a case of TdP, caused by a complete heart block and hypokalemia, which was successfully treated by implanting a permanent pacemaker and correction of the electrolyte imbalance.

The Experience of Transradial Coronary Intervention for Chronic Total Occlusion

BACKGROUND AND OBJECTIVE: We try to evaluate the feasibility of transradial approach in patients with a chronic total occlusion. SUBJECTS AND METHODS: Between Mar., 2000 and Oct., 2002, 52 consecutive patients, with 54 lesions, underwent transradial coronary intervention for a chronic total occlusion, which was defined as duration of an occlusion of more than 1 month. The patients were divided into the success or failure group, with the clinical, angiographic and procedural factors compared between the two groups. RESULTS: The overall success rate of the transradial approach was 57.7% (31/54). The most common cause of failure of the transradial coronary intervention was an inability to pass the lesions using a guidewire (17 of 23 failures, 74%). Five cases were crossed over to the femoral artery due to an approach failure of the guiding catheter into the coronary ostium; severe subclavian tortuosity and stenosis in 2 cases, radial artery looping in 1 and poor guiding support in the other 2. A procedural success was more common in lesions with no side branch, no bridging collateral, short duration of occlusion and lesions less than 15mm in length. Non-Q wave myocardial infarction occurred in 1 case. There were no major entry site complications. CONCLUSION: The radial artery might be a feasible vascular route in the percutaneous coronary intervention of chronic total occlusions with comparable procedural success rates and no major access site complications.

Predictive Factors of Survival for Intra-aortic Balloon Pump in Acute Myocardial Infarction Treated with Angioplasty

BACKGROUND AND OBJECTIVES: Intra-aortic balloon pumps (IABP) are useful tools for hemodynamic support in patients with hemodynamic instability or cardiogenic shock due to acute myocardial infarction (AMI). The purpose of this study was to examine the clinical characteristics and outcomes in patients with AMI who underwent IABP support, and to identify predictors of in-hospital mortality. SUBJECTS AND METHODS: We retrospectively analyzed 46 consecutive patients with an acute myocardial infarction, who underwent primary or rescue percutaneous coronary intervention, with IABP support, between March 1997 and June 2002. The patients were divided into survivors and non-survivors. We compared the clinical characteristics, hemodynamic parameters and therapeutic outcomes between the two groups, and assessed the clinical and angiographic predictors of in-hospital mortality. RESULTS: The overall survival rate was 39%. The indications of IABP support were cardiogenic shock (50%), unstable hemodynamics during coronary angioplasty (13%) and high risk intervention (35%). There were no significant differences in clinical diagnosis, infarct location, Killips classification, risk factors, ejection fraction, pain to balloon time, clinical indications for IABP, extents of coronary artery disease and left ventricular end diastolic pressure between the two groups. The survival group was younger than the non-survival group (p=0.04), and the TIMI III flow after PCI was more frequent in the survival group (p=0.01). The TIMI III flow was a predictor of in-hospital mortality (p=0.01). CONCLUSION: The predictive factor of survival following IABP was the TIMI III flow in patients with AMI who underwent primary or rescue PCI.

A Case of Percutaneous Removal of Cutted Left Atrial Pressure Catheter after Mitral Valve Replacement

We experienced a case of the successful retlement of a remnant cutted left atrial pressure catheter found in the left ventricle and ascending aorta on the 67 th day after a mitral valve replacement, using a PTCA guiding catheter and a guide wire.

Efficacy of Embolic Protection using PercuSurge GuardWire System During Primary Percutaneous Coronary Intervention with the Lesions Suggesting Large Thrombus Burden

BACKGROUND AND OBJECTIVES: We evaluated the efficacy of embolic protection using the PercuSurge GuardWire (PSG) system during primary percutaneous coronary intervention (PCI) on lesions with angiographic features suggesting large thrombus burden of the infarct-related artery (IRA). SUBJECTS AND METHODS: Between June 2002 and May 2003, we enrolled 30 patients who underwent primary PCI with angiographic features suggesting large IRA thrombus burden (abrupt end occlusive pattern, persistent dye stasis, reference diameter >4 mm, floating thrombus, accumulated thrombus >5 mm). Fourteen patients received primary PCI with the PSG system (PSG group) and 16 received primary PCI without the PSG system (control group). We compared angiographic results (TIMI flow, myocardial blush grade) and > or =50% resolution of ST segment elevation at 2 hours after reperfusion. RESULTS: Baseline clinical and angiographic characteristics were not significantly different between the two groups. Primary PCI with the PSG system was performed successfully in all patients. Post PCI TIMI grade 3 flow and myocardial blush grade 3 were achieved significantly more often in the PSG group (100% vs. 69%, p=0.022; 57% vs. 6%, p=0.004, respectively). Resolution of ST-segment elevation > or =50% was observed significantly more often in the PSG group (79% vs. 31%, p=0.01). CONCLUSION: Primary PCI with the PercuSurge GuardWire system might improve coronary blood flow and micro-vascular circulation in patients with angiographic features suggesting large thrombus burden.

A case of Prader-Willi syndrome with bilateral cryptorchidism and diabets mellitus / 대한내과학회지

Prader-Willi syndrome (PWS) is a complex, multisystem disorder comprising congenital hypotonia, feeding difficulties, hypogonadism and hypogenitalism, short stature, small hands and feet, mental and psychomotor retardation, distinctive facial appearance, onset of obesity in early childhood and a tendency to develop glucose intolerance in adolescence. Yet the syndrome remains difficult to diagnose due to the subtle nature of many of the manifestations. We report an 19-year old man with PWS, confirmed by fluorescence in situ hybridization (FISH) with DNA probes specific for the PWS region on chromosome 15.

Correlation between P300 Latency and Cognitive Capacity Screening Examination in Patients with Brain Lesion

OBJECTIVE: To verify the correlation between auditory event-related potential and Cognitive Capacity Screening Examination (CCSE) in patients with brain lesion. METHOD: P300 study using an auditory paradigm was performed in thirty patients with brain lesion, age ranged from thirteen to seventy-three years-old, and then was compared with the score of CCSE. RESULTS: The mean latency of P300 was 383.07+/-50.63 msec. The mean score of CCSE was 17.10+/-8.62. There was no significant difference in P300 latency and score of CCSE between male and female, and among the types of brain lesion. There was significant negative correlation between P300 latency and score of CCSE (p<0.05, r= 0.686), between score of CCSE and age (p<0.05, r= 0.364). There was significantly high intra-rater reliability in P300 latency study (alpha=0.9771). CONCLUSION: We conclude that P300 electrodiagnostic study is useful for reflection of cognitive function in patients with brain lesion.

An Analysis on Curriculum Content of Child Nursing in Korea / 아동간호학회지

The purpose of nursing education is to prepare the professional practitioner as nurse who will be interested in the health and the related aspects of community and will assume responsibility for contributing toward the improvement of the health for the all. This means that nursing education must provide opportunities for the development of knowledge, skills, and attitudes which make this possible. Consequently, this approach has relevance for nursing education. Faculty engaged in endless debates about what is to be included, and to what death, and what will be given short shrift as a result. Thus, it can be seen why there is so much confusion and lack of agreement between the emphasis and objectives in nursing. This study attempted to review and identify the curriculum content of child nursing in Korea to build and develop the standard curriculum contents for national board examination for nurses and child's health needs for the coming 21st century. The questionnaire was consisted of items for selection and organization of the knowledge components and type of unit with weigh to be attained in child nursing. Response of 34% of nursing program in university and junior college. Content analysis was done by using consensual validation of essential knowledge for curriculum content to identify what is obvious or trivial. This study pointed out that it is not yet apparent that demographic fact has greatly influenced child nursing curriculum content. In a similar vein the majority of content of child nursing devote little time and weigh to social and epidemically significant to child health. It seems to be needed that the content of child nursing may push the paradigm shift in nursing education such as health promotion and prevention for postretinal roles of child and family. In conclusion, it is time to convoke and content and standardization on job analysis for national board exam for nurses in Korea.

A Case of Brachial Plexus Block in a Patient with Multiple Sclerosis / 대한마취과학회지

Multiple sclerosis is an acquired, demyelinating disease of the central nervous system Clinically, it is characterized by episodes of focal disorder of the optic nerves, spinal cord, and brain, which remit to a varying extent and recur over a period of many years. Because of the possibilities of neurologic exacerbation, general anesthesia is usually recommended, while spinal anesthesia is discouraged. Epidural anesthesia may be less of a risk than spinal anesthesia, because the concentration of local anesthetic in spinal cord white matter is lower. Other regional anesthesia is not likely to predispose postoperative exacerbation of multiple sclerosis, but a controlled study has not been performed. A 17 year-old female patient with advanced multiple sclemsis was successfully managed for internal fixation of ulnar fracture using brachial plexus block. The patient recovered well after block without any aggravation of neurologic symptoms.