Increased Aortic Stiffness is Associated with Increased Left Ventricular Mass and Diastolic Dysfunction

BACKGROUND AND OBJECTIVES: Stiffening of the aorta is a potential risk factor for increased cardiovascular morbidity and mortality. Increased aortic stiffness can be associated with an increased left ventricular (LV) mass and diastolic dysfunction. The aim of the study was to evaluate the relationship of the aortic stiffness to the LV hypertrophy (LVH) and diastolic dysfunction. SUBJECTS AND METHODS: A total of 188 consecutive patients, without overt cardiovascular disease or symptoms, were included. The LV mass and diastolic filling patterns were assessed. The aortic strain and distensibility were indirectly obtained from the aortic diameters, using echocardiography and blood pressure measurements. RESULTS: Of the 188 patients (92 males, 54+/-14 years old), hypertension was found in 57 and diabetes in 29, with both found in 32 patients. The aortic strain (3.77+/-2.42 vs. 5.13+/-4.27, p<0.001) and distensibility (0.11+/-0.09 vs. 0.22+/-0.21, p<0.001) were significantly lower, but the LV mass index (112.5+/-39.2 vs. 87.8+/-19.0 gm/m2, p<0.001) higher, in the hypertensive compared to normotensive patients. Also, the aortic strain (3.07+/-2.42 vs. 5.18+/-4.01, p<0.001) and distensibility (0.10+/-0.12 vs. 0.21+/-0.20, p<0.001) were lower in patients with LVH. The E/E' ratio was higher in the hypertensive patients (10.9+/-5.0 vs. 8.1+/-3.1, p<0.001) and in those with LVH (10.8+/-5.6 vs. 8.4+/-3.2, p<0.001). In a multivariate analysis, the parameters closely related with aortic strain were age (standardized coefficient beta=-0.240, p=0.001), LV mass index (beta=-0.158, p=0.025) and IVRT (beta=-0.155, p=0.035). The parameters significantly related with aortic distensibility were age (beta=-0.344, p<0.001) and LV mass index (beta=-0.224, p=0.001). CONCLUSION: Increased aortic stiffness is associated with an increased LV mass and diastolic abnormality.

Bioavailability of EVA-Coated Metallic Stents Implanted in the Rabbit Iliac Artery

BACKGROUND AND OBJECTIVES: Coronary artery stenting actually shows a high efficacy in the treatment of coronary heart disease, but has the major limitation of restenosis. The ethylene-vinyl acetate copolymer (EVA), a biocompatible nondegradable copolymer, has been employed as a rate-controlling membrane in several drug delivery systems. Herein, the feasibility of an EVA-coated coronary stent was evaluated as a possible route for localized drug delivery. MATERIALS AND METHODS: A total of 15 rabbits were employed in this study. An uncoated stent was implanted into the non-diseased iliac artery in six rabbits, and an EVA-coated stent into a further nine. On the 30th day following the stent implantations, stented segments of the iliac arteries were removed for histological processing and morphometric analysis. RESULTS: The mean neointimal area of the uncoated and coated groups were 1.009 and 1.011 mm2 (p=0.56), respectively. No inflammatory cells were found in coated group. There were no apparent differences between the two groups. CONCLUSION: The results from this study have demonstrated that an EVA-coated coronary stent might be an appropriate method for the controlled-release of a drug.

A Case of Pheochromocytoma Presented with Life: Threatening Cardiogenic Shock

It is often possible to diagnose a pheochromocytoma only when a disastrous cardiac complication like a hypertensive crisis, episodes of unexpected left ventricular failure, myocarditis, arrhythmias, myocardial infarction and sudden death appears secondarily. We revealed that a patient who had been treated with a reversible left ventricular systolic dysfunction with cardiogenic indeed had a pheochromocytoma. Upon initial admission, a 35 years old man had upper respiratory tract infection and abdominal discomfort. Blood pressure was 140/90 mmHg and EKG showed transiently paroxysmal supraventricular tachycardia. Eight hours after admission, he appeared to be in cardiogenic shock. Echocardiography showed extensive global hypokinesia with severe left ventricular systolic dysfunction. Following conservative management he progressively recovered normal cardiac function although we did not discern the etiology of the left ventricular systolic dysfunction. He was readmitted six months later due to episodic headache and high blood pressure. Fortunately, due to the history of reversible left ventricular systolic dysfunction with cardiogenic shock, we were able to quickly assess him as having a pheochromocytoma. The laboratory data and radiological findings were compatible with this tumor, which was subsequently successfully removed through surgery. We suggest that the diagnosis of pheochromocytoma should be considered in young patients presenting with acute heart failure of non-specific origin.

Association of Neutrophil Adhesion Molecules Expression and Change of sICAM-1 Concentration after Coronary Artery Stenting with Later Restenosis

BACKGROUND: Neointimal hyperplasia, as the most important mechanism of restenosis after intracoronary artery stenting, its severity is closely correlated with the degree of local inflammatory reaction initiated by vasular injury during stenting procedure. So, we proceeded this study to determine whether inflammatory markers such as CD11b/CD18 (Mac-1) adehsion molecules of neutrophils, sICAM-1 (soluble intercellular adhesion molecule-1), ESR, and CRP increase or not in the peripheral circulation after coronary artery stenting, and whether there is any association between these findings and the degree of later restenosis. METHOD: 32 patients (chronic stable angina 4, unstable angina 17, acute myocardial infarction 11) underwent single vessel coronary artery stenting were enrolled in our study. Blood samples were obtained from peripheral vein just before coronary artery stenting and 48 hours thereafter. The degrees of CD11b/CD18 expression on the surface of neutrophils were analyzed by flow cytometry with monoclonal antibodies, and sICAM-1 by ELISA method. At each times, ESR and CRP were also measured. Follow-up coronary artery angiography was performed with QCA analysis at least 6 months later. We compared the each 48 hours values with the baseline (just before procedure) values. Percentage increments (as a ratio 48 hours values to baseline) of CD11b/CD18 expression, sICAM-1, ESR, and CRP levels were also compared with the results of follow-up QCA analysis. RESULTS: Restenosis (diameter stenosis > or = 50%) occurred in 6 patients (19%) at follow up angiography. 48 hours values of CD11b/CD18 expression, sICAM-1, ESR, and CRP were significantly elevated from the baseline values (each p values, CD11b : < 0.0001, CD18 : 0.01, sICAM-1 : < 0.0001, ESR : 0.005, and CRP : 0.001). The percentage increments of CD11b/CD18 expression were more elevated in restenosis group than nonrestenosis group (CD11b : 341+/-215%/74+/-95%, CD18 : 84+/-60%/17+/-37%, each p < 0.001, 0.001). There was some positive correlation between the percentage increments in the expression of CD11b and the late loss index at the follow up angiography (r=.43, p<0.05). CONCLUSIONS: Through this study, we found that the activation of neutrophils was occurred, and that sICAM-1 level was increased after coronary artery stenting in the peripheral blood. There was some correlations between the degree of CD11b expression on the surface of neutrophils and the severity of late lumen loss of inserted stents. The measurements of increased neutrophil adhesion molecules of CD11b/CD18 levels at 48hrs after coronary stenting may have a value as the predictor of subsequent late restenosis.

Acute Arterial Occlusion of the Left Lower Extremity during Prolonged Fasting

Acute arterial occlusion of the extremity may result from obstruction of an artery by embolism or by thrombosis in situ. This results in the sudden cessation of blood flow to an extremity. So immediate managements are required to prevent propagation of the clot and to restore blood flow to the ischemic extremity promptly. We report a case of a acute arterial occlusion which was developed during prolonged fasting. A 59-year-old male was transferred due to severe ischemic pain, coldness and loss of pulse in left lower extremity during fast. The arteriogram shows a complete obstruction of external iliac artery and non-visualization of femoral artery and popliteotibial artery in the left lower extremity. Selective intra-arterial urokinase thrombolytic therapy and percutaneous transluminal angioplasty resulted in recannulation of obstructed artery and relief of symptoms.

The Effects of Esophageal Varix Eradication on Pericardial Gastric Varix by Endoscopic Injection Sclerotherapy with Ethanolamine Oleate / 대한소화기내시경학회지

Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.

The Effects of Esophageal Varix Eradication on Pericardial Gastric Varix by Endoscopic Injection Sclerotherapy with Ethanolamine Oleate / 대한소화기내시경학회지

Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various therapeutic interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved. Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had a past history of esophageal variceal bleeding in Chonbuk National Univesity Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been complete obliterated and removed. To investigate the effects of esophageal varix eradication by EIS on combined peri- cardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of combined pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure. Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3cc(1-18cc), mean duration of EIS was 39 days, and mean follow up was 62 days after complete EIS procedure. In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required specific management. During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in l8 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were l6 cases(45.7%) and only 1 case(2.9%) was more aggravated. So, these results suggest that EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.

A Case of Familial Adenomatous Polyposis (FAP) with A Large Sentinel Polyp / 대한소화기내시경학회지

Familial adenomatous polyposis(FAP) is a rare hereditary disorder characterized by the development of hundreds to thounds polyps throughout the colon and rectum. Moreover, several extracolonic manifestations are seen. Recently, this disease is recognized as a adenomatous polyposis syndrome which can involve the entire astrointestinal tract. Several reports have demonstrated a high incidence of gastroduodenal polyps in patients with familial adenomatous polyposis. These colon polyps can be eventually developed as colon cancer, if not be treated. So early diagnosis is needed and prophylactic surgery should be erformed. We experienced a case of familial adenomatous polyposis with a large sentinel polyp on the sigmoid colon, presenting hematochezia and mucoid diarrhea. He was early treated before progression to carcinoma by total colectomy, rectal mucosectomy and J pouch ileoanal anastomosis.

A case of renovascular hypertension associated with pheochromocytoma / 대한신장학회잡지

No abstract available.