Effects of long-term triple anti-platelet therapy with low-dose cilostazol after drug-eluting stent implantation / 대한내과학회지

BACKGROUND/AIMS: A recent clinical trial demonstrated that triple anti platelet therapy resulted in significantly larger minimal luminal diameter and lower restenosis rate compared with conventional therapy after bare metal stent (BMS) implantation. However, it is uncertain that this result will be repeated after drug eluting stent (DES) implantation, especially with low dose cilostazol therapy. Thus, we performed a prospective, randomized study to evaluate the effectiveness of long term triple therapy with low dose cilostazol after DES implantation. METHODS: We analyzed 109 patients (132 lesion) prospectively, who underwent successful coronary DES implantation. The patients were divided into two groups according to combined anti platelet regimen: triple combination of aspirin, clopidogrel, and low dose cilostazol (50 mg/bid) (Group I, n=56) or dual combination of aspirin and clopidogrel (Group II, n=53) for 6 months. The minimal luminal diameter and binary restenosis rate were compared at 6 month follow up by coronary angiogram. The rates of stent thrombosis, major adverse cardiac events (MACE), and bleeding complication were also analyzed. RESULTS: The baseline clinical and angiographic characteristics were not different between the two groups. Angiographic follow-up was performed in 80 patients (109 lesions, 74%). The minimal luminal diameter at 6 month was 2.25+/-0.63 mm in group I and 2.30+/-0.56 mm in group II (p=0.742). Restenosis occurred in 4 patients (7.2%) in group I and 3 patients (5.6%) in group II (p=0.611). There were no differences in the rates of stent thrombosis, MACE, or bleeding complications between the two groups. CONCLUSIONS: Long term triple anti platelet therapy with low dose cilostazol after DES implantation was not effective in obtaining larger minimal luminal diameter or reducing restenosis rate, but it was used safely without increasing bleeding complication.

Immunohistochemical comparison of the telomerase expression between low-grade and high-grade gastric dysplasia / 대한내과학회지

BACKGROUND: Telomeres are simple repeats elements located at each end of the chromosomes of eukaryotic cells. The main function of telomeres is to cap the chromosome end and protect it from enzymatic attack. Telomerase that facilitates the synthesis of telomere has been detected in not only cancer, but also in precancerous lesion. In this study, we compared the telomerase expression between low-grade and high-grade gastric dysplasia. METHODS: The telomerase expression of 43 patients with gastric dysplasia (22 low-grade and 21 high-grade) was evaluated by immunohistochemical staining in tissues. RESULTS: The telomerase expression was much higher in the tissues from the patients with high-grade gastric dysplasia than in those tissues of the patients with low-grade gastric dysplasia. CONCLUSIONS: Activation of telomerase may be related with the malignant potentiality in gastric cells. Further studies are needed to define the role of telomerase in gastric tumorigenesis.

Three Sporadic Cases of Acute Hepatitis E / 대한소화기학회지

Acute hepatitis E is an endemic disease, commonly reported in Indian subcontinent, China, Africa, Central America, and so forth. It is a self-limiting disease like other acute hepatitis except in pregnant patient. Although sporadic hepatitis E is noted all over the world, most of them are associated with travel history to HEV-endemic area. In Korea, Hepatitis E is rarely reported. Moreover, sporadic acute hepatitis E without travel history to HEV-endemic area is very rare. We experienced three sporadic cases of acute hepatitis E, without travel history. All of them presented acute hepatitis symptoms, elevated aminotransferase, and positive IgM HEV Ab. Symptoms and aminotransferase levels were normalized during hospitalization and IgM HEV Ab converted negative after 4-8 months. We report three sporadic cases of onset-acute hepatitis E without travel history to HEV-endemic area.

A Case of Coronary Air Embolism of the Left Coronary Arteries that Manifested as Cardiogenic Shock

Coronary air embolism remains a serious complication of coronary catheterization despite performing careful procedure to prevent this. We report here on a case of massive coronary air embolism that was complicated by cardiogenic shock in a 52-year-old male patient with angina pectoris. The patient had a stenosis in the middle left anterior descending artery (LAD) and percutaneous coronary intervention (PCI) was planned for the LAD lesion. During PCI, inadvertent manipulation of a pressure line induced massive air embolism in both proximal left coronary arteries, and this manifested as cardiogenic shock. The patient recovered after supportive measures and successive intracoronary injections of nitroglycerin and then he eventually underwent successful PCI.

The Effect of Primary Percutaneous Coronary Intervention after the Administration of Tirofiban Alone or Tirofiban Combined with Low dose Alteplase in Patients with Acute Myocardial Infarction on ST Elevation Resolution, TIMI Flow and Short-Term Clinical O

BACKGROUND AND OBJECTIVES: The combination of platelet glycoprotein IIb/IIIa inhibitors and a low dose thrombolytic agent may produce early Thrombolysis In Myocardial Infarction (TIMI) 3 flow and a high rate of ST elevation resolution in an ST elevation acute myocardial infarction (STEMI). The clinical effect of tirofiban combined with low dose alteplase, prior to primary percutaneous coronary intervention (PCI) in STEMI, were evaluated on the ST elevation resolution, TIMI flow and 30-day clinical outcomes. SUBJECTS AND METHODS: Following aspirin, clopidogrel and standard heparin, 45 patients with STEMI were randomized into 2 groups; tirofiban administration (Group I; n=23, 64+/-10 years; 15 male) or combined administration of tirofiban with 40 mg alteplase prior to primary PCI (Group II; n=22, 59+/-11 years; 19 male). The pre- and post-interventional TIMI flow grades, ST elevation resolution and bleeding complications were compared between the two groups. The major adverse cardiac events (MACE) were compared between the two groups during 30-days of clinical follow-up. RESULTS: Group II had a higher pre-interventional TIMI flow (TIMI flow> or =2: 34.8% vs. 90.9%, p<0.0001) and rate of ST elevation resolution (49.0+/-27.8% vs. 66.6+/-27.2%, p=0.045) than Group I. A major bleeding complication developed in 1 (5.0%) Group II patient, and minor bleeding complications developed 1 patient from each group (Group I; 9.5% vs. Group II; 10%, p=0.959). CONCLUSION: Combined administration of tirofiban with alteplase prior to primary PCI leads to a higher TIMI flow and more frequent ST elevation resolution, without bleeding complications, compared to a single administration of tirofiban.