Pyriform Sinus Fistula: A Single Center Experience / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pyriform sinus fistula with 3rd and 4th branchial cleft anomaly is an extremely rare congenital condition that is not very well understood owing to its rarity. The aim of the study was to review our experience with pyriform sinus fistulae to better understand them. SUBJECTS AND METHOD: Of 163 patients with branchial anomaly treated at our institute between 1999 and 2011, medical records of 15 patients with pyriform sinus fistula were retrospectively reviewed. RESULTS: Overall, 9.2% had pyriform sinus fistulae and this proportion was higher than that of patients with 1st branchial anomaly. The mean age at the time of initial symptom presentation was 11.9 years. However, five patients (33.3%) were not diagnosed at that time because pyriform sinus fistula was not suspected. Computed tomography (CT) was the most sensitive diagnostic tool in patients suspected to have pyriform sinus fistulae; the sensitivity of CT was 86.7%, whereas that for esophagography was only 20%. Conservative surgical treatment involving cauterization of the opening of the fistula tract was performed in nine patients and showed favorable results with 22.2% of recurrence rate during a mean follow-up period of 23.1 months. In 67.7% of the patients, the causative organisms were bacteria inhabiting human mouth, suggesting that infection source for pyriform sinus fistula may be food contents and discharge of upper aerodigestive tract. CONCLUSION: The incidence of pyriform sinus fistula may be higher than expected. Therefore, the possibility of pyriform sinus fistulae coexisting should be considered while treating young patients with perithyroidal infection.

A Case of Kaposi's Sarcoma on Oropharynx and Hypopharynx in Human Immunodeficiency Virus-Negative Patient / 대한이비인후과학회지

The number of patients diagnosed with Kaposi's sarcoma has grown steadily since it was first discovered in 1972 by Moric Kaposi, a Hungarian dermatologist. Kaposi's sarcoma can be classified into four subtypes according to clinical form, epidemiology, and prognosis: idiopathic, endemic or African, immunosuppresion related, and acquired immunodeficiency syndrome related or epidemic Kaposi's sarcoma. A single idiopathic Kaposi's sarcoma in the head and neck area is very rarely found in an immunocompetent person. We experienced a case of Kaposi's sarcoma of the oropharynx and hypopharynx. The patient was healthy 70-year-old man and had no signs of being human immunodeficiency virus positive or immunocompromised. The patient was treated with inductive chemotherapy using capecitabine (Xeloda(R))/cisplatin followed by radiotherapy to a total 54 Gy.

Comparison of Upper Airway Morphology between Position-Dependent Sleep Apnea Patients and Position-Independent Sleep Apnea Patients

BACKGROUND AND OBJECTIVES: The aim of this study is to compare polysomnography (PSG) data and upper airway morphology between a position-dependent sleep apnea (PDSA) group and a position-independent sleep apnea (PISA) group. MATERIALS AND METHODS: This is a retrospective analysis into which 58 patients who were evaluated with overnight polysomnography, lateral cephalometry, and multidetector computed tomography (MD-CT, spiral CT scan) to diagnosis obstructive sleep apnea were enrolled. The patients were divided in two groups: the PDSA group who had a supine apnea-hypopnea index (AHI) that was at least two times higher than the non-supine AHI and the PISA group in whom the AHI in the supine position was less than twice that in the lateral position. Twelve cephalometric variables were measured. MD-CT measurements were evaluated in four neck levels from the hard palate to the top of the epiglottis. Minimal cross-sectional area (mCSA) and collapsibility index (CI) were calculated at each level. RESULTS: AHI was significantly higher in the PISA compared with PDSA. None of the cephalomeric measurements were significantly different between the two groups. In the MD-CT measurements, the mCSA of the low retropalate area (LRP) in the awake state was significantly lower in the PISA group compared to that in the PDSA group. In the sleep state, the CI was significantly higher in the high and low retroglossal areas (HRG and LRG) in the PISA compared to those in the PDSA group. CONCLUSION: In the supine position, PISA had increased collapsibility at the levels of the HRG and LRG during sleep compared to those in PDSA. In the future, a further evaluation with MD-CT in a non-supine position is needed.

A Case of Facial Nerve Schwannoma Presenting as an External Auditory Canal Mass

Facial nerve schwannoma is a rare benign tumor that arises from the Schwann cell sheath of facial nerve. Although the tumor can occur anywhere along the course of the peripheral nerve, it is frequently present as an internal auditory canal mass in the head and neck region. We experienced a rare case of facial nerve schwannoma on the mastoid segment, which was presented as an external auditory canal mass in a 24-years-old man. The lesion was removed via the transmastoid approach and the facial nerve was grafted using the greater auricular nerve. The patient's facial nerve function was preserved postoperatively as House-Brackmann grade III.

Correlations of C-reactive protein levels and Framingham coronary risk score / 대한내과학회지

BACKGROUND: The Framingham coronary risk score is a simplified coronary prediction tool developed to enable clinicians to estimate cardiovascular risk. C-reactive protein (CRP), a marker of low-grade inflammation, has been extensively studied in several large, prospective, epidemiological studies. However, few studies are available that have directly compared CRP levels with the Framingham coronary risk score. METHODS: A total of 13,052 individuals that visited our hospital for comprehensive medical tests between January 2002 and June 2003, were enrolled in the study (7,978 men, 5,074 women, mean age 44.8+/-11.0 years). Plasma samples were assayed for determination of CRP level by using a clinically validated high-sensitive assay. The Framingham coronary risk score was calculated by using previously published algorithms that used baseline cardiac risk factors including age, HDL cholesterol level, total cholesterol level, smoking status, blood pressure, and history of diabetes. Pearson correlation coefficients relating these individual risk factor scores and a total score were calculated. The CRP levels were divided into different categories; into 4 groups based on the quartiles of the CRP levels and 3 groups based on the baseline CRP levels of 0.3 mg/dL. The CRP levels were compared with the Framingham coronary risk score and the Framingham 10-year coronary heart disease risk according to each group. RESULTS: CRP levels significantly correlated with the Framingham coronary risk score (rtotal=0.373, p<0.01; rmen=0.351, p<0.01; rwomen=0.378, p<0.01). The CRP levels also correlated with individual components of the Framingham coronary risk score, which included age (rtotal=0.302, p<0.01; rmen=0.330, p<0.01; rwomen=0.287, p<0.01), blood pressure (rtotal=0.275, p<0.01; rmen=0.214, p<0.01; rwomen=0.270, p<0.01) and HDL-cholesterol level (rtotal=0.221, p<0.01; rmen=0.198, p<0.01; rwomen=0.221, p<0.01). Furthermore CRP levels correlated with calculated the Framingham 10-year coronary heart disease risk (rtotal=0.366, p<0.01, rmen=0.301, p<0.01, rwomen=0.420, p<0.01). The Framingham coronary risk score and calculated Framingham 10-year coronary heart disease risk increased with each increasing CRP level category(quartiles and risk, p<0.01). CONCLUSIONS: The CRP level correlated well with the Framingham coronary risk score and is a useful factor for predicting cardiovascular risk in Korean patients.

Efficacy and Complications of Angio-Seal(r) Device in Patients Undergoing Coronary Angiography and Angioplasty

BACKGROUND AND OBJECTIVES: The Angio-Seal(r) (a St. Jude Medical Co., USA) hemostatic puncture closure device produces direct femoral arterial hemostasis, by anchoring a collagen plug to the anterior vascular wall, through a sheath delivery system. The rapid and effective hemostasis leads to earlier ambulation, minimized hospital stay, patient discomfort and vascular complications. This study was performed to evaluate the efficacy and complications of an Angio-Seal in patients undergoing coronary angiography and angioplasty. SUBJECTS AND MEHTODS: A total 228 consecutive patients, admitted to our hospital for percutaneous coronary intervention, between October 2001 and May 2002, were enrolled and randomized into 2 groups. 116 patients were treated with an Angio-Seal and the other 112 with manual compression only (control group). The clinical characteristics, procedure related factors, time to ambulation, times to outpatient discharge and complications were analyzed in each patient. All the clinical and procedure-related factors, leading to oozing and delayed bleeding, were also analyzed in the 113 patients who had a successfully completed Angio-Seal deployment. RESULTS: The times to ambulation (7.96+/-5.81 hours vs. 23.32+/-3.35 hours) and times to outpatient discharge (2.00+/-0.94 days vs. 3.47+/-3.61 days) were significantly shorter in the Angio-Seal compared to the control group (p=0.001 & p=0.001, respectively). There was oozing in 20 patients (17.7%) and delayed bleeding in 6 (5.3%) of the successful Angio-Seal deployment group. The occurrence of oozing was significantly higher in the heparin infusion cases (40%. 18.3%, p=0.034), and was correlated with a later hematoma formation rate and the size of the hematoma (30% vs. 9.7%, 0.68+/-1.26 cm vs. 0.17+/-0.70 cm, p=0.015 & p=0.001, respectively). Delayed bleeding was correlated to the hematoma occurrence rate (50% vs. 11.2%, p=0.006). CONCLUSION: The Angio-Seal resulted in earlier ambulation and shorten the patients' hospital stay. Oozing, delayed bleeding, hematomas were noted as complications. Oozing and delayed bleeding were correlated with a high hematoma occurrence rate. Careful inspection of the puncture sites, following an Angio-Seal deployment, should be performed.

Ruptured sinus of valsalva aneurysms : Clinical features and surgical results / 대한내과학회지

BACKGROUND: Aneurysms of sinus Valsalva are rare anomalies thought to be primarily congenital in origin. To evaluate the clinical features and surgical results associated with ruptured aneurysm of sinus of Valsalva, we reviewed the clinical characteristics and follow up results of the patients. METHODS: From January, 1991, through June 2001, 33 patients with ruptured aneurysm of sinus of Valsalva underwent surgical correction from the above five university hospitals. The patients included 24 men and 9 women, with a mean age of 32+/-13 years. We reviewed symptoms, physical examination findings, ECG findings, the coexistent cardiac anomalies, echocardiographic findings, surgical results in 33 patients. RESULTS: Patterns of fistula tract were right coronary sinus-right ventricle in 24 patients (73%), noncoronary sinus- right atrium in 3 patients (9%), noncoronary sinus - right ventricle in 3 patients (9%), right coronary sinus - right atrium in 2 patients (6%) and right coronary sinus - right ventricle and right atrium in 1 patient (3%). Combined cardiac anomalies were VSD (20 cases; 61%), ASD (1 case; 3%) and PDA (1 case; 3%). But, only 12 cases of VSD (60%) were diagnosed with preoperative transthoracic echocardiography. The aneurysmal sacs were excised in all patients and the defects were closed with a patch in 21 patients (64%) and without patch in 12 patients (36%). No recurrence was observed during follow-up periods (68+/-38 months) for all survivors and there was no late complications or symptoms. CONCLUSION: In sinus of Valsalva aneurysm patients, combined cardiac anomalies, especially VSD, are common. Careful preoperative echocardiography should be performed to detect combined anomalies. And, surgical results are excellent without recurrence.

Types of In-Stent Restenosis and Predictive Factors for Diffuse Type In-Stent Restenosis

BACKGROUND AND OBJECTIVES: oronary stents have been used increasingly in the field of coronary intervention. However, in-stent restenosis (ISR) remains a therapeutic challenge. The subsequent response to repeat intervention in the restenotic lesion may be predicted by the angiographic pattern of ISR. In particular, the restenosis rate following re-intervention in this lesion is higher. This study evaluated the incidence of restenosis types and the predictors for diffuse type ISR. SUBJECTS AND METHODS: he study population included 66 patients with in-stent restenotic lesions after stent implantation. Angiographic restenosis was defined as a diameter stenosis of > or = 50% at follow-up coronary angiography. Patterns of ISR were defined as focal type ( or = 10 mm in length). The patients were divided into two groups according to the angiographic patterns of ISR. Clinical characteristics, pre-stenting angiographic features, and stenting procedure related factors were analyzed. A multivariate logistic regression analysis was performed in order to identify the independent predictors for diffuse-type ISR. RESULTS: ngiographic analysis of 66 restenotic lesions showed diffuse type in 29 lesions (44%) and focal type in 37 (56%). Most of the focal in-stent restenoses occured in the proximal and mid portions of the stents. The reference diameter (3.02+/-0.37 mm vs 3.25+/-0.46 mm, p=0.046) and post-stenting minimal luminal diameter (2.89+/-0.36 vs 3.19+/-0.39 mm, p=0.002) were significantly smaller in the diffuse type as compared to the focal type, whereas other parameters were significantly different. Using multivariate logistic regression analysis, the only predictive factor for diffuse type ISR was post-stenting MLD (OR=4.74, p=0.025). CONCLUSION: mall post-stenting MLD (<3 mm) has a high risk for diffuse type INR. Therefore, new therapeutic strategies are required for these lesions.

Early Outcome and Short Term Restenosis Rate of the Mitral Balloon Valvuloplasty in Mitral Stenosis Patients with Mild Mitral Regurgitation

BACKGROUND: Percutaneous mitral balloon valvuloplasty (PMV) has been proposed as an alternative to surgery for selected patients with symptomatic mitral stenosis. The presence of mild mitral regurgitation (MR) in mitral KERN=5535>stenosis is usually not considered as a contraindication for the procedure. But, the results of PMV in the subgroup KERN=>of patients with concomitant mild MR are unknown. Accordingly, this study evaluates the clinical outcome of a consecutive series of patients with mitral stenosis and mild MR undergoing PMV. METHODS: Between August 1992 and December 1996 we attempted to dilate the mitral valves of 43 consecutive patients with symptomatic mitral stenosis. Mean age of the group was 45.9+/-10.6 years and 37 patients were women. They were divided into two groups according to the presence or absence of mild MR before the procedure. Clinical feature, inital result, complication were compared. RESULTS: 1) Age, gender, symptomatic status, and atrial fibrillation were similar in both groups. 2) Patients with MR had more thickened valve (2.50+/-0.33 vs 1.84+/-0.55, p=0.048) and subvalvular tissue (2.55+/-0.73 vs 1.88+/-0.73, p=0.015), higher echocardiographic score (8.44+/-1.01 vs 7.08+/-1.65, p=0.004). 3) Mitral valve area gain on the first day after PMV was smaller in patients with MR(p=0.008). 4) The success rate of PMV, the incidence of severe MR after PMV, and the restenosis rate on 6 month were similar in both groups. CONCLUSION: Although the PMV in patients with mild MR obtained smaller increments in mitral valve area compared to those without MR, they showed similar immediate and short-term results after PMV.

The Myocardial Protective Effect and Change of the Monophasic Action Potential Duration by Adenosine Receptor, Protein Kinase C and KATP Channel in Ischemic Preconditioning in Cats

BACKGROUND AND OBJECTIVES: The myocardial protective effect of ischemic preconditioning is well known. However, the mechanism is remains unclear. The purpose of this study is to determine the role of adenosine, protein kinase C, KATP channel and the change of monophasic action potential duration on cardioprotective effect of ischemic preconditioning in cat. Materials AND METHODS: In this experiment, 66 cats were allocated into 7 groups:control (n=10), ischemic preconditioning (n=10), adenosine pre-treated (n=10), SPT (8-p-sulfophenyl theophylline) pre-treated (n=9), polymyxin B pre-treated (n=9), glibenclamide pre-treated (n=9) and nicorandil pre-treated (n=9) groups. Ischemic preconditioning was performed in ischemic preconditioning, SPT pre-treated, polymyxin B pre-treated and glibenclamide pre-treated groups by 3 episodes of 5 minutes ischemia and 10 minutes reperfusion. All animals were subjected to 40 minutes of ischemia and 40 minutes reperfusion. Monophasic action potential duration at 50% repolarization (MAP50) was measured in the ischemic and non-ischemic area respectively by epicardial probe throughout the experiment. The effect of ischemic preconditioning was determined by infarct size (% area at risk). RESULTS: Ischemic preconditioning, adenosine pre-treatment and nicorandil pre-treatment groups demonstrated a significant reduction in infarct size (26+/-4%, 25+/-4% and 34+/-8% infarction of the risk zone, respectively, p<0.01, p<0.01 and p<0.05 vs. control) with respect to control (41+/-8% infarction of the risk zone). However, pretreatment with SPT, polymyxin B or glibenclamide abolished the effect of ischemic preconditioning. Ischemic preconditioning group exhibited a significant reduction of MAP50 duration in the ischemic area during preconditioning;at the first preconditioning 128+/-11 msec vs. 144+/-10 msec control, at the second preconditioning 110+/-10 msec vs.147+/-10 msec control (p<0.01), at the third preconditioning 114+/-10 msec vs. 145+/-11 msec control (p<0.05). But, pretreatment with SPT, polymyxin B and glibenclamide prevented the reduction of MAP50 in the ischemic area during ischemic preconditioning. During 40 minutes ischemia, the shortening of MAP50 was more pronounced in the preconditioned group than in control group;at 5 minutes 112+/-13 msec vs. 124+/-10 msec control, at 10 minutes 89+/-12 msec vs. 133+/-11 msec control (p<0.05 ), at 20 minutes 93+/-12 msec vs. 136+/-11 msec control (p<0.05), and at 30 minutes 107+/-19 msec vs. 144+/-14 msec control (p<0.05). In adenosine pre-treated group, the MAP50 was significantly shortened than control group throughout 40 minutes occlusion period;at 5 minutes 90+/-8 msec (p<0.05), at 10 minutes 77+/-9 msec (p<0.05), at 20 minutes 92+/-8 msec (p<0.05), and at 30 minutes 103+/-8 msec (p<0.05). Nicorandil pretreatment pronounced the ischemic shortening of MAP50 in ischemic area and the effect was significant during early ischemic period;at 10 minutes 98+/-22 msec (p<0.05 vs. control). In pretreatment groups with SPT, polymyxin B or glibenclamide, the ischemic preconditioning of MAP50 measured in non-ischemic area was not significantly different compared with control group. MAP50 measured in ischemic area during reperfusion was not significantly different between groups. CONCLUSION: Based on this study, adenosine receptor-protein kinase C-KATP channel activation and monophasic action potential duration shortening during ischemia play an important role in myocardial protection during ischemic injury.

Pyoderma Gangrenosum in Ulcerative Colitis / 대한소화기내시경학회지

Ulcerative colitis is an inflammatory disorder that affects the rectum and extends proximally to affect a variable extent of the colon. The major symptoms of ulcerative colitis include diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. Ulcer-ative colitis also may be complicated by many local and systemic disorders as extrain-testinal manifestations. Pyoderma gangrenosum is the most severe dermatologic com-plication associated with ulcerative colitis. It is a painful , chronic, ulcerating skin disease of unknown cause. Diagnosis is clinical, there being no accepted histological diagnostic criteria. Conventional therapy is empirical, usually with high dose corticosteroids, but var-ious other agents have been tried with occasional success including topical antibiotics, cyclosporine, disodium cromoglycate, and dapsone. This patient was treated with high dose corticosteroid (prednisolone 1 mg/kg/day) and discharged with clinical improvement. So we report this case with a literature review.

Predictive factors of restenosis after successful percutaneous transluminal coronary angioplasty / 대한내과학회지

OBJECTIVE: Restenosis after successful PTCA remains the main limitation of this technique. Restenosis is a response to injury of the vessel wall, platelet aggregation, thrombus formation, liberation of growth factors, cellular hyperplasia involving predominantly smooth muscle proliferation and migration, and intercellular matrix formation. The identification of risk factors for restenosis could help to prevent and reduce the impact of this phenomenon. We undertook this study to evaluate retrospectively the association between risk factors and restenosis after PTCA METHODS: We studied 123 patients and 174 lesions that underwent successful PTCA and the follow-up period (from PTCA to follow-up angiography) was 8.2+/-5.8 months in all patients. They were divided into two groups according to the restenosis. Clinical feature, lesional feature, PTCA procedural feature, and other risk factors were compared. Restenosis was defined as the cutoff point of >50% in diameter stenosis at angiographic follow-up. RESULTS: 1) Restenosis was found in 68 lesions after successful PTCA(39.1%). 2) Clinical features of restenosis group are similar to no restenosis group 3) Thrombus (p=0.002), total occlusion(p=0.001), severity of stenosis in the initial lesion(p=0.013) and residual stenosis(p=0.001) were found to be independently associated with restenosis, whereas other lesional characteristics were not. 4) Balloon inflation duration(p=0.017) and dissection(p=0.002) were found to be independently associated with restenosis, whereas other procedural characteristics were not. CONCLUSION: Thrombus, total occlusion, dissection, severity of stenosis in the initial lesion, balloon inflation time, residual stenosis were found to be associated with restenosis after PTCA in our study.

A Case of Bronchitis and Bronchial Dysplasia Associated with Typhoid Fever / 결핵

Typhoid fever is an acute systemic febrile disease caused by Salmonella typhi. The classic picture of the disease consists of prolonged continuous or remitting fever, abdominal pain, diarrhea, rose spots and delirium. Salmonella infection can lead to diffuse organ involvement, including bone, lung, thyroid, kidney, liver, spleen, heart, pericardium, intestine and skin and cause a variety of complications. Pulmonary manifestations occur in only 1 percent of the patients. Mild cough with sticky sputum is the earliest symptom and bronchitis, pneumonia and lung abscess were presented. Recenfly we experienced a case of typhoid fever complicated by bronchitis, dysplasia in a 37-year-old male physician who was improved with ceftriaxone and ciprofloxacin We report this case with a review of the literature.

Effect of Treatment with Intensified Induction Regimen in Adult Acute Lymphocytic Leukemia / 대한혈액학회지

BACKGROUND: Adult acute lymphocytic leukemia (ALL) is a hematologic malignant disease characterized by an uncontrolled proliferation of immature lymphocytes and their progenitors. Progress in the treatment of adults with ALL has been more difficult to achieve, and until recently there was general agreement that adults have lower remission rates, briefer duration of remissions, and shorter survival times than that of children receiving identical treatment. METHODS: Twenty one patients with ALL were treated with remission induction chemotherapy consisting of vincristine, prednisolone, daunorubicin and L-asparaginase. After successful remission induction, consolidation-intensification and maintenance therapy, CNS prophylaxis were done. RESULTS: 1) The overall complete remission (CR) rate was 66.7% (14/21). The median remission duration for the 14 patients with CR was 16 months (3~31 months) and the median overall survival time was 11 months (1~35 months). The 3-year relapse free survival rate was 14.3% and the median time to complete remission was 41 days (18~71 days). The median overall survival time of complete remission group was 31.8 months and non-response group was 1.4 months. 2) Five (23.8%) patients died during the induction therapy period and two patients did not respond to treatment. 3) Six out of fourteen patients (42.9%) who had achieved remission relapsed and the sites of relapse were the bone marrow (66.7%) and CNS (16.7%). 4) Fourteen patients (66.7%, 14/21) died during follow-up period. The main causes of death were infection in eight cases (57.1%) and hemorrhage in two (14.3%). 5) Favorable factors influencing the remission rate were initial response to chemotherapy and sex (P=0.031), and factor influencing survival time was complete remission (P=0.005). CONCLUSION: This induction regimen was thought to be effective in remission rate, but it has considerable number of side effects and the shortness of the remission duration. In the future, more intensified induction and consolidation chemotherapy should be considered.

A Case of Bronchitis and Bronchial Dysplasia Associated with Typhoid Fever / 결핵

Typhoid fever is an acute systemic febrile disease caused by Salmonella typhi. The classic picture of the disease consists of prolonged continuous or remitting fever, abdominal pain, diarrhea, rose spots and delirium. Salmonella infection can lead to diffuse organ involvement, including bone, lung, thyroid, kidney, liver, spleen, heart, pericardium, intestine and skin and cause a variety of complications. Pulmonary manifestations occur in only 1 percent of the patients. Mild cough with sticky sputum is the earliest symptom and bronchitis, pneumonia and lung abscess were presented. Recenfly we experienced a case of typhoid fever complicated by bronchitis, dysplasia in a 37-year-old male physician who was improved with ceftriaxone and ciprofloxacin We report this case with a review of the literature.

Relationship between Angiographic Coronary Artery Morphology and Successful Intracoronary Thrombolysis in Acute Myocardial Infarction

BACKGROUND: It is well known that intracoronary thrombolysis during the early period of acute myocardial infarction leads to the limitation of myocardial necrosis, preserves left ventricular function, and improves survivals. The recanalization rate of intracoronary rrokinase infusion into infarct-related coronary artery was known as 62-94 percents in previos studies. The various factors influence the outcome of intracoronary thrombolysis, including total dose of urokinase, time from onsrt of chest pain to thrombolysis. The purpose of this study was to evaluate whether the occlusion site morphology influences recanalization rates of intracoronary thrombolysis. METHODS: We evaluated infarct-related coronary artery morphology of 56 acute mycardial infarction patients who performed intracoronary thrombolytic therapy within 6-12 hours after the onset of acute myocardial infarction. Intracoronary urokinase infusion was performed at a rate of 25000 IU/minute. The presence of calcification, collaterals, side branches and the stump site morphologies(thrombus type, pencil type, cutting type) were identified on magnified 35mm cine frames. RESULTS: Reperfusion was successed in 34 patients and failed in 22 patients. There were no statistically significant difference in the pressure of calcification, collaterals, and side branches between success and failure groups. Intracoronary thrombus was identified in 21 percent of success group, but not in failure group. The reperfusion rates according to stump site morphology were 76% in thrombus type, 58% in cutting type, and 42% in pencil type(p<0.05). CONCLUSION: Our study indicates the presence of intracoronary thrombus and the morphology of thrombus type is more effective in intracoronary thrombolysis in acute myocardial infarction. The identification of types of the coronary obstruction will be helpful for the selection of intracoronary thrombolysis in acute myocardial infarction patients. And the results suggest that the difference of stump composition show different stump morphologies.

The Characteristics of Clinical Presentation and In-hospital Outcome of Acute Myocardial Infarction Patients Older than 65 Years of Age

BACKGROUND: The aging of the patient population is one of rhe most important factirs influencing health care delivery. Currently 5% of the Korean population is elderly, defined as older than 65years of age, with this group projected to increase to 13.1% by the year 2021. Cardiovascular disease is the leading cause of death and of disability in the elderly age group. mong them, coronary heart disease is the most importane. METHOD: Study population composed of 216 patients who were admittied to the hospital with first acute myocardial infarction and they were divided into two groups according to the age(older than 65 years of age vs younger). Clonical features, risk factors of coronary heart disease, in-hospital outcome and complication were compared in elderly patients and others group. Results : 1) The risk factors of coronary heart disease is similar to younger patients but pattern of chest pain is less typical than younger patients. 2) Clinical presentation of elderly patients is similar to younger patients except Killip class on admission.(1.66vs 1.91,P=0.04) 3) In-hospital mortality of elderly patients in higher than younger patients. In addition to an increased incidence of death, recurrent ischemia, stroke, AV block, ventricular arrythmia, pulmonary edema occured more frequently with advanced age. 4) Especially in the thrombolytic therapy group, in-hospital death, reinfarction and recurrent ischemia is higher than primary PTCA group in elderly patients. CONCLUSIONS: Diagnosis of acute chest pain is difficult in elderly patients and in-hospital mortality and morbidity is higher than in younger patients. Thus more accurate diagnosis and discriminative therapeutic modality is needed.

Clinical Feature of Non-Q Wave Myocardial infarction : Relationship with EKG Findings and Infarct Related Arteries

BACKGROUND: Despite extensive investigation, the clinical features and prognostic significance of the non-Q wave myocardial infarction, when compared with Q wave myocardial infarction, remain controversial. And no definite relationship between EKG findings and infarct related arteries has been reported. METHOD: A retrospective analysis was done on 205 patient with acute myocardial infarction who were undergone coronary angiography and left ventriculography. Among them, 30 patient with non-Q wave myocardial infarction and 175 patients with Q wave myocardial infarction. RESULTS: 1) There was no significant difference between the two groups in risk factors, prevalence of preinfarct angina and preinfarct heart failure. 2) The faction of patients with non-Q wave myocardial infarction who received thromobolytic therapy was significantly less, compared to patient with Q wave myocardial infarction(p<0.0001). 3) The patients with non-Q wave myocardial infarction had a smaller infarct size estimated by peak creatine phosphokinase(p<0.01). But there was no difference in Killip's classification and left ventricular ejection fraction. 4) In patients with non-Q wave myocardial infarction, 87% of the patients had one or more abnormal EKG finding other than Q wave, and the most frequent abnormal finding was primary T wave change. 5) The location of infarct-related artery was significantly different between group(p<0.0001). The most frequently involved coronary artery in non-Q wave myocardial infarction was left circumflex coronary artery, especially in patients with normal EKG findings. 6) There was no significant difference between the two groups in the prognosis. CONCLUSION: There were significant differences between non-Q wave and Q wave myocardial infarction in the infarct size and the location of infarct related arteries. but not in the risk factors, the prevalence of previous coronary artery disease and prognsis. Further prospective and collaborative studies should be performed to define conclusion.