Comparison of facet joint degeneration in firefighters and hospital office workers

BACKGROUND: There are few published studies on the relationship between occupational lumbar load and facet joint degeneration (FJD). This cross-sectional study was conducted to evaluate the effect of physical lumbar load on FJD by comparing magnetic resonance imaging (MRI) findings of firefighters (FFs) and hospital office workers (HOWs). METHODS: We randomly sampled 341 male FFs and 80 male HOWs by age stratification. A questionnaire and clinical examination, including MRI of the lumbar spine (T12-S1), were conducted. FJD was diagnosed and graded by using the classification of Pathria et al., and reclassified into two groups as follows: no FJD (grade 0) and FJD (grades 1, 2, and 3). The prevalence of FJD was analyzed according to occupational group. RESULTS: The prevalence of FJD ranged from 31% (L1–L2) to 75% (L4–L5) in the FFs, and from 18% (L1–L2) to 69% (L4–L5) in the HOWs. After adjustment for age, body mass index, and frequency of physical exercise, the adjusted odds ratios (OR) for FJD in the FFs were significantly higher than those in the HOWs at all lumbar spinal levels, except for L3–L4 (L1–L2: OR, 2.644; 95% confidence interval [CI], 1.317–5.310; L2–L3: OR, 2.285; 95% CI, 1.304–4.006; L4–L5: OR, 1.918; 95% CI, 1.037–3.544; L5–S1: OR, 1.811; 95% CI, 1.031–3.181). CONCLUSION: This study shows that FFs exhibit a greater likelihood of having FJD than HOWs after controlling for other risk factors of FJD. This suggests that the physical occupational demands of FFs affect their risk of developing FJD.

Nonunion of subtrochanteric fractures: comminution or malreduction

Objective: This study aimed to investigate the impact on nonunion of the extent of comminution and postoperative displacement in patients surgically treated for subtrochanteric fractures

Methods: From 2008 to 2013, 44 patients with subtrochanteric fractures underwent surgery and follow-up. Retrospective data collection showed that it had 32 male and 12 female. Their mean age was 45 years. The case distribution according to Seinsheimer classification was as follows: IIA,8; IIB, 5; IIC, 7; IIIA, 8; IIIB, 3; IV, 9; and V, 4. Cephalomedullary nails were used in 28 cases; ordinary nails, in 9; and plates, in 7. After surgery, the fractures were evaluated for displacement on anteroposterior [AP] and lateral radiography

Results: Of the 44 patients, 37 achieved union from primary surgery at a mean time of 8.4 months. Five cases did not show union within the follow-up period. Two cases of nail breakage were diagnosed as non-union. Among the non-union cases, two were Seinsheimer classification IIIA; 3, IV; and 2, V. Displacement was observed on the lateral and A Pradiographs of 4 cases, on only the lateral radiographs of two cases, and in neither radiograph of one case. The risk of non-union was approximately 15.4 and 24.2 times higher when displacement was observed on the AP [95% confidence interval [CI]: 1.33-176.82] and lateral images [95% CI: 1.76-335.67], respectively

Conclusion: When displacement occurred after surgical treatment for subtrochanteric fractures, the risk of nonunion increased owing to the difficulty achieving stable fixation

One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion

PURPOSE: In the present study, 1-year outcome of intravitreal dexamethasone implant in macular edema secondary to central retinal vein occlusion (CRVO) was evaluated. METHODS: The medical records of 22 patients (22 eyes) with macular edema secondary to CRVO were reviewed retrospectively. All patients were treated with intravitreal dexamethasone implant more than twice a year and followed up at least for 1 year from the first dexamethasone implant injection. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured every 2 months after the first injection. Adverse effects, including cataract formation and elevation of IOP, were analyzed. RESULTS: The mean patient age was 64.3 ± 9.5 years and 10 patients (45.5%) were male. The average number of injections was 2.4 ± 0.6 and the interval between the first and second injection was 22.0 ± 6.4 weeks. The mean BCVA (log MAR) was 0.82 ± 0.50 and 0.72 ± 0.62 at baseline and after 1 year, respectively. Vision was significantly improved for 8 months after the first injection (p < 0.05). However, vision was not different from baseline after 1 year. The CMT was significantly decreased compared to baseline (p < 0.001). Subgroup analysis revealed that BCVA was improved and CMT decreased significantly when intravitreal dexamethasone concentration was presumed sufficient. Moreover, CMT decreased significantly in hypertensive and ischemic groups compared with normotensive and non-ischemic groups, respectively (p < 0.001). Elevated IOP was observed in 6 eyes (27.3%), but all 6 eyes became normal after topical agent was applied. Cataract formation was observed in 3 eyes (13.6%). CONCLUSIONS: Intravitreal dexamethasone implant resulted in visual acuity stabilization and macular edema reduction in patients having macular edema secondary to CRVO without significant adverse events.

The effect of applying ethnicity-specific spirometric reference equations to Asian migrant workers in Korea

OBJECTIVES: Asian migrant workers in Korea have various ethnicities. The purpose of this study was to evaluate the difference in spirometric interpretation made using the set of third National Health and Nutrition Examination Survey (NHANES III) reference equations and the relevant ethnicity-specific reference sets. METHODS: Spirometry was performed on 166 migrant and 498 Korean male workers between March and November 2012. We analyzed the spirometric data of healthy never-smokers. Spirometric patterns were evaluated using the NHANES III reference set and some relevant ethnicity-specific equations (Eom's equation for Koreans, Ip's equation for East Asians, Crapo's equation for Central Asians, Memon's equation for South Asians, and Gnanou's equation for Southeast Asian people). RESULTS: In all migrant groups except the Central Asian group, the forced expiratory volume in 1 second percentage (FEV1%) and forced vital capacity percentage (FVC%) calculated using each of the ethnicity-specific reference equations considered were significantly higher than those calculated using the NHANES III reference set. This study showed that in the evaluation of the spirometric result of subjects from Southeast Asia or South Asia, the percentage of cases with an abnormal FEV1 or FVC increased when the NHANES III set of equations was used as compared to when the ethnicity-specific equations were used. CONCLUSIONS: We found that the spirometric results of all ethnic groups were higher and the composition of the abnormal spirometric result was lower when the ethnicity-specific reference equations were used instead of the NHANES III reference set.

Decline in non-smoking workers' urine cotinine levels after increased smoking regulation in Korea

OBJECTIVES: To identify any association between implementing smoking regulation policies and workers' urine cotinine concentration levels in Korea. METHODS: From the first stage of the Korean National Environmental Health Survey conducted by the National Institute of Environmental Research from 2009 to 2011, 2,475 non-smoking workers selected. We analyzed the trend in the changes of cotinine concentration in urine using the general linear model and linear regression, in various jobs as categorized by the National Center for Health Statistics (NCHS) and Korea Standard Classification of Occupations (KSCO). RESULTS: The urine cotinine concentration tended to decrease every year (2.91 ng/ml in 2009, 2.12 ng/ml in 2010, and 1.31 ng/ml in 2011), showing a decreasing trend (P < 0.001). The total subjects' decreased cotinine concentration in urine between 2009 and 2011 was 2.72 ng/ml (54.1 % relative decrease). The changes in each subgroup's urine cotinine concentration ranged from 1.59 to 6.03 ng/ml (33.2 to 77.5 %). All groups except for the managerial group (n = 49), which had a small sample size, had statistically significant negative regression coefficients (p < 0.05). The ranges of the decrease in urine cotinine were 2.75 ng/ml (53.6 %) for males and 2.72 ng/ml (54.9 %) for females. The negative slope in urine cotinine level was statistically significantly greater in men than women. The changes in urine cotinine by occupation as classified by the NCHS occupational categories ranged from 2.43 to 3.36 ng/ml (46.6 to 61.5 % relative decrease). The negative slopes in urine cotinine levels of the white-collar and farm workers were statistically significantly greater than those of the service workers and blue-collar workers. The change by occupation as classified by the KSCO ranged from 1.59 to 6.03 ng/ml (a 33.2 to 77.5 % relative decrease). The negative slopes in urine cotinine levels of the professionals and related workers and clerks were statistically significantly greater than those of the service workers and plant and machine operators and assemblers. CONCLUSIONS: The cotinine concentration in urine among non-smoking worker groups tended to decline from 2009 to 2011. Such a result may be an indirect indicator of the effectiveness of smoking regulation policies including the revision of the National Health Promotion Act.

The Relationship between Possibility of Bipolar Disorder and Suicidal Attempt in Emergency Room / 정신신체의학

OBJECTIVES: The aim of this study was to investigate the factors including possibility of bipolar disorder that are related to intensity of suicidal idea. METHODS: The study subjects consisted of 50 patients who did suicidal attempt and treated at the Inje University Haeundae Paik Hospital Emergency Room. All participants underwent psychiatric interview and underwent Columbia Suicide Severity Rating Scale(C-SSRS), Beck Depression Inventory(BDI), Korean Version of Mood Disorder Questionnaire(MDQ) and Bipolar Spectrum Diagnostic Scale(BSDS) to evaluate patient's suicide attempt, severity of depression and possibility of bipolar disorder. RESULTS: Compared to non-high risk group, suicide high risk group showed significantly higher BDI(p<0.001) and intensity of ideation(IOI) in C-SSRS(p<0.001). Also intensity of ideation(IOI) was correlated with Mood Disorder Questionnaire(MDQ) bipolarity positive(p=0.033). CONCLUSION: The present study indicated that possibility of bipolar disorder plays a significant role in suicide attempters. Assessment of suicide ideation severity and possibility of bipolar disorder should be considered when suicide attempters come to emergency room.

High lead exposure in two leaded bronze ingot foundry workers

BACKGROUND: Awareness about lead poisoning in South Korea has increased; however, occupational exposures occurring in small-scale businesses have not been thoroughly investigated. We report two cases of high lead exposure in a leaded bronze ingot foundry. CASE PRESENTATION: Two employees, a 54-year-old primary operator and a 46-year-old assistant, at a small-scale metalworking company who had been employed for 18 years and 1 month, respectively, showed elevated blood lead levels (61.1 mug/dL and 51.7 mug/dL, respectively) at an occupational health checkup. Neither worker complained of abnormal symptoms nor signs related to lead poisoning. Health assessment follow-ups were conducted and biological exposure indices of lead were calculated every four weeks. After the initial follow-up assessment, both workers were relocated from the foundry process to the metalworking process. In addition, a localized exhaust system was installed after the second follow-up. CONCLUSIONS: Foundry workers in a small-scale businesses might be at high risk of lead exposure because these businesses might be vulnerable to poor industrial hygiene. Therefore, regular occupational health checkups are required.

Outbreak of Sudden Cardiac Deaths in a Tire Manufacturing Facility: Can It Be Caused by Nanoparticles?

OBJECTIVES: The purpose of this study was to review clinical characteristics and working environments of sudden cardiac death (SCD) cases associated with a tire manufacturer in Korea, and review possible occupational risk factors for cardiovascular disease including nanoparticles (ultrafine particles, UFPs). METHODS: We reviewed (i) the clinical course of SCD cases and (ii) occupational and non-occupational risk factors including chemicals, the physical work environment, and job characteristics. RESULTS: Possible occupational factors were chemicals, UFPs of rubber fume, a hot environment, shift work, overworking, and noise exposure. The mean diameter of rubber fume (63-73 nm) was (larger than diesel exhaust [12 nm] and outdoor dust [50 nm]). The concentration of carbon disulfide, carbon monoxide and styrene were lower than the limit of detection. Five SCD cases were exposed to shift work and overworking. Most of the cases had several non-occupational factors such as hypertension, overweight and smoking. CONCLUSION: The diameter of rubber fume was larger than outdoor and the diesel exhaust, the most well known particulate having a causal relationship with cardiovascular disease. The possibility of a causal relation between UFPs of rubber fume and SCD was not supported in this study. However, it is necessary to continue studying the relationship between large sized UFPs and SCD.

RE: Hemopericardium Following Acupuncture?

No abstract available.

Factors Affecting Patients' Graft Choice in Anterior Cruciate Ligament Reconstruction

BACKGROUND: Multiple studies have reported that allografts are acceptable alternatives to autografts for anterior cruciate ligament (ACL) reconstructions. Our clinical practice allows patient involvement in graft decision-making. This study examined the patients' preference for graft selection and the factors affecting their decision. METHODS: Patients scheduled to undergo an ACL reconstruction surgery (n = 129) at a university medical center in Korea were enrolled in this study. Information leaflets with graft descriptions were provided prior to hospital admission, and the patients were allowed to choose one of two surgical graft types. The patients were asked to complete a questionnaire that reflected their decision-making processes, and the patients' trends and factors affecting their choice of graft were analyzed based on their responses. RESULTS: Most patients (54.3%) selected autografts for the ACL reconstruction. The surgeon's explanation was the most important factor affecting the final patient decision followed by the information derived from Internet searches. Patients who derived the majority of their understanding of the graft types from the Internet chose allografts at significantly higher rates. CONCLUSIONS: Patient graft selection is a reasonable way of designating the type of surgical procedure. Most patients selected autografts for their ACL reconstruction. However, patients who performed significant Internet-based research tended to prefer allografts.

Characteristics of Work-related Musculoskeletal Disorders in Korea and Their Work-relatedness Evaluation

Work-related musculoskeletal disorders (WMSDs) can be compensated through the Industrial Accident Compensation Insurance Act. We looked at the characteristics of WMSDs in worker's compensation records and the epidemiological investigation reports from the Occupational Safety and Health Research Institute (OSHRI). Based on the records of compensation, the number of cases for WMSDs decreased from 4,532 in 2003 to 1,954 in 2007. However the proportion of WMSDs among the total approved occupational diseases increased from 49.6% in 2003 to 76.5% in 2007, and the total cost of WMSDs increased from 105.3 billion won in 2004 to 163.3 billion won in 2007. The approval rate of WMSDs by the OSHRI accounted for 65.6%. Ergonomic and clinical characteristics were associated with the approval rate; however, the degenerative changes had a minimal affect. This result was in discordance between OSHRI and the Korea Workers' Compensation & Welfare Service. We presumed that there were perceptional gaps in work-relatedness interpretation that resulted from the inequality of information in ergonomic analyses. We propose to introduce ergonomic analysis to unapproved WMSDs cases and discuss those results among experts that will be helpful to form a consensus among diverse groups.

Asbestos-related Diseases among Asbestos Textile Factory Workers and Residents Around the Factory

The asbestos textile industry is characterized by the highest asbestos ambient air concentration of those workers who have suffered from high incidence of lung cancer, malignant mesothelioma, and other asbestos related diseases (ARDs). Also, asbestos dust occurred in a factory can be disseminated into the environmental air around the factory, which can cause ARDs among residents of the factory. High lung cancer and malignant mesothelioma mortality rates among asbestos textile workers were established, and increase of ARDs among residents around the factory has been reported. A large number of environmentally exposed residents as well as severity of health problems among asbestos textile workers would cause huge social problems. The high exposure group needs to be monitored for early detection and management. In addition, a nationwide mandatory malignant mesothelioma registration system to identify exposure sources and high risk groups might help to predict and manage ARDs.

Bacterial Contamination of Allografts from Living Donors / 대한정형외과학회잡지

PURPOSE: To analyze the rate of allograft contamination from living donors using a swab culture method and to determine the necessity of antibacterial processing. MATERIALS AND METHODS: From September 2001 to June 2004, 334 allografts were obtained from living donors undergoing total joint arthroplasty. Two hundred and fourteen allografts were obtained from the femoral heads, 86 from the knee joint, and 34 from other sources. All allografts from donors with inflammatory diseases were discarded. After retrieving the graft, the entire surface of the allograft was carefully swabbed, and the specimen was inoculated and cultured on blood agar for 48 hours. A bacterial culture with the entire tissue was also carried out on discarded allografts, and the rate of contamination was compared with that of used allografts. RESULTS: Of the 334 allografts, 20 (6%) allografts were culture positive using swab method. 132 allografts were discarded. The reasons for discarding were a prior medical history in 26, no informed consent in 54 and a positive blood test in 10. The rate of contamination of the discarded allografts was 15% (20/132) using the swab method, and 19% (25/132) using entire tissue culture method. The sensitivity of the swab culture technique was only 44%. CONCLUSION: The low sensitivity implies that the swab method is unsuitable for detecting bacterial contamination. Unprocessed swab-culture-negative grafts may be contaminated with organisms that can cause infections. Therefore, additional antibiotic processing such as gamma-irradiation will be required.

Influences of Job Stressors on Psychosocial Well-being, Fatigue and Sleep Sufficiency among Firefighters / 대한산업의학회지

OBJECTIVES: To measure the job stressors and stress responses among firefighters. METHODS: We created a structured, self-reported questionnaire about job stressors using Karasek's Job Content Questionnaire (JCQ), psychosocial stress using Psychosocial Well-being Index, Short Form(PWI-SF) and fatigue using Multidimensional Fatigue Scale (MFS). The questionnaire also included sociodemographic data, job-related factors, and health-related behaviors. We collected questionnaires from 104 male firefighters, 35 male emergency medical service (EMS) rescuers and 28 male administrators in three different municipal fire departments in Busan from September 23 to October 2, 2003. Chi-square test and multiple logistic regression analysis were used to examine the job stressors using SPSS (10.0). The statistical significance level was 0.05. RESULTS: Both PWI-SF and MFS scores increased in the order of EMS rescuers, firefighters and administrators. Using multiple logistic regression analysis, sleep insufficiency showed statistically significant effects on both PWI-SF (OR=5.19, 95% CI=2.14~12.57) and MFS (OR=2.13, 95% CI=1.02~4.46). Alcohol drinking (OR=0.28, 95% CI=0.10~0.75) had a protective effect on MFS. The odds ratios in job loss and shiftwork were 3.44 (95% CI=1.25~9.42) and 8.69 (95% CI=2.87~26.36) on MFS. Monthly income showed a statistically significant effect on both MFS (OR=5.09, 95% CI=1.34~19.41) and sleep sufficiency (OR=7.27, 95% CI=1.62~32.61). However, there was no statistical significance among the JCQ items on either PWI-SF or MFS. CONCLUSIONS: Firefighters in this study had potential psychosocial stress and moderate level of fatigue scale. As a causal factor for these outcomes, sleep insufficiency and job loss, lower monthly income and shiftwork were statistically significantly, which confirm the need for countermeasures to ensure optimal sleep time and to raise monthly income. Further follow-up study using more in-depth interview is also required to identify the effects of both alcohol consumption and job loss.

The Effects of Stiffness in Transverse Ligament and Wire Diameter on Atlanto-Axial Posterior Fixations / 대한정형외과연구학회지

PURPOSE: To analysis the effects of reduction of stiffness in transverse ligament and wire diameter on atlanto-axial posterior fusion and fixations using finite element model. MATERIALS AND METHODS: The finite element model of occipito-atlanto-axis was made based on cadaver with a normal occiput and cervical spine. In order to investigate the effects of the wire diameter on the posterior fusion and fixations, an unstable atlanto-axial finite element model was made to reduce stiffness of the transverse ligament orderly (50%, 75%, 100%). And the wire was tied according to Brooks and Jenkins'method after modeling the grafted bone to fit in the space between the atlas and axis. The wire diameter was 18G, 20G and 22G. Anterior atlanto-dens interval (AADI) was measured after placing 1.5 Nm pure flexion movement on the occiput. RESULTS: The AADI was increased as the stiffness of transverse ligament was reduced. In the case of 50%, 75% and 100% decrement, the AADI were 3.37 mm, 3.87 mm and 4.94 mm. In the case of 50% and 75% decrement, the sufficient fixations were obtained although we used thin wire. However, in the 100% decrement, the AADI was exceeded the 3 mm when we used thin wire (20G, 22G) and sufficient fixations were obtained with only 18G. CONCLUSION: The sufficient fixations were obtained regardless of wire diameter in the partial tear of transverse ligament. In the complete tear, the minimal 18G wire diameter was useful to acquire sufficient fixations. However, the results were derived from the finite element model analysis. Thus further verification should be necessary to confirm the results using cadaver experiments.

A case of allgrove syndrome / 대한내과학회지

Allgrove syndrome, also known as Tripple A syndrome is characterized by ACTH-resistant adrenal insufficiency, achalasia of esophagus and alacrima. Since its first description by Allgrove et al. (1978), more than 60 cases from all over the world have been reported. In Korea, however, there was no report of this Allgrove syndrome. We report studies on a 18-year old male patient with this rare triad. The patient had alacrima from birth; isolated glucocorticoids deficiency had been diagnosed at 6 years of age and achalasia at age 18. We report the case with the review of literature.

The Effects of (66)Ho-Loaded Radioactive Stent in a Porcine Model

BACKGROUND AND OBJECTIVES: Vascular brachytherpy known to be an effective method in the prevention of restenosis following percutaneous coronary intervention (PCI). In this study we observed the effects of a radioisotope-loaded stent in a porcine model. MATERIALS AND METHODS: Holmium-166 ((166)Ho) was loaded onto the stent surface using impregnated polyurethane, and placed the stents into 7 porcine coronary arteries. Four weeks after stent overdilation injury, histopathological examination was performed. RESULTS: The absorbed dose of (166)Ho to the coronary artery, from the 158.5+/-140.9 microCi (166)Ho stent, was about 141 Gy at a depth of 0.5 mm, which was calculated by Monte Carlo EGS 4 Code. The mean external, and internal elastic lamina areas, the luminal and neointimal areas and the histopathological area stenosis in the 7 porcine coronary arteries were 7.6+/-2.8 mm2, 4.7+/-1.6 mm2, 2.4+/-1.4 mm2, 2.3+/-1.6 mm2 and 49.4+/-24.9%, respectively. The histopathological findings revealed remarkable inflammatory reactions and thrombosis in two of the porcine coronary arteries. CONCLUSION: (166)Ho radioactive loaded stents, using impregnated polyurethane, may inhibit neointimal hyperplasia, but the problems of stent thrombosis and inflammation should be solved.

A Case of Torsade de Pointes Associated with Hypopituitarism due to Hemorrhagic Fever with Renal Syndrome

We describe a 51-yr-old man presenting with syncope due to torsade de pointes. The torsade de pointes was refractory to conventional medical therapy, including infusion of isoproterenol, MgSO4, potassium, lidocaine, and amiodarone. His past history, physical findings, and hormone study confirmed that QT prolongation was caused by anterior hypopituitarism that developed as a sequela of hemorrhagic fever with renal syndrome. The long QT interval with deep inverted T wave was completely normalized 4 weeks after starting steroid and thyroid hormone replacement. Hormonal disorders should be considered as a cause of torsade de pointes, because this life-threatening arrhythmia can be treated by replacing the missing hormone.

The Role of Fibrinogen, Lipoprotein (a) and C-Reactive Protein in Acute Thrombotic Occlusion after Percutaneous Coronary Intervention

BACKGROUND: Acute thrombotic occlusion after percutaneous coronary intervention (PCI) is a serious complication that provokes acute myocardial infarction, cardiac death or emergent bypass surgery. The role of fibrinogen, C-reactive protein (CRP) and lipoprotein (a) [Lp(a)] in the patients who developed acute thrombotic occlusion after PCI was investigated. METHODS: The patients with acute coronary syndrome who underwent PCI at Chonnam National University Hospital between Jan. 1999 and Jun. 2000 were divided into two groups according to the occurrence of acute thrombotic occlusion: patients with thrombotic occlusion after PCI (Group I; 62.3+/-8.8 years, M:F=19:8) and patients without thrombotic occlusion after PCI (Group II; 59.6+/-10.6 years, M:F=271:95). Clinical and angiographic characteristics, levels of fibrinogen, CRP and Lp(a) were compared between two groups. RESULTS: There were no significant differences in the level of fibrinogen between two groups. The patients with elevated CRP (>0.5mg/dL) were more common in Group I than those in Group II (88.9% vs. 42.3%, p=0.0001) and the value of CRP was higher in Group I than in Group II (4.97+/-5.18 mg/dL vs. 2.27+/-4.23 mg/dL, p=0.002). The patients with high Lp(a) (>30mg/dL) were more prevalent in Group I than those in Group II (44.4% vs 18.6%, p=0.001). There were no significant differences in the risk factors for coronary artery disease, except for diabetes mellitus (Group I : Group II, 40.7% : 16.9%, p=0.002). Thrombolysis in Myocardial Infarction (TIMI) flow of Group I was lower than in Group II (p=0.0001). Multiple regression analysis after the adjustment for age, sex and other cardiovascular risk factors, diabetes mellitus, low TIMI flow, high CRP and Lp(a) were independently associated with the occurrence of acute thrombotic occlusion (p=0.008, 0.0001, 0.031, 0.035, respectively). CONCLUSION:The elevated values of CRP and Lp(a), diabetes mellitus, and low TIMI flow are significant predictive factors for the acute thrombotic occlusion in patients with acute coronary syndrome after PCI.

A Case of Successful Primary Coronary Intervention for the Total Occlusion of Left Main Stem with the Aid of Abciximab

A 61-yr-old male patient presented with severe chest pain with cardiogenic shock due to an extensive anterolateral myocardial infarction. Two-dimensional echocardiogram showed severe left ventricular systolic dysfunction (ejection fraction=17%). Emergent coronary angiogram obtained immediately after placing temporary pacing electrode revealed total thrombotic occlusion in the left main stem. We performed direct coronary intervention using kissing balloon technique with the aid of Abciximab (ReoPro(R)) infusion. Residual stenosis with thrombus remained even after high pressure balloon dilatations, therefore we placed two stents, one in the ostia of left anterior descending (LAD) and the other in left circumflex artery (LCX). Coronary angiogram after kissing stents showed improved LAD and LCX flows without residual stenosis. Chest pain resolved and blood pressure normalized after coronary intervention. The whole procedure time was 15 min. Follow-up coronary angiogram taken one week later showed patent previous stented arteries, and echocardiography demonstrated 40% of left ventricular ejection fraction. The clinical course for one-year follow-up was uneventful.