Removal of Dislodged Stent by Using 8 Fr Sheath and Forcep during Transradial Coronary Stenting

Stent dislogement or migration is not a rare complication. Its incidence varies from 1.4% to 8% of the cases. When stent migration occurs, the usual treatment or management is to implant stent in the distal peripheral artery or proximal coronary artery. But, probably the best treatment is safe retrieval of the dislodged stent. During the transfemoral coronary intervention, undeployed stent can be more easily retrieved into the guiding catheter with relatively larger guiding catheter luminal space. Also, larger sheath can be changed more easily when the retrieval of stent is difficult. In the transradial coronary stenting, usual size of guiding catheter is 6 Fr, makes it difficult to retrieve relatively bulky stent when deployment of stent fails. We report 2 cases of stent dislodgment during transradial coronary stenting which can be successfully removed by using myocardial biopsy forcep through 8 Fr sheath. These combination could be one of the valuable methods, especially during transradial stenting.

Dual Left Anterior Descending Coronary Artery: Incidence, Angiographic Features and Clinical Significance in the Era of Revascularization

BACKGROUND AND OBJECTIVES: An anatomic variant of left anterior descending coronary artery (LAD), termed "dual LAD", consists of early bifurcation of the proximal LAD into one early terminating branch (short LAD) which remains in the anterior interventricular sulcus (AIVS) and doesn't reach the apex, and the second (long LAD), which has a variable course outside the AIVS but returns to the distal sulcus and continues to the apex. Its incidence, angiographic features and clinical significance are investigated. MATERIALS AND METHOD: Consecutive 696 coronary angiograms during October 1997 through August 1998 were analyzed. RESULTS: A dual LAD variant was noted in 45 patients (6%) of the 696 patients. Type I, in which the long LAD descends on the left ventricular side of the AIVS before reentering the AIVS, was noted in 24 patients (53%) and type II, in which the long LAD descends on the right ventricular side of the AIVS before reentering the AIVS, in 21(47%). First septal branch was commonly originated from LAD proper in both type (54% vs 52%), but first diagonal branch from LAD proper (63%) in type I, from short LAD (71%) in type II. Presence of dual LAD was recognized before percutaneous coronary intervention (10) or bypass surgery (2) in 12 (63%) of 19 patients. Regional wall motion abnormalities (RWMA) were localized in distal septum or anterolateral wall in 2 patients with short or long LAD obstruction, respectively. CONCLUSION: Recognition of dual LAD is essential to prevent errors of interpretation of the coronary angiogram, to plan optimal strategy for percutaneous coronary intervention or bypass surgery, especially in case of total occlusion, and to understand localized septal or anterolateral RWMA.

A Case of Gastroenteritis due to Vibrio fluvialis / 감염

V. fluvialis is a gram-negative, oxidase-producing, halophilic bacterium. It is normally found in coastal waters and seafoods. There have been a few reports on Vibrio fluvialis gastroenteritis in other countries, whereas there has been no previous report of V. fluvialis infections in Korea. Reports from other countries showed that V. fluvialis was isolated mostly from infants and children. We experienced a rare case of gastroenteritis due to V. fluvialis in a 55-year-old man with liver cirrhosis who ate an ark shell. He was admitted due to mild abdominal pain and severe watery diarrhea followed by rapidly progressive dehydration, electrolyte imbalance, and hepatorenal syndrome for a week. This patient was not improved by intensive care and antibiotic therapy.

A Case of Duodenal Bulb Carcinoid Tumor Causing a Carcinoid Syndrome without Liver Metastasis / 대한소화기내시경학회지

A primary duodenal carcinoid tumor causing carcinoid syndrome is rare. In case of accompanying carcinoid syndrome in a primary duodenal carcinoid tumor, it mostly suggests massive liver metastasis. In rare case, venous drainage of carcinoid tumor and systemic venous drainage are directly connected without passing through the portal system. Therefore, it is rare and interesting case which a primary duodenal carcinoid tumor accompanies carcinoid syndrome without liver metastasis. We experienced an occasion of a primary carcinoid tumor located in duodenal bulb in a 56 year-old woman. This patient came to our hospital because of intermittent diarrhea, epigastric pain and facial flushing. And it was surely diagnosed as carcinoid tumor by gastrointestinal endoscopic biopsy. She was hospitalized for surgery and we were able to confirm that carcinoid syndrome was accompanied through biochemical test. However, metastatic lesion was not found at liver, small and large intestine. We report this case with reference to documents due to rarity.