Effects of cilostazol treatment on angiographic restenosis after coronary stent placement

BACKGROUND AND OBJECTIVES: Cilostazol is a potent antiplatelet agent with antiproliferative properties. Few data are available about the effect of cilostazol on post-stenting restenosis. The aim of this study was to evaluate the impact of cilostazol on post-stenting restenosis. MATERIALS AND METHOD: Four hundred and nine patients (494 lesions) scheduled for elective stenting were randomized to receive aspirin plus ticlopidine (group A, n=01, 240 lesions) or aspirin plus cilostazol (group B, n=08, 254 lesions), starting 2 days before stenting. Ticlopidine was given for 1 month and cilostazol for 6 months. Follow-up angiography was performed at 6 months, and clinical evaluation at regular intervals. RESULTS: Baseline characteristics were similar between the two groups. Procedural success rate was 99.6% in group A and 100% in group B. There were no cases of stent thrombosis after stenting. Angiographic follow-up was performed in 380 of the 494 eligible lesions and angiographic restenosis rate was 27% in group A, and 22.9% in group B (p=S). However, diffuse type in-stent restenosis was more common in group A than in group B (54.2% vs 26.8%, respectively, p<0.05). In diabetic patients, angiographic restenosis rate was 50% in group A and 21.7% in group B (p<0.05). Clinical events during the follow-up did not differ between the two groups. CONCLUSION: The combination therapy with aspirin plus cilostazol seems to be an effective antithrombotic regimen with comparable results to aspirin plus ticlopidine, but it does not reduce the overall angiographic restenosis rate after elective coronary stenting.

Coronary Angioplasty in Patients with Multivessel Coronary Artery Disease

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) has been broaden in reccent years. However,we considered many aspects in performing angioplasty in patient with multivessel disease. There were procedural success rate, complication, risk, restenosis and long-term effect. So we evaluated the initial success rate, safety and follow-up results. METHODS: To assess the likelihood of initial success in patients with multivessel coronary artery disease, single or multiple site angioplasy were performed at 449 lesions from 273 patients(Male 202,Female 71, Mean age 60.0+/-9.4 years). To evaluate the restenosis rate of angioplasty in multivessel disease, follow-up coronary angiogram were performed at 164 lesions from 95 patients at average 6months after angioplasty. RESULTS: The extent of coronary artery disease revealed that two vessel disease were 200(73.3%) and triple vessel disease were 73(26.7%). Single vessel angioplasty(SVA) was performed in 180(40.1%) lesions and multivessel angioplasty(MVA) was performed in 269(59.9%) lesions. Procedural success was achieved 377(84.0%) out of total 449 lesions. The proccdural success rate was 81.1% in SVA and 85.9% in MVA. According to major epicardial coronary artery, procedural success rate of left anterior descending artery was 82.0%, left circumflex artery 92.4% and right coronary artery 79.4%. According to angiographic morphology of lesions, procedural success rate of type A was 95.7%, type B 88.9% and type C 56.4%. Complete revascularization was done in 87 patients(31.9%) out of 273 patients. Major cause of failure of angioplasty in multivessel disease was inability to pass the guide wire cross the lesion due to total occlusion. Complications included dissection in 101, acute closure in 7(9.7%), coronary artery perforation in 2, cardiogenic shock in 1 and ventricular fibrillation in 1. Follow-up coronary angiography revealed the restenosis rate was 42.2%. CONCLUSION: Coronary angioplasty in selected patients with multivessel coronary artery disease might be useful and have relatively good immediate and long-term results.

A Case of Primary Thyroid Lymphoma Involving Bone Marrow (Stage IVE) Assoeiated with Hashimoto's Thyroiditis / 대한내분비학회지

Primary lymphoma of the thyroid is a relatively rare malignant tumor of the thyroid. It is known to be frequently associated with Hashimoto's thyroiditis. In Korea, a few cases of primary lymphoma of the thyroid have been reported and most of these cases were in the stage I E or II E. Recently, we experienced a case of the primary thyroid lymphoma, stage IV E associated with Hashimoto's thyroiditis in a 70-year-old woman who presented with dysphagia and dyspnea due to rapidly enlarging neck mass.She was treated with combination chemotherapy(cyclophosphamide, adriamycin, vincristine and methylprednisolone) and local radiotherapy and achieved partial response with resolution of dysphagia and dyspnea.

Two Cases of Aortic Intramural Hematoma Diagnosed with Transesophageal Echocardiography

Aortic intramural hematoma(AIH) is known as a variant of acute dissection due to rupture of the vasa vasorum without a intimal tear. In elderly hypertension patients patients with aortic dissection but without the characteristic echocardiographic findings of a double-channel aorta, this disease entity should be suspected and attention should be given to find segmental wall thickening of the aorta >0.7cm. AIH may progress to typical dissection or to rupture in considerable number of the patients, so careful follow-up is necessary and the same management principles for the patients with dissection can be applied in this variant. We report two cases of AIH showing typical eccentric mural thickening without dissection membrane with transesophageal echocardiographic follow-up.

A Case of Superior Vena Cava Syndrome Caused by Klebsiella Pneumonia / 결핵

Superior vents lava(SVC) syndrome is mostly related to a malignant process, but many different benign causes haute also been described. We report a case of SVC syndrome caused by Klebsiella pneumonia diagnosed by sputum culture and serial chest X-ray changes. A 27-year-old man had been in stable health until three days before admission, when he complained of pleuritic chest pain, facial flushing, and shortness of breath. Examination of the head and neck disclosed edema of face and both arms, and jugular venous distention to the angle of the jaw. The chest auscultation resealed decreased breath sound without crackle on right upper lung field. The chest roentgenogram showed homogenous air space consolidation on right upper lobe, asociated with downward displacement of minor fissure and contralateral displacement of trachea, but air bronchogram was not seen. We began antibiotic therapy under impression of pneumonia after assailable culture was taken from blood and sputum. SVC scintigraphy showed stasis of drain of right brachiocephalic vein at the proximal portion with reflux into the right internal jugular vein and faintly visible SVC via the collaterals. Sputum culture resealed Klebsiella pneumoniae. Antibiotic therapy resulted in a cure of infection and disappearance of facial swelling. Follow-up SVC scintigraphy after 20 days showed normal finding. We first report a case of SVC syndrome caused by klebsiella pneumonia