Résumé
OBJECTIVES: Infection and replication of the hepatitis B virus are closely related to the host immunity. Anticancer chemotherapy decreases the immune response of the host, Especially, glucocorticoid can activate the replication of hepatitis B virus directly. It is well known that hepatitis B virus infection and hepatic complications are more common in patients with hematologic malignancies like malignant lymphoma. We studied the incidence of hepatitis B virus infection and hepatic complications following anti-cancer chemotherapy in patients with malignant lymphoma. METHODS: Among 224 cases diagnosed as malignant lymphoma from January 1989 to December 1993 at Yonsei University Medical Center, 77 cases tested for hepatitis B virus serology was studied. RESULTS: 1) Eighteen cases (23%) was HBsAg positive. 2) The results of hepatitis C virus serology in six cases were all negative. 3) Eight (57%) of 14 follow-up cases had hepatic complications, Two patients had fulminant hepatitis, two nonicteric hepatitis and four icteric hepatitis. 4) Interferon-alpha was administered in three cases among the patients with hepatic complications. Loss of HBeAg was observed in one case and loss of HBsAg in another case. CONCLUSION: Serious hepatic complications can be occurred following anticancer chemotherapy in HBsAg-positive patients with malignant lymphoma. Therefore, we recommend that patients being considered as candidates for anticancer chemotherapy should routinely undergo serologic test for Hepatitis B virus. In addition HBsAg-positive patients with anticancer chemotherapy should be regularly monitored for hepatic injury. And with the careful use of steroid and interferon, prolongation of survival might be searched for these patients.
Sujets)
Humains , Centres hospitaliers universitaires , Traitement médicamenteux , Études de suivi , Tumeurs hématologiques , Hepacivirus , Hépatite , Hépatite B , Antigènes e du virus de l'hépatite virale B , Antigènes de surface du virus de l'hépatite B , Virus de l'hépatite B , Incidence , Interféron alpha , Interférons , Lymphomes , Tests sérologiquesRésumé
BACKGROUND: The ablation of accessory pathways(APs) using radiofrequency(RF) energy has been establihed as a primary modality of treatment for atrioventricular reentranr tachycardia with probrn safety and high rate of success. However, the ablation of posteroseptal(PS) APs had been recognized as being more difficult to ablate than those in other location because of the complex three dimensional anatony of the posterior apace, and multifarious approaches have been proposed. We analyzed electrophysiologic characteristics and results of catheter ablation of 70 consecutive patients, who underwent RF ablation of PS APs with or without booster direct current(DC) shock. METHODS: Teh AP location was confirmed to be in the PS region, ablation was attepmted at the atrial aspect of the tricuspid annulus adjacent to the coronary sinus ostium, within the coronary sinus in couding middle cardiac vein, or underneath the mitral annulus close to the septum using retrograde transaortic approach if deemed necessory. A continuous, unmodulated sine wave radiofr-equency generator was used as the source of energy for ablation. The site was considered optimal for ablation when the electrogram obtained from the ablation catheter had one or more of the following characteristics : (1) short VA intervals with an A : V ratio of -1.0 amd discrete, high frequency potentials or fractionated electrograms between local atrial and ventricular de-flections(accessory pathway potential) ; (2) vrntricular activation occurred simultaneously with or earlier than the delta wave during sinus rhythm with manifest preexcitation ; and (3) atrial activation occurred simultaneously with or earlier than that recorded in the reference coronary sinus dlectrogram during retrograde AP conduction. ucceccful criteria was complete loss of anterograde and retrograed AP conduction. RESULTS: Seventy consecutive patients(male 44, female 26) with PS APs underwent catheterablation. anifest preexcitation was present in 40 patients and concealed APs in 30. Two patients had double APs. AP conduction was successfully eleminated in 60 of 70 cases at initial attempt(success rate 85.7%). Successful ablation sites of 60 patients were as follows ; 29 at the left PS region, 14 at the margin of the coronary sinus ostium, 8 in the proximal portion of the coronary sinus, 6 at the ticuspid annulus, and 3 at the inferomedial portion of right atium. The mean shortest VA interval in successful group was shorter than that in failed group(85+-19msec versus 100+-22msec). ecurrence was noted in 8 patients(13.3%) during a mean follow-up period of 33.1+-13.3 months. ive patients with recurrence and two patient of unsuccessful initial attempt underwent the second catheter ablation and 5 patients were successful. Complications occurred in 11 patients ; transient high degree AV block in 8, pneumothorax in 2, and transient cerebral ischemic attack in one patient. CONCLUSION: These data suggested that posteroseptal APs could be ablated at the oeft sode or the right side PS region in similsr proportion. This series, even though it included learning period, showed slightly lower success rate(87.5%) than that of total APs success rate in our experience(90.8%). Therefore a firm grasp of the anatomic characteristic of the posterior space and meticulous mapping may facilitate the achievement of successful results in the ablation of porteroseptal accessory pathways.
Sujets)
Femelle , Humains , Bloc atrioventriculaire , Ablation par cathéter , Cathéters , Sinus coronaire , Études de suivi , Force de la main , Apprentissage , Pneumothorax , Récidive , Choc , Tachycardie , VeinesRésumé
Pseudoaneurysm is one of the undesirable complications of interventional cardiology procedures involving peripheral puncture site. Nowadays, it is not uncommon as a consequences of more complex interventional preocedures, larger catheters and prolonged anticoagulation treatment. Surgical repair has been mainstay of treatment for pesudoaneurysm. However, sucessful closures of pseudoaneurysms have been reported recently by using direct compression guided by color doppler ultrasound. We report a case of pseudoaneurysm in femoral artery, which was developed at the right inguinal puncture site in 38 year old male patient with unstabel angina who had received continuous intravenous infusion of heparin and had undergone coronary angiography treated successfully with direct compression guided by color doppler ultrasound.
Sujets)
Adulte , Humains , Mâle , Faux anévrisme , Cardiologie , Cathéters , Coronarographie , Artère fémorale , Héparine , Perfusions veineuses , Ponctions , ÉchographieRésumé
Pulmonary embolism is the impaction of material into branches of the pulmonary arterial bed. It usually occurs in patients with primary hypercoagulable states or secondary hypercoagulable states like cancer, preganancy, and estrogen replacement therapy. We report a case of a pulmonary embolism in a patient with positive lupus anticoagulant who received estrogen replacement therapy. The patient was referred due to suddenly developed shortness of breath and echogenic mass densities in the right atrium on 2 dimensional echocardiography. The patient was markedly improved with intravenous urokinase and subsequent oral anticoagulant therapy. Related articles are also reviewed.
Sujets)
Femelle , Humains , Dyspnée , Échocardiographie , Oestrogénothérapie substitutive , Oestrogènes , Atrium du coeur , Inhibiteur lupique de la coagulation , Embolie pulmonaire , Activateur du plasminogène de type urokinaseRésumé
BACKGROUND: Measurements of coronary flow reserve(CFR) and phasic coronary flow profile are useful in assessment of the physiologic significance of coronary lesions. However, alterations in hemodynamic status are known to influence coronary flow reserve. The purpose of this study was to assess the effect of increase in heart rate on maximal pharmacologin coronry flow reserve and phasic flow pattern. METHODS: We investigated 12 patients(9 females and 3 males, mean age : 49+/-12 years) with normal coronary artery and atypical chest pain syndrome for the measurement of CFR and coronary flow profile. CFR and systolic and diastolic coronary flow velocity integral(CFVI) were measured at the proximal portion of left anterior descending artery with 0.018 inch(12MHz) Doppler guide wire before and during intracoronary injection of 12 mcg of adenosine. The heart rate at the baseline ranging from 62 beats/min to 79 beats/min(mean : 70+/-5 beats/min) was increased to 100 beats/min and again to 120 beats/min by right atrial pacing. RESULTS: CFR progressively decreased from 3.0+/-0.5 at baseline to 2.4+/-0.4 during pacing at 100 beats/min and to 2.0+/-0.3 during pacing at 120 beats.min(p0.05). Systolic CFVI/min was increased at baseline(185+/-35% at 120 beats/min, p0.05). CONCLUSION: Increase in heart rate induces a substantial reduction in maximal CFR. Thus,heart rate appears to be one of important variable for the measurement of CFR and phasin coronary flow profile.
Sujets)
Femelle , Humains , Mâle , Adénosine , Artères , Douleur thoracique , Vaisseaux coronaires , Rythme cardiaque , Coeur , Hémodynamique , HyperhémieRésumé
BACKGROUND: In the diagnosis of acute myocardial infarction, measurement of CK-MB is widely used as an enzyme test, but it needs special instruments, lacks specificity in the presence of concomitant skeletal muscle injuries, and has narrow diagnostic time window. Cardiac specific troponin T-a new marker for the diagnosis of myocardial injury-is now available. Besides the quantitative assay, rapid qualitative asay is also possible with the development of rapid assay Kit. We studied about the efficacy of the Troponin T rapid assay Kit in early doagnosis of actue myocardial infarction in the emergency room. METHODS: Total Ck, Ck-MB, LDH and serum troponin T activities were determined when the patients arrived at the emergency room and at the same time Troponin T rapid assay kit test was done. Final diagnosis was made through the serial measurement of CK, CK-MB and LDH. Diagnostic efficacy of each rest was evaluated. RESULTS: Overall diagnostic sensitivity and specificity of Troponin T rapid assay kit were 0.97 and 0.91. When evaluated only with the initial results, Troponin T rapid assay kit showed sensitivity 0.87, specificity 0.97, serum troponin T 0.75, 0.92, and Ck-Mb 0.81,0.95. In one patient who was finally diagnosed as a septic shock, Ck-MB was elevated but serum troponin T was not and Troponin T rapid assay kit test showed negative result. CONCLUSION: Troponin T rapid assay kit test seems to show nearly the same sensitivity and specificity in diagnosis of acute myocardial infarction compared to CK-MB. This test can be done simply and easily in a short time. Thus, with the use of this test, morbidity, mortality and economic loss due to misdiagnosis and delay of diagnosis of myocardial infarction might be reduced.