Delayed Stent Fracture after Successful Sirolimus-Eluting Stent(Cypher(R)) Implantation

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stent (SES) is very effective for preventing in-stent restenosis through the suppression of neointimal proliferation. Treatment failure cases related to stent fracture have recently been reported on, but any studies concerning the pattern or mechanism of SES fracture are very rare. SUBJECTS AND METHODS: Between December 2003 to January 2005, 457 patients underwent follow-up coronary angiography after SES implantation at three referral center. We reviewed the angiographic and procedural data for eleven of theses patients [6 males (55%), mean age: 60 year-old age, range: 43-74 years] who were proven to have experience complete SES fracture. RESULTS: The left anterior descending artery (LAD) and right coronary artery (RCA) stent fracture were 7 cases (63%) and 4 cases (37%), respectively. Myocardial bridge was shown in 6 cases with LAD fracture (86%). Overlapping stent implantation was performed in 5 cases (45%). The mean value of the maximal angulations at the fracture site before intervention was 50 degrees (range; 39-70 degrees) and the mean change between the maximal and minimal angulations was 13.2 degrees (range; 2-28 degrees). The mean stent diameter and length were 3.0 mm (range; 2.75-3.50 mm) and 40 mm (range; 23-52 mm). Stent inflation with high pressure was performed on 6 cases (54%) and it's frequency was higher in the RCA than the LAD (3 cases, 75%, mean inflation pressure: 13.1 mmHg). The mean follow-up duration was 7.2 month and only 2 cases were admitted due to the recurrent chest pain. The binary restenosis rate was 55% (6 cases) and the restenotic lesions were treated by balloon angioplasty in 2 cases and additional stenting was done in 2 cases. CONCLUSION: Our results demonstrated that SES fracture occurred in 7 cases with LAD lesion and in 4 cases with RCA lesion. Long stenting including overlapping implantation and more than 40 degrees angulated long stent implantation may be the factors for SES fracture. Our results also showed high pressure stent inflation was performed more frequently at the RCA lesion, and myocardial bridge and kinking motion was detected more frequently at the LAD lesions.

Clinical Predictors of Alcohol Withdrawal Syndrome in Patients with Alcoholic Liver Disease / 대한간학회지

BACKGROUND/AIMS: Although alcohol withdrawal syndrome (AWS) is often developed in the patients with alcoholic liver disease, the studies about which clinical factors are associated with the development of AWS have been rarely studied. The aim of this study was to reveal clinical factors indicating a higher risk for the development of AWS at admission. METHODS: The retrospective case-controlled study was conducted among patients with alcoholic liver disease. The cases were divided into two groups according to whether AWS was developed or not. We compared their past medical history, physical examination and laboratory data at admission. RESULTS: AWS was significantly developed in patients who had experienced AWS in the past, increased serum chloride concentration at admission. CONCLUSIONS: It is possible to predict the patients who are more likely develop to AWS by means of past medical history and a serum biochemical test at admission. We suggest more intensive therapy will be required to prevent the development of AWS in these patients. These results are preliminary and need further prospective development and validation, particularly regarding the variety of variables.

Three Cases of Polymyositis Developed Associated with Chronic Liver Disease / 대한내과학회지

Polymyositis is characterized by symmetrical proximal muscle weakness, nonsuppurative inflammation of striated skeletal muscle, elevation of muscle enzyme, and abnormality of electromyographical change, but its pathogenesis is not clear. The incidence of polymyositis is low, and that associated with chronic liver disease is rare. Clinical importance of polymyositis associated with chronic liver disease is that it is a reversible disease which can be treated with glucocorticoid. We experienced three cases of polymyositis associated with chronic liver disease which was treated with prednisolone. And we report these cases with a brief review of literature. So, the further study about the influence of chronic liver disease on the polymyositis is warranted.