Cardiovascular Response during Thermal Stress: Comparison with Whole-Body Immersion and Half-Body Immersion

BACKGROUND AND OBJECTIVES: The beneficial effects of systemic thermal therapy such as taking a hot tub or sauna have been described for patients with cardiovascular disease. Despite such positive effects, there is still concern over the safety of these procedures. Half-body immersion has recently been widely used as an alternative to achieve the same benefit, and it is better tolerated than conventional whole-body immersion (WBI). However, there has been no study that has clarified the cardiovascular effect of half-body immersion (HBI). SUBJECTS AND METHODS: We asked 13 healthy men (age : 20 to 27 years) to immerse themselves to the shoulder level on day 1) and to the umbilical level on Day 2 for 20 minutes in a hot tub, respectively (temperature : 39.0 to 41.0degrees C). Changes of skin (TSk) and esophageal temperature (TEo), hemodynamic and autonomic responses, and symptom scale were measured during the immersion. RESULTS: All the volunteers were compliant and there were no adverse events. During immersion, the TEo increased continuously with each methods, but 10 minutes after immersion the TEo for the WBI patients was higher (p=0.03). The heart rate (HR) increased and the diastolic blood pressure decreased for both conditions. In contrast to HBI, the ejection fraction (EF) (p=0.10), and cardiac output (CO)(p=0.005) increased continuously for WHI. Among the HRV parameters, the values for the low-to-high frequency ratio (p=0.03) increased significantly with WHI after 10 minutes. The symptom scale during (p=0.01) and immediate after immersion in the hot tub (p=0.005) was better for HBI. CONCLUSION: Core temperature, echocardiographic systolic parameters and sympathetic activity were increased more slowly for HBI compared to WBI. This suggests that HBI could be a safer alternative for systemic thermal therapy for the patients with cardiovascular disease.

A Case of Gigantic Ectasia of Right Coronary Artery Associated with Acute Myocardial Infarction

Coronary artery ectasia is an uncommon disorder diagnosed in 1 to 4% of patients undergoing coronary arteriography. Coronary artery ectasia is often considered a variant of atherosclerotic coronary artery disease, although other causes should be considered. Complications from this disease usually occur as thrombo-embolic phenomena primarily due to thrombosis in the ectatic segment of the coronary artery. A 53-year old man was transferred to our ER, presenting with acute inferior wall infarction. Coronary angiogram showed a gigantic ectatic right coronary artery (RCA) with occlusion of the mid portion by a huge mural thrombus. We injected and infused glycoprotein IIb-IIIa inhibitor in the RCA, however the lysis of thrombus was minimal. Subsequently, we infused Urokinase into the RCA for 2 days. Follow-up angiography revealed partial lysis of the thrombus. The patient demonstrated no thrombo-embolic events during two months of coumadinization, and follow-up angiography revealed a complete lysis of the thrombus.

A Case of Eosinophilia Associated Massive Deep Vein Thrombosis Treated with Local Urokinase Infusion

Venous thrombosis is uncommon in young individuals. Hypereosinophilia is a rare cause of thrombosis that usually involves the heart and small vessels like retinal vessels. We report a case of massive deep vein thrombosis that developed in a young patient with hypereosinophilia who was successfully treated with continuous local infusion of urokinase.

Subglottic Stenosis in Wegener's granulomatosis: A Case Report / 대한류마티스학회지

Wegener's granulomatosis (WG)is a multisystemic inflammatory disease characterized by necrotizing granulomatous inflammation and vasculitis of unknown etiology which classically affects the upper airway,lung,and kidney.Subglottic stenosis (SGS)is rare and occurs independently of other features of active WG. SGS can be a life-threatening manifestation of disease,and prompt diagnosis is essential.Since the presenting symptoms of SGS can be nonspecific,SGS should be considered in the differential diagnosis of any patient with WG who has increasing dyspnea,voice change,or cough.Although both surgical and medical treatments have been utilized,the optimal therapeutic approach to SGS in patients with WG has not been determined.So far,a case of WG with SGS has not been reported in Korea.Recently,we experienced a case of 59-year-old woman with SGS in WG.She responded to prednisolone and methotrexate therapy and did not require surgical intervention.So we report this case with a review of literatures.

Selective Proteinuria Index as a Prognostic Index in IgA Nephropathy / 대한신장학회잡지

PURPOSE: Proteinuria is the hallmark of glomerular injury and results from alterations in glomerular permeability. The permeability of diseased glomerulus has been estimated by selectivity of proteinuria. Recently, some authors showed a significant relationship between selectivity of proteinuria and tubulointerstial damage. The present study examines the role of protein selectivity as a prognostic marker in patients with IgA nephropathy and its correlation with other prognostic indices. METHODS: The selective proteiuria index of 81 cases with IgA nephropathy diagnosed between 1990 and 2000 were reviewed, and each case was subclassified using the following : highly selective(SPI0.2). The mean age of the patients was 27+/-15 years with a follow-up period of 38+/-24 months. Six patients had highly selective proteinuria, thirty three patients had moderately selective proteinuria, and forty two patients had nonselective proteinuria. RESULTS: 1) A significant relationship was found between the SPI and Haas subclasess(p=0.01). With respect to clinical presentaion, hypertension(0, 4, 11 cases, p<0.05), proteinuria(0.52+/-0.35, 1.85+/-1.55, 2.79+/-2.51 g/day, p<0.05) were significant correlation.2) Chronic renal failure was significantly higher in patients with nonselective proteinuria in comparison with patients with selective proteinuria(p<0.05).3) Markers of renal failure by the Cox proportional hazards model were Cr(Exp(B)=4.2, p<0.001), Ccr (Exp(B)=2.1, p<0.05), SPI(Exp(B)=1.7, p<0.05), hypertension(Exp(B)=1.6, p<0.05). 4) In 28 patients of IgA nephropathy with nephrotic syndrome, 9 patients were moderately selective, 19 patients were nonselective. The response to therapy, evaluated retrospectively, was 67% and 16% in moderate and nonselective proteinuria(p=0.01). CONCLUSION: There is a significant relationship between selectivity of proteinuria and clinical para meters. Moreover, the selectivity of proteinuria has a predictive value on functional outcome.

Aortic Dissection Complicated with Lower Extremity and Renal Ischemia Treated by Percutaneous Stent Insertion

A 62-year-old woman was admitted due to acute pain in the back and the right lower extremity. CT and angiography showed a chronic dissection of the ascending aorta and a newly developed dissection of the descending aorta complicated with ischemia of the left renal artery and right lower extremity. Therefore, a Wall stent was inserted percutaneously at the descending thoracic aorta and the stenotic left renal artery was opened by percutaneous transluminal renal angioplasty with a Mac (4.0 x 22 mm, Amg, Korea) stent. Thereafter, renal function was normalized and the blood pressure was better controlled at discharge. A follow up CT scan 3 months after the procedure showed patent true lumen of the descending thoracic aorta and left renal artery.

Role of inflammation in stable angina patients without hypercholesterolemia

BACKGROUND AND OBJECTIVES: Hypercholesterolemia is a major risk factor for coronary artery disease. Other risk factors play a more important role in the pathogenesis of atherosclerosis in patients with low cholesterol level. We perform this study to evaluate the relative role of inflammation in stable angina patients without hypercholesterolemia. MATERIAL AND METHODS: Sixty seven stable angina patients without peripheral vascular disease were divided into two groups according to their LDL cholesterol level, group 1 with LDL cholesterol or =130mg/dl. Patients with conditions that might change C-reactive protein(CRP) level, previous PTCA or CABG, history of acute coronary syndrome, on lipid lowering treatment and whose troponin T level was above the normal were excluded. Angiographic severity was evaluated by the Gensini and Jenkins scores. RESULTS: There were no differences in age, gender, BMI, angiographic severity and incidence of major risk factors except hypertension. CRP(log CRP) was significantly higher in group 1(0.65mg/dl vs. 0.28mg/dl, p=0.002). CONCLUSION: In stable angina patients without hypercholesterolemia, inflammation plays a more important role in the pathogenesis of coronary atherosclerosis than the patients with high cholesterol level.

Comparison of Core(R) stent and Palmaz-Schatz(R) stent in a Porcine Stent Restenosis Model

BACKGROUND AND OBJECTIVES: The purpose of this study is to compare new Core(R) stent and Palmaz-Schatz(R) (PS)stent in a porcine coronary stent restenosis model. METHODS: Twelve pigs underwent balloon injury and followed by implantation of oversized, tubular types of Core(R) and PS(R) stents (stent/artery ratio 1.2:1) in twenty-four coronary arteries. Quantitative analyses of initial and follow-up coronary angiograms at 4 weeks after stenting were performed. By morphometric analysis, the extents of injury and neointimal area were compared between two stented groups. The stent flexibility and longitudinal staightening effect were compared between two groups by the bending test and measurement of the angle changes. RESULTS: 1) Reference vessel diameter, stented artery diameter, and diameter stenosis were not different between two groups. 2) The neointimal area was significantly smaller in the Core(R) stent group than in the PS(R) stent group (1.81+/-0.67 mm2 vs 2.93+/-0.94 mm2, p=0.006). 3) Core(R) stent had more flexible property than PS(R) stent. 4) The angle changes after stent implantation were not different between two groups(13.2+/-9.0, 14.4+/-11.1, p=0.88). CONCLUSION: Core(R) stent is effective in the inhibition of neointimal formation in a porcine coronary stent restenosis model. And this results may be due to more improved flexibility of the Core(R) stent and further clinical trials may be needed.

A Case of Complete Resolution of Aortic Dissection in the Descending Thoracic Aorta Treated with Endovascular Stent-Graft Implantation

The aortic dissection is an acute aortic syndrome, caused by an intimal tear and subsequent splitting of the media by the pulsatile blood flow. Though there would be differences in the origin of aortic dissection and therapeutic modalities, the intermediate and long-term prognoses are poor. Endovascular Stent-graft implantation is a revolutionary technique in the treatment of aortic dissection. The endovascular stent grafting in aortic dissection is less invasive and feasible method and is an effective tool for closing the entry site and promoting clot formation, reducing the size of the false lumen. Therefore, endovascular Stent-graft implantation makes possible the desirable remodelling of aorta. We report 33 year-old male with aortic dissection in the thoracic aorta, which was treated with endovascular Stent-graft implantation. Over the favorable remodelling, his dissection was healed completely by the endovascular treatment using Stent-graft.

A case of primary pulmonary cryptococcosis misdiagnosed as lung cancer / 감염

No abstract available.

A case of primary pulmonary cryptococcosis misdiagnosed as lung cancer / 감염

No abstract available.