Retrieval of a dislodged and dismounted coronary stent; using a rendezvous and snare technique at the brachial artery level via femoral approach / 영남의대학술지

Coronary stent dislodgement during percutaneous coronary intervention, which occurs when the stent is passed through tortuous and calcified lesions, is not a rare complication. Without proper treatment, such as fixing with another stent in the coronary artery or removing the undeployed stent from the coronary artery or systemic artery system, this complication can cause serious problems. We experienced the unusual situation of a dismounted and dislodged coronary stent, in which retrograde retrieval to the radial artery was impossible during transradial coronary intervention. We report on use of a rendezvous and snare technique at the brachial artery level via femoral puncture, which resulted in resolution without surgery.

Mechanical Thrombectomy by the Rolling Technique Using a Coronary Wire in a Patient with Recurrent Inferior Vena Cava Filter Thrombosis / 대한내과학회지

A permanent inferior vena cava (IVC) filter with anti-coagulation therapy may be considered in patients with recurrent pulmonary embolism. IVC filter thrombosis is a challenging clinical problem. Here, we report our experience in treating one such patient using mechanical thrombectomy via the rolling technique with a 0.014-inch coronary wire.

Peripheral Transluminal Angioplasty for Limb Salvage in Critical Limb Ischemia in an Old Cerebral Infarction with Multiple Contractures / 대한내과학회지

Percutaneous transluminal angioplasty is being used to treat peripheral artery disease increasingly in place of conventional peripheral vascular surgery. Critical limb ischemia is the most severe form of peripheral artery disease and presents with ischemic resting pain and non-healing foot wounds or gangrene. It can result in amputation and increased mortality if aggressive revascularization to obtain sufficient blood is not performed as soon as possible. Generally, both femoral arteries are used for vascular access. However, we could not use the femoral artery for vascular access in a patient with multiple contractures of the extremities due to an old cerebral infarction. Consequently, we used the left brachial artery to perform successful revascularization of the left foot in critical limb ischemia.

Recurrent Acute Pulmonary Embolism Associated With Protein S Deficiency

Pulmonary embolism is a common clinical problem in patients with immobilization, cancer, indwelling central venous catheter and surgery. However, although rare, it may occur in patients with inherited thrombophilia. Protein S deficiency is known to increase the risk of venous thrombosis and pulmonary embolism. There are many reports of venous thrombosis with protein S deficiency, but there are few reports of arterial thrombosis, especially recurrent acute pulmonary embolism. Here, we report a case of recurrent pulmonary embolism associated with type II protein S deficiency.

Alcohol Drinking Related Health Characteristics in Men of National Merit More than 60 Years Old

BACKGROUND: The purpose of this study was to investigate alcohol drinking related health characteristics for improvement of life stability and well-being in war veterans. METHODS: The research design was a descriptive survey design with a convenience sample. Data collection was performed using self-report questionnaires and included 163 veterans who were >60 years old and who visited a cardiovascular medicine out-patient department. The process of a change in drinking consciousness was investigated together with healthy action changes, including drinking temptation and deciding to drink alcohol. RESULTS: Failing at work was the greatest drinking temptation. The subjects knew that if they drank continuously, they would become addicted to alcohol. Most subjects experienced mental stress and difficulty living. CONCLUSION: These findings indicate that access to an evidence-based treatment program and systems of care should be provided for veterans who drink alcohol and have other health conditions and illnesses.

Surgical Removal of Endovascular Stent after Migration to the Right Ventricle Following Right Subclavian Vein Deployment for Treatment of Central Venous Stenosis

Central venous stenosis or occlusion occurs in 11-50% of hemodialysis patients with prior subclavian vein cannulation and ipsilateral fistula or shunt. Most patients are asymptomatic but some require treatment to reduce the risk of thrombosis and improve inadequate hemodialysis pressure. In these cases, endovascular intervention, including ballooning and stenting, is a feasible strategy for selected patents. We report an unusual case of a 40-year-old man on hemodialysis that underwent endovascular stenting to treat right subclavian vein stenosis and experienced stent migration to the right ventricle, requiring surgical removal.

Randomized clinical trial on the efficacy of Escherichia coli-derived rhBMP-2 with beta-TCP/HA in extraction socket

PURPOSE: This randomized clinical trial was conducted to assess the safety and effectiveness of the ErhBMP-2 in alveolar bone regeneration as well as preservation of the beta-TCP bone graft material that contains ErhBMP-2. MATERIALS AND METHODS: This study involved 72 patients at the 3 study centers. The patients, who were divided into 2 groups: the experiment group who had ErhBMP-2 coated TCP/HA and the control group who had TCP/HA graft material alone transplanted immediately after tooth extraction. CT was taken before and 3 months after the transplantation and healing status was compared between the two groups. The efficacy endpoints that were used to measure the degree of bone induction included alveolar bone height and 3 measurements of bone width. The paired t test was used to determine the significance of the changes (P<.05). RESULTS: Changes in alveolar bone height were -1.087 +/- 1.413 mm in the control group and -.059 +/- 0.960 mm in the experimental group (P<.01). At 25% extraction socket length [ESL], the changes were 0.006 +/- 1.149 mm in the control group and 1.279 +/- 1.387 mm in the experimental group. At 50% ESL, the changes were 0.542 +/- 1.157 mm and 1.239 +/- 1.249 mm, respectively (P<.01 for 25% ESL, and P<.05 for 50% ESL). During the experiment, no adverse reactions to the graft material were observed. CONCLUSION: ErhBMP-2 coated beta-TCP/HA were found to be more effective in preserving alveolar bone than conventional beta-TCP/HA alloplastic bone graft materials.

Delayed Pleural Effusion after Right Subclavian Vein Catheterization: A Case Report / 대한구급학회지

Central venous catheterization is commonly used for supplying large amounts of fluids, total parenteral nutrition and for monitoring central venous pressure. Numerous complications exist with the technique, including pneumothorax, arterial puncture with vessel injury, catheter embolus, mediastinal hematoma, hydrothorax, and the thrombus of the vein. We reported an uncommon case of pleural effusion, due to catheter tip migration and penetration, which occurred 4 days after central venous catheterization.

A Case of Accelerated Idioventricular Rhythm Lasted for 5 Days after Reperfusion in a Patient with Spasm-induce Myocardial Infaction: A Case Report / 대한구급학회지

A 56-year-old man presented with right coronary arterial spasm accompanied by ST segment elevation in the inferior leads. A reperfusion arrhythmia, accelerated idioventricular rhythm (AIVR), developed 1 hour after a nitroglycerin infusion. The AIVR was sustained for 5 days without hemodynamic instability, and resolved spontaneously during hemodynamic monitoring in the coronary intensive care unit.

A Case of Intracardiac Metastasis of Hepatocellular Carcinoma Presenting with Functional Tricuspid Valve Stenosis Accompanied with Hepatopulmonary Syndrome

Intracardiac metastasis of hepatocellular carcinoma with functional tricuspid valve stenosis is not common. Furthermore, hepatopulmonary syndrome associated with hepatocellular carcinoma is rarely encountered. We present a case of intracardiac metastasis of hepatocellular carcinoma presenting with functional tricuspid valve stenosis accompanied with hepatopulmonary syndrome.

The Attitudes of Primary Caregivers of Critically Ill Elderly Patients on Do-Not-Resuscitate Status

BACKGROUND: A questionnaire for the primary caregivers of critically ill elderly patients on Do-Not-Resuscitate(DNR) status was developed. METHODS: The survey was administered to 132 primary caregivers of critically ill elderly patients in a veteran's hospital in Busan. RESULTS: The age range of the primary caregivers was 51-60 years. Of the primary caregivers, 58.3% of them were the patient's wife, 62.1% didn't have job, and 50.8% were not aware of the DNR status. Of the primary caregivers, 56.8% did not think about the patient's DNR, but if they heard about DNR from a physician, 68.9% of them could accept it. The most important reason for a DNR is pain relief of the dying patient. According to 72.7% of respondents, the patient should be asked about the DNR, but input from the family and physician should be included. Further, 68.2% of the respondents will consider a DNR for themselves in the future because they don't support meaningless life. The respondents were more inclined to think about DNR status, accept DNR status, and consider DNR status for themselves when they learned about the DNR from the physician and the patient is asked about the DNR. CONCLUSION: Primary caregivers are often required to think about DNR status. The findings of this study can be the basis for making objective standards concerning DNR status.

Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Artery: An Extremely Rare Variety of Single Coronary Artery

Single anomalous coronary artery is a rare congenital anomaly of the coronary circulation. Right coronary artery (RCA) arising from the left anterior descending artery is an extermely rare variety of single coronary artery. We report a 68-year-old patient with a single coronary artery system, in whom the right coronary artery originated from the mid left anterior descending artery.

A Case of Liver Abscess Metastasizing to Prostate Resulting in Prostatic Abscess

Klebsiella pneumoniae(K. pneumoniae) infection has a tendency of abscess formation and it is known to be associated with diabetes mellitus. Metastatic infection was an important feature of K. pneumoniae liver abscess and bacteremia, metastatic prostate abscess was rare. We present a case of a 81-year-old man with K. pneumoniae liver abscess and metastatic prostate abscess, This patient was successfully treated with percutaneous abscess drainage of liver abscess and transurethral incisional drainage of prostate abscess.

Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy

PURPOSE: The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatment modality. METHODS: Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics. RESULTS: Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P<0.001): 4.9+/-3.1 days in Group 1, 7.5+/-3.7 days in Group 2, and 3.8+/-0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P=0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086). CONCLUSIONS: To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate.

The Effect and Retention of CPR Training in Nursing Students

PURPOSE: This study was done to evaluate the effect and retention of CPR training in nursing students. METHODS: The participants were 64 nursing students enrolled in K University in Busan. Data were collected from April 3 to October 20, 2006 using a structured questionnaire. Data were analyzed using the SPSS/PC 12.0 statistical program. RESULTS: The first hypothesis, that knowledge (t=-17.865, p=0.000) and skill (t=-11.216, p= 0.000) scored directly following the teaching program would be higher than before the program, was supported. The second hypothesis, that knowledge (t=-8.325, p=0.171) and skill (t=-9.812, p=0.062) scored directly after the teaching program would be higher than two months later, was rejected. The third hypothesis, that knowledge (t=-9.162, p=0.010) and skill (t=-6.019, p=0.023) scored two months after the program would be higher than four months after the program, was supported. The last hypothesis, that knowledge (t=9.169, p=0.210) and skill (t=-5.012, p=0.319) scored four months after the program would be higher than six months after the program, was rejected. CONCLUSION: Overall retention of CPR training among nursing students, without reinforcement, decreases most significantly between two and four months following initial training. Accordingly CPR training should be repeated with the same clients every four months.

Transluminal Removal of a Fractured and Embolized Indwelling Central Venous Catheter in the Pulmonary Artery

Vascular catheters are associated with complications such as infection, thrombosis and stenosis. The embolization of a venous catheter fragment is a rare complication. A 39-year-old woman underwent placement of a totally implantable venous access device for chemotherapy to treat a recurrent liposarcoma of the left thigh. The "pinch-off sign" was noted on a routine chest X-ray but that was ignored. Three-months after implantation of the intravenous access device, the indwelling central catheter was fractured and embolized to the pulmonary trunk. The catheter in the pulmonary trunk was successfully removed through a percutaneous femoral vein approach using a pigtail catheter and goose neck snare.

Mitral-aortic Intervalvular Fibrosa Pseudoaneurysm with Dual Fistula and Complete AV Block after Aortic Valve Replacement in a Patients with Infective Endocarditis of Aortic Valve

The involvement of subaortic structures in the aortic valve endocarditis appears more common than previously recognized. The most common location of the subaortic complications is mitral-aortic intervalvular fibrosa(MAIVF) and the complications may be presented as abscess or pseudoaneurysm. We describe a case of infectious pseudoaneurysm of mitral-aortic intervalvular fibrosa mimicking abscess. In our case, complete AV block was revealed on ECG after aortic valve replacement (AVR). Several days after the first operation, re-do AVR and reconstruction of the MAIVF was performed because of complete AV block and dual fistula complicated by pseudoaneurysm in MAIVF.

A case of anomalous origin of left coronary artery from the pulmonary artery: Report of an adult case / 대한내과학회지

Anomalous origin of the left coronary artery from pulmonary artery was first described in a child by Brooks. This ALCAPA syndrome is a rare congenital anomaly occuring in approximately 0.25~0.50% of children having congenital heart disease. Although approximately 80 to 90% of patients develop congestive heart failure and die in infancy, some pateints may present this syndrome in adolescents or adults. This anomaly was detected during elective coronary angiogram in a 63 year-old female patient with typical angina. Down-sloping ST depression was demonstrated on exercise stress ECG. Coronary angiogram and pulmonary angiogram revealed an anomalous origin of left coronary artery from pulmonary artery.

Safety and Efficacy of Radiofrequency Catheter Ablation in Treatment of Tachyarrhythmia in Elderly Patients

BACKGROUND: Radiofrequency(RF) catheter ablation has been widely and successfully employed to cure young adult and old aged patients of a variety of arrhythmias. Only limited data exist which compare the results in two groups. The aim of this study was to compare the efficacy and safety of RF catheter ablation in old-aged patients(Group 1. older than 65 years old) versus young adult patients(Group 2. younger than 65 years old). METHOD: Clinical and electrophysiologic data were reviewd retrospectively in 385 patients who underwent radiofrequency catheter ablation from December. 1997 through May 2004. Procedure ralated results were used to compare 2 groups RESULTS: Mean age of each groups was 68.4+/-3.37 in group 1 versus 37.5+/-14.04 in group 2. There was no difference between two groups in gender, types of tachyarrhythmia, success rate, rate of complication and recurrence. No severe complications, such as death, vascular dissection, rupture, and major cerebrovascular accidents were present in either group. Procedure related variables, including fluroscopic time, were similar between 2 groups. CONCLUSION: RF catheter ablation is a safe and feasible primary treatment method for tachyarrhythmia in elderly patients, results similar to those achived with younger patients.

Safety and Efficacy of Radiofrequency Catheter Ablation in Treatment of Tachyarrhythmia in Elderly Patients

BACKGROUND: Radiofrequency(RF) catheter ablation has been widely and successfully employed to cure young adult and old aged patients of a variety of arrhythmias. Only limited data exist which compare the results in two groups. The aim of this study was to compare the efficacy and safety of RF catheter ablation in old-aged patients(Group 1. older than 65 years old) versus young adult patients(Group 2. younger than 65 years old). METHOD: Clinical and electrophysiologic data were reviewd retrospectively in 385 patients who underwent radiofrequency catheter ablation from December. 1997 through May 2004. Procedure ralated results were used to compare 2 groups RESULTS: Mean age of each groups was 68.4+/-3.37 in group 1 versus 37.5+/-14.04 in group 2. There was no difference between two groups in gender, types of tachyarrhythmia, success rate, rate of complication and recurrence. No severe complications, such as death, vascular dissection, rupture, and major cerebrovascular accidents were present in either group. Procedure related variables, including fluroscopic time, were similar between 2 groups. CONCLUSION: RF catheter ablation is a safe and feasible primary treatment method for tachyarrhythmia in elderly patients, results similar to those achived with younger patients.