Relationship between Angiographic Late Loss and 5-Year Clinical Outcome after Drug-Eluting Stent Implantation

PURPOSE: Currently, insufficient data exist to evaluate the relationship between angiographic late loss (LL) and long-term clinical outcome after drug-eluting stent (DES) implantation. In this study, we hypothesized that angiographic LL between 0.3 and 0.6 mm correlate with favorable long-term clinical outcomes. MATERIALS AND METHODS: Patients were enrolled in the present study if they had undergone both DES implantation in single coronary vessel and a subsequent follow-up angiogram (n=634). These individuals were then subdivided into three groups based on their relative angiographic LL: group I (angiographic LL 0.6 mm, n=134). During a 5-year follow-up period, all subjects were tracked for critical events, defined as any cause of death or myocardial infarction, which were then compared among the three groups. RESULTS: Mean follow-up duration was 63.0+/-10.0 months. Critical events occurred in 25 subjects in group I (6.6%), 5 in group II (4.0%), and 17 in group III (12.7%), (p=0.020; group I vs. group II, p=0.293; group II vs. group III, p=0.013). In a subsequent multivariate logistic regression analysis, chronic renal failure [odds ratio (OR)=3.29, 95% confidence interval (CI): 1.48-7.31, p=0.003] and long lesion length, defined as lesion length >28 mm (OR=1.88, 95% CI: 1.02-3.46, p=0.042) were independent predictors of long-term critical events. CONCLUSION: This retrospective analysis fails to demonstrate that post-DES implantation angiographic LL between 0.3 and 0.6 mm is protective against future critical events.

Prevalence and Clinical Characteristics of Pulmonary Arterial Hypertension in Human Immunodeficiency Virus-Infected Patients / 대한내과학회지

BACKGROUND/AIMS: Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is a complication of HIV infection. Due to improvements in HIV survival rates following the introduction of highly active antiretroviral therapy, HIV-PAH has become an important cause of HIV-related morbidity. Thus, the objective of this study was to explore the prevalence and characteristics of HIV-PAH. METHODS: Ninety-two patients were enrolled in the study from March to August 2010. We investigated clinical characteristics and performed echocardiography. HIV-PAH was defined as having a mean pulmonary arterial pressure (mPAP) > or = 25 mmHg based on Mahan's equation, without lung disease or heart disease. The HIV-PAH-possible group was defined as having a tricuspid regurgitation velocity (TRV) of 2.9-3.4 m/s and a pulmonary arterial systolic pressure (PASP) of 37-50 mmHg. RESULTS: Fifteen patients (16.3%) met the criteria of HIV-PAH based on mPAP. With respect to TRV, six patients met the criteria of the HIV-PAH-possible group. Based on the criteria of mPAP, the duration of HIV infection was not different with or without HIV-PAH. HIV RNA titers and CD4 T cell counts tended to be higher in HIV-PAH patients (8,607 +/- 11 vs. 1,067 +/- 64 copies/mL, p = 0.371; 471 +/- 148 vs. 499 +/- 252 cells/mm3, p = 0.680, respectively). Echocardiographic indices of the right ventricle were significantly deteriorated in the HIV-PAH group as compared with the non-HIV-PAH group (TASPE: 20.52 vs. 23.2, p = 0.001; Tei index: 0.42 vs. 0.39, p = 0.037). In a multivariate regression analysis, HIV activity factors (HIV duration, HIV RNA titer, and CD4 cell count) were not associated with echocardiographic indices of PAH (mPAP, PASP, and pulmonary vascular resistance). CONCLUSIONS: In this study, the prevalence of HIV-PAH was comparable to that of previous studies.

Prevalence and Clinical Characteristics of Pulmonary Arterial Hypertension in Human Immunodeficiency Virus-Infected Patients / 대한내과학회지

BACKGROUND/AIMS: Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is a complication of HIV infection. Due to improvements in HIV survival rates following the introduction of highly active antiretroviral therapy, HIV-PAH has become an important cause of HIV-related morbidity. Thus, the objective of this study was to explore the prevalence and characteristics of HIV-PAH. METHODS: Ninety-two patients were enrolled in the study from March to August 2010. We investigated clinical characteristics and performed echocardiography. HIV-PAH was defined as having a mean pulmonary arterial pressure (mPAP) > or = 25 mmHg based on Mahan's equation, without lung disease or heart disease. The HIV-PAH-possible group was defined as having a tricuspid regurgitation velocity (TRV) of 2.9-3.4 m/s and a pulmonary arterial systolic pressure (PASP) of 37-50 mmHg. RESULTS: Fifteen patients (16.3%) met the criteria of HIV-PAH based on mPAP. With respect to TRV, six patients met the criteria of the HIV-PAH-possible group. Based on the criteria of mPAP, the duration of HIV infection was not different with or without HIV-PAH. HIV RNA titers and CD4 T cell counts tended to be higher in HIV-PAH patients (8,607 +/- 11 vs. 1,067 +/- 64 copies/mL, p = 0.371; 471 +/- 148 vs. 499 +/- 252 cells/mm3, p = 0.680, respectively). Echocardiographic indices of the right ventricle were significantly deteriorated in the HIV-PAH group as compared with the non-HIV-PAH group (TASPE: 20.52 vs. 23.2, p = 0.001; Tei index: 0.42 vs. 0.39, p = 0.037). In a multivariate regression analysis, HIV activity factors (HIV duration, HIV RNA titer, and CD4 cell count) were not associated with echocardiographic indices of PAH (mPAP, PASP, and pulmonary vascular resistance). CONCLUSIONS: In this study, the prevalence of HIV-PAH was comparable to that of previous studies.

Late Stent Thrombosis After Drug-Eluting Stent Implantation: A Rare Case of Accelerated Neo-Atherosclerosis and Early Manifestation of Neointimal Rupture

An 80-year old woman suffered from sudden onset of chest pain and dyspnea, and visited the emergency room. She received stent implantation with a biolimus A9-eluting stent (Nobori(R) 3.0x24 mm) at a the mid-portion of the left anterior descending artery 5 months prior to admission. The emergency 5-month follow-up angiogram was performed under the impression of late stent thrombosis. The follow-up angiogram showed subtotal occlusion at the mid-portion of the left anterior descending artery, which was the same segment of previous stent implantation 5 months ago. Immediately after thrombus aspiration with the thrombus aspiration catheter, the optical coherence tomography showed layered appearance of neointimal hyperplasia and neointimal rupture within the previously stented segment. Thus, neointimal rupture within accelerated growth of neointimal tissue was observed within a relatively shorter period (i.e., about 5 months) after stent implantation.

A Case of Neointimal Calcification in a Drug-Eluting Stent / 대한내과학회지

Neointimal hyperplasia is the main mechanism of stent restenosis. Therefore, drug-eluting stents have replaced bare metal stents because there is less neointima and scar formation. Recently, some cases of stent restenosis after using a bare metal stent were found to involve calcification, not neointimal hyperplasia, and regarded as de novo atherosclerosis. We report unusual circular calcification inside a drug-eluting stent, which we called neointimal calcification.

A Case of Neointimal Calcification in a Drug-Eluting Stent / 대한내과학회지

Neointimal hyperplasia is the main mechanism of stent restenosis. Therefore, drug-eluting stents have replaced bare metal stents because there is less neointima and scar formation. Recently, some cases of stent restenosis after using a bare metal stent were found to involve calcification, not neointimal hyperplasia, and regarded as de novo atherosclerosis. We report unusual circular calcification inside a drug-eluting stent, which we called neointimal calcification.

Treatment of Two Cases of Retropharyngeal Hematomas / 대한이비인후과학회지

Retropharyngeal hematoma is a rare lesion developed after trauma. The development of retropharyngeal hematoma following minor trauma is a rare occurrence. Because this lesion has the possibility of compressing the potential airways, the rapid assessment and treatment are needed. This article discusses two cases of hematoma formation in the retropharyngeal space in an elderly drunken man after a seemingly minor injury. Management is consisted of tracheostomy, endotracheal intubation, and aspiration of hematoma. And retropharyngeal hematoma is associated with cervical extension or flexion injuries, anticoagulation therapy, great vessel trauma, and foreign body ingestion, etc.

A Case of Hemangioendothelioma on the Nasal Septum / 대한이비인후과학회지

Hemangioendothelioma(HE) is a rare intermediate-grade malignant vascular neoplasm first described in 1982 by Weiss and Enzinger as a specific entity. The HE is differentiated by both in its characteristic behavior and histologic appearance into benign (hemangioma) and malignant tumor (angiosarcoma). The tumor rarely occurs in the nose and paranasal cavity. At least four distinct entities are recognized within HE: epitheloid HE, spindle cell HE, kaposiform HE, malignant endovascular papillary angioendothelioma. However, it is difficult to classify a small remaining group of vascular neoplasms that show a considerable overlap in their histologic appearance. The composite and polymorphous HE are therefore classified separately. Surgical excision is the treatment of choice. Generally, the prognosis is good. The authors recently experienced a case of HE on the nasal septum which was treated by excision. We report this case with the review of literature.

A Case of Adenomatoid Odontogenic Tumor / 대한이비인후과학회지

Adenomatoid odontogenic tumor (AOT) which accounts for only about 3% of all odontogenic tumors is characterized by the duct-like structures of epithelial components at the lesion. There are three variants of AOT; 1) follicular, a central lesion associated with an embedded tooth; 2) extrafollicular, a central lesion without connection to a tooth; and 3) peripheral. AOT slowly grows with few or no symptom. The central variants account for 97.2%, 73.0% of which are follicular variants. AOTs occur most commonly in the second and third of life and have a distinct predilection for the anterior maxilla of young female. The pathogenesis of this odontogenic tumor appears to involve persistent remnants of the dental lamina, especially after odontogenesis of the successional and accessional laminae. Conservative surgical excision is the treatment of choice.