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Jae-Bin Seo,
Si-Hyuck Kang,
Seung-Ho Hur,
Kyung Woo Park,
Tae-Jin Youn,
Jong-Seon Park,
Han-Mo Yang,
Hae-Young Lee,
Hyun-Jae Kang,
Bon-Kwon Koo, [......],
Woo-Young Chung,
Soo-Joong Kim,
Doo-Il Kim,
Byung-Ok Kim,
Min-Su Hyon,
Keum-Soo Park,
Tae-Joon Cha,
Chul-Woong Yoo,
Hui-Kyung Jeon,
Hyo-Soo Kim
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ABSTRACT: Paclitaxel-eluting stents (PESs) have been shown to inhibit neointimal hyperplasia after percutaneous coronary intervention. Coroflex Please (B Braun, Melsungen, Germany) is a newly developed PES. We compared the clinical and angiographic efficacy of Coroflex Please with Taxus Liberte (Boston Scientific, Natick, MA) in a real-world practice.
We performed a prospective, open-label, randomized, controlled study that enrolled 945 patients undergoing percutaneous coronary interventions in 18 centers in Korea. The primary end point was clinically driven target vessel revascularization at 9 months. The baseline characteristics were mostly similar and comparable between 2 groups. At 9 months, the incidence of clinically driven target vessel revascularization was 14.6% for Coroflex and 6.4% for Taxus, which was significantly different (hazard ratio 2.43, 95% CI 1.50-3.94, noninferiority P value = 1.000). This is well corroborated by the difference of in-stent late loss between 2 stents (0.71 ± 0.64 mm vs 0.52 ± 0.50 mm, P < .001) by 9-month follow-up angiography (n = 415 vs 215). Among secondary clinical end points, stent thrombosis (definite and probable) for 1 year was 2.2% in Coroflex and 1.3% in Taxus (P = .317). Also, myocardial infarction for 9 months was higher in Coroflex group than that in Taxus (4.9% vs 1.6%, P = .012), which was partly contributed by the higher incidence of periprocedural myocardial infarction in Coroflex arm (2.2% vs 0.3%, P = .028).
Coroflex Please was inferior to Taxus Liberte with regard to clinical and angiographic efficacy.
American heart journal 05/2013; 165(5):733-43. · 4.65 Impact Factor
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ABSTRACT: We present a rare case involving a ruptured sinus of Valsalva aneurysm (SVA) and acute myocardial infarction in a 39-year-old male patient. Coronary angiography showed normal findings; however, the patient showed remarkably elevated levels of cardiac enzymes and decreased left ventricular function with apical akinesia on transthoracic echocardiography. Transesophageal echocardiography revealed shunt flow from the SVA to the right atrium without significant aortic regurgitation. Preoperative cardiac arrest was managed by cardiopulmonary resuscitation, and surgical repair was performed by closing the entrance of the aneurysm. However, the compromised hemodynamic status was not reversed by surgery.
Journal of cardiovascular ultrasound 03/2013; 21(1):23-5.
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ABSTRACT: PURPOSE: To determine specific imaging features of hepatic metastasis from colorectal cancer, focusing on the hepatobiliary phase (HBP) of gadoxetic acid-enhanced MRI. MATERIALS AND METHODS: Over a 2-year period, 79 hepatic metastatic lesions were identified from 32 patients (22 men and 10 women) who proven colorectal cancer and underwent gadoxetic acid-enhanced 3.0T MRI. Hepatic metastases were proven pathologically in 16 patients: by surgical liver resection (n=14) and by US-guided biopsy (n=2). The remaining 16 patients were considered to have hepatic metastasis based on imaging studies and clinical information. Two radiologists evaluated the imaging features of each MRI sequence, including high resolution T2WI, dynamic contrast enhancement study with hepatobiliary phase, and diffusion weighted image. We also compared SI of the lesions on T2WI and HBP. RESULTS: T2WI showed homogeneous high SI (n=25; 31.7%), target appearance (n=3; 3.8%), reversed target appearance (n=2; 2.6%), and heterogeneously high SI (n=49; 62%). On HBP, homogeneous defect were seen in 22 lesions (27.9%), target appearance in five lesions (6.4%), reversed target appearance in two lesions (2.5%), and heterogeneous defect in 50 lesions (63.3%); including reticular (70%), partially globular (26%), and diffuse GGO-like (4%) patterns. According to the imaging features on HBP, the homogeneous defect and heterogeneous defect groups had a mean ADC value of 0.99×10(-3) and 1.07×10(-3)mm(2)/s, respectively, without statistically significant difference. CONCLUSION: Hepatic metastasis from colorectal cancer usually showed as a heterogeneous defect on HBP and a heterogeneous high SI on T2WI. The generally accepted "true defect" was not a common finding in hepatic metastasis from colorectal cancer.
European journal of radiology 08/2012; · 2.65 Impact Factor
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Ji Young Park,
Seung-Woon Rha,
Kanhaiya L Poddar,
Sureshkumar Ramasamy,
Kang-Yin Chen,
Yong-Jian Li,
Byoung Geol Choi,
Sung Kee Ryu, Jae Woong Choi,
Sang Hyun Park, [......],
Sun Won Kim,
Jin Oh Na,
Cheol Ung Choi,
Hong Euy Lim,
Jin Won Kim,
Eung Ju Kim,
Seong Woo Han,
Chang Gyu Park,
Hong Seog Seo,
Dong Joo Oh
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ABSTRACT: High-dose aspirin has been reported to aggravate coronary artery spasm (CAS). However, it is unknown whether low-dose aspirin (LDA; 100mg) has deleterious impact on CAS. We assessed the impact of LDA on CAS induced by intracoronary acetylcholine (ACh) provocation test. A total of 2789 consecutive patients without significant coronary artery disease who underwent ACh test between November 2004 and March 2010 were enrolled. The patients were divided into two groups: the aspirin group taking LDA before ACh test (n=221) and the no aspirin group not taking aspirin (n=2568). At baseline, the prevalence of old age, diabetes mellitus, hypertension, and hyperlipidemia were higher in the aspirin group. During the ACh test, the incidence of significant CAS, ischemic chest pain, as well as severe and multivessel spasm was higher in the aspirin group. The response rate to lower ACh dose was higher in the aspirin group. Multivariate analysis showed that the previous use of LDA was an independent predictor of CAS (adjusted odds ratio, 1.6, 95% confidence interval, 1.0-2.3; p=0.031). However, it is likely that the association of LDA and CAS that we have observed is not causal but may be hypothesis generating due to significant baseline differences. Further, male gender, old age, lipid-lowering drugs, baseline spasm, and myocardial bridge were independent predictors of CAS. LDA was more frequently associated with CAS and ischemic symptoms, as well as severe and multivessel spasm, suggesting the patients who have received LDA would require more intensive medical therapies and close follow up.
Journal of Cardiology 07/2012; 60(3):187-91. · 1.28 Impact Factor
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ABSTRACT: The purpose was to describe magnetic resonance imaging (MRI) findings of breast cancer liver metastasis using gadoxetic acid (Gd-EOB-DTPA) with an emphasis on the added value of the hepatobiliary phase (HBP).
Nine patients with 13 liver metastases were included in the study after the medical records of 29 breast cancer patients who underwent Gd-EOB-DTPA-enhanced MRI between February 2008 and June 2010 were reviewed. The diagnoses of liver metastasis were established by percutaneous liver biopsy or surgery and on the basis of image findings. Two radiologists retrospectively evaluated signal intensity (SI) and sizes of metastases and patterns of enhancement in an HBP. The SI ratio was calculated as the SI of the central hyperintense portion in "target" lesions divided by the SI of nearby normal liver parenchyma on the HBP. We also measured apparent diffusion coefficient (ADC) values from Diffusion Weighted Image (DWI).
Liver metastases were all hypointense [n=13/13 (100%)] on T1-weighted imaging (WI), and many lesions had a "target" appearance with a central high SI and a peripheral low SI rim (47%) on T2WI. Dynamic study showed rim enhancement on the arterial phase (85%) and a "target" appearance, consisting of a central enhancing portion with peripheral washout or hypointense rim, on the HBP (62%). The mean SI ratio was 0.7. The mean ADC value of "target" appearing metastases was 1.25 (×10(-3) mm(2)/s; range 1.3-1.6) compared with a mean value of 0.8 (×10(-3) mm(2)/s; range 0.8-1.4) in homogeneous defect on the HBP. There was statistically significant difference (P<.05).
Breast cancer liver metastases commonly demonstrated as a peripheral ring enhancement on arterial dominant phase and a target sign with a central round enhancing portion and a peripheral hypointense rim on the HBP.
Magnetic Resonance Imaging 05/2012; 30(8):1083-90. · 1.99 Impact Factor
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ABSTRACT: To validate the diagnostic performance of quadruple phase low tube voltage liver CT through the comparison with Gd-EOB-DTPA enhanced liver MRI for the detection of HCC.
Non-obese patients (38 men, eight women) with 68 HCCs underwent quadruple-phase CT at 16 MDCT (using low tube voltage, 80kVp; moderately high tube current, 280mAs) and Gd-EOB-DTPA-enhanced 3T MRI. Three observers independently and randomly reviewed the CT and MR images on a tumor-by-tumor basis. The diagnostic accuracy of these techniques for detecting HCC was assessed using alternative free-response receiver operating characteristic analysis. Sensitivity and positive predictive values were evaluated. The mean effective doses for the low dose CT were also evaluated.
The areas under the ROC curves were 0.963, 0.959, and 0.941 for low dose CT and 0.981, 0.982, and 0.976 for MRI. Differences in Az of the two techniques for each observer were not statistically significant (P>.05). Differences in sensitivity and positive predictive values between the two techniques for each observer were not also statistically significant: sensitivity (86.8%, 82.4%, 85.3% for CT and 95.6%, 94.1%, 91.2% for MRI) and positive predictive values (92.2%, 90.3%, 89.2% for CT and 92.9%, 92.8%, 92.5% for MRI). Six HCCs (8.8%) in five patients were observed only on hepatobiliary phase of MRI, and all were smaller than 1.5cm. The mean effective dose for CT was approximately 10.2mSv.
Quadruple-phase low-dose liver CT (80kVp, 280mAs) had relatively good diagnostic performance for detecting HCC in non-obese patients. Because no significant difference was observed between low-dose CT and MRI, the use of low-dose liver CT can be justified based on its reduced radiation effects.
European journal of radiology 01/2012; 81(4):e605-11. · 2.65 Impact Factor
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Ji Young Park,
Seung-Woon Rha,
Zhe Jin,
Kanhaiya L Poddar,
Sureshkumar Ramasamy,
Kang-Yin Chen,
Yong-Jian Li,
Byoung Geol Choi,
Sung Kee Ryu, Jae Woong Choi, [......],
Amro Elnagar,
Yun Kyung Kim,
Jin Oh Na,
Cheol Ung Choi,
Hong Euy Lim,
Jin Won Kim,
Eung Ju Kim,
Chang Gyu Park,
Hong Seog Seo,
Dong Joo Oh
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ABSTRACT: 1. Coronary artery spasm (CAS) is known to be a major cause of myocardial ischaemia. Multivessel coronary spasm (MVS) in particular is likely to induce more severe and prolonged myocardial ischaemia than single vessel spasm (SVS). 2. In the present study, a total of 1082 consecutive patients without significant coronary artery disease who underwent an acetylcholine (ACh) provocation test between March 2004 and April 2009 were investigated. Patients were divided into three groups: an MVS group (n = 275), an SVS group (n = 376) and a non-CAS group (n = 431). Differences in clinical and angiographic characteristics following the ACh provocation test were evaluated between the MVS, SVS and non-CAS groups. 3. At baseline, patients in the MVS group had the highest prevalence of peripheral artery disease (PAD), hyperlipidaemia, smoking and old age, as well as the highest triglyceride levels. Calcium channel blockers were most frequently prescribed in MVS patients before the ACh test. During the ACh test, the highest prevalence of chest pain, ischaemic electrocardiogram changes, baseline spasms and diffuse and severe spasms were observed in the MVS group. The response rate to lower ACh doses that induce CAS was also higher in the MVS group. Multivariate analysis showed that the presence of PAD (odds ratio (OR) 2.0; P = 0.006) and baseline spasm (OR 1.4; P = 0.045) were independent predictors of ACh-induced MVS. 4. In conclusion, ischaemic symptoms, diffuse and severe spasm and baseline spasm were more frequently associated with MVS patients, suggesting more intensive medical therapies and close clinical follow up would be required for this patient group.
Clinical and Experimental Pharmacology and Physiology 09/2011; 38(12):819-23. · 1.85 Impact Factor
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Woong Chol Kang,
Taehoon Ahn,
Kyounghoon Lee,
Seung Hwan Han,
Eak Kyun Shin,
Myung Ho Jeong,
Jung Han Yoon,
Jong Sun Park,
Jang Ho Bae,
Seung Ho Hur,
Seung Woon Rha,
Seok Kyu Oh,
Doo Il Kim,
Yangsoo Jang, Jae Woong Choi,
Byung Ok Kim
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ABSTRACT: The aim of this study was to compare the efficacy and safety of zotarolimus-eluting stents (ZES), sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
This study was a prospective, single-blind, multicentre, randomised trial. The primary endpoint was major adverse cardiac events (MACE) at 12 months post-procedure, defined as cardiac death, recurrent myocardial infarction (MI), or ischaemia-driven target lesion revascularisation (TLR). An angiographic substudy was performed at nine months among 348 patients. From October 2006 to April 2008, 611 patients with STEMI undergoing primary PCI were randomly assigned to treatment with ZES (n=205), SES (n=204), or PES (n=202). The cumulative incidence of MACE was 5.9% in the ZES group, 3.4% in the SES group and 5.7% in the PES group at 12-month follow-up (p=0.457). There was a trend towards a lower rate of ischaemia-driven TLR at 12- (p=0.092) and 18-month (p=0.080) follow-up in the SES group compared to the ZES and PES groups. No difference was observed in rates of cardiac death, recurrent MI and combined death and/or recurrent MI among three groups at 12- and 18-month follow-up. The rate of stent thrombosis was similar among the three groups (2.0% in each group, p=1.000).
As compared with SES and PES, the use of ZES in patients with STEMI undergoing primary PCI, showed similar rates of MACE, cardiac death and recurrent MI at 12 and 18 months. There was a trend towards a higher rate of TLR with ZES or PES compared to SES.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2011; 7(8):936-43. · 3.29 Impact Factor
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ABSTRACT: To evaluate the relationship between hepatic fat infiltration and abdominal fat volume by using computed tomography (CT).
Three hundred and six patients who visited our obesity clinic between November 2007 and April 2008 underwent fat protocol CT scans. The age range of the patients was 19 to 79 years and the mean age was 49 years. The male to female ratio was 116:190. Liver and spleen attenuation measurements were taken with three regions of interests (ROIs) from the liver and two ROIs from the spleen. Hepatic attenuation indices (HAIs) were measured as follows: (1) hepatic parenchymal attenuation (CT(LP)); (2) liver to spleen attenuation ratio (LS ratio); and (3) difference between hepatic and splenic attenuation (LS(dif)). Abdominal fat volume was measured using a 3 mm slice CT scan starting at the level of the umbilicus and was automatically calculated by a workstation. Abdominal fat was classified into total fat (TF), visceral fat (VF), and subcutaneous fat (SF). We used a bivariate correlation method to assess the relationship between the three HAIs and TF, VF, and SF.
There were significant negative correlations between CT(LP), LS ratio, and LS(dif) with TF, VF, and SF, respectively. The CT(LP) showed a strong negative correlation with TF and VF (r = -0.415 and -0.434, respectively, P < 0.001). The correlation between CT(LP) and SF was less significant (r = -0.313, P < 0.001).
Fatty infiltration of the liver was correlated with amount of abdominal fat and VF was more strongly associated with fatty liver than SF.
World Journal of Gastroenterology 07/2011; 17(28):3335-41. · 2.47 Impact Factor
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ABSTRACT: Thyroid storm and severe decompensated thyrotoxicosis are life-threatening diseases, requiring immediate treatment in an intensive care unit. Thyrotoxic heart disease is common in patients with hyperthyroidism; thyrotoxic cardiomyopathy with poor left ventricular systolic function is rare. Here, we report a patient who presented with severe decompensated thyrotoxicosis and reversible thyrotoxic cardiomyopathy after ingestion of a mixed seafood stew thought to contain tetrodotoxin or a related marine neurotoxin.
The patient was a 50-year-old woman who was seen at the emergency room of another hospital with altered mentality and flaccid quadriplegia after eating a mixed seafood stew. At the other hospital, she was diagnosed as having tetrodotoxin intoxication on the basis of her clinical presentation. The patient was placed on assisted ventilation and transferred to our hospital the following day because of persisting fever, tachycardia, and respiratory depression. Upon admission, thyroid storm was diagnosed on the basis of thyroid function tests (total triiodothyronine was 354 ng/dL, free thyroxine was 3.45 ng/dL, and thyroid-stimulating hormone was <0.01 mU/L) and clinical manifestations. On the third hospital day, she complained of chest discomfort and progressively worsening dyspnea. Echocardiography showed reduced left ventricular systolic function (left ventricular ejection fraction, 47%; left ventricular fractional shortening, 24.4%) with regional wall motion abnormality of anteroseptal wall and apex and diastolic dysfunction (grade 1, relaxation abnormality), suggesting thyrotoxic cardiomyopathy. She was treated with 10 mCi of radioactive iodine and methimazole, and her thyroid and cardiac function normalized.
The patient reported here developed thyroid storm and cardiac decompensation shortly after a clinical event consistent with ingestion of marine neurotoxin. This adds to the list of stresses that have been associated with thyroid storm and emphasizes the need to fully evaluate patients who, on initial evaluation, appear to have only a single disorder.
Thyroid: official journal of the American Thyroid Association 06/2011; 21(6):679-82. · 2.60 Impact Factor
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ABSTRACT: To describe the paradoxical high signal intensity of hepatocellular carcinoma (HCC) in the hepatobiliary phase on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).
A database search was performed to identify cases of HCC that showed unusual prolonged enhancement in the hepatobiliary phase of Gd-EOB-DTPA MRI. All patients received 3.0-T liver MRI including precontrast T1-weighted images, T2-weighted images and a post Gd-EOB-DTPA-enhanced dynamic study. The signal intensity of HCC was measured at pre-enhanced, arterial, portal, delayed and hepatobiliary phase using regions of interest. Radiologic and pathologic correlation was performed for the paradoxically prolonged enhancing portion of HCC in the hepatobiliary phase.
Four patients (all male, age range 44-70; mean 57.5 years) were included in this study. All patients showed HCC lesions that were low signal intensity (SI) on T1-WI, high SI on T2-WI, enhanced in arterial phase, and washed-out in delayed phase. All cases showed paradoxically high SI in hepatobiliary phase, which was unusual for HCC. Pathologically, they were all diagnosed as well-differentiated HCC with prominent cytoplasm and a bile secreting appearance.
HCC may demonstrate the prolonged high signal intensity at the hepatobiliary phase on Gd-EOB-DTPA enhanced MRI. These HCCs tended to be highly differentiated and to have prominent bile secretion.
Magnetic Resonance Imaging 01/2011; 29(1):83-90. · 1.99 Impact Factor
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ABSTRACT: To evaluate the value of the fade-out sign in the diagnosis of fatty liver (FL) on hepatic ultrasound (US).
We evaluated 127 patients who underwent hepatic US, including 70 patients with FL and 57 normal control subjects. US images were qualitatively evaluated for the presence of the fade-out sign. This sign was considered present if there was a dark band on the deep portion of the liver on the harmonic image when compound sonography (CS) was converted to tissue harmonic CS mode. The degrees of FL were classified into mild, moderate, and severe. The distribution of lengths of dark bands in three groups was examined, and a multiple comparison of the average dark band length was carried out using one-way ANOVA.
The fade-out sign was seen in 55 of 70 FL patients (78.6%) compared to 3 of 57 control subjects (5.3%) (p<0.001). The sensitivity, specificity, accuracy, and positive predictive value of the fade-out sign for the US diagnosis of FL were 78%, 94%, 85.8%, and 94.8%, respectively. Among the 70 FL, there were 28 mild FL (mean length of dark band; 8.3 mm±8.2), 31 moderate FL (mean; 28 mm±6.3), and 11 severe FL (mean; 51 mm±8.3). There were significant differences in band length according to severity (p<0.01).
The fade-out sign on hepatic harmonic US was frequently present in FL. As fat infiltration increased, the fade-out sign lengthened. The fade-out sign offers a specific and new sign of FL.
European journal of radiology 12/2010; 80(3):e258-62. · 2.65 Impact Factor
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ABSTRACT: The purpose of this study was to describe magnetic resonance (MR) findings of focal eosinophilic liver disease using gadoxetic acid (Gd-EOB-DTPA).
Nineteen patients (M:F=14:5; age range, 26-66 years; mean age, 50 years) with 35 focal eosinophilic liver lesions were included after reviewing the medical records of 482 patients who underwent Gd-EOB-DTPA-enhanced MR imaging (MRI) on a 3.0-T unit between April 2008 and June 2009. The diagnosis of focal eosinophilic liver disease was established by means of percutaneous liver biopsy or surgery and consistent clinical findings. Two radiologists retrospectively reviewed MR images with consensus. Margin, shape and distribution of the lesions were analyzed. We also evaluated signal intensity of focal hepatic lesions on T(1)- and T(2)-weighted images and patterns of enhancement in dynamic contrast study.
The mean diameter of the lesions was 1.7 cm (range, 0.7-6.1 cm). Most of the focal eosinophilic liver lesions [n=31/35 (88.6%)] had poorly defined margins. They were usually isointense or slightly hypointense [n=34/35 (97.2%)] on T(1)-weighted images and hyperintense [n=32/35 (91.4%)] on T(2)-weighted images. Dynamic study showed enhancement (rim or homogeneous) on the arterial phase [n=21/35 (60%)] and hypointensity on the late venous phase [n=31/35 (88.6%)]. All the lesions were hypointense on the hepatobiliary phase images.
Focal eosinophilic liver lesions tend to be hyperintense on the arterial phase and hypointense on the late venous phase during dynamic study of Gd-EOB-DTPA-enhanced MRI. Although these findings mimic other focal hepatic lesions, poorly defined margins of the lesions and peripheral eosinophilia might help distinguish focal eosinophilic liver disease from other hepatic lesions.
Magnetic Resonance Imaging 11/2010; 28(9):1327-34. · 1.99 Impact Factor
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ABSTRACT: Minimally invasive robot-assisted cardiac surgery is generally performed nowadays. To avoid the interference of a superior vena cava (SVC) cannula during surgery, it should be inserted before the operation. The position of this cannula is very important because it can cause poor venous drainage during operation. The proper position of the SVC cannula was investigated in the present study.
The position of the SVC cannula using the transesophageal echocardiography (TEE) and chest X-ray in 45 patients was ascertained. The distances from the SVC cannula tip to the carina, sternal end of the right clavicle and the lower margin of the T4 vertebral body on chest X-rays were measured. The mean depth of the SVC cannula was 142.0+/-11.6 mm. The correlation coefficients of cannula depth with sex, weight and height were 0.519, 0.399 and 0.382, respectively.
The appropriate depth of an SVC cannula has weakly positive relationships with sex, weight and height. The results of the present study suggest that chest X-rays might be necessary to confirm the appropriate location of the cannula and that TEE might be the method of choice for correct positioning of the SVC cannula in minimally invasive robot-assisted cardiac surgery.
Circulation Journal 02/2010; 74(2):284-8. · 3.77 Impact Factor
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ABSTRACT: OBJECTIVE: The purpose of this article is to describe the "pseudo washout" sign of high-flow hepatic hemangioma that mimics hypervascular tumor on gadoxetic acid-enhanced MRI. CONCLUSION: High-flow hemangiomas might show relatively low signal intensity because of gadoxetic acid contrast uptake in the surrounding normal liver parenchyma during the equilibrium (3-minute delay) phase. Such findings are called pseudo washout and can mimic hypervascular hepatic tumors. However, high-flow hemangioma can be diagnosed by observing bright signal intensity on T2-weighted imaging, arterial phase-dominant enhancement, pseudo washout sign during the equilibrium phase, and isointense or slightly increased signal intensity on subtraction images.
American Journal of Roentgenology 12/2009; 193(6):W490-6. · 2.78 Impact Factor
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ABSTRACT: In anomalous right coronary artery (RCA), extravascular coronary compression results in dynamic obstruction which can cause effort angina as well as syncope. Measurement of dynamic intracoronary pressure gradient (DeltaP) change across the lesion using dobutamine challenge with rapid atrial pacing (RAP) can be used for assessment of dynamic obstruction in anomalous coronary artery. We report a case of anomalous origin of RCA which dynamic diastolic pressure gradient (DeltaP) was measured using this method. During dobutamine challenge with RAP, diastolic DeltaP significantly increased from 6 mm Hg at baseline to 13 mm Hg, and when diastolic DeltaP reached to 13 mm Hg, T wave inversion was observed, the chest pain was developed. After intracoronary stenting, diastolic DeltaP decreased to 2 mm Hg, chest pain was relieved, and T wave inversion was disappeared. The patient was asymptomatic at two months' follow-up.
International journal of cardiology 02/2009; 142(1):e11-4. · 7.08 Impact Factor
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Jae-Bin Seo,
Hui-Kyung Jeon,
Kyung-Woo Park,
Jong-Seon Park,
Jang-Ho Bae,
Sang-Wook Kim,
Keon-Woong Moon, Jae-Woong Choi,
Sang-Gon Lee,
Woo-Young Chung,
Tae-Jin Youn,
Soo-Joong Kim,
Doo-Il Kim,
Byung-Ok Kim,
Min-Su Hyon,
Keum-Soo Park,
Tae-Joon Cha,
Hweung-Kon Hwang,
Seung-Ho Hur,
Hyo-Soo Kim
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ABSTRACT: Previous randomized trials have showed the superiority of Paclitaxel-eluting stent over bare metal stent in angiographic and clinical outcomes. Coroflex Please stent is a newly developed drug eluting stent using the Coroflex stent platform combined with the drug paclitaxel contained in a polymer coating. PECOPS I trial, one-arm observational study, showed that the clinical and angiographic outcomes of Coroflex Please stent were within the range of those of Taxus, the 1st generation paclitaxel-eluting stent (PES). However, there have been no studies directly comparing the Coroflex Please stent with the Taxus Liberte stent that is the newest version of Taxus. Therefore, prospective, randomized trial is required to demonstrate the non-inferiority of Coroflex Please stent compared with Taxus Liberte stent in a head-to-head manner.
In the comparison of Efficacy between COroflex PLEASe ANd Taxus stent(ECO-PLEASANT) trial, approximately 900 patients are being prospectively and randomly assigned to the either type of Coroflex Please stent and Taxus Liberte stent via web-based randomization. The primary endpoint is clinically driven target vessel revascularization at 9 months. The secondary endpoints include major cardiac adverse events, target vessel failure, stent thrombosis and angiographic efficacy endpoints.
The ECO-PLEASANT trial is the study not yet performed to directly compare the efficacy and safety of the Coroflex Please versus Taxus Liberte stent. On the basis of this trial, we will be able to find out whether the Coroflex Please stent is non-inferior to Taxus Liberte stent or not.
ClinicalTrials.gov number, NCT00699543.
Trials 01/2009; 10:98. · 2.02 Impact Factor
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U-Hyoung Seo,
Hyun-Joo Lee,
Woo-Sang Ryu,
Jung-Myun Kwak,
Bong-Kyung Shin,
Wan-Bae Kim,
Sun-Il Lee,
Sung-Soo Park, Jae-Woong Choi,
Seon-Hahn Kim,
Sang-Yong Choi,
Young-Jae Mok
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ABSTRACT: Ectopic livers are rarely seen intra-abdominal lesions. Ectopic hepatocellular carcinoma (HCC) can be defined as an HCC arising from hepatic parenchyma located in an extrahepatic organ or tissue. The authors report a case of a primary, well-differentiated HCC arising from ectopic liver tissue in the left subphrenic space at the upper portion of the gastrorenal ligament that was successfully treated by laparoscopic resection. A 59-year-old man was referred to our department for the management of an intra-abdominal mass, which was incidentally found in a follow-up abdominal computed tomography scan for splenic laceration. The preoperative diagnosis suggested that it was a nonspecific stomach mass of maximal diameter 4.5 cm, such as, a gastrointestinal stromal tumor, located between the diaphragm and spleen. A computed tomography scan identified no mass in the liver. Laparoscopic resection was performed, and the final pathologic result confirmed that it was a HCC. The patient's postoperative course was unremarkable. This is the first reported case of a laparoscopically treated ectopic HCC. Moreover, laparoscopic resection was found to be safe and reliable in this case.
Surgical laparoscopy, endoscopy & percutaneous techniques 11/2008; 18(5):508-10. · 1.23 Impact Factor
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Digestive Diseases and Sciences 08/2007; 52(7):1722-4. · 2.12 Impact Factor
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ABSTRACT: To evaluate the features of the Günther-Tulip filter (GTF) with or without tilting toward the anterior or posterior direction with use of phantom models and to describe our preliminary clinical experience to detect tilting and to reposition the GTF with regard to the maneuver's feasibility and usefulness.
Two types of phantom models were made by inserting a GTF in a tube with or without tilting toward the anterior or posterior direction. Changes of the fluoroscopic features were observed in the postero-anterior projection. For the clinical trials, transjugular placement of the GTF in the inferior vena cava (IVC) was performed in 12 patients. As the result of the phantom study, repositioning of the filter was repeated until the four anchoring hooks stood on an imaginary line before releasing. Finally, cavograms were obtained and the angles were measured between the axis of the filter and the IVC axis and the coronal plane in the lateral projection.
In the phantom study, the four anchoring hooks stood in a transverse imaginary line when the filter without tilting was located at the center of the fluoroscopic projection. In the clinical trials, the mean number of repositionings was 1.67, and the mean angles between the axis of the filter and the IVC axis and the coronal plane in the lateral projection of the cavogram were 0.08 degrees +/- 2.32 and 0.18 degrees +/- 5.09, respectively.
For placement of the Günther-Tulip filter, the maneuver to detect tilting and to reposition it was feasible and useful to prevent tilting seen after initial placement.
Journal of vascular and interventional radiology: JVIR 04/2007; 18(3):427-36. · 1.81 Impact Factor
