Abstract Background Almost all data on drug-eluting stents (DES) fracture have been derived from initial platform of first-generation DES such as Cypher Bx® (CBX) and Taxus Express® . However, ...incidence and clinical impact of fracture of newer DES platforms (including Cypher Select® , Taxus® Liberté™, Endeavor® , and Xience™ V) that have been used widely in current clinical practice have not yet been studied. Methods and results We analyzed data of 1518 lesions treated with the newer DES platforms in patients who underwent follow-up coronary angiography and compared the results with those of 622 lesions treated with the CBX. The group of newer DES platforms showed significantly lower incidence of stent fracture (SF) than the CBX group (1.25% vs. 5.8%, p < 0.001). Binary restenosis (42.1% vs. 6.6%, p < 0.001) and target lesion revascularization (TLR) (47.3% vs. 6.2%, p < 0.001) related to SF in the newer DES platforms’ group were significantly higher than those not related to SF. Notably, SF-related binary restenosis (42.1% vs. 36.1%, p = 0.52) and TLR (47.3% vs. 41.6%, p = 0.2) were similar between the newer DES platforms’ group and the CBX group. On multivariable logistic regression analysis, lesion angulation >45° (odds ratio OR: 7.6; 95% confidence interval CI: 2.2–26.31), RCA stenting (OR: 5.14; 95% CI: 1.62–16.3) and total stent length (OR: 1.18; 95% CI: 1.03–1.33) were identified as independent predictors for fracture of the newer DES platforms, while closed-cell design stent (Cypher Select® ) was not. Conclusions Although implantation of the newer DES platforms might reduce the occurrence of SF compared with the CBX, SF-related binary restenosis and TLR remain similarly high. And to predict SF in the newer DES platforms’ era, lesion characteristics on index procedure are more important than implanted stent design.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background Although a biliary stricture is one of the most important complications that develop after living donor liver transplantation (LDLT), a standard approach has not yet been established. ...Objective The aim of this study was to evaluate the usefulness of nonoperative management in repairing a post-LDLT biliary stricture. Design A total of 60 patients were referred, from July 2004 to July 2007, for management of a post-LDLT biliary stricture. The patients had ERCP if the hepatic arterial flow was patent on a Doppler sonography. If endoscopic therapy failed, then percutaneous transhepatic drainage (PTBD) was performed to dilate the stricture. If the percutaneous approach also failed, then a repeated PTBD was performed after a 3-dimensional abdominal CT (3D-CT). Setting Division of Gastroenterology, Department of Internal Medicine, Yongdong Severance Hospital. Patients Sixty patients were referred from Catholic University Hospital of Korea for ERCP. Results ERCP was performed on all 60 patients, and 38 (63%) were successfully treated. When the shape of the distal side of the bile-duct anastomosis was classified into 3 categories (pouched, triangular, and intermediate), the pouched shape showed the lowest success rate of endoscopic therapy (25% 4/16). Fifteen of 22 patients in whom endoscopic therapy failed were treated by using PTBD. Nine of the 15 patients were successfully managed in the first PTBD attempt, and 4 of the 6 patients in whom the first attempt of PTBD failed had repeated PTBD after a 3D-CT. Four patients were successfully treated with repeated PTBD of the alternative branch approach after a 3D-CT. Conclusions ERCP is a feasible first modality in the treatment of a post-LDLT biliary stricture, but, in failed cases, especially in the pouched shape, PTBD can be attempted. When initial PTBD trial fails, a biliary-tract examination, such as a 3D-CT, can be useful for a repeated PTBD trial.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background: SKI306X, which consists of biologically active ingredients from Clematis mandsburica, Tricbosantbes kirilowii , and Prunella vulgaris , was developed and tested in preclinical ...trials in Korea. Those studies found that SKI306X was associated with an anti-inflammatory and analgesic effect, and that it can delay the destruction of cartilage in rheumatoid arthritis (RA). Objective: The aim of this study was to compare the pain relief and tolerability of SKI306X and celecoxib in patients with RA. Methods: This study was a 6-week, multicenter, randomized, double-blind, double-dummy, Phase III, noninferiority clinical trial. Eligible patients were aged 18 to 80 years, had a history of RA with a disease duration of ≥3 months, and were functional American College of Rheumatology (ACR) class I, II, or III before entry. After a washout period of 2 weeks, patients were randomized to SKI306X 200 mg TID or celecoxib 200 mg BID for 6 weeks. The primary end point was a change in patient assessment of pain intensity using a visual analog scale (VAS). The secondary end points were a 20% improvement in response rate as defined by the ACR (ACR20) and the frequency of rescue medication use. Results after 3 and 6 weeks of treatment were compared with baseline and between treatment groups, and all patients were assessed for adverse events (AEs), clinical laboratory data, and vital signs. AEs were identified based on spontaneous reports by patients during interviews conducted by the investigators and the study coordinator. Results: Two hundred twenty-two Korean patients from 7 medical centers were assessed and 183 were enrolled and randomized to 1 of 2 treatment groups. Ninety-one patients (10 male, 81 female; mean SD age, 52.13 12.64 years; mean SD duration of RA, 9.08 10.23 years; no. % of ACR class I, II, and III, 13 14.29, 44 48.35 and 34 37.36 patients, respectively) received SKI306X 200 mg TID and 92 patients (10 male, 82 female; mean SD age, 51.78 10.94 years; mean SD duration of RA, 8.78 7.78 years; no. % of ACR class I, II, and III, 14 15.22, 44 47.83, and 34 36.96 patients, respectively) received celecoxib 200 mg BID. An analysis of the change in reported pain intensity as determined by VAS (mm) score between baseline and week 3 (mean SD, 13.64 16.62 vs 14.45 15.89), and between baseline and week 6 (18.4 20.8 vs 17.9 19.1, respectively) suggested that SKI306X was not inferior to celecoxib. The number of patients who achieved ACR20 response rate was not significantly different between the SKI306X group and the celecoxib group at week 3 (16/87 18.4% vs 24/87 27.6%, respectively) and at week 6 (29/87 33.3% vs 29/87 33.3%). The frequency of rescue medication use was not significantly different between the SKI306X group and celecoxib group at week 3 (54/87 62.1% vs 47/87 54.0%, respectively) or week 6 (57/87 65.5% vs 49/87 56.3%). Drug-related AEs were reported by 27 (29.7%) patients in the SKI306X group and 22 (23.9%) patients in the celecoxib group. The most frequent drug-related AEs were epigastric pain (9/91 9.9%) in the SKI306X group and glutamyltranferase elevation (4/92 4.3%) in the celecoxib group. No significant between-group differences were observed in the prevalence of drug-related clinical- or laboratory-determined AEs. Conclusion: The results of this study suggest that SKI306X was generally well tolerated and not inferior to celecoxib in regard to pain relief in these Korean patients with RA.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Study Objective Young age is a possible risk factor of endometriosis recurrence after surgery. However, the efficacy of postoperative medical treatment has not been well addressed in ...adolescents. The purpose of this study was to evaluate whether postoperative medical treatment is as effective in adolescents as it is in adults in the prevention of endometrioma recurrence. Design A retrospective cohort study. Setting Samsung Medical Center, Seoul, Korea. Participants This study included 176 reproductive-aged women who underwent conservative laparoscopic surgery for pathology-confirmed endometrioma. Women were classified into 2 groups according to age: adolescents (20 years of age and younger, n = 34; group I) and reproductive-aged women (aged 25-35 years, n = 142; group II). Interventions The same surgeon performed all of the surgeries for uniformity. Postoperatively, patients were treated monthly with a gonadotropin-releasing hormone agonist depot for 3-6 months, followed by cyclic oral contraceptives. Main Outcome Measures Endometrioma recurrence was determined using ultrasonography. The recurrence rate of endometrioma was compared between the 2 groups. Results During the treatment period (median, 41.0 months; range, 6-159 months), recurrence was noted in 8 cases (4.5%). After adjusting for confounders (which were statistically different between the groups), the cumulative proportion of recurrent endometriomas after 60 months was comparable between the 2 groups (5.3% in group I and 8.5% in group II). Conclusion Long-term postoperative medical treatment with cyclic oral contraceptives after a gonadotropin-releasing hormone agonist can be as effective in adolescents as it is in adults in the prevention of endometrioma recurrence.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
To assess contrast-enhanced magnetic resonance (MR) angiographic findings of uterine arteries (UAs) and to evaluate the diagnostic utility of this imaging modality for the prediction of ovarian ...artery (OA) embolization (OAE).
The authors retrospectively evaluated 349 patients who underwent contrast-enhanced MR angiography before UA embolization (UAE) for symptomatic fibroid tumors or adenomyosis. The diameters of the UAs were compared with those of the inferior mesenteric arteries (IMAs) and classified into two groups: group I, in which the diameters of both UAs were the same as or greater than that of the IMA; and group II, in which at least one UA was smaller than the IMA or was not visible. The presence of an enlarged OA was also evaluated. Sensitivity and specificity were calculated for UA diameter, enlarged OA, and the combination of the two.
Nine of 22 patients (40.9%) in group II underwent OAE, which was a significantly higher incidence (P < .001) than in group I (nine of 327; 2.8%). Among eight patients with enlarged OAs, six (75%) underwent OAE. Relative UA diameter had a sensitivity of 50% and specificity of 96.1%; the respective values for enlarged OAs were 33.3% and 99.3%. The combination of UA diameter and enlarged OAs showed a sensitivity and specificity of 72.2% and 95.4%, respectively.
In addition to the identification of enlarged OAs, contrast-enhanced MR angiography allows a comparison between UA and IMA diameters and therefore can be helpful for the prediction of OAE.
Abstract A 74-year-old man presented with recent inferior wall myocardial infarction. The right ventricle (RV) was strikingly dilated and akinetic along the free wall compatible with right ...ventricular infarction. Accordingly, severe functional tricuspid regurgitation (TR) was detected. Coronary angiogram revealed total occlusion on the proximal right coronary artery (RCA). There was collateral blood flow from the left anterior descending (LAD) artery to the right ventricular ischemic region. The LAD artery also had a significant stenosis which might limit the required amount of blood supply to collateral blood vessels. Because of the technical difficulty in the intervention of RCA, the patient underwent percutaneous intervention on the LAD artery. After the revascularization of LAD artery, severe TR was abolished accompanied by the right ventricular functional recovery. < Learning objective: Isolated ischemic tricuspid regurgitation was rarely manifested because the right ventricle has a more favorable oxygen supply–demand ratio than the left ventricle and receives extensive collateral flow from the left-to-right collateral system. In our case, the right ventricle was receiving blood flow through collateral circulation from septal branches of the left anterior descending coronary artery due to the total occlusion of proximal right coronary artery. This case displays the remarkable role of collateral circulation in restoring right ventricular function and in treating ischemic tricuspid regurgitation.>
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objectives The aim of this study was to evaluate long-term clinical outcomes after implantation of sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES) among patients with unprotected ...left main coronary artery (LMCA) disease. Background There have been few comparisons of long-term outcomes among currently available drug-eluting stents (DES) for the treatment of LMCA disease. Methods A total of 858 consecutive patients with unprotected LMCA stenosis were treated with SES (n = 669) or PES (n = 189) between May 2003 and June 2006. Primary outcome was the composite of death, myocardial infarction (MI), or target vessel revascularization (TVR). Results Baseline clinical and angiographic characteristics were similar in the 2 groups. During 3 years of follow-up, the adjusted risk of primary composite outcome was similar among the groups (SES vs. PES: 25.8% vs. 25.7%, hazard ratio HR: 0.95, 95% confidence interval CI: 0.64 to 1.41, p = 0.79). The 2 groups also showed a comparable adjusted rate of each component of outcome: death (9.1% vs. 11.0%, HR: 0.92, 95% CI: 0.47 to 1.80, p = 0.82), MI (8.1% vs. 8.0%, HR: 0.80, 95% CI: 0.43 to 1.48, p = 0.47), and TVR (12.1% vs. 10.6%, HR: 1.10, 95% CI: 0.53 to 2.29, p = 0.81). The 3-year rates of definite or probable stent thrombosis were 0.6% in the SES group and 1.6% in the PES group (adjusted p = 0.18). Conclusions In consecutive patients with unprotected LMCA disease undergoing DES implantation, SES and PES showed similar long-term clinical outcomes in terms of death, MI, repeat revascularization, and stent thrombosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Objectives To retrospectively evaluate the diagnostic performance of qualitative and quantitative radiographic parameters for diagnosing adult acute epiglottitis, and identify the prevalence ...and risk factors of false-negative neck radiography-based diagnosis of acute epiglottitis. Methods An emergency physician and a radiologist independently reviewed neck radiographs of 91 patients with laryngoscopy-confirmed acute epiglottitis and 91 control subjects between March 2010 and June 2016 for qualitative and quantitative radiographic parameters of acute epiglottitis, and concluded a diagnosis. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of radiographic parameters, while independent risk factors of false-negative diagnosis were determined by multivariate logistic regression analysis. Inter-observer agreement was also calculated. Results All radiographic parameters showed good diagnostic performance with sensitivities and specificities of 33.0–80.2% and 64.8–100%, respectively. Epiglottis width (EW) > 6.3 mm showed the highest diagnostic performance (area under the ROC curve AUC: 0.867, sensitivity: 75.8%, specificity: 97.8%). Interobserver agreement for all radiographic parameters was excellent (range: 0.893–0.991). The lateral neck radiography-based false-negative diagnosis rate was 31.9%, and previous oral antibiotic usage was an independent risk factor of false-negative results. Conclusion EW > 6.3 mm showed the best diagnostic accuracy, facilitating a neck radiograph-based diagnosis of acute epiglottitis. However, false-negative results on neck radiograph are quite common and previous oral antibiotic usage is a risk factor. Based on the knowledge of the usefulness and risk factors of false-negative results of neck radiography, diagnostic process for acute epiglottitis using neck radiography need to be changed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Objectives This study sought to investigate whether the outcome of drug-eluting stent (DES) treatment and that of coronary artery bypass grafting (CABG) differed in diabetic and nondiabetic patients ...with unprotected left main coronary artery (LMCA) disease. Background Diabetes mellitus has been shown to be a risk factor for adverse events and a major determinant in selection of a revascularization strategy in patients with multivessel or LMCA disease. Methods A total of 1,474 patients with unprotected LMCA stenosis who received DES (n = 784) or underwent CABG (n = 690) were examined. We compared the effects of these 2 treatments on long-term clinical outcomes (death; the composite of death, Q-wave myocardial infarction MI, or stroke; and target vessel revascularization TVR), according to diabetic status. Results After adjustment of covariates, the risk of death (hazard ratio HR: 0.95, 95% confidence interval CI: 0.62 to 1.46, p = 0.83) and the composite of death, Q-wave MI, or stroke (HR: 0.96, 95% CI: 0.65 to 1.42, p = 0.85) at 3 years were similar in the DES and CABG groups. However, the rate of TVR was significantly higher in the DES group (HR: 4.31, 95% CI: 2.28 to 8.15, p < 0.001). These trends were consistent in both diabetic and nondiabetic patients. We also did not observe a diabetes-associated excess risk of death (pinteraction = 0.90 and 0.16), or a composite of death, Q-wave MI, or stroke (pinteraction = 0.68 and 0.93), or TVR (pinteraction = 0.23 and 0.92), between patients receiving either treatment. Conclusions The prognostic impact of diabetes on long-term treatment with DES or CABG for patients with unprotected LMCA disease was minimal.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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