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Background and Objectives:The restrictive filling pattern (RFP) is accepted as a poor prognostic marker in congestive heart failure (CHF) patients. But, recently the RFP has been categorized into various prognosis subgroups by their clinical signs or echocardiographic markers with loading manipulation. But, in critically ill or severe dyspneic patients these loading anipulations are not practical to apply. Therefore, we tried to establish simple, reliable prognostic echocardiographic variables in CHF patients with the RFP. Materials and Method:40 patients with the RFP were observed for 35±19 months after echocardiographic examination. We obtained baseline peak early (E), late (A) mitral inflow velocities, E/A ratio, deceleration time of E velocity (DT), peak early (E'), late (A') diastolic mitral annulus velocities, E'/A' ratio, reversibility of the RFP. The reversibility of RFP was defined as E/A ratio reverse (<1) during the Valsalva's maneuver. With the clinical and survival data during follow up period, we established significant prognostic variables in these patients. Results:In univariate analysis, low systolic blood pressure (p=0.013), low A velocity(p=0.044), low A' velocity (p=0.028) and the irreversibility of RFP (p=0.024) were significant drastic prognosis variables. Especially, patients with A velocity <0.32 m/sec or A' velocity <0.04 m/sec showed significantly higher mortality. Conclusion:In CHF patients with the RFP, A velocity and A' velocity are very practical prognostic echocardiographic variables and patients with the low A velocity (<0.32 m/sec) or the low A' velocity (<0.04 m/sec) showed higher mortality rate.
Background : Candesartan is a long-acting, selective angiotensin II type 1 receptor blocker1). It is administered orally as the inactive prodrug candesartan cilexetil (CC) which is rapidly and completely converted to candesartan during gastrointestinal absorption. The objective of this study was to confirm antihypertensive efficacy and safety of CC through comparing with enalapril maleate (EM) in mild to moderate essential hypertensive patients. Methods : This study was an two centers, randomized, double-blind, non-inferiority study of once-daily 8mg CC versus 10mg EM, including 78 (age, 32 to 72 years) mild to moderate essential hypertensives (mean sitting diastolic blood pressure (MSiDBP), 95~114mmHg) for 8weeks. After 4 weeks study period, drugs were eventually increased to 16mg and 20mg in non-responders who were defined as MSiDBP was equal to or greater than 90mmHg. The reduction of trough MSiDBP, side effects and laboratory findings were compared between CC and EM at the end of this study. Results : In the 66 patients evaluable for intention to treat analysis, at the end of 8 weeks of treatment, reduction of MSiDBP were similar in both drugs (14.4±7.7mmHg for CC, 10.2±9.8mmHg for EM, p=0.059). There was no significant difference between the two drugs in the systolic blood pressure reduction, blood pressure normalizing rate, number of dose escalation patients. Cough significantly less occurred in CC group but other safety profiles were comparable in both groups. Conclusion : The antihypertensive efficacy, safety and tolerability of once-daily administration of CC are not inferior to those of EM in essential hypertensive patients.
Persistent left superior vena cava is a rare congenital anomaly resulting from the failure of the left cardinalvein to degenerate in utero. This anomaly was discovered in 0.3% of large autopsy examinations. Its mostrelevant clinical implication is the association with cardiac impulse formation and conduction problems. Inthe case of DDD pacemaker implantation for this anomaly, skillful manual stylet shaping is required or anactive fixation device, for example a screw device for stable positioning of pacemaker leads, is needed. Weexperienced a case of sick sinus syndrome in a patient with persistent left superior and absent right superiorvena cava in 72-year-old man. We successfully implanted a DDD type pacemaker through the left superiorvena cava via coronary sinus. This is the first Korean report of a successfully implanted permanent pacemakerin a patient with persistent left superior and absent right superior vena cava. 우측 상대정맥이 없는 지속성 좌측 상대정맥에서는 드물지 않게 동방 결절의 기능 장애나 전도 장애가 동반되며 이로 인해 영구적 인공 심박동기의 삽입이 필요하나 복잡한 전극 진입 경로에 의하여 전극의 안정한 삽입이 어려운 경우가 많다. 저자들은 우측 상대정맥이 없는지속성 좌측 상대정맥에 동기능 부전이 동반한 72세 남자에게 영구형 DDD형 인공 심박동기를 적절하게 삽입한 1예를 경험하였기에 문헌 고찰과 함께 이를 보고하는 바이다.
In this paper, a design technique using a bypass capacitor is proposed to improve the antenna efficiency of an inverted-F antenna (IFA) with a band stop matching circuit (BSMC). The proposed antenna operates in the LTE bands 26 and 5(814~ 894 MHz). The bandwidth of the IFA is expanded from 803~863 MHz to 800~888 MHz using the impedance change caused by the BSMC. To enhance the antenna efficiency in the expanded frequency band, the bypass capacitor is applied to the IFA with the BSMC. The bypass capacitor improves the efficiency of the antenna by reducing the current variation of the IFA with the BSMC. The proposed antenna has a bandwidth of 804~895 MHz and the antenna efficiency increases by more than 10 % in the extended frequency band by using the bypass capacitor.
Background and Objectives:An intracoronary brachytherapy is the only approved treatment for in-stent restenosis. However, a considerable rate of restenosis occurs after a brachytherapy. Up to now, there was no long term outcome for repeated brachytherapy for these lesions. Subjects and Methods:Eleven patients were admitted due to angina, with significant ischemic evidence in the stress test after the intracoronary brachytherapy. These patients were re-treated with a β-emitting 188 rhenium-DTPA (diethylene triamine penta-acetic acid) filled balloon catheter system, using an identical method and radiation dose (17.6 Gy) to the initial radiation treatment. The long term angiographic and clinical outcomes of repeated brachytherapy in these patients were evaluated. Results:The angiographic and clinical data of ten patients were evaluated, as 1 was lost. The follow-up period was 37.4±16.2 months (range, 8 to 53 months). There was no angiographic restenosis or target lesion revascularization (TLR) during the short term follow-up period (mean 6 months). but 2 restenosis (25%) occurred in the 2 year follow-up period and one other was added during the long term clinical follow-up period. All these restenosis lesions needed revascularization. These three TLRs occurred at 15, 24 and 43 months after the repeated brachytherapy. There was no death or nonfatal MI. No vascular perforation, aneurysm or late thrombosis was observed. Conclusion:A repeated brachytherapy for the treatment of a failed intracoronary brachytherapy lesion is safe and acceptably effective during the long term follow-up period. This modality might be considered as a therapeutic option for failed intracoronary brachytherapy lesions. 배경 및 목적:방사선 치료는 스텐트 내 재협착에 효과를 인정 받은 유일한 치료법이나 지속적으로 재협착이 발생한다. 이에 대한 치료법으로 현재까지 단기 추적에서 좋은 효과를 낸 것은 방사선 재치료이지만 아직 장기적인 안전성과 효과에 대한 보고는 없는 상태이다.방 법:방사선 치료 후 발생한 재협착 환자들 중 11명에게 188Re-DTPA(rhenium-188 diethylene triamine penta-acetic acid)로 채워진 관상동맥 풍선도자를 사용하여 1차 방사선 치료와 같은 방법과 방사선량으로 풍선도자-혈관벽 계면으로부터 1.0 mm 깊이에 17.6 Gy를 조사한 후 혈관 조영술상의 특성과 임상 경과를 분석하여 방사선 재치료의 장기적인 안정성과 효과 등을 후향적으로 추이하였다. 결 과: 1명의 환자가 조기에 추적이 안되어 10명의 혈관 조영술과 임상 성적을 분석하였다. 총 추적기간 37.4±16.2개월(8~53개월)이었다. 평균 6개월간에 걸친 단기 추적에서는 유의한 재협착이나 목표 병변 재개통술의 발생이 없었다. 2년 추적 기간에 2명에서 협착과 이에 연관된 목표 병변 재개통술이 발생하였다(25%;8명 중 2명). 2년 혈관 조영 추적 이후에 실시된 임상 경과 추이 도중 1명에서 협착과 이에 연관된 목표 병변 재개통술이 추가적으로 발생하여 목표 병변 재개통술은 방사선 재치료 후 15, 24, 43개월에 발생하였다. 추적 기간 동안 사망, 심근경색을 일으킨 예는 없었으며 관상동맥 천공, 혈관류 혹은 후기 혈전증 등은 없었다. 평균 6개월의 단기 추적에서는 목표 병변 재개통술이 발생하지 않았다. 결 론: 장기적인 추적을 통하여 관상동맥 방사선 치료 후에 발생한 재협착 병변에 방사선 재치료는 안전하고 효과적인 치료법으로 생각되며 관상동맥 방사선 치료 후에 발생한 재협착 병변에 대한 치료 방법으로 고려하여야 할 방법이라 하겠다.