Ching-Cheng Lin

Usefulness of technetium-99 m sestamibi myocardial perfusion SPECT in detection of cardiovascular involvement in patients with systemic lupus erythematosus or systemic sclerosis

The main purpose of the study was to evaluate the utility of technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (Tc-99m sestamibi SPECT) in detection of cardiac involvement in systemic lupus erythematosus (SLE) or systemic sclerosis (SS) patients. Fifty SLE or SS female patients with cardiac symptom/sign such as chest discomfort and/or dyspnea and/or occasionally palpitation and 50 SLE or SS female patients without any cardiac symptom/sign were investigated using Tc-99m sestamibi SPECT during rest and stress after dipyridamole infusion. Twenty-five age- and sex-matched healthy females were also included as controls in this study. The results of Tc-99m sestamibi SPECT were classified into four types including normal, persistent perfusion defect (PD), reversible perfusion defect (RD), and reverse perfusion defect (RR). The results of Tc-99m sestamibi SPECT in the 25 healthy females were normal. Perfusion abnormalities were detected in 44/50 (88%) symptomatic SLE or SS patients. However, myocardial perfusion abnormalities were only detected in 19/50 (38%) asymptomatic SLE or SS patients (P value<0.05 by a chi2 test). However, for risk factor of coronary artery disease and abnormal resting EKG, the incidences were not significant between symptomatic and asymptomatic patients (P values >0.05 by a chi2 test). Tc-99m sestamibi SPECT is a useful noninvasive imaging modality to detect cardiac involvement in symptomatic or asymptomatic SLE or SS patients.

Usefulness of thallium-201 muscle perfusion scan to investigate perfusion reserve in the lower limbs of Type 2 diabetic patients

This study evaluated the usefulness of thallium-201 muscle perfusion scan (Tl-201 muscle scan) to investigate perfusion reserve in the lower limbs of asymptomatic Type 2 diabetic patients without peripheral ischemia findings. Tl-201 muscle scan was carried out in 36 diabetic male patients with Type 2 diabetes mellitus of more than 10 years in duration who had no evidence of peripheral arterial disease in their history, physical examination, or Doppler ultrasonography. A control group consisted of 24 healthy age-matched nondiabetic men. Each subject flexed their right foot maximally both dorsally and plantar 60 times. In the middle of this exercise, 2mCi Tl-201 was injected intravenously. Three minutes after the injection, a posterior image of both calves was obtained using a gamma camera. Rectangular regions of interest (ROIs) were symmetrically drawn over both calves. The total count (Ct) in the resting calf was subtracted from the Ct in the exercising calf, and the percentage increase, termed the perfusion reserve, was determined. A significant difference was found between the perfusion reserves of the Type 2 diabetic patients and control groups (70.2+/-10.7% and 98.6+/-9.4%, respectively; P<.05). In conclusion, the perfusion reserve in the lower limb muscles in Type 2 diabetic patients may be measured by Tl-201 muscle perfusion scan.

Double Mycotic Aneurysms of the Ascending Aorta

Infection in the vascular tree has been proved to be one of the greatest challenges for cardiovascular surgeons. Of these, mycotic aneurysms of the ascending aorta were considered to be almost always lethal until recently. A thorough survey of the literature indicates that only 42 cases of mycotic aneurysm of the ascending aorta have been reported. All the reported cases of mycotic aneurysm of the ascending aorta were a single lesion in the ascending aorta except a case reported in 1993. This report describes an additional case of double mycotic aneurysms of the ascending aorta caused by Pseudomonas infection.

Acute aortic dissection type A with acute coronary involvement: a novel classification.

BACKGROUND Acute coronary involvement (ACI) due to acute aortic dissection (AAD) type A is potentially fatal. We examined selected patients with AAD type A, which had evolved over 14 years, and acute coronary involvement. The purpose of this study was to determine the characteristics of patients with ACI due to AAD type A. METHODS Between 1997 and 2011, we recruited 20 patients (14.1%) with ACI (14 men, 6 women; mean age: 51.8 ± 11.8 years; age range: 35-79 years) from 142 patients who had undergone surgical repair of AAD type A. RESULTS We propose a novel 4-category classification scheme based on the surgical pathological findings. The right coronary artery was involved in 15 patients, and the left was involved in 5 patients. Fourteen patients had preoperative myocardial ischemia. In the other 6 patients, acute coronary involvement was found intraoperatively. Patients with ACI were significantly younger than those without ACI (51.8 ± 11.8 vs. 61.0 ± 11.8; p = 0.001), a lower prevalence of intramural hematoma (5.0% vs. 32.8%; p = 0.011), a higher aortic regurgitation rate (95.0% vs. 53.5%; p = 0.001). Patients presenting with ACI had an in-hospital mortality rate of 20.0% (4/20), while those without ACI had an in-hospital mortality rate of 19.7% (24/122). CONCLUSIONS Acute coronary involvement due to AAD type A is not always associated with coronary malperfusion. Patients with ACI were much younger, had a higher aortic regurgitation rate, and, less commonly, had intramural hematoma. This new classification scheme would make it more convenient for surgeons to decide on treatment options for this special cohort.

Double right coronary artery and its clinical implications

Congenital anomalies of the coronary arteries are present in 0.2-1.4% of the general population. These anomalies represent one of the most confusing issues in the field of cardiology and challenges for interventional cardiologists and cardiac surgeons if the anomalies are unrecognised. Double right coronary artery is one of the rarest coronary arteries. Previously, the probability of developing atherosclerotic changes in patients with a double right coronary artery was considered to be equal to that in those without it. In reality, however, a high prevalence of atherosclerotic coronary artery disease was found in patients with a double right coronary artery originating from a single ostium after our comprehensive literature search through the PubMed database. Owing to the fact that double right coronary artery is both a congenital and potentially atherosclerotic coronary artery disease at diagnosis, coronary intervention or cardiac operation is more complicated than previously believed. Individuals with a double right coronary artery may be unaware of its presence until an accidental finding during coronary angiography or cardiac operation and are at risk for unsuspected complications of atherosclerotic coronary artery disease or during cardiac operation. Therefore, it is important to obtain information on the anatomic variants of this congenital coronary anomaly in patients who are undergoing either coronary intervention, aortic root operation or myocardial revascularisation. To our knowledge, this is the first comprehensive article to discuss the anomalies and their clinical implications.

An efficient method for the culture of Helicobacter pylori from gastric biopsies with two-section petri dishes.

Purpose.Helicobacter pylori is the principal cause of chronic gastritis and is strongly associated with peptic ulcer disease and gastric cancer, as well as with gastric lymphoma (mucosa-associated lymphoid tissue [MALT] type). H. pylori could be recovered by many kinds of media, however, it could not be detected efficiently. This study was trying to ameliorate the isolation and detection rate with selective and non-selective media. Methods. First, type strain (ATCC 43504) was cultured with twelve different kinds of sheep blood agar based on brain heart infusion medium for five days. Then five better non-selective media and five selective media were chosen for the biopsy, which were incubated at 37°C in a microaerophilic incubator for five days. Endoscopic biopsies were collected from 623 patients at Kaohsiung Medical University Hospital. Results. It was found that non-selective media, which contain 5% modified chocolate agar (the ratio of fresh and heated sheep blood is 2) with 1% Isovitalex, had the best detection rate (91.1 ± 0.6)%. Furthermore, 5% modified chocolate agar with 1% Isovitalex and 1% antibiotics would increase the detection rate to (97.1 ± 0.3)%. Conclusions. According to Ansorgs method, the best detection rate (98.4 ± 0.7)% could be obtained with two-section petri dishes which had 5% modified chocolate agar with antibiotics and the other without antibiotics.

Coexistent mitral stenosis and coronary artery fistula presenting as myocardial ischemia: case report.

We report a 50-year-old female case of mitral stenosis with congenital coronary artery fistula communicating the left anterior descending artery to pulmonary artery. In reviewing the literature, mitral stenosis associated with coronary artery fistula is rare. The case was initially treated medically for congestive heart failure. The electrocardiogram revealed severe myocardial ischemia and no obvious etiology was found clinically. The coronary angiogram demonstrated the diagnosis of coronary artery fistula. Myocardial ischemia improved markedly after surgical correction of the valvular disease and the fistula. The patient continued to do well during 2 years and 10 months follow up. The concomitant mitral stenosis masked the symptoms of coronary artery fistula, and made us fall to diagnose the condition initially. Valvular heart disease associated with severe myocardial ischemia without obvious atherosclerotic stenosis of coronary artery reminded us of the possibility of coronary artery fistula, though it has rarely been reported.

High prevalence of asymptomatically poor muscle perfusion of lower extremities measured in type II diabetes patients with abnormal myocardial perfusion

Foot problems are the most common cause of hospital admission in patients with type II diabetes mellitus (DM). Poor muscle perfusion of lower extremities is thought to be the major component in the pathogenesis of foot problems. Therefore, it is important and interesting to investigate if high prevalence of poor muscle perfusion of lower extremities in type II DM patients with abnormal myocardial perfusion and more cardiovascular risk factors. We used a well-established and noninvasive radionuclide method (Xe-133 muscle washout) to objectively evaluate the anterior tibial muscle perfusion of 60 type II DM male patients without symptoms/signs of peripheral vascular disease (PVD) in the lower extremities. The patients were separated into groups according to the myocardial perfusion imaging results and cardiovascular risk factor survey. Meanwhile, 30 normal male controls with a matched age distribution were also included for comparison. The muscle perfusions were of significant difference (P-values <.05) between (1) 60 type II DM patients (1.84+/-0.43 ml/100 g/min) and 30 normal controls (2.95+/-0.52 ml/100 g/min), (2) 24 patients with abnormal myocardial perfusion (1.31+/-0.45 ml/100 g/min) and 36 patients with normal myocardial perfusion (2.24+/-0.48 ml/100 g/min), as well as (3) 28 patients with more cardiovascular risk factors (1.33+/-0.46 ml/100 g/min) and 22 patient with less cardiovascular risk factors (2.22+/-0.49 ml/100 g/min). Based on Xe-133 muscle washout method, we concluded that the muscle perfusion in the lower extremities of type II DM patients without symptoms/signs of PVD is significantly decreased and related to abnormal myocardial perfusion and more cardiovascular risk factors.

Acute Myocardial Infarction with Patient Coronary Artery after a Long-Distance Flight -a Case Report

Acute myocardial infarction is unusual in a young woman, especially with normal coronary arteriography. There are several mechanisms hypothesized, including coronary artery embolism, coronary spasm, illegal drug abuse and toxic condition. However, the etiology could be detected in only one third of these patients. Although air travel is known to precipitate deep vein thrombosis and pulmonary embolism, it is unclear whether it also causes myocardial infarction. We report a 37 year-old woman who had no risk factor for coronary artery disease, who suffered from acute myocardial infarction complicated with ventricular fibrillation after a long-distance flight across the Pacific Ocean from the United States to Taiwan. The coronary arteriogram disclosed patent coronary artery with slight intraluminal haziness in the proximal left anterior descending artery. The left ventriculogram demonstrated akinesia of anterolateral and apical segments with apical thrombus formation. We reviewed the related literature and considered the myocardial infarction in this patient was related to coronary thrombus formation after long-distance air travel.

Paradoxical Regression of Aortic Dissecting Aneurysm After 10 Years of Follow-Up

![Figure][1] In February 2000, a 56-year-old man sought treatment at our emergency department with severe chest pain. The computed tomography (CT) scan showed acute type A aortic dissection. An emergent surgical repair was performed. After discharge, he kept regular close follow-up and