I-Chang Hsieh

Lactococcus garvieae infections in humans : possible association with aquaculture outbreaks

Lactococcus garvieae is an important pathogen in aquaculture, outbreaks of which significantly affect production. It is a rare pathogen with a low virulence in human infection. The relation between the aquaculture outbreak and the human infection has not been clarified. Prospective and retrospective epidemiologic surveillance of the four patients with L. garvieae infection between 2000 and 2003 and their relations to the aquaculture outbreaks of L. garvieae were conducted. All the four patients with L. garvieae infection were associated with gastrointestinal disorders. Three of the four patients gave a history of consuming raw fish and in three of the four patients, the infection occurred in summer between June and August while there is a decrease of fisheries production and an increase in L. garvieae infection in aquaculture farms. There was a 100% identity of 16S rDNA sequence of L. garvieae isolates from patient 1 and from the squid muscle obtained from the restaurant where patient 1 consumed the raw fish. Sporadic occurrence of L. garvieae infection in human appears to correlate with the seasonal aquaculture outbreaks of L. garvieae infection. The presence of gastro‐intestinal disorder may facilitate L. garvieae infection.

Aortic valve sclerosis is an echocardiographic indicator of significant coronary disease in patients undergoing diagnostic coronary angiography

Aortic valve sclerosis (AVS) is considered to be a manifestation of generalised atherosclerosis that involves the aortic valve. It has been associated with higher cardiovascular morbidity and mortality in a population‐based study. This investigation used transthoracic echocardiography (TTE) to evaluate the prevalence and significance of AVS in 357 Chinese patients with suspected coronary artery disease (CAD). This work reveals that AVS is an independent echocardiographic predictor of significant CAD in such clinical setting (O.R.u2003=u20033.18; 95% confidence interval 1.52–6.7; pu2003=u20030.002). Other independent predictors include male gender, diabetes mellitus and hypertriglyceridemia. The predictive value of AVS for the presence of CAD is more prominent in females and in subjects aged <65 years. The recognition of AVS on TTE should alert the physicians to the possibility of underlying significant CAD, and further evaluation with aggressive management is indicated, even though no angiographic documentation is available.

Late clinical and electrophysiologic outcome of radiofrequency ablation therapy by the inferior approach in atrioventricular node reentry tachycardia

A late electrophysiologic study was conducted in 182 of 289 patients with slow-fast atrioventricular node reentry tachycardia 81 +/- 36 days after radiofrequency ablation therapy by the inferior approach. Of these 182 patients, electrophysiologic study immediately after ablation revealed a selective modification of the slow pathway in 159, a modification of both the slow and fast pathways in 15, a modification of the fast pathway alone in 3, and failure of ablation in 5. One hundred two patients had no induction of echoes; 75 had induction of fewer than four echoes; and 5 had induction of sustained tachycardia with or without isoproterenol infusion. The late electrophysiologic study in these 182 patients revealed a persistent effect without changes in conduction properties in 161 (88%) patients. A change in conduction properties was noted in 21 patients, including 5 with resumption of slow- or fast-pathway conduction with induction of sustained tachycardia, 8 with improved fast- or slow-pathway conduction, and 8 with an additional depression of fast- or slow-pathway conduction. Of the 102 patients with no induction of echoes and the 75 patients with induction of fewer than four echoes during the immediate postablation electrophysiologic study, 5 (3 and 2, respectively) patients had induction of tachycardia. Of the 5 patients with induction of sustained tachycardia in the immediate postablation electrophysiologic study, 3 continued to have induction of sustained tachycardia; 1 had induction of echoes only; and 1 had no induction of echoes.(ABSTRACT TRUNCATED AT 250 WORDS)

Severe coronary artery spasm with anaphylactoid shock caused by contrast medium--case reports.

This study reports 2 cases of severe coronary artery spasm with anaphylactoid shock caused by contrast medium. The first patient had anaphylactoid shock in response to contrast medium and severe coronary spasms of both the left anterior descending coronary artery and the left circumflex coronary artery. The patient developed ventricular arrhythmia and complete atrioventricular block following the severe coronary spasm. The second patient had a totally occluded right coronary artery, owing to a spasm after anaphylactoid shock. Anaphylactoid shock should always be considered when persistent shock is noted after the coronary artery spasm has been relieved.

Pulmonary pseudosequestration receiving arterial supply from a coronary artery fistula : A case report

A forty-eight-year-old man with a history of pulmonary tuberculosis and scarring of both hila and upper lobes was noted to have bilateral pulmonary pseudosequestration, in which the blood supply originated from a coronary artery fistulous vessel arising from the left circumflex artery and draining into the pulmonary artery. This is the first reported patient with the source of blood supply to the pulmonary pseudosequestration arising from a coronary artery fistula.

Acute and long-term outcomes of drug-eluting stent implantations in aorto-ostial, left anterior descending artery-ostial, and nonostial lesions

This study was designed to evaluate the acute and long‐term clinical and angiographic outcomes of drug‐eluting stent (DES) implantations in aorto‐ostial, left anterior descending artery (LAD)‐ostial and nonostial lesions.

C-reactive protein in predicting coronary artery disease in subjects with aortic valve sclerosis before diagnostic coronary angiography.

Background:Although previous studies have suggested that aortic valve sclerosis (AVS) shares common histologic features with atherosclerosis and is an indicator of significant coronary artery disease (CAD), many patients with aortic valve disease do not have coexisting coronary atherosclerotic disease and vice versa. It is important to find the subjects with AVS who are most likely to have concomitant CAD and require aggressive evaluation. Hypothesis:We hypothesized that the systemic inflammatory marker, high-sensitive C-reactive protein (hs-CRP), may be associated with AVS, and may be helpful before coronary angiography in identifying the presence of concomitant CAD in patients with AVS. Methods:This study included 227 patients with suspected CAD undergoing transthoracic echocardiography and coronary angiography. AVS was defined as a focal area of increased echogenicity and thickening of the aortic valve leaflets without restriction in motion. Data of atherosclerotic risk factors including hs-CRP were collected. Results:Technically satisfactory ultrasound recordings were obtained in 217 subjects (96% of enrolled patients). Patients with AVS were older (65±10 vs. 60±10 years old; P = 0.0004), had higher serum creatinine levels (115.2 ± 79.7 vs. 88.6 ± 35.4 &mgr;mol/L; P= 0.04), and had greater prevalence of obstructive CAD (75% vs. 53%; P= 0.001) than those with normal aortic valves. CRP levels were not associated with AVS, and failed to predict concomitant CAD in patients with AVS. Additionally, none of the established risk factors were independent predictors of the presence of CAD in AVS patients. Conclusion:Hs-CRP levels appear to not be associated with AVS, and are of little value in terms of predicting the presence of concurrent CAD before coronary procedure.

Radiofrequency ablation for supraventricular and ventricular tachycardia in young patients

Radiofrequency ablation therapy was conducted in 86 consecutive children and young patients with a mean age of 14 +/- 3 years (range = 3-18). Fifty-two patients had Wolff-Parkinson-White syndrome, one had re-entry tachycardia incorporating a nodoventricular fiber, 22 had atrioventricular node re-entry tachycardia, two had atrial tachycardia and nine had idiopathic ventricular tachycardia. Radiofrequency ablation was successful in 50 of the 52 patients (96%) with Wolff-Parkinson-White syndrome and the one with nodoventricular fiber. Radiofrequency modification of the atrioventricular node using the inferior approach was successful in eliminating atrioventricular node re-entry tachycardia in 20 of the 22 patients (91%). Radiofrequency ablation in the two patients with atrial tachycardia was unsuccessful. Of the nine patients with idiopathic ventricular tachycardia, eight from the left ventricle and one from the right ventricular outflow tract, eight were successfully ablated (88%). Follow-up over a period ranging from 1 to 46 months (21 +/- 13) revealed a recurrence of tachycardia in seven patients; a late electrophysiological study in 38 patients revealed the induction of tachycardia in 11 patients (seven with accessory pathway-mediated tachycardia, three with atrioventricular node re-entry tachycardia and one with idiopathic ventricular tachycardia). All 11 patients were successfully ablated by a second trial. In conclusion, radiofrequency ablation therapy is effective and safe in pediatric patients with supraventricular and ventricular tachycardia and should be considered as the therapy of choice in this group of patients.

Association Between Peripheral Vascular Disease Indexes and the Numbers of Vessels Obstructed in Patients With Coronary Artery Disease

Introduction:The numbers of vessels obstructed in patients with coronary artery disease (CAD) is an important prognostic factor. Pulse wave velocity (PWV), ankle-brachial index (ABI) and the estimated glomerular filtration rate (eGFR) are associated with increasing CAD risks; however, the association between the numbers of vessels obstructed and PWV, ABI and eGFR is not clear. Methods:PWV, ABI and eGFR of 58 patients underwent coronary angiography for angina pectoris and acute coronary syndrome were measured. The variables that may be related to the number of vessels involved were analyzed using univariate linear regression followed by stepwise multivariate linear regression to determine the best-fit model. Results:The average PWV, ABI and eGFR were 1523 ± 281 cm/sec, 1.16 ± 0.06 and 76.0 ± 16.7 mL/min/1.73 m2 for patients with no CAD; 1496 ± 230 cm/sec, 1.14 ± 0.09 and 82.3 ± 12.4 mL/min/1.73 m2 for 1-vessel CAD; 1733 ± 298 cm/sec, 1.07 ± 0.17 and 63.0 ± 26.3 mL/min/1.73 m2 for 2-vessel CAD and 1996 ± 664 cm/sec, 0.99 ± 0.19 and 56.2 ± 27.3 mL/min/1.73 m2 for 3-vessel CAD. Age, diabetes, hypertension, pulse pressure, serum creatinine, eGFR, ABI and PWV were correlated with the numbers of vessel obstructed in univariate regression. In stepwise multivariate linear regression, diabetes, PWV and ABI was independently linked to the numbers of vessels obstructed (P=0.021, 0.004 and 0.025). Conclusion:Noninvasive indexes for atherosclerotic vascular disease including PWV and ABI are linked to the number of vessels obstructed in patients with CAD.

Effects of adenosine on paroxysmal atrial tachycardia

Abstract In conclusion, adenosine is effective in terminating paroxysmal atrial tachycardia that is electrically inducible and terminable. Because both reentry and triggered automaticity could be operative in this arrhythmia, “adenosine-sensitive paroxysmal atrial tachycardia” would be a better descriptive term for this form of arrhythmia.