Variable Association between Components of the Metabolic Syndrome and Electrocardiographic Abnormalities in Korean Adults

BACKGROUND/AIMS: Resting electrocardiogram (ECG) abnormalities have been strongly associated with cardiovascular disease mortality. Little is known, however, about the association between individual components of metabolic syndrome and ECG abnormalities, especially in Asian populations. METHODS: We examined clinical and laboratory data from 31,399 subjects (age 20 to 89 years) who underwent medical check-ups. ECG abnormalities were divided into minor and major abnormalities based on Novacode criteria. Ischemic ECG findings were separately identified and analyzed. RESULTS: The overall prevalence rates of ECG abnormalities were significantly higher in subjects with than in those without metabolic syndrome (p < 0.01). Ischemic ECG was strongly associated with metabolic syndrome in all age groups of both sexes, except for younger women. In multiple logistic regression analysis, metabolic syndrome was independently associated with ischemic ECG (odds ratio, 2.30 [2.04 to 2.62]; p < 0.01), after adjusting for sex, age, smoking, and family history of cardiovascular disease. Of the metabolic syndrome components, hyperglycemia in younger subjects and hypertension in elderly subjects were major factors for ischemic ECG changes, whereas hypertriglyceridemia was not an independent risk factor in any age group. The association between ischemic ECG findings and central obesity was weaker in women than in men. CONCLUSIONS: Metabolic syndrome was strongly associated with ECG abnormalities, especially ischemic ECG findings, in Koreans. The association between each component of metabolic syndrome and ECG abnormalities varied according to age and sex.

A Villous Adenoma with Foci of Adenocarcinoma Arising in the Common Hepatic Duct / 대한소화기내시경학회지

Villous adenoma of the extrahepatic duct is a rare disease. Even though it is benign, it has malignant potential and is considered a premalignant lesion. We here report one case of villous adenoma with foci of adenocarcinoma arising in the common hepatic duct. A 60-year-old male was admitted to our hospital because of epigastric pain. The cholangiogram revealed a large filling defect in the right intrahepatic and common hepatic duct with intrahepatic bile duct dilatation. The patient underwent right lobectomy. Grossly, stalked papillay tumor originated in the common hepatic duct was overriding the right intrahepatic duct. Microscopically, the tumor was composed of stratified tall columnar cells with various dysplasia and there were foci of invasive adenocarcinoma.

Three Cases of Dysphagia Due to Vascular Ring in Adults / 대한소화기내시경학회지

Vascular rings resulting from abnormalities of the aortic arch can cause symptoms of esophageal or tracheal compression early in life. Right aortic arch with aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then left arch with aberrant right subclavian artery. These anomalous vessels usually do not produce symptoms, but occasionally symptomatic patients require surgical intervention. Development of symptoms later in life is due to atherosclerotic enlargement of the arch (Kommerell's diverticulum). We experienced three adults who had anomalous vessels with dysphagia. Diagnosis was made by esophagography and chest CT. Of these three patients, one patient had Kommerell's diverticulum and underwent surgical repair to prevent rupture of an enlarged diverticulum as well as to relieve dysphagia. We consider that diagnosis of dysphagia caused by anomalous vessel is made by noninvasive chest CT and that the patients who have enlarged diverticulum should undergo surgical repair even with mild symptoms to prevent vascular rupture.

Recent trends and clinical outcomes of infective endocarditis / 대한내과학회지

BACKGROUND: We sought to analyze the recent trends and clinical outcomes of infective endocarditis in Korea using newly proposed diagnostic criteria, Duke criteria, for this potentially life-threatening disease. METHODS: Retrospective analysis of medical records including echocardiographic data, blood culture and operation records was done for 156 patients (male 103) with clinical diagnosis of infective endocarditis at Asan Medical Center from 1989 to January 1998. RESULTS: One hundred eighteen patients (75%) fulfilled the criteria for definite group (Group I) in Duke criteria, whereas 38 patients (25%) for possible group (Group II). Mean age was 48+/-16 years. Although valvular heart disease was the most common underlying heart disease (49/156, 31%), in more than half (84/156, 54%) infective endocarditis was the first clinical presentation without previous medical history of any cardiac disease. Surgical intervention was required in 69 patients (44%), and the frequency of surgery during hospital course did not show any difference in Group I versus Group II (44% vs. 45%). Overall mortality was 17%, and did not show any difference in Group I versus Group II. Surgical mortality was 12% (8/69), which was not significantly different form mortality with medical treatment (21%, 18/87). Among 98 survivors in Group I, 84 patients (86%) were followed for average 34+/-24 months (0.5-98 months). Five-year survival and event-free survival rate were 85+/-7 % and 57+/-8 % respectively. CONCLUSION: Recently the mean age of patients with infective endocarditis increased dramatically, and infective endocarditis could be an initial clinical presentation without any previous medical history of cardiac disease in many patients. Surgical intervention was needed in considerable numbers of patients and infective endocarditis still shows relatively high mortality. There were no significant different clinical features in Group I and II.

An Impacted Pancreatic Stone at the Orifice of the Minor Papilla Causing a Bout of Acute Pancreatitis in a Patient with Pancreas Divisum / 대한소화기내시경학회지

Pancreas divisum is the most common congenital anomaly of the pancreas. Whether pancreas divisum is the cause of chronic abdominal pain, acute pancreatitis, or chronic pancreatitis is a matter of controversy yet. We recently experienced a case of acute pancreatitis due to an impacted stone at the orifice of the minor papilla in a 58 year-old man with pancreas divisum who showed clear radiologic evidences of dorsal chronic pancreatitis. The bout of acute pancreatitis recovered rapidly after endoscopic treatment (minor papilla sphincterotomy, stone removal, and endoscopic nasopancreatic drainage). We herein report an unusual manifestation of pancreas divisum in which endoscopic treatment was effective.

A Case of Mucin-Hypersecreting Intrahepatic Bile Duct Tumor Combined with Pancreatic Intraductal Papillary Mucinous Tomor (IPMT) / 대한소화기내시경학회지

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a recently understood unique clinicopathologic disease entity comprising approximately 1% of all exocrine pancreatic tumors and 11% of cystic neoplasms of pancreas. It has been reported worldwide, mostly in Japan. It is generally characterized by recurrent pancreatitis, mucin oozing from the papilla of Vater, and dilated pancreatic duct with intraductal filling defects. Microscopically, the mucin-producing columnar epithelium forms papillary proliferation into the dilated pancreatic duct and this feature differentiates IPMT of the pancreas from the more common mucinous cystic neoplasms of the pancreas which usually do not communicate with the pancreatic duct. On the other hand, mucin-hypersecreting bile duct tumors have been rarely reported in the English literature. We herein present the first case of mucin-hypersecreting bile duct tumor combied with IPMT of the pancreas with a review of the related literature.

A Case of Pancreas Divisum Associated with a Pancreatic Duct Stone and Stricture for which Extracorporeal Shock Wave Lithotripsy was Effective / 대한소화기내시경학회지

A 40-year-old man was presented with recurrent abdominal pain. An ERCP (Endoscopic RETROGRADE Cho-langiopancreatography) revealed complete pancreas divisum and pancreatic duct stricture with a stone. Initially, endoscopic stone removal through the minor papilla origice was unsuccessful due to an impacted pancreatic stone associated with a dominant stricture at the dorsal pancreatic duct. Extracorporeal shock wave lithotripsy (ESWL) was performed twice and the impacted pancreatic stone was fragmented. After ESWL, endoscopic stone removal became possible and pancreatic stenting was performed for the correction of the dorsal duct stricture. This case in herein reported in which ESWL was successful in treating an impacted dorsal pancreatic duct stone associated with pancreas divisum.