Acceptability of Low Intensity Anticoagulation Therapy after Mechanical Heart Valve Replacement / 대한흉부외과학회지

BACKGROUND: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. MATERIAL AND METHOD: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: 47.4+/-15.1): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (MVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. RESULT: The follow-up period was 835.3 patient-years (mean: 5.9+/-3.5) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs (2.16+/-0.23) of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those (2.03+/-0.27) measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). CONCLUSION: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients' compliance should be done for achieving more effective anticoagulation therapy.

Relationship between body fat distribution and atherosclerotic risk factors in Korean populations / 대한내과학회지

BACKGROUND: Obesity is an independent risk factor for the development of coronary artery disease and associated with insulin resistance, hyperlipidemia and hypertension. In many studies, visceral adipose tissue is highly correlated with adverse coronary risk profile. Left ventricular (LV) hypertrophy also is an independent risk factor for cardiovascular mortality and morbidity. However, few data are available concerning the relations of LV hypertrophy to body fat composition, especially in Korean subjects. Therefore, this study was intended to evaluate the relation between body fat distribution and atherosclerotic risk factors including metabolic parameters and LV mass. METHODS: Total 138 subjects who visited the healthy promotion center in Kangbuk Samsung hospital (97 men, 41 women) were to recruited to the study. Body fat distribution was assessed by Abdomial CT (computer tomography) and Bioelectrical impedance analysis (Body Composition Analyzer Inbody 2.0, Biospace, Seoul, Korea) RESULTS: Visceral adipose tissue volume was higher in male subjects while subcutaneous adipose tissue volume and % body fat were higher in female subjects (p<0.05). Serum triglyceride and uric acid level were elevated in male subjects but HDL-cholesterol level was elevated in female subjects (p0.05). Increasing age was correlated with waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio, LV mass (p0.05). Visceral adipose tissue volume was positively correlated with body mass index, waist-hip ratio, blood pressure, total cholesterol, triglyceride, uric acid and negatively correlated with HDL-cholesterol (p0.05). After adjustment for age and sex, this correlation was significantly remained. LV mass was positively correlated with body mass index, waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio (p0.05). In the multiple regression analysis, the independent predictor for LV mass was visceral adipose tissue volume (beta=0.252, p0.05). CONCLUSION: Body fat distribution is associated with traditional cardiovascular risk factors. Especially, visceral adipose tissue is correlated with the components of metabolic syndrome and LV mass which is independent risk factor of cardiovascular morbidity and mortality.

An Observation on the Incidence of Drowning Death in Korea / 예방의학회지

This paper describes the incidence and some epidemiological features of drowning accident out of a series of our study on the epidemiology of various accidents in Korea. By the daily press it is apparent from the frequent reporting of swimming accidents that the incidence would be high. In the rural areas, there are, at present about 1,250 artificial lakes and farm ponds to be utilized for rice production. The reservoirs, irrigation ditches and riversides are also used for recreation. In most places facilities for aquatic activities is meager, and safety measures for the prevention of drowning is not sufficiently enforced. In the survey crude data on drowning were collected from the concerned governmental statistic books for the period 1955 to 1967 which were compiled not in a uniform way. Drowning were classified into two categories, one is accidental drowning, E929 and the other is due to cataclysm, E934, according to the WHO international classification of diseases. Epidemiological variables in relation to drowning accident were obtained through qualitative analysis of informations from the popular newspapers. The following summary may be drawn; 1. The average number of deaths due to accidental drowning totaled 1,088 annually and the mortality rate per 100,000 population was 3.4. The 42.0% of all drowning were rescued and the remaining were not saved. 2. The sex ration(M/F) of the victims for all ages was 5 to 1, which had a wide range of difference among the age groups. The young ages less than 20 years occupied 68.0% of all deaths. 3. The percentage distribution of the causes of accidents revealed 31.9% for careless swimming, 45.5% for unskilled, 16.6% for swimmer's cramp and 6.0% for drunken. The distribution of places where accidents occurred showed 88.0% for rivers, water reservoirs, irrigation ditches and 12.0% for regular swimming pools. The seasonal distribution of cases indicated 85.0% of the total were seen during the summer months, June-August, and 50.0% of them occurred on Sundays. 4. The average annual deaths due to cataclysm were 402 and mortality rate per 100,000 population was 1.6, but the number of victims due to cataclysm varied greatly each year. 5. The accident cases due to cataclysm were classified into 60.0% for injuries, 40.0% for deaths. The 26.8% of all deaths were missing cases. 6. The deaths due to either accidental drowning or cataclysm totaled 1,490, and the death rate per 100,000 for the whole country was 5.0.