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1.
Article in English | WPRIM | ID: wpr-903726

ABSTRACT

Background/Aims@#Hypertension (HT) has a significant impact on public health and medical expenses. However, HT is a chronic disease that requires the long-term follow-up of a large number of patients. @*Methods@#The Korean Hypertension Cohort (KHC) study aimed to develop a model for calculating cardiovascular risk in HT patients by linking and utilizing the detailed clinical and longitudinal data from hospitals and the national health insurance claim database, respectively. This cohort had a planned sample size of over 11,000 HT patients and 100,000 non-HT controls. Eligible patients were hypertensive patients, who were presenting for the first time and were diagnosed with HT as a main disease from 2006 to 2011. Long-term survival data over a period of approximately 9 years were obtained from the national health insurance claim and national health examination data. @*Results@#This cohort enrolled 11,083 patients with HT. The mean age was 58.87 ± 11.5 years, 50.5% were male, and 31.4% were never-treated HT. Of the enrolled patients, 32.9% and 37.7% belonged to the high and moderate cardiovascular risk groups, respectively. Initial blood pressures were 149.4 ± 18.5/88.5 ± 12.5 mmHg. During the 2 years hospital data follow-up period, blood pressures lowered to 130.8 ± 14.1/78.0 ± 9.7 mmHg with 1.9 ± 1.0 tablet doses of antihypertensive medication. Cardiovascular events occurred in 7.5% of the overall patients; 8.5%, 8.8%, and 4.7% in the high, moderate, and low risk patients, respectively. @*Conclusions@#The KHC study has provided important information on the long-term outcomes of HT patients according to the blood pressure, comorbid diseases, medication, and adherence, as well as health behaviors and health resource use.

2.
Article in English | WPRIM | ID: wpr-896022

ABSTRACT

Background/Aims@#Hypertension (HT) has a significant impact on public health and medical expenses. However, HT is a chronic disease that requires the long-term follow-up of a large number of patients. @*Methods@#The Korean Hypertension Cohort (KHC) study aimed to develop a model for calculating cardiovascular risk in HT patients by linking and utilizing the detailed clinical and longitudinal data from hospitals and the national health insurance claim database, respectively. This cohort had a planned sample size of over 11,000 HT patients and 100,000 non-HT controls. Eligible patients were hypertensive patients, who were presenting for the first time and were diagnosed with HT as a main disease from 2006 to 2011. Long-term survival data over a period of approximately 9 years were obtained from the national health insurance claim and national health examination data. @*Results@#This cohort enrolled 11,083 patients with HT. The mean age was 58.87 ± 11.5 years, 50.5% were male, and 31.4% were never-treated HT. Of the enrolled patients, 32.9% and 37.7% belonged to the high and moderate cardiovascular risk groups, respectively. Initial blood pressures were 149.4 ± 18.5/88.5 ± 12.5 mmHg. During the 2 years hospital data follow-up period, blood pressures lowered to 130.8 ± 14.1/78.0 ± 9.7 mmHg with 1.9 ± 1.0 tablet doses of antihypertensive medication. Cardiovascular events occurred in 7.5% of the overall patients; 8.5%, 8.8%, and 4.7% in the high, moderate, and low risk patients, respectively. @*Conclusions@#The KHC study has provided important information on the long-term outcomes of HT patients according to the blood pressure, comorbid diseases, medication, and adherence, as well as health behaviors and health resource use.

3.
Neurointervention ; : 117-123, 2018.
Article in English | WPRIM | ID: wpr-730256

ABSTRACT

PURPOSE: Wide-neck aneurysms (WNAs) associated with a dilated parent artery (PA) are not uncommon morphological abnormalities and usually cause inappropriate wall apposition and incomplete neck coverage of a tubular stent in stent-assisted coiling of aneurysms. We aimed to introduce a fusiform-shaped stent (FSS) and test its effectiveness in treating intracranial WNAs associated with a dilated PA using a three-dimensional (3D) model. MATERIALS AND METHODS: Two FSS types were designed with the middle one-third segment dilated by 10% (FSS10) and 20% (FSS20) and were compared with the tubular-shaped stent (TSS). A patient-specific 3D WNA model was prototyped and produced, and in vitro stent placement was performed. Angiographic images of the three stent types were analyzed and compared using predetermined parameters. RESULTS: The stent lumens were significantly larger in FSS10 and FSS20 than in TSS in the middle segments (P=0.046), particularly FSS20 (P=0.018). The non-covered area at the ostium tended to be smaller in FSS10 and FSS20 than in TSS, but the difference was not significant (P>0.05). The stent length was significantly longer in FSS10 and FSS20 than in TSS. The stent cell size was significantly larger in FSS than in TSS. CONCLUSION: Better vessel wall apposition and aneurysmal neck coverage was observed for FSS than for TSS. No significant difference was observed between FSS10 and FSS20.


Subject(s)
Aneurysm , Arteries , Cell Size , Endovascular Procedures , Humans , In Vitro Techniques , Intracranial Aneurysm , Neck , Parents , Stents
4.
Korean Circulation Journal ; : 441-443, 2014.
Article in English | WPRIM | ID: wpr-149405

ABSTRACT

Although Brucella endocarditis is a rare complication of human brucellosis, it is the main cause of the mortality in this disease. Traditionally, the therapeutic approach to endocarditis caused by Brucella species requires a combination of antimicrobial therapy and valve replacement surgery. In the literature, only a few cases of mitral prosthetic valve endocarditis caused by Brucella species have been successfully treated without reoperation. We present a case of a 42-year-old man with a prosthetic mitral valve infected by Brucella abortus who was cured solely by medical treatment.


Subject(s)
Adult , Brucella , Brucella abortus , Brucellosis , Endocarditis , Heart Valve Prosthesis , Humans , Mitral Valve , Mortality , Reoperation
5.
Article in English | WPRIM | ID: wpr-69680

ABSTRACT

BACKGROUND: We aimed to evaluate the performance of serum cystatin C-based equations in calculating the glomerular filtration rate (GFR) in patients with varying stages of chronic kidney disease (CKD). METHODS: Serum cystatin C and creatinine levels were measured in 615 CKD patients. The CKD stage was determined by the creatinine-based estimated GFR (eGFR) equation using the four-variable abbreviated Modification of Diet in Renal Disease equation suggested by the Kidney Disease Outcome Quality Initiative with the addition of a coefficient applicable to Korean populations (K-aMDRD). In each CKD stage, the ratio of serum cystatin C to creatinine was calculated and six different cystatin C-based equations were used to estimate GFR. Cystatin C-based eGFR and aMDRD eGFR values were compared using the paired t test, Pearson correlation test, and the Bland-Altman plot. RESULTS: The mean age of patients was 53.21+/-14.45 years; of the 615 patients, 346 were male. The serum cystatin C-to-creatinine ratio was inversely correlated with the CKD stage. Compared with the K-aMDRD values, the results of the Hoek, Filler, and Le Bricon's cystatin C-based eGFR equations were lower in CKD Stages 1-3 and higher in Stages 4 and 5. However, the results of the Orebro-cystatin (Gentian) equation [GFR=100/ScytC (mL/minute/1.73m2) - 14] were similar to those of the K-aMDRD equation in CKD Stages 4 and 5 (15.44+/-9.45 vs. 15.17+/-9.05mL/minute/1.73m2, respectively; P=0.722; bias=0.27+/-8.87). CONCLUSION: The eGFRs obtained from the six cystatin C-based equations differed widely. Therefore, further studies are required to determine the most accurate equation to estimate GFR in Koreans with CKD.


Subject(s)
Creatinine , Cystatin C , Diet , Glomerular Filtration Rate , Humans , Kidney Diseases , Male , Renal Insufficiency, Chronic
6.
Article in English | WPRIM | ID: wpr-65821

ABSTRACT

Myocardial revascularization using the left internal thoracic artery (LITA) has become a standard method for coronary artery bypass graft (CABG) surgery due to its long-term graft patency and lower repeated revascularization rate compared to a saphenous vein graft. The prevalence of significant subclavian artery stenosis was reported to be 0.2-6.8% in patients undergoing CABG surgery using LITA. We present a case of 49-year-old female patient who complained of resting chest pain and left arm pain after CABG surgery using the LITA. NSTEMI was caused by de novo subtotal left subclavian artery stenosis proximal to the LITA. The left subclavian artery was successfully stented, and the patient experienced complete relief of pain.


Subject(s)
Arm , Chest Pain , Coronary Artery Bypass , Female , Humans , Mammary Arteries , Middle Aged , Myocardial Infarction , Myocardial Revascularization , Perfusion , Prevalence , Saphenous Vein , Stents , Subclavian Artery , Subclavian Steal Syndrome , Transplants
7.
Article in English | WPRIM | ID: wpr-218656

ABSTRACT

Left atrial (LA) dissection is a rare entity, which is, in most cases, observed after valvular intervention. Transesophageal echocardiography (TEE) is considered to be a modality of choice in the diagnosis of LA dissection. However, LA dissection might be missed clinically in the absence of significant hemodynamic changes, and moreover physicians are occasionally reluctant to perform TEE due to its semi-invasiveness. Recently, cardiac magnetic resonance (CMR) has been introduced as a modality to perform different roles to existing imaging modalities, such as echocardiography. Given that CMR can provide information on tissue characteristics, it may give incremental information to TEE. We here present a rare case of LA dissection following LA myxoma removal, where CMR can make a correct diagnosis and guide management strategy.


Subject(s)
Diagnosis , Diagnosis, Differential , Echocardiography , Echocardiography, Transesophageal , Hematoma , Hemodynamics , Myxoma
8.
Article in English | WPRIM | ID: wpr-169639

ABSTRACT

The authors regret that, in the above article, one of the co-authors' names was incorrectly printed. It is now reproduced correctly above.

9.
Korean Circulation Journal ; : 569-572, 2013.
Article in English | WPRIM | ID: wpr-24537

ABSTRACT

Thiamine (vitamin B1) serves as an important cofactor in body metabolism and energy production. It is related with the biosynthesis of neurotransmitters and the production of substances used in defense against oxidant stress. Thus, a lack of thiamine affects several organ systems, in particular the cardiovascular and nervous system. The cardiac insufficiency caused by thiamine deficiency is known as cardiac beriberi, with this condition resulting from unbalanced nutrition and chronic excessive alcohol intake. Given that the disease is now very rare in developed nations such as Korea, it is frequently missed by cardiologists, with potentially fatal consequences. Herein, we present a case study in order to draw attention to cardiac beriberi. We believe that this case will be helpful for young cardiologists, reminding them of the importance of this forgotten but memorable disease.


Subject(s)
Beriberi , Cardiovascular System , Developed Countries , Korea , Nervous System , Thiamine , Thiamine Deficiency
10.
Article in English | WPRIM | ID: wpr-199429

ABSTRACT

Prosthetic valve thrombosis (PVT) can be a life-threatening complication that requires immediate treatment. We present a case of 57-year-old woman with tricuspid PVT who was definitely diagnosed by multi-detector-row computed tomography limited with echocardiography. The patient was treated successfully with an alternative approach using low molecular weight heparin bridging therapy followed by intensifying anticoagulation alone.


Subject(s)
Echocardiography , Female , Heparin, Low-Molecular-Weight , Humans , Middle Aged , Thrombosis , Tricuspid Valve
11.
Article in English | WPRIM | ID: wpr-56452

ABSTRACT

Takayasu's arteritis is a chronic inflammatory disorder that mainly involves medium to large sized arteries. Although pulmonary artery involvement is reported with a prevalence of about 10% to 50%, its clinical significance is underestimated. We report here one case of Takayasu's arteritis complicated by severe pulmonary hypertension due to right main pulmonary artery total occlusion.


Subject(s)
Arteries , Humans , Hypertension, Pulmonary , Prevalence , Pulmonary Artery , Takayasu Arteritis , Tricuspid Valve Insufficiency
12.
Article in English | WPRIM | ID: wpr-162486

ABSTRACT

Immunoglobulin G4-related sclerosing disease is a novel clinicopathological disease entity known to involve various organs including the pancreas, bile ducts, gall bladder, retroperitoneum, kidney, salivary gland, lung and prostate. The most common organ involved is the pancreas and cases without pancreatic involvement are uncommon. Positive response to steroids is an important characteristic of this disease and this enables early diagnosis, which is required for good prognosis. We demonstrate a case of immunoglobulin G4-related tubulointerstitial nephritis in a 59-year-old male accompanied by sclerosing cholangitis and sialadenitis without any evidence of pancreatic infiltration. The patient was treated with prednisolone and was fully recovered in 6 months.


Subject(s)
Bile Ducts , Cholangitis , Cholangitis, Sclerosing , Early Diagnosis , Humans , Immunoglobulins , Kidney , Lung , Male , Middle Aged , Nephritis, Interstitial , Pancreas , Prednisolone , Prognosis , Prostate , Salivary Glands , Sialadenitis , Steroids , Urinary Bladder
13.
Korean Journal of Medicine ; : 111-115, 2011.
Article in Korean | WPRIM | ID: wpr-131160

ABSTRACT

The Nutcracker syndrome refers to compression of the left renal vein between the aorta and superior mesenteric artery, which results in renal vein and left gonadal vein varices, hematuria, and left flank pain. Here, we report a case of biopsy-proven membranoproliferative glomerulonephritis with radiologically documented Nutcracker syndrome. The patient presented with generalized edema for several months. In order to evaluate isomorphic hematuria, we performed computed tomography (CT), which showed Nutcracker syndrome. A renal biopsy revealedmembranoproliferative glomerulonephritis, Type I. In conclusion, inadults with Nutcracker syndrome that involves severe proteinuria, the possibility of combined glomerulonephritis must be considered.


Subject(s)
Aorta , Biopsy , Edema , Flank Pain , Glomerulonephritis , Glomerulonephritis, Membranoproliferative , Gonads , Hematuria , Humans , Mesenteric Artery, Superior , Proteinuria , Renal Veins , Varicose Veins , Veins
14.
Korean Journal of Medicine ; : 111-115, 2011.
Article in Korean | WPRIM | ID: wpr-131157

ABSTRACT

The Nutcracker syndrome refers to compression of the left renal vein between the aorta and superior mesenteric artery, which results in renal vein and left gonadal vein varices, hematuria, and left flank pain. Here, we report a case of biopsy-proven membranoproliferative glomerulonephritis with radiologically documented Nutcracker syndrome. The patient presented with generalized edema for several months. In order to evaluate isomorphic hematuria, we performed computed tomography (CT), which showed Nutcracker syndrome. A renal biopsy revealedmembranoproliferative glomerulonephritis, Type I. In conclusion, inadults with Nutcracker syndrome that involves severe proteinuria, the possibility of combined glomerulonephritis must be considered.


Subject(s)
Aorta , Biopsy , Edema , Flank Pain , Glomerulonephritis , Glomerulonephritis, Membranoproliferative , Gonads , Hematuria , Humans , Mesenteric Artery, Superior , Proteinuria , Renal Veins , Varicose Veins , Veins
15.
Article in English | WPRIM | ID: wpr-75324

ABSTRACT

BACKGROUND/AIMS: Autologous stem cell transplantation (ASCT) has become the treatment of choice for patients with multiple myeloma (MM). Studies have shown that maintenance treatment with interferon-alpha is associated with improved survival rates following ASCT. However, despite these recent advances in regimes, relapses are inevitable; thus, the prediction of relapse following ASCT requires assessment. METHODS: We retrospectively analyzed 39 patients who received ASCT between 2003 and 2008. All patients received chemotherapy with vincristine, adriamycin, and dexamethasone (VAD), and ASCT was performed following high-dose melphalan conditioning therapy. We evaluated the influence of the post-transplant day +14 (D+14) bone marrow plasma cell percent (BMPCp) (> or = 2 vs. or = 50 vs. or = 50% at diagnosis, CR after 3 cycles of VAD therapy, del (13q) by fluorescence in situ hybridization, and BMPCp > or = 2% at post-transplant D+14 were correlated with PFS and OS. A multivariate analysis revealed that a post-transplant D+14 BMPCp > or = 2% (PFS, hazard ratio [HR] = 4.426, p = 0.008; OS, HR = 3.545, p = 0.038) and CR after 3 cycles of VAD therapy (PFS, HR = 0.072, p = 0.014; OS, HR = 0.055, p = 0.015) were independent prognostic parameters. CONCLUSIONS: Post-transplant D+14 BMPCp is a useful parameter for predicting the outcome for patients with MM receiving ASCT.


Subject(s)
Adult , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow/pathology , Combined Modality Therapy , Female , Hematopoietic Stem Cell Transplantation , Humans , Male , Middle Aged , Multiple Myeloma/mortality , Plasma Cells/pathology , Predictive Value of Tests , Retrospective Studies , Transplantation, Autologous
16.
Article in English | WPRIM | ID: wpr-115524

ABSTRACT

OBJECTIVE: To explore potential relationships between sperm DNA integrity and both semen parameters and clinical outcomes. METHODS: Semen analysis of 498 samples was performed according to the 2010 criteria of the World Health Organization. The sperm DNA fragmentation Index (DFI) of the semen samples was assessed using a neutral comet assay. RESULTS: Sperm DFI showed a significant correlation with semen parameters, including the patient's age, sperm viability, motility, morphology, and number of leukocytes (p or =14% group (44 cycles, 55.3%), but there was no difference in the other clinical outcomes between the two groups. In the > or =14% group, the pregnancy rates of the ICSI cycles (40.0%) and half-ICSI (44.0%) were higher than conventional IVF cycles (30.7%), but the difference was not statistically significant. CONCLUSION: Along with the conventional semen analysis, the sperm DFI assessed using the comet assay was shown to improve the quality of the semen evaluation. To evaluate the precise effect of ICSI on pregnancy rates in the patients who demonstrate high sperm DFI values, further study is necessary.


Subject(s)
Comet Assay , DNA , DNA Fragmentation , Fertilization , Humans , Leukocytes , Pregnancy Rate , Semen , Semen Analysis , Sperm Injections, Intracytoplasmic , Spermatozoa , World Health Organization
17.
Article in Korean | WPRIM | ID: wpr-35465

ABSTRACT

Menetrier's disease is a rare entity characterized by large, tortuous gastric mucosal folds. The mucosal folds in Menetrier's disease are often most prominent in the body and fundus. Histologically, massive foveolar hyperplasia (hyperplasia of surface and glandular mucous cells) is noted, which replaces most of the chief and parietal cells. Profuse mucus is usually observed during the endoscopy but there have been few cases that show interesting endoscopic findings such as mucus bridge or water pearl. Herein, we report a case of Menetrier's disease showing mucus bridge by excessive mucus observed during the endoscopy.


Subject(s)
2-Pyridinylmethylsulfinylbenzimidazoles/therapeutic use , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Clarithromycin/therapeutic use , Drug Therapy, Combination , Gastric Mucosa/pathology , Gastritis, Hypertrophic/diagnosis , Gastroscopy , Helicobacter Infections/diagnosis , Helicobacter pylori , Humans , Male , Middle Aged , Mucus/metabolism , Proton Pump Inhibitors/therapeutic use , Tomography, X-Ray Computed
18.
Article in Korean | WPRIM | ID: wpr-211279

ABSTRACT

Rectal implantation cysts can be caused by continued growth in the submucosa of traumatically misplaced columnar epithelium during previous surgery. Cases of implantation cyst occurring at the site of anastomosis have rarely been reported. Rectal implantation cysts occurring at an anastomosis site after a low anterior resection for rectal cancer need to be distinguished from locally recurrent rectal cancer. Here we present a case of rectal implantation cysts in a patient with rectal cancer who underwent laparoscopic low anterior resection 9 months previously. The diagnosis was made according to the characteristic image findings of endoscopic ultrasonography and enodsocopic ultrasonography-guided fine needle aspiration. This is the first case report of rectal implantation cyst in Korea.


Subject(s)
Biopsy, Fine-Needle , Endosonography , Epithelium , Humans , Korea , Rectal Neoplasms
19.
Korean Journal of Medicine ; : 387-393, 2010.
Article in Korean | WPRIM | ID: wpr-125934

ABSTRACT

BACKGROUND/AIMS: There is an increased risk of tuberculosis (TB) with impaired cellular immunity and extrapulmonary TB is more common in patients with chronic kidney disease. We explored the clinical features and treatment outcomes of extrapulmonary TB according to renal function. METHODS: This retrospective study reviewed the medical records of patients diagnosed with extrapulmonary TB between January 2003 and December 2007. We classified the patients into two groups using the glomerular filtration rate (eGFR), estimated using the Modification of Diet in Renal Disease (MDRD) formula cut-off of 60 mL/min/1.73 m2 and evaluated their clinical features, treatment outcome and mortality (Group I vs. Group II, > or = 60 mL/min/1.73 m2). RESULTS: The mean eGFR of Groups I (n=30) and II (n=312) was 34+/-19 and 102+/-26 mL/min/1.73 m2, respectively. The pleura was the most frequent site of TB in both groups (Group I, 30.0% vs. Group II, 28.2%; p=0.379). There was no treatment failure or recurrence in either group. The mortality was higher in Group I (22.2% vs. 2.8%; p<0.01). In a multivariate analysis, eGFR<60 mL/min/1.73 m2 was an independent risk factor for mortality (HR=11.51, CI 2.512-52.741; p=0.002). CONCLUSIONS: Mortality related to extrapulmonary TB was higher in patients with impaired kidney function and kidney function was an independent predictor. However, there was no difference in treatment failure and recurrence according to renal function.


Subject(s)
Diet , Glomerular Filtration Rate , Humans , Immunity, Cellular , Kidney , Medical Records , Multivariate Analysis , Pleura , Prognosis , Recurrence , Renal Insufficiency, Chronic , Retrospective Studies , Risk Factors , Treatment Failure , Treatment Outcome , Tuberculosis
20.
Article in Korean | WPRIM | ID: wpr-63655

ABSTRACT

PURPOSE: Vascular access failure is the most common reason for hospitalization among hemodialysis (HD) patients. Cilostazol, which has antiplatelet action and vasodialtory effects, significantly reduces the risk of restenosis after percutaneous coronary intervention in many patients. We conducted this study to evaluate the relationship between the use of antiplatelet agents, especially cilostazol, and arteriovenous fistula (AVF) patency in HD patients. METHODS: A total of 241 patients underwent native AVF creation from January 2001 to December 2008. Among these patients, we selected 86 patients excluding 38 patients (15.8%) with primary technical failure, 49 patients without complete data and 68 patients used cilostazol less than 1 month. Demographic characteristics, medication history and fistula failure rate were collected and analyzed to elucidate the effect of cilostazol to native AVF. RESULTS: From all groups, AVF failure occurred in 24 patients (27.9%). 28 patients received cilostazol (62.3 %) and mean duration of cilostazol therapy was 229.5+/-115.7 days. All patients were classified into two groups according to cilostazol (Cilostazol [n=28, 32.6%] vs. non-Cilostazol [n=58, 67.4%]. There was no statisticallly significant difference in failure rate between the two groups (32.1% vs. 25.9%, p=0.543). In diabetes group, patients who received statin have much lower AVF failure rate (0% vs. 32.4%, p=0.024). Logistic regression analysis showed that female was independent risk factor for access failure (HR 5.549, CI 1.104-27.877, p=0.037). CONCLUSION: Cilostazol and other antiplatelet agent had a no significant association with AVF patency. Female was an independent risk factor for access failure.


Subject(s)
Arteriovenous Fistula , Female , Fistula , Hospitalization , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Logistic Models , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors , Renal Dialysis , Risk Factors , Tetrazoles , Vascular Patency
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