The Comparison of the Associations of Lipoprotein(a) and the Atherogenic Index of Plasma With Coronary Artery Calcification in Patients Without High LDL-C: A Comparative Analysis

Objective@#Lipoprotein(a) (Lp[a]) and the atherogenic index of plasma (AIP) have been reported as predictive markers of coronary artery calcium (CAC). However, previous studies demonstrated that the cardiovascular risk associations with Lp(a) are attenuated in patients with low-density lipoprotein cholesterol (LDL-C) levels ≤135 mg/dL. However, few articles have identified the risk factors of CAC in patients without high LDL-C. Therefore, we performed this study to investigate the association of Lp(a) and AIP with CAC in patients with LDL-C levels ≤135 mg/dL. @*Methods@#This study included 625 lipid-lowering agent naive patients with LDL-C levels ≤135 mg/dL who underwent coronary computed tomographic angiography. We performed multivariate logistic regression analysis to evaluate the risk factors for a coronary artery calcium score (CACS) >0, CACS ≥400, and CAC ≥90th percentile. @*Results@#The mean age of the patients was 55.0±7.9 years and their mean LDL-C level was 94.7 ±23.3 mg/dL. Multivariate regression analysis showed that age, male sex, diabetes, hypertension, Lp(a), and AIP were independent predictors of CAS>0. Age, male sex, and diabetes were independent predictors of CACS≥400. Diabetes, hypertension, and AIP were independent predictors of CAC ≥90th percentile (all p<0.05). Unlike Lp(a), higher AIP tertiles were associated with significantly higher CAC percentiles and greater proportions of patients with CACS ≥400 and CAC ≥90th percentile. @*Conclusion@#In patients without high LDL-C, AIP could be a more reliable predictor of CAC than Lp(a).

Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

Background@#To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in theAsian population at mid-term follow-up. @*Methods@#From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with minimum 2 years follow-up were enrolled. We evaluated the clinical and radiological outcomes, and complications at the last follow-up. In addition, we dividedthese patients into notching and no-notching groups and compared the demographics, preoperative, and postoperative characteristics ofpatients. @*Results@#Visual analogue scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles Shoulder Scale, and SimpleShoulder Test scores improved significantly from preoperative (5.00, 3.93, 1.72, 3.94) to postoperative (1.72, 78.91, 28.34, 7.66) (p<0.05)outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft waswell-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20 of 38 patients (53%). In thecomparison between notching and no-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications included three metaphyseal fractures and one inferior screw malposition. Postoperative complications included ectopic ossification, scapular neckstress fracture, humeral stem relaxation, and late infection in one case each. @*Conclusions@#BIO-RSA showed improved clinical outcomes at mid-term follow-up in Asian population. However, we observed higherscapular notching compared to the previous studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (ATdistance) might reduce scapular notching.

Mid-term outcomes of bony increased offset-reverse total shoulder arthroplasty in the Asian population

Background@#To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in theAsian population at mid-term follow-up. @*Methods@#From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with minimum 2 years follow-up were enrolled. We evaluated the clinical and radiological outcomes, and complications at the last follow-up. In addition, we dividedthese patients into notching and no-notching groups and compared the demographics, preoperative, and postoperative characteristics ofpatients. @*Results@#Visual analogue scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles Shoulder Scale, and SimpleShoulder Test scores improved significantly from preoperative (5.00, 3.93, 1.72, 3.94) to postoperative (1.72, 78.91, 28.34, 7.66) (p<0.05)outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft waswell-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20 of 38 patients (53%). In thecomparison between notching and no-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications included three metaphyseal fractures and one inferior screw malposition. Postoperative complications included ectopic ossification, scapular neckstress fracture, humeral stem relaxation, and late infection in one case each. @*Conclusions@#BIO-RSA showed improved clinical outcomes at mid-term follow-up in Asian population. However, we observed higherscapular notching compared to the previous studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (ATdistance) might reduce scapular notching.

Isolated calcific tendinitis at the posterosuperior labrum: a rare case study

Calcific tendinitis of the shoulder joint, also known as chemical furuncle of the shoulder, causes intense shoulder pain and usually occurs within 1–2 cm from the insertion of the rotator cuff. We experienced a rare case of calcific tendinitis in the posterosuperior labrum of the shoulder joint in a 39-year-old male patient who presented with severe pain and weakness in the right shoulder. Radiographs and magnetic resonance imaging (MRI) findings showed calcific tendinitis in the posterosuperior labrum of the shoulder joint. A 1-week attempt at conservative treatment failed, so the calcified deposit in the posterosuperior labrum was arthroscopically removed. The patient’s symptoms were completely relieved, and satisfactory clinical outcomes were achieved. Postoperative follow-up X-ray and MRI showed no recurrence of calcific tendinitis.

Isolated calcific tendinitis at the posterosuperior labrum: a rare case study

Calcific tendinitis of the shoulder joint, also known as chemical furuncle of the shoulder, causes intense shoulder pain and usually occurs within 1–2 cm from the insertion of the rotator cuff. We experienced a rare case of calcific tendinitis in the posterosuperior labrum of the shoulder joint in a 39-year-old male patient who presented with severe pain and weakness in the right shoulder. Radiographs and magnetic resonance imaging (MRI) findings showed calcific tendinitis in the posterosuperior labrum of the shoulder joint. A 1-week attempt at conservative treatment failed, so the calcified deposit in the posterosuperior labrum was arthroscopically removed. The patient’s symptoms were completely relieved, and satisfactory clinical outcomes were achieved. Postoperative follow-up X-ray and MRI showed no recurrence of calcific tendinitis.

A Rare Cause of Spontaneous Echo Contrast in Echocardiography

No abstract available.

Serum levels of carbohydrate antigen 125 in combination with N-terminal pro-brain natriuretic peptide in patients with acute decompensated heart failure

BACKGROUND/AIMS@#Carbohydrate antigen 125 (CA-125) is an emerging prognostic biomarker for heart failure. We aimed to test the long-term prognostic value of CA-125 in combination with N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute decompensated heart failure (ADHF).@*METHODS@#This observational study included a total of 413 patients (64.1 ± 15.6 year-old, 214 men) with ADHF. All-cause mortality during the 2-year follow-up was investigated for the prognosis.@*RESULTS@#During the follow-up (mean follow-up, 591 ± 233 days), 109 deaths (26.0%) were recorded. In the multivariable analysis model, CA-125 was an independent factor associated with all-cause mortality (log CA-125: hazard ratio, 1.23; 95% confidence interval, 1.02 to 1.48; p = 0.030) together with age, sex, New York Heart Association class, β-blocker, and NT-proBNP. The Kaplan-Meier survival analysis demonstrated that the group with both low marker levels showed the best 2-year survival (87.9%) followed by the group with low NT-proBNP and high CA-125 (76.1%), high NT-proBNP and low CA-125 (64.7%) and high NT-proBNP and high CA-125 levels (54.3%) (p < 0.001). Addition of CA-125 in combination with NT-proBNP and established risk factors further increased the predictive power for mortality in patients with ADHF.@*CONCLUSIONS@#CA-125 was an independent factor associated with all-cause mortality in patients with ADHF. Combination of CA-125 with NT-proBNP significantly improved the prediction of mortality in patients with ADHF.

Serum Levels of PCSK9 Are Associated with Coronary Angiographic Severity in Patients with Acute Coronary Syndrome

BACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a circulating protein that promotes degradation of the low density lipoprotein receptor. PCSK9 has emerged as a target for lipid-lowering therapy, but the predictive value of the serum level of PCSK9 for the severity of coronary disease is largely unknown. METHODS: From December 2009 to July 2012, 121 individuals who underwent coronary angiography (CAG) because of clinically suspected acute coronary syndrome were enrolled in this study. Serum levels of PCSK9 and metabolic parameters were measured. SYNTAX (SYNergy between percutaneous coronary intervention with [paclitaxel-eluting] TAXUS stent and cardiac surgery) and GRACE (Global Registry of Acute Coronary Events) scores were calculated. RESULTS: Individuals with CAG lesions (n=100) had significantly higher levels of PCSK9 than those without lesions (n=21). The study population was stratified into three groups according to serum levels of PCSK9. The odds radio for occurrence of one or more CAG lesions was significantly higher in the group with the highest level of PCSK9 (odds ratio, 7.468; P=0.011) than in the group with the lowest level of PCSK9. Serum PCSK9 was positively associated with the number of involved coronary arteries. Multivariable linear regression indicated that levels of PCSK9 were positively correlated with GRACE risk scores and SYNTAX scores. CONCLUSION: Serum PCSK9 concentrations are higher in patients with coronary artery lesions, and are associated with SYNTAX and GRACE scores, suggesting that PCSK9 is a potential biomarker of the severity of coronary artery disease.

Relationship between Circulating FGF21 Concentrations and the Severity of Coronary Artery Damage in Subjects with Cardiovascular Disease

OBJECTIVE: Fibroblast growth factor (FGF) 21 is a recently established therapeutic target for treating metabolic syndromes, which include potential precursors to cardiovascular disease, suggesting a link between FGF21 and atherosclerosis. However, the association between serum FGF21 concentrations and coronary artery disease remain controversial. The aim of this study is to evaluate the association between circulating FGF21 concentrations and coronary artery lesions and clinical severity. METHODS: We enrolled 137 subjects who underwent coronary angiography, due to suspected acute coronary syndrome (ACS), from December 2009 to July 2012. Serum FGF21 levels were measured. Coronary artery lesions and clinical severities of the subjects were evaluated using the SYNergy between percutaneous coronary intervention with (paclitaxel-eluting) TAXus stent and cardiac surgery (SYNTAX) and Global Registry of Acute Coronary Events (GRACE) scoring system, respectively. RESULTS: After adjusting for established cardiovascular disease risk factors, including age, body mass index, total cholesterol, and low-density lipoprotein cholesterol, patients with coronary artery lesions (n=112 men) had significantly higher levels of FGF21 than individuals without such lesions (n=25; men) (377.1±20.1 pg/mL vs. 267.1±43.5 pg/mL; p=0.026). However, no correlations were found between serum levels of FGF21 and either the calculated STNTAX score (r=0.117; p=0.176) or GRACE risk score, which is a risk prediction tool applicable for ACS subjects (r=0.113; p=0.193). CONCLUSION: Although serum levels of FGF21 were higher in individuals with coronary lesions than in those without such lesions, FGF21 levels were not associated with angiographic severity.

A Hypereosinophilic Syndrome with Cardiac Involvement from Thrombotic Stage to Fibrotic Stage

Cardiac involvement is a major cause of morbidity and mortality in hypereosinophilic syndrome (HES). It is classified into 3 stages by the degree of eosinophils-mediated heart injury; acute necrotic stage, thrombotic stage, and fibrotic stage. Nonetheless, definitive evidence that each patient passes sequentially through these stages is lacking. We present a case of 48-year-old male patient with dyspnea and peripheral edema who underwent valve replacement surgery due to severe mitral regurgitation. After the valve replacement, HES with cardiac involvement in the thrombotic stage was diagnosed. In the follow-up study, the patient progressed into fibrotic stage of HES.

Case of Recurrent Ventricular Fibrillations with Osborn Wave Developed during Therapeutic Hypothermia

Therapeutic hypothermia (TH) has been used to protect neurological functions in cardiac arrest patient. Although Osborn wave is not pathognomonic of hypothermia, it is a well-known electrocardiogram finding of hypothermic patients. The cellular and ionic mechanisms of the Osborn wave have been suggested, and its relationship to tachyarrhythmias, such as ventricular tachycardia and ventricular fibrillation, is being explored. This case highlights the arrhythmogenic potential of Osborn wave and individual difference in response of TH.

A Case of Thymic Carcinoma Misdiagnosed as Epipericardial Fat Necrosis / 대한내과학회지

Epipericardial fat necrosis (EPFN) is an uncommon benign condition of unknown etiology. It presents as an unexplained acute severe pleuritic chest pain that is associated with the presence of a well-defined juxtacardiac mass usually located in or near the cardiophrenic angle. Although its typical clinical manifestations and chest computed tomography findings might lead to successful diagnosis of this rare disease, an unusual mass location such as the anterosuperior mediastinum should be considered and biopsies should be performed. We herein report a case of thymic carcinoma that was suspected initially to be EPFN.

A Case of Portal Vein and Splenic Vein Occlusion after Endoscopic Variceal Occlusion Therapy in Gastric Variceal Bleeding / 계명의대학술지

Acute gastric variceal bleeding is one of the most serious complications in portal hypertension, and is associated with high mortality and morbidity. Endoscopic variceal obturation (EVO) using Histoacryl(R) (n-butyl-2-cyanoacrylate) has been accepted as an effective hemostatic procedure in acute gastric variceal bleeding. However, EVO is not a widely performed because of technical difficulties and complications such as mucosal ulceration, perforation, and systemic embolism. Herein, we report a patient who developed hepatic failure caused by portal vein occlusion by Histoacryl(R) injection for management of gastric variceal bleeding.

Recurrent Syncope Episodes and Exercise Intolerance in Hypertrophic Cardiomyopathy Combined with Atrioventricular Conduction Disturbance

A 30-year-old female patient with known hypertrophic cardiomyopathy (HCMP) was admitted for recurrent syncope episodes. Electrocardiogram (ECG) showed 2 : 1 atrioventricular (AV) block. Stress echocardiography with bicycle showed high grade AV block at high stage of the exercise associated with exercise intolerance and dyspnea. Twenty-four hour ECG monitoring also revealed high grade AV block and 1 episode of non-sustained ventricular tachycardia. Implantable cardioverter/defibrillator-pacemaker (ICD-P) was inserted. After implantation of ICD-P, conduction disturbance and exercise intolerance were improved. AV block is a rare complication HCMP. There are just a few case reports that present symptoms caused by conduction disturbance in HCMP. This case describes repeated syncope episodes and exercise intolerance caused by conduction disturbance during exercise in HCMP patient. For evaluating the cause of syncope in HCMP, stress echocardiography can be helpful to understand the probable mechanism of syncope.

Corneal Abrasion Occurred during Transconjunctival Blepharoplasty in a Patient with History of LASIK Operation

PURPOSE: LASIK, one of the currently popular ophthalmic procedures, can sometimes result in dry eye symptoms. In the patient who had underwent LASIK operation, the periorbital surgery may be more likely to lead to such a complication as dry eye symptom. We would like to report a case of corneal abrasion occurred after transconjunctival blepharoplasty in post-LASIK state and suggest the method about preventing the complication. METHODS: A 30-year-old female patient underwent transconjunctival blepharoplasty and microfat graft into the face. She had history of LASIK operation 2 years ago. Corneal protector was applied to both eye during transconjunctival operation. After the surgery, she complained of visual blurring at left side. Ophthalmic examination revealed corneal abrasion of left eye. RESULTS: Cornea protecting lens was applied to left eye for 2 weeks. Steroid and antibiotic eye drops were applied for relieving the symptoms and the prevention from progressing of complication. After 1 week, visual power and acuity was recovered to preoperative state. No other specific complications happened. CONCLUSION: Post-LASIK patient may have possibility of decreased corneal sensation and tear production. Preoperative ophthalmic examination is recommended for the prevention of complication. When corneal protector is applied, we suggest Optagel(R) as a useful lubricant.

Overview of Filler: Compositions, Effects, Rheological Consideration

As increasing demands for facial soft tissue augmentation by injection and minimal invasive procedures, filler has become increasingly popular and a suitable method for patients' demands. Over several decades, many filler products have been introduced. Successful clinical application of filler products requires a thorough understanding of their compositions, effects, and rheology. This study reviewed filler products according to the classification of effect duration: permanent, semipermanent, temporary.

Transconjunctival Subperiosteal Septal Reset for the Correction of Orbital Fat Bulging and Tear Trough

Transconjunctival lower blepharoplasty has gained interest because of less-invasiveness and fast recovery. This is a study about operative skill, strength, and weakness of transconjunctival lower blepharoplasty and a trial for suggesting the guidelines for patient selection. The authors reviewed the medical records and photographs of 530 patients(M:F=470:60) who underwent transconjunctival lower blepharoplasty with orbital fat reposition and subperiosteal septal reset, retrospectively. Most of the patients were satisfied with results for correction of orbital fat bulging and tear trough deformity. Eighteen patients(3.4%) developed relapse of fat bulging requiring revision with subsequent fat removal(seventeen patients) or fat reposition(one patient). Two patient(0.4%) developed entropion. One case was corrected with revisional surgery and the other case was recovered after an injection of triamcinolone. Delayed hematoma was developed in five patients. Surgical evacuation was required in 3 cases. Minor problems included postoperative swelling, bruise, and transient paresthesia that resolved spontaneously. Transconjunctival lower blepharoplasty is an excellent surgical choice for correction of orbital fat bulging and tear trough in the patients who have proper tension of soft tissue. Invisible scar, fast recovery, and low complication rate are merits of this method.

Strategy for the Treatment of Infraorbital Dark Circles

Infraorbital dark circles refer to the darkness of lower eyelids and can be a significant cosmetic problem for the people of any age and sex. Although the general concern for dark circles is increasing, little has been published about the treatment of dark circles in the scientific literature. Dark circles are not a single disease but combination of causative symptoms. We classified patients to five groups according to patients' symptoms; bulging of infraorbital fat(Ia), sunken lower eyelids(Ib), depression or groove on midface(Ic), thin translucent skin(IIa), and excessive pigmentation(IIb). We reviewed medical records and photographs of patients retrospectively. The classification of patients and the treatment of the groups were evaluated. Problems of shape, especially bulging of infraorbital fat was the main cause of dark circles in most patients(65.2%). The treatment of each group included transconjunctival fat reposition or removal(Ia), single fat cell graft(Ib,IIa), microfat graft(Ic), and various dermatologic therapies(IIb). We obtained better results when we did combination of the treatments according to symptomatic groups.

Removal of Microfat Graft in Lower Eyelid with Transconjunctival Approach

PURPOSE: Microfat graft is a common procedure for correcting tear trough deformity and dark circle. Because the tissue in this area is very thin, the grafted fat, sometimes, induces palpable lumps and uneven skin contour. When it happens, the surgical removal of the grafted fat is often needed. The authors made attempt of transconjunctival approach for removal, and this made infraorbital fat repositioning possible at the same time. METHODS: 15 female patients with history of microfat graft on lower eyelid, got operation for the grafted fat removal with transconjunctival approach from April of 2009 to July of 2010. The dissection was performed in accordance with infraorbital fat repositioning surgery. Through the transconjunctival incision, knotted fat on orbital septum and orbicularis oculi muscle was removed without damage on skin. After grafted fat removal, subperiosteal space was made 1~2mm below the inferior orbital rim by elevating periosteum. With preserving orbital septum, infraorbital fat was repositioned and anchored to subperiosteal space. Finally, transconjunctival incision was closed with absorbable suture material. RESULTS: 14 patients in the study showed satisfactory results. The problems like uneven skin contour and knotted fat mass, were all solved. In only one patient, incomplete correction was observed, as bulging on her right lower eyelid still remained. One patient complained of transient numbness on lower eyelid, but there was no specific complication other than this. CONCLUSION: The authors attempted the method of transconjunctival approach to remove former grafted fat in lower eyelid and reposition infraorbital fat simultaneously. Since the study brought great results, the method would be helpful to patients and surgeons.

The Relationship between Socioeconomical Status and Incidence of Facial Bone Fracture

PURPOSE: The human face is the most exposed part of the body, and in patients with simple or complex trauma from traffic accidents, industrial calamities, sports injuries, human assaults, and daily accidents, facial trauma occupies an important portion. The etiology of facial trauma vary on a society's economic, cultural, and environmental status. METHODS: Regarding patients who were admitted from between the years 2000 to 2009 at the Hanyang University hospital, the authors studied how the changes in the economic status in the past 10 years of our country influences the incidence of facial bone fractures. RESULTS: In this study, 1) The unemployment rate showed a strong negative relationship with the total number of inpatients with facial bone fractures, the number of male patients, the number of female patients, the number of patients with facial bone fractures caused by fall down, the number of patients who were admitted for shorter than 7 days, and the number of the facial bone fracture patients with their age in the twenties. 2) The consumer price index showed a strong positive relationship with the number of female patients, the number of patients who were admitted for shorter than 7 days, and the number of the facial bone fracture patients with their age in the teens and fifties. CONCLUSION: Looking at the results of correlation analysis and multiple regression analysis with economic indicators, the unemployment rate showed negative influence to the total number of inpatients with facial bone fractures, and the number of inpatients with facial bone fractures caused by fall down, with statistical significance.