Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry

Background and Objectives@#The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. @*Methods@#We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. @*Results@#Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. @*Conclusions@#Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.

Efficacy and Safety of Omega-3 Fatty Acids in Patients Treated with Statins for Residual Hypertriglyceridemia: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia.METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment.RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups.CONCLUSION: The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

Bioequivalence data analysis for the case of separate hospitalization

A bioequivalence study is usually conducted with the same-day drug administration. However, hospitalization is occasionally separated for logistical, operational, or other reasons. Recently, there was a case of separate hospitalization because of difficulties in subject recruitment. This article suggests a better way of bioequivalence data analysis for the case of separate hospitalization. The key features are (1) considering the hospitalization date as a random effect than a fixed effect and 2) using “PROC MIXED” instead of “PROC GLM” to include incomplete subject data.

Hippocampal Atrophy Identified by Volumetric Measurement in Intractable Epilepsy Cases

BACKGROUND: Recurrent seizures result in brain damage, but it is usually gradual, minimal, and difficult to observe by visual inspection of magnetic resonance images (MRIs). It is well known that hippocampal structure is vulnerable to seizure-associated brain damage. We measured the hippocampal volume in patients with epilepsy to evaluate the degree of damage to the hippocampus. METHODS: We recruited 33 patients with epilepsy and 21 healthy subjects from January 2007 to December 2008. We subclassified the patients into two groups: (1) 14 patients with intractable epilepsy and (2) 19 patients with drug-responsive epilepsy. In each group, the volumes of the left and right hippocampus were measured by manual drawing on brain MRIs. We compared the hippocampal volume in intractable epilepsy, drug-responsive epilepsy, and healthy subjects. The compounding effect of hippocampal sclerosis was ruled out by excluding eight patients with hippocampal sclerosis; we then compared the hippocampal volume in the two groups with epilepsy. RESULTS: The volume of the bilateral hippocampus on brain MRIs was smaller in patients with intractable epilepsy than in those with drug-responsive epilepsy and healthy subjects (left, p<0.004; right, p<0.03). After excluding the patients with hippocampal sclerosis by visual inspection, the hippocampal volumes were also found to be smaller in patients with intractable epilepsy than in those with drug-responsive epilepsy (left, p<0.04; right, p<0.05). CONCLUSIONS: While there is no definitive abnormality of the hippocampus on visual inspection of brain MRIs, we determined the degree of hippocampal atrophy and volume loss in patients with intractable epilepsy. Hippocampal volumetry will be helpful for the assessment of brain damage in patients with intractable epilepsy.

Recurrent Vasospasm of Internal Carotid Artery Causing Recurrent Ischemic Stroke

The etiology of ischemic stroke in young adults often remains unclear. Extracranial internal carotid artery (ICA) vasospasm is uncommon and has been reported in only a few cases. We present a case of migrainous headache and recurrent ischemic stroke due to recurrent extracranial ICA vasospasm without evidence of carotid artery dissection or fibromuscular dysplasia.

A Case of Recurrent Cerebral Infarction due to Carotid Compression by a Neurogenic Tumor in the Neck / 대한뇌졸중학회지

A 62-year-old man with a neurogenic tumor in the neck was admitted to our hospital for recurrent ischemic stroke due to carotid occlusion. The magnetic resonance (MR) angiograms revealed the occlusion of the right internal carotid artery (ICA). Arterial compression by the tumor could be considered as the cause of ICA occlusion. Since neurogenic tumors of the neck have significant surgical risks, the patient underwent extracranial-intracranial arterial bypass (EC-IC bypass) surgery. We report a case with recurrent ischemic stroke due to carotid compression by a neurogenic tumor of the neck.

Nutritional Quality of Korean Adults' Consumption of Lunch Prepared at Home, Commercial Places, and Institutions: Analysis of the Data from the 2001 National Health and Nutrition Survey

This study compared the nutritional quality of Korean adults's consumption of lunch prepared at home, commercial places, and institutions. The one day food intake data collected via 24-hour recall in the 2001 National Health and Nutrition Survey were analyzed. Individuals with 19 . 64 years of age were selected (n = 5,756). Sampling weights in the Survey were used to generate nationally representative estimates. Lunch was categorized into three groups according to the place where the lunch was prepared: home, commercial places, and institutions such as schools and work places. Comparison among the three groups was made for 19 . 39 years old men (n = 1,387) and women (n = 1,572) and 40 . 64 years old men (n = 1,364) and women (1,433), respectively. The lunch prepared away from home contained more calories. The lunch prepared commercially was higher in calories percentages from fat than that prepared either at home or at institutions. Across the age and gender groups, lunch prepared at home contribute a high level of sodium intake. Among individuals with 40 . 64 years of age, but not those with 19 . 39 years of age, lunch prepared commercially was as sodium dense as that prepared at home. Among individuals with 19 . 39 years of age, the sodium density of lunch prepared commercially was about the same as that prepared at institutional food service of which the menus were planned by dieticians. Such differences in nutritional quality among meals prepared at home, commercial places, and institutions should be considered and applied for the content development of nutrition education and policy.

DNA Pooling as a Tool for Case-Control Association Studies of Complex Traits

Case-control studies are widely used for disease gene mapping using individual genotyping data. However, analyses of large samples are often impractical due to the expense of individual genotyping. The use of DNA pooling can significantly reduce the number of genotyping reactions required; hence reducing the cost of large-scale case-control association studies. Here, we discuss the design and analysis of DNA pooling genetic association studies.

Urban and rural Differences in the Prevalence of Gender and Age specific Obesity and related Health Behaviors in Korea

The objective of this study was to discuss the residential difference in gender and age specific prevalence of obesity by body mass index (BMI) and obesity related health behaviors in the Republic of Korea. A total of nationally representative 2,583 men and 3,087 women (age: 20-64 yr) was used as subjects from 1998 National Health and Nutrition Survey. All statistics were calculated using SUDAAN to consider a stratified multistage probability sampling design. The prevalence of obesity (BMI> or =25) was significantly different by age, gender and residential areas. Although younger men aged 20-49 yr did not show a residential difference in the prevalence of obesity, men aged 50-64 yr showed differences, highest in big cities and lowest in rural areas. However, in women, a higher prevalence was observed in rural areas compared to urban areas in the younger age group (20-49 yr), but not in the older age group. Residential differences of obesity related health behaviors existed mostly in the older population, but not in the younger population. The urban-rural differences demonstrate the various stages of behavioral transition that Korea is currently undergoing. Therefore, different strategies considering those factors are needed to manage obesity problems in Korea.

A Case of Hyperplastic Gastric Polyposis with Morphological Changes during Short Follow-up Period / 대한소화기내시경학회지

Hyperplastic polyps are often multiple and by far the most frequent lesions among gastric polyps, contributing for about 90% of the polypoid lesions observed in the stomach. However, hyperplastic gastric polyposis is rare and was not exactly evaluated for natural course. These lesions are considered reactive and not genetically determined conditions. So it has been claimed that the hyperplastic polyps and hyperplastic polyposis are non-neoplastic lesions that result from regenerative hyperplastic reaction to inflammation and erosion. Recently we experienced a hyperplastic gastric polyposis with morphological changes during short follow-up period and reported herein.

Prominent Large V Wave in Mitral Stenosis and It's Clinical Significance

BACKGROUND AND OBJECTIVES: Although a prominent large V wave in left atrial pressure tracing (PVLAP) has been reported to be associated with significant mitral regurgitation (MR) or decreased left atrial compliance (LAC), it is sometimes observed in patients with tight mitral stenosis (MS). The purpose of this study was to determine the prevalence and the hemodynamic significance of PVLAP in tight MS. MATERIALS AND METHODS: Catheterization data before percutaneous mitral balloon valvuloplasty (PMV) were analyzed in 84 consecutive patients and PVLAP was defined as V wave 10 mm Hg higher than mean left atrial pressure (MLAP). RESULTS: PVLAP was observed in 45% (38/84) and factors associated with PVLAP were younger age (p=0.02), higher MLAP (p<0.01), higher mitral gradient (p=0.04), smaller valve area (p=0.01) and low echo score (p=0.02): among them MLAP was the only independent factor in multivariate analysis. The presence of PVLAP had no effect on the result of PMV and successful PMV abolished PVLAP. CONCLUSION: PVLAP was observed not infrequently in these selected patients with MS referred for PMV. The presence of PVLAP was not associated with MR and had good correlation with MLAP, which suggest that PVLAP be determined by decreased LAC.

Nonsurgical Treatment for Severe Hemolysis Following Transcatheter Closure of the Patent Ductus Arteriosus Using the Rashkind Umbrella Device / 대한내과학회지

Transcatheter occlusion of the patent ductus arteriosus(PDA) using the Rashkind double umbrella device has become an accepted practice as an effective alternative to surgical ligation in many centers. We experienced three cases of medically refractory severe mechanical hemolysis following transcatheter closure of PDA due to residual shunt. Hemolysis resolved rapidly and completely after deployment of second or more Rashkind umbrellas without surgical correction of the residual shunt. In conclusion, reinsertion of the Rashkind umbrella is a useful modality for treatment of severe hemolysis developed after transcatheter closure of the PDA.

Effect of Patient Position with Spinal Anesthesia on the Heart Rate, Arterial Blood Pressure and Arterial Blood Gas Change / 대한마취과학회지

BACKGROUND: Anorectal procedures are performed in the prone jack-knife or lithotomy position. The effect of lithotomy and prone jack-knife position on the heart rate, arterial blood pressure and arterial blood gas has not been compaired. METHODS: 39 consecutive patients who underwent surgery for anorectal disease were performed saddle block. They were randomly classified into two groups: prone jack-knife position(J; n=19) and lithotomy position(L; n=20); patients with cardiovascular disease were excluded. The two groups were well matched for age, gender, weight and height. After spinal anesthesia, heart rate(HR), blood pressure(BP), and arterial blood gases(ABG) including pH, PaO2, PaCO2, HCO3- were measured in the supine position to establish a base line. After position change to either jack-knife or lithotomy, HR, BP(systolic, mean and diastolic) at 10, 20, and 30 minutes and ABG at 20minutes were measured again in each group. The two groups were then compared and any changes were recorded. Premedication was not perfomed in both group. Statistical analysis was performed by Mann-Whitney U test; significance was set at P <0.05. RESULTS: There were no differences between the two groups in terms of baseline HR, BP and ABG. However, HR at 10, 20 and 30 minutes after position change in the L group were increased compared with those of J group(deltaHR (number/minute) at 10 minutes: +3.2+/-7.0(L) versus - 2.8+/-4.9(J), P <0.05, 20 minutes: +5.6+/-7.4(L) versus - 1.8+/-5.2(J), P <0.05, 30 minutes: +6.4+/-8.4(L) versus - 1.2+/-6.0(J), p <0.05), and systolic BP at 30 minutes was increased in the J group(deltaBP: +4.0+/-9.0 mmHg(L) versus +10.1+/-9.9 mmHg(J), p <0.05). 3 patients in the J, and 2 in the L group had complaint of headache and/or upper arm discomfort. CONCLUSION: HR was increased in the lithotomy position, systolic BP at 30 minutes after position change was increased in the J group. But the differences were not so significant clinically. Another parameters were no differences between the two groups. Therefore there is no supiriority in lithotomy or jack-knife position on HR, BP and ABG when anorectal procedure is undergone under spinal anesthesia.

Fat Embolism after Bilateral Total Knee Replacement Arthroplasty: A case report / 대한마취과학회지

Fat embolism is a significant complication following total joint arthroplasty. Fat embolism syndrome has both pulmonary and neurologic manifestations that can be life threatening. But, with appropriate fluid management, adequate ventilation, and the prevention of hypoxemia, outcome is usually excellent. We experienced fat embolism following bilateral total knee replacement. A 65-year-old woman had a surgery under general anesthesia. There was no specific anesthetic problems during the operation. After bilateral tourniquet release, O2 saturation decreased to 85% and neurologic symptom was developed. With adequate supportive treatment including mechanical ventilation, she was cured without complication.

We Anesthetized a Patient with Unexpected Pheochromocytoma, Diagnosed during Operation: 1 case report / 대한마취과학회지

Pheochromocytoma is a tumor which secretes catecholamine and produces remarkable hemodynamic changes during the perioperative period. It is reported that in cases where a patient with undiagnosed pheochromocytoma is operated on, the mortality rate can reach 25% to 50%. The subject in this study was a 55-year-old female patient who was diagnosed having a retroperitoneal mass which looked like a neurogenic tumor. During the manipulation, serious hypertension and tachycardia were developed. The authors at that time suspected a pheochromocytoma, interrupted the operation, and after insertion of arterial line and sodium nitroprusside infusion, the rest of the operation was restarted. After the extirpation of the tumor, as the patient suffered serious hypotension, the concentration of the inhalation agent was reduced, ephedrine was injected, the proper amount of fluid and blood were administered, and, as a result, the operation was carried out safely, and postoperative course was unremarkable.

A case of free-floating left atrial ball thrombus in mitral stenosis / 영남의대학술지

A free-floating ball thrombus in the left atrium is a rare complication of the mitral valvular disease. A 53-year-old man was admitted for pain and paresthesia on both legs. On admission he had auscultatory sign of mitral stenosis and mitral regurgitation, and the roentgenogram of his chest revealed a slight pulmonary ve..ous congestion, enlargement of the pulmonary conus and cardiomegaly. Laboratory findings including complete blood counts, coagulation studies and blood chemistry were normal. An echocardiographic examination revealed a mitral stenosis and a free-floating ball thrombus in the left atrium. We performed the emergent open heart surgery for removal of the ball thrombus and mitral replacement successfuly with Duromedics 29 mm valve. The size of thrombus was 39 X 32 X 30 mm.

Comparision of signal - averaged electrocardiography (SAECG) determined by flank lead system (FLS) and pyramidal lead system (PLS) in healthy young adults / 영남의대학술지

It has recently become possible to record electrical activity originationg from abnormally conducting myocardium from the body surface with high-gain amplification and averaging technique. These signals, which result from delayed ventricular activation(late potentials), have been recorded in patients with documented ventricular tachyarrythmia. Several electrode lead system for detecting ventricular late potential were introduced. Pyramidal electrode lead system(PLS) is useful. Also interpretation of SAECG in the young could be of value in detecting those at risk for episodic ventricular tachycardia, but suffer from a lack of data in normal young people. There was no difference between normal values, determined by FLS and PLS at high pass filtering of 25 Hz and 80 Hz, but significant, difference was found in HFLAD and RMS-40 of 40 Hz (p<0.05). These results will provide a basis for interpretations of SAECG, determined by FLS and PLS in healthy young adults with normal QRS duration. SELECTION OF SUBJECTS: For this study, normal healthy young adult volunteers (age : mean 24 years) were recruited from the medical students at Yeungnam University Hospital, Internal Medicine. Twenty fourths male and seventeenths female subjects were selected. All subjects had normal resting ECGs as judged from both the standard 12 channel lead and echocardiography, and none had a history of cardiovascular disease. All subjects were considered to be in good general physical condition. SIGNAL-AVERAGED ELECTROCARDIOGRAPHY: In order to obtain low noise recordings with a small number of averaging cycles, all subject ware asked to relax completely in the supine position. Silver/silver chloride electrodes were attached after the skin was cleaned with alcohol, to constitute classic flank lead system(FLS) and pyramidal lead system(PLS). Signals were recorded and processed using a commercially available microprocessor-augmented ECG cart(Marquette Electronics, USA) suitable for portable bedside recording.

Evaluation of left artial appendage function by transesophageal echocardiography

No abstract available.

A case of pseudomelanosis duodeni associated with chronic renal failure / 대한내과학회지

No abstract available.

Circadian Variation of Transient Myocardial Ischemia

BACKGROUND: Quyyumi et al described circadian variation of ischemic eletrocardio-graphic changes and heart rate in patients with and without significant coronary disease in 1985. Rocco et al also described circadian variation of transient myocaldial ischemia in patients with coronary artery disease. They also noted an increse in ischemic eletrocardiographic abnormalities in the morning hours.In recent years the important of circadian variation of cardiovascular phenomena has generated a great deal of interest. Such phonomena include the occurrence of ischemia in patients with both chronic stable angina and variant angina, myocaldial infarction, sudden cardiac death, ventricular arrhythmia and platelet aggregability. METHOD: To examine whether a significant circadain variation of transient myocardial ischemia exists and to better understand the character of such variation, 35 patients with againa pectoris(15 patients treated with nitrate and/or caclcum channel blocker and 20 patients without treatment) underwent 24 hours ambulatory monitoring of ischemic ST segment changes during daily life. RESULT: Only 21% of the episodes of ST depression were accompanied by chest pain. While 79% were asymptomatic. A significant circadian increase in ischemic activity was found with 44% of episodes and 40% of total ischemic time in not treated group, and 52% of episodes and 56% of total ischemic time in treated group, occuring between 6 A.M. to 12 P.M.(P<0.05 respectively) When the distribution of ischemic episodes was corrected for the variable time of waking, the peak ischemic activity was occuring in the 1st and 2nd hours after rising. There were no significant differences in heart rate at onset and heart rate at 1 min before onset. CONCLUSION: Is summary, transient myocardial ischemia in the absence of pain was more common and there were a significant circadian variation of transient myocardial ischemia with peak activity in the morning. In addition most of transient myocardial were not preceded by a rise in heart rate.