Medical Resource Consumption and Quality of Life in Peripheral Arterial Disease in Korea: PAD Outcomes (PADO) Research

BACKGROUND AND OBJECTIVES: We aimed to investigate the history of medical resource consumption and quality of life (QoL) in peripheral arterial disease (PAD) patients in Korea. METHODS: This was a prospective, multi-center (23 tertiary-hospitals, division of cardiology), non-interventional study. Adult patients (age ≥20 years) suffering from PAD for the last 12-month were enrolled in the study if they met with any of following; 1) ankle-brachial index (ABI) ≤0.9, 2) lower-extremity artery stenosis on computed tomography angiography ≥50%, or 3) peak-systolic-velocity-ratio (PSVR) on ultrasound ≥2.0. Medical chart review was used to assess patient characteristics/treatment patterns while the history of medical resource consumption and QoL data were collected using a patient survey. QoL was measured using EuroQoL-5-dimensions-3-level (EQ-5D-3L) score system, and the factors associated with QoL were analyzed using multiple linear regression analysis. RESULTS: This study included 1,260 patients (age: 69.8 years, male: 77.0%). The most prevalent comorbidities were hypertension (74.8%), hyperlipidemia (51.0%) and diabetes-mellitus (50.2%). The 94.1% of the patients took pharmacotherapy including aspirin (76.2%), clopidogrel (53.3%), and cilostazol (33.6%). The 12.6% of the patients were receiving smoking cessation education/pharmacotherapy. A considerable number of patients (500 patients, 40.0%) had visit history to another hospital before diagnosis/treatment at the current hospital, with visits to orthopedic units (50.4%) being the most common. At the time, 29% (or higher) of the patients were already experiencing symptoms of critical limb ischemia. Baseline EQ-5D index and EQ VAS were 0.64±0.24 and 67.49±18.29. Factors significantly associated with QoL were pharmacotherapy (B=0.05053; p=0.044) compared to no pharmacotherapy, and Fontaine stage improvement/maintain stage I (B=0.04448; p < 0.001) compared to deterioration/maintain stage II–IV. CONCLUSIONS: Increase in disease awareness for earlier diagnosis and provision of adequate pharmacotherapy is essential to reduce disease burden and improve QoL of Korean PAD patients.

Medical Resource Consumption and Quality of Life in Peripheral Arterial Disease in Korea: PAD Outcomes (PADO) Research

BACKGROUND AND OBJECTIVES@#We aimed to investigate the history of medical resource consumption and quality of life (QoL) in peripheral arterial disease (PAD) patients in Korea.@*METHODS@#This was a prospective, multi-center (23 tertiary-hospitals, division of cardiology), non-interventional study. Adult patients (age ≥20 years) suffering from PAD for the last 12-month were enrolled in the study if they met with any of following; 1) ankle-brachial index (ABI) ≤0.9, 2) lower-extremity artery stenosis on computed tomography angiography ≥50%, or 3) peak-systolic-velocity-ratio (PSVR) on ultrasound ≥2.0. Medical chart review was used to assess patient characteristics/treatment patterns while the history of medical resource consumption and QoL data were collected using a patient survey. QoL was measured using EuroQoL-5-dimensions-3-level (EQ-5D-3L) score system, and the factors associated with QoL were analyzed using multiple linear regression analysis.@*RESULTS@#This study included 1,260 patients (age: 69.8 years, male: 77.0%). The most prevalent comorbidities were hypertension (74.8%), hyperlipidemia (51.0%) and diabetes-mellitus (50.2%). The 94.1% of the patients took pharmacotherapy including aspirin (76.2%), clopidogrel (53.3%), and cilostazol (33.6%). The 12.6% of the patients were receiving smoking cessation education/pharmacotherapy. A considerable number of patients (500 patients, 40.0%) had visit history to another hospital before diagnosis/treatment at the current hospital, with visits to orthopedic units (50.4%) being the most common. At the time, 29% (or higher) of the patients were already experiencing symptoms of critical limb ischemia. Baseline EQ-5D index and EQ VAS were 0.64±0.24 and 67.49±18.29. Factors significantly associated with QoL were pharmacotherapy (B=0.05053; p=0.044) compared to no pharmacotherapy, and Fontaine stage improvement/maintain stage I (B=0.04448; p < 0.001) compared to deterioration/maintain stage II–IV.@*CONCLUSIONS@#Increase in disease awareness for earlier diagnosis and provision of adequate pharmacotherapy is essential to reduce disease burden and improve QoL of Korean PAD patients.

The Control of Drug Release and Vascular Endothelialization after Hyaluronic Acid-Coated Paclitaxel Multi-Layer Coating Stent Implantation in Porcine Coronary Restenosis Model

BACKGROUND AND OBJECTIVES: Hyaluronic acid (HA) is highly biocompatible with cells and the extracellular matrix. In contrast to degradation products of a synthetic polymer, degradation products of HA do not acidify the local environment. The aim of this study was to fabricate an HA-coated paclitaxel (PTX)-eluting stent via simple ionic interactions and to evaluate its effects in vitro and in vivo. MATERIALS AND METHODS: HA and catechol were conjugated by means of an activation agent, and then the stent was immersed in this solution (resulting in a HA-coated stent). After that, PTX was immobilized on the HA-coated stent (resulting in a hyaluronic acid-coated paclitaxel-eluting stent [H-PTX stent]). Study groups were divided into 4 groups: bare metal stent (BMS), HA, H-PTX, and poly (L-lactide)-coated paclitaxel-eluting stent (P-PTX). Stents were randomly implanted in a porcine coronary artery. After 4 weeks, vessels surrounding the stents were isolated and subjected to various analyses. RESULTS: Smoothness of the surface was maintained after expansion of the stent. In contrast to a previous study on a PTX-eluting stent, in this study, the PTX was effectively released up to 14 days (a half amount of PTX in 4 days). The proliferation of smooth muscle cells was successfully inhibited (by 80.5±12.11% at 7 days of culture as compared to the control) by PTX released from the stent. Animal experiments showed that the H-PTX stent does not induce an obvious inflammatory response. Nevertheless, restenosis was clearly decreased in the H-PTX stent group (9.8±3.25%) compared to the bare-metal stent group (29.7±8.11%). CONCLUSION: A stent was stably coated with PTX via simple ionic interactions with HA. Restenosis was decreased in the H-PTX group. These results suggest that HA, a natural polymer, is suitable for fabrication of drug-eluting stents (without inflammation) as an alternative to a synthetic polymer.

Usefulness of an Implantable Loop Recorder in Patients with Syncope of an Unknown Cause

PURPOSE: The mechanisms underlying syncope remain unknown in about 20% of patients with recurrent syncope. The implantable loop recorder (ILR) has been shown to be a useful diagnostic tool in patients with unexplained syncope even after negative initial evaluations. Nevertheless, ILR has rarely been used in clinical practice. MATERIALS AND METHODS: This study included 18 consecutive patients who had an ILR implanted at our center because of recurrent unexplained syncope after extensive diagnostic tests between February 2006 and June 2011. RESULTS: Diagnosis was confirmed in 10 (55.6%) of the 18 enrolled patients (13 males, 61+/-15 years). The confirmed diagnoses included sick sinus syndrome (n=6, 60%), advanced atrioventricular block (n=2, 20%) and ventricular tachyarrhythmia (n=2, 20%). The mean follow-up durations of the total study subjects and the diagnosed patients were 11.3+/-10.6 months and 5.6+/-9.2 months, respectively. Of the 10 diagnosed patients, 8 (80%) were diagnosed within 6 months of loop recorder implantation. CONCLUSION: ILR may be a valuable and effective diagnostic tool for patients with unexplained syncope.

QTc Prolongation after Ventricular Septal Defect Repair in Infants

BACKGROUND AND OBJECTIVES: Prolonging of the corrected QT interval (QTc) has been reported after cardiac surgery in some studies. However, there have not been many studies on infant open cardiac surgery for ventricular septal defect (VSD) repair. This study was performed to define the changes in QTc and to find related post-surgery factors in this patient group. SUBJECTS AND METHODS: From 2008 to 2012, 154 infants underwent VSD repair at the Severance Cardiovascular Hospital. This study includes 105 of these cases. QTc was measured in these patients retrospectively. Demographic data and peri-procedural data, such as Aristotle score, cross-clamp time and bypass time, were analyzed. The exclusion criteria included multiple and small VSDs that underwent direct closure. RESULTS: Mean post-operative QTc was increased compared to the pre-operative measurements (from 413.6+/-2.3 to 444.9+/-2.5, p<0.001). In multiple linear regression, the comprehensive Aristotle score was associated with increasing QTc (p=0.047). The incidence of transient arrhythmia, such as atrial tachycardia, junctional ectopic tachycardia, premature atrial contraction, or premature ventricular contraction, was associated with QTc prolongation (p=0.005). Prolonged QTc was also associated with cross-clamp time (p=0.008) and low weight (p=0.042). Total length of stay at the intensive care unit and intubation time after surgery were not associated with QTc prolongation. CONCLUSION: Prolonged QTc could be seen after VSD repair in infants. This phenomenon was associated with peri-procedural factors such as the Aristotle score and cross-clamp time. Patients with QTc prolongation after cardiac surgery had an increased tendency towards arrhythmogenicity in the post-operative period.

Factors Related to Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction

Despite recent successful efforts to shorten the door-to-balloon time in patients with acute ST-segment elevation myocardial infarction (STEMI), prehospital delay remains unaffected. Nonetheless, the factors associated with prehospital delay have not been clearly identified in Korea. We retrospectively evaluated 423 patients with STEMI. The mean symptom onset-to-door time was 255 +/- 285 (median: 150) min. The patients were analyzed in two groups according to symptom onset-to-door time (short delay group: 180 min). Inhospital mortality was significantly higher in long delay group (6.9% vs 2.8%; P = 0.048). Among sociodemographic and clinical variables, diabetes, low educational level, triage via other hospital, use of private transport and night time onset were more prevalent in long delay group (21% vs 30%; P = 0.038, 47% vs 59%; P = 0.013, 72% vs 82%; P = 0.027, 25% vs 41%; P < 0.001 and 33% vs 48%; P = 0.002, respectively). In multivariate analysis, low educational level (1.66 [1.08-2.56]; P = 0.021), symptom onset during night time (1.97 [1.27-3.04]; P = 0.002), triage via other hospital (1.83 [1.58-5.10]; P = 0.001) and private transport were significantly associated with prehospital delay (3.02 [1.81-5.06]; P < 0.001). In conclusion, prehospital delay is more frequent in patients with low educational level, symptom onset during night time, triage via other hospitals, and private transport, and is associated with higher inhospital mortality.

Clinical Characteristics of Primary Epiploic Appendagitis

PURPOSE: Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis. METHODS: We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications. RESULTS: In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 +/- 11.9 vs. 69.7 +/- 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 +/- 2.9 vs. 22.6 +/- 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001). CONCLUSION: In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.

Comparison of clinical outcomes and hospital cost between open appendectomy and laparoscopic appendectomy / 대한외과학회지

PURPOSE: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.

Comparison of clinical outcomes and hospital cost between open appendectomy and laparoscopic appendectomy / 대한외과학회지

PURPOSE: Laparoscopic appendectomy has been recognized to have many advantages such as greater cosmetic results, less postoperative pain and shorter hospital stays. On the other hand, the cost of laparoscopic procedures is still more expensive than that of open procedures in Korea. The aim of this study is to compare clinical outcomes and hospital costs between open appendectomy and laparoscopic appendectomy. METHODS: Between January 1, 2010 and December 31, 2010, 471 patients were diagnosed with acute appendicitis. Of these, 418 patients met the inclusion criteria and were divided into two groups of open appendectomy (OA) group and laparoscopic appendectomy (LA) group. We analyzed the clinical data and hospital costs. RESULTS: The mean operation time for laparoscopic appendectomy (72.17 minutes) was significantly longer than that of open appendectomy (46.26 minutes) (P = 0.0004). The mean amounts of intravenous analgesics for OA group (2.00 times) was greater than that of LA group (1.86 times) (P < 0.0001). The complication rate was similar between the two groups (OA, 6.99% vs. LA, 10.87%; P = 0.3662). The mean length of postoperative hospital stay was shorter in LA group (OA, 4.55 days vs. LA, 3.60 days; P = 0.0002). The mean total cost covered by the National Health Insurance was more expensive in LA group (OA, 1,259,842 won [Korean monetary unit] vs. LA, 1,664,367 won; P = 0.0057). CONCLUSION: Clinical outcomes of laparoscopic appendectomy were superior to that of open appendectomy even though the cost of laparoscopic appendectomy was more expensive than that of open appendectomy. Whenever surgeons manage a patient with appendicitis, laparoscopic appendectomy should be considered as the procedure of choice.

Atrial Mechanical Function After Maze Procedure for Atrial Fibrillation Concomitant With Mitral Valve Surgery

BACKGROUND AND OBJECTIVES: The maze procedure is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). We compared the left atrial mechanical function (LAMF) of patients whose rhythm was converted to SR after maze procedure with that of patients whose rhythm was not converted to SR and determined if preoperative left atrial volume index (LAVI) and immediate postoperative LAMF could predict conversion of AF to SR. SUBJECTS AND METHODS: We prospectively evaluated 80 patients with AF treated with the maze procedure between March 2005 and February 2007. LAMF was assessed by looking at left atrial ejection volume (LAEV) and ejection fraction (LAEF) during echocardiography before, 2 weeks after, and 6 months after the procedure. RESULTS: Of the 80 enrolled patients, 71 were converted to SR after the maze procedure (SR group), and 9 were not converted to SR (AF group). There were no significant differences in age, sex, hypertension, diabetes mellitus, renal failure, stroke, thyroid dysfunction, or smoking history between the groups. Pre-operative LAVI (p=0.010) was a predictor of conversion of AF to SR. LAEF gradually increased in the SR group during follow-up, but not in the AF group. CONCLUSION: LAMF recovered in the SR group after the maze procedure, irrespective of clinical presentation and initial LAMF. Preoperative LAVI predicted SR conversion.

A case of percutaneous coil embolization of renal artery aneurysm / 대한내과학회지

Renal artery aneurysms are relatively uncommon, being found in approximately 0.09% of the general population. They are usually found incidentally during investigation of patients with microscopic hematuria or high blood pressure. Rupture is the most lethal complication of renal aneurysms. Surgical treatment had been common for these aneurysms. We report a case of about 2-cm-diameter renal artery aneurysm successfully treated by embolization with non-detachable platinum coil.

A Case of Small Cell Variant of T-Cell Prolymphocytic Leukemia / 대한혈액학회지

T-cell prolymphocytic leukemia (T-PLL) is a post-thymic T-cell malignancy that has an aggressive clinical course and it is a distinct clinico-biological entity from other T-cell disorders. It is now apparent that this disease represents a separate entity from CLL. Clinically, T-PLL presents with hepatosplenomegaly, lymphadenopathy, skin lesion, and marked lymphocytosis exceeding 100x109/L. Because its clinical course is aggressive, the treatment is difficult. We report a case of small cell variant of T-cell with a review of literatures.

A Case of Metastatic Thyroid-Papillary Carcinoma to the Breast / 한국유방암학회지

We report a case of metastatic thyroid-papillary carcinoma of the breast. A 42-year-old woman was admitted to our hospital due to palpable masses on both breasts. Past history revealed that she had three individual thyroid operations due to thyroid papillary carcinoma. The first was a left lobectomy 6 years ago, the second was a subtotal thyroidectomy 2 years ago, and the third was a excision of the neck mass due to last year's recurrence. The patient underwent mass excisions on both breasts under the impression of a benign tumor. Pathologic findings of the masses showed similar histologic findings of the thyroid papillary carcinoma and immunohistochemical stainings demonstrated that the tumors originated from the thyroid.

Evaluation of Nutritional Safety for the Herbicide-Resistant Rice in Growing Male Rats

This study was conducted to evaluate the safety of herbicide-resistant rice, a genetically modified organism (GMO) developed by the Rural Development Administration, in Sprague-Dawley rats. The nutrient content of herbicide-resistant polished and brown cooked rice was compared with that of conventional Ilpum polished and brown cooked rice to assess composition equivalence. Compositional analysis was performed to measure proximates, fiber, and minerals before animal feeding. Growing male rats were fed one of the following four diets for six weeks: Ilpum polished cooked rice (IP) and Ilpum brown cooked rice (IB) as a non-GMO and herbicide-resistant polished cooked rice (GP) and brown cooked rice (GB) as a GMO. We checked clinical symptoms (anorexia, salivation, diarrhea, polyuria, anuria, fecal change) every day, food intake, change of body weight twice a week, and serum biochemistry and organ weights after 6 weeks of experimental feeding among the four groups. Nutrient content of the herbicide-resistant rice was similar to that of the non-transgenic control and was within the published range observed for non-transgenic rice. We could not find any significant difference in the above-mentioned items as the index to be checked in the animals fed the GMO. These results suggest that the nutrient content of genetically modified herbicide-resistant rice is compositionally equivalent to that of conventional Ilpum rice and that growing male rats fed herbicide-resistant rice are no different from those fed Ilpum rice, non-GMO for 6 weeks.

Fundus Fluorescein Photography Using Oral Fluorescein

Fundus fluorescein angiography has become a standard diagnostic test in ophthalmology. It is reported, however, that various side effects occur with intravenous administration of fluorescein sodium. After it was determined that the oral use of fluorescein sodium was harmless, it was applied to clinical cases. Fundus fluorescein photography was performed in 30 subjects. After fasting fluorescein sodium was administered in a dose of 20 mg/kg body weight followed by the ingestion of 50 ml of water. The first oral fluorogram was taken 10 minutes after peroral dye administration, and repeated 5 times at an interval of 10 minutes. The results of this study were as follows: 1. We obtained sufficient fluorescein images in 28 of the 30 subjects(93%). 2. The fluorescence in the fundus became detectable about 10 minutes after peroral administration. 3. Maximal intensity of fluorescence was usually seen at 30 minutes after peroral administration. 4. There were no adverse reactions from any subject. 5. This may be preferred in studies of children, patients with no visible veins, patients who are psychologically unsuitable for injections, unstable patients who have severe diseases(cardiovascular accident, myocardial infarction, hypertension etc) and in large scale surveys.

A Case of Granular Cell Myoblastoma of the Orbit

The authors experienced a case of orbital granular cell myoblastoma in a 22 year old female, which is extreamely rare. The tumor mass had grown since 6 years ago in her right orbit. On ocular examination, the right eye was proptosed and displaced out and upward. Extraocular movements showed slight limitation of adduction of the right eye. The computed tomographic scanning revealed well defined hypervascular mass density in the right orbit. The mass was removed by modifiedkronlein approach and histopathologic examination revealed it to have features typical of granular cell myoblastoma.