We report a case of a 36 year old female with coronary artery obstructive disease(Left coronary osteal stenosis), who had been admitted due to severe headache and vomitting. In admission, she was diagnosed as moyamoya disease on cerebral angiogram. She had no history of hypertension, diabetes mellitus, hyperlipidemia, smoking. She had experienced angina for 2 years, and 1 year ago she ws diagnosed as bypass surgery with left main coronary artery angioplasty. In moyamoya disease, several portions of extracranial arteries have been found to be involved, but so far, only one case has been reported the coronary involvement on coronary angiogram in the world. And, there has not been a report about moyamoya disease combined with left main osteal lesion yet. This present case indicates that we need to exam for extracranial vascular system including the heart in moyamoya disease.
Adult ; Angioplasty ; Arteries ; Constriction, Pathologic* ; Coronary Vessels ; Diabetes Mellitus ; Female ; Headache ; Heart ; Humans ; Hyperlipidemias ; Hypertension ; Moyamoya Disease* ; Smoke ; Smoking

Pregnancy and the puerperium are associated with an increased risk of stroke, and stroke is considered an important cause of maternal morbidity and mortality during this time. Pregnancy and delivery can lead to substantial alterations in systemic arterial and venous hemodynamics that may predispose to cerebrovascular disorders. We present one case of cerebral hemorrhage in puerperium after a normal pregnancy without any manifestation of preeclampsia or eclampsia and the other case with recurred cerebral hemorrhage in 16 gestational weeks pregnancy with previous cerebral hemorrhage history.
Cerebral Hemorrhage* ; Cerebrovascular Disorders ; Eclampsia ; Female ; Hemodynamics ; Mortality ; Postpartum Period* ; Pre-Eclampsia ; Pregnancy ; Stroke

PURPOSE: The medical records of 524 renal recipients who have been transplanted until December 2000 in our hospital were reviewed in order to compare the incidence of the surgical and medical complications according to their different treatment protocols. METHODS: To compare the surgical complications, the recipients were divided according to their ureter reconstruction method and donor type. Group 1; living donor and modified Politano method are done. Group 2; living donor but an extravesical ureteroneocystostomy. Group 3; cadaver donor and an extravesical anastomosis. Regarding the medical complications, recipients who received Sandimmun based immunosuppression (with steroid and/or azathioprine) were grouped as 1, those recipients with Neoral based immunosuppression (with steroid and/or cellcept) were grouped as 2, and re-cipients immunosuppressed by prograf based immunosuppression (with steroid and/or cellcept) were grouped as 3. The incidence of complications and adverse effects in each group and per recipient were described as the percentage of the total incidence. RESULTS: Most of the surgical complications including an allograft rupture, ureteral fistula, lymphocele and reoperation due to bleeding were developed during the first month after transplantation but decreasing in group 2 and 3. An ureter stricture and renal artery stenosis developed after 6 months. Infectious complications were developed in 60.7% of recipients and among them, a viral infection occurred in 41.9% which was followed by bacterial and fungal infection. However, the incidence of infection also decreased in group 3. Herpes infections were the most common in viral infection and their incidence showed a dual peak (within 6 months and after 1 year). The recurrence of the original disease, mostly a focal sclerosing glomerulosclerosis, and de novo cancer showed lower incidence in group 3 but the follow up duration should be considered. Tremor and hirsutism are two of the most common adverse effects but showed a different incidence in group 3. Some side effects such as diarrhea, post-transplant diabetes were more common in group 3 than in group 1 and 2. CONCLUSION: The decreasing incidence of complications and the drug side effects in recent days might be due to a better understand of the surgical procedures and the development of new immunosuppressants. However, new side effects or toxicity by new immunosuppressant must be considered seriously.
Allografts ; Cadaver ; Clinical Protocols ; Constriction, Pathologic ; Cyclosporine ; Diarrhea ; Fistula ; Follow-Up Studies ; Hemorrhage ; Hirsutism ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation* ; Living Donors ; Lymphocele ; Medical Records ; Recurrence ; Renal Artery Obstruction ; Reoperation ; Rupture ; Tacrolimus ; Tissue Donors ; Tremor ; Ureter

OBJECTIVES: The present study aimed to evaluate the validity of a set of self-reported questionnaires for periodontitis for estimating the prevalence of chronic adult periodontitis in the Korean population. METHODS: The questionnaire is comprised of a total of 14 questions with four summarized concepts including self-diagnosis of oral status, subjective signs related to oral health, smoking and drinking status, and use of auxiliary oral hygiene devices including scaling. The predictiveness of the measures from these self-reported questions was assessed by logistic regression modeling using receiver operating characteristic (ROC) statistics, sensitivity, and specificity. RESULTS: The sensitivity, specificity, and AUC including all questions were 0.571, 0.768, and 0.781, respectively; the sum of sensitivity and specificity was 1.34. To gain robustness, a simplified predictive model was built with six questions. Its results were 0.536, 0.817, and 0.762 for sensitivity, specificity, and AUC, respectively. The sum of sensitivity and specificity was found to be 1.35. CONCLUSIONS: The self-reported questionnaire for periodontitis showed considerable validity, but further study is required to provide optimal validity and predictability.
Area Under Curve ; Chronic Periodontitis ; Drinking ; Logistic Models ; Oral Health ; Oral Hygiene ; Periodontal Diseases ; Periodontitis* ; Prevalence ; Surveys and Questionnaires* ; ROC Curve ; Sensitivity and Specificity ; Smoke ; Smoking

OBJECTIVES: The purpose of this study was to develop a self-administered questionnaire survey to determine its validity and reliability as well as to improve the instructions for measurement of periodontal disease during oral examination for reliably calculating the prevalence of periodontal disease. METHODS: The data obtained was analyzed using SPSS 20.0 and the WINSTEPS program that employs the Rasch model to evaluate validity and reliability of the instrument. RESULTS: We developed a self-administered questionnaire survey consisting of 14 questions based on NHANES. We confirmed the reliability by testing and re-testing the questionnaire survey using selfadministered methods. The average Kappa index obtained was 0.73, which indicated a relatively high reliability. CONCLUSIONS: Reliability and validity of the self-administered assessment tool for periodontal disease developed for the local situation/circumstances of Korea is suitable to be applied for oral examination of a large population. Moreover, the questionnaire survey for periodontal disease could be used to acquire data for constructing a database for oral health policy development.
Diagnosis, Oral ; Korea ; Nutrition Surveys ; Oral Health ; Periodontal Diseases* ; Policy Making ; Prevalence ; Surveys and Questionnaires* ; Reproducibility of Results*

East Asian surgeons generally report lower morbidity and mortality rates for gastrectomy with D2 lymphadenectomy than do surgeons in Western countries; however, the disparity remains unexplained. The aim of this article was to determine the feasibility and safety regarding cases in which East Asian surgeons perform such procedures in Caucasian patients (CPs). Twelve CPs underwent gastrectomy with lymphadenectomy for gastric cancer at Yonsei University Severance Hospital, Seoul, Korea between June 2011 and April 2014. Procedures performed included total gastrectomy (7 of 12, 58%), distal gastrectomy (4 of 12, 33%), and completion total gastrectomy (1 of 12, 8%). Nine patients (75%) underwent D2 lymphadenectomy, and D1+ lymphadenectomy was performed in three others (25%). In four patients (33%), combined resections were carried out. The median values of surgical parameters were as follows: operative time, 266.5 min (range, 120-586 min); estimated blood loss, 90 mL (range, 37-350 mL); retrieved lymph node count, 37.5 (range, 22-63); and postoperative hospital stay, 13.7 days (range, 5-63 days). No mortality was encountered, although two patients (17%) experienced complications (both Clavien-Dindo classification grade IIIa anastomotic leakages), which were successfully managed by conservative treatment. In the hands of East Asian surgeons, mortality and short-term morbidity appears to be acceptably low in CPs subjected to gastrectomy with lymphadenectomy for gastric cancer.
Adult ; Aged ; *European Continental Ancestry Group ; Female ; *Gastrectomy/adverse effects ; Humans ; Length of Stay ; *Lymph Node Excision/adverse effects ; Male ; Middle Aged ; Operative Time ; *Patients ; Pilot Projects ; Republic of Korea ; Safety ; Stomach Neoplasms/pathology/*surgery ; *Surgeons

BACKGROUND AND OBJECTIVES: With the increasing survival of preterm infants, pulmonary hypertension (PH) related to bronchopulmonary dysplasia (BPD) has become an important complication. The aim of this study was to investigate the characteristics and outcome of PH in preterm infants with BPD and to identify the risk factors for PH. SUBJECTS AND METHODS: We reviewed the records of 116 preterm infants with BPD cared for at a single tertiary center between 2004 and 2008. RESULTS: Twenty-nine (25%) infants had PH >2 months after birth. PH occurred initially at a median age of 65 days (range, 7-232 days). Severe BPD, a birth weight <800 g, long-term ventilator care and oxygen supplementation, a high ventilator setting, infection, and a patent ductus arteriosus (PDA) were related to PH based on univariate analysis (p<0.05). The infants who had longer oxygen supplementation were significantly more likely to have PH (odds ratio, 18.5; 95% confidence interval, 4.1-84.6; p<0.001). PH was improved in 76% of infants after a median of 85 days (range, 20-765 days). Four infants (14%) died. The death of 3 infants was attributed to PH. CONCLUSION: BPD was frequently complicated by PH. Although PH resolved in the majority of infants, PH in preterm infants with BPD can be fatal. Regular screening for PH and adequate management are required.
Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Infant ; Infant, Newborn ; Infant, Premature ; Mass Screening ; Oxygen ; Parturition ; Risk Factors ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Pulmonary arterial hypertension (PAH) is a rare disease with a poor prognosis. The aim of this study was to characterize PAH in pediatric patients by evaluating the patients demographics, clinical and hemodynamic variables, treatments, and outcomes. SUBJECTS AND METHODS: Sixty-five patients who were diagnosed with PAH at Seoul National University Children's Hospital between January 1985 and August 2007 were retrospectively reviewed. RESULTS: There was no difference in gender distribution (males, 33; females, 32). The mean age at the time of diagnosis was 5.7+/-5.2 years and the mean follow-up period was 6.3+/-5.5 years. The major causes of PAH were congenital heart disease (CHD) in 32 patients (49.2%) and idiopathic PAH in 11 patients (16.9%). The most common presenting symptom was dyspnea in 44 patients (67.7%). The mean cardiothoracic ratio was 58.9+/-8.3%, which decreased to 55.9+/-8.3% after vasodilator therapy (p=0.011). The mean pulmonary arterial pressure at the time of cardiac catheterization was 59.7+/-18.7 mmHg and the mean pulmonary vascular resistance was 14.9+/-9.7 wood units . m2. Forty-three of 65 patients (66.2%) had vasodilator therapy (prostacycline, sildenafil, and bosentan). A statistically significant decrease in tricuspid valve regurgitation velocity (4.8+/-0.8 m/sec vs. 3.6+/-1.0 m/sec, p=0.001), and an increase in diastolic dimension of the left ventricle (28.3+/-12.1 mm vs. 33.2+/-10.2 mm, p=0.021) on echocardiography before and after vasodilator therapy was demonstrated. The 5-, 10-, and 15-year survival rates were 96%, 92% and 65%, respectively. Six of 65 patients (9.2%) with PAH died. There was no significant correlation between outcome and the immediate response to the vasodilators. CONCLUSION: PAH is a devastating disease which is rare in children. PAH in children has a variable pattern cause and progression, the confirmation of which requires analysis of detailed registries from nationwide hospitals.
Arterial Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Child ; Demography ; Dyspnea ; Echocardiography ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Diseases ; Heart Ventricles ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary ; Piperazines ; Prognosis ; Purines ; Rare Diseases ; Registries ; Retrospective Studies ; Sulfones ; Survival Rate ; Tricuspid Valve Insufficiency ; Vascular Resistance ; Vasodilator Agents ; Wood ; Sildenafil Citrate