Many surgical methods for the reconstruction of orbital floor fractures have been reported, and theseinclude transorbital, transantral and transnasal endoscopic approaches, among others. The choice of surgical approach and materials for the reduction of orbital blowout fractures depends on the surgeon's experience and preference. For the cases of large orbital floor fractures, reduction has beenperformed most frequently through the transantral approach, and the herniated orbital tissue generally has been supported by asilastic block, silastic tube or urethral balloon catheter. However, the transantral approach has significant drawbacks that includethe requirement of removal surgery, displacement of materials, and inflammation of the maxillary sinus. To overcome these negative effects, the authors used fibrin glue tosecure the reduction through the transantral approach in two cases of patients with orbital floor fractures.
Catheters ; Fibrin Tissue Adhesive* ; Humans ; Inflammation ; Maxillary Sinus ; Orbit* ; Orbital Fractures

Atrial fibrillation (AF) is a strong risk factor for ischemic stroke and systemic embolism. To prevent thromboembolic events in patients with AF, anticoagulation therapy is essential. The anticoagulant strategy is determined after stroke and bleeding risk assessments using the CHA2DS2-VASc and HAS-BLED scores, respectively; both consider clinical risk factors. Vitamin K antagonists (VKAs) are the sole anticoagulant option in AF patients with a prosthetic mechanical valve or moderate-severe mitral stenosis; in all other AF patients VKA or non-vitamin K antagonist oral anticoagulants are therapeutic options. However, antiplatelet therapy should not be used for stroke prevention in AF patients. Anticoagulation is not needed in AF patients with low stroke risk but strongly recommended in those with a with low bleeding risk. Left atrial appendage (LAA) occlusion offers an alternative in AF patients in whom long-term anticoagulation is contraindicated. Surgical occlusion or the exclusion of LAA can be considered for stroke prevention in AF patients undergoing cardiac surgery. In this article, we review existing data for stroke prevention and suggest optimal strategies to prevent stroke in AF patients.

Atrial fibrillation (AF) is a strong risk factor for ischemic stroke and systemic embolism. To prevent thromboembolic events in patients with AF, anticoagulation therapy is essential. The anticoagulant strategy is determined after stroke and bleeding risk assessments using the CHA2DS2-VASc and HAS-BLED scores, respectively; both consider clinical risk factors. Vitamin K antagonists (VKAs) are the sole anticoagulant option in AF patients with a prosthetic mechanical valve or moderate-severe mitral stenosis; in all other AF patients VKA or non-vitamin K antagonist oral anticoagulants are therapeutic options. However, antiplatelet therapy should not be used for stroke prevention in AF patients. Anticoagulation is not needed in AF patients with low stroke risk but strongly recommended in those with a with low bleeding risk. Left atrial appendage (LAA) occlusion offers an alternative in AF patients in whom long-term anticoagulation is contraindicated. Surgical occlusion or the exclusion of LAA can be considered for stroke prevention in AF patients undergoing cardiac surgery. In this article, we review existing data for stroke prevention and suggest optimal strategies to prevent stroke in AF patients.

PURPOSE: Hybrid therapy with catheter ablation of the cavo-tricuspid isthmus (CTI) and continuation of anti-arrhythmic drugs (AAD), or electrical cardioversion with AADs might be alternative treatments for patients with persistent atrial fibrillation (AF). The goal of study was to assess the long term success rate of hybrid therapy for persistent AF compared to antiarrhythmic medication therapy after electrical cardioversion and identify the independent risk factors associated with recurrence after hybrid therapy. MATERIALS AND METHODS: A total of 32 patients with persistent AF who developed atrial flutter after the administration of a class Ic or III anti-arrhythmic drug were enrolled. This group was compared with a group (33 patients) who underwent cardioversion and received direct current cardioversion with AADs. Baseline data were collected, and electrocardiogram and symptom driven Holter monitoring were performed every 2-4 months. RESULTS: There was no significant difference in the baseline characteristics between the groups. The 12 month atrial arrhythmia free survival was better in the hybrid group, 49.0% vs. 33.1%, p=0.048. However, during a mean 55.7+/-43.0 months of follow up, the improved survival rate regressed (p=0.25). A larger left atrium size was an independent risk factor for the recurrence of AF after adjusting for confounding factors. CONCLUSION: Despite favorable outcome during 12 month, the CTI block with AADs showed outcomes similar to AAD therapy after electrical cardioversion over a 12 month follow up period. Minimal substrate modification with AADs might be an alternative treatment for persistent AF with minimal atrial remodeling.
Adult ; Aged ; Anti-Arrhythmia Agents/*therapeutic use ; Atrial Fibrillation/*drug therapy/mortality/*surgery ; Catheter Ablation/*methods/mortality ; Combined Modality Therapy ; *Electric Countershock/mortality ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/mortality/prevention & control ; Retrospective Studies ; Risk Factors ; *Tricuspid Valve

Non-reentrant focal tachycardias occur spontaneously, facilitated by catecholamine infusion, but they cannot be initiated or terminated with programmed stimulation. These tachycardias exhibit early activation before the QRS, however, do not typically show the mid-diastolic potential that is crucial for reentrant tachycardia maintenance. Electrophysiological studies are useful for distinguishing focal from macro-reentrant ventricular tachycardia. We report herein a case of patient without a history of structural heart disease who presented with a focal Purkinje ventricular tachycardia and heart failure. The focal Purkinje ventricular tachycardia was eliminated by radiofrequency catheter ablation. All of the patien's symptoms were improved after ablation.
Adult ; Cardiomyopathies/*surgery ; Catheter Ablation/*methods ; Humans ; Male ; Tachycardia, Ventricular/*surgery ; Ventricular Dysfunction/surgery

A 56-yr-old man with aborted sudden cardiac death underwent implantable cardioverter defibrillator (ICD) implantation. While the ICD was being implanted, a left subclavian venogram failed to visualize the left subclavian vein, which was attributed to likely prolonged indwelling of the left subclavian sheath for venous access. Accordingly, the right subclavian vein was punctured and the ICD lead was diverted from the right side area to the active Can in the left pectoral area by tunneling over the sternum for high defibrillation threshold. The approach used in this case may be considered in patients who had difficult left subclavicular venous access and it may be prudent to save the left subclavian vein for ICD implantation in patients with fatal tachyarrhythmia.
Coronary Angiography ; Death, Sudden, Cardiac/prevention & control ; *Defibrillators, Implantable ; Electric Countershock ; Electrocardiography ; Heart Rate ; Humans ; Male ; Middle Aged ; Stents ; Subclavian Vein/*surgery ; Tachycardia, Ventricular/therapy

BACKGROUND: South Korea's population is aging more rapidly than any other country. Aging of the productive population will lead to shortage of labor and the decreasing quality of the labor force in South Korea. South Korea needs health care strategies to support the establishment of work environments that are appropriate for elderly workers who have reduced physical capacity. This paper aims to identify occupations that are dominated by aged workers and assess the exposure to hazards and work-related health problems of aged workers in these occupations. METHODS: We identified the 20 occupations in South Korea that employ the most aged workers (at least 55 years-old), among all 149 occupations that are defined as minor categories (identified by three digits) by the Korean Standard Classification of Occupations (KSCO). Exposure to hazards and work-related health problems of individuals in these occupations were evaluated by analyzing the results of the fourth Working Conditions Survey of 2014. RESULTS: Among the 20 occupations that employ the most aged workers, ‘Elementary Occupations', which the KSCO classifies as major category (9), had the largest proportion of aged workers. After this, there were five occupations of skilled manual workers and six occupations of skilled non-manual workers. Aged workers in elementary and skilled manual occupations reported frequent exposure to job-specific hazards, such as noise, vibrations, high and low temperatures, solvents, and chemicals. Relative to other workers, aged workers in the occupations reported more frequent exposure to ergonomic hazards, such as tiring or painful positions, carrying or moving heavy loads, and repetitive movements, and also reported more work-related musculoskeletal disorders and general fatigue. Injury due to accident was common in machinery-handling occupations. CONCLUSION: Job-specific hazards should be reduced to prevent occupation-related disorders in elementary and skilled manual occupations that are dominated by aged workers.
Aged ; Aging ; Classification ; Delivery of Health Care ; Employment ; Fatigue ; Humans ; Korea* ; Noise ; Occupations* ; Solvents ; Vibration

OBJECTIVES: The characteristics of depressive symptoms in the family members of home-dwelling patients with dementia have not been clearly reported. This study aimed to investigate the characteristics of depressive symptoms in middle-aged family members living with a patient with dementia. METHODS: This study used the data from the nationwide 2017 Korea Community Health Survey. Among the 228,381 survey participants, 77,276 participants in their 40s and 50s were finally selected for this study. The participants consisted of 760 family members of home-dwelling dementia patients and 76,516 general family members comprising a control group. RESULTS: The positive rate of Patient Health Questionnaire-9 (PHQ-9)-measured depressive symptoms was significantly higher in the family members of home-dwelling dementia patients (4.4%; control group: 1.9%). After adjusting for potential confounders, the prevalence of PHQ-measured depressive symptoms was 1.72 times (95% confidence interval [CI], 1.03 to 2.85) higher in the family members of home-dwelling dementia patients compared to the control group. The positive rate of depressive symptoms was 2.26 times higher (95% CI, 1.26 to 4.05) in the female middle-aged family members of home-dwelling dementia patients compared to the control group. In addition, those who reported having symptoms almost every day in the PHQ-9 questions had significantly higher positive rates on questions about loss of interest, depression, sleep disturbance, fatigue, poor appetite, and suicidal ideation, and not on questions regarding feelings of worthlessness and psychomotor agitation, compared to the control group. CONCLUSIONS Active interventions are needed to relieve depression in the family members of home-dwelling dementia patients.

OBJECTIVES: The characteristics of depressive symptoms in the family members of home-dwelling patients with dementia have not been clearly reported. This study aimed to investigate the characteristics of depressive symptoms in middle-aged family members living with a patient with dementia. METHODS: This study used the data from the nationwide 2017 Korea Community Health Survey. Among the 228,381 survey participants, 77,276 participants in their 40s and 50s were finally selected for this study. The participants consisted of 760 family members of home-dwelling dementia patients and 76,516 general family members comprising a control group. RESULTS: The positive rate of Patient Health Questionnaire-9 (PHQ-9)-measured depressive symptoms was significantly higher in the family members of home-dwelling dementia patients (4.4%; control group: 1.9%). After adjusting for potential confounders, the prevalence of PHQ-measured depressive symptoms was 1.72 times (95% confidence interval [CI], 1.03 to 2.85) higher in the family members of home-dwelling dementia patients compared to the control group. The positive rate of depressive symptoms was 2.26 times higher (95% CI, 1.26 to 4.05) in the female middle-aged family members of home-dwelling dementia patients compared to the control group. In addition, those who reported having symptoms almost every day in the PHQ-9 questions had significantly higher positive rates on questions about loss of interest, depression, sleep disturbance, fatigue, poor appetite, and suicidal ideation, and not on questions regarding feelings of worthlessness and psychomotor agitation, compared to the control group. CONCLUSIONS Active interventions are needed to relieve depression in the family members of home-dwelling dementia patients.

Systemic sclerosis (SS) is a connective tissue disease and cardiac involvement is common. Primary cardiac involvement such as conduction system disturbances and arrhythmias can also occur. However, reports of sustained ventricular tachycardia (VT) are rare. We report a case of catheter ablation of sustained ventricular tachycardia in a patient with systemic sclerosis using a conventional mapping system. A 64-yr-old woman with a 10-yr history of SS was referred for management of her ventricular tachycardia. There was no structural abnormality in cardiac chambers. However, electrophysiologic study revealed electrical substrate of ventricular tachycardia which could be ablated with pacemapping and substrate mapping. This case demonstrated successful conventional mapping and catheter ablation in a hemodynamically unstable patient with SS.
*Catheter Ablation ; Electrocardiography ; Female ; Humans ; Middle Aged ; Scleroderma, Systemic/*complications/*diagnosis ; Tachycardia, Ventricular/*etiology/physiopathology/*surgery