No abstract available.
Tongue*

BACKGROUND: Catheter ablation using radiofrequency energy has been established as the most important mode of treatment in patients with accessory pathway. However the ablation of midseptal accessory pathways had been recognized as being more difficult to ablate than other located pathway because of the low incidence and the difficult localization of ablation site. This paper describes the electrophysiologic characteristics of successfully ablated midseptal accessory pathway using radiofrequency energy. METHOD: Routine electrophysiologic studies were performed in 13 patients with midseptal accessorypathway. Guided by the recording of VA interval, the ablation catheter was positioned in all patients in an area bounded anteriorly by the tip electrode of the His bundle catheter and posteriorly by the coronary sinus ostium. Local electrograms during orthodromic atrioventricular reentrant tachycardia or right ventricular apical pacing were compared for 13 patients with midseptal accessory pathway and consequent 13 patients with posteroseptal accessory pathway. RESULT: 13 patients with midseptal accessory pathway; eight with constant Wolff-Parfinson-White syndrome, one with intermittent Wolff-Parkinson-White syndrome and four with concealed bypass track underwent attempts at ablation of their pathway using radiofrequency energy. 11 accessory pathways were successfully ablated without complication during the firstsession. A second attempt at ablation was made in two patients with success(one; recurred case, the other one; failed case at the first session). In the surface 12-Lead ECG, all eight patientswith constant Wolff-Pakinsin-White syndrome had not shownen Qrs complex at lead 3. Two patient with midseptal accessory pathway had transient left bundle branch block during orthodromic tachycardia. The VA interval during left bundle branch block was not change compared to that during narrow complex tachycardia in both. In all patients with midseptal accessory pathway, the VA interval in his bundle electrogram were almost similar to that in the coronary sinus ostial electrogram, which was not observed in the patients with posteroseptal accessory pathway. CONCLUSION: We suggest that VA interval during orthodromic tachycardia and right ventricular apcial pacing is the most reliable market for identifying midseptal accessory pathway, especially distinguishing from posteroseptal accessory pathway.
Bundle of His ; Bundle-Branch Block ; Catheter Ablation ; Catheters ; Coronary Sinus ; Electrocardiography ; Electrodes ; Electrophysiologic Techniques, Cardiac ; Humans ; Incidence ; Tachycardia ; Wolff-Parkinson-White Syndrome

Purpose: Post-fracture sleeping disorders can lead to a deterioration of mental and physical health and delay recovery to pre-fracture status. Here, an analysis was conducted to determine if sleep disturbance is a risk factor for delirium in patients older than 60 years of age with surgically treated proximal femoral fractures. Materials and Methods: This retrospective study included 316 patients with surgically treated proximal femoral fractures between January 2014 and December 2016; 33 patients were removed from analysis due to exclusion criteria. Confirmation of delirium was made by a neurologist upon consultation for cognitive impairment and sleeping disorders were confirmed by a doctor or nurse based on the Pittsburgh sleep quality index. Potential risk factors other than a sleep disorder (e.g., history of cognitive impairment, medical illness, preoperational levels of albumin and hemoglobin, transfusion) were also analyzed as variables for the development of delirium. Results: The sensitivity and specificity of a sleeping disorder as a risk factor for the development of delirium were 0.75 and 0.76, respectively; the positive and negative predictive values were 0.64 and 0.93, respectively. A sleeping disorder was significantly related to the development of the delirium (odds ratio adjusted for age, sex and body mass index was 5.78, P<0.01). In those with a history of cognitive impairment, the adjusted odds ratio for the development of delirium was 6.03 (P<0.01). Conclusion Sleeping disorders occurring after a surgically repaired proximal femoral fracture in patients 60 years of age or older could be an independent predictive factor of delirium.

BACKGROUND: Several kinds of stents have shown their safety and efficacy to treat acute or subacute closure after balloon angioplasty as well as to reduce restenosis rate. However, one of the limitations of stents is difficult to deploy especially in tortuos vessels, lesions at a bend, and distal to previously deployed stents. The Micro stent II, which was one of the most recently developed stents, ia a rapid-exchage balloon expandable stainless steel stent with a zigzag design connected with a continuous single weld in each 3mm segments. It scores over excellent trackability and optimum radio-opacity. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report our experiences with Micro-II stent implanatation in the first 76 patients at Tonsei cardiovascular center to assess its safety and efficacy in patients with complex coronary anatomy and clinical results in the first months. METHODS: Between January 1996 and July 1996, eighty-six Micro-II stent were implanted in the coronary arteries of 76 patients(male 65.8%, age 59+/-10 year). Forty-five patients had unstable angina, the others had stable angina(17pts), acute myocardial infarction(14pts). RESULTS: 1) Indication of stenting was de novo 51(59.3%), suboptimal result 25(29.1%), restenosis 1(1.2%) and 9(10.4%) of lesions were stented in bail out situation. 2) Single stent were implanted in 76(88.4%)lesions, overlapping stent in 10(11.6%)lesions. Among overlapping stents, the second stent with Micro-II stent and with another kind of stent were 4.6%, 7.0%, respectively. 3) Procedure related complication including a subacute closure was occurred in 1(1.2%) patient who had distal dissection and 45% residual stenosis. In 12(14%) lesions, preistent dissection has been noticed after stent impantation. 4) Angiographic success(defined as a residual stenosis of <30% without major dissection) was achieved in 82 of 86 attempts(95.3%). The procedual success rate(defined as a residual stenosis of <30% without occurrence of major clinical events within 4 weeks after procesure) was 96.1%(73/76 patients). Angiographic success and procedural success rate in calcified lesion were 100% and 100%, respectively. Angiographic success and procedural success rate in more than 45` angulated lesion were 97% and 100%, respectively. 5) The mean minimal luminal diameter of the target lesions was increased from 0.42+/-0.40mm before stent implantation to 2.93+/-0.50mm(p<0.001). The percentage of diameter stenosis was reduced from 86.49+/-13.04% to 1.40+/-7.11%(p<0.001) after stent implantation. CONCLUSION: Coronary stenting with AVE Micro-II stent can be safety performed and is particularly beneficial in tortuous and calcified arteries. There was a high tendency for peristent dissection which need to special consideration to avoid. Follow-up data is needed to assess mid and term patency. Coronary artery disease . AVE Micro-II stent . Immediate results.
Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Humans ; Phenobarbital ; Stainless Steel ; Stents*

STUDY DESIGN: Retrospective controlled study. OBJECTIVES: The aim of this study was to determine if unilateral TLIF is comparable to conventional PLIF with regard to radiologic and clinical outcomes, and to examine the viability of local bone for bone grafting in lumbar interbody fusion. SUMMARY OF LITERATURE REVIEW: TLIF, a modified form of PLIF, is a new spinal fusion technique that avoids the typical complications of PLIF. MATERIALS AND METHODS: We analyzed 32 cases of single-level TLIF or PLIF in patients with degenerative or isthmic spondylolisthesis, who were followed for more than 1 year. The patients in group 1 underwent TLIF, and the patients in group 2 underwent PLIF. The fusion rate, changes in disc height, and degree of anterolisthesis in the fused segment were analyzed radiologically. The clinical results were evaluated using the Oswestry Disability Index and visual analog scale. We also analyzed operative time, blood loss, and complications in both groups. RESULTS: Radiologically and clinically, there were no significant differences between the two groups in terms of fusion rate, changes in disc height, or degree of anterolisthesis in the fused segment. The mean operative time was 200 minutes in group 1 and 240 minutes in group 2. The mean blood loss was 854 ml in group 1 and 1102 ml in group 2(p>0.05). CONCLUSIONS: TLIF is a potentially useful alternative to conventional PLIF in patients with degenerative or isthmic spondylolisthesis. Additionally, local bone may be a viable source of bone grafts for single-level TLIF and PLIF.
Bone Transplantation ; Humans ; Operative Time ; Retrospective Studies ; Spinal Fusion ; Spondylolisthesis ; Transplants

Behcet's disease is chronic and systemic inflammatory vasculitis, characterized by immunologically involving in variable size of arteries and veins. Clinically, principal manifestations are recurrent oral ulcer, genital ulcer, skin and eye lesions. Compared to other connective tissue disease, cancer is not accompanied commonly in Behcet's disease. But, immunological confusion such as T cell depletion or B cell hyperplasia, or long-term of immunosuppressive treatment lead to occurrence of malignancy. Recently, we experienced a case of maxillary mass, induced to abrupt headache in Behcet's disease, confirmed diffuse large B cell lymphoma by biopsy, and treated by rituximab-CHOP chemotherapy. Thus we report these with literature review.
Biopsy

BACKGROUND: Lipoprotein lipase(LPL) is a key enzyme in the metabolism of serum triglyceride(TG) which is utilized in the peripheral tissue as free fatty acid and stored in adipose tissue. LPL gene consists of 10 exons which encode 475 amino acids and more than 9 LPL gene polymorphisms have been reported. LPL gene polymorphism is related to lipids level and the severity of atherosclerosis in coronary artery disease. In Korea, LPL polymorphism has not been reported yet. The purpose of this study is to konw the incidences of LPL gene polymorphism and it's relationship with blood lipids level and the severity of atherosclerosis. METHODS: Subjects were divided into three groups; normal controls(n=50), coronary artery disease(CAD, n=51) and cerebrovascular disease(CVD, n=52). The PCR- amplified genomic DNA from peripheral white blood cell was analyzed with restriction fragment length polymorphism(RFLP) by two different restriction enzymes(Pvu II, Hind III). RESULTS: Total cholesterol(TC) was higher in CVD than in controls and CAD (203+/-60mg/dl vs 188+/-37, 167+/-42, p<0.01). Triglyceride(TG) was also elevated in CAD(166+/-65mg/dl vs 122+/-62 in controls, p<0.05). HDL cholesterol(HDL-C) was higher in controls than in CVD and CAD(49+/-9mg/dl vs 36+/-10, 44+/-9, p<0.05). The incidence of Hind III RFLP and Pvu II RFLP was not different among groups. There was no correlation between LPL gene RFLP and lipid profile. There was no correlation between LPL gene RFLP and severity of coronary arterial stenosis. The incidence of Hind III RFLP (-/-) homozygotes was lower in Korean than in other country(5% vs 7-10%). The incidence of Pvu II RFLP (-/-) homozygotes was lower in Korean than in other country(10.3% vs 18-29%). CONCLUSIONS: The LPL gene mutations in intron 6 and 8 have no direct effects on the lipid profiles and the severity of coronary artery disease. Although LPL is a key enzyme in TG metabolism, two mutations in this study could not change the activity of LPL, nor were a marker linked to other site of mutation(s). The mutation(s) in exon which encode amino acid for enzyme activity should be detected to dissect the pathphysiologic mechanism in the atherogenesis.
Adipose Tissue ; Amino Acids ; Atherosclerosis ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; DNA ; Exons ; Homozygote ; Incidence* ; Introns ; Korea ; Leukocytes ; Lipoprotein Lipase* ; Lipoproteins* ; Metabolism ; Polymorphism, Restriction Fragment Length

Reninoma is a tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia because of hypersecretion of renin. We present a case of a 29-year-old female patient with reninoma and concomitant variant angina. The patient had uncontrolled hypertension and elevated plasma renin activity and aldosterone levels. Imaging studies revealed a mass in the left kidney, which was further confirmed as a renin-producing lesion via selective venous catheterization. During the evaluation, the patient had acute-onset chest pain that was diagnosed as variant angina after a provocation test. After partial nephrectomy, the plasma renin activity and plasma aldosterone levels decreased and blood pressure normalized. We report a case of reninoma with variant angina.
Adult ; Aldosterone ; Angina, Unstable ; Blood Pressure ; Catheterization ; Catheters ; Chest Pain ; Female ; Humans ; Hypertension ; Hypokalemia ; Kidney ; Kidney Neoplasms ; Nephrectomy ; Plasma ; Renin

OBJECTIVES: The lung cancer mortality in Korea has increased remarkably during the last 20 years, and has been the first leading cause of cancer-related deaths since 2000. The aim of the current study was to examine the time trends of occupational lung cancer and carcinogens exposure during the period 2006-2009 in South Korea, by assessing the proportion of occupational burden. METHODS: We defined occupational lung cancer for surveillance, and developed a reporting protocol and reporting website for the surveillance of occupational lung cancer. The study patients were chosen from 9 participating university hospitals in the following 7 areas: Seoul, Incheon, Wonju, Daejeon, Daegu, Busan, and Gwangju. RESULTS: The combined proportion of definite and probable occupational lung cancer among all lung cancers investigated in this study was 10.0%, 8.6%, 10.7%, and 15.8% in the years 2006 to 2009, respectively, with an average of 11.7% over the four-year study period. The main carcinogens were asbestos, crystalline silica, radon, polyaromatic hydrocarbons (PAHs), diesel exhaust particles, chromium, and nickel. CONCLUSION: We estimated that about 11.7% of the incident lung cancer was preventable. This reveals the potential to considerably reduce lung cancer by intervention in occupational fields.
Asbestos ; Carcinogens ; Chromium ; Crystallins ; Hospitals, University ; Humans ; Hydrocarbons ; Korea ; Lung ; Lung Neoplasms ; Radon ; Republic of Korea ; Silicon Dioxide ; Vehicle Emissions

PURPOSE: Local excision of early rectal cancers with favorable histologic features can provide comparable survival rate to radical surgery with minimal morbidity and mortality, showing excellent functional results. But, still worried about high local recurrence rate and poor survival rates for local excision. This study was performed to investigate complications and evaluate oncological out comes after local excision for rectal cancers. METHODS: We evaluated 80 cases underwent local excision among 1681 patients with rectal cancer between January 1989 and December 2000. The mean age was 58+/-11 years and median follow up period was 24 (range: 1-82) months. Type of surgery for early rectal cancer were transanal excision in 51 cases (63.8%), transsphincteric approach in 12 cases (15%) and endoscopic submucosal resection alone in 17 cases (21.2%). RESULTS: The distance from the anal verge was 5.9+/-2.6 cm and the mean tumor size was 2.5+/-2.0 cm. Pathological depth of invasion revealed 52 Tis, 21 T1, 6 T2, and 1 T3 tumors. Cellular differentiation was well-differentiated tumor in 73% and moderately-differentiated in 27%. On histologic examination, 65% of them comprised underlying adenoma component. Leakage from the closure site was observed in two cases of transsphincteric approach. One case required abdominoperineal resection and the other was managed by temporary colostomy. Adjuvant chemoradiation was performed in 10 cases: one Tis with positive resection margin, 6 deep T1, and 3 T2 tumors. Five tumors was salvaged by immediate surgery: one T1 with positive resection margin, 3 T2 with positive resection margin, and 1 T3. During the follow up period, one local recurrence was developed after 25 months of surgery and salvaged by low anterior resection. CONCLUSION: Local excision for rectal cancer can be performed safely in strictly selected patients and meticulous surgical technique according to tumor location is mandatory to reduce postoperative complications.
Adenoma ; Colostomy ; Follow-Up Studies ; Humans ; Mortality ; Postoperative Complications ; Rectal Neoplasms* ; Recurrence ; Survival Rate