We report a case with an isolated single coronary artery originating from the ascending aorta, which to our knowledge has never been described before. A 51-year-old man presented for evaluation of atypical chest pain, suffering from a short resting chest pain for 3 days. However, serial electrocardiogram showed no change during chest pain. Cardiac enzymes such as CK-MB, Troponin-I, and myoglobin were within normal limit. Aortography and coronary angiography revealed a single coronary artery originating from the postero-lateral wall of the ascending aorta above the left coronary siuns. However, this anomaly was not of clinical significance based on the atypical nature of the chest pain, negative exercise echocardiography and an absence of obstruction of the coronary artery.
Aorta* ; Aortography ; Chest Pain ; Coronary Angiography ; Coronary Sinus* ; Coronary Vessel Anomalies ; Coronary Vessels* ; Echocardiography ; Electrocardiography ; Humans ; Middle Aged ; Myoglobin ; Troponin I

No abstract available.
Humans ; Hypertension* ; Perindopril*

Posterior reversible encephalopathy syndrome is a clinicoradiological syndrome characterized by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. Hypertensive brainstem encephalopathy (HBE), a brainstem variant of posterior reversible encephalopathy syndrome, is rare. In addition, a concomitant occurrence of acute ischemic stroke and HBE is even more rare. We here report three patients with HBE accompanied by acute cerebral infarction detected by brain magnetic resonance imaging and the importance of initial blood pressure control.

A 48-year-old man came with a left-sided headache that was compatible with diagnostic criteria of cluster headache. Left oculomotor nerve palsy developed 2 weeks after headache onset. Magnetic resonance imaging showed wall thickening and enhancement by contrast material in the lateral aspect of the left cavernous sinus, consistent with a possible inflammatory lesion. The patient reported the almost complete remission of the pain and diplopia after steroid therapy. We speculate that Tolosa-Hunt syndrome should be included as a cause of cluster-like headaches.

Background: The importance of establishing a regional stroke safety net for the treatment of acute stroke is increasingly emphasized. In this study, we analyzed effectiveness of transferring the suspected acute ischemic stroke (AIS) patients through the 1899-0215 hotline system from 119 ambulances and nearby hospitals. Methods: From July 2015 to July 2022, we analyzed data from 632 suspected acute stroke patients through the hotline. Furthermore, we investigated the proportion of patients in the target population who were eligible for reperfusion therapy and compared cases transferred by 119 emergency services (EMS) with those transferred from nearby hospitals. Results: Six hundred thirty-two suspected acute stroke patients were transferred to our stroke center through the 1899-0215 hotline system. The accuracy of diagnosing acute stroke among transferred patients is 81.0% for 119 EMS and 80.5% for cases transferred from nearby hospitals. Of the 200 patients transferred from hospitals, they were transferred from 47 nearby hospitals with an average transfer distance of 38.2 km and an average transfer time of 65 minutes. Among 291 patients diagnosed with AIS, The onset-to-door time was significantly shorter (p<0.01) for patients transferred by 119 EMS. The proportion of patients who received reperfusion therapy was significantly higher (p<0.01) for those transferred by 119 EMS. Conclusions The hotline service will become a useful tool for establishing a regional stroke network in the Busan area, and its effectiveness will be particularly useful for 119 EMS. Measures are needed in the Busan metropolitan region to ensure the speediness of transferring acute stroke patients between hospitals.

Acute encephalopathies can be defined as an acute central nervous system (CNS) insult, due to an underlying pathology. The clinical symptoms almost always include an acute state of confusion and cognitive impairment. Toxic encephalopathies can occur acutely or chronically depending on the toxic drugs and other substances as well as the individual metabolism of the drug. The organs acutely affected include the heart, lung and kidneys. However, the brain, spinal cord and sympathetic nerves can be affected chronically. If the toxic substance passes through the bloodbrain barrier into the hypothalamus and the posterior pituitary gland, the result can be diabetes insipidus. If the substance affects the anterior pituitary gland, the result can include hormone dysfunction, impaired immune function and altered cognition or personality. We report a patient that developed acute toxic encephalopathy after the prescribed dose of oxycodone was exceeded.
Brain ; Central Nervous System ; Cognition ; Diabetes Insipidus ; Heart ; Humans ; Hypothalamus ; Kidney ; Lung ; Neurotoxicity Syndromes ; Oxycodone ; Pituitary Gland, Anterior ; Pituitary Gland, Posterior ; Spinal Cord

BACKGROUND: With mitral valvular heart disease, chronic atrial fibrillation(AF) is not likely to return to sinus rhythm after the operation. We evaluate the long term results and factors in recurrence of AF after modified Maze operation with mitral valve surgery. MATERIAL AND METHOD: From 1990 to 1996, 35 patients with chronic AF underwent modified Maze operation with mitral valve procedure in patients with chronic AF. The mean duration of AF was 7.7 +/-4.5 years. The concomitant operations were 34 mitral valve replacement(with 4 tricuspid annuloplasty and 3 tricuspid valve replacement)and 1 mitral valve repair. We analyzed the long term results and factors in recurrence of AF. RESULT: At immediate postoperatively, 33 of the 35 patients(93.9%) were converted to sinus rhythm. There was one operative death. However, AF recurred in 12 out of 35 patients during hospitalization and AF in these 12 patients were treated with antiarrhythmic drugs and electrical defibrillation 2-3 months later. Two out of twelve patients were failed in conversion to sinus rhythm after cessation of medication with side effects. During follow-up(71.1 +/-17.5 months, range 3-9 years), AF recurred in 9 patients and overall conversion rate to sinus rhythm was 73.5%. Predictors of postoperative AF included: duration of preoperative AF(maintenance group: recurrence group=6.3 years VS. 10.3 years, p=0.008) and cardiothoracic ratio on preoperative chest X-ray(0.58 VS. 0.72, p=0.009). CONCLUSION: AF surgery with mitral valve procedure increase the chance of recovery into sinus rhythm, reduce the incidence of atrial arrhythmia, and reduce the left atrial size with decreasing wall stress simultaneously. In order to decrease the incidence of postoperative arrhythmia, proper modification of the surgery with medical therapy should be considered.
Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Heart Valve Diseases ; Hospitalization ; Humans ; Incidence ; Mitral Valve ; Recurrence ; Thorax ; Tricuspid Valve

Recently, worldwide dietary reference intakes have been considered an important guideline for public health. Some governments and the World Health Organization (WHO) provide guidelines concerning dietary intake. Although an ingredient may have a history of use as a culinary material, changes in the environment over time suggest that the acceptable maximum intake each of food/culinary material should be regularly evaluated. Arctium lappa L. has been used as a culinary material for many centuries in Korea and Japan and some recent studies have reported related therapeutic effects. However, there are no reports on the safety of repeated oral administration. In this study, we evaluated the safety of a 8-weeks repeated oral intake of A. lappa. We concluded that treatment with <250 mg/kg A. lappa, which was within the safety range, resulted in body weight decrease and blood glucose suppression.
Administration, Oral* ; Arctium* ; Blood Glucose ; Body Weight ; Japan ; Korea ; Public Health ; Recommended Dietary Allowances ; Therapeutic Uses ; World Health Organization

BACKGROUND: Tourniquets are used to provide a bloodless surgical field for extremities. Hypotension due to vasodilation and bleeding after tourniquet deflation is a common event. Hemodynamic stability is modulated by the autonomic nervous system (ANS). Heart rate variability (HRV) is a sensitive method for detecting individuals who may be at risk of hemodynamic instability during general anesthesia. The purpose of this study was to investigate ANS function to predict hypotension after tourniquet deflation. METHODS: Eighty-six patients who underwent total knee replacement arthroplasty (TKRA) were studied. HRV, systolic blood pressure variability (SBPV) and baroreflex sensitivity (BRS) were analyzed. We assigned two groups depending on the lowest systolic blood pressure (SBP) or mean BP (MBP) after tourniquet release (Group H; SBP < 80 mmHg or MBP < 60 mmHg, Group S; SBP > 80 mmHg and MBP > 60 mmHg). RESULTS: Fifteen patients developed severe hypotension and ten patients were treated with ephedrine. Of the parameters of HRV, SBPV, and BRS, only BRSSEQ was significant being low in Group H. BRS and high-frequency SBPV were correlated with the degree of MBP change after tourniquet deflation. CONCLUSIONS: Preoperative low BRS is associated with hypotension after tourniquet deflation, suggesting the importance of baroreflex regulation for intraoperative hemodynamic stability.
Anesthesia, General ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Autonomic Nervous System ; Baroreflex ; Blood Pressure ; Ephedrine ; Extremities ; Heart Rate ; Hemodynamics ; Hemorrhage ; Humans ; Hypotension ; Tourniquets ; Vasodilation

BACKGROUND: Mitral and pulmonary venous(PV) flow velocity variables are being used for the indirect evaluation of left ventricular(LV) diastolic function. However, these flow velocities are influenced by age, loading conditions and other factors. This study was designed to evaluate usefulness of left atrial size and function in addition to the relation of mitral and PV flow velocity variables in the estimation of LV filling pressures. METHODS: Mitral and PV flow velocity variables. left artial size and function were assessed just before a cardiac catherization in 31 patients. According to the LV filling pressures, patients were divided into two subgroups and echocardiographic variables were compared. RESULTS: 1) LV end-diastolic pressure was related to the duration of reverse flow in the PV at atrial contraction(r=0.58) and difference in mitral and PV flow velocity duration at atrial contraction(r=0.54), and the similar findings were observed in other left ventricular filling pressures. 2) Left atrial size and volumes were greater in the subgroup of abnormal LV filling pressures(P < 0.05), but left atrial ejection fraction was not different between subgroups. CONCLUSION: In addition to variables of the mitral and PV flow velocities, left atrial size and volume may provide an additive value in the estimation of left ventricular filling pressures.
Echocardiography ; Echocardiography, Doppler ; Humans