Although the carotid endarterectomy presently represents the standard therapeutic approach for most patients with significant carotid artery stenosis, a percutaneous transluminal angioplasty (PTA) with stenting has become an alternative method for treating patients with co-mobid conditions, particulary coronary artery disease. A PTA with stenting has the potential for being safer, less traumatic, more cost-effective, and useful in patients at high surgical risk. As well, they are not limited to the cervical carotid artery. But it is reported that carotid angioplasty by femoral approach is difficult to do in 1 - 2% of patients with carotid stenosis due to abnormal origin of carotid artery or occlusion of femoral arteries. We succeeded in PTA with stenting of tight stenosis of right internal carotid artery through the transseptal approach in case of a sharply angled right brachiocephalic artery take-off from the aorta. The transseptal approach can be used for PTA with stenting in case of problems with femoral approach.
Angioplasty ; Aorta ; Arteries ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Disease ; Endarterectomy, Carotid ; Femoral Artery ; Humans ; Stents*

PURPOSE: Cardiovascular risk factor modification is important for patients with coronary artery disease to prevent poor progression of the disease. Without an understanding and an awareness of risk factors, patients with coronary artery disease are not able to reduce their risk by the lifestyle modification. The aims of this study were to assess patient's awareness of risk factors and to identify predictors of awareness of risk factors. METHODS: A descriptive correlational study using a cross-sectional survey method was performed. The sites of the study were three hospitals in Seoul, Korea. The sample consisted of 214 subjects. The awareness of risk factors and other subjects' characteristics were measured by a questionnaire developed for this study. RESULTS: A range of subjects (gender: 72.0%; hyperlipidemia: 51.9%; hypertension: 40.7%; obese: 37.4%; age: 35.5%; smoking: 22.4%; diabetes: 19.2%; family history: 18.2%) were not able to accurately identify the risk factors. Among predictors, gender (beta=-.17) and diabetics (beta=-.25) had statistically significant influences on awareness of risk factors. CONCLUSION: Our findings highlight the lack of awareness of risk factors for coronary artery disease. The findings have important implications for nursing practice in terms of guiding educational strategies for the modification of risk factors for coronary heart disease.
Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Cross-Sectional Studies ; Humans ; Korea ; Life Style ; Risk Factors ; Surveys and Questionnaires

PURPOSE: This paper proposes proper and effective neck exercises by comparing the deep and superficial cervical flexor muscle activities and thickness according to the pressure level during cranio-cervical flexion exercises between a normal posture group and forward head posture group. METHODS: A total of 20 subjects (8 males and 12 females) without neck pain and disabilities were selected. The subjects' craniovertebral angles were measured; they were divided into a normal posture and a forward head posture group. During cranio-cervical flexion exercises, the thickness of the deep cervical flexor neck muscle and the activity of the surface neck muscles were measured using ultrasound and EMG. RESULTS: The results showed that the thickening of the deep cervical flexor was increased significantly to 28 and 30 mmHg in the forward head posture group. The sternocleidomastoid muscle activity increased significantly to 24, 26, 28, and 30 mmHg in the forward head posture group. The anterior scalene muscle activity increased significantly to 26, 28, and 30mmHg in the forward head posture group. A significant difference of 26, 28, and 30 mmHg in the sternocleidomastoid and anterior scalene muscles was observed between two groups. CONCLUSION: To prevent a forward head posture and maintain proper cervical curve alignment, the use of the superficial cervical flexor muscles must be minimized. In addition, to perform a cranio-cervical flexion exercises to effectively activate the deep cervical flexor muscles, 28 and 30 mmHg for normal posture adults and 28 mmHg for adults with forward head postures are recommended.
Adult ; Exercise ; Head ; Humans ; Male ; Muscles ; Neck ; Neck Muscles ; Neck Pain ; Posture ; Ultrasonography

Background: Agent Orange, an herbicide sprayed during the Vietnam War, is a known carcinogen. However, there have been no studies on its association with basal cell carcinoma (BCC) or the nature of BCC in defoliant-exposed patients. Objective: To determine the clinical and histological characteristics of BCC in patients exposed to defoliants. Methods: Chart analysis was performed on patients diagnosed with BCC at Veterans Health Service Medical Center from January 2011 to December 2020. The clinical data were compared between the defoliant-exposed and non-exposed groups. Histopathological characteristics were compared according to histological subtype and presence of pigmentation. Results: Of 227 patients with BCC, 117 were defoliant-exposed and 110 were unexposed. The mean age at diagnosis of skin cancer was 73.9 years. The age at diagnosis was significantly lower in the defoliant-exposed group than in the unexposed group (71.3 years vs. 76.7 years, p＜0.001). In most cases, BCC was identified as pigmented papules and nodules on the face. Nonpigmented lesions were observed more frequently in the defoliant-exposed group than in the unexposed group; however, this difference was not statistically significant. Histologically, the nodular type was the most common subtype in both groups. Additionally, 33.3% of the defoliant group and 25.9% of the control group showed melanin pigmentation, and no statistically significant difference was observed in tumor depth between the two groups. Conclusion As veterans of the Vietnam War advance in age, dermatologists should continuously pay attention to BCC in defoliant-exposed patients, and early diagnosis and proper management should be ensured.

A 72-year-old man presented with incidentally found palpable abdominal mass of unknown duration. On admission, he had blood pressure of 120/80mmHg and pulse of 70 beats per minute. He consumed a pack of cigarettes per day for 45 years. He denied any prior chest pain episodes. The serum lipid profiles were within normal range. Electrocardiogram revealed sinus rhythm without ST-T wave change. Digital subtraction angiography revealed aneurysmal dilatation of both common iliac arteries to the proximal part of the external iliac arteries. Transthoracic echocardiography revealed normal left ventricular wall motion except a pseu-doaneurysm at the apex (Fig. 1). Color Doppler (Fig. 2) and intravenous contrast echocardiography (Fig. 3) showed free blood flow communication through the neck of the pseudoaneurysm. Coronary angiography revealed no significant luminal narrowing of coronary arteries. Left ventriculogram showed an aneurysm at the apex (Fig. 4). During the period of 8 months follow-up, the patient did not have any event or complain any symptom.
Aged ; Aneurysm ; Aneurysm, False* ; Angiography, Digital Subtraction ; Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Dilatation ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Iliac Artery ; Neck ; Phenobarbital ; Reference Values ; Tobacco Products

BACKGROUND AND OBJECTIVES: To evaluate the feasibility and the short- and mid-term follow-up outcomes of endovascular stent-graft implantation in patients with Stanford type B aortic dissection. SUBJECTS AND METHODS: Twenty-eight patients with Stanford type B aortic dissection were evaluated. An aortogram was performed immediately after the procedure and a follow-up computed tomography (CT) scan was performed within one week, between 3 and 6 months, and annually thereafter. Clinical status was also evaluated at the same time. RESULTS: Endovascular stent-graft implantation at the target site was successful in 27 patients (96.4%). There were primary endoleaks in 6 patients and one case of procedure failure owing to migration of the stent-graft; and no procedure-related mortality. The number of patients with early complications requiring treatment was 2 (2/27, 4%). Fourteen patients experienced postimplantation syndrome (14/27, 52%). The average follow-up period was 22.1+/-17.5 months. Complete resolution or thrombosis of the false lumen was achieved in 14 patients and partial thrombosis was achieved in 10 patients. Operative treatments were required in three patients due to a progressing dissection or new dissection. There were no deaths and no instances of aneurysm or aortic rupture during the follow-up period. CONCLUSION: Endovascular stent-graft implantation for Stanford type B aortic dissection is a feasible, safe, and effective treatment modality. All patients who underwent surgery had a persisting leak. Therefore, regular evaluation of the aortic dissection and management of endoleaks were crucial for a favorable outcome in endovascular stent-graft implantation for a Stanford type B aortic dissection.
Aneurysm ; Aortic Rupture ; Endoleak ; Follow-Up Studies ; Humans ; Mortality ; Thrombosis

BACKGROUND/AIMS: Despite the U.S. Food and Drug Adminstration approving a magnetic resonance imaging (MRI)-conditional pacemaker system in 2011, many physicians remain reluctant to perform MRI scanning in patients with cardiac implantable electronic devices. Herein, we aimed to evaluate the real-world safety of MRI in these patients. METHODS: This single-center retrospective study examined the interrogation data and outcomes of patients with pacemakers or implantable cardioverter defibrillators who underwent MRI. MRI interrogation data were collected pre- and post-MRI and after 1 month of follow-up; these included the lead impedance, measured P- and R-wave amplitudes, and capture threshold. We compared these results between the magnetic resonance (MR)-conditional and conventional groups. RESULTS: From September 2013 to December 2015, 35 patients with cardiac implantable electronic devices underwent 43 MRI scans, with a mean follow-up of 5 months. Among these 35 patients, 14 (40%) had MR-conditional devices and 21 (60%) had conventional devices. Seven patients had high voltage devices, which were all the conventional type. There were no adverse events associated with MRI during the follow-up period, and there were no significant differences in the interrogation data changes between the conventional and MR-conditional groups. CONCLUSIONS: This single-center retrospective study found that MRI can be performed safely in patients with pacemakers or implantable cardioverter defibrillators, regardless of the MRI support, as long as appropriate precautions are taken.
Defibrillators, Implantable* ; Electric Impedance ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies

Background: A direct potassium hydroxide (KOH) smear is used to diagnose onychomycosis despite its broad sensitivity range. For a more accurate diagnosis, histopathologic examination can be used and consistently show high sensitivity. Objective: We investigated the value of histopathologic examination of the nail plate as a diagnostic tool for onychomycosis. We proposed effective routine diagnostic staining to compare sensitivity between periodic acid-Schiff (PAS) and Gomori’s methenamine silver (GMS) staining. Methods: This retrospective study was conducted from January 1, 2019 to May 31, 2020, and included 97 patients who showed negative results on direct KOH smear but had clinical manifestations that implied onychomycosis. We performed nail plate biopsy and PAS or GMS staining to identify fungal hyphae missed in the direct KOH smear. Sensitivity comparison between PAS and GMS was performed in co-stained samples. Results: Among 97 patients with 102 cases, 55 cases (53.9%) of onychomycosis were confirmed by histopathologic examination. A total of 68 patients (70.1%) had a previous medical history of antifungal agents within previous six months. PAS and GMS staining were concurrently performed in 73 cases, and onychomycosis was confirmed in 41 cases. The sensitivity of PAS was 100% (41/41), while that of GMS was 87.8% (36/41); this difference was not significant. Conclusion This study suggests that histologic examination of the nail plate is an effective tool to diagnose onychomycosis and can be performed with a direct KOH smear. Two staining methods, PAS and GMS, are recommended for concurrent performance to enhance the identification of fungal hyphae.

Background: A direct potassium hydroxide (KOH) smear is used to diagnose onychomycosis despite its broad sensitivity range. For a more accurate diagnosis, histopathologic examination can be used and consistently show high sensitivity. Objective: We investigated the value of histopathologic examination of the nail plate as a diagnostic tool for onychomycosis. We proposed effective routine diagnostic staining to compare sensitivity between periodic acid-Schiff (PAS) and Gomori’s methenamine silver (GMS) staining. Methods: This retrospective study was conducted from January 1, 2019 to May 31, 2020, and included 97 patients who showed negative results on direct KOH smear but had clinical manifestations that implied onychomycosis. We performed nail plate biopsy and PAS or GMS staining to identify fungal hyphae missed in the direct KOH smear. Sensitivity comparison between PAS and GMS was performed in co-stained samples. Results: Among 97 patients with 102 cases, 55 cases (53.9%) of onychomycosis were confirmed by histopathologic examination. A total of 68 patients (70.1%) had a previous medical history of antifungal agents within previous six months. PAS and GMS staining were concurrently performed in 73 cases, and onychomycosis was confirmed in 41 cases. The sensitivity of PAS was 100% (41/41), while that of GMS was 87.8% (36/41); this difference was not significant. Conclusion This study suggests that histologic examination of the nail plate is an effective tool to diagnose onychomycosis and can be performed with a direct KOH smear. Two staining methods, PAS and GMS, are recommended for concurrent performance to enhance the identification of fungal hyphae.