Angiosarcoma is a rare malignant vascular tumor of endothelial cell origin. Most lesions of cutaneous angiosarcoma occur over the face and scalp. We experienced a case of angiosarcoma of the scalp in a 63-year-old man. Multiple pea-sized erythematous papules and nodules developed on the forehead 6 months ago. Thereafter, the lesions have extended to make violaceous, compressible and hemorrhagic plaques. On histologic examination, there were irregular, often anastomosing vascular channels lined by the atypical endothelial cells in the dermis.
Dermis ; Endothelial Cells ; Forehead ; Hemangiosarcoma* ; Humans ; Middle Aged ; Scalp*

Some cases of plaster ingestion include the occurrence of gastrointestinal obstruction that requires surgery. To date, there are no reports on the treatment of plaster lesions in the mouth. A 50-year-old woman was referred to the emergency department after intentionally drinking a solution of approximately 100 g of plaster powder in 250 mL of water, 3 hours earlier. On arrival, the patient was alert but unable to speak because the plaster had hardened in her mouth. Hardened plaster was also found in her stomach. There was no evidence of acute gastrointestinal obstruction on abdominal computed tomography; we therefore decided to perform surgical observation. The intraoral plaster lesions were successfully removed using forceps, and the plaster bezoar was successfully eliminated without surgical treatment. The present case shows that not all patients with plaster poisoning require surgery; the patient’s conditions, such as gastrointestinal obstruction, should indicate the course of treatment.

This is to analyze and compare the distribution of the liver function test and its abnormal rates of the preemployment screening for office workers in asymptomatic young age groups between female and male. Liver function test(SGPT and SGOT) of 8,184 young adults(2,633 in female and 5,551 in male) were examined during the period from Jan.1,1994 to Dec. 31, 1994. The results were as follows; 1. Mean level of SGPT was 9.l+/-7.6(IU/L) in female, 21.0+/-27.9(IU/L) in male, and that of SGOT was 15.1+/-6.0(IU/L) in female, 20.5+/-26.5(IU/L) in male. There were significant differences(p<0.01) between female and male in both SPT and SGOT. And also there was significant increasing trend(p<0.05) by age groups in male for SGPT, decreasing trend(p<0.01) in female for SGOT. 2. In the abnormal rates of liver function test by the level of cut-off value, there were significant differences up to twice between the lowest and the highest cut-off value in both female(0.4% vs 0.7%) and male(6.5% vs 12.4%) 3. Abnormal rate of SGPT was 0.4% in female and 6.3% in male, and that of SGOT was 0.2% in female and 1.2% in male with significant differences between female and male in both tests.
Alanine Transaminase ; Aspartate Aminotransferases ; Female ; Humans ; Liver Function Tests* ; Liver* ; Male ; Mass Screening*

In July 2010, we identified an outbreak of vancomycin-resistant enterococci (VRE) in our 26-bed neonatal intensive care unit. We performed an epidemiological investigation after clinical cultures of 2 neonates were positive for VRE. Identification, susceptibility testing, and molecular characterization were performed. Cultures of 3 surveillance stool samples of inpatients and 5 environmental samples were positive for VRE. All isolates were identified as Enterococcus faecium containing the vanA gene. Two distinct clones were identified by performing pulsed-field gel electrophoresis. The 2 clones exhibited different pulsotypes, but they represented identical Tn1546 types. Two sequence types, ST18 and ST192, were identified among all of the isolates with multilocus sequence typing. Our investigation determined that the outbreak in the neonatal intensive care unit was caused by 2 genetically different clones. The outbreak may have occurred through clonal spread and horizontal transfer of the van gene.
Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/genetics ; Bacterial Typing Techniques ; Carbon-Oxygen Ligases/genetics ; DNA, Bacterial/analysis ; *Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium/drug effects/*genetics/isolation & purification ; Feces/microbiology ; Genotype ; Gram-Positive Bacterial Infections/diagnosis/epidemiology/*microbiology ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Multilocus Sequence Typing ; Vancomycin/pharmacology ; *Vancomycin Resistance

PURPOSE: Osteoarthritis (OA) of the temporomandibular joint (TMJ) elicits cartilage and subchondral bone defects. Growth hormone (GH) promotes chondrocyte growth. The aim of this study was to evaluate the efficacy of intra-articular injections of GH to treat TMJ-OA.MATERIALS AND METHODS: Monosodium iodoacetate (MIA) was used to induce OA in the TMJs of rats. After confirming the induction of OA, recombinant human GH was injected into the articular cavities of rats. Concentrations of GH and IGF-1 were measured in the blood and synovial fluid, and OA grades of cartilage and subchondral bone degradation were recorded by histological examination and micro-computed tomography.RESULTS: MIA-induced OA in the rat TMJ upregulated insulin-like growth factor-1 (IGF-1) rather than GH levels. GH and IGF-1 concentrations were increased after local injection of GH, compared with controls. Locally injected GH lowered osteoarthritic scores in the cartilage and subchondral bone of the TMJ.CONCLUSION: Intra-articular injection of GH improved OA scores in rat TMJs in both cartilage and subchondral bone of the condyles without affecting condylar bone growth. These results suggest that intra-articular injection of human GH could be a suitable treatment option for TMJ-OA patients in the future.

BACKGROUND: Several studies suggested that epicardial adipose tissue (EAT) might be associated with metabolic syndrome and coronary atherosclerosis. But, little had been studied whether the thickness of EAT on echocardiography could represent the whole amount of EAT. The purpose of this study was to identify the best echocardiographic methods reflecting total amount of EAT. \METHODS: Sixty subjects (32 women, mean: 58+/-12 years-old) who underwent 64-slice multidetector computed tomography (MDCT) were consecutively enrolled. All CT scanning was performed one Brilliance CT-64-channel configuration scanner (Philips, Cleveland, USA) and axially contiguous 10-mm-thickeness sections were obtained from aortic valve to diaphragm level. EAT area was manually traced in each slice and summed up. The EAT thickness was measured as the echo-lucent or echo-dense space between epicardium and pericardium at parasternal long-axis, modified 4-chamber, and apical 4-chamber view. RESULTS: The EAT thickness at parasternal long-axis and modified 4-chamber view and the sum of EAT thickness from each views (median thickness: 1.0, 2.8, 1.1 and 5.0 mm, respectively) were all correlated with total EAT area on MDCT. Among echo parameters, the EAT thickness measured on parasternal long-axis view during diastole correlated best with total EAT area on MDCT (r=0.572, p<0.001). CONCLUSION: The echocardiographic EAT measurement might be easily accessible and less harmful method representing whole amount of EAT. The measurement of the thickness of EAT on parasternal long-axis view during diastole by echocardiography might be feasible and reliable in the studying field of EAT.
Adipose Tissue ; Aortic Valve ; Coronary Artery Disease ; Coronary Vessels ; Diaphragm ; Diastole ; Echocardiography ; Female ; Humans ; Multidetector Computed Tomography ; Pericardium ; Risk Factors

BACKGROUND AND OBJECTIVES: To evaluate the association between chronic infection with Chlamydia pneumoniae, as measured by Immunoglobulin G and A, and acute myocardial infarction (AMI) in Korea. MATERIALS AND METHODS: A total of 136 patients [normal control 65 cases (male:female 27:8, mean age 55.1+/-11.7 years), AMI 71 cases (male:female 54:17, mean age 58.9+/-12.7 years)] had immunoglobulin G, A, and M antibody titers measured against Chlamydia pneumoniae by microimmunoflorescence assay and had coronary angiography performed. We investigated the incidence of major adverse cardiac events (MACE) at 6 month follow-up. Controls were defined as patients with no significant stenosis on coronary angiography. RESULTS: 1) AMI patients were more likely to be male (76.1: 41.5%) and smokers (67.6: 16.9%) compared with the controls. >2) In AMI patients, there was a weak correlation with IgG and IgA antibody titers (r=0.39, p=0.001).> 3) After adjusting for gender and smoking status, IgG and IgA antibody titers were similar between two groups.> 4) Increased IgG and IgA titers did not affect the MACE during follow-up. CONCLUSION: Chronic Chlamydia pneumoniae infection detected by immunoglobulin assay is not significantly associated with AMI. Further studies, such as polymerase chain reaction, immunocytochemistry, or culture of the atheromatous plaques, are needed to better define the association.
Chlamydia* ; Chlamydophila pneumoniae* ; Constriction, Pathologic ; Coronary Angiography ; Follow-Up Studies ; Humans ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulins ; Immunohistochemistry ; Incidence ; Korea* ; Male ; Myocardial Infarction* ; Plaque, Atherosclerotic ; Polymerase Chain Reaction ; Risk Factors* ; Smoke ; Smoking

BACKGROUND: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction. METHODS: We conducted a multicenter, prospective, non-interventional study. Patients with CHADS2 ≥ 1 and treated with VKA (started within the last 3 months) were enrolled from April 2013 to March 2014. Demographic and clinical features including risk factors of stroke and VKA treatment information was collected at baseline. Treatment patterns and international normalized ratio (INR) level were evaluated during follow-up. Time in therapeutic range (TTR) > 60% indicated well-controlled INR. Treatment satisfaction on the VKA use was measured by Treatment Satisfaction Questionnaire for Medication (TSQM) after 3 months of follow-up. RESULTS: A total of 877 patients (age, 67; male, 60%) were enrolled and followed up for one year. More than half of patients (56%) had CHADS2 ≥ 2 and 83.6% had CHA2DS2-VASc ≥ 2. A total of 852 patients had one or more INR measurement during their follow-up period. Among those patients, 25.5% discontinued VKA treatment during follow-up. Of all patients, 626 patients (73%) had poor-controlled INR (TTR < 60%) measure. Patients' treatment satisfaction measured with TSQM was 55.6 in global satisfaction domain. CONCLUSION: INR was poorly controlled in Korean NVAF patients treated with VKA. VKA users also showed low treatment satisfaction.
Atrial Fibrillation* ; Drug Interactions ; Follow-Up Studies ; Humans ; International Normalized Ratio ; Male ; Prospective Studies ; Risk Factors ; Stroke ; Thromboembolism ; Vitamin K* ; Vitamins*

BACKGROUND AND OBJECTIVES: Despite significant advances in the treatment of acute myocardial infarction (MI), the prevention of sudden cardiac death (SCD), the most common mode of death in patients with MI, remains challenging. Furthermore, previous Korean MI registries did not address the issue of post-MI SCD. Additional risk stratifiers of post-MI SCD are still required to compensate for the limitation of using left ventricular ejection fraction to predict lethal arrhythmic events. SUBJECTS AND METHODS: We designed the first Korean prospective nationwide multicenter registry primarily focused on SCD; the Korean noninvasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (K-REDEFINE). The registry consists of 2 groups of patients presenting with (1) acute MI or (2) acute heart failure (HF) at 25 tertiary referral cardiovascular centers. The primary endpoint of the MI group study of K-REDEFINE registry is the incidence and risk factors of post-MI SCD. In particular, the association between the risk of SCD and non-invasive Holter-based electrocardiogram (ECG) variables will be evaluated, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/variability (a marker of autonomic function). Other secondary study outcomes include atrioventricular arrhythmias, HF-related admission, repeated myocardial ischemic events, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will provide new prospects for the better management of MI patients with high risk of SCD by clarifying the burden and predictors of SCD and the clinical utility of various non-invasive ambulatory ECG-based variables in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction* ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke ; Stroke Volume

BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is one of the most common causes of death in patients with heart failure (HF). However, there are no available data on SCD in previous Korean HF registries. Additionally, although widely used, the utility of left ventricular (LV) ejection fraction (EF) in risk stratification for SCD is limited. SUBJECTS AND METHODS: The Korean non-invasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (KREDEFINE) is the first Korean prospective, nationwide multicenter registry, primarily focused on SCD. The registry consists of 2 groups of patients presenting with (1) acute HF or (2) acute myocardial infarction (MI) at 25 tertiary referral cardiovascular centers. Using the HF-group data of the K-REDEFINE registry, the incidence and risk factors of SCD in patients with HF will be assessed. In particular, the efficacy of Holter-based ECG variables, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/ variability (maker of autonomic function), in risk stratification for SCD will be evaluated. Other cardiovascular outcomes will also be analyzed, including atrioventricular arrhythmias, HF-related admission, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will pave the way for better management of patients with HF at high risk of SCD by elucidating the burden and risk factors of SCD and the clinical utility of various non-invasive ambulatory ECG-based parameters in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Cause of Death ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke