AC/A ratio of alternating fixation metbod(AF) using Major Amblyoscope was compared with that of simultaneous fixation method(SF). Under SF, AC/A ratio was greater than that of AF and standard deviation of both method was not significantly different. This indicates tbat AC/A ratio of SF was not accurate, because fusional convergence was invariably participated. Therefore, when we measure the AC/A ratio by tbe gradient method using the Major Amblyoscope, AF was desirable.

AC/A ratio of alternating fixation metbod(AF) using Major Amblyoscope was compared with that of simultaneous fixation method(SF). Under SF, AC/A ratio was greater than that of AF and standard deviation of both method was not significantly different. This indicates tbat AC/A ratio of SF was not accurate, because fusional convergence was invariably participated. Therefore, when we measure the AC/A ratio by tbe gradient method using the Major Amblyoscope, AF was desirable.

Central serous chorioretinopathy is a relatively good prognosis. But certain patients present poor visual outcome. To clarify the courses and factors that affect final visual outcome, 36 patients who did not receive any treatment were studied respectively. The smoke stack type of leakage was more frequently noted in fresh cases. The courses of the disease were similar in spite of difference of type of leakage. The type of leakage did not affect both the initial and final visual acuity. And among the cases with poor visual outcome, there were noted other lesions such as pigment epithelial decompensation, choroidal atrophy and subretinal neovascular membrane.
Atrophy ; Central Serous Chorioretinopathy* ; Choroid ; Humans ; Membranes ; Prognosis ; Smoke ; Visual Acuity

Branch retinal vein occlusion is a disease of relatively good prognosis concerning visual acuity. We have studied 33 patients with temporal branch retinal vein occlusion who have not been treated to investigate the cause of branch retinal vein occlusion and poor visual outcome. The possible causes were as follow; Hypertension was found in 25 patients, hyperlipidemia in two, adiposity in one, Diabetes Mellitus in one and unknown causes in 4 patients. Among those twenty five patients who have hypertension, 6 of them showed eleveted systolic blood pressure, while diastolic blood pressure remains normal, suggesting that high systolic pressure might be a more significant factor than diastolic pressure. Poor visual outcome has been found in eight patients. Four as chronic macular edema. Two has preretinal membrane and remaining two has vitreous opacity and macular hole, respectively. In overall, better prognosis has been observed in inferotemporal branch retinal vein occlusion than insuperotemporal branch retinal vein occlusion. Also, patients who did not have macular hemorrhage had better visual outcome than those who had.
Adiposity ; Blood Pressure ; Diabetes Mellitus ; Hemorrhage ; Humans ; Hyperlipidemias ; Hypertension ; Macular Edema ; Membranes ; Prognosis ; Retinal Perforations ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Visual Acuity

BACKGROUND AND OBJECTIVES: Optimal international normalized ratio (INR) in elderly atrial fibrillation (AF) patients at higher risk of hemorrhagic events remains unclear. We investigated the efficacy and safety of low-intensity warfarin therapy (target international normalized ratio [INR], 1.6-2.6) in elderly Korean patients with nonvalvular AF (NVAF). SUBJECTS AND METHODS: We enrolled 528 NVAF patients (mean age, 67±9 years; 361 men) who were actively taking warfarin. Major events were defined based on the annual rates of ischemic stroke, systemic embolism, and major bleeding events requiring blood transfusion or hospitalization. Time in therapeutic range (TTR) was 45±19% for all patients. RESULTS: Ischemic stroke and systemic embolism occurred in 20 patients with INR between 1.00 and 2.44 (16 ischemic strokes and 4 systemic embolisms) and major bleeding in 37 patients with INR between 1.74 and no coagulation (exceed laboratory detection capability, more than 10 [7 intracranial hemorrhages, 21 gastrointestinal bleedings, and 9 others]). Incidence rates of ischemic or hemorrhagic events at INR<2.00, 2-3, and >3 were 3.0%, 1.4%, and 20.1% per year, respectively. In patients who were ≥70 years old, CHADS₂, CHA₂DS₂VASc, and HAS-BLED scores were significantly higher compared with those in patients who were <70 years old. When we applied the INR between 1.6 and 2.6, as recommended by the Japanese AF Guideline for patients≥70 years old, the TTR increased from 43.8% to 58.6%. In addition, ischemic or hemorrhagic event rates decreased from 1.9% to 1.2% within the optimal INR range. CONCLUSION: Low-intensity warfarin therapy (INR, 1.6-2.6) should be considered in elderly Korean patients with NVAF.
Aged* ; Asian Continental Ancestry Group ; Atrial Fibrillation* ; Blood Transfusion ; Embolism ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; International Normalized Ratio* ; Intracranial Hemorrhages ; Stroke ; Warfarin*

A 60-year-old male patient with coronavirus disease-2019 showed new onset ST-segment elevation in V1–V2 leads on electrocardiogram and cardiac enzyme elevation in intensive care unit. He had a history of type 2 diabetes mellitus, hypertension, and dyslipidemia. He was receiving mechanical ventilation and veno-venous extracorporeal membrane oxygenation treatment for severe hypoxia. Two-D echocardiogram showed regional wall motion abnormalities. We performed primary percutaneous coronary intervention for acute myocardial infarction complicating cardiogenic shock under hemodynamic support. He expired on the 16th day of admission because of cardiogenic shock and multi-organ failure. Active surveillance and intensive treatment strategy are important for saving lives of COVID-19 patients with acute myocardial infarction.

Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of 10 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific findings on the laboratory based manometry, but DES was diagnosed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry should always be performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature.
Adult ; Chest Pain ; Deglutition Disorders ; Diagnosis* ; Esophageal Spasm, Diffuse* ; Esophagus ; Humans ; Male ; Manometry* ; Swallows

BACKGROUND AND OBJECTIVES: The impact of multivessel coronary disease (MVD) with chronic total occlusion (CTO) on one-year mortality in patients with acute myocardial infarction (AMI) is not clearly known. We investigated the impact of MVD with concurrent CTO lesion on one-year mortality in patients with AMI. SUBJECTS AND METHODS: We studied 1008 consecutive patients who underwent coronary angiography between November 2005 and December 2008 with a diagnosis of AMI. RESULTS: Among 1008 patients, 432 patients (43%) had MVD, and 88 patients (8.7%) had CTO lesion. The one-year overall mortality was higher in patients with MVD than in patients with single vessel disease (SVD) (10.2% vs. 5.9%, p=0.012). However, the one-year overall mortality was not significantly higher in patients with CTO lesion than in patients without that lesion (12.5% vs. 7.3%, p=0.080). In multivariate analysis, independent predictors of one-year overall mortality were age older than 65 years {hazard ratio (HR) 2.41, 95% confidence interval (CI): 1.43 to 4.08}, Killip class > or =III (HR 3.59, 95% CI: 2.24 to 5.77), ST-elevation myocardial infarction (HR 2.45, 95% CI: 1.49 to 4.05) and MVD (HR 1.76, 95% CI: 1.07 to 2.89). CONCLUSION: Patients with MVD showed higher one-year mortality than patients with SVD. However, the presence of CTO was not an independent predictor of one-year mortality in this study that included patients with successfully revascularized CTO lesion.
Chronic Disease ; Coronary Angiography ; Coronary Disease ; Coronary Occlusion ; Glycosaminoglycans ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Prognosis

Uterine adenomyosis is a common benign pelvic tumor in women. One of the complications that may be infrequently associated with the huge pelvic mass is venous stasis of the lower extremities and may develop thrombophlebitis secondary to pelvic compression. Intravascular thrombosis in the deep vein of the legs is a serious illness that sometimes cause death due to acute pulmonary thromboembolism. Deep vein thrombosis (DVT) has been reported to be closely related to pregnancy, surgical procedure, long term bedrest, obesity, and oral contraceptives. However, there is few report about deep vein thrombosis caused by huge uterine adenomyosisWe report a case of deep vein thrombosis caused by huge adenomyosis was treated by hysterectomy, thrombectomy, and thrombolysis with a brief review of the literature.
Adenomyosis* ; Bed Rest ; Contraceptives, Oral ; Female ; Humans ; Hysterectomy ; Leg* ; Lower Extremity ; Obesity ; Pregnancy ; Pulmonary Embolism ; Thrombectomy ; Thrombophlebitis ; Thrombosis ; Veins ; Venous Thrombosis*