OBJECTIVE: Metabolic syndrome (MS) is associated with increased left ventricular (LV) mass and diastolic dysfunction. This study uses relatively load-independent Doppler tissue echocardiography to examine whether MS is associated with decreased longitudinal contractile reserve during dynamic exercise. METHODS: A total of 112 patients with relatively well-controlled, treated hypertension who complained of exertional dyspnea were enrolled (average age, 56.7+/-10.5 years). Fifty-six were non-diabetic patients with MS (group 1), and 56 were age-sex matched hypertensive patients without MS (group 2). Exercise stress echo was performed using a symptom-limited, multistage, supine bicycle exercise test. Multiple Doppler parameters were obtained at baseline, at each stage of exercise. RESULTS: There was no significant difference between the two groups in terms of age, gender, and hemodynamic variables. E/E', an index of LV filling pressure, was significantly higher in the MS group at rest and during exercise. The longitudinal contractile reserve, the change in S' (longitudinal tissue velocity) from baseline to peak exercise, was significantly lower in the MS group (2.00+/-1.65 vs. 2.90+/-1.66, P=0.015). Multiple regression analysis showed independent association of MS with longitudinal contractile reserve when controlled for confounding factors, such as LV mass index, gender, blood pressure, and age (beta=-0.235, P=0.035). CONCLUSION: Longitudinal contractile reserve was reduced in MS patients compared to others, although both groups demonstrated similar longitudinal contractile function at rest. We present the first demonstration that metabolic syndrome is independently associated with LV systolic dysfunction during exercise in hypertensive patients.
Blood Pressure ; Dyspnea ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Hypertension

Synovial cyst on prevertebral space of C1-2 joint is rare but may be associated hemorrhagic event. We describe a case of a 72-year-old woman who presented with sudden severe headache in her left occipital area with dyspnea. She had rheumatoid arthritis for 14-years. Large hemorrhagic cystic mass was seen around prevertebral space of the atlantoaxial joint on the left side on cervical MRI (magnetic resonance image) and it obstructed the nasopharyngeal cavity. Aspiration of the cystic lesion was performed via transoral approach, followed by posterior occipito-cervical fusion. The specimen was xanthochromic, suggesting old hemorrhage. The patient was tolerable on her postoperative course and showed good respiration and relieved headache. We suggest that repeated microtrauma due to atalantoaxial subluxation associated with rheumatoid arthritis as a main cause of hemorrhagic event on the cyst.
Arthritis, Rheumatoid ; Atlanto-Axial Joint ; Dyspnea ; Female ; Headache ; Hemorrhage ; Humans ; Joints ; Respiration ; Synovial Cyst

A 38-year-old woman who had undergone pelvic lymphangioma resection two months previously presented with cough and dyspnea. Transthoracic echocardiography and CT demonstrated the presence of a mixed cystic/solid component tumor involving the inferior vena cava, heart and pulmonary artery. Complete resection of the cardiac tumor was performed and lymphangioma was confirmed based on histopathologic examination. To the best of our knowledge, this is the first report of lymphangiomatosis with cardiac and pelvic involvement in the published clinical literature.
Adult ; Female ; Heart Neoplasms/diagnosis/*pathology ; Humans ; Lymphangioma/diagnosis/*pathology/surgery ; Neoplasm Invasiveness ; Neoplasms, Second Primary/diagnosis/*pathology ; Pelvic Neoplasms/*pathology/surgery ; Pulmonary Artery/*pathology ; Vena Cava, Inferior/*pathology

Objective: This study investigated the prevalence and comorbidities of attention deficit hyperactivity disorder (ADHD) among adults and children/adolescents in Korea. Methods: This study used data from the Korea Health Insurance Review and Assessment Service collected from 2008 to 2018. Study participants comprised patients with at least one diagnosis of ADHD (International Statistical Classification of Diseases and Related Health Provisions, 10th revision code F90.0). Prevalence rates and psychiatric comorbidities were also analyzed. Results: We identified 878,996 patients diagnosed with ADHD between 2008 and 2018. The overall prevalence rate of diagnosed ADHD increased steeply from 127.1/100,000 in 2008 to 192.9/100,000 in 2018; it increased 1.47 times in children/adolescents (≤ 18 years) and 10.1 times in adults (＞ 18 years) during this period. Among adult and children/adolescent ADHD patients, 61.84% (95% confidence interval [95% CI] 61.74−61.93) and 78.72% (95% CI 78.53− 78.91) had at least one psychiatric comorbidity, respectively. Conclusion Our results showed that the prevalence rate of diagnosed ADHD has increased in Korea; however, it is lower than the global average. Further studies are required to identify and treat vulnerable populations appropriately.

OBJECTIVES: In 2002, the Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) was published, but there has been a need for a guideline about detailed issues of depressive disorder. We revised KMAP-MDD and reestablished Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006. METHODS: A questionnaire had been developed by the executive committee for KMAP-DD. The review committee consisted of 101 experienced psychiatrists. From the total of 22 questions in the questionnaire, 7 questions were evaluated for these subjects . We classified the expert opinions to 3 categories according to its confidence interval; first, second and third line. RESULTS: SSRI and venlafaxine were the first line antidepressants (AD) for atypical and melancholic depression. For dysthymic disorder and minor depressive disorder, SSRI was recommended as the first line medications. Only AD medications was a preferred initial strategy for treating premenstrual dysphoric disorder, mild to moderate and severe non-psychotic postpartum depression. In severe psychotic postpartum depression, combination therapy of AD and atypical antipsychotics was the treatment of choice. SSRI was preferred when considering sedation, anticholinergic and cardiovascular adverse effects. Also, experts recommended mirtazapine against gastrointestinal adverse effects and bupropion in avoiding sexual dysfunction. CONCLUSION: These results suggest that clinicians have to consider both clinical situations and drug adverse effects in the choice of antidepressant medications.
Advisory Committees ; Antidepressive Agents ; Antipsychotic Agents ; Bupropion ; Depression* ; Depression, Postpartum ; Depressive Disorder* ; Depressive Disorder, Major ; Dysthymic Disorder ; Expert Testimony ; Female ; Humans ; Psychiatry ; Surveys and Questionnaires

Intravascular ultrasonography (IVUS) imaging is a user-friendly technique widely used during coronary interventions. An 80-year-old man was admitted with chest pain, and successful percutaneous coronary intervention was performed with stent implantation. One week later, the patient complained of further chest pain. Urgent coronary angiography showed total occlusion of the middle left anterior descending artery and the aspiration of thrombi was high. IVUS imaging showed inadequate stent strut apposition and distal dissection. We attempted another stent implantation but the IVUS catheter was stuck on the 0.014 inch wire. Therefore, we tried to pass the wire across the lateral side. After the wire was successfully passaged, the sprinter balloon was passed through the crushed stent to expand it. After 4 days later, the patient was discharged with no symptoms or electrocardiographic change.
Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Arteries ; Catheters ; Chest Pain ; Coronary Angiography ; Electrocardiography ; Humans ; Percutaneous Coronary Intervention ; Stents ; Ultrasonography, Interventional

A 36-year-old man with a history of Behcet's syndrome and vascular complications visited the emergency room due to sudden chest pain and dyspnea. He had no coronary risk factors. Electrocardiography showed ST elevations in multiple precordial leads. Echocardiography showed akinesia of the anterior wall, interventricular septum, and apex, with a movable round mass measuring 1.4 x 1.5 cm in the right atrium. Cardiac computed tomography (CT) suggested the presence of a thrombus in the coronary sinus protruding into the right atrium. Coronary angiography revealed total occlusion with thrombi in the proximal left anterior descending coronary artery. Thrombectomy and stent insertion were performed. After the procedure, the patient was prescribed warfarin. Follow-up CT indicated the disappearance of the thrombi originating from the coronary sinus.
Adult ; Behcet Syndrome ; Chest Pain ; Coronary Angiography ; Coronary Sinus ; Coronary Vessels ; Dyspnea ; Echocardiography ; Electrocardiography ; Emergencies ; Follow-Up Studies ; Heart Atria ; Humans ; Myocardial Infarction ; Risk Factors ; Stents ; Thrombectomy ; Thrombosis ; Warfarin

OBJECTIVE: Bipolar depression has a disabling course and its treatment represents a major challenge. Recently, a randomized, controlled trial of quetiapine monotherapy in patients with bipolar depression showed significant reductions in depressive symptomatology. The purpose of this study was to evaluate the efficacy of quetiapine in bipolar depression in the clinical setting. METHODS: This study was a multi-center, prospective, open-label, observational, 8-week evaluation of the efficacy of quetiapine in patients with bipolar depression. Patients with a DSM-IV-TR diagnosis of bipolar depression (bipolar I disorder, most recent episode depressed and bipolar II disorder, most recent episode depressed) were included and treated with quetiapine. The dose of quetiapine was flexible and concomitant mediations were permitted, by clinical judgment. Clinical improvements were rated with the Clinical Global Impression-Bipolar version (CGI-BP) and Montgomery-Asberg Depression Rating Scale (MADRS) at baseline, week 4, and week 8. RESULTS: A total of 1,193 patients were recruited and 46 (3.9%) patients were dropped from the study. The mean initial dose of quetiapine was 192.3+/-181.9 mg/day and the mean doses at weeks 4 and 8 were 315.2+/-229.7 mg/day and 337.1+/-229.9 mg/day, respectively. CGI-BP and MADRS were significantly improved at weeks 4 and 8, compared with baseline. In addition, improvements at week 8 were greater than at week 4. Subjectively, about 75% of the patients reported therapeutic compliance above 75% at weeks 4 and 8. Seven (0.6%) and four (0.3%) patients showed manic/hypomanic episodes at weeks 4 and 8, respectively. CONCLUSION: This study suggests that quetiapine improves depressive symptoms in bipolar depression, with minimal incidence of manic switching. We suggest that quetiapine could be an effective and safe option in treating bipolar depression.
Bipolar Disorder ; Compliance ; Depression ; Dibenzothiazepines ; Humans ; Incidence ; Judgment ; Prospective Studies ; Quetiapine Fumarate

Among the various kinds of percutaneous coronary intervention techniques for balloon non-crossable severe calcified coronary stenosis, rotational atherectomy (RA) is known to be a therapy of choice. We describe a case in which a 1.25 mm RA burr non-crossable heavily calcified stenosis was successfully treated by the RA through '6 in 8 child-mother' guiding technique.
Atherectomy, Coronary* ; Catheters* ; Constriction, Pathologic ; Coronary Stenosis* ; Percutaneous Coronary Intervention