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.

We describe a 72-year-old man who presented with left hemiparesis due to acute cerebral infarction in the right fronto-temporal lobe. Three months prior to admission, he was hospitalized for right hemiparesis due to the acute cerebral infarction in the left anterior cerebral artery territory. To investigate the cause of his recurrent embolic event, a chest computed tomography scan and echocardiography were performed, which revealed advanced lung cancer invading contiguously through the pulmonary veins to the right main pulmonary artery and left atrium. Tumor embolism is a rare cause of stroke, occurring with primary or metastatic neoplasms of the lung. Echocardiography is a useful tool in patients with cerebral embolic episodes.
Aged ; Anterior Cerebral Artery ; Cerebral Infarction ; Echocardiography ; Heart Atria ; Humans ; Lung ; Lung Neoplasms ; Neoplastic Cells, Circulating ; Paresis ; Pulmonary Artery ; Pulmonary Veins ; Stroke ; Thorax

OBJECTIVE: Since the previous publication of Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) in 2002, there has been a substantial need for the revision of treatment algorithm due to rapid progress in the management for bipolar disorder. We focused on the maintenance treatment of bipolar I and bipolar II disorders of KMAP-BP revised in 2006. METHOD: The questionnaire to survey the expert opinion of medication for bipolar disorder was completed by the review committee consisting of 70 experienced psychiatrists. It was composed of 37 questions, and each question includes various sub-items. We classified the expert opinion to 3 categories (the first-line treatment, the second-line, the third-line) by x2 test. A part of this revision regarding maintenance treatment had 6 items ; 2 on bipolar I and 4 on bipolar II disorder. RESULTS: There was no 'treatment of choice' in maintenance treatment. In case of bipolar I mania without history of depression, mood stabilizer (MS) monotherapy was 1st-line treatment. In maintenance management for bipolar II disorder, two treatment options were recommended. Treatment with MS alone or combinations of MS and atypical antipsychotics were preferred in recently recovered patients from hypomania. Atypical antipsychotics were more favored in the maintenance treatment for bipolar I and II disorders than previous KMAP-BP. CONCLUSIONS: There is no 'treatment of choice' in maintenance strategies for bipolar disorder. Atypical antipsychotics are more preferred than the previous KMAP-BP. Also there is an increasing interest on the maintenance use of lamotrigine in bipolar depression.

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

Mood stabilizers and atypical antipsychotics are commonly combined for the treatment of bipolar mania. The aim of this study was to compare the effectiveness and tolerability of topiramate and divalproex in combination with risperidone for treating acute mania patients in a naturalistic treatment setting. Seventy-four patients who met the DSM-IV criteria for bipolar mania were enrolled in this study. In order to assess the efficacy and the extrapyramidal symptoms, the Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson-Angus Rating Scale were measured at the baseline and at weeks 1, 3 and 6. From the baseline to the endpoint, the YMRS and CGI scores were reduced by 67.9% and 56.6% in the topiramate group. The YMRS and CGI scores were also reduced by 63.7% and 58.2% in the divalproex group. The weight and BMI increased significantly by 3.6% and 3.3% from the baseline to the endpoint in the divalproex group, while they decreased by 0.4% and 0.5%, respectively, with no significant difference in the topiramate group. There were no serious adverse events in either group. Topiramate is effective and tolerable for treating acute mania, and may also be a promising alternative to a weightgain liable mood stabilizer such as divalproex.
Antipsychotic Agents ; Bipolar Disorder* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Risperidone ; Valproic Acid*

BACKGROUND: The strength of each heart beat and the stiffness of large arteries contribute to blood pressure (BP). When the large arteries are stiff and their resistance greater, the afterload increases and this may change the function of the heart. However, the relation between common carotid artery stiffness and heart function in hypertensive patients has not been clarified. METHODS: Two hundred and twenty hypertensive patients underwent transthoracic and carotid echocardiography. Measurements of local arterial stiffness were taken at the right common carotid artery level and stiffness parameter (beta), pressure-strain elasticity modulus and intima-media thickness were calculated. Brachial cuff BP was measured just before starting the carotid study. The patients with any cardiovascular disease, diabetes mellitus, stroke, transient ischemic attack, or carotid stenosis were excluded. RESULTS: Carotid artery stiffness parameter (beta) was correlated with age and left ventricular mass index (p < 0.005). Even though beta was not correlated with LV systolic function, it was inversely correlated with diastolic function as measured by early mitral annular velocity. When the artery was stiffer, early mitral annular velocity (e') decreased (p < 0.001) and the index of left atrial (LA) pressure (early diastolic mitral inflow E velocity/e') increased (p = 0.001). In logistic regression, diastolic dysfunction was affected by age (beta -0.385, p = 0.001), LA volume index (beta 0.175, p = 0.013) and beta (beta -0.273, p = 0.019). CONCLUSION: In hypertensive patients, changes in carotid artery stiffness can affect the diastolic function, independent of age and LA volume index. Therefore, measurements and control of carotid stiffness can play an important role in the prevention of diastolic heart failure.
Arteries ; Blood Pressure ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Artery, Common ; Carotid Stenosis ; Diabetes Mellitus ; Echocardiography ; Elastic Modulus ; Female ; Heart ; Heart Failure, Diastolic ; Humans ; Ischemic Attack, Transient ; Logistic Models ; Stroke ; Vascular Stiffness