The occurrence of atrial fibillation during an electrophysiologic study or catheter ablation in patients with accessory pathways is a common problem and sometimes complicates the localization and ablation procedure of accessory pathways. In patients with sustained atrial fibrillation, it is often time-consuming to terminate atrial fibrillation by drugs or electrical cardioversion. We performed successful radiofrequency catheter ablation in a patient with right-sided accessory pathway during atrial fibrillation requiring repeated electrical cardioversion. The target site was determined by activation mapping and morphology of unipolar electrogram at a site of early ventricular activation.
Atrial Fibrillation* ; Catheter Ablation ; Electric Countershock ; Humans

The long QT syndrome is believed to result from abnormalities of cardiac sympathetic innervation and of myocardial repolarization. The therapeutic modalities for patients with ventricular arrhythmias due to the long QT syndrome include beta blocker, cardiac sympathetic denervation, pacemaker and ICD implantation. Recently, we underwent transvenous ICD implantation in a patient with this syndrome who had recurrent syncopal episodes due to rapid polymorphic ventricular tachycardia and strong family history of sudden death.
Arrhythmias, Cardiac ; Death, Sudden ; Humans ; Long QT Syndrome* ; Sympathectomy ; Syncope ; Tachycardia, Ventricular

The long QT syndrome is believed to result from abnormalities of cardiac sympathetic innervation and of myocardial repolarization. The therapeutic modalities for patients with ventricular arrhythmias due to the long QT syndrome include beta blocker, cardiac sympathetic denervation, pacemaker and ICD implantation. Recently, we underwent transvenous ICD implantation in a patient with this syndrome who had recurrent syncopal episodes due to rapid polymorphic ventricular tachycardia and strong family history of sudden death.
Arrhythmias, Cardiac ; Death, Sudden ; Humans ; Long QT Syndrome* ; Sympathectomy ; Syncope ; Tachycardia, Ventricular

No abstract available.
Ankle Fractures* ; Ankle*

Fitz-Hugh-Curtis syndrome (FHCS) is characterized by inflammation of the perihepatic capsules associated with the pelvic inflammatory disease (PID). FHCS is not a serious disease, but if not treated properly, it can result in increased medical costs, prolonged treatment, and dissatisfaction with treatment. However, early recognition of FHCS in the emergency department can be difficult because its symptoms or physical findings may mimic many other diseases. Although contrast-enhanced computed tomography (CECT) is the useful imaging modality for recognition of FHCS, it is available only when a high suspicion is established. We performed point-of-care ultrasonography in an 18-year-old woman who had a sharp right upper quadrant (RUQ) abdominal pain without PID symptoms and found a thickened or three-layer hepatic capsule. These findings coincided with areas showing increased hepatic capsular enhancement in the arterial phase of CECT. These results show that if the thickened or three-layer hepatic capsule without evidence of a common cause of RUQ pain is observed on ultrasonography in women of childbearing age with RUQ abdominal pain, the physician can consider the possibility of FHCS.
Abdominal Pain ; Adolescent ; Capsules ; Emergency Service, Hospital ; Female ; Humans ; Inflammation ; Pelvic Inflammatory Disease ; Point-of-Care Systems ; Ultrasonography

Fitz-Hugh-Curtis syndrome (FHCS) is characterized by inflammation of the perihepatic capsules associated with the pelvic inflammatory disease (PID). FHCS is not a serious disease, but if not treated properly, it can result in increased medical costs, prolonged treatment, and dissatisfaction with treatment. However, early recognition of FHCS in the emergency department can be difficult because its symptoms or physical findings may mimic many other diseases. Although contrast-enhanced computed tomography (CECT) is the useful imaging modality for recognition of FHCS, it is available only when a high suspicion is established. We performed point-of-care ultrasonography in an 18-year-old woman who had a sharp right upper quadrant (RUQ) abdominal pain without PID symptoms and found a thickened or three-layer hepatic capsule. These findings coincided with areas showing increased hepatic capsular enhancement in the arterial phase of CECT. These results show that if the thickened or three-layer hepatic capsule without evidence of a common cause of RUQ pain is observed on ultrasonography in women of childbearing age with RUQ abdominal pain, the physician can consider the possibility of FHCS.

Background: The incidence of inappropriate shocks remains high at 30% in patients with implantable cardioverter-defibrillators (ICDs). This retrospective study sought to examine the efficacy of strategic programming (ICD programming with a long detection interval and high-rate cutoff) in reducing electrical storm, inappropriate shocks, and unexpected hospital visits in patients with ICDs with/without cardiac resynchronization therapy with defibrillator (CRT-Ds). Methods: This was a single tertiary center retrospective study, evaluating the clinical outcomes, especially regarding inappropriate therapies in patients with ICDs or CRT-Ds. Enrolled patients underwent ICD or CRT-D implantations from January 2008 to May 2016. Clinical information was attained by a thorough chart review. Results: We analyzed 155 defibrillator patients from January 2008 to May 2016 (124 patients had ICDs and 31 had CRT-Ds). Since we adopted this strategic programming as a default programming from 2015 implanted ICDs and CRT-Ds, we divided the patients into two groups: devices implanted before 2015 (group A, n = 94) versus implanted after 2015 (group B, n = 61). During a median of 1289 days of follow-up, electrical storms occurred in three patients (eight events) in group B versus 11 (28 events) in group A (P = 0.18); appropriate therapies were delivered in 27 patients (56 events) in group A versus 7 (15 events) in group B (P = 0.72); inappropriate therapies were delivered in 15 patients (21 events) in group A versus 1 with 1 episode in group B (P = 0.03); and 5 unexpected hospitalizations occurred in four patients in group B versus 36 in 24 patients in group A (P = 0.02). Conclusion The clinical application of strategic programming reduced inappropriate shocks and unexpected hospitalizations in ICD and CRT-D patients.

Peripheral cholangiocarcinoma (PCC) is defined as a malignancy of intrahepatic bile duct presenting as a focal liver mass, specifically, those located peripheral to the 2nd-order branchings of the bile duct. During the study period of 11 years from Jan. 1985 through Dec. 1995, a total of 12 patients underwent liver resection for PCC at the Department of Surgery, Inje University Paik Hospital, Seoul. This figure accounts for 8.3% of primary liver cancer. There were 9 men and 3 women with a ratio of 3:1, the mean age was 53.3 years with a range of 39 to 67 years. Twenty-five per cent of the patients had concomitant intrahepatic stone (IHS). HBsAg was positive in one case (8.3%) who had chronic hepatitis. No patient had liver cirrhosis. The accurate preoperative diagnosis of PCC in 3 cases was difficult because of the association with IHS. These 3 patients underwent surgery under the diagnosis of chronic cholangitis rather than PCC. CEA and CA 19-9 were elevated in 70% and 50% of the patients, respectively. In most cases concomitant measurement of CEA and AFP facilitated the differentiation between PCC and hepatocellular carcinoma. As to the tumor characteristics, 83% of the patients had tumors greater than 5 cm in diameter, indicating the advanced stage of the tumor at the time of resection. The site of origin of tumor mass was distributed more or less evenly between the hepatic lobes. The patients with mass-forming, expanding type of tumors made up 58% of the cases, infiltrating type 25%, and the remainder being the combination of both. A significant number of patients, 27%, had nodal metastasis. Two thirds of the patients underwent major hepatic resections. Segmentectomies here include the resection of lateral segment done as a treatment for IHS, which later proved to be cancer on histologic examination. There was no operative death among the 12 patients. The overall median survival time was 12 months. The overall survival rates at 1, 3, and 5 years were 42.4%, 42.4%, and 42.4%, respectively. Only the radicality of the resection was the statistically significant risk factor for survival by univariate analysis. The 5-year survival rate was 100% in 6 patients who had curative resection (no lymph node invasion, no peritoneal seeding, clear resection margin). The prognosis of patients with advanced PCC is unfavorable unless the tumor is entirely removed. In view of the association of IHS in a significant portion of the cases, the possible coexistence of the carcinoma should always be borne in mind when dealing with patients with IHS.
Bile Ducts ; Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular ; Cholangiocarcinoma ; Cholangitis ; Diagnosis ; Female ; Hepatitis B Surface Antigens ; Hepatitis, Chronic ; Humans ; Liver ; Liver Cirrhosis ; Liver Neoplasms ; Lymph Nodes ; Male ; Mastectomy, Segmental ; Neoplasm Metastasis ; Prognosis ; Risk Factors ; Seoul ; Survival Rate

Primary hepatic sarcomas are uncommon, representing less than 1% of the primary malignant lesions of the liver. Three patients underwent resection for primary hepatic sarcoma at the Department of Surgery, Inje University Paik Hospital, Seoul: a 6 year-old girl with malignant mesenchmoma, a 74 year-old man with malignant fibrous histiocytoma and a 53 year-old man with rhabdomyosarcoma. Abdominal mass, fever with chills, and abdominal pain were the presenting symptoms, respectively. The patient with rhabdomyosarcoma was positive for HBsAg and had chronic active hepatitis. AFP level was elevated in this patient. CA 19-9 level was elevated in the patient with malignant fibrous histiocytoma. CEA levels were normal in all cases. All these tumors were hypodense on computed tomography. Malignant mesenchymoma was hypovascular and rhabdomyosarcoma was hypervascular on angiography. Immunohistochemical stains of the tumors were positive for vimentin but negative for epithelial markers, differentiating these lesions from other hepatic tumors. Electron microscopic examination was helpful in the diagnosis of the specific type of primary hepatic sarcoma. None had postoperative adjuvant chemotherapy or radiotherapy. The patient with malignant mesenchymoma, who underwent right hepatic trisegmentectomy, was disease free at 32 months. The patient with malignant fibrous histiocytoma, who underwent non-curative excision, died of the tumor at 2 months. The patient with rhabdomyosarcoma, who underwent posterior segmentectomy, was alive at 4 months. Resection of primary hepatic sarcoma should be executed if feasible, with potential survival measured in years, in view of the lack of other effective treatment modalities.
Abdominal Pain ; Aged ; Angiography ; Chemotherapy, Adjuvant ; Child ; Chills ; Coloring Agents ; Diagnosis ; Female ; Fever ; Hepatitis B Surface Antigens ; Hepatitis, Chronic ; Histiocytoma, Malignant Fibrous ; Humans ; Liver* ; Mastectomy, Segmental ; Mesenchymoma ; Middle Aged ; Radiotherapy ; Rhabdomyosarcoma ; Sarcoma* ; Seoul ; Vimentin

OBJECTIVES: Electroconvulsive therapy (ECT) is the important treatment method which has a good effect on refractory depression, schizophrenia at acute stage, patients with suicidal ideation. Although ECT results in better effects and less adverse effects in acute stage of illnesses as compared with pharmacotherapy, clinical implications are decreasing. Thus, authors surveyed a view of Korean psychiatrists about ECT to find whether there are prejudices and/or misconceptions for ECT. METHODS: Authors made survey questionaire for the attitudes of ECT, based on the APA task force 14, a clinical study in Korea, Hermann et al's report, and questioned Korean psychiatrists on their opinions for ECT through the internet E-mail, who are the members of Korean Neuropsychiatric Association (KNPA) serving in hospitals with psychiatric inpatient units. RESULTS: 122 psychiatrists answered to survey questionnaire. 89.4% have positive attitude about ECT. They thought that ECT has relatively safe and potent therapeutic effects, and less adverse effects. The rate of psychiatrists who have been no experience to perform ECT was 13.9% (n=16). Interestingly all of them had been trained serve in university hospitals now. The rate of psychiatrists who had experienced practicing ECT past but, not experienced within 2 years recently was 48.7% (n=56). While psychiatrists who have been no experience of ECT were more worried about adverse effects, doctors who experienced practicing ECT thought preferably the aspect of safety and potent effects of ECT. Psychiatrists who prefer psychotherapy were more likely to concern about adverse effect of ECT, but there were no differences in other aspects when compared with others. Most psychiatrists participated in this survey had positive attitudes about application of ECT to geriatric patients, but negative at child&adolescent patients. CONCLUSION: Authors recognized that many Korean psychiatrists agreed with performing ECT, and expected good results, but in reality, it is difficult to expect for them to perform ECT. Several factors may be associated for that: the changes in trend of psychiatric treatment, production of novel psychotropic drugs, researches trends which pharmacotherapy is prevailing in the fields of psychiatry, and problems of education, that is, lack of standard educational curriculums and systemic training course at residency for ECT.
Advisory Committees ; Curriculum ; Depressive Disorder, Treatment-Resistant ; Drug Therapy ; Education ; Electroconvulsive Therapy* ; Electronic Mail ; Hospitals, University ; Humans ; Inpatients ; Internet ; Internship and Residency ; Korea ; Prejudice ; Psychiatry* ; Psychotherapy ; Psychotropic Drugs ; Surveys and Questionnaires ; Schizophrenia ; Suicidal Ideation