Pseudohypoaldosteronism is a disorder in which synthesis of aldosterone is normal but unresponsiveness of the target to the aldosterone activates angiotensin-renin system which in turn elevates levels of renin and aldosterone. This salt-losing syndrome causes life-threatening hyponatremia and hyperkalemia. Despite of the normal renal and adrenal function, due to deficiency of aldosterone function, reabsorption of sodium and excretion of potassium in the kidney is impaired. Sodium loss not only from the kidney but also from sweat gland, salivary gland and colon may occur in some cases. We experienced two cases of pseudohypoaldosteronism in a 3-day-old male and 6-month-old female. The hyponatremia, hyperkalemia, elevation of plasma renin activity and aldosterone concentration were observed without renal and adrenal dysfunction. Brief review and related literatures were also presented.
Aldosterone ; Colon ; Female ; Humans ; Hyperkalemia ; Hyponatremia ; Infant ; Kidney ; Male ; Plasma ; Potassium ; Pseudohypoaldosteronism* ; Renin ; Salivary Glands ; Sodium ; Sweat Glands

STUDY DESIGN: Prospective study. OBJECTIVES: This study was conducted to investigate changes in perceptions of treatment using narcotic analgesics and quality of life in chronic back pain patients. SUMMARY OF LITERATURE REVIEW: Negative perceptions of narcotic analgesics as pain killers have been established as factors affecting compliance and adherence. MATERIALS AND METHODS: A total of 140 patients who had chronic back pain for over 3 months were examined using clinical scales such as the Korean version of the Oswestry Disability Index (KODI), the Short Form-12 (SF-12), and a visual analog scale (VAS). The survey regarding narcotic analgesics classified patients as having positive perceptions if they reported absolutely not wanting to use them or being unlikely to use them at the primary interview and after 4 weeks of treatment. RESULTS: Ninety-four patients (68%) reported negative perceptions of narcotic analgesics at the primary interview. Sixty-one of those patients (64%) changed their perceptions, reporting positive perceptions after 4 weeks of treatment, as indicated by the ODI (p=0.01), SF-12 (p=0.01), and VAS (p=0.01) scores. A change from positive to negative perceptions after 4 weeks of treatment was observed in 13 patients (28%) who experienced adverse effects of narcotics treatment (p=0.01). Among the 33 patients (23%) whose negative perceptions did not change, dissatisfaction with previous treatment was found to be a contributing factor in 22 (66%). CONCLUSIONS: Clinical improvements after treatment using narcotic analgesics in chronic back pain patients resulted in a significant positive impact on perceptions about narcotic analgesics. Narcotic analgesics could be an alternative treatment choice in chronic back pain patients because of improvements in their quality of life.
Back Pain* ; Chronic Pain ; Compliance ; Humans ; Narcotics ; Prospective Studies ; Quality of Life* ; Visual Analog Scale ; Weights and Measures

BACKGROUND AND OBJECTIVES: Tinnitus, a common complaint of workers who are exposed to noise, can cause substantial negative effects on the quality of life of these workers. The aim of this study was to analyze the characteristics of tinnitus in patients with noise-induced hearing loss and the relationship between tinnitus and the duration of noise exposure. SUBJECTS AND METHOD: Thirty-three patients with subjective tinnitus and noise-induced hearing loss were included in this study. Tinnitus questionnaire, Tinnitus Handicap Inventory (THI) and audiological examinations were investigated according to the duration of noise exposure. RESULTS: There was a significant correlation between the tinnitus loudness and the duration of noise exposure. Patients who had longer periods of noise exposure had a louder tinnitus and higher THI score. However, there is no significant correlation between the characteristics of tinnitus and aging process. CONCLUSION: The duration of noise exposure influences the loudness and distress of tinnitus. An awareness of tinnitus should be considered as part of hearing conservation program.
Aging ; Hearing ; Hearing Loss ; Hearing Loss, Noise-Induced* ; Humans ; Methods ; Noise* ; Quality of Life ; Tinnitus*

The potent antioxidant and anti-hypertension activities have evidenced gastric enzymatic hydrolysates from flounder fish and their derived peptides. However, peptide composition and functional effect in various enzymatic hydrolysates differ by enzyme types, hydrolyzed times temperatures, etc. Therefore, we determined potential anti-hypertensive effect of hydrolysates produced from flounder fish using commercial enzymes such as Protamex, Flavourzyme, and Kojizyme which are common food grade proteases and characterized on its derived peptides. In this study, Protamex-mediated hydrolysate showed a more potent anti-hypertension effect than other commercial enzymes. Protamex-mediated hydrolysate was fractionated into three ranges of molecular weight (above 10 kDa (FPH-I), 5-10 kDa (FPH-II), and below 5 kDa (FPH-III)). The FPH-III exhibited the strongest anti-hypertensive effect, and it was revealed that three active peptides, valine-phenylalanine-serine-glycinetryptophan-alanine-alanine (VFSGWAA), leucine-histidine-phenylalanine (LHF) and tryptophan-proline-tryptophan (WPW) were contained. The activities were confirmed via angiotensin-converting enzyme (ACE) inhibition and molecular docking simulation. Among the three peptides, LHF and WPW have a molecular structure stability against the gastrointestinal digestion. LHF showed a significant anti-hypertension effect at 9 h after oral administration in spontaneously hypertensive rats (SHRs). Therefore, we suggest that Protamex-mediated hydrolysate would be an excellent anti-hypertensive agent due to the existence of stabilized functional peptides, including LHF and WPW.

Pseudoaneurysm is one of life-threatening complications of chronic or acute pancreatitis. It can lead to massive bleeding into the abdominal cavity, the retroperitoneum, or the gastrointestinal tract. Hemosuccus pancreaticus, meaning hemorrhage through the pancreatic duct into the duodenum is an important diagnostic clue suggesting the presence of pancreatic pseudoaneurysm. A 74-year-old man presented with hematochezia and active bleeding from the ampulla of Vater was noted on upper endoscopy. Abdominal computed tomography scan demonstrated a nodular enhancing lesion within the pancreatic duct. Celiac trunk angiography also showed a nodular enhancing lesion suggesting pseudoaneurysm in the pancreas. However, due to the difficulty of identifying the feeder artery of pseudoaneurysm by selective angiography, embolization was not feasible. Therefore, distal pancreatectomy was performed and ruptured pseudoaneurysm within the pancreatic duct could be confirmed. Herein, we report a case of hemosuccus pancreaticus due to ruptured intraductal pseudoaneurysm that was successfully treated by surgical management.
Abdominal Cavity ; Aged ; Ampulla of Vater ; Aneurysm, False* ; Angiography ; Arteries ; Duodenum ; Endoscopy ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatitis

PURPOSE: This study aims to determine whether early closure (within 7 d) of significant patent ductus arteriosus (PDA) with indomethacin or ligation reduces neonatal morbidity when compared with delayed closure (after 7 d). METHODS: Fifty-eight extremely-low-birth-weight infants admitted to the NICU of Seoul National University Hospital from April 2005 to May 2007 with PDA were studied retrospectively. RESULTS: The mean gestational age (GA) was 26+/-2 weeks (range, 23-32 wk), and the birth weight was 782+/-146 g (range, 430-990 g). The delayed closure group was associated with early GA (25.7+/-1.7 wk vs. 27.1+/-2.0 wk, P=0.013), in vitro fertilization (IVF) (55% vs 24%, P=0.017), and the absence of preeclampsia (5% vs. 34%, P=0.013). There was no difference in ductal size between the early closure and delayed closure groups. The incidence of bronchopulmonary dysplasia (95% vs 65%, P=0.012) and intraventricular hemorrhage (70% vs. 39%, P=0.027) increased in the delayed closure group. Using regression analysis adjusted for gestational age, delayed closure correlated positively with the duration of ventilator support (P=0.008), hospitalization (P=0.020), time to full enteral feeding (P<0.001), and total parenteral nutrition (P=0.010).. CONCLUSION: Delayed closure of the hemodynamically significant patent ductus arteriosus in extremely-low-birth-weight infants is significantly related to the development of various morbidities. Thus, early closure of PDA is needed within the first week of life.
Birth Weight ; Bronchopulmonary Dysplasia ; Ductus Arteriosus, Patent ; Enteral Nutrition ; Fertilization in Vitro ; Gestational Age ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature ; Ligation ; Parenteral Nutrition, Total ; Pre-Eclampsia ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Feasibility of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via left snuffbox approach is still concerned. We aimed to investigate efficacy and safety of the left snuffbox approach for CAG and PCI. METHODS: Left snuffbox approach was tried in 150 patients who planned to perform CAG or PCI for suspected myocardial ischemia between 1 November 2017 and 31 March 2018. RESULTS: Success rate of radial artery (RA) cannulation via snuffbox approach was 88.0% (n=132). Among 132 individuals, 58 (43.9%) acute coronary syndrome (ACS) patients were included. The diameter of snuffbox RA was significantly smaller than conventional RA (2.57 mm vs. 2.72 mm, p < 0.001) from quantitative computed angiography of 101 patients. However, CAG via snuffbox approach by 6 French sheath was successfully performed in all 132 patients. In addition, there was significant correlation between the snuffbox and conventional RA diameter (r=0.856, p < 0.001). In 42 PCI cases, including 25 patients with acute myocardial infarction (AMI), the success rate of PCI via snuffbox approach was 97.6% (n=41). Intravascular imaging-guided PCI was performed in 8 (19.5%) patients and multi-vessel PCI in 4 (9.8%) cases. Regarding vascular complication, forearm swelling with bruising, not requiring surgery or transfusion, occurred in 2 (4.9%) PCI cases. CONCLUSIONS: Left snuffbox approach is suitable for CAG and PCI compared with the conventional radial approach.
Acute Coronary Syndrome ; Angiography ; Catheterization ; Coronary Angiography ; Forearm ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Radial Artery

BACKGROUND AND OBJECTIVES: Feasibility of coronary angiography (CAG) and percutaneous coronary intervention (PCI) via left snuffbox approach is still concerned. We aimed to investigate efficacy and safety of the left snuffbox approach for CAG and PCI. METHODS: Left snuffbox approach was tried in 150 patients who planned to perform CAG or PCI for suspected myocardial ischemia between 1 November 2017 and 31 March 2018. RESULTS: Success rate of radial artery (RA) cannulation via snuffbox approach was 88.0% (n=132). Among 132 individuals, 58 (43.9%) acute coronary syndrome (ACS) patients were included. The diameter of snuffbox RA was significantly smaller than conventional RA (2.57 mm vs. 2.72 mm, p < 0.001) from quantitative computed angiography of 101 patients. However, CAG via snuffbox approach by 6 French sheath was successfully performed in all 132 patients. In addition, there was significant correlation between the snuffbox and conventional RA diameter (r=0.856, p < 0.001). In 42 PCI cases, including 25 patients with acute myocardial infarction (AMI), the success rate of PCI via snuffbox approach was 97.6% (n=41). Intravascular imaging-guided PCI was performed in 8 (19.5%) patients and multi-vessel PCI in 4 (9.8%) cases. Regarding vascular complication, forearm swelling with bruising, not requiring surgery or transfusion, occurred in 2 (4.9%) PCI cases. CONCLUSIONS Left snuffbox approach is suitable for CAG and PCI compared with the conventional radial approach.

BACKGROUND/AIMS: Contrast-induced nephropathy (CIN) is an important complication of diagnostic coronary angiography (CAG) and percutaneous coronary intervention (PCI). We investigated the incidence and predictors of the development of CIN in acute coronary syndrome (ACS) patients with renal dysfunction undergoing PCI. METHODS: From January 2005 to June 2010, we evaluated the clinical, laboratory, and angiographic data of 406 patients with ACS who had a serum creatinine > or = 1.3 mg/dL and underwent CAG or PCI. The patients were divided into two groups according to the development of CIN (CIN, n = 92; no CIN, n = 314). RESULTS: Of the 406 patients, 92 (22.7%) developed CIN. The development of CIN was associated with a lower baseline body mass index (p = 0.001), decreased left ventricular ejection fraction (LVEF) (p < 0.001), decreased creatinine clearance (CrCl) (p < 0.001), lower albumin (p < 0.001), lower hemoglobin (p = 0.003), higher N-terminal pro B type natriuretic peptide (p = 0.001), and greater contrast medium volume (CMV) (p = 0.021). On multiple logistic regression analysis, LVEF < 40% (OR, 4.080; 95% CI, 2.087-7.977; p < 0.001), albumin < 3.5 g/dL (OR, 2.042; 95% CI, 1.211-3.440; p = 0.007), and CMV/CrCl > or = 3.5 (OR, 1.964; 95% CI, 1.243-3.101; p = 0.004) were independent predictors of CIN. The cut-off value for CMV/CrCl was 3.5, and that for albumin was 3.55 g/dL. CONCLUSIONS: CIN occurred in 22.7% of the patients with ACS and renal dysfunction who underwent CAG or PCI. Independent predictors of CIN were decreased LVEF, decreased albumin, and increased CMV/CrCl ratio.
Acute Coronary Syndrome ; Body Mass Index ; Coronary Angiography ; Creatinine ; Hemoglobins ; Humans ; Incidence ; Logistic Models ; Percutaneous Coronary Intervention ; Stroke Volume

PURPOSE: To evaluate the risk factors of hepatocellular carcinoma (HCC) extension into the right atrium (RA) and determine poor prognostic factors for HCC extension to the heart. MATERIALS AND METHODS: A total of 665 patients who were newly diagnosed with HCC were analyzed retrospectively from January 2004 to July 2012. The patients were divided into two groups: 33 patients with HCC extending into the RA and 632 HCC patients during the same period. The patients with HCC extending into the RA were subdivided into shorter survival group (<2 months) and longer survival group (> or =2 months). RESULTS: The prevalence of HCC extending to the RA was 4.96%. In multivariate analysis, a modified Union Internationale Contre le Cancer (UICC) stage higher than IVA, hepatic vein invasion, concomitant inferior vena cava and portal vein invasion, and multinodular tumor type were risk factors for HCC extending to the RA. In multivariate analysis, Cancer of the Liver Italian Program (CLIP) score >3 (p=0.016, OR: 13.89) and active treatment (p=0.024, OR: 0.054) were associated with prognostic factors in patients HCC extending into the RA. Active treatment such as radiation (n=1), transcatheter arterial chemoembolization (TACE) (n=11), Sorafenib (n=1), and combined modalities (n=2) were performed. CONCLUSION: Modified UICC stage higher than IVA, vascular invasion and multinodular tumor type are independent risk factors for HCC extending to the RA. Active treatment may prolong survival in patients HCC extending into the RA.
Carcinoma, Hepatocellular* ; Heart Atria ; Heart* ; Hepatic Veins ; Humans ; Liver Neoplasms ; Methods ; Multivariate Analysis ; Neoplasm Metastasis ; Portal Vein ; Prevalence ; Prognosis ; Retrospective Studies ; Risk Factors* ; Vena Cava, Inferior