The appendiceal abscess is a common complication of acute appendicitis and usually is located in the right lower quadrant of the abdomen. An epigastric appendiceal abscess has never been reported at an unusual location. We experienced an unusual case of a 49-year-old man with an epigastric appendiceal abscess. Initially, this abscess was suspected to be a pancreatic abscess. Abdominal CT scan and barium enema demonstrated a hyperrotated cecum with an appendiceal abscess in the left upper quadrant of the abdomen. An gastroscopy revealed a small fistula-like lesion with purulent coating at the bulging posterior gastric wall. The abscess resolved spontaneously. We believe that the abscess drained into the stomach through a small fistula between the stomach and abscess cavity. There was no recurrence for over 6 months.
Abscess/diagnosis* ; Appendicitis/diagnosis* ; Case Report ; Fistula/diagnosis ; Human ; Male ; Middle Age ; Stomach Diseases/diagnosis*

BACKGROUND: Adiponectin is a fat-based protein that alters the insulin sensitivity, has anti-inflammatory properties, and reduces the incidence of cardiovascular disease (CVD). However, this connection is unclear in patients with chronic wasting disease, such as heart failure or end-stage renal disease (ESRD). Therefore, this study examined the relationship between adiponectin and the cardiovascular risk/predictive factors in ESRD patients. METHODS: The serum concentrations of adiponectin and leptin were measured in 48 adult patients on maintenance hemodialysis. In addition, the blood levels of B-type natriuretic peptide (BNP) and cardiac troponin T (cTnT) as cardiovascular biomarkers were measured, and the CVD history was reviewed in order to determine if there was any correlation with adiponectin. RESULTS: There was a significant correlation between the adiponectin levels and the serum concentrations of HDL-cholesterol (r=0.456, p=0.001), triglyceride (r=-0.528, p<0.001), and leptin (r=-0.427, p=0.002) and an inverse correlation with the body mass index (BMI) (r=-0.326, p=0.024). The BNP levels were positively correlated with the adiponectin concentrations (r=0.372, p=0.009) and negatively correlated with the BMI (r=-0.310, p=0.032), and there was a slight positive correlation between cTnT and adiponectin (r=0.276, p=0.058). Patients with a history of CVD had higher levels of cTnT (p=0.012) and BNP (p=0.017), and a lower BMI (p=0.026) than patients without such a history. There was no significant difference in the adiponectin levels between the two patient groups. CONCLUSIONS: A higher adiponectin level is related to a favorable lipid profile. However, adiponectin is not directly associated with a history of CVD, and there was a correlation between a higher adiponectin level and a higher BNP and lower BMI, which are cardiovascular predictive factors, in ESRD patients. However, further research with more patients will be needed to properly determine the complicated relationship between adiponectin and the development of CVD.
Adiponectin* ; Adult ; Biomarkers ; Body Mass Index ; Cardiovascular Diseases* ; Heart Failure ; Humans ; Incidence ; Insulin Resistance ; Kidney Failure, Chronic* ; Leptin ; Natriuretic Peptide, Brain ; Renal Dialysis ; Triglycerides ; Troponin T ; Wasting Disease, Chronic

A total of 782 blood and 465 tissue samples from 1,039 wild animals and 127 dairy goats were collected from January 2011 to December 2013 in 10 provinces of South Korea and tested for the presence of brucellosis. The Rose Bengal test revealed that 8.0% (52/650) of the serum samples were seropositive, while 4.2% (33/782) of the serum samples were positive for Brucella antibodies by competitive enzyme-linked immunosorbent assay. Of the 650 sera examined, only 16 (2.5%) were positive by both serological tests. Direct polymerase chain reaction (PCR) assay using B4/B5 primers for Brucella abortus (BCSP31) revealed the prevalence of Brucella to be 26.5% (129/487) in blood samples and 21% (98/465) in tissue samples while, 16S rRNA PCR detected Brucella DNA in 6.8% (33/487) and 2.6% (12/465) in blood and tissue samples, respectively. Of PCR-positive samples, only 6.2% (30/487) of blood samples and 2.4% (11/465) of tissue samples were found to be positive by both BCSP31 and 16S rRNA PCRs. However, Brucella strains were isolated by blood culture from only two out of 487 blood samples (0.4%). This characterization and identification of pathogenic Brucella isolates is the first to clearly indicate that the organisms were Brucella abortus biovar 1.
Animals ; Animals, Wild ; Antibodies ; Brucella abortus* ; Brucella* ; Brucellosis ; DNA ; Enzyme-Linked Immunosorbent Assay ; Goats ; Korea* ; Polymerase Chain Reaction ; Prevalence ; Rose Bengal ; Serologic Tests

PURPOSE: To evaluate the ability of coronary computed tomographic angiography (CCTA) to predict the need of coronary revascularization in symptomatic patients with stable angina who were referred to a cardiac catheterization laboratory for coronary revascularization. MATERIALS AND METHODS: Pre-angiography CCTA findings were analyzed in 1846 consecutive symptomatic patients with stable angina, who were referred to a cardiac catheterization laboratory at six hospitals and were potential candidates for coronary revascularization between July 2011 and December 2013. The number of patients requiring revascularization was determined based on the severity of coronary stenosis as assessed by CCTA. This was compared to the actual number of revascularization procedures performed in the cardiac catheterization laboratory. RESULTS: Based on CCTA findings, coronary revascularization was indicated in 877 (48%) and not indicated in 969 (52%) patients. Of the 877 patients indicated for revascularization by CCTA, only 600 (68%) underwent the procedure, whereas 285 (29%) of the 969 patients not indicated for revascularization, as assessed by CCTA, underwent the procedure. When the coronary arteries were divided into 15 segments using the American Heart Association coronary tree model, the sensitivity, specificity, positive predictive value, and negative predictive value of CCTA for therapeutic decision making on a per-segment analysis were 42%, 96%, 40%, and 96%, respectively. CONCLUSION: CCTA-based assessment of coronary stenosis severity does not sufficiently differentiate between coronary segments requiring revascularization versus those not requiring revascularization. Conventional coronary angiography should be considered to determine the need of revascularization in symptomatic patients with stable angina.
Aged ; Angina, Stable/*diagnostic imaging ; Coronary Angiography/*methods ; Coronary Stenosis/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; Predictive Value of Tests ; Tomography, X-Ray Computed ; United States

Bioresorbable vascular scaffold (BRS) is an innovative device that provides structural support and drug release to prevent early recoil or restenosis, and then degrades into nontoxic compounds to avoid late complications related with metallic drug-eluting stents (DESs). BRS has several putative advantages. However, recent randomized trials and registry studies raised clinical concerns about the safety and efficacy of first generation BRS. In addition, the general guidance for the optimal practice with BRS has not been suggested due to limited long-term clinical data in Korea. To address the safety and efficacy of BRS, we reviewed the clinical evidence of BRS implantation, and suggested the appropriate criteria for patient and lesion selection, scaffold implantation technique, and management.
Coronary Disease ; Drug Liberation ; Drug-Eluting Stents ; Humans ; Korea ; Stents ; Thrombosis

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.
Acute Disease ; Aged ; Drug Therapy, Combination ; Female ; Hemorrhage ; Heparin/*therapeutic use ; Heparin, Low-Molecular-Weight/*therapeutic use ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/epidemiology/mortality/*therapy ; Myocardial Revascularization ; Odds Ratio ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors/metabolism ; Prognosis ; Registries