Background and Objectives: This study aimed to investigate the association between cardiovascular events and 2 different levels of elevated on-treatment diastolic blood pressures (DBP) in the presence of achieved systolic blood pressure targets (SBP). Methods: A nation-wide population-based cohort study comprised 237,592 patients with hypertension treated. The primary endpoint was a composite of cardiovascular death, myocardial infarction, and stroke. Elevated DBP was defined according to the Seventh Report of Joint National Committee (JNC7; SBP <140 mmHg, DBP ≥90 mmHg) or to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) definitions (SBP <130 mmHg, DBP ≥80 mmHg). Results: During a median follow-up of 9 years, elevated on-treatment DBP by the JNC7 definition was associated with an increased risk of the occurrence of primary endpoint compared with achieved both SBP and DBP (adjusted hazard ratio [aHR], 1.14; 95% confidence interval [CI], 1.05–1.24) but not in those by the 2017 ACC/AHA definition. Elevated ontreatment DBP by the JNC7 definition was associated with a higher risk of cardiovascular mortality (aHR, 1.42; 95% CI, 1.18–1.70) and stroke (aHR, 1.19; 95% CI, 1.08–1.30). Elevated on-treatment DBP by the 2017 ACC/AHA definition was only associated with stroke (aHR, 1.10;95% CI, 1.04–1.16). Similar results were seen in the propensity-score-matched cohort. Conclusion Elevated on-treatment DBP by the JNC7 definition was associated a high risk of major cardiovascular events, while elevated DBP by the 2017 ACC/AHA definition was only associated with a higher risk of stroke. The result of study can provide evidence of DBP targets in subjects who achieved SBP targets.

Background: Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. Methods: Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). Results: On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. Conclusions Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.
Aged ; Alzheimer Disease* ; Atrophy* ; Cognition Disorders ; Dementia* ; Diagnosis ; Humans ; Korea* ; Pemetrexed ; ROC Curve

No abstract available.
Humans ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms*

Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.
Adult ; Aortic Aneurysm, Abdominal/diagnosis/pathology/*surgery ; Blood Vessel Prosthesis Implantation/methods ; Graft Survival ; Humans ; Kidney/blood supply ; *Kidney Transplantation ; Male ; Reperfusion Injury/prevention & control ; Tomography, X-Ray Computed ; Transplantation, Homologous

The co-occurrence of multiple sclerosis and peripheral demyelinating neuropathy is rare. It has been disputed whether these are pathologically related or coincidental findings. We report a 36-year-old woman who presented with diplopia, right facial palsy and left-sided weakness. Brain magnetic resonance imaging showed a lesion indicative of central demyelinating disease. Nerve conduction studies revealed peripheral multifocal demyelinating neuropathies. We suggest that the central and the peripheral lesions may be continua of a demyelinating process.
Adult ; Brain ; Demyelinating Diseases ; Diplopia ; Facial Paralysis ; Female ; Humans ; Magnetic Resonance Imaging ; Multiple Sclerosis ; Neural Conduction

Infection of both native and prosthetic vessels are most frequently seen in the groin. The successful treatment of prosthetic graft infection requires excision of the affected graft, adequate debridement, and restoration of circulation. Restoration of arterial circulation can be accomplished by using in situ reconstruction with femoral vein, cryopreserved allografts, or antibiotic-impregnated synthetic grafts. The obturator and lateral femoral bypasses are the most frequently used extra-anatomic bypasses. We experienced one case of bilateral obturator bypasses for the femoral graft infection.
Allografts ; Debridement ; Femoral Vein ; Groin ; Transplants*

Infection of both native and prosthetic vessels are most frequently seen in the groin. The successful treatment of prosthetic graft infection requires excision of the affected graft, adequate debridement, and restoration of circulation. Restoration of arterial circulation can be accomplished by using in situ reconstruction with femoral vein, cryopreserved allografts, or antibiotic-impregnated synthetic grafts. The obturator and lateral femoral bypasses are the most frequently used extra-anatomic bypasses. We experienced one case of bilateral obturator bypasses for the femoral graft infection.
Allografts ; Debridement ; Femoral Vein ; Groin ; Transplants*

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.
Abdomen ; Diagnosis ; Femoral Vein ; Gyeongsangbuk-do ; Humans ; Iliac Vein ; Lower Extremity ; Lung ; Mesenteric Veins ; Phlebography ; Popliteal Vein ; Pulmonary Embolism ; Thrombosis ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Venous Thrombosis*

PURPOSE: Computed-tomography (CT) is known as a useful modality to diagnose the occurrence and extent of deep vein thrombosis (DVT) and the existence of pulmonary embolism (PE). This article will focus on the availability of DVT-CT at Kyungpook National University Hospital. METHOD: From 1994 to 2006, 403 DVT patients were documented for the extent of thrombus and the existence of PE. DVT-CTs, according to our protocol, were obtained for 136 patients; there were 112 CT scans taken that were limited to the abdomen and lower extremity, and 47 patients underwent only chest CT to diagnose PE. Other modalities such as duplex scan and venography for DVT and lung scan for PE were also performed for 155 patients. RESULT: The patients in the CT group (248 patients) demonstrated that the extent of the thrombus was in the inferior vena cava (IVC) in 38 (16%), the iliac veins (IVs) in 98 (40%), the femoral veins (FVs) in 73 (29%), the popliteal veins (PVs) in 3 (1%), and the mesenteric veins in 24 (10%). For the group that underwent venography or duplex scanning (155 patients), the extent of thrombus was in the IVC in 4 (3%), the IVs in 47 (30%), the FVs in 73 (47%), and the PVs in 21 (14%). For the 136 patients who underwent DVT-CTs, 38 (28%) cases had PE. The DVT-CT and lung scan were in agreement for all the 12 cases who underwent both two tests. CONCLUSION: In the present study, DVT-CT accurately revealed the extent of DVT and it is a useful tool for making the diagnosis of PE.
Abdomen ; Diagnosis ; Femoral Vein ; Gyeongsangbuk-do ; Humans ; Iliac Vein ; Lower Extremity ; Lung ; Mesenteric Veins ; Phlebography ; Popliteal Vein ; Pulmonary Embolism ; Thrombosis ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Venous Thrombosis*