Coronary arteriovenous fistula is relatively rare disease and originates more commonly in the right than in the left cononary artery. We report one case of cononary arteriovrnous fistula which we have experienced recently in 22 years old female, who has complained of dyspnea on exertion and intermittent anterior chest pain radiating to the left shoulder for several years. It was detected by transthoracic and transesophageal echocardiography and confirmed by cardiac catheterization and coronary angiography. In this case, the fistula was originated from the right coronary artery and drained into the posterior wall of the right ventricle, the coronary artery was dilated(diameter=1.5cm) and tortuous and significant shunt was measured(Qp/Qs=2.31). The opening of the fistula draining into right ventricle was obliterated with sutures.
Arteries ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Dyspnea ; Echocardiography* ; Echocardiography, Transesophageal ; Female ; Fistula ; Heart Ventricles ; Humans ; Rare Diseases ; Shoulder ; Sutures ; Young Adult

BACKGROUND AND OBJECTIVES: It has been recently reported that coronary artery disease (CAD) is more correlated with postprandial triglyceride (TG) levels than fasting TG levels. We performed this study to compare the patients with CAD to age- and sex-matched controls in regard to postprandial TG levels and to know the effects of fenofibrate on postprandial TG levels. MATERIALS AND METHOD: Serum TG, total cholesterol (C), HDL-C and LDL-C were measured before, and 2, 4, 6, 8, and 24 hours after a high-fat meal in 22 patients (mean: 60 yr) with CAD and 12 normal subjects (mean: 54 yr). The same parameters were also serially measured after the high-fat meal plus fibrate in 10 patients with CAD (mean: 59 yr). RESULTS: he patients group without fibrate showed that more prolonged and exaggerated hypertriglyceridemia following the meal than normal subjects, especially 4 to 8 hours after the meal and that lower HDL-C throughout the test duration. These changes were also persisted when hyperlipidemic patients were excluded out of the patients group. The patients with fibrate did not show such a significant elevation of TG levels 4 to 8hours after the meal compared when normal subjects. The time to reach the peak TG levels after the meal was 4, 6, and 4 hours after the meal in normal subjects, patients with CAD, and fibrate group, respectively. CONCLUSION: Coronary artery disease is clearly related with postprandial hypertriglyceridemia than fasting TG levels and postprandial hypertriglyceridemia can be somewhat prevented by fibrate.
Cholesterol ; Coronary Artery Disease* ; Coronary Vessels* ; Fasting ; Fenofibrate ; Humans ; Hypertriglyceridemia* ; Meals* ; Triglycerides

BACKGROUND: This study was to verify the necessity of a control program developed to improve compliance, by conducting a research on the status of medication compliance in the elderly with chronic diseases in rural area and analyzing the related variables. METHODS: The organized questionnaire and pill-count were used to collect information on personal details, physical status, drugs taken in the elderly over 65 years old suffering from more than two chronic diseases in one rural area. RESULTS: The mean age of the subjects was 73.13+/-6.36 (65~93), and the number of the subjects in compliance group was 60 (77.9%) and the accuracy of self-report which was identified by pill-count was 0.86. Polypharmacy and visiting several clinics were the main factors that decided a low- degree of compliance, with OR of 5.92 (95% CI 1.11~31.44, P=0.037), and 4.25 (95% CI 1.03~17.53, P=0.045), respectively. CONCLUSION: Systematic efforts are necessary and plans must be established without delay to increase compliance in the elderly in the rural, expansively to manage chronic diseases in stay-at-home elders.
Aged ; Chronic Disease ; Compliance ; Humans ; Medication Adherence ; Polypharmacy ; Republic of Korea ; Stress, Psychological ; Surveys and Questionnaires

No abstract available.
Aged* ; Herpes Zoster* ; Humans ; Neuralgia, Postherpetic* ; Pain Management*

Objective: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.