PURPOSE: The purpose of this study was to report the authors’ experience with external ventricular drainage (EVD) before endovascular treatment (EVT) in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) and to investigate its relation to hemorrhagic complications. MATERIALS AND METHODS: Between March 2010 and December 2017, a total of 122 patients were recruited who had an aSAH, underwent EVT to secure the ruptured aneurysm, and had EVD performed within 72 hours of rupture. The pre-embo EVD group (n=67) comprised patients who underwent EVD before EVT, and the post-embo EVD group (n=55) comprised those who underwent EVD after EVT. RESULTS: Overall, EVD-related hemorrhage occurred in 18 patients (14.8%): six (8.9%) in the pre-embo EVD group and 12 (21.8%) in the post-embo EVD group (P=0.065). No rebleeding occurred between EVD and EVT in the pre-embo EVD group. Clinical outcomes at discharge did not differ significantly between groups (P=0.384). At discharge, the final modified Rankin Scale score in patients who experienced pre-embo rebleeding was better in the pre-embo EVD group than in the post-embo EVD group (P=0.041). Current use of an antiplatelet agent or anticoagulant on admission (odds ratio [OR], 2.928; 95% confidence interval [CI], 1.234–7.439; P=0.042) and stent use (OR, 2.430; 95% CI, 1.524–7.613; P=0.047) remained independent risk factors for EVD-related hemorrhagic complications. CONCLUSION: EVD before EVT in patients with aSAH in acute period did not increase the rate of rebleeding as well as EVD-related hemorrhagic complications. Thus, performing EVD before EVT may be beneficial by normalizing increased intracranial pressure. Especially in patients with rebleeding before the ruptured aneurysm is secured, pre-embo EVD may improve clinical outcomes at discharge.
Aneurysm ; Aneurysm, Ruptured ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Intracranial Pressure ; Risk Factors ; Rupture ; Stents ; Subarachnoid Hemorrhage

PURPOSE: To plug the biopsy site in eight patients with coagulopathy who had undergone percutaneous liverbiopsy. To this end, gelfoam cartridge was used as a sealant. MATERIALS AND METHODS: Using an 18G Tru-Cut-typedisposible automated biopsy gun(Soo Ho Medi-tech, Seoul, Korea) and under US guidance, eight patients underwentpercutaneous liver biopsy. After the gun had fired, the biopsy specimen in the inner stylet was retrieved whilethe outer cannula was held in place ; the cannula was then used to plug the biopsy tracks with gelfoam, using twoor three cartridges. If bleeding occurred, this was controlled by the use of more gelfoam cartridges. RESULTS: Diagnostic target tissue was obtained in seven of the eight patients(87.5%). Hepatocellular carcinoma wasdiagnosed in five cases and metastatic cancer in two. Profuse bleeding was observed in one patient(12.5%) andresolved by gelfoam plugging. CONCLUSION: We believe that in patients with coagulopathy who are required toundergo liver biopsy plugging the liver biopsy track with gelfoam cartridge is a simple, safe and useful method.
Biopsy* ; Carcinoma, Hepatocellular ; Catheters ; Fires ; Gelatin Sponge, Absorbable ; Hemorrhage* ; Humans ; Liver ; Seoul

Myofibroblastoma of the breast is a rare benign mesenchymal tumor that is known to occur in middle-aged and elderly men, yet there are some recent reports showing no certain difference for the gender distribution of this malady. Localized mass excision can usually provide a complete cure. To the best of our knowledge, there have been no reports of metastasis or recurrence of this tumor. Here we describe the sonographic findings of a case of recurrent myofibroblastoma after surgical excision for suspected fibroadenomas in both breasts of a 25-year-old woman.
Adult ; Aged ; Breast ; Female ; Fibroadenoma ; Humans ; Male ; Neoplasm Metastasis ; Neoplasms, Muscle Tissue ; Recurrence

BACKGROUND AND OBJECTIVES: Patients with renal dysfunction (RD) experience worse prognosis after myocardial infarction (MI). The aim of the present study was to investigate the impact of admission estimated glomerular filtration rate (eGFR) on clinical outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation MI (STEMI). SUBJECTS AND METHODS: We retrospectively evaluated 4,542 eligible patients from the Korea Acute Myocardial Infarction Registry (KAMIR). Patients were divided into three groups according to eGFR (mL/min/1.73 m2): normal renal function (RF) group (eGFR > or =60, n=3,515), moderate RD group (eGFR between 30 to 59, n=894) and severe RD group (eGFR <30, n=133). Baseline characteristics, angiographic and procedural results, and in-hospital outcomes between the three groups were compared. RESULTS: Age, gender, Killip class > or =3, hypertension, diabetes, congestive heart failure, peak creatine kinase-MB, high sensitivity C-reactive protein, B-type natriuretic peptide, left ventricle ejection fraction, multivessel disease, infarct-related artery and rate of successful PCI were significantly different between the 3 groups (p<0.05). With decline in RF, in-hospital complications developed with an increasing frequency (14.1% vs. 31.8% vs. 45.5%, p<0.0001). In-hospital mortality rate was significantly higher in the moderate and severe RD groups as compared to the normal RF group (2.3% vs. 13.9% vs. 25.6%, p<0.0001). Using multivariate logistic regression analysis, adjusted odds ratio for in-hospital mortality was 2.67 {95% confidence interval (CI) 1.44-4.93, p=0.002} in the moderate RD group, and 4.09 (95% CI 1.48-11.28, p=0.006) in the severe RD group as compared to the normal RF group. CONCLUSION: Decreased admission eGFR was associated with worse clinical courses and it was an independent predictor of in-hospital mortality in STEMI patients undergoing primary PCI.
Arteries ; C-Reactive Protein ; Creatine ; Glomerular Filtration Rate ; Heart Failure ; Heart Ventricles ; Hospital Mortality ; Humans ; Hypertension ; Korea ; Logistic Models ; Myocardial Infarction ; Natriuretic Peptide, Brain ; Odds Ratio ; Percutaneous Coronary Intervention ; Prognosis ; Retrospective Studies

BACKGROUND/AIMS: The aim of this study was to evaluate the impact of diabetes mellitus (DM) on in-hospital and 1-year mortality in patients who suffered acute myocardial infarction (AMI) and underwent successful percutaneous coronary intervention (PCI). METHODS: Among 5,074 consecutive patients from the Korea AMI Registry with successful revascularization between November 2005 and June 2007, 1,412 patients had a history of DM. RESULTS: The DM group had a higher mean age prevalence of history of hypertension, dyslipidemia, ischemic heart disease, high Killip class, and diagnoses as non-ST elevation MI than the non-DM group. Left ventricular ejection fraction (LVEF) and creatinine clearance were lower in the DM group, which also had a significantly higher incidence of in-hospital and 1-year mortality of hospital survivors (4.6% vs. 2.8%, p = 0.002; 5.0% vs. 2.5%, p < 0.001). A multivariate analysis revealed that independent predictors of in-hospital mortality were Killip class IV or III at admission, use of angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, LVEF, creatinine clearance, and a diagnosis of ST-elevated MI but not DM. However, a multivariate Cox regression analysis showed that DM was an independent predictor of 1-year mortality (hazard ratio, 1.504; 95% confidence interval, 1.032 to 2.191). CONCLUSIONS: DM has a higher association with 1-year mortality than in-hospital mortality in patients with AMI who underwent successful PCI. Therefore, even when patients with AMI and DM undergo successful PCI, they may require further intensive treatment and continuous attention.
Aged ; Angioplasty, Balloon, Coronary/adverse effects/*mortality ; Chi-Square Distribution ; Diabetes Mellitus/*mortality ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/mortality/*therapy ; Proportional Hazards Models ; Prospective Studies ; Registries ; Republic of Korea ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

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

BACKGROUND AND OBJECTIVES: The first on-line registration of Korea Acute Myocardial Infarction patients (KAMIRs) has been carried out throughout the 41 primary percutaneous coronary intervention (PCI) centers that are supported by the Korean Circulation Society (KCS), as reported in the memorandum of the 50th Anniversary of the KCS. SUBJECTS AND METHODS: Between Nov 2005 and June 2006, 4905 patients were enrolled in KAMIR and 4110 eligible patients (2855 males and 1255 females; mean age=64.3+/-13.5 years) were analyzed. The treatment strategy for acute myocardial infarction (AMI) was analyzed according to the gender differences in the area of acute ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). RESULTS: For the initial selection of a treatment strategy for STEMI, primary PCI was more commonly performed in males than females (69.8% vs. 68.3%, respectively, p=0.008), but age was the most important predictors after multivariate adjustment. During the hospital stay, PCI regardless of its subtype was more commonly done in the males than in the females with both STEMI and NSTEMI (STEMI: 89.1% vs. 84.9%, respectively, p=0.004; NSTEMI: 74.7% vs. 63.5%, respectively, p<0.001). The success rate of PCI in STEMI patients was not different between the genders (95.0% vs. 93.6%, respectively, p=0.399), but that of NSTEMI was higher in the males than the females (96.9% vs. 95.8%, respectively, p=0.004). CONCLUSION: For the initial treatment of AMI in Korea, females are treated more conservatively than males, but age was the most important predictor for invasive treatment. The success rate of PCI was higher for the males than the females.
Angioplasty ; Anniversaries and Special Events ; Female ; Humans ; Korea* ; Length of Stay ; Male ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Sex Characteristics* ; Stents ; Thrombolytic Therapy

BACKGROUND/AIMS: To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD). METHODS: This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 calculated by the modification of diet in renal disease method. RESULTS: At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049). CONCLUSIONS: Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
Aged ; *Drug-Eluting Stents/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*etiology/mortality/*therapy ; Paclitaxel/administration & dosage ; Prospective Studies ; Registries ; Renal Insufficiency, Chronic/*complications ; Republic of Korea/epidemiology ; Sirolimus/administration & dosage/analogs & derivatives