PURPOSE: We compared the clinical manifestations of patients with tsutsugamushi disease between children and adults. METHODS: From January 2003 to December 2012, 768 patients diagnosed with tsutsugamushi disease were retrospectively reviewed, and the clinical characteristics, laboratory findings, and complications were compared between children and adults. RESULTS: No patterns of annual increases in the number of patients were noted in both children and adults. The higher incidences occurred in October and November respectively. By gender, male outnumbered female in children, but the opposite trend was seen in adults. By residential area, the urban distribution of children was higher than that of adults. Rashes (P=0.001) and eschar (P=0.004) were more common in children, while myalgia was more common in adults. Children had a high prevalence of anemia (P=0.041), and low incidence rates of thrombocytopenia, abnormal liver and renal function. Children yielded better results in the duration of their hospital stay and the incidence of complications (P<0.001). A comparison of the therapeutic effects of doxycycline and macrolide antibiotics, which was performed only on the children, did not reveal any significant differences. CONCLUSION: Compared to adults, children had higher incidence rates of male patients and more often suffered from rashes and eschar. Children yielded better results in the laboratory findings and duration of the hospital stay and complications. Therefore, when children are suspected to have tsutsugamushi disease, especially during its peak occurrence period, detailed physical examination and serological test should be performed to ensure a prompt diagnosis, and the use of macrolide antibiotics, which have fewer side effects, is expected to yield the same therapeutic effects.
Adult* ; Anemia ; Anti-Bacterial Agents ; Child* ; Diagnosis ; Doxycycline ; Exanthema ; Female ; Humans ; Incidence ; Length of Stay ; Liver ; Male ; Myalgia ; Physical Examination ; Prevalence ; Retrospective Studies ; Scrub Typhus* ; Serologic Tests ; Thrombocytopenia

Background: The main cause of death in pulmonary embolism (PE) is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to reperfusion therapy of PE. However, little is known about the patients that benefit from ECMO. Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed. Results: During the study period, nine patients received ECMO in high-risk PE. The median age of the patients was 60 years (range, 22–76 years), and six (66.7%) were male. All nine patients had cardiac arrests, of which three occurred outside the hospital. All the patients received mechanical support with veno-arterial ECMO, and the median ECMO duration was 1.1 days (range, 0.2–14.0 days). ECMO with anticoagulation alone was performed in six (66.7%), and ECMO with reperfusion therapy was done in three (33.3%). The 30-day mortality rate was 77.8%. The median time taken from the first cardiac arrest to initiation of ECMO was 31 minutes (range, 30–32 minutes) in survivors (n=2) and 65 minutes (range, 33–482 minutes) in non-survivors (n=7). Conclusion High-risk PE with cardiac arrest has a high mortality rate despite aggressive management with ECMO and reperfusion therapy. Early decision to start ECMO and its rapid initiation might help save those with cardiac arrest in high-risk PE.

Electrical injury may lead to a conduction disorder of the heart. We report here on a 36-year-old man, who was treated with a permanent pacemaker, after an electrical injury induced high-degree atrioventricular block and clinical manifestations (dizziness and dyspnea).
Adult ; Atrioventricular Block* ; Electric Injuries ; Heart ; Heart Conduction System ; Humans

BACKGROUND AND OBJECTIVES: Increased carotid intima-media thickness (IMT) is known to be associated with adverse cardiovascular events in the patients with risk factors or established atherosclerosis. However, the prognostic importance of carotid IMT is uncertain in the patients who underwent percutaneous coronary intervention (PCI). We sought to evaluate the association of carotid IMT with major adverse cardiovascular events (MACE) and restenosis in the patients who underwent PCI. SUBJECTS AND METHODS: The study population consisted of 308 consecutive patients who underwent PCI, and they were followed up for mean of 30.6+/-13.3 months. Base on the median values of carotid IMT, which was measured in the right common carotid artery at the time of PCI with using high-resolution ultrasound and a semiautomatic method, the subjects were divided into the thick (n=156, 1.003+/-0.14 mm) and thin IMT (n=152, 0.748+/-0.07 mm) groups, and they were followed up for at least 1 year. RESULTS: Patients with thick carotid IMT were older (61+/-9 years vs. 57+/-10 years, respectively, p=0.001), had a higher body mass index (25.0+/-3.0 vs. 23.9+/-4.0, respectively, p=0.017), a history of previous myocardial infarction (20% vs. 9%, respectively, p=0.008), more multivessel disease and more restenosis (34.6% vs. 23.0%, respectively, p=0.025) than those patients with a thin carotid IMT. However other MACEs such as death, myocardial infarction, stroke, heart failure and target lesion revascularization did not show any significant differences between the two groups. Multivariate Cox regression analysis showed that carotid IMT was an independent predictor of restenosis (odds ratio: 1.754, 95% confidence interval: 1.1296 to 2.726, p=0.012). CONCLUSION: An increased carotid IMT is associated with restenosis, but it does not have clinical prognostic importance for the patients who underwent PCI during a mean follow up period of 31 months.
Angioplasty, Balloon, Coronary ; Atherosclerosis ; Body Mass Index ; Carotid Artery, Common ; Carotid Intima-Media Thickness* ; Follow-Up Studies ; Heart Failure ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Prognosis ; Risk Factors ; Stroke ; Ultrasonography

No abstract available.
Endocarditis* ; Hypertension ; Mitral Valve

Liposarcoma in esophagus is rare, moreover the pedunculated form is very rare. We experienced a case of liposarcoma in a 36-year-old man who had intermittent swallowing difficulty for 7 months. Endoscopy and esophagography revealed that a smooth longitudinal tumor mass occupied the esophageal lumen. Esophagotomy and surgical excision was done. The tumor was 4 cm in length and 3 cm in average diameter with an obvious stalk measuring 3.5 cm in length and 1.5 cm in diameter. Microscopic examination disclosed a lipoma with focal ulceration and liposarcomatous change infiltrating into interstitial fibrous tissue at its distal end.
Adult ; Deglutition ; Endoscopy ; Esophagus* ; Humans ; Intestines* ; Lipoma ; Liposarcoma* ; Stomach* ; Ulcer

No abstract available.
Aminophylline* ; Humans* ; Ritodrine* ; Uterus*

OBJECTIVES: Although pregnancy in women who are 35 years old or more is considered a high risk pregnancy, it has occurred more frequently in recent years. The aim of our study was to evaluate the course of delivery and perinatal outcomes in women who are 35 years old or more. METHOD: We have compared 765 cases of the elderly gravida over the age of 35 at the department of Obstetrics and Gynecology, Mokpo, Catholic Hospital, from January 1, 1997 to December 31, 1999, with 800 cases of randomly chosen young pregnant women during the same period. RESULTS: There were 765 cases of the elderly gravida among total 8285 deliveries and the incidence of the elderly gravida for 3 years was 9.2%. The rate of elderly gravida was increased from 8.2% in 1997 to 10.0% in 1999. 46.9% were in the age group of 35 to 36 years. The incidence of primigravida was 13.9%. 93.6% of total cases was vertex presentation breech presentation was 5.2%, and transverse lie was 1.2%. The percentage of preterm pregnancy was 9.5% in elderly gravida, and 4.0% in control group. post-term pregnancy was 2.0% in elderly gravida, and 1.0% in control group.The rate of cesarean section was 48.8%, compared with 26.7% in the control group. Among the indications of cesarean section, the highest incidence was previous cesarean section (40.0%) and elderly primigravida (18.0%), fetal distress (10.7%), cephalopelvic disproportion (7.5%), and abnormal presentation (6.7%). Concerning the prenatal complications, the incidence of hypertensive disorder was 4.3%, and 2.6% in control group. The incidence of low birth weight and macrosomia were 8.9%, 8.8% in elderly gravida, and 5.5%, and 9.3% in control group. The incidence of IUFD was 3.1% in elderly gravida, and 0.63% in control group. Male-to-female sex ratios were 1.12:1 in elderly gravida, 1:1.16 in elderly primigravida, 1.17:1 in elderly multi gravida, and 1.20:1 in control group. CONCLUSION: The rate of elderly gravida increased in recent years, and the cesarean rate was higher compared with the control group. But there was no difference in perinatal mortality. The reasons for increasing rate of cesarean delivery may be due to physician and patient concern over pregnancy outcome in older women. Therefore it is necessary to exert more attention to pregnancies in those over the age of 35.
Adult ; Aged ; Breech Presentation ; Cephalopelvic Disproportion ; Cesarean Section ; Female ; Fetal Distress ; Gynecology ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Jeollanam-do ; Obstetrics ; Perinatal Mortality ; Pregnancy ; Pregnancy Outcome ; Pregnancy, High-Risk ; Pregnant Women* ; Sex Ratio

BACKGROUND AND OBJECTIVES: Undiagnosed diabetes mellitus (DM) or impaired glucose tolerance (IGT) is not uncommon in patients with coronary atherosclerosis and is known to be associated with abnormal scores for atherosclerosis surrogates. We sought to determine the prevalence of undiagnosed DM or IGT, and the association between insulin resistance (IR) and atherosclerosis surrogates in patients with coronary atherosclerosis. SUBJECTS AND METHODS: The study population consisted of 187 consecutive patients with angiographically proven coronary atherosclerosis (mean: 61 years old, 94 males). We measured carotid intima-media thickness (IMT) and flow mediated brachial artery dilatation (FMD). We also did oral glucose tolerance tests (OGTT), quantitative insulin-sensitivity check indexes (QUICKI) and homeostasis model assessment-IR (HOMA-IR). RESULTS: Abnormal OGTT was found in 164 patients (87.7%), even though there were only 63 known cases of DM (33.7%). There were 58 patients (31%) with newly diagnosed IGT and 43 patients (23%) with newly diagnosed DM. There were 71 patients (38%) who had IR (defined as measured HOMA-R > or =3.0). HOMA-IR showed a positive correlation with body mass index (BMI) (r=0.275, p<0.001) and triglycerides (r=0.2, p=0.01), whereas QUICKI had a negative correlation with BMI (r=-0.26, p<0.001), total cholesterol (r=-0.15, p=0.04), triglycerides (r=-0.21, p=0.004) and low-density lipoprotein-cholesterol (LDL-C) (r=-0.17, p=0.02). HOMA-IR and QUICKI were not significantly correlated with IMT or FMD. CONCLUSION: This study suggests that there is a high incidence of undiagnosed DM and IGT, but atherosclerosis surrogates are not associated with IR in patients with coronary atherosclerosis.
Atherosclerosis ; Body Mass Index ; Brachial Artery ; Carotid Intima-Media Thickness ; Cholesterol ; Coronary Artery Disease ; Diabetes Mellitus ; Dilatation ; Glucose ; Glucose Tolerance Test ; Homeostasis ; Humans ; Incidence ; Insulin ; Insulin Resistance ; Prevalence ; Triglycerides

BACKGROUND AND OBJECTIVES: A prolonged heart rate-corrected QT interval (QTc) is known to be related to an increased risk of coronary artery disease (CAD) and sudden cardiac death, while the carotid intima-media thickness (IMT) is related to CAD. We sought to evaluate the relationship among the QTc, the carotid IMT and the severity of CAD. SUBJECTS AND METHODS: The QTc and the carotid IMT were measured in 165 consecutive patients who underwent coronary angiography. The measurement of the QTc was done automatically by a digital QT GuardTM system (GE Marquette Medical System, Milwaukee, USA) and the carotid IMT was measured by M'ATH software (METRIS Co., Argenteuil, France). The severity of CAD was divided into minimal disease (90, 54.5%), one-vessel disease (32, 19.4%), and multi-vessel disease (43, 26.1%), according to the number of vessels that were narrowed by more than 50%. RESULTS: The mean values of the QTc were 415.1+/-20.5 msec in the minimal disease group, 411.7+/-17.0 msec in the one-vessel disease group and 434.2+/-46.1 msec in the multi-vessel disease group. The QTc was correlated with age (r=0.236, p=0.002), HDL cholesterol (r=-0.160, p=.043), the right carotid IMT (r=0.17, p=0.026), the left carotid IMT (r=0.178, p=0.022) and the severity of CAD (r=0.243, p=0.002). On the multiple linear regression analysis after adjustment for age and HDL cholesterol, the QTc was an independent factor for the severity of CAD. CONCLUSION: These results suggest that repolarization abnormalities are associated with the severity of CAD and they may reflect the severity of the morphologic atherosclerotic surrogates.
Carotid Arteries ; Carotid Intima-Media Thickness* ; Cholesterol, HDL ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death, Sudden, Cardiac ; Heart ; Humans ; Linear Models