Serrated adenoma (SA) is a distinct form of colorectal neoplasia and it is defined as a neoplastic lesion composed of a monotonous cell population with atypical nuclei proliferating in serrated glandular architectures. Hyperplastic polyp is considered a benign lesion with no malignant potential. However, SA progressed into frank carcinoma has been demonstrated in an individual case, and 'serrated neoplasia pathway' is suggested by some authors as an alternative to classical adenoma-carcinoma sequence. Distinguishing between hyperplastic polyp and SA is important because of the different management implications and the increased potential for neoplastic progression in the latter, but sometimes it is very difficult. SA is usually small and sessile polypoid lesion. We report a case of SA presenting as large fungating mass similar to colon cancer, diagnosed as hyperplastic polyp initially by colonoscopic biopsy and confirmed as after SA the surgery.
Adenoma* ; Biopsy ; Colon* ; Colonic Neoplasms* ; Polyps

PURPOSE: Infrainguinalfemoropopliteal bypass (IFPB) is recommended to peripheral arterial disease (PAD) with a long occlusion of the superficial femoral artery (SFA). The aims of our study were to determine the patency of graft materials, and identify the risk factors of graft failure. METHODS: From January 1995 to April 2011, we had performed 380 IFPBs in 351 patients, including 302 femoro-above the knee (AK) bypasses and 78 femoro-below the knee (BK) bypasses. We compare age, sex, severity of ischemia between polytetra-uoroethylene (PTFE) graft and saphenous vein (SV) graft, and evaluate patency rate rates of the two groups. RESULTS: The primary patency rates at 5 years for SV (n = 76 limbs) and PTFE grafts (n = 226 limbs) in AK were 85.2% and 64.5% (log rank = 0.03), and the secondary patency rates at 5 years for SV and PTFE grafts in AK were 88.2% and 79.0% (log rank = 0.13). The primary patency rates at 5 years for SV (n = 50 limbs) and PTFE grafts (n = 28 limbs) in BK were 63.2% and 40.0% (log rank = 0.08), and the secondary patency rates at 5 years for SV and PTFE grafts in BK were 71.6% and 55.5% (log rank = 0.18). CONCLUSION: There was no statistical significant difference in secondary patency rates between SV and PTFE in IFPB. PTFE grafts as SV grafts can be a good alternative bypass material in IFPB instead of SV grafts.
Femoral Artery ; Humans ; Ischemia ; Knee ; Peripheral Arterial Disease ; Polytetrafluoroethylene ; Risk Factors ; Saphenous Vein* ; Transplants*

BACKGROUND: Atrial fibrillation is the commonest arrhythmia seen in clinical practice. However, there have been no epidemiologic data on its prevalence in general population of Korea. We performed this study to investigate the prevalence of atrial fibrillation in Korea. METHODS: From March 1, 1999 to July 31, 2000, Kangwon Branch, Korea Association of Health (KAH) parformed electrocardiograms to investigate the health status in the general public in Kangwon Province. We analyzed these data by of chi square(2) test. RESULTS: A total of 45,133 persons participated in the health screening performed by KAH. The number of persons above 40 years old were 13,768, with men and women 6,367 (46.2%) and 7,401 (53.8%)respectively. Prevalence among those above 40 years old was 0.72% and the prevalence among men, 0.96% (61 persons) was significantly higher than that of women, 0.51% (38 persons)(p<0.01). In the group above 60 years old with the prevalence of 1.24%, a similar phenomenon was observed with 1.57% (40 persons) in men and 0.97% (29 persons) in women (p<0.05). CONCLUSION: Prevalence of atrial fibrillation became higher as age increased, specifically in persons older than 40 years.
Adult ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Electrocardiography ; Female ; Gangwon-do* ; Humans ; Korea ; Male ; Mass Screening ; Middle Aged ; Prevalence*

Preoperative assessment of electrocardiographical(EKG) abnormalities in the patients with subarachnoid hemorrhage(SAH) is importment. Authors analyzed 58 SAH patients who had EKG abnormalities of neurogenic origin. EKG abnormalities consisted of T wave abnormality, arrhythmia, ST segment change, QT prolongation and U wave. Five patients were dead in this study because of brain swelling(3 cases) and cerebral spasm(2 cases). EKG abnormalities were normalized 13 days after aneurysmal SAH. Radioactive nuclear(99mTc-pyrophosphate) scan of myocardial revealed normal findings in the patients with EKG abnormalities of neurogenic origin. It is concluded that life-saving surgical intervention need not be delayed in the patients with EKG abnormalities of neurogenic origin. On the other hand, patients who had cardiac origin EKG abnormalities need a careful and detailed preanesthetic cardiac evaluation.
Aneurysm* ; Arrhythmias, Cardiac ; Brain ; Electrocardiography* ; Hand ; Humans ; Subarachnoid Hemorrhage

PURPOSE: As general population survival has improved in the last few decades, the age of patients participating in renal transplantation also has increased. This study aimed to investigate the impact of donor and recipient age as predictor of long-term graft survival in renal transplantation. METHODS: We analyzed the transplantation outcome in 598 patients, who received renal transplantation from 1978 to 2003 at Hanyang Universitiy. Patients were divided into four groups according to the age at renal transplantation. Group A (donor age> or =50, recipient age> or =50, n=19/3.2%), group B (donor age> or =50, recipient age<50, n=153/25.5%), group C (donor age<50, recipient age> or =50, n=69/11.6%), group D (donor age<50, recipient age<50, n=357/59.8%). Univariate analysis was used to assess the effect of donor and recipient age as predictor factors of graft outcome. We used Kaplan Meier log-rank method for graft survival and P values less than 0.05 were considered significant. RESULTS: In elderly donor group, graft survival was 89.8% at 1 year, 76.4% at 3 years and younger donor group was 92.8 at 1year, 84.0% at 3 years and the differences showed statistic significance (P=0.009). Univariate analysis of age factor showed a significant reduction of graft survival in recipients transplanted with kidneys coming from donors older than 50 years, however recipient age greater than 50 years was not found as an independent risk factor. The incidence of rejection was 24.6% in elderly donor group and 23.5% in younger donor group (P=NS). Among the four groups, the most valuable result was group D and the 1 year and 3 years graft survival were 93.1%, 84.5% respectively but it was not significant statistically (P=0.50). CONCLUSION: This result is important for the design of allocation and transplantation strategies for kidneys procured in elderly donors and recipients.
Age Factors ; Aged ; Graft Survival ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Risk Factors ; Tissue Donors* ; Transplants

Central sleep apnea (CSA) is attributed to medical or neurological conditions including stroke. The association of lesion location and CSA in patients with ischemic stroke has not been well elucidated. A 69-year-old man with a history of hypertension and diabetes mellitus was admitted due to stroke. The brain magnetic resonance imaging showed an acute ischemic stroke in the right ventral thalamus and adjacent hypothalamus. During hospitalization, polysomnography (PSG) was performed because repetitive cessation of respiration during sleep was observed by chance. PSG showed severe CSA; the apnea-hypopnea index (AHI) was 73.5 with a minimum oxygen saturation of 89% and central apnea index (CAI) was 63.0. Two years later, follow-up PSG showed that AHI was 7.2 with a minimum oxygen saturation of 91% and CAI was 1.0. We report the patient with CSA after ischemic stroke with right thalamus and adjacent hypothalamus, which resolved spontaneously with time.
Aged ; Brain ; Cerebral Infarction ; Diabetes Mellitus ; Follow-Up Studies ; Hospitalization ; Humans ; Hypertension ; Hypothalamus ; Magnetic Resonance Imaging ; Oxygen ; Polysomnography ; Respiration ; Sleep Apnea, Central ; Stroke ; Thalamus

OBJECTIVES: To evaluate the correlation between T-score of lumbar spine and that of proximal femur using dual energy x-ray absorptiometry (DXA) and the accuracy of the diagnosis of osteoporosis. MATERIAL AND METHODS: From December 2009 to January 2012, 300 female patients were selected who underwent bone mineral density (BMD) test using DXA. After measuring BMD of proximal femur and lumbar spine, the score of BMD in each age group was compared by two sites. Also, the concordance of the diagnosis of osteoporosis was evaluated. RESULTS: The result showed significantly lower T-score and BMD as it goes to the elderly group. As it goes for 60's age group and even more for 70's age group, lumbar spine showed lower BMD than proximal femur. In all age groups, lumbar spine and proximal femur T-score showed significant correlation; however, it showed the least states at 60's age group. Discordance rate of osteoporosis diagnosis was 33% and 47.3% each at lowest t-score and total t-score. 60's age group showed the highest discordance rate, and osteoporosis group showed the highest rate. CONCLUSIONS: When measuring BMD for diagnosis of osteoporosis, since it shows significant discordance between proximal femur and lumbar spine, it is necessary to measure BMD simultaneously on both parts.
Absorptiometry, Photon ; Aged ; Bone Density ; Diagnosis ; Female ; Femur ; Humans ; Osteoporosis ; Spine

There were many reports of infected pseudoaneurysms of the forearm that are caused by arterial injury or cannulation. However, spontaneous pseudoaneurysm of forearm artery without any history of arterial injury or cannulation is rare. Here, we report the case of an infected pseudoaneurysm in the forearm after infective endocarditis, without arterial injury or cannulation. A 76-year old man had a large, growing, pulsatile mass of the radial artery after experiencing infective endocarditis. We performed an interposition with great saphenous vein graft after removing the aneurysm. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis and treatment of pain in the extremity and swelling after infective endocarditis.
Aneurysm ; Aneurysm, False ; Aneurysm, Infected ; Arteries ; Catheterization ; Diagnosis, Differential ; Endocarditis ; Extremities ; Forearm ; Radial Artery ; Saphenous Vein ; Transplants

Congenital hemolytic anemia is mainly developed due to intrinsic defects of erythrocytes, but in some cases the cause of hemolytic anemia is unclear. Gilbert's syndrome shows mild, chronic unconjugated hyperbilirubinemia that is due to reduced UDP glucuronosyltransferase (UGT-1A1) activity and this develops because of UGT-1A1 gene mutation. We report here on a case of severe hyperbilirubinemia in a 17-year-old male who was diagnosed with congenital hemolytic anemia of an unknown cause combined with Gilbert's syndrome.
Adolescent ; Anemia, Hemolytic ; Anemia, Hemolytic, Congenital ; Erythrocytes ; Gilbert Disease ; Glucuronosyltransferase ; Humans ; Hyperbilirubinemia ; Male

Intradialytic hypotension during dialysis adversely affects a patient's prognosis and increases mortality. We report a case in which intradialytic hypotension that persisted after the administration of midodrine was relieved after the use of fludrocortisone. Administration of 0.2 mg of fludrocortisone occurred 30 minutes before dialysis. We compared 45 sessions of dialysis without fludrocortisone administration and 45 sessions of dialysis with fludrocortisone administration in one patient. The number of times in which systolic blood pressure became lower than 80 mmHg and the number of early terminations of dialysis due to a decrease in systolic blood pressure were higher in the sessions without fludrocortisone administration than in the sessions with fludrocortisone administration (P < 0.05). Fludrocortisone may be helpful for the treatment of intradialytic hypotension that does not respond to midodrine administration.
Blood Pressure ; Dialysis ; Fludrocortisone* ; Humans ; Hypotension* ; Midodrine ; Mortality ; Prognosis ; Renal Dialysis