This report details the CT, MR, and angiography findings of a solitary fibrous tumor involving the larynx of a 34-year-old man. A precontrast CT scan revealed a well-defined isodense mass in the submucosal region of the supraglottic larynx. The tumor appeared as a mixed intensity lesion on the T1- and T2-weighted MR images. A T2-weighted MR image showed a central, round, and low signal intensity area within the mass. For both the CT and MR images, the mass demonstrated heterogeneous enhancement following the administration of contrast material. The angiography showed a hypervascular tumor with heterogeneous persistent staining.
Adult ; Angiography ; Humans ; Laryngeal Neoplasms/blood supply/*diagnosis ; Magnetic Resonance Imaging ; Male ; Solitary Fibrous Tumors/blood supply/*diagnosis ; Tomography, X-Ray Computed

BACKGROUND: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. METHODS: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. RESULTS: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of −24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. CONCLUSION: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors affecting the supply of cardiovascular surgeons, an active intervention of policies can be prescribed for the areas that have failed to meet the appropriate market distributions.
Aged ; Aging ; Cardiovascular Diseases ; Delivery of Health Care ; Economics, Medical ; Foster Home Care ; Health Policy ; Health Services Needs and Demand ; Humans ; Insurance, Health ; Korea ; National Health Programs ; Surgeons* ; Thoracic Surgery

BACKGROUND: This study analyzed the association between the volume of heart surgeries and treatment outcomes for hospitals in the last five years. METHODS: Hospitals that perform heart surgeries were chosen throughout Korea as subjects using from the Health Insurance Review and Assessment Service. The treatment outcome of the heart surgeries was defined as the mortality within 30 postoperative days, while the annual volume of the surgeries was categorized. Logistic regression was used as the statistical analysis method, and the impacts of the variables on the heart surgery treatment outcomes were then analyzed. RESULTS: The chance of death of patients who received surgery in a hospital that performed 50 or more surgeries annually was noticeably lower than patients receiving operations from hospitals that performed fewer than 50 surgeries annually, indicating that the chance of death decreases as the annual volume of heart surgeries in the hospital increases. In particular, the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually. CONCLUSION: These results indicate that accumulation of a certain level of heart surgery experience is critical in improving or maintaining the quality of heart surgeries. In order to improve the treatment outcomes of small hospitals, a support policy must be implemented that allows for cooperation with experienced professionals.
Heart ; Humans ; Insurance, Health ; Korea ; Logistic Models ; Methods ; Mortality ; Quality of Health Care ; Thoracic Surgery ; Treatment Outcome*

BACKGROUND: This study uses the relevance index to understand the condition of regional medical service use for cardiovascular surgery and to identify the medical service use imbalance between regions. METHODS: This study calculated the relevance index of 16 metropolitan cities and provinces using resident registration address data from the Ministry of Government Administration and Home Affairs and the 2010–2014 health insurance, medical care assistance, and medical benefits claims data from the Health Insurance Review and Assessment Service. We identified developments over the 5-year time period and analyzed the level of regional imbalance regarding cardiovascular surgery through the relative comparison of relevance indexes between cardiovascular and other types of surgery. RESULTS: The relevance index was high in large cities such as Seoul, Daegu, and Gwangju, but low in regions that were geographically far from the capital area, such as the Gangwon and Jeju areas. Relevance indexes also fell as the years passed. Cardiovascular surgery has a relatively low relevance index compared to key types of surgery of other fields, such as neurosurgery and colorectal surgery. CONCLUSION: This study identified medical service use imbalance between regions for cardiovascular surgery. Results of this study demonstrate the need for political intervention to enhance the accessibility of necessary special treatment, such as cardiovascular surgery.
Colorectal Surgery ; Daegu ; Gangwon-do ; Gwangju ; Insurance, Health ; Neurosurgery ; Seoul

OBJECTIVE: The objective of this study was to evaluate the degree of intelligible speech in workers wearing hearing protective devices and the differences in background noise type. METHODS: A total 82 shipyard company employees and normal hearing volunteers were recruited as subjects from a company in Ulsan: subjects were classified to the hearing-impaired group or to the control group according to hearing status. They were tested pure tone and speech audiometry in varying test environments including signal-to-noise ratio and background noise type in a headphone and in a free field environment. RESULTS: For both groups, the attenuation of hearing protective devices was greater at high frequencies. For the hearing-impaired group, speech discrimination scores differences between the unprotected and the protected ear were not significant between background noise type, when speech was presented at 65 dBA. However speech intelligibility in white noise background was lower than in the other background noise types when speech was presented at 75 dBA. CONCLUSIONS: Workers' speech intelligibility increased with an increasing signal-to-noise ratio. Speech intelligibility was also dependent on background noise type. Workers and their colleagues were trained to pronounce words more loudly and more clearly when they wearing hearing protective devices or other communication methods that do not use sound signal should be considered.
Audiometry, Speech ; Ear ; Ear Protective Devices ; Hearing ; Humans ; Noise ; Signal-To-Noise Ratio ; Speech Intelligibility ; Speech Perception

Nine patients, who had once low back operation due to herniated lumbar disc, underwent repeated low back surgery at the same level because of persistent or recurred symptoms. All patients were proved to have no psychological or compensative problems. Seven of them had satisfactory results but two, one who had no definite symptom free interval and had surgically proven epidural fibrosis only and another who underwent reoperation as early as 45 days after the first operation had persistent previous symptoms. After review of these cases we obtained several favorable factors which influence the post-operative results. When a patient had a definite symptoms free interval longer than 2 years or the main offending lesion was proved to be a disc herniation or spinal stenosis, satisfactory results could be anticipated.
Fibrosis ; Humans ; Reoperation* ; Spinal Stenosis

Background and Objectives: This study aimed to investigate the protective effect of polydeoxyribonucleotide (PDRN) against skin flap necrosis in a murine skin flap model.Materials and Method Twenty mice with rectangular skin flaps on the dorsum were randomly divided into the PDRN (n=10) and pentobarbital sodium (PBS) (n=10) injection groups. PDRN (8 mg/kg) was subdermally injected at 12 different points immediately after the operation. After 7 days, the flap perfusions were evaluated using a laser speckle contrast imaging (LSCI) system, and specimens were collected for immunohistochemistry analysis. Results: The percentage of survival area relative to the total flap area was significantly higher in the PDRN group (60.87%±7.63%) than in the PBS group (45.23%±10.72%) (p<0.05). The mean LSCI perfusion signal of the distal part of the skin flap in the PBS group was 0.57±0.12, and that in the PDRN group was 0.74±0.13 (p<0.05). The PDRN group had a significantly lower interleukin 1 beta expression than the PBS group and higher vascular endothelial growth factor α expression than the PBS group (p<0.05). Conclusion These findings suggest that subdermally injected PDRN is more effective in enhancing flap survival during necrosis.

BACKGROUND: The prediction of the postoperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to predict the outcome, but their usefulness has neither been evaluated nor been widely used. The purpose of this study was to assess the NT-proBNP as a prognostic factor for the prediction of the postoperative cardiac risk as compared with the existing cardiac indices in elderly patients undergoing orthopedic surgery. METHODS: From September 2003 to January 2004, we examined 50 patients older than 60 years, who were scheduled to undergo orthopedic surgery. The plasma NT-proBNP concentration, clinical cardiac indices and left ventricular ejection fraction were measured prior to the operation. The postoperative outcomes were followed and predictors for postoperative cardiac risk were identified. RESULTS: Cardiac complications occurred in 22% of the patients. A statistically significant increase in the cardiac complications was observed in the patients with higher plasma concentration of NT-proBNP (p<0.001), higher original cardiac index score (p<0.001), higher revised cardiac index score (p=0.004) and that fell into the major group of the American college of cardiology/American heart association guidelines (p=0.018). The NT-proBNP concentrations were positively correlated with the original cardiac index score (r=0.666, p<0.001), revised cardiac index score (r=0.429, p=0.002) and grouping by the ACC/AHA guidelines (r=0.497, p<0.001). The area under the receiver-operating characteristic curve for the plasma NT-proBNP (0.946, 95% CI) was superior to the other cardiac indices. The optimal cut-off point for the prediction of postoperative cardiac complications occurred at a plasma NT-proBNP, concentration of 539.3 pg/mL and provided a 90.9% sensitivity, 92.3% sensitivity, 79.9% positive predictive value and 97.3% negative predictive value. The independent predictors for postoperative adverse cardiac event were age and Goldman index. CONCLUSION: The plasma NT-proBNP level may be a useful parameter for the prediction of postoperative cardiac complications.
Aged* ; Heart ; Humans ; Orthopedics ; Plasma* ; Risk Assessment ; Stroke Volume

BACKGROUND: The aim of this study was to compare the antihypertensive effect of S-(-)-amlodipine nicotinate with ramipril in patients with essential hypertension. METHODS: Total 138 patients (54.5 +/- 10.5 years, 69 males) were enrolled in this study between 2008 and 2010. Amlodipine 2.5 mg or ramipril 2.5 mg was treated once in a day for 8 weeks. Epidemiologic analysis was performed in intend-to-treat (ITT) group. Efficacy analysis was performed in the differences of diastolic blood pressure in study groups. Abnormal reactions were divided with severities and drug-relationship. RESULTS: The change of diastolic blood pressures were more prominent with -12.7 +/- 7.02 mm Hg in amlodipine group, and -9.6 +/- 7.38 mm Hg in ramipril group (p = 0.023). The change of systolic blood pressures was higher in amlodipine group with -18.1 +/- 7.91 mm Hg, and -14.3 +/- 11.96 mm Hg in ramipril group (p = 0.047). Blood pressure normalization rates were 81.3% (48 of 59 patients) in amlodipine group, and 61.4% (35 of 57 patients) in ramipril group (p = 0.017). Abnormal reaction occurred in 5.8% (4 of 68 patients) of amlodipine group and 14.2% (10 of 70 patients) of ramipril group (p = 0.102). The most frequent abnormal reaction was respiratory symptom. CONCLUSIONS: S-Amlodipine-Nicotinate was more effective than ramipril in hypertensive patients without significant abnormal reaction.
Amlodipine ; Blood Pressure ; Humans ; Hypertension ; Niacin ; Ramipril

Stent thrombosis is a fatal complication in patients who have undergone percutaneous coronary intervention, and discontinuation of anti-platelet agent is a major risk factor of stent thrombosis. We report a rare case of very late stent thrombosis (VLST) following discontinuation of anti-platelet agents in a patient who experienced acute myocardial infarction and essential thrombocytosis. She had undergone implantation of a drug eluting stent (DES) and a bare metal stent (BMS) two and half years prior to her presentation. VLST developed in DES, not in BMS, following interruption of anti-platelet therapy.
Drug-Eluting Stents ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Risk Factors ; Stents ; Thrombocythemia, Essential ; Thrombocytosis ; Thrombosis