Double aortic arch is the most common type of symptomatic vascular ring. In most patients, the symptoms are manifested at birth or in early infancy. Double aortic arch usually has more severe symptoms than other types of complete vascular rings. We experienced one case of complete duplicated double aortic arch with left descending aorta and left patent ductus arteriosus. A one-day-old female neonate was transferred to our hospital because of mild dyspnea and stridor. She showed intractable CO2 retention and respiratory difficulty with time in spite of ventilator therapy. She died of respiratory failure 23 hours after birth. On autopsy, we found that the diameter of the vascular ring was 0.7cm in maximum extent. It was ovoid and contained trachea and esophagus. The trachea was flattened due to allowing 0.1x0.2cm. The compression level of the trachea was approximately 1cm from the tracheal bifurcation.
Aorta, Thoracic* ; Autopsy* ; Ductus Arteriosus, Patent ; Dyspnea ; Esophagus ; Female ; Heart Defects, Congenital ; Humans ; Infant, Newborn ; Parturition ; Respiratory Insufficiency ; Respiratory Sounds ; Trachea ; Ventilators, Mechanical

Background and Objectives: Despite recent improvements in advanced life support, the overall survival rate after cardiac arrest remains low. We aimed to examine the association of a multidisciplinary team approach with clinical outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) in the emergency department (ED). Methods: This retrospective, single-center, observational study included 125 patients who underwent ECPR in the ED between May 2004–December 2018. In January 2014, our institution implemented a multidisciplinary extracorporeal membrane oxygenation (ECMO) team. Eligible patients were classified into pre-ECMO-team (n=65) and post-ECMO-team (n=60) groups. The primary outcome was in-hospital mortality. Results: In-hospital mortality (72.3% vs. 58.3%, p=0.102) and poor neurological outcomes (78.5% vs. 68.3%, p=0.283) did not differ significantly between the pre- and post-ECMOteam groups. However, among the 60 patients who experienced in-hospital cardiac arrest,in-hospital mortality (75.8% vs. 40.7%, p=0.006) and poor neurological outcomes (78.8% vs. 48.1%, p=0.015) significantly decreased after the multidisciplinary team formation.Multivariable logistic regression analysis showed that the multidisciplinary team approach (adjusted odds ratio, 0.20; 95% confidence interval, 0.07–0.61; p=0.005) was an independent prognostic factor for in-hospital mortality in in-hospital cardiac arrest patients. Conclusions A multidisciplinary team approach was associated with improved clinical outcomes in in-hospital cardiac arrest patients undergoing ECPR in the ED. These findings may help in improving the selection criteria for ECPR in the ED. Further studies to overcome the study limitations may help improving the outcomes of out-of-hospital cardiac arrest patients.

PURPOSE: To report on the current practices in breast magnetic resonance imaging (MRI) in Korea. MATERIALS AND METHODS: We invited the 68 members of the Korean Society of Breast Imaging who were working in hospitals with available breast MRI to participate in a survey on how they performed and interpreted breast MRI. We asked one member from each hospital to respond to the survey. A total of 22 surveys from 22 hospitals were analyzed. RESULTS: Out of 22 hospitals, 13 (59.1%) performed at least 300 breast MRI examinations per year, and 5 out of 22 (22.7%) performed > 1200 per year. Out of 31 machines, 14 (45.2%) machines were 1.5-T scanners and 17 (54.8%) were 3.0-T scanners. All hospitals did contrast-enhanced breast MRI. Full-time breast radiologists supervised the performance and interpreted breast MRI in 19 of 22 (86.4%) of hospitals. All hospitals used BI-RADS for MRI interpretation. For computer-aided detection (CAD), 13 (59.1%) hospitals sometimes or always use it and 9 (40.9%) hospitals did not use CAD. Two (9.1%) and twelve (54.5%) hospitals never and rarely interpreted breast MRI without correlating the mammography or ultrasound, respectively. The majority of respondents rarely (13/21, 61.9%) or never (5/21, 23.8%) interpreted breast MRI performed at an outside facility. Of the hospitals performing contrast-enhanced examinations, 15 of 22 (68.2%) did not perform MRI-guided interventional procedures. CONCLUSION: Breast MRI is extensively performed in Korea. The indication and practical patterns are diverse. The information from this survey would provide the basis for the development of Korean breast MRI practice guidelines.
Breast Neoplasms ; Breast* ; Diagnosis ; Korea ; Magnetic Resonance Imaging* ; Mammography ; Surveys and Questionnaires ; Ultrasonography

PURPOSE: To compare birth weight between infants with a single umbilical artery (SUA) and normal infants, investigate the associated anomalies of infants with SUA and isolated SUA (no abnormality of external appearance on birth, except SUA), and determine the prognosis of infants with isolated SUA. METHODS: Live-born infants with SUA (n=59) detected by physical examination from among 15,193 live births in seven university hospitals in Korea between January 1, 2004, to August 1, 2007, were reviewed retrospectively, with 236 normal infants serving as the control group. RESULTS: A statistical difference was observed between the groups in birth weight and in vitro fertilization. The incidence of infants with SUA was 0.37%. Congenital malformations were observed in 21 infants with cardiovascular (n=15, 25.4%), gastrointestinal (n=2, 3.4%), genitourinary (n=9, 15.3%), neuromusculoskeletal (n=6, 10.2%), central nervous system (n=1, 1.7%), chromosomal (n=1, 1.7%), and other (n=3, 5.1%) abnormalities. There were 49 (83.1%) infants with isolated SUA in this study population; among them, the associated congenital malformations were cardiovascular (n=6, 12.2%) and genitourinary (n=6, 12.2%) abnormalities. Two infants with cyanotic heart disease were operated and four infants with acyanotic heart disease showed improvements without any treatment. Six infants with genitourinary abnormalities on renal ultrasound had mild hydronephrosis without further consequences. CONCLUSION: The incidence of structural abnormalities in the cardiovascular and genitourinary systems is high and the genitourinary anomalies associated with isolated SUA have relatively good prognosis.
Birth Weight ; Central Nervous System ; Fertilization in Vitro ; Heart Diseases ; Hospitals, University ; Humans ; Hydronephrosis ; Incidence ; Infant ; Korea ; Live Birth ; Parturition ; Physical Examination ; Prognosis ; Retrospective Studies ; Single Umbilical Artery ; Umbilical Arteries ; Urogenital Abnormalities ; Urogenital System

Intramural esophageal dissection is a rare but clinically important condition in the field of gastroenterology. Classically, intramural esophageal dissection rarely occurs in patients who are anticoagulated or have poor medical condition, and its clinical presentation may include chest pain, dysphagia and hematemesis. Herein, we present a case of intramural esophageal dissection in an alcoholic hepatitis patient that was diagnosed by endoscopy and successfully treated with conservative management.
Deglutition Disorders/diagnosis ; Enteral Nutrition ; Esophageal Diseases/*diagnosis/surgery ; Esophagoscopy ; Hepatitis, Alcoholic/*pathology ; Humans ; Intubation, Gastrointestinal ; Male ; Middle Aged

The purpose of this study was to examine the urban-rural differences in the prevalence and associated factors with type 2 diabetes mellitus (T2DM) in Korean adults. A total of 1,060 adults >30 yr of age from urban (189 males and 331 females) and rural districts (219 males and 321 females) were recruited. Anthropometric measures, blood pressure, lipid profiles, and fasting and 2-hr after 75-g oral glucose load blood glucose were obtained. The crude- and age-standardized prevalence of T2DM was 15.4% and 14.5%, and 11.7% and 8.6% in urban and rural districts, respectively. Diabetic subjects were older and obese, and had a higher triglyceride level, and systolic blood pressure compared to non-diabetes in both population. Multivariate regression analysis revealed that older age, high triglyceride levels, central obesity, and hypertension were significantly associated with T2DM in both areas. Low monthly incomes were significantly associated with T2DM in urban population, while a family history of T2DM was significantly associated with T2DM in rural area. T2DM is more prevalent in urban than in rural population, and low economic status or genetic factor is differently associated with T2DM in both population, respectively.
Adult ; Age Factors ; Aged ; Diabetes Mellitus, Type 2/complications/*epidemiology ; Female ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Obesity/complications ; Prevalence ; Regression Analysis ; Republic of Korea/epidemiology ; Risk Factors ; Rural Population ; Socioeconomic Factors ; Triglycerides/blood ; Urban Population

Neurilemmomas are relatively uncommon, slowly growing tumors which originate from Schwann cells. Intrathoracic neurilemmomas often occur in the chest wall and posterior mediastinum, but endobronchial neurilemmomas are exceedingly rare. These tumors in trachea or bronchus are usually detected by radiologic examinations, mostly computed tomography scan of chest. An 88-year-old man was admitted for management of pneumonia in left lower lobe and parapneumonic effusion. On bronchoscopic examination, there was a small polypoid nodule less than 1 cm in diameter mimicking an endobronchial inflammatory polyp at the bifurcation of the right anterior segmental bronchus and lateral segmental bronchus and under auto-fluorescence imaging, the nodule showed reddish brown area with defined margin. The bronchoscopic biopsy revealed that the bronchial nodule was endobronchial neurilemmoma. This is an interesting case of endobronchial neurilemmoma mimicking a bronchial polyp that is detected incidentally via bronchoscopy.
Aged, 80 and over ; Biopsy ; Bronchi ; Bronchoscopy ; Humans ; Mediastinum ; Neurilemmoma* ; Optical Imaging ; Pneumonia ; Polyps* ; Schwann Cells ; Thoracic Wall ; Thorax ; Trachea

Background: The quick sequential organ failure assessment (qSOFA) score is suggested to use for screening patients with a high risk of clinical deterioration in the general wards, which could simply be regarded as a general early warning score. However, comparison of unselected admissions to highlight the benefits of introducing qSOFA in hospitals already using Modified Early Warning Score (MEWS) remains unclear. We sought to compare qSOFA with MEWS for predicting clinical deterioration in general ward patients regardless of suspected infection. Methods: The predictive performance of qSOFA and MEWS for in-hospital cardiac arrest (IHCA) or unexpected intensive care unit (ICU) transfer was compared with the areas under the receiver operating characteristic curve (AUC) analysis using the databases of vital signs collected from consecutive hospitalized adult patients over 12 months in five participating hospitals in Korea. Results: Of 173,057 hospitalized patients included for analysis, 668 (0.39%) experienced the composite outcome. The discrimination for the composite outcome for MEWS (AUC, 0.777;95% confidence interval [CI], 0.770–0.781) was higher than that for qSOFA (AUC, 0.684;95% CI, 0.676–0.686; P < 0.001). In addition, MEWS was better for prediction of IHCA (AUC, 0.792; 95% CI, 0.781–0.795 vs. AUC, 0.640; 95% CI, 0.625–0.645; P < 0.001) and unexpected ICU transfer (AUC, 0.767; 95% CI, 0.760–0.773 vs. AUC, 0.716; 95% CI, 0.707–0.718; P < 0.001) than qSOFA. Using the MEWS at a cutoff of ≥ 5 would correctly reclassify 3.7% of patients from qSOFA score ≥ 2. Most patients met MEWS ≥ 5 criteria 13 hours before the composite outcome compared with 11 hours for qSOFA score ≥ 2. Conclusion MEWS is more accurate that qSOFA score for predicting IHCA or unexpected ICU transfer in patients outside the ICU. Our study suggests that qSOFA should not replace MEWS for identifying patients in the general wards at risk of poor outcome.

Purpose: The diagnosis of pulmonary fungal infections is challenging due to the difficulty of obtaining sufficient specimens. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needle rinse fluid has become an emerging diagnostic material. This study evaluated the role of routine fungal culture from EBUS-TBNA needle rinse fluid, in addition to histopathologic examination and fungal culture of EBUS-TBNA core tissue, in the diagnosis of pulmonary fungal infections. Materials and Methods: Among patients who underwent EBUS-TBNA, those with results for at least one of three tests (histopathologic examination, fungal culture of EBUS-TBNA core tissue or needle rinse fluid) were included. Patients with a positive test were divided into two groups (clinical fungal infection and suspected fungal contamination) according to their clinical assessment and therapeutic response to antifungal. Results: Of 6072 patients, 41 (0.7%) had positive fungal tests and 9 (22%) were diagnosed as clinical fungal infection. Of the 5222 patients who were evaluated using a fungal culture from EBUS-TBNA needle rinse fluid, 35 (0.7%) had positive results. However, only 4 out of 35 (11.4%) were classified as clinical fungal infection. Positive results were determined in 4 of the 68 (5.9%) evaluated by a fungal culture of EBUS-TBNA core tissue, and all were diagnosed as clinical fungal infection. Conclusion Routine fungal culture of EBUS-TBNA needle rinse fluid is not useful due to the low incidence of fungal infection and high rate of contamination. However, fungal culture of EBUS-TBNA core tissue and needle rinse fluid should be considered in patients with clinically suspected fungal infection.

Background: This study aimed to evaluate whether the effect of tachycardia varies according to the degree of tissue perfusion in septic shock. Methods: Patients with septic shock admitted to the intensive care units were categorized into the tachycardia (heart rate > 100 beats/min) and non-tachycardia (≤ 100 beats/min) groups. The association of tachycardia with hospital mortality was evaluated in each subgroup with low and high lactate levels, which were identified through a subpopulation treatment effect pattern plot analysis. Results: In overall patients, hospital mortality did not differ between the two groups (44.6% vs. 41.8%, P = 0.441), however, tachycardia was associated with reduced hospital mortality rates in patients with a lactate level ≥ 5.3 mmol/L (48.7% vs. 60.3%, P = 0.030; adjusted odds ratio [OR], 0.59, 95% confidence interval [CI], 0.35–0.99, P = 0.045), not in patients with a lactate level < 5.3 mmol/L (36.5% vs. 29.7%, P = 0.156; adjusted OR, 1.39, 95% CI, 0.82–2.35, P = 0.227). Conclusion In septic shock patients, the effect of tachycardia on hospital mortality differed by serum lactate level. Tachycardia was associated with better survival in patients with significantly elevated lactate levels.