OBJECTIVES: This prospective cohort study investigated the association between blood pressure (BP) as measured in different body postures and all-cause and cardiovascular (CV) mortality risk. METHODS: This population-based investigation included 8,901 Korean adults in 2001 and 2002. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured sequentially in the sitting, supine, and standing positions and classified into 4 categories: (1) normal, SBP <120 mmHg and DBP <80 mmHg; (2) high normal/prehypertension, SBP 120-129 mmHg and DBP <80 mmHg/SBP 130-139 mmHg or DBP 80-89 mmHg; (3) grade 1 hypertension (HTN), with SBP 140-159 mmHg or DBP 90-99 mmHg; and (4) grade 2 HTN, SBP ≥160 mmHg or DBP ≥100 mmHg. The date and cause of individual deaths were confirmed in the death record data compiled until 2013. Data were analyzed using Cox proportional hazard regression. RESULTS: Significant associations were found between the BP categories and all-cause mortality, but only when BPs were measured in the supine position. The multivariate hazard ratios (95% confidence intervals, [CIs]) were 1.36 (95% CI, 1.06 to 1.75) and 1.59 (95% CI, 1.06 to 2.39) for grade 1 HTN and grade 2 HTN, respectively, compared with the normal category. The associations between the BP categories and CV mortality were significant regardless of body posture among participants ≥65 years, whereas they were significant for supine BP measurements only in those <65 years. CONCLUSIONS BP measured in the supine position predicted all-cause mortality and CV mortality better than BP measured in other postures.

PURPOSE: Intra-amniotic infection (IAI) is often polymicrobial, and the 16S rDNA PCR assay has a major limitation that its interpretation is difficult in the presence of multiple 16S rDNAs. Denaturing gradient gel electrophoresis (DGGE) can overcome this limitation by separating PCR products based on sequence. We performed the DGGE analysis to investigate bacterial prevalence and diversity in amniotic fluids from pregnant women with preterm births and gastric fluids from their newborns. METHODS: DNA was extracted from bacterial cells in amniotic fluid (AF) and gastric fluid (GF) and was amplified with universal 16S rDNA primers. For DGGE analysis, the PCR products were loaded onto polyacrylamide gels that were made with denaturing gradients. RESULTS: Bacterial 16S rDNA was detected by PCR from all AF and GF samples. The bacterial species in AF samples were the following: Lactobacillus reuteri (87.0%), uncultured Enterococcus species (65.2%), Ureaplasma urealyticum (13.0%), and Enterococcus faecalis (4.3%). The bacterial species in GF samples were the following: Lactobacillus reuteri (95.2%), uncultured Enterococcus species (42.9%), and Ureaplasma urealyticum (4.8%). Two or more species were identified from 69.6% of AF and 47.6% of GF samples. CONCLUSION: We suggest that DGGE analysis allows improved understanding of microbial diversity and community in AF and GF.
Acrylic Resins ; Amniotic Fluid ; Collodion ; Denaturing Gradient Gel Electrophoresis ; DNA ; DNA, Ribosomal ; Enterococcus ; Enterococcus faecalis ; Female ; Gels ; Humans ; Infant, Newborn ; Infant, Premature ; Lactobacillus reuteri ; Polymerase Chain Reaction ; Pregnant Women ; Premature Birth ; Prevalence ; Ureaplasma urealyticum

Xiphodynia is a term used to describe a painful xiphoid process, and this is a rare musculoskeletal disorder that can radiate to the anterior chest, epigastrium, neck, shoulders and back. Clinical awareness of xiphodynia is important for making its correct diagnosis. We report here on two cases of xiphodynia. The diagnosis was suggested by the reproduction of the anterior chest pain or/and the epigastrium pain with light pressure on the xiphoid process. The patient of case 1 had suffered from xiphodynia throughout the years, and this patient underwent surgical excision of the xiphoid process. The patient of case 2 received an injection of local anesthetic agent to the xiphoid process.
Chest Pain ; Humans ; Light ; Neck ; Reproduction ; Shoulder ; Thoracic Wall ; Thorax ; Xiphoid Bone

BACKGROUND/OBJECTIVES: It is well-known that alcohol consumption is associated with stroke risk as well as with aldehyde dehydrogenase 2 gene (ALDH2) polymorphisms. However, it is unclear whether ALDH2 polymorphisms are associated with stroke risk independent of alcohol consumption and whether such association is modified by sex. We evaluated sex-specific associations of a common ALDH2 polymorphism and alcohol consumption with stroke risk in a Korean population. SUBJECTS/METHODS: We conducted a prospective cohort study involving 8,465 men and women, aged 40-69 years and free of stroke between June, 2001 and January, 2003, and followed for the development of stroke. We identified new cases of stroke, which were self-reported or ascertained from vital registration data. Based on genome-wide association data, we selected a single-nucleotide polymorphism (rs2074356), which shows high linkage disequilibrium with the functional polymorphism of ALDH2. We conducted Cox proportional hazards regression analysis considering potential risk factors collected from a baseline questionnaire. RESULTS: Over the median follow-up of 8 years, 121 cases of stroke were identified. Carrying the wild-type allele of the ALDH2 polymorphism increased stroke risk among men. The multivariate hazard ratio [95% confidence interval] of stroke was 2.02 [1.03-3.99] for the wild-type allele compared with the mutant alleles, but the association was attenuated after controlling for alcohol consumption. Combinations of the wild-type allele and other risk factors of stroke, such as old age, diabetes mellitus, and habitual snoring, synergistically increased the risk among men. Among women, however, the ALDH2 polymorphism was not associated with stroke risk. CONCLUSIONS: The prospective cohort study showed a significant association between a common ALDH2 polymorphism and stroke risk in Korean men, but not in Korean women, and also demonstrated that men with genetic disadvantages gain more risk when having risk factors of stroke. Thus, these men may need to make more concerted efforts to control modifiable risk factors of stroke.
Alcohol Drinking* ; Aldehyde Dehydrogenase* ; Alleles ; Cohort Studies* ; Diabetes Mellitus ; Female ; Follow-Up Studies ; Humans ; Linkage Disequilibrium ; Male ; Prospective Studies* ; Surveys and Questionnaires ; Risk Factors ; Snoring ; Stroke*

A 51-year-old male was admitted three month previously with a cardiac stab injury and he underwent direct cardiac repair. He had no problem after this event. He complained of dyspnea that started 2 months after the original injury. Echocardiography showed severe tricuspid regurgitation and so, chordac replacement and ring annuloplasty was performed. Herein we report on a case of tricuspid valve repair for treating tricuspid insufficiency following a cardiac stab injury.
Dyspnea ; Echocardiography ; Humans ; Male ; Middle Aged ; Tricuspid Valve Insufficiency* ; Tricuspid Valve* ; Wounds, Stab

Ramsay Hunt syndrome associated with the Varicella zoster virus (VZV) infection is characterized by vesicles on the pinna, otalgia, facial nerve palsy and sensorineural hearing loss. Although significant complications from VZV infection are increasing, thrombosis associated with VZV infection is one of the rare complications in adults. The VZV itself could cause endothelial damage in the various organs. Subsequently, the thrombosis might be complicated. A previously healthy 84 year-old female patient was diagnosed with Ramsay Hunt syndrome. On the 7th day of antiviral treatment, she complained of sudden breathlessness. She was hypoxemic with an elevated alveolar-arterial oxygen difference and needed to be supported by mechanical ventilation. Massive pulmonary thrombosis was documented by computerized tomography and she successfully underwent thrombolytic therapy. We report a case of massive pulmonary thromboembolism associated with VZV infection, treated with thrombolytic therapy.
Adult ; Earache ; Facial Nerve ; Female ; Hearing Loss, Sensorineural ; Herpes Zoster ; Herpes Zoster Oticus ; Herpesvirus 3, Human ; Humans ; Oxygen ; Paralysis ; Parkinsonian Disorders ; Pulmonary Embolism ; Respiration, Artificial ; Thrombolytic Therapy ; Thrombosis

PURPOSE: This study was performed to recognize the importance of early diagnosis and early operation for midgut volvulus in newborn babies and infants. METHODS: A retrospective review of the medical records for 21 patients operated on for midgut volvulus at Asan Medical Center from April 1991 to May 2001 was done. The cases of malrotation without volvulus were excluded. RESULTS: There were 15 males and 6 females. Neonates comprised 76% of the total and all others were less than 7 months of age. The most common symptom was bilious vomiting of sudden onset. Fetal volvulus occurred in one. Simple X-rays showed nonspecific findings except in 4 cases with proximal bowel dilation and 1 case with free air. Ultrasonography was diagnostic in all 18 cases. Surgery was performed on the same day of admission in 11 cases and on the next day in 5. All showed clockwise volvulus from 180 to 900 degrees. Gastric perforation was accompanied in one case. One death was recorded in fetal volvulus. Two cases were complicated by adhesive obstruction. CONCLUSION: Midgut volvulus should be considered in healthy babies, especially in newborns, presenting with bilious vomiting. Ultrasonography is an effective, noninvasive diagnostic tool. Early diagnosis and operation of midgut volvulus are vitally important to decrease mortality and to prevent severe complication.
Adhesives ; Chungcheongnam-do ; Early Diagnosis ; Female ; Humans ; Infant ; Infant, Newborn ; Intestinal Obstruction ; Intestinal Volvulus* ; Male ; Medical Records ; Mortality ; Retrospective Studies ; Ultrasonography ; Vomiting

A case was presented of a 41-year-old male with progressive claudication and numbness in the lower extremities. A MRI showed swelling of the spinal cord with an intramedullary high signal intensity on a T2-weighted image. The patient was diagnosed with transverse myelitis and was started on intravenous steroids. However, there were no significant effects with the steroid treatment. An angiography showed a spinal dural arteriovenous fistula fed by a T11 radicular artery. An endovascular embolization was performed and the claudication and numbness were improved. We report a case of spinal dural arteriovenous fistula misdiagnosed as transverse myelitis.
Adult ; Angiography ; Arteries ; Central Nervous System Vascular Malformations* ; Humans ; Hypesthesia ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Myelitis, Transverse* ; Spinal Cord ; Steroids

Objective: This study investigates the triggers and clinical features of anaphylaxis, and determines the risk factors associated with severe anaphylaxis. Methods: This is a retrospective observational study spanning a duration of 2 years (2020-2021) using the electronic data of patients diagnosed with anaphylaxis in the university-affiliated emergency center. Severe anaphylaxis was defined as refractory anaphylaxis requiring ≥3 times epinephrine administration and/or continuous epinephrine infusion. Baseline and clinical characteristics were compared between the severe and the non-severe anaphylaxis groups. Binary logistic regression analysis was performed to reveal independent risk factors associated with severe anaphylaxis. Results: The median age of study patients was determined to be 53.0 years (range, 37.5-65.0 years). Fifty-eight patients (58.0%) were male. Drugs were found to be the most common trigger. In clinical manifestations, cutaneous manifestation was the most common. Severe anaphylaxis occurred in 19 patients (19.0%). Latent time was shorter in the severe anaphylaxis group-10.0 minutes (5.0-20.0) vs. 30.0 minutes (10.0-60.0), P<0.001. Drug as a trigger (68.4% vs. 39.5%, P=0.023), hypotension (57.9% vs. 9.9%, P<0.001), cardiovascular manifestation (84.2% vs. 40.7%, P=0.001), and hyperlactatemia (73.7% vs. 46.9%, P=0.036) were more frequently observed in the severe anaphylaxis group. Shorter latent time, drug as a trigger, and presence of hypotension were independent risk factors for severe anaphylaxis. Conclusion Anaphylaxis patients with shorter latent time, diagnosed with drugs as a trigger, and presenting with hypotension, must be subjected to careful monitoring and early active treatment.

PURPOSE: The aim of this study was to review our experience with neuroendocrine carcinoma (NEC) of the colon and rectum to highlight the clinical and pathological characteristics in this relatively uncommon malignancy. METHODS: From December 1995 to December 2006, 11 patients with NEC were identified from our database of 6,143 colorectal cancer patients (0.18%), which does not include carcinoid tumors. The pathology was retrospectively reviewed and the tumors were categorized as pure NEC, including well-differentiated NEC (n=3), poorly-differentiated (n=3) and mixed endocrine/exocrine tumor (n=5) on the basis of the histology and immunohistochemical findings. RESULTS: The mean age of the patients was 57 yr (range, 37 to 69 yr). The tumors were located as follows: 8 in the colon and 3 in the rectum. The diagnosis of NEC was suggested preoperatively from the tissue biopsy in 2 of 9 patients (22.2%). The tumors were advanced at the time of diagnosis, with American Joint Committee on Cancer Stage III (n=7) and Stage IV disease (n=4). Most tumors stained positive by immunohistochemistry for neuroendocrine markers, including synaptophysin (7/9, 77.8%); however, chromogranin was expressed in 4 of 9 NEC tumors (44.4%). Metastatic disease was detected at the time of diagnosis in 36.4% (4/11) of the patients. The median survival for NEC was 16 mo (3.6-67.4 mo), and for pure NEC and mixed endocrine/exocrine tumor was 4.1 mo and 23.6 mo, respectively. CONCLUSION: NEC had distinctive cytoarchitectural features and was often immunoreactive for neuroendocrine markers. Our findings showed that pure NEC had aggressive behavior and a poor prognosis.
Biopsy ; Carcinoid Tumor ; Carcinoma, Neuroendocrine ; Colon ; Colorectal Neoplasms ; Humans ; Immunohistochemistry ; Joints ; Prognosis ; Rectum ; Retrospective Studies ; Synaptophysin