Interruption of the aortic arch is an uncommon congenital cardiovascular malformation invariably accompanied by other cardiovascular anomalies. This carries a 76% mortality rate in the first month of life. We recently experienced a case of interruption of the aortic arch with patent ductus arteriosus in a 21-year-old man with systolic murmur. he did not showed any other symptoms or signs. Cardiac catheterization with angiography showed interruption of the aortic arch with many systemic arterial collaterals and patent ductus arteriosus.
Angiography ; Aorta* ; Aorta, Thoracic ; Cardiac Catheterization ; Cardiac Catheters ; Ductus Arteriosus, Patent* ; Humans ; Mortality ; Systolic Murmurs ; Young Adult

STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to evaluate the efficacy of epidural steroid injection (ESI) for treating lumbar spinal stenosis (LSS) SUMMARY OF LITERATURE REVIEW: Treatment for lumbar spinal stenosis has generally consisted of some form of conservative treatment or surgery. Surgery may be contraindicated in many stenotic patients because of their significant comorbidities. Therefore, conservative management is necessary for those who cannot or do not want to undergo surgery. MATERIALS AND METHODS: From January 2002 to June 2003, we retrospectively analyzed 128 patients, 55 years or older, who received ESI (s). The average age of the men and women was 47 and 81, respectively. Their mean age was 76 (age range: 55~84). The injection materials were 2 ml methylprodnisolone acetate (40 mg/cc) in combination with 3 cc normal saline and 3 cc lidocaine. The follow up period was 12 months to 30 months. We measured the outcomes by the duration and amount of pain relief, the change in functional status and the rate of performing surgery; patient satisfaction was assessed by a 5-item questionnaire. RESULT: Of the 128 participants, 31% reported more than 2 months of pain relief, 41% reported less than 2 months of pain relief and 27% reported no relief from the injection (s). Sixteen percent subsequently had surgery. Sixty-nine percent reported improvement in their functional abilities. Seventy-two percent were at least somewhat satisfied with ESI as a form of treatment. CONCLUSION: ESI is a reasonable treatment for LSS as it provided one third of our patient population with sustained relief and more than half with sustained improvement in function.
Comorbidity ; Female ; Follow-Up Studies ; Humans ; Lidocaine ; Male ; Patient Satisfaction ; Surveys and Questionnaires ; Retrospective Studies ; Spinal Stenosis* ; Spine

The visualization of coronary arteries by transthoracic two-dimensional echocardiography has been used for over 10 years. In many cases, the imaging quality is too poor to allow an anatomic evaluation. During the last few years, transesophageal echocardiography has been shown to provide optimal imaging quality in virtually all patients and of all cardiac structures including the coronary arteries. The purpose of this study was to test the ability of transesophageal echocardiography in the visualiation of the coronary arteries and assessment of coronary blood flow by transesophageal two-dimensional pulsed Doppler echocardiography. We Studied 285 patients, 91 men and 194 women, aged 16 to 81 year(mean 50.6 year men, mean 54.2 year women). We have been used a 5-MHz phased array transducer with incorporated color-coded Doppler. The left main coronary artery was visualized 95.1%, left circumflex artery 27.4, left anterior descending artery 21.4% and the main stem of the proximal right coronary artery 45.1%. The time-sequential left anterior descending artery flow pattern generally consisted of a small late systolic component and a large diastolic component. The peak flow velocity in the proximal left anterior descending artery during diastole was 40.8+/-8.0cm/sec(integrity 7.6+/-0.9) and during late systole was 18.5+/-5.5cm/sec(integrity 2.9+/-0.9). There were no complications during and after examination. This study suggests that transesophageal color-coded Doppler two-dimensional echocardiography appers to be a feasible noninvasive technique for imaging the proximal left coronary artery and the left anterior descending artery flow is detectable from the transesophageal approach.
Arteries ; Coronary Vessels* ; Diastole ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Echocardiography, Transesophageal ; Female ; Humans ; Male ; Systole ; Transducers

Transesophageal echocardiography(TEE) is a new acoustic window to the cardiac structures and great vessels via retrocardiac esophagus. Because of the close relation between the esophagus and the heart, higher transducer frequencies can be applied, therefore leading to improved resolution and more accurate images than transthoracic echocardiography. We describe our experience with the first 353 awake patients. The procedure was well tolerated by the patients and associated with no major complications, within examination 10 to 20 minutes. Clinical diseases which appear to be suited for TEE includes 1) evaluation of native valve diseases, particulary mitral valve, pathologic valvular abnormalities and color Doppler regurgitant flows ; 2) assesment of prosthetic heart valves to better define malfunction and important pathologic associations ; 3) congenital heart disease, particularly atrial septal defect ; 4) endocarditis and detection of vegetations and complications ; 5) detection of thrombus and tumors, size, location, morphology, stalk ; and 6) aortic pathology including atherosclerosis, aneurysm and dissection. We conclude that transesophageal echocardiography is a new imaging technique that is rapidly evolving into a major tool for general cardiac imaging in a variety pathologic conditions and is a safe and useful tool in patients. Future advances in probe technology will continue to expand its applications.
Acoustics ; Aneurysm ; Atherosclerosis ; Echocardiography ; Echocardiography, Transesophageal* ; Endocarditis ; Equidae ; Esophagus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Valves ; Humans ; Mitral Valve ; Pathology ; Thrombosis ; Transducers

Purpose: This randomized controlled study aimed to evaluate the effects of an electric toothbrush with 3 colors of light-emitting diodes (LEDs) on antiplaque and bleeding control. Methods: This randomized, placebo-controlled, double-blinded, parallel-group clinical trial included 50 healthy adults with gingivitis, who were randomly assigned to 2 groups. The experimental group used electric toothbrushes with 3 colors of LEDs and the control group used the same electric toothbrush as the experimental group, but with LED sources with one-hundredth of the strength. The subjects used the electric toothbrush 3 times a day for 4 minutes each time. As clinical indices, bleeding on marginal probing (BOMP), the LöeSilness gingival index (GI), and the Turesky-Quigley-Hein plaque index (QHI) were assessed at baseline, at 3 weeks, and at 6 weeks. Results: There were significant decreases in all clinical indices (BOMP, GI, QHI) in both the experimental and control groups compared to baseline at 3 weeks and at 6 weeks. In a comparison between the experimental and control groups, no statistically significant differences were observed for any clinical indices at 3 weeks (P>0.05). However, at 6 weeks, statistically significant differences were observed between the experimental and control groups in BOMP and GI, which are indicators of gingival inflammation (P<0.05). Conclusions This study demonstrated that an electric toothbrush combined with 3-color LEDs reduced gingival bleeding and inflammation after 6 weeks.

Anticoagulants ; Dalteparin ; Hemorrhage ; Heparin ; Humans ; Mortality ; Multivariate Analysis ; Proportional Hazards Models ; Recurrence ; Rivaroxaban ; Urinary Tract ; Venous Thromboembolism

Purpose: Studies in western countries have shown a decline in the incidence of ruptured abdominal aortic aneurysm (rAAA) with advancements in endovascular repair and screening. However, according to health insurance data in Korea based on rAAA code (I71.3), overall rAAA has been increasing. This study aimed to validate the I71.3 code for rAAA and attempt to define the true incidence of rAAA in Korea. Methods: A 20-year multicenter retrospective review of rAAA was undertaken from the period of January 1, 2000 to December 31, 2020. All patients were diagnosed with the rAAA code I71.3 in each of the 4 hospitals. The CT images and surgical records of these patients were reviewed to differentiate true rAAA and misdiagnosis. Further data on true rAAA patient outcomes including mortality and treatment success were also collected. Results: A total of 305 rAAA (I71.3) codes were identified in the 4 centers. However, medical record review showed true rAAA in only 131 (43.0%). The remaining 174 cases (57.0%) were misdiagnosed. Impending ruptures were the most common misdiagnoses (37.9%). The total in-hospital mortality including deaths before treatment was 38.9% (n = 51), while mortality of treated patients was 24.4% (n = 15). Conclusion The analysis of I71.3 code for rAAA showed that only 43.0% were true rAAA and the remaining 57.0% were misdiagnosed. This indicates that the I71.3 code is overestimated in National Health Insurance-based data and that the true incidence of rAAA could be much lower.

Background/Aims: Few studies have attempted to interpret unusually high predicted pulmonary function test results. This study aimed to investigate the demographic features of patients with an unusually high predicted pulmonary function. Methods: The demographic data of subjects who underwent pulmonary function testing at a tertiary referral hospital during between January 2011 and December 2011 were retrospectively reviewed. Results: Of the 68,693 included patients, 55 (0.08%) had a percent predicted forced expiratory volume in 1 second or forced vital capacity ≥ 140%. These patients had a relatively older median age (72 years vs. 54 years, p < 0.001), female predominance (65.5% vs. 42.5%, p = 0.001), lower body weight (52.5 kg vs. 64.5 kg, p < 0.001) and shorter height (148.4 cm vs. 164.2 cm, p < 0.001). Furthermore, 6.1% of women older than 80 years with weight < 50 kg and height < 150 cm had a high predicted pulmonary function. Conclusions A high predicted pulmonary function is not rare among elderly subjects with a small body size. Physicians should consider the demographics of the examinees, especially those of minority populations, particularly as the test results might be determined using an incorrect reference equation.

Objectives: Two randomized, controlled studies comparing outcomes in patients treated with direct oral anticoagulants or low-molecular weight heparin for cancer-associated venous thromboembolism (VTE) have previously been performed. However, gynecologic cancers accounted for approximately 10% of the study populations. We compared the outcomes of patients with primary gynecological cancers who were treated for cancer-associated VTE with either rivaroxaban or dalteparin. Methods: The 162 eligible patients with gynecologic cancers who were treated with either dalteparin (n=60) or rivaroxaban (n=102) were reviewed. The primary outcome was a composite event, which included recurrence or clinically relevant bleeding events during the therapeutic period. Secondary outcomes were recurrence, clinically relevant bleeding events, and mortality. Results: During the therapeutic period, there were no significant differences between the groups in the proportion of composite events, recurrence, or clinically relevant bleeding. Multivariate analysis using the Cox proportional hazards model also showed no significant difference in the number of composite events and clinically relevant bleeding between the groups. In the rivaroxaban group, 44.0% of patients experienced gastrointestinal bleeding and 24.0% experienced urinary tract bleeding. In the dalteparin group, bleeding was most common in the urinary tract (44.4%) and at the injection site (22.2%). Conclusion In this study, although there were no significant differences in effectiveness or safety between the rivaroxaban and dalteparin groups, rivaroxaban use was associated with a higher rate of clinically relevant bleeding than dalteparin. Therefore, caution should be taken when prescribing rivaroxaban for gynecologic cancer-associated VTE and bleeding events should be carefully monitored.

OBJECTIVE: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. METHODS: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. RESULTS: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4–9 vs. 6; IQR, 4–8; P < 0.001). Mechanical ventilator (29% vs. 21%, P < 0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78–1.28; P=0.999) for the transferred group compared with the non-transferred group. CONCLUSION: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
Emergencies* ; Emergency Service, Hospital* ; Hospital Mortality ; Humans ; Logistic Models ; Mortality ; Observational Study* ; Odds Ratio ; Prognosis ; Prospective Studies ; Renal Replacement Therapy ; Retrospective Studies* ; Sepsis ; Shock ; Shock, Septic* ; Tertiary Care Centers* ; Ventilators, Mechanical