BACKGROUND: Increased left ventricular mass in patients with essential hypertension, coronary artery disease, chronic renal failure or in general population has been suggested as a useful predictor of increased cardiovascular morbidity and mortality. Many studies have reported that left ventricular mass is correlated postively with body size. Thereafter normalization of left ventricular studies, but it is uncertain which is appropriate. This study was designed to determine the appropriate method for normalization of left ventricular mass to exclude influence of body size in normal adults. METHODS: We measured left ventricular mass 100 normal adults by M-mode echocardiogram using ASE cube method without(Devereux and Reichek's method) and with correction(Devereux and Alonso's method). Left ventricular mass were normalized for body weight, height, body surface area, body surface area1.5, height2.0 and height2.7 RESULTS: 1) Left ventricular mass by Devereux and Reichek's method correlated well with that by Devereux and Alonso's method(r=1.0,p<0.001). 2) Corrected left ventricular mass correlated well with weight(r=0.64, p<0.001), height(r=0.49, p<0.05), body surface area(r=0.53, p<0.01) and body mass index(r=0.58, p<0.001). 3) Correlation coefficients of left ventricular mass/weight with weight, of ventricular mass/height with height, of ventricular mass/height2.0 with height, of ventricular mass/height2.7 with height, of ventricular mass/body surface area with body surface area and of ventricular mass/body surface area1.5 with body surface area were 0.12, -0.05, -0.29, -0.42, 0.13 and -0.11 respectively. 4) Peak systolic wall stress correlated with age and left ventricular mass, but end systolic wall stress did not correlated with left ventricular mass. CONCLUSIONS: The current indexation method of left ventricular mass for height may reduce the variability associated with body size. Furthermore, it could be used reliably in normal Korean adults.
Adult* ; Body Height ; Body Size* ; Body Surface Area ; Body Weight ; Coronary Artery Disease ; Echocardiography ; Humans ; Hypertension ; Kidney Failure, Chronic ; Mortality

PURPOSE: Voice change after thyroidectomy has generally been the result of damage to the recurrent or superior laryngeal nerve. But many patients complain voice alteration without laryngeal nerve injury after thyroidectomy. The purpose of this study is to investigate whether strap muscle division results in any subjective or objective functional sequelae in voice, through long-term follow-up prospectively. METHODS: Twenty-two female patients who had undergone thyroid surgery between July 1998 and December 1999, were studied. The patients who were planned for neck dissection, who had benign laryngeal disease or vocal cord paresis, and whose vocal cord paresis were developed after thyroid surgery, were excluded from this study. Twelve patients had undergone thyroidectomy via retraction of strap muscle and ten patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionnaires for changes of voice, acoustics (fundamental frequency, jitter, shimmer, signal to noise ratio, noise to harmonic ratio, voice range), and aerodynamic (maximal phonation time) analyses were done. RESULTS: The subjective voice symptoms after thyroidectomy were disturbances of high pitch, singing, loud voice, and easy fatigue at phonation. There were no significant differences in voice parameters on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group through long-term follow-up. CONCLUSION: We conclude that strap muscle division does not result in any subjective or objective functional problems in voice. We suggest that surgical division and reconstruction of these muscles should be employed routinely when operating on large, toxic or neoplastic glands.
Acoustics ; Fatigue ; Female ; Follow-Up Studies ; Humans ; Laryngeal Diseases ; Laryngeal Nerve Injuries ; Laryngeal Nerves ; Muscles ; Neck Dissection ; Noise ; Phonation ; Prospective Studies ; Signal-To-Noise Ratio ; Singing ; Thyroid Gland ; Thyroidectomy* ; Vocal Cord Paralysis ; Voice*

Failure in regression of fetal left common cardinal vein, commonly referred to as persistent left superior vena cava, is one of the most frequently encountered anomalies of the systemic venous return. We experienced a case of persistent left superior vena cava in a 60-year-old male who presented with exertional dyspnea and intermittent cough for 1 year. We found that the persistent left superior vena cava drained into right atrium via markedly dilated coronary sinus in transthoracic and contrast transesophageal echocardiography. The patient had also interruption of inferior vena cava, confirmed by venogram during right heart catheterization, so that the blood of inferior vena cava drained into left superior vena caba via hemiazygos vein. The patient improved with medical treatment and was discharged.
Cardiac Catheterization ; Cardiac Catheters ; Coronary Sinus ; Cough ; Dyspnea ; Echocardiography, Transesophageal ; Heart Atria ; Humans ; Male ; Middle Aged ; Veins ; Vena Cava, Inferior ; Vena Cava, Superior

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.
Anastomosis, Roux-en-Y* ; Cholangiopancreatography, Endoscopic Retrograde* ; Endoscopes ; Extremities ; Gastrectomy* ; Humans

Background: and PurposeWe aimed to determine the effect of demographic factors on cortical thickness and brain glucose metabolism in healthy aging subjects. Methods: The following tests were performed on 71 subjects with normal cognition: neurological examination, 3-tesla magnetic resonance imaging, 18F-fluorodeoxyglucose positron-emission tomography, and neuropsychological tests. Cortical thickness and brain metabolism were measured using vertex- and voxelwise analyses, respectively. General linear models (GLMs) were used to determine the effects of age, sex, and education on cortical thickness and brain glucose metabolism. The effects of mean lobar cortical thickness and mean lobar metabolism on neuropsychological test scores were evaluated using GLMs after controlling for age, sex, and education. The intracranial volume (ICV) was further included as a predictor or covariate for the cortical thickness analyses. Results: Age was negatively correlated with the mean cortical thickness in all lobes (frontal and parietal lobes, p=0.001; temporal and occipital lobes, p<0.001) and with the mean temporal metabolism (p=0.005). Education was not associated with cortical thickness or brain metabolism in any lobe. Male subjects had a lower mean parietal metabolism than did female subjects (p<0.001), while their mean cortical thicknesses were comparable. ICV was positively correlated with mean cortical thickness in the frontal (p=0.016), temporal (p=0.009), and occipital (p=0.007) lobes. The mean lobar cortical thickness was not associated with cognition scores, while the mean temporal metabolism was positively correlated with verbal memory test scores. Conclusions Age and sex affect cortical thickness and brain glucose metabolism in different ways. Demographic factors must therefore be considered in analyses of cortical thickness and brain metabolism.

BACKGROUND: It has been reported that about one-sixth of all cerebral infarcts are due to cerebral embolism of cardic origin. But transthoracic echocardiographic examination(TTE) of patients with embolic strokes has made low yield for identifying the cause of cardiac or extracardiac source of embolism. Recently, transesophageal echocardiography(TEE) has been proved to be more sensitive than TTE for that purpose. We have studied to detect the potential sources of embolism and to asess the diagnostic yield of TEE in the patient with ischemic strokes. METHOD: Thirty-nine patients with recent cerebral ischemic events(19 men, 20 women, mean age 61), and thirty-eight control patients with other cardiac disease(14 men, 24 women, mean age 52) were examined by both TTE and biplane TEE. For detection of patent foramen ovale, transesophageal contrast echocardiography using 10 ml of agitated saline was performed in all patients. Thoracic aorta, arch of aorta, and ascending aorta were examined during pull back of esophageal probe. RESULTS: 1) TEE is superior to TTE for detection of potential sources pf embolism in the ischemic stroke patients(82 vs 21%, p < 0.001). 2) The potential sources of embolism diagnosed by TEE in the ischemic stroke patients were as follows : 18 aortic atherosclerotic plaque or clot, 11 left atrial(LA) spontaneous echo contrast, 8 LA appendage thrombus, 6 LA thrombus, 6 atrial septal aneurysm, 6 mitral stenosis, 3 patent foramen ovale and 1 prosthetic valve. 3) TEE is the unique procedure to diagnose aortic lesions, LA spontaneous echo contrast, atrial septal aneurysm and patent foramen ovale. 4) The incidence of the aortic lesions by TEE is significantly higher in the patients with ischemic stroke than in the controls(46 vs 11%, p < 0.01). CONCLUSION: Transesophageal echocardiography is useful for detection of potential cardiac and extracardiac sources of embolism compared with TTE and is a unique method for diagnosing aortic atherosclerotic lesion, left atrial spontaneous echo contrast, atrial septal aneutysm, patent foramen ovale and small left atrial appendage thrombus.
Aneurysm ; Aorta ; Aorta, Thoracic ; Atrial Appendage ; Dihydroergotamine ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Female ; Foramen Ovale, Patent ; Humans ; Incidence ; Intracranial Embolism ; Male ; Methods ; Mitral Valve Stenosis ; Plaque, Atherosclerotic ; Stroke ; Thrombosis

BACKGROUND AND PURPOSE: Evaluating instrumental activities of daily living (IADL) is an important part of procedure to diagnose dementia. The Korean-Instrumental Activities of Daily Living (K-IADL) has been used extensively in Korea. However, its cut-off score has not been reformulated since 2002. The purpose of this study was to yield a new optimal cut-off score for the K-IADL and confirm the validity of this new cut-off score with various dementia groups. METHODS: We retrospectively collected a total of 2,347 patients' K-IADL data from 6 general hospitals in Korea. These patients had mild cognitive impairment (MCI) or dementia with various etiologies for cognitive impairment. We also recruited a normal control group (n=254) from the community. Korean-Mini Mental State Examination, Short version of the Geriatric Depression Scale, Clinical Dementia Rating, and Global Deterioration Scale were administered to all participants. Caregivers completed K-IADL and Barthel Index. RESULTS: K-IADL scores were significantly different among dementia subgroups, but not significantly different among MCI subgroups. Based on internal consistency, correlations with other scales, and factor analysis, K-IADL showed excellent reliability and validity. The new optimal cut-off score to diagnose dementia was 0.40, which gave a sensitivity of 0.901 and a specificity of 0.916. Positive predictive value for dementia using the new cut-off score was 94.2% for Alzheimer's disease, 100% for vascular dementia, and 84% for Parkinson's disease. CONCLUSIONS: Our results illustrate that the new K-IADL cut-off score of 0.40 is reliable and valid for screening impairments of daily functioning resulting from various etiologies.
Activities of Daily Living* ; Alzheimer Disease ; Caregivers ; Cognition Disorders ; Dementia ; Dementia, Vascular ; Depression ; Hospitals, General ; Humans ; Korea ; Mass Screening ; Mild Cognitive Impairment ; Parkinson Disease ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Weights and Measures

The aim of the study is to investigate the association between cerebral white matter hyperintensity (WMH) and the functional improvement using the Korean version of Modified Barthel Index (K-MBI) score during inpatient stroke rehabilitation. One hundred sixty participants were divided into 2 groups based on the severity of WMH according to Fazekas scale: Mild WMH group was defined as patients with Fazekas scale 0 and 1, and severe WMH group was defined as Fazekas scale 2 and 3. Functional status was assessed using the K-MBI score, and functional gains were calculated from the K-MBI score. The absolute functional gain in mild WMH group was significantly higher compared to severe WMH group (p < 0.05). In addition, patients in mild WMH had higher absolute functional efficiency, rehabilitation effectiveness, and relative functional efficiency. In the generalized linear model analyses, there was an association between functional outcomes and severity of WMH. In this study, the severity and extent of WMH are significantly correlated with poor functional improvement in patients with ischemic stroke. The WMH could be considered as one of many factors that can influence functional recovery during rehabilitation of stroke.
Humans ; Inpatients ; Linear Models ; Recovery of Function ; Rehabilitation ; Stroke ; White Matter

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration and/or biopsy (EUS-FNA/B) have been used to diagnose subepithelial tumors (SETs) and extraluminal lesions in the gastrointestinal tract. Our group previously reported the usefulness of EUS-FNA/B for rectal and perirectal lesions. This study reports our expanded experience with EUS-FNA/B for rectal and perirectal lesions in terms of diagnostic accuracy and safety. We also included our new experience with EUS-FNB using the recently introduced ProCore needle. METHODS: From April 2009 to March 2014, EUS-FNA/B for rectal and perirectal lesions was performed in 30 consecutive patients. We evaluated EUS-FNA/B performance by comparing histological diagnoses with final results. We also investigated factors affecting diagnostic accuracy. RESULTS: Among 10 patients with SETs, EUS-FNA/B specimen results revealed a gastrointestinal stromal tumor in 4 patients and malignant lymphoma in 1 patient. The diagnostic accuracy of EUS-FNA/B was 50% for SETs (5/10). Among 20 patients with non-SET lesions, 8 patients were diagnosed with malignant disease and 7 were diagnosed with benign disease based on both EUS-FNA/B and the final results. The diagnostic accuracy of EUS-FNA/B for non-SET lesions was 75% (15/20). The size of lesions was the only factor related to diagnostic accuracy (P=0.027). Two complications of mild fever and asymptomatic pneumoperitoneum occurred after EUS-FNA/B. CONCLUSIONS: The overall diagnostic accuracy of EUS-FNA/B for rectal and perirectal lesions was 67% (20/30). EUS-FNA/B is a clinically useful method for cytological and histological diagnoses of rectal and perirectal lesions.
Biopsy* ; Biopsy, Fine-Needle ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Fever ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Lymphoma ; Needles ; Pneumoperitoneum ; Rectum

BACKGROUND/AIMS: Endoscopic ultrasound-guided fine needle aspiration and/or biopsy (EUS-FNA/B) have been used to diagnose subepithelial tumors (SETs) and extraluminal lesions in the gastrointestinal tract. Our group previously reported the usefulness of EUS-FNA/B for rectal and perirectal lesions. This study reports our expanded experience with EUS-FNA/B for rectal and perirectal lesions in terms of diagnostic accuracy and safety. We also included our new experience with EUS-FNB using the recently introduced ProCore needle. METHODS: From April 2009 to March 2014, EUS-FNA/B for rectal and perirectal lesions was performed in 30 consecutive patients. We evaluated EUS-FNA/B performance by comparing histological diagnoses with final results. We also investigated factors affecting diagnostic accuracy. RESULTS: Among 10 patients with SETs, EUS-FNA/B specimen results revealed a gastrointestinal stromal tumor in 4 patients and malignant lymphoma in 1 patient. The diagnostic accuracy of EUS-FNA/B was 50% for SETs (5/10). Among 20 patients with non-SET lesions, 8 patients were diagnosed with malignant disease and 7 were diagnosed with benign disease based on both EUS-FNA/B and the final results. The diagnostic accuracy of EUS-FNA/B for non-SET lesions was 75% (15/20). The size of lesions was the only factor related to diagnostic accuracy (P=0.027). Two complications of mild fever and asymptomatic pneumoperitoneum occurred after EUS-FNA/B. CONCLUSIONS: The overall diagnostic accuracy of EUS-FNA/B for rectal and perirectal lesions was 67% (20/30). EUS-FNA/B is a clinically useful method for cytological and histological diagnoses of rectal and perirectal lesions.
Biopsy* ; Biopsy, Fine-Needle ; Diagnosis ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Fever ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Lymphoma ; Needles ; Pneumoperitoneum ; Rectum