BACKGROUND/AIMS: Ulcerative colitis (UC) is a chronic inflammatory bowel disease with heterogeneous clinical features. Data on the disease course and prognosis of UC patients who have been regularly treated are lacking. We aimed to investigate relapse rates of UC in remission and factors related to relapse. METHODS: We retrospectively analyzed clinical courses of 84 patients (43 males, median age 43 years, ranged 20-73 years) diagnosed as UC at Ajou University Hospital between January 1997 and December 2005 based on clinical, endoscopic and pathologic findings, and who were regularly followed for at least one year after the remission. RESULTS: Study subjects consisted of 32 proctitis (38%), 21 left-sided colitis (25%), and 31 subtotal or total colitis (37%). Of 84 patients, relapse was observed in 52 patients (62%) during the follow-up period (ranged 1-9 years). The relapse rate was 24%, 41%, 51%, 65%, 71%, and 79% at 1 year, 2 years, 3 years, 4 years, 5 years and 6 years, respectively. Among sex, age, hemoglobin, ESR, and the extent of disease on admission, decrease of hemoglobin level was the only independent factor related to relapse (odds ratio=2.67, 95% CI (1.32-5.42), p<0.01). CONCLUSIONS: In Korea, relapse of UC in remission is not rare. Decrease of hemoglobin level is an independent risk factor related to its relapse, while the extent of disease is not.
Adult ; Aged ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antimetabolites/therapeutic use ; Azathioprine/therapeutic use ; Chronic Disease ; Colitis, Ulcerative/*diagnosis/*epidemiology/therapy ; Data Interpretation, Statistical ; Female ; Follow-Up Studies ; Hemoglobins/analysis ; Humans ; Male ; Mesalamine/therapeutic use ; Middle Aged ; Odds Ratio ; Recurrence ; Retrospective Studies ; Risk Factors ; Time Factors

BACKGROUND/AIMS: In patients with coronary artery stents, the cost of clopidogrel has been cited as a factor in the premature discontinuation of therapy. Thus, the introduction of lower-cost generic clopidogrel may increase patient compliance. However, platelet inhibition by generic clopidogrel has not been compared to the original clopidogrel formulation in patients with coronary artery stents. METHODS: We prospectively enrolled 20 patients receiving chronic therapy with the original clopidogrel bisulfate (Plavix(R)). After assessing patient compliance with Plavix(R), maintenance therapy was switched to generic clopidogrel bisulfate (Plavitor(R)). Platelet reactivity was assessed at baseline and 30-day after the switch using conventional aggregometry and the VerifyNow P2Y12 assay. RESULTS: All patients completed maintenance therapy with Plavitor(R). Before and after switching therapy maximal (36.5 +/- 7.9% vs. 39.8 +/- 16.2%, p = 0.280) and late platelet aggregation (23.5 +/- 10.9% vs. 29.1 +/- 18.3%, p = 0.156) with 5 micromol/L adenosine diphosphate (ADP) stimulus did not differ. Likewise, 20 micromol/L ADP-induced platelet aggregation and P2Y12 reaction unit in patients on Plavitor(R) therapy was comparable to that in patients on Plavix(R) therapy. However, Bland-Altman analysis showed wide limits of agreement between measured platelet reactivity on Plavix(R) vs. Plavitor(R) therapies. CONCLUSIONS: Among patients on Plavix(R) maintenance therapy with coronary stents, replacement with Plavitor(R) shows a comparable inhibition of ADP-induced platelet aggregation. However, due to poor inter-therapy agreement, between two regimens, physicians may be cautious when introducing generic clopidogrel bisulfate.
Aged ; Angioplasty, Transluminal, Percutaneous Coronary ; Combined Modality Therapy ; Coronary Artery Disease/*drug therapy/therapy ; *Drug-Eluting Stents ; Drugs, Generic/*administration & dosage/adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Patient Compliance ; Platelet Aggregation/drug effects ; Platelet Aggregation Inhibitors/*administration & dosage/adverse effects ; Prospective Studies ; Receptors, Purinergic P2/metabolism ; Ticlopidine/administration & dosage/adverse effects/*analogs & derivatives

BACKGROUND AND OBJECTIVES: The effect of palliative injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients on voice and swallowing function is uncertain and there are few previous studies of its suitability, benefits as a palliative treatment option. The purpose of this study is to confirm the objective results of voice and swallowing function after palliative office-based hyaluronic acid injection laryngoplasty in cancer-related unilateral vocal cord paralysis patients. MATERIALS AND METHOD: 36 patients who had unilateral vocal cord paralysis from non-thyroidal, extralaryngeal neoplasms were included in this study. To evaluate the clinical outcome, we analyzed perceptual GRBAS grading, acoustic analysis, aerodynamic study, Electroglottography (EGG), Voice Handicap Index (VHI-30) about voice function and disability rating scale (DRS), gastric tube dependency, aspiration pneumonia about swallowing function and 36-Item Short Form Survey version 2 (SF-36v2) about quality of life. RESULTS: In GRBAS scale, G (p < 0.001), R (p=0.004), B (p=0.001), A (p=0.011), and S (p=0.007) showed significant improvement. Jitter, shimmer, speaking fundamental frequency, maximal phonation time, VHI-30, DRS score, gastric tube dependency, aspiration pneumonia, and SF-36v2 were significantly improved after injection (p=0.016, p=0.011, p=0.045, p=0.005, p < 0.001, p < 0.001 p=0.003, p < 0.001, and p < 0.001 respectively). CONCLUSION: From this study we concluded office-based hyaluronic acid injection can be used as a useful palliative treatment option in cancer-related ill patients with unilateral vocal cord paralysis. Palliative hyaluronic acid injection laryngoplasty avoids the need for tube feeding, thus reducing the risk of aspiration pneumonia. These outcomes are accompanied by significant improvement in voice quality.
Acoustics ; Deglutition ; Enteral Nutrition ; Humans ; Hyaluronic Acid ; Laryngoplasty ; Methods ; Palliative Care ; Phonation ; Pneumonia, Aspiration ; Quality of Life ; Vocal Cord Paralysis ; Voice ; Voice Quality

The incidence of infrarenal aneurym is about 6 percent after the age 60 years. A primary aortocaval fistula is present in less than 1% of all abdominal aortic aneurysms. Atherosclerotic abdominal aortic aneurysm account for about 90% of spontanous aortocaval fistula. The most common site of fistulation is the inferior vena cava. Until recently, surgical repair was the only method of treatment and was associated high incidence of morbidity and motality. With rapid development of aortic stent-graft technique, endovascular stent-graft repair may offer an alterative to the management of this often fatal condition. We report a case of 72-years old male with aortocaval fistula in the abdominal aorta, which was treated with endovascular stent-graft implantation. About 30 days before procedure, the patient diagnosed inferior acute myocardial infarction with triple vessel disease and also suffered from chronic obstructive pulmonary disease. After the stent-graft inserting, no further communication from aorta to inferior vena cava and improving symptoms and sign of congestive heart failure. He was discharged without complication, about 2 months after admission.
Aged ; Aneurysm ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Endovascular Procedures ; Fistula* ; Heart Failure ; Humans ; Incidence ; Male ; Myocardial Infarction ; Pulmonary Disease, Chronic Obstructive ; Rupture* ; Vena Cava, Inferior

Objectives: This study evaluated the response in Daegu, Korea to the first wave of the coronavirus disease 2019 (COVID-19) pandemic according to a public health emergency response model. Methods: After an examination of the official data reported by the city of Daegu and the Korea Centers for Disease Control and Prevention, as well as a literature review and advisory meetings, we chose a response model. Daegu’s responses were organized into 4 phases and evaluated by applying the response model. Results: In phase 1, efforts were made to block further transmission of the virus through preemptive testing of a religious group. In phase 2, efforts were concentrated on responding to mass infections in high-risk facilities. Phase 3 involved a transition from a high-intensity social distancing campaign to a citizen participation–based quarantine system. The evaluation using the response model revealed insufficient systematic preparation for a medical surge. In addition, an incorporated health-related management system and protection measures for responders were absent. Nevertheless, the city encouraged the participation of private hospitals and developed a severity classification system. Citizens also played active roles in the pandemic response by practicing social distancing. Conclusions This study employed the response model to evaluate the early response in Daegu to the COVID-19 pandemic and revealed areas in need of improvement or maintenance. Based on the study results, creation of a systematic model is necessary to prepare for and respond to future public health emergencies like the COVID-19 pandemic.

The aim of this study was to describe the incidence of metabolic syndrome and to identify five components as metabolic syndrome predictors. The final study included 1,095 subjects enrolled in a rural part of Daegu Metropolitan City, Korea for a cohort study in 2003. Of these, 762 (69.6%) subjects had participated in the repeat survey. During the five-year follow-up, incidence density was significantly higher for women than for men (men, 30.0/1,000 person-years; women, 46.4/1,000 person-years). In both men and women, incidence of metabolic syndrome showed a significant increase with increasing number of metabolic syndrome components at baseline. Compared with individuals presenting none of components at baseline, relative risks were increased 1.22 (men; 95% CI, 0.43-3.51), 2.21 (women; 95% CI, 0.98-4.97) times more for individuals with one component of metabolic syndrome and 5.30 (men; 95% CI, 2.31-12.13), 5.53 (women; 95% CI, 2.78-11.01) times more for those who had two components. In multivariate analysis, the most powerful risk factor for metabolic syndrome was abdominal obesity in men and low HDL-cholesterol in women (adjusted relative risk, 3.28, 2.53, respectively). Consequently, finding a high risk group for metabolic syndrome according to gender and prevention of metabolic syndrome through lifestyle modification are essential.
Adult ; Aged ; Cholesterol, HDL/blood ; Cohort Studies ; Diabetes Mellitus, Type 2/complications ; Female ; Follow-Up Studies ; Humans ; Hypertension/complications ; Hypertriglyceridemia/complications ; Incidence ; Male ; Metabolic Syndrome X/complications/*epidemiology ; Middle Aged ; Multivariate Analysis ; Obesity, Abdominal/complications ; Republic of Korea/epidemiology ; Risk Factors

BACKGROUND AND OBJECTIVES: Smoking increases inhibition of clopidogrel-induced platelet reactivity in patients undergoing elective coronary stenting. However, an association between pre-admission smoking (PS) and post-clopidogrel platelet reactivity in patients with acute myocardial infarction (AMI) has not been determined. SUBJECTS AND METHODS: Study cohorts were recruited from a pool of patients at our hospital who were undergoing coronary stenting for AMI (n=134). Immediately after arrival at the emergency room (ER), all patients received a 600 mg loading dose of clopidogrel followed by a maintenance dose of 75 mg/day. Platelet aggregation was measured with light transmittance aggregometry (LTA) after addition of 5 or 20 micromol/L adenosine diphosphate (ADP). RESULTS: Maximal platelet aggregation (Agg(max)) was lower in PS patients after 5 micromol/L ADP (43.6+/-15.7% vs. 48.4+/-12.5%, p=0.096) and 20 micromol/L ADP stimuli (56.2+/-15.6% vs. 61.3+/-11.6%, p=0.073) compared with non-smoking (NS) patients. However, there were no differences in 5 micromol/L (42.6+/-16.3% vs. 43.8+/-15.6%, p=0.776) and 20 micromol/L ADP-induced Agg(max) (54.8+/-14.3% vs. 56.5+/-15.9%, p=0.692) between PS patients <0.5 pack/day and > or =0.5 pack/day. Although more PS patients met the criteria for low post-clopidogrel platelet reactivity (LPPR) (< or =37%; the lowest quartile of 5 micromol/L ADP-induced Agg(max)) than NS patients (30.9% vs. 13.5%, p=0.048), advancing age was the only independent predictor of LPPR {odds ratio (OR) 0.960, 95% confidence interval (CI) 0.929 to 0.993, p=0.019}. CONCLUSION: PS is significantly not associated with decreased residual platelet reactivity in AMI patients.
Adenosine Diphosphate ; Blood Platelets ; Cohort Studies ; Emergencies ; Humans ; Light ; Myocardial Infarction ; Platelet Aggregation ; Smoke ; Smoking ; Stents ; Ticlopidine

Papillary thyroid carcinomas comprise approximately 80 percent of all thyroid cancers, but haves a good prognosis, with overall survival rates at 10 years of about 80 to 95 percent. They spreads through the lymphatic system, and the lung is the most frequent metastasis site. If distant metastasis is present, the overall survival rate is about 40 percent. Although malignant pleural effusion, with pleural metastasis is a rare complication in patients with papillary thyroid carcinoma, the development of malignant pleural effusion is an extremely adverse prognostic indicator. We recently experienced a case of malignant pleural effusion with papillary thyroid carcinoma. A 54-year-old woman was admitted to the hospital because of dyspnea. A chest X-ray showed massive pleural effusion in the right hemithorax. Previously total thyroidectomy, and iodine-131 therapy had been performed, but a local recurrence and pulmonary metastasis developed 5 years later, accompanied by malignant pleural effusion with pleural metastasis. We performed diagnostic thoracentesis, which confirmed a metastatic papillary thyroid carcinoma. This patient was a rare case of paplillary thyroid carcinoma, in which the disease was represented by a rapid deterioration with malignant pleural effusion. So we report this case with a review of the literature.
Dyspnea ; Female ; Humans ; Lung ; Lymphatic System ; Middle Aged ; Neoplasm Metastasis* ; Pleural Effusion ; Pleural Effusion, Malignant* ; Prognosis ; Recurrence ; Survival Rate ; Thorax ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy