OBJECTIVE: Splenectomy has been proposed to be the standard therapy for patients with steroid refractory immune thrombocytopenic purpura (ITP). This study aimed to describe valuable factors predicting the effect of splenectomy in patients with ITP. METHODS: A total of 51 adult patients who underwent splenectomy for steroid refractory ITP were evaluated their medical records retrospectively. The response to the treatment was classified on the basis of the platelet count. RESULTS: The responding group included 35 patients (68.8%), the partial-responding group included 4 patients (7.8%), and non-responding group was 12 patients (23.5%). On univariate analysis, the response of splenectomy correlated with only the intravenous immune globulin (IVIG) response (66.7%, P=0.006), but hemolysis, autoantibody, a presence of accessory spleen, the response of steroid were not significantly associated with the effect of splenectomy. On multivariate analysis, the response of IVIG and the amount of platelet transfusion were independent variables of the response of splenectomy. CONCLUSION: Patients with ITP who have good responses to IVIG are likely to have a good or favorable responses to splenectomy.
Adult ; Hemolysis ; Humans ; Immunoglobulins, Intravenous ; Medical Records ; Multivariate Analysis ; Platelet Count ; Platelet Transfusion ; Purpura* ; Purpura, Thrombocytopenic, Idiopathic ; Retrospective Studies ; Spleen ; Splenectomy* ; Thrombocytopenia*

Abdominal aortic aneurysm has traditionally been treated by open repair. Aortic endovascular stent grafting has recently been introduced as a new modality. We report here on three cases of endovascular stent grafting that were performed by cardiovascular surgeons for the treatment of abdominal aortic aneurysm in the high risk patients with multiple comorbidities such as old age, hypertension, renal failure, cerebrovascular accident and immobility.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Comorbidity ; Humans ; Hypertension, Renal ; Stents ; Stroke ; Transplants

Background: The depth of anesthesia is an essential factor in surgical prognosis. The neurotoxic effect of chemotherapeutic drugs affects the sensitivity to anesthetics. This study was conducted to determine whether the effect-site concentration (Ce) of propofol for loss of consciousness (LOC) differs in patients undergoing preoperative chemotherapy. Methods: A total of 60 patients scheduled for surgery for colorectal cancer under general anesthesia were included in this study. Patients who had received chemotherapy comprised the experimental (C) group, and those without a previous history of chemotherapy comprised the control (N) group. Propofol was administered as an effect-site target-controlled infusion, and the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scores were evaluated. When the plasma concentration and Ce were similar, and if the MOAA/S score did not change, the target Ce was increased by 0.2 μg/ml; otherwise, the Ce was maintained for 2 min and then increased. Results: The Ce values of propofol for loss of verbal contact (LVC) in groups C and N were 2.40 ± 0.39 and 2.29 ± 0.39 μg/ml (P = 0.286), respectively, and those for LOC in groups C and N were 2.69 ± 0.43 and 2.50 ± 0.36 μg/ml (P = 0.069), respectively. No significant difference was observed in Ce values between the two groups. Conclusions Chemotherapy had no effect on the Ce of propofol for LVC and LOC in patients with colorectal cancer. We do not recommend reducing the dose of propofol for the induction of LOC in patients with colorectal cancer undergoing chemotherapy.

Objective: To assess the effect of left atrial appendage (LAA) isolation on LAA emptying and left atrial (LA) function using cardiac MRI in patients who underwent successful catheter ablation of atrial fibrillation (AF). Materials and Methods: This retrospective study included 84 patients (mean age, 59 ± 10 years; 67 males) who underwent cardiac MRI after successful catheter ablation of AF. According to the electrical activity of LAA after catheter ablation, patients showed either LAA isolation or LAA normal activity. The LAA emptying phase (LAA-EP, in the systolic phase [SP] or diastolic phase), LAA emptying flux (LAA-EF, mL/s), and LA ejection fraction (LAEF, %) were evaluated by cardiac MRI. Results: Of the 84 patients, 61 (73%) and 23 (27%) patients showed LAA normal activity and LAA isolation, respectively.Incidence of LAA emptying in SP was significantly higher in LAA isolation (91% vs. 0%, p < 0.001) than in LAA normal activation. LAA-EF was significantly lower in LAA isolation (40.1 ± 16.2 mL/s vs. 80.2 ± 25.1 mL/s, pp < 0.001) than in LAA normal activity. Furthermore, LAEF was significantly lower in LAA isolation (23.7% ± 11.2% vs. 31.1% ± 16.6%, p = 0.04) than in LAA normal activity. Multivariate analysis demonstrated that the LAA-EP was independent from LAEF (p = 0.01). Conclusion LAA emptying in SP may be a critical characteristic of LAA isolation, and it may adversely affect the LAEF after catheter ablation of AF.

Background: To propose fully automatic segmentation of left atrium using active learning with limited dataset in late gadolinium enhancement in cardiac magnetic resonance imaging (LGE-CMRI). Methods: An active learning framework was developed to segment the left atrium in cardiac LGE-CMRI. Patients (n = 98) with atrial fibrillation from the Korea University Anam Hospital were enrolled. First, 20 cases were delineated for ground truths by two experts and used for training a draft model. Second, the 20 cases from the first step and 50 new cases, corrected in a human-in-the-loop manner after predicting using the draft model, were used to train the next model; all 98 cases (70 cases from the second step and 28 new cases) were trained. An additional 20 LGE-CMRI were evaluated in each step. Results: The Dice coefficients for the three steps were 0.85 ± 0.06, 0.89 ± 0.02, and 0.90 ± 0.02, respectively. The biases (95% confidence interval) in the Bland-Altman plots of each step were 6.36% (−14.90–27.61), 6.21% (−9.62–22.03), and 2.68% (−8.57–13.93). Deep active learning-based annotation times were 218 ± 31 seconds, 36.70 ± 18 seconds, and 36.56 ± 15 seconds, respectively. Conclusion Deep active learning reduced annotation time and enabled efficient training on limited LGE-CMRI.

Objective: To assess the effect of left atrial appendage (LAA) isolation on LAA emptying and left atrial (LA) function using cardiac MRI in patients who underwent successful catheter ablation of atrial fibrillation (AF). Materials and Methods: This retrospective study included 84 patients (mean age, 59 ± 10 years; 67 males) who underwent cardiac MRI after successful catheter ablation of AF. According to the electrical activity of LAA after catheter ablation, patients showed either LAA isolation or LAA normal activity. The LAA emptying phase (LAA-EP, in the systolic phase [SP] or diastolic phase), LAA emptying flux (LAA-EF, mL/s), and LA ejection fraction (LAEF, %) were evaluated by cardiac MRI. Results: Of the 84 patients, 61 (73%) and 23 (27%) patients showed LAA normal activity and LAA isolation, respectively.Incidence of LAA emptying in SP was significantly higher in LAA isolation (91% vs. 0%, p < 0.001) than in LAA normal activation. LAA-EF was significantly lower in LAA isolation (40.1 ± 16.2 mL/s vs. 80.2 ± 25.1 mL/s, pp < 0.001) than in LAA normal activity. Furthermore, LAEF was significantly lower in LAA isolation (23.7% ± 11.2% vs. 31.1% ± 16.6%, p = 0.04) than in LAA normal activity. Multivariate analysis demonstrated that the LAA-EP was independent from LAEF (p = 0.01). Conclusion LAA emptying in SP may be a critical characteristic of LAA isolation, and it may adversely affect the LAEF after catheter ablation of AF.

Purpose: The aim of this study is to demonstrate the association between recurrent atrial fibrillation (AF) and left ventricular (LV) adverse remodeling after catheter ablation and to evaluate the change of myocardial extracellular volume fraction (ECV) by catheter ablation outcomes. Materials and Methods: We retrospectively recruited 60 patients (44 men and 16 women) with a median age of 57 years (range, 32–78 years) who underwent cardiac MRI before and at 6–12 months after catheter ablation of AF. Cardiac MRI quantified myocardial ECV (%) in the left ventricle. Depending on myocardial ECV after catheter ablation, patients were divided into two groups: 1) LV adverse remodeling with ECV ≥ 28%; and 2) no adverse LV remodeling with ECV < 28%. Multivariable analysis was performed to assess the association between recurrent AF and LV remodeling. Results: Of 60 patients, 21 (35%) were in the LV adverse remodeling group (mean ECV ± standard deviation [SD]: 29.8% ± 1.4%) and 39 (65%) were in the no adverse LV remodeling group (mean ECV ± SD: 24.7% ± 1.5%). The incidence of recurrent AF was significantly greater in the LV adverse remodeling group than in the no adverse LV remodeling group (81% vs. 13%, p < 0.001). In patients with recurrent AF, mean myocardial ECV significantly increased from 27.7% ± 2.3% to 29.2% ± 2.3% (p = 0.004) after catheter ablation. In a multivariable analysis after adjusting sex, age, and myocardial ECV before catheter ablation, recurrent AF was independently associated with LV adverse remodeling after catheter ablation (odds ratio: 28.9, 95% confidence interval: 6.8–121.7, p < 0.001). Conclusion When monitoring with cardiac MRI, sustained AF was significantly associated with LV adverse remodeling through an increase in myocardial ECV after catheter ablation of AF.