42 patients with the clinical evidences of endocarditis were examined by echocardiography. In 28 of 42 cases(66.7%) vegetation was present, whereas in 14(33.3%) vegetation was not visualized. Alpha-hemolytic streptococcus was the most common infecting organism(47.6%) and rheumatic heart disease was the most common predisposing heart disease(47.6%). Patients with echocardiographically demonstrable vegetation had a higher incidence of congestive heart failure compared to the patients without vegetation(75.0% vs. 21.4% p<0.05). But major embolism was not significantly different in the two groups. Mortality was higher in the patients with vegetation than in the patients without it(39.3% vs. 0%, p<0.05). Among vegetation positive patients, mortality was highest in aortic valve patients.(58.3%) So patietns with aortic valve vegetation should be regarded as high risk group and early surgical intervention should be considered if indicated. The causes of mortality were congestive heart failure(45.5%), cerebral embolism(36.4%), myocardial infarction(9.1%) and ventricular tachycardia(9.1%) in decreasing frequency.
Aortic Valve ; Echocardiography* ; Embolism ; Endocarditis ; Endocarditis, Bacterial* ; Estrogens, Conjugated (USP) ; Heart ; Heart Failure ; Humans ; Incidence ; Mortality ; Rheumatic Heart Disease ; Streptococcus

In the management of postoperative fluid collection, the conventional percutaneous drainage method can be employed. Because of abdominal incisions and various types of surgical drains and/or T-tubes, the application of this method is not always easy, however. We inserted a drainage catheter through a pre-existing percutaneous track formed by a surgical drain located adjacent to the site of abnormal fluid collection. There was no need to remove the drain nor make an additional puncture in the abdominal wall. A dilator was inserted along the drain, and a guide wire was used to negotiate its intraperitoneal track and readch the accumulated fluid. The procedure was simple and safe. We briefly deseribe our experience of this modified percutaneous drainage technique, as used in three cases involving postoperative fluid collection.
Abdominal Wall ; Catheters ; Drainage* ; Punctures

Intramedullary nailing has been reported to have better outcome compared with traditional plate fixation in surgical treatment of intertrochanteric fractures. We evaluated the trends of surgical treatment of intertrochanteric fracture in Korea. Data of patients with intertrochanteric fractures, who were operated between the years of 2006 and 2011, was obtained from the Health Insurance Review and Assessment Service. The ratio of intramedullary nailing increased from 27.9% in 2006 to 64.3% in 2011 (P < 0.001), while the ratio of plate fixation decreased. During recent 5 yr, the utilization of intramedullary nailing doubled in clinical practice of intertrochanteric fractures in Korea.
Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Cohort Studies ; Databases, Factual ; Female ; Fracture Fixation, Intramedullary/*trends ; Hip Fractures/*surgery ; Humans ; Male ; Middle Aged ; Republic of Korea

BACKGROUND: Hemiarthroplasty is a common operation to treat femoral neck fracture in elderly patients. The choice of whether to use cemented stem or cementless stem in hemiarthroplasty has been controversial in clinical practice. However, recent trends regarding stem choice in South Korea are not known or documented. In this study, we assessed the trends of stem fixation in hemiarthroplasty for femoral neck fractures in South Korea. METHODS: Data of patients with femoral neck fractures, who were operated on between the years of 2007 and 2011 and were > or = 50 years old at the time of operation, were obtained from the Health Insurance Review and Assessment Service. All new visits or admissions to clinics or hospitals for femoral neck fractures were identified using the International Classification of Disease Tenth Revision diagnostic code (S720). The trends in the utilization of cemented and cementless hemiarthroplasty were then analyzed. RESULTS: The proportion of cementless hemiarthroplasty increased from 42.7% of all surgical procedures in 2007 to 61.4% of all surgical procedures in 2011 (p < 0.001), while the use of cemented hemiarthroplasty demonstrated a corresponding decrease. CONCLUSIONS: There was a current trends towards using cementless stems in hemiarthroplasty for femoral neck fractures in South Korea.
Aged ; Aged, 80 and over ; Bone Cements ; Cementation/*trends ; Female ; Femoral Neck Fractures/*surgery ; *Hemiarthroplasty/methods/trends ; Hip Prosthesis/*trends/utilization ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology

PURPOSE: Chondroid syringoma is a rare tumor of the skin which arises from apocrine and eccrine glands. We report a case of chondroid syringoma arising from upper eyelid. METHODS: A 73-year-old man with a slowly growing mass on the center of right upper eyelid. Ocular examination revealed a smooth, firm, well-circumscribed and pink colored nodule measuring 15 by 17 mm in the right upper lid. Well developed superficial vessels were found on the surface of the nodule. Neither tenderness nor ulceration was accompanied. Total excision of the tumor and upper lid reconstruction with posterior auricular skin graft were done. RESULTS: Histologic examination revealed numerous glandular structures which were composed of two layers of epithelium and were scattered in abundant fibromyxoid and chondroid stroma. The histopathological diagnosis was chondroid syringoma. CONCLUSIONS: Since chondroid syringoma may occur in the eyelid, and although uncommon, it should be included in the differential diagnosis of firm and nodular tumors. The surgeon should plan for complete excision to reduce the possibility of recurrence or malignant transformation.
Adenoma, Pleomorphic* ; Aged ; Diagnosis ; Diagnosis, Differential ; Eccrine Glands ; Epithelium ; Eyelids* ; Humans ; Recurrence ; Skin ; Transplants ; Ulcer

OBJECTIVE: To know when we can identify fetal Y chromosome SRY gene by using fetal DNA in maternal plasma. METHODS: DNA from maternal plasma of 62 pregnant women (48: inpatients, 14: outpatients) underwent a sensitive Y-PCR assay to identify SRY gene of Y chromosome. RESULTS: Of the patients, fetus-derived Y sequences were detected in 37 (88.1%) of the 42 maternal plasma samples from women bearing male fetuses. One of the 20 women bearing female fetuses had positive result from plasma DNA. Seventh gestational week was the earliest gestation of gender identification. CONCLUSION: We could identify fetal gender using fetal DNA in maternal plasma (sensitivity 88.1%). The earlist to detect was 7th gestational week.
DNA* ; Female ; Fetus ; Genes, sry ; Humans ; Inpatients ; Male* ; Plasma* ; Pregnancy ; Pregnant Women ; Y Chromosome

PURPOSE: To evaluate the safety and the influence of embolization of severe arterioportal shunts, and the effect of the procedure on the survival rate of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. MATERIALS AND METHODS: This study involved a total of 54 patients with hepatocellular carcinoma in whom hepatic arteriography revealed severe arterioportal shunt. From among this total, 34 patients (embolization group) underwent chemoinfusion after shunt embolization, while 19 (control group) underwent chemoinfusion only. The embolic materials included PVA particles and/or Gelfoam pieces. The frequency of postembolization symptoms (Chi-squared test) and changes in laboratory values (paired t-test) were compared between the two groups, and shunt improvement was also evaluated. Patient survival was tested using the Kaplan-Meier method. RESULTS: Fever and RUQ pain were more frequent in the embolization group (p<0.001). The complications of embolization included severe postembolization syndrome (n=1), acute hepatic failure (n=2), hepatic infarction (n=1), and sepsis (n=1). There were no significant changes in laboratory values. Among the 28 patients (24 of embolization group and four of control group) who underwent follow-up angiography, arterioportal shunt became less severe or disappeared in ten of the embolization group. For the embolization and control groups, the mean survival interval was 29.5 +/-5.4 weeks and 10.3 +/-3.1 weeks (p=0.0002), respectively. The best results were seen in the PVA particle group (p=0.01). CONCLUSION: The embolization of severe arterioportal shunts is relatively safe and increases patient survival rate.
Angiography ; Carcinoma, Hepatocellular* ; Fever ; Follow-Up Studies ; Gelatin Sponge, Absorbable ; Humans ; Infarction ; Liver Failure, Acute ; Portal Vein ; Sepsis ; Survival Rate ; Thrombosis

We aimed to develop the Korean version of Short Blessed test (SBT-K) by analyzing its reliability and validity, showing its usefulness as a dementia screening instrument. The translation, including back translation procedure, was carried out, keeping the basic structure of SBT. SBT-K. The Korean Version of Blessed Dementia Scale-Activity of Daily Living (BDS-ADL-K) and Clinical Dementia Rating Scale (CDR) were administered to 224 dementia patients and 191 control subjects, and The Korean Version of Consortium to Establish a Registry of Alzheimer's Disease-Mini-Mental State Examination (CERAD-MMSE-K) was to 157 patients and 167 controls. The correlation of SBT-K scores between two raters, correlation between the test and retest after one month, and its internal consistency were analyzed. To verify the concurrent validity of SBT-K, its correlation with each test: CERAD-MMSE-K, BDS-ADL-K, and CDR was analyzed. The sensitivity and specificity for each cut-off point of SBT-K were calculated and the Receiver Operator Characteristic (ROC) curve analysis was done to get its optimal cut-off point. SBT-K was found to have significantly high internal consistency, inter-rater reliability, and test-retest reliability. The significant correlation of SBT-K with each test described above was also shown. Its optimal cut-off point was estimated as 10/11, and the sensitivity and specificity were 0.85 and 0.90, respectively. The ROC curve analysis indicated that the diagnostic efficiency of SBT-K was comparable with CERAD-MMSE-K. We conclude that SBT-K has not only high reliability and validity, but also usefulness as a screening instrument for dementia.
Dementia* ; Humans ; Mass Screening* ; Reproducibility of Results* ; ROC Curve ; Sensitivity and Specificity

A functional single lung caused by lung diseases or pneumonectomy can result in anatomic and physiologic changes that may interfere with the conduct of subsequent coronary artery bypass surgery. Since this type of case is extremely rare, there has not been any report on this in Korea. A 71-year-old female with a history of a destroyed left lung from pulmonary tuberculosis 13 years ago was admitted for evaluation of her increasing chest pain that she'd experienced for 2 weeks. Since coronary angiographies demonstrated 80% stenosis of the left main os, 90~95% stenosis of the p-LAD, 90% stenosis of the m-LCx and 90% stenosis of the RCA, coronary artery bypass surgery (CABG) was planned. Off-pump CABG with vein grafts through a median sternotomy was performed and the patient recovered the same as other CABG patients without complications.
Aged ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Female ; Humans ; Korea ; Lung ; Lung Diseases ; Pneumonectomy ; Sternotomy ; Transplants ; Tuberculosis, Pulmonary ; Veins

PURPOSE: To evaluate the impact of adjuvant chemotherapy (AC) in patients with upper tract urothelial carcinoma and lymphovascular invasion (LVI) after radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analyzed the clinical records and clinicopatholgic outcomes of patients (n=552) treated with RNU between 1986 and 2013. Patients treated with neoadjuvant chemotherapy and those for whom LVI status was not recorded were excluded. Patients were divided into two groups according to LVI (n=86) or no LVI (n=256). RESULTS: The study included 344 patients (240 men and 104 women) with a median of 53.9 months of follow-up (range, 1-297 months) after RNU. Tumors were organ confined (T2/N0) in 211 (61.3%) and tumor grade high in 291 (84.6%). AC was administered in 64 patients (18.6%). A total of 280 patients (81.4%) were treated with surgery alone. Patients with LVI tended to be older (p=0.049), have a higher pT stage (pT3/T4, p<0.001), be pN+ (p<0.001), have a high tumor grade (p<0.001), and experience recurrence (p<0.001). In the multivariate analysis, LVI was an independent prognostic factor for cancer-specific survival and overall survival (p=0.002 and p<0.001, respectively). The multivariate analysis demonstrated that in the subgroup of patients with LVI, AC was a significant prognostic factor for cancer-specific survival and overall survival (hazard ratio, 0.51; p=0.027 and hazard ratio, 0.50; p=0.025, respectively). CONCLUSIONS: AC does not seem to reduce mortality in patients with advanced upper tract urothelial carcinoma after RNU. In the subgroup of patients with LVI, AC had a positive impact on cancer-specific survival and overall survival. LVI would be helpful for selecting patients who are appropriate for AC.
Aged ; Carcinoma, Transitional Cell/drug therapy/*mortality/surgery ; *Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms/drug therapy/*mortality/surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Nephrectomy ; Prognosis ; Retrospective Studies ; Survival Rate ; Ureter/pathology ; Ureteral Neoplasms/drug therapy/*mortality/surgery ; Urinary Tract/pathology