Variant angina is characterized by repeated attack at rest associated with ST-segment elevation on ECG and caused by the spasm of coronary artery. But, the pathogenesis of spasm is not well known. A 44-year old man was transferred for the management of intramural hematoma at descending thoracic aorta and uncontrolled hypertension. We started to control hypertension with nitroprusside, propranolol, amlodipine, and doxazocin. At 4th hospital day, severe chest pain, dizziness, and diaphoresis were developed, and ECG showed not only ST-segment elevation on lead II, III, aVF but also 2 degree AV block(Mobitz type II). CK-MB revealed 52.3 ng/dl. When coronary angiography performed emergently, it showed total occlusion of right coronary artery (RCA) and diffuse minimal narrowing of left anterior descending coronary artery (LAD). After nitroglycerin was infused via right coronary catheter, the RCA was opened completely, and reperfusion arrhythmia was developed. Medication were changed to nifedipine, diltiazem, nicorandil, isosorbide mononitrate and he had no more chest pain.
Adult ; Amlodipine ; Aorta, Thoracic ; Arrhythmias, Cardiac ; Catheters ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Diltiazem ; Dizziness ; Electrocardiography ; Hematoma* ; Humans ; Hypertension ; Isosorbide ; Myocardial Infarction* ; Nicorandil ; Nifedipine ; Nitroglycerin ; Nitroprusside ; Propranolol ; Reperfusion ; Spasm

PURPOSE: We evaluated the impact of renal tumor size on the oncologic and surgical efficacy of laparoscopic renal cryosurgery (LRC) according to our intermediate-term experience in Korea. MATERIALS AND METHODS: From June 2005 to October 2008, we enrolled 37 patients who underwent LRC for 40 renal tumors. Patients were stratified into four groups according to renal tumor size. Patients who presented with a maximum tumor diameter (MTD) of at least 1 cm but less than 2 cm were assigned to Group 1, those with an MTD equal to or greater than 2 but less than 3 cm were assigned to Group 2, those with an MTD equal to or greater than 3 but less than 4 cm were assigned to Group 3, and those with an MTD equal to or greater than 4 cm were assigned to Group 4. Oncologic and clinical outcomes in each group were compared. RESULTS: The four groups showed no statistically significant differences in preoperative variables, including age, sex, body mass index, American Society of Anesthesiologists scores, baseline renal function and hemoglobin, and length of hospital stay. Regarding surgical aspects, however, operation time, estimated blood loss, and postoperative complications were significantly increased in patients with larger tumors. Three patients in Group 3 required postoperative transfusions, and 1 patient in Group 4 required conversion to open renal cryosurgery. During the mean follow-up period of 31.6 months, radiologic evidence of tumor recurrence was found in only 2 patients in Group 4. CONCLUSIONS: In this series, LRC for renal tumors smaller than 3 cm was conducted safely without radiologic evidence of tumor recurrence during intermediate-term follow-up. For tumors larger than 3 cm, however, the transfusion rate increased, and for renal tumors larger than 4 cm, the tumor recurrence rate increased significantly.
Body Mass Index ; Carcinoma, Renal Cell ; Cryosurgery ; Follow-Up Studies ; Hemoglobins ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Recurrence

We describe a 44-year-old woman with paresthesia, fatigue, and palpitation, 10 days after human papillomavirus (HPV) vaccination. The quantitative sensory test showed abnormal detection threshold in her foot. Tilt test result indicated postural orthostatic tachycardia syndrome. Symptoms were improved after immunomodulating therapy, pain control drug, and oral beta blocker medication. This is first case report for small fiber neuropathy and autonomic dysfunction after HPV vaccination in Korea.
Adult ; Erythromelalgia ; Fatigue ; Female ; Foot ; Humans ; Korea ; Papillomavirus Vaccines ; Paresthesia ; Postural Orthostatic Tachycardia Syndrome ; Vaccination

PURPOSE: The MIB1 labeling index is new method utilizing a monoclonal antibody against Ki-67 antigen and useful for evaluating the proliferation rate in breast cancer due to its ease of use and reliability. We compared the MIB1 labeling index to other, well established prognostic factors and assessed the prognostic value of MIB1 in 564 breast cancers. METHODS: The MIB1 (Ki-67 equivalent monoclonal antibody) proliferation rate, MIB1 labeling index, was determined in formalin-fixed, paraffin-embedded tissue specimens of 564 primary breast cancer patients who underwent surgery between March 1998 and February 2000 at Seoul National University Hospital. The clinicopathologic characteristics of the primary tumor such as age, tumor size, histologic type, nuclear grade, histologic grade, hormone receptor status and various tumor markers (p53, c-erbB-2, bcl-2) were compared with the value of the MIB1 labeling Index. RESULTS: The mean value of MIB1 labeling index was 6.9. MIB1 labeling index was correlated to younger age (p= 0.011), histologic types, low nuclear grade (p=0.0001), high histologic grade (p=0.0001), p53 positive (IDC) (p=0.0001), c-erbB-2 positive (DCIS) (p=0.01), comedo type (DCIS) (p= 0.001) and inversely correlated to hormone receptor positivity (p=0.0001), bcl-2 positive (IDC) (p=0.001). No correlation was found in tumor size, lymph node status and c-erbB-2 positive (IDC). CONCLUSION: The MIB1 labeling index correlated well with well-established poor prognostic factors. The MIB1 labeling index may be an important prognostic determinant in breast cancer.
Biomarkers, Tumor ; Breast Neoplasms* ; Breast* ; Humans ; Ki-67 Antigen ; Lymph Nodes ; Seoul

BACKGROUND/AIMS: Although balloon-occluded retrograde transvenous obliteration (BRTO) has been used as a new procedure for gastric variceal bleeding due to its feasibility and minimal invasiveness, reports regarding the results of BRTO are not well presented in Korea. Therefore, we analyzed the results of our experience in recent 39 months. METHODS: Twenty eight patients who received BRTO for primary hemostasis or secondary prevention of gastric variceal bleeding from December 2001 to March 2005 were analyzed retrospectively. RESULTS: Twenty three men and five women were involved, and the mean age was 53.7+/-9.6 years. Technical and clinical success rates were 89.3% and 85.7%, respectively. Follow-up duration was 17.5+/-12.5 months in 23 patients. Gastric varices disappeared in 78.3% and decreased in 21.7%. Relapses occurred in 4.3% of the patients. Preexisting hepatic encephalopathy improved in all 11 patients. Aggravation of ascites, esophageal varices, portal hypertensive gastropathy were observed in 45.8%, 30.4%, 56.5%, respectively. Increased Child-Pugh score (p<0.001) and decreased albumin concentration (p=0.002) were observed 3 days after BRTO, but resolved 7 days later. Increased albumin concentration and decreased Child-Pugh score maintained thereafter. Rebleeding occurred in 3 patients which were caused by esophageal varices. Two-year survival rate was 54.6%. Presence of hepatocellular carcinoma (HCC) (p=0.001) and Child-Pugh grade (p=0.033) affected the survival, but HCC was the only independent risk factor (p=0.010, OR=15.837) in multivariate analysis. CONCLUSIONS: BRTO is an effective therapeutic procedure for primary hemostasis, secondary prevention, and for improving survival in gastric variceal bleeding patients.
Adult ; Aged ; Aged, 80 and over ; *Balloon Occlusion ; Esophageal and Gastric Varices/*complications ; Female ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Male ; Middle Aged ; Recurrence

PURPOSE: A 70-gene prognostic signature has prognostic value in patients with node-negative breast cancer in Europe. This diagnostic test known as "MammaPrint(TM) (70-gene prognostic signature)" was recently validated and implementation was feasible. Therefore, we assessed the 70-gene prognostic signature in Korean patients with breast cancer. We compared the risk predicted by the 70-gene prognostic signature with commonly used clinicopathological guidelines among Korean patients with breast cancer. We also analyzed the 70-gene prognostic signature and clinicopathological feature of the patients in comparison with a previous validation study. METHODS: Forty-eight eligible patients with breast cancer (clinical T1-2N0M0) were selected from four hospitals in Korea. Fresh tumor samples were analyzed with a customized microarray for the 70-gene prognostic signature. Concordance between the risk predicted by the 70-gene prognostic signature and risk predicted by commonly used clinicopathological guidelines (St. Gallen guidelines, National Institutes of Health [NIH] guideline, and Adjuvant! Online) was evaluated. RESULTS: Prognosis signatures were assessed in 36 patients. No significant differences were observed in the clinicopathological features of patients compared with previous studies. The 70-gene prognosis signature identified five (13.9%) patients with a low-risk prognosis signature and 31 (86.1%) patients with a high-risk prognosis signature. Clinical risk was concordant with the prognosis signature for 29 patients (80.6%) according to the St. Gallen guidelines; 30 patients (83.4%) according to the NIH guidelines; and 23 patients (63.8%) according to the Adjuvant! Online. Our results were different from previous validation studies in Europe with about a 40% low-risk prognosis and about a 60% high-risk prognosis. The high incidence in the high-risk group was consistent with data in Japan. CONCLUSION: The results of 70-gene prognostic signature of Korean patients with breast cancer were somewhat different from those identified in Europe. This difference should be studied as whether there is a gene disparity between Asians and Europeans. Further large-scale studies with a follow-up evaluation are required to assess whether the use of the 70-gene prognostic signature can predict the prognosis of Korean patients with breast cancer.
Asian Continental Ancestry Group ; Breast ; Breast Neoplasms ; Diagnostic Tests, Routine ; Europe ; Follow-Up Studies ; Gene Expression Profiling ; Genes, vif ; Humans ; Incidence ; Korea ; National Institutes of Health (U.S.) ; Prognosis

PURPOSE: Sentinel lymph node (SLN) biopsy has emerged as a substitute for a conventional axillary lymph node (ALN) dissection in early breast carcinomas. We evaluated SLN biopsy in breast carcinoma using a gamma-detection probe in order to identify its accuracy as a staging procedure for lymph node status. METHODS: Fifty-one patients with breast carcinomas who underwent a SLN biopsy followed by an ALN dissection between June 1999 and January 2001 were evaluated. Tc 99m antimony trisulfide colloid was used as a tracer and SLN biopsy using a gamma-detection probe was done following breast lymphoscintigraphy. Intraoperative imprint cytology (II C) was done for each SLN. If a SLN biopsy was free of metastasis by permanent hematoxylin and eosin (H&E) staining, immun ohistochemical (IHC) staining using pan-cytokeratin was do ne to detect micrometastasis. RESULTS: ALN metastases were identified in 21.6% of pa tients and the resection rate of SLN was 94.1%. The mean number of resected SLN was 1.8, all located at the axilla. IIC had a sensitivity of 72.7% and a spe cificity of 100%. The false-negative rate of SLN biopsy was 12.5% when SLNs were evaluated by H&E staining alone. However, the false-negative rate improved up to 0% when IHC staining was added. CONCLUSION: SLN biopsy using a gamma-detection probe proved to be a very sensitive method to detect SLN in breast carcinoma patients. Frozen biopsy should be added to im prove the outcomes of intraoperative examination of SLN. If permanent biopsy revealed that SLN was free of tumorthe by H&E staining, IHC staining should be done to improve false-negative rate of SLN biopsy.
Antimony ; Axilla ; Biopsy* ; Breast Neoplasms* ; Breast* ; Colloids ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Lymph Nodes ; Lymphoscintigraphy ; Neoplasm Metastasis ; Neoplasm Micrometastasis

PURPOSE: Sentinel lymph node (SLN) biopsy has emerged as a substitute for a conventional axillary lymph node (ALN) dissection in early breast carcinomas. We evaluated SLN biopsy in breast carcinoma using a gamma-detection probe in order to identify its accuracy as a staging procedure for lymph node status. METHODS: Fifty-one patients with breast carcinomas who underwent a SLN biopsy followed by an ALN dissection between June 1999 and January 2001 were evaluated. Tc 99m antimony trisulfide colloid was used as a tracer and SLN biopsy using a gamma-detection probe was done following breast lymphoscintigraphy. Intraoperative imprint cytology (II C) was done for each SLN. If a SLN biopsy was free of metastasis by permanent hematoxylin and eosin (H&E) staining, immun ohistochemical (IHC) staining using pan-cytokeratin was do ne to detect micrometastasis. RESULTS: ALN metastases were identified in 21.6% of pa tients and the resection rate of SLN was 94.1%. The mean number of resected SLN was 1.8, all located at the axilla. IIC had a sensitivity of 72.7% and a spe cificity of 100%. The false-negative rate of SLN biopsy was 12.5% when SLNs were evaluated by H&E staining alone. However, the false-negative rate improved up to 0% when IHC staining was added. CONCLUSION: SLN biopsy using a gamma-detection probe proved to be a very sensitive method to detect SLN in breast carcinoma patients. Frozen biopsy should be added to im prove the outcomes of intraoperative examination of SLN. If permanent biopsy revealed that SLN was free of tumorthe by H&E staining, IHC staining should be done to improve false-negative rate of SLN biopsy.
Antimony ; Axilla ; Biopsy* ; Breast Neoplasms* ; Breast* ; Colloids ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Lymph Nodes ; Lymphoscintigraphy ; Neoplasm Metastasis ; Neoplasm Micrometastasis

The objective of this study was to determine the nutritional support in patients treated in medical intensive care units (MICUs) by evaluating the extent of current nutritional support using the patient care plan and considering the association between nutritional status and the amount of nutrition supplied. From April to December 2010, 114 patients (age > or = 18 years) admitted to the MICU and who underwent nutritional support for > 5 days were included. Descriptive statistics showed that the 114 patients received nutritional support within 1.2 +/- 0.7 days and for 16.2 +/- 11.7 days in the MICUs. The total delivered/required caloric ratio was 81.08 +/- 27.31%, and the protein ratio was 80.32 +/- 28.93%. Patients who received > 80% of required calories and protein showed improved nutritional status (p < 0.05). The results showed that adequate nutritional support is crucial to critically ill patients. We suggest early nutritional screening using simple tools such as periodic monitoring and management to recalculate nutritional status and nutritional requirements and nutritional support using a multidisciplinary method. Systematic nutritional support teams are needed to provide adequate nutritional support for patients in the MICU.
Critical Illness ; Humans ; Intensive Care Units ; Mass Screening ; Nutritional Requirements ; Nutritional Status ; Nutritional Support ; Patient Care