No abstract available.

The principle of surgery of the parotid gland is adequate removal of the tumor with functional and anatomical preservation of all blanches of the facial nerve. There are two main surgical approaches to superficial or total conservative parotidectomy. Anterior approach and posterior approach. Preliminary identification of the main trunk of the facial nerve is probably the most favoured techniques, but identification of the peripheral blanches of the facial nerve, with subsequent Proximal dissection to the main trunk, is long established but less popular technique. We have prospectively experienced the low incidence of facial nerve damage in series of 55 conservative parotidectomies performed using the anterior approach. The techniques employed is described with a deport of results obtained in the belief that this approach warrants greater popularity and saute technique.
Facial Nerve ; Incidence ; Parotid Gland ; Prospective Studies

BACKGROUND AND OBJECTIVES: The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM. MATERIALS AND METHODS: Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation. RESULTS: Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality. CONCLUSION: Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.
Asian Continental Ancestry Group ; Atrioventricular Block ; Cardiology ; Decision Making* ; Humans ; Japan* ; Korea* ; Pacemaker, Artificial ; Sick Sinus Syndrome

No abstract available.
Occupational Health*

BACKGROUND: The catheter ablation usin radiofrequency(RF) energy in patients with atrioventricular nodal reentrant tachycardia(AVNRT) and atrioventricular reentrant tachycardia(AVRT) ahs been proved as a safe and effective nonpharmacologic therapeutic modality. The purpose of our study was to evaluate the success rate and complications of the initial experience and to determine the extent of myocardial damage of RF catheter ablation. METHODS: Electrophysiologic study was performed with the standard technique. Twenty five patinents(M:F=16:9, mean age:42 years old) underwent RF catheter ablation in St. May's Hospital from April to December in 1994. The RF generator in this study was RFG-3D model and catheters were 6F or 7F steerable catheters with 4mm kistal tip. In order to evaluate the extent of myocardial damage the WBC count, LDH, CK, and CK-MB fraction were checked before and after RF catheter ablation and the Tc99m myocardial scintigraphy was performed within 72 hours of the porcedure. RESULTS: Six of twenty five patients had AVNRT, in which the success rate of selective ablation of the slow pathway was 83.8%. Nineteen patients with AVRT had one accessory pathway. The ablation success rate of 14 accessory pathways in left free wall location was 85.7%, and that of 3 in left posteroseptal location was 66.6%. Two right sided accessory pathways were not ablated successfully. The level of CK-MB fraction after ablation was within normal limit. Only one case revealed grade 2 of hot spot in Tc99m myocardial scintigraphy. CONCLUSION: The RF catheter ablation in patients with AVNRT and AVRT is a safe and effective nonpharmacologic therapeutic modality. But right sided accessory pathways are more difficult to ablate than left sided accessory pathways, requiring more experiences and better technique. The extent of myocardial damage after RF catheter ablation reveals relatively minimal by cardiac enzyme study and Tc99mmyocardial scintigraphy.
Catheter Ablation* ; Catheters ; Humans ; Myocardial Perfusion Imaging ; Radionuclide Imaging ; Tachycardia, Supraventricular*

Atrial flutter, a common rhythm disturbance, was first described over 80 years ago. Despite extensive investigations, several important issues remain unresolved concerning its exact mechanism and management. Present therapeutic strategies often appear effective to prevent and terminate atrial flutter. However, controlled trial and definitive studies comparing the various treatment options are surprisingly scarce. Here we report on a study of 9 episodes of spontaneous atrial flutter(AF)(flutter wave cycle length 224+/-39 msec) treatedd by transesophageal atrial pacing(TAP) in 9 patients(7 men and 2 women; mean age 56.9 yrs). TAP was effective in 5 patients : sinus rhythm resumption was immediate in 3 patients and followed a short period of atrial fibrillation in 2 patients. TAP was unsuccessful in 4 patients. All the patients tolerated the procedure well. These data strongly support the immediate first choice use of TAP in AF therapy.
Atrial Fibrillation ; Atrial Flutter* ; Female ; Humans ; Male

Ventricular tachycardia is an important tachyarrhythmia which is encountered commonly in clinical field. The accompanying manifestations could be variable just from palpitation to sudden cardiac death. The classification of this arrhythmia has not completly settled yet, but in a broad way this arrhythmia is classified according to the prescence or abscence or underlying heart disease, especially coronary artery disease. Recently, therapeutic modalities for this arrhythmia have been changed a lot from classical antiarrhythmic drugs to radiofrequency ablation or ICD implantation although there are still some problems to overcome. We experienced a case of 34-year-old female having an incessant ventricular tacycardia which was abolished after endomyocardial biopsy performed to differentiate underlying myocardial pathology.
Adult ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Biopsy* ; Catheter Ablation ; Classification ; Coronary Artery Disease ; Death, Sudden, Cardiac ; Female ; Heart Diseases ; Humans ; Pathology ; Tachycardia ; Tachycardia, Ventricular*

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate the effectiveness and selected adverse events of radiofrequency catheter ablation in patients treated for drug-refractory atrial fibrillation (AF) using claims data provided by the Health Insurance Review and Assessment Service, which covers all ablation procedures conducted in South Korea. SUBJECTS AND METHODS: The study population included patients who underwent catheter ablation for AF between January 2011 and December 2013. A total of 3,850 patients without a previous history of catheter ablation procedure were enrolled. We analyzed 2-year effectiveness of the index ablation. Any redo ablation, electrical cardioversion, or use of antiarrhythmic drug beyond the blanking period of 3 months was considered a failure of index ablation. RESULTS: Overall recurrence rate following AF ablation was 61.1%. The recurrence rate was lower in patients under 65 years old than in those over 65 years old (hazard ratio [HR] 0.89; 95% confidence interval [CI], 0.81 to 0.97, P=0.009). Repeat ablation was more frequent in men (HR 1.56; 95% CI, 1.20 to 2.04; P=0.001) and patients under 65 years old (HR 1.79; 95% CI, 1.34 to 2.38; P < 0.001). Electric cardioversion was more frequent in men (HR 1.35; 95% CI, 1.06 to 1.72; P=0.014) than in women. The overall rate of stroke, blood transfusion, significant pericardial complication, and cardiopulmonary resuscitation was 0.5%, 4.8%, 2.7%, and 0.2%, respectively. CONCLUSIONS: In the present study, old age was associated with treatment failure of catheter ablation for drug-refractory AF in the Korean population. Overall recurrence did not vary with respect to sex.
Atrial Fibrillation ; Blood Transfusion ; Cardiopulmonary Resuscitation ; Catheter Ablation ; Catheters ; Electric Countershock ; Female ; Hemorrhage ; Humans ; Insurance, Health ; Korea ; Male ; Pericardiocentesis ; Recurrence ; Stroke ; Treatment Failure

BACKGROUND: Recently, many institutions have acquired multi-detector computed tomography (MDCT) systems. This made it easier and more convenient to use MDCT as a initial diagnostic modality for hemoptysis. The purpose of this study was to evaluate the usefulness of MDCT before bronchoscopy and/or bronchial arterial embolization (BAE) for hemoptysis. METHODS: We studied a total of 125 patients with hemoptysis who underwent, between 2006 and 2008, MDCT in a routine protocol before bronchoscopy and/or BAE. One hundred two patients underwent bronchoscopy and 29 patients underwent BAE. We compared the usefulness of MDCT and bronchoscopy for detecting the bleeding site and identifying the cause. We also evaluated our ability, using MDCT, to detect instances where the bronchial artery caused hemoptysis. RESULTS: The rate of detection of a bleeding site was 75.5% on MDCT and 50.9% on bronchoscopy. MDCT and bronchoscopy detected the bleeding site in agreement in 62.7% of patients. MDCT alone found the bleeding site in 27.5% of cases. MDCT identified the cause of hemoptysis in 77.5% and bronchoscopy in 11.8%. In 29 patients who underwent BAE, we detected a total of 37 hypertrophied bronchial arteries that were causing hemoptysis. Of 37 bronchial arteries, 23 (62.2%) were depicted on MDCT. CONCLUSION: MDCT is superior to bronchoscopy for detecting the bleeding site and identifying the cause of hemoptysis. MDCT can also predict the side of affected bronchial artery with depiction of hypertrophied bronchial artery and localizing the bleeding site. Doing MDCT before bronchoscopy and BAE can provide a guideline for the next step.
Bronchial Arteries ; Bronchoscopy ; Hemoptysis ; Hemorrhage ; Humans ; Tomography, X-Ray Computed

OBJECTIVES: This study was purposed to determine the levels of PCBs and DDE in adipose tissue and serum and to evaluate the relations with factors affecting these levels. METHODS: We analyzed adipose tissues and sera from 52 gynecologic benign disease patients aged 27-78 years, except hormonal diseases such as breast cancer and endometriosis. We also surveyed age, education, occupation, body mass index (BMI), smoking, drinking, number of children, and duration of breastfeeding by questionnaires. Tissue and serum levels of PCBs and DDE were measured using gas chromatography. RESULTS: The median and geometric mean levels of PCBs were 48. 29 ng/g, 56. 78 ng/g for adipose tissue and 4. 67 uc/L, 4. 85 m/L for serum, and those of DDE were 142.89 ng/g, 117.06 ng/g for adipose tissue and l. 75 m/L, 2.09 ua/L for serum, respectively. Adipose tissue and serum levels for DDE showed high correlation (r=0. 310, p=0. 0002), but those of PCBs didn' t (r=0.029, p=0.2582). In analyses of the differences of the means of log transformed adipose tissue and serum PCBs and DDE levels for groups of potential covariates, only adipose tissue DDE levels were significantly associated with number of children (p=0.015), age at first birth (p=0.014) and BMI (p=0.035). In multiple regression analysis, adipose tissue DDE levels were significantly increased with decreasing number of children and increasing age at first birth. CONCLUSIONS: This study suggested that parity and adiposity were associated with levels of DDE in adipose tissue, and adipose tissue is a better biomarker than serum for evaluating the long-term exposure of organochlorines.
Adipose Tissue* ; Adiposity ; Birth Order ; Body Mass Index ; Breast Feeding ; Breast Neoplasms ; Child ; Chromatography, Gas ; Dichlorodiphenyl Dichloroethylene* ; Drinking ; Education ; Endometriosis ; Female ; Humans ; Occupations ; Parity ; Polychlorinated Biphenyls* ; Questionnaires ; Smoke ; Smoking