PURPOSE: The purpose of this study was to report on splenic artery aneurysms (SAAs) treated by transcatheter embolization in our single-center institution and to evaluate the clinical outcomes of patients with SAA by aneurysm location. MATERIALS AND METHODS: The original medical records and imaging results of 52 patients with SAA treated in our center between January 1, 1995 and December 31, 2013 were reviewed. Of these cases, 7 patients (13.5%) underwent surgery, 4 patients (7.5%) underwent serial observation, and 1 patient had stent insertion only, leaving 40 patients (78.9%) who underwent endovascular treatment using a coil, with or without N-butyl-2-cyanoacrylate. RESULTS: Aneurysms were located in the distal third of the splenic artery in 27 patients (67.5%), in the middle third in 9 cases (22.5%), and in the proximal third in 4 cases (10%). Of the 40 included patients, 25 were female (62.5%). Twenty-eight patients (70%) were asymptomatic. The mean aneurysm diameter was 2.48 cm (range, 0.8-6.0 cm). Complications involved pancreatitis (n=1) and early spleen infarction (n=29: <1/3 in 14, 1/3-2/3 in 10, and >2/3 in 5). Postembolization syndrome was noted in 26 patients (65%). There were no significant differences by aneurysm location in the postoperative increase in the values of white blood cells, amylase, lipase, and C-reactive protein (P=0.067, P=0.881, P=0.891, and P=0.188, respectively). CONCLUSION: At our institution, endovascular management is safe, has high technical success, and represents the first-line treatment for SAA, regardless of aneurysm location.
Amylases ; Aneurysm* ; C-Reactive Protein ; Embolization, Therapeutic ; Enbucrilate ; Female ; Humans ; Infarction ; Leukocytes ; Lipase ; Medical Records ; Pancreatitis ; Spleen ; Splenic Artery* ; Stents

53-year-old female was admitted to our institution with alternating atrial flutter and junctional bradycardia. The patient had undergone the Warden procedure to correct sinus venosus type atrial septal defect combined with partial anomalous pulmonary venous return, and ring tricuspid annuloplasty for severe tricuspid regurgitation. She also had persistent left superior vena cava (PLSVC). With the assistance of a 3D electroanatomic mapping system, catheter ablation therapy was used successfully to treat atrial flutter associated with a channel in the right atrial scar, and a pacemaker was implanted through the PLSVC because of resulting symptomatic bradycardia.
Atrial Flutter ; Bradycardia* ; Cardiac Surgical Procedures ; Catheter Ablation ; Cicatrix ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Humans ; Middle Aged ; Pacemaker, Artificial ; Scimitar Syndrome ; Tachycardia* ; Tricuspid Valve Insufficiency ; Vena Cava, Superior*

Medical and catheter-based ablation therapies have been successfully applied in treating supraventricular tachycardia, supported by abundant evidences from clinical trials. However, Special populations such as pediatric populations, pregnant patients, or patients with congenital heart diseases are easily excluded from clinical trials; thus, caution is needed when adopting results from clinical trials conducted in the usual adult population.
Adult ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Pediatrics ; Pregnancy ; Tachycardia, Supraventricular*

To verify whether laser-induced branch retinal vein occlusion in the rabbit can be used as the experimental model for the human study. The temporal retinal vein of the right eye was occluded with argon laser photocoagulator with parameters of 500 micrometerspot size, 0.2 second duration, 150-200 microWatt power in twelve pigmented rabbits. The left eye was used as a control. An electroretinogram was taken before and 1,3,7,15 and 28 days after vein occlusion. B/a ratio and oscillatory potentials increased in the eyes with occluded veins. Comparing the pre-occlusion values with those of post-occlusion, the changes were not statistically significant. But differences between the values of right and those of left eye were significant. We can suppose that the discrepancies may result from the difference in timing of examination. In conclusion, the rabbit model of laser-induced experimental branch retinal vein occlusion may not be adequate for the study of clinical branch retinal vein occlusion.
Argon ; Humans ; Models, Theoretical ; Rabbits* ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Veins

Choline is important for normal membrane function, acetylcholine synthesis and methyl group metabolism. In this study, 185 food items customarily eaten by Koreans were selected from the data of the 2001 Korean National Health and Nutrition Survey and analyzed on the total choline content of the foods using enzymatic method of choline oxidase. Foods with high choline concentration (mg/100 g) were listed in sequence of quail egg (476.04 mg), dried squid (452.42 mg), beef liver (427.16 mg), pork liver (424.92 mg), tuna canned in oil (414.44 mg), boiled and dried anchovy (381.30 mg), dried Alaskan pollack (378.88 mg), chicken egg (309.88 mg), chicken liver (259.38 mg), soybean (238.62 mg), French bread with garlic (193.18 mg) and barley (183.73 mg). From this result, it is shown that dried fishes, prepared fishes, livers, eggs, pulses and cereals might be categorized as high choline food. Citron tea and green tea showed low choline content below 1 mg. Vegetables and fruits were also categorized into low choline food. No choline was detected in red pepper powder, beer, soju, soybean oil and corn oil out of foods analyzed in this study. Further study is required for analytic procedure of the foods of which results are inconsistent with USDA's data such as rice and wheat flour.
Acetylcholine ; Alcohol Oxidoreductases ; Beer ; Bread ; Capsicum ; Edible Grain ; Chickens ; Choline ; Corn Oil ; Decapodiformes ; Eggs ; Fishes ; Fruit ; Garlic ; Hordeum ; Liver ; Membranes ; Nutrition Surveys ; Ovum ; Oxidoreductases ; Quail ; Soybean Oil ; Soybeans ; Tea ; Triticum ; Tuna ; Vegetables

Radical nephrectomy with tumor thrombectomy for advanced renal cell carcinoma is an oncologically relevant approach that can achieve long-term survival even in the presence of distant metastases. However, the surgical techniques pose significant challenges. The objective of this clinical review was to present technical recommendations for tumor thrombectomy in the vena cava to facilitate surgical treatment. Transesophageal echocardiography is required to prepare for this procedure. Cardiopulmonary bypass should be considered when the tumor thrombus has invaded the cardiac chamber and clamping is not feasible because of the inability to milk the intracardiac chamber thrombus in the caudal direction. Prior to performing a cavotomy, it is crucial to clamp the contralateral renal vein and infrarenal and suprahepatic inferior vena cava (IVC). If the suprahepatic IVC is separated from the surrounding tissue, it can be gently pulled down toward the patient’s leg until the lower margin of the atrium becomes visible. Subsequently, the tumor thrombus should be carefully pulled downward to a position where it can be clamped. Implementing the Pringle maneuver to reduce blood flow from the hepatic veins to the IVC during IVC cavotomy is simpler than clamping the hepatic veins. Sequential clamping is a two-stage method of dividing thrombectomy by clamping the IVC twice, first suprahepatically and then midretrohepatically. This sequential clamping technique helps minimize hypotension status and the Pringle maneuver time compared to single clamping. Additionally, a spiral cavotomy can decrease the degree of primary closure narrowing. The oncological prognoses of patients can be improved by incorporating these technical recommendations.

Major peripheral arterial graft infection is a potentially devastating complication of vascular surgery, associated with significant mortality and high amputation rates. Autologous saphenous veins are considered optimal arterial conduits for lower extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients. This study describes two patients with major peripheral graft infection, but without available autologous veins, who underwent graft excision and cryopreserved cadaveric arterial allograft reconstruction. Although long-term graft durability is unclear because of gradual deterioration and degeneration, these findings suggest that cadaveric allografts may be good options for patients with major peripheral graft infection.
Allografts* ; Amputation ; Blood Vessel Prosthesis ; Cadaver* ; Humans ; Lower Extremity ; Mortality ; Saphenous Vein ; Tissue Preservation ; Transplants* ; Veins

Using 49 capacitive-coupled electrodes, mattress-type harness was developed to obtain posterior body surface potential map (P-BSPM) in dressed individuals. The aim of this study was to investigate how valuable information P-BSPM could provide, especially in discrimination of old myocardial infarction (OMI). P-BSPM of 59 individuals were analyzed; 23 normal control, 11 right bundle branch block (RBBB), 3 left bundle branch block (LBBB) and 19 OMI patients. Principal component analysis and linear hyper-plane approach were used to evaluate diagnostic performance. The axes of P-BSPM vector potential corresponded well with 12-lead electrocardiogram. During QRS, the end point of P-BSPM vector potential demonstrated characteristic clockwise rotation in RBBB, and counterclockwise rotation in LBBB patients. In OMI, initial negativity on P-BSPM during QRS was more frequently located at lower half, and also stronger in patients with inferior myocardial infarction (MI). The area under the receiver-operating characteristic curve of P-BSPM during QRS in diagnosing overall OMI, anterior MI, and inferior MI was 0.83 (95% confidence interval, 0.70-0.97), 0.71 (0.47-0.94), and 0.98 (0.94-1.0), respectively (P = 0.022 for anterior vs inferior MI groups). In conclusion, the novel P-BSPM provides detailed information for cardiac electrical dynamics and is applicable to diagnosing OMI, especially inferior myocardial infarction.
Adult ; Aged ; Area Under Curve ; Body Surface Potential Mapping/instrumentation/*methods ; Bundle-Branch Block/diagnosis ; Electrocardiography ; Electrodes ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis ; Principal Component Analysis ; ROC Curve

BACKGROUND AND OBJECTIVES: The cardiac autonomic nervous system is an emerging target for therapeutic control of atrial fibrillation (AF). We evaluated the effects of low-intensity autonomic nerve stimulation (LI-ANS) on atrial electrophysiology, AF vulnerability, and neural remodeling. SUBJECTS AND METHODS: Fourteen dogs were subjected to 3 hours rapid atrial pacing (RAP, 5 Hz) and concomitant high frequency LI-ANS (20 Hz, at voltages 40% below the threshold) as follows: no autonomic stimulation (control, n=3); or right cervical vagus nerve (RVN, n=6), anterior right ganglionated plexi (ARGP, n=3), and superior left ganglionated plexi (SLGP, n=2) stimulation. Programmed and burst atrial pacing were performed at baseline and at the end of each hour to determine atrial effective refractory period (ERP), window of vulnerability (WOV), and inducibility of sustained AF. RESULTS: Atrial ERP was significantly shortened by 3 hours RAP (in control group, DeltaERP=-47.9+/-8.9%, p=0.032), and RAP-induced ERP shortening was attenuated by LI-ANS (in LI-ANS group, DeltaERP=-15.4+/-5.9%, p=0.019; vs. control, p=0.035). Neither WOV for AF nor AF inducibility changed significantly during 3 hours RAP with simultaneous LI-ANS. There was no significant difference between the control and LI-ANS group in nerve density and sprouting evaluated by anti-tyrosine hydroxylase and anti-growth associated protein-43 staining. Among the various sites for LI-ANS, the ARGP-stimulation group showed marginally lower DeltaWOV (p=0.077) and lower nerve sprouting (p=0.065) compared to the RVN-stimulation group. CONCLUSION: Low-intensity autonomic nerve stimulation significantly attenuated the shortening of atrial ERP caused by RAP. ARGP may be a better target for LI-ANS than RVN for the purpose of suppressing atrial remodeling in AF.
Animals ; Atrial Fibrillation ; Atrial Remodeling ; Autonomic Nervous System ; Autonomic Pathways* ; Dogs ; Electrophysiology* ; Ganglion Cysts ; Vagus Nerve

BACKGROUND AND OBJECTIVES: Radiofrequency catheter ablation (RFCA) exposes patients to fixed angle radiation for extended periods of time. We investigated the incidence and characteristics of radiation-induced dermatitis (RID) associated with RFCA. SUBJECTS AND METHODS: We screened 1347 consecutive patients from 2000 to 2011 who underwent RFCA for any indication and reviewed patients with dermatologic issues at the 1-month follow-up. Skin lesions were classified into three groups: most likely RID, probable RID, and possible RID. RESULTS: Of the 1347 enrolled patients, 12 (0.89%) experienced dermatologic issues within 1 month after RFCA, including six patients (0.45%) clinically classified as 'most likely RID' and four patients (0.30%) with 'probable RID'. Ten patients, including most likely RID or probable RID patients, developed skin lesions on the right back and upper arm. Skin lesions did not improve without meticulous treatment, and three cases required surgical intervention. We compared the RID group to the remaining 1335 patients (normal group). The mean body mass indices (BMIs) of the RID and normal groups were 29.3 and 23.9 kg/m², respectively (p<0.001). Radiation exposure times were longer in the RID group (180±31.0 vs. 47±49.9 minutes, p<0.001). We further analyzed 44 patients (6 RID cases and 38 normal patients) that had BMIs >26 kg/m2 and exposure times >115 minutes based on receiver operator characteristic curve analyses. Among the 35 patients without RID, 29 patients (82.9%) did not use biplane fluoroscopy. CONCLUSIONS: Patients with high BMIs have a higher risk of developing severe RID with increasing fluoroscopy times using biplane fluoroscopy.
Arm ; Body Mass Index ; Catheter Ablation* ; Dermatitis ; Fluoroscopy ; Follow-Up Studies ; Humans ; Incidence* ; Radiation Exposure ; Radiodermatitis* ; Skin