BACKGROUND: We have no information about the safety and effectiveness when we perform overdilating a sirolimuseluting stent(SES) with high pressure. In some specific animal model, the study reported overdilatation of SES with high pressure resulted in increase of restenosis. The aim of this study was to evaluate the safety and effectiveness of overdilatation of SES with high pressure. METHODS: 97 patients underwent PCI using SES between August 2003 and July 2005 were divided into two group(high pressure group, low pressure group), stents were implanted with high pressure(>18 atm) and low pressure(<12 atm). We compared between the two group of safety of stents, major adverse cardiac events(MACE), rate of restenosis, late loss. RESULTS: In high pressure group, there are more type C lesion(51% vs 38%, p<0.01). There were no significant differences between the two groups regarding MACE(12.8% vs 17.2%, p=0.78), in-stent restenosis rate(2.6 % vs 5.2%, p=0.65). There are small increasing of late loss in high pressure group, but no statistically significant difference(0.30 vs 0.15, p=0.05). CONCLUSION: Implantation of SES overdilated with high pressure is able to be performed safely to obtain wider inner lumen of stents.
Dilatation ; Humans ; Models, Animal ; Myocardial Ischemia ; Stents

STUDY DESIGN: Case report. OBJECTIVES: We report a very rare case of the inferior accessory ossicle of the anterior arch of the atlas misdiagnosed as anterior arch fracture. SUMMARY OF LITERATURE REVIEW: It is necessary to know the existence of inferior accessory ossicle of the anterior arch of the atlas, even though it is extremely rare. MATERIALS AND METHODS: A 29-year-old woman was referred to our emergency service unit with symptoms of neck pain and scalp laceration, after being involved in a car accident. She was diagnosed as the inferior accessory ossicle of the anterior arch of the atlas, by multiple diagnostic mordalities. RESULTS: The symptom of neck pain was relieved spontaneously, and her symptom has been relieved at her latest visit, as a follow up within 3 months. CONCLUSIONS: It is important to be aware of cervical anatomical variants because we commonly confuse it with other pathologic conditions, such as a fracture and thus, misdiagnose the condition.
Adult ; Emergencies ; Female ; Follow-Up Studies ; Humans ; Lacerations ; Neck Pain ; Scalp

PURPOSE: The option of selecting isotonic rather than hypotonic fluids for maintenance fluid in children has been advocated by some authors. Pneumonia and CNS infections are frequent clinical settings for acute hyponatremia because of nonosmotic anti-diuretic hormone stimuli in children. We conducted the present study to identify the incidence of hyponatremia in pneumonia and CNS infection of children and to determine the importance of maintenance intravenous fluid therapy regimen and other related factors. METHODS: The study included 1,992 patients admitted to the Department of Pediatrics at Pusan National University Children's Hospital between November 2008 and August 2011, who were diagnosed with pneumonia or CNS infections and checked for serum sodium concentration. Their clinical data including laboratory findings were reviewed retrospectively. RESULTS: During the study period, 218 patients were identified to have acute hyponatremia among 1,992 patients. The overall incidence of hyponatremia was 10.9%. The incidence of hyponatremia in encephalitis (37.3%) was highest and the incidence in bacterial meningitis (27.4%), viral meningitis (20.0%), bacterial pneumonia (11.1%), mycoplasma pneumonia (9.2%), and viral pneumonia (6.8%) were in descending order. The mean age was higher in hyponatremic patients than in isonatremic patients. The incidence of hyponatremia was higher in who had 0.18% NaCl in 5% dextrose (D5 0.18% NS) than 0.45% NaCl in 5% dextrose infusion (D5 1/2NS) (9.0% vs. 2.2%). SIADH was identified in 20.5% among hospital acquired hyponatremic patients after adequate evaluation for SIADH. CONCLUSION: We recommend D5 1/2NS rather than D5 0.18% NS as the maintenance fluid given to children with pneumonia or infectious CNS diseases.
Central Nervous System Diseases ; Child ; Encephalitis ; Fluid Therapy ; Glucose ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome ; Incidence ; Meningitis ; Meningitis, Bacterial ; Meningitis, Viral ; Pediatrics ; Pneumonia ; Pneumonia, Bacterial ; Pneumonia, Mycoplasma ; Pneumonia, Viral ; Sodium

PURPOSE: Major hepatic resection is sometimes inevitable in patients with impaired liver function. We evaluated risk factors that cause postoperative liver failure after major hepatic resection in patients with over a 10% Indocyanine Green Retention rate at 15 minutes (ICGR15). METHODS: From Apr. 2002 to Aug. 2009, 32 patients who had over a 10% rate of ICGR15 underwent major hepatic resection (> or =4 Couinaud segments). Among the 32, 9 patients showed postoperative liver failure (less than 50% prothrombine time and/or 5 mg/dl or higher of total bilirubin). This high-risk group was compared to the rest who constituted a low-risk group. RESULTS: Patients with esophageal varix were more common in the high risk group (4 versus 2, p=0.043). Other clinicopathologic features showed no difference between the two groups. We had 2 in-hospital deaths in the high risk group. CONCLUSION: Great care is needed in patients with esophageal varix and limited liver function during major hepatic resection.
Carcinoma, Hepatocellular ; Esophageal and Gastric Varices ; Hepatectomy ; Humans ; Indocyanine Green ; Liver ; Liver Failure ; Prothrombin ; Retention (Psychology) ; Risk Factors

A 31-year-old male presented with severe back pain and paraparesis. Imaging studies demonstrated an extraosseous, extradural mass without bone invasion at the T11-T12 vertebral level, located dorsal to the thecal sac. The spinal cord was compressed ventrally. The lesion was completely excised after a T11-T12 laminectomy. Histopathological examination revealed a cavernous hemangioma. The patient's symptoms improved after excision of the lesion.
Adult ; Back Pain ; Epidural Neoplasms ; Hemangioma, Cavernous* ; Humans ; Laminectomy ; Male ; Paraparesis ; Spinal Cord ; Thoracic Vertebrae

BACKGROUND AND OBJECTIVES: Patients with metabolic syndrome (MS) have an increased risk of cardiovascular events. However, only limited studies are available on the effect of MS on restenosis and on the clinical outcome of patients undergoing percutaneous coronary intervention (PCI). The aim of this study is to assess the role of MS in the development of restenosis, and risk of a 6-month major adverse cardiac event (MACE) and a 12-month MACE, as well as the difference of outcome between the use of bare metal stents (BMSs) and the use of drug eluting stents (DESs). SUBJECTS AND METHODS: This is a one center, retrospective study. The study population comprised 151 patients undergoing percutaneous coronary intervention (PCI) with BMSs and 200 patients undergoing PCI with DESs. The study population was classified into two groups of patients with MS and patients without MS. RESULTS: The baseline clinical characteristics were similar in the two groups (with or without MS) except for hypertension, diabetes, body mass index, triglyceride level and high-density lipoprotein level. The frequency of in-stent restenosis of the patients that were implanted with BMSs or DESs was not different between two groups, based on a 6 month follow-up quantitative coronary angiographic analysis (BMSs: 30% vs 22.2%, p= 0.352; DES: 3.3% vs 2.2%, p=0.76; for patients with and without MS, respectively). The percent of patients with a 6-month MACE for patients implanted with BMSs was not statistically different for patients with or without MS (30% vs 22.2%, p=0.352) but the percent of patients with a 12-month MACE showed a statistically significant higher level for the MS group (38.6% vs 23.5%, p=0.044). The percent of patients with a 6-month MACE for patients implanted with DESs was also not statistically different between two groups (5.8% vs 1.7%, p= 0.123). CONCLUSION: Patients with MS undergoing BMSs or DESs implantation do not show higher levels of in-stent restenosis and levels of a 6-month MACE. The number of 12-month MACEs of patients implanted with BMSs is statistically higher, but the number of 6-month MACEs of patients implanted with DESs is not different for the MS group. We conclude that MS is not risk factor of in-stent restenosis in PCI but MS may influence the long-term clinical outcome in patients undergoing PCI.
Body Mass Index ; Coronary Restenosis ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Hypertension ; Lipoproteins ; Percutaneous Coronary Intervention* ; Retrospective Studies ; Risk Factors ; Stents ; Triglycerides

Atypical femoral fracture related to a long-term bisphosphonate therapy has commonly been reported; however, a fracture at the site other than the femur has rarely been reported to date. Herein, we report a case of a patient on long-term bisphosphonate therapy who presented atypical tibial insufficiency fracture at the anterolateral aspect of diaphysis, without trauma. We, for the first time in Korea, present this case with a literature review.
Diaphyses ; Femoral Fractures ; Femur ; Fractures, Stress* ; Humans ; Korea ; Tibia*

Partial or complete absence of the posterior arch of the atlas is a well-documented anomaly but a relatively rare condition. This condition is usually asymptomatic so most are diagnosed incidentally. There have been a few documented cases of congenital defects of the posterior arch of the atlas combined with atlantoaxial subluxation. We report a very rare case of congenital anomaly of the atlas combined with atlantoaxial subluxation, that can be misdiagnosed as posterior arch fracture.
Adult ; Cervical Atlas/*abnormalities ; Diagnosis, Differential ; Female ; Humans ; Spinal Diseases/*diagnosis

Totally implanted central venous access devices for chemotherapy (chemoport) are being used increasingly in lung cancer patients. Vascular catheters are associated with various complications including infection, thrombosis as well as spontaneous fractures and embolization of the catheter, which is known as 'pinch-off syndrome'. 'Pinch-off syndrome' refers to the compression of a subclavian central venous catheter between the clavicle and first rib resulting in an intermittent or permanent obstruction, which can lead to tears, transection, or embolization. We report two cases of fractured and embolized implanted subclavian venous catheters in which the fragments were removed percutaneously. A 62-year-old man presented with back pain with a duration of a few weeks. The chest radiograph revealed complete transsection and embolization of the catheter into the right atrium. In addition, a 47-year-old woman with a chemoport had a grade 3 pinch-off sign in a chest radiograph demonstrating complete transsection and embolization of the catheter into the pulmonary artery. Both cases were managed by retrieving the embolized distal fragment percutaneously and removing the proximal section of the catheter.
Back Pain ; Catheters ; Central Venous Catheters ; Clavicle ; Drug Therapy ; Female ; Fractures, Spontaneous ; Heart Atria ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Pulmonary Artery ; Radiography, Thoracic ; Ribs ; Thrombosis ; Vascular Access Devices

BACKGROUND: There are several echocardiographic parameters, such as early transmitral velocity/tissue Doppler mitral annular early diastolic velocity(E/Ea) or deceleration time, reported to be reliable indices to estimate pulmonary capillary wedge pressure(PCWP). Recently, B-type natriuretic peptide(BNP) level is also reported to increase in accordance with increased left ventricular filling pressure in systolic or diastolic heart failure. This study was performed to compare E/Ea and BNP for the ability to estimate PCWP. METHODS: Several echocardiographic Doppler parameters including especially E/Ea were obtained from transthoracic Doppler echocardiography. Simultaneously, serum BNP level and PCWP estimated by using Swan-Ganz catheter were obtained, respectively. RESULTS: E/Ea revealed a correlation of r=0.88 (p<0.001) with PCWP compared with r=0.45 (p<0.001) between BNP and PCWP. E/Ea > or =11 was the optimal cutoff to predict PCWP > or =15 mmHg (sensitivity, 94%; specificity, 90%), whereas the optimal BNP cutoff was > or =250 pg/mL (sensitivity, 52%; specificity, 74%). CONCLUSION: Mitral E/Ea has a better correlation with PCWP than BNP. Mitral E/Ea appears more sensitive and specific than BNP for PCWP > or =15 mmHg in cardiac patients.
Capillaries ; Catheters ; Deceleration ; Echocardiography ; Echocardiography, Doppler* ; Heart Failure, Diastolic ; Humans ; Natriuretic Peptide, Brain* ; Pulmonary Wedge Pressure* ; Sensitivity and Specificity