Objective: This study enrolls diverse hospitals and analyzes the differences in meal provision and nutrition management services for patients with dysphagia. Methods: A nationwide survey was conducted by mail and mobile for 850 medical institutions, and data were collected from 217 hospitals. We analyzed the status of the dysphagia diet and nutrition management by considering the type of hospital. Results: Among the hospitals surveyed, 167 (77%) provided texture-modified diets for dysphagia patients. The status of providing dysphagia diets and nutrition management for dysphagia differed depending on the institution. In particular, nutrition services for dysphagia patients in long-term care hospitals were poor. Difficulties in providing a dysphagia diet included the complexity of the cooking process, difficulty maintaining constant viscosity, difficulty in hygiene management, and low meal bills. Using commercial thickeners in cooking accounted for 72.5%, and only 41.9% of hospitals provided a commercial thickener with meals. Compared to the regular diet, the additional food cost to provide a single dysphagia diet meal was estimated to be 500-1,000 won. Based on a 5-point scale, we determined that the average scores for the importance and performance of nutrition management in patients with dysphagia were 4.29 and 3.19 points, respectively. Regardless of the type of hospital, performances of all the steps in the nutrition care process were significantly lower than their importance. Conclusion Several difficulties are encountered in meal provision and nutrition management for patients with dysphagia, including the burden of expenses and human resources. Thus, the medical fees for a dysphagia diet need to be reasonably increased. Moreover, national health insurance should additionally cover nutrition education for dysphagia patients.

Hypertrophic cardiomyopathy (HCM) has diverse pathophysiological and clinical features, according to the extent and severity of the hypertrophy development. Hypertrophy mostly involves the left ventricle and sometimes causes a left ventricular outflow tract obstruction. Right ventricular involvement is less frequent, and even the severe form of a right ventricular outflow tract (RVOT) obstruction by concurrent right ventricular hypertrophy in a patient with HCM is rare. We report a case of biventricular HCM with a clinically, morphologically, and hemodynamically significant RVOT obstruction, which had been treated successfully with surgical myectomy.
Cardiomyopathy, Hypertrophic ; Heart Ventricles ; Humans ; Hypertrophy ; Hypertrophy, Right Ventricular

Hypertrophic cardiomyopathy (HCM) has diverse pathophysiological and clinical features, according to the extent and severity of the hypertrophy development. Hypertrophy mostly involves the left ventricle and sometimes causes a left ventricular outflow tract obstruction. Right ventricular involvement is less frequent, and even the severe form of a right ventricular outflow tract (RVOT) obstruction by concurrent right ventricular hypertrophy in a patient with HCM is rare. We report a case of biventricular HCM with a clinically, morphologically, and hemodynamically significant RVOT obstruction, which had been treated successfully with surgical myectomy.

BACKGROUND: Cefcapene pivoxil hydrochloride (CFPN-PI) is an oral ester cephalosporin antibiotic with a broad spectrum. In this study, we investigated the pharmacokinetics (PK) and tolerability of CFPN-PI following single oral administration in healthy Korean subjects. METHODS: An open label, dose escalation, parallel group study was conducted in 18 healthy male volunteers. A single dose of CFPN-PI was administered to 6 subjects in each treatment group of 100, 150 and 200 mg. Serial blood and urine samples were collected up to 12 h and 24 h after dosing, respectively. Plasma and urine concentrations of cefcapene were measured by HPLC-UV. PK parameters were estimated using non-compartmental analysis. For the safety evaluation, adverse event monitoring, clinical laboratory tests and physical examination were performed throughout the study. RESULTS: Median values of time to peak plasma concentration were observed around 1.5 to 2.0 h. Maximum plasma concentrations (Cmax) were 1.04 +/- 0.22, 1.24 +/- 0.46 and 1.56 +/- 0.43 mg/L (mean +/- SD), and area under the plasma concentration time curve (AUCinf) were 2.94 +/- 0.46, 3.97 +/- 1.28 and 4.70 +/- 1.19 h*mg/L in 100, 150 and 200 mg dose groups, respectively. The differences of dose normalized Cmax and AUCinf among three groups were not statistically significant. The fractions of drug excreted in urine unchanged were 31.5 % - 42.9 %. There were no serious adverse events or clinically significant abnormalities related to CFPN-PI. CONCLUSION: CFPN-PI was well tolerated with single oral administration and showed a linear PK property within 100 - 200 mg in healthy Korean male subjects.
Administration, Oral* ; Humans ; Male ; Pharmacokinetics ; Physical Examination ; Plasma

A 27-year-old man with bacterial endocarditis of the mitral valve and embolic episodes was bound to have a large right coronary artery fistula communicating with the left ventricle, immediately inferior to the posterior mitral annulus. The perforation of the posterior leaflet and coronary arteriovenous fistula was identified using two-dimensional Doppler echocardiography. The diagnosis was confirmed by coronary angiography, and the patient underwent a successful operation.
Arteriovenous Fistula ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels ; Echocardiography, Doppler ; Endocarditis ; Endocarditis, Bacterial ; Fistula ; Heart Ventricles ; Humans ; Mitral Valve

The presence of severe pulmonary arterial hypertension (PAH) in patients with atrial septal defect (ASD) is still thought to preclude shunt closure, although there are several reports of good clinical outcomes after vasodilator therapy. We report the case of a young woman with ASD and severe PAH who was able to successfully undergo percutaneous shunt closure following 1 year use of the oral endothelin receptor antagonist, bosentan.
Female ; Heart Septal Defects, Atrial* ; Humans ; Hypertension, Pulmonary* ; Receptors, Endothelin* ; Sulfonamides

A subaortic membrane is an uncommon cause for left ventricular outflow tract obstruction. Hypertrophic cardiomyopathy with dynamic left ventricular outflow tract obstruction would mask the presence of the subaortic membrane on transthoracic echocardiography and cause a false diagnosis. We report a patient with subaortic stenosis due to flail subaortic membrane misdiagnosed as obstructive hypertrophic cardiomyopathy on transthoracic echocardiography, identified on transesophageal echocardiography and cardiac catheterization.
Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic ; Constriction, Pathologic ; Echocardiography ; Echocardiography, Transesophageal ; Humans ; Masks ; Membranes

BACKGROUND AND OBJECTIVES: Arterial stiffness is well known as an important risk factor for cardiovascular disease. At our institution, we assessed the association between arterial stiffness, as determined by brachial ankle pulse wave velocity (baPWV), and the extent of coronary artery disease (CAD), as detected by conventional coronary angiography (CAG) in patients who visited the outpatient clinic for angina without any previous history of heart disease. In addition, we evaluated if the level of baPWV could predict the revascularization as a clinical outcome. SUBJECTS AND METHODS: On a retrospective basis, we analyzed the data of 651 consecutive patients who had undergone baPWV and elective CAG for suspected CAD between June 2010 and July 2011, at a single cardiovascular center. RESULTS: The baPWV was one of the statistically meaningful predictors of significant CAD (diameter of stenosis >50%) in addition to male gender, age, the level of high density lipoprotein-cholesterol, and hemoglobin A1c in multivariate analysis. However, baPWV was not the significant predictor of revascularization. When the extent of CAD was classified into following 4 groups; no significant CAD, 1-, 2- and 3-vessel disease, there was significant difference of baPWV between the significant and non-significant CAD group, but there was no difference of baPWV among the 3 significant CAD groups, although there was a trend toward the positive correlation. CONCLUSION: Although baPWV was an independent predictor of significant CAD, it was neither associated significantly with the extent of CAD nor with the risk of revascularization. Therefore, baPWV has a limited value for portending the severity of CAD in patients with chest pain.
Ambulatory Care Facilities ; Animals ; Ankle ; Atherosclerosis ; Cardiovascular Diseases ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Heart Diseases ; Hemoglobins ; Humans ; Male ; Multivariate Analysis ; Pulse Wave Analysis ; Retrospective Studies ; Risk Factors ; Vascular Stiffness

The anomalous origin of the right coronary artery (RCA) is a rare condition. Most RCA anomalies are usually found incidentally, but these findings have clinical significance because many patients, particularly young ones, present with sudden death, myocardial ischemia and syncope without other symptoms. We describe a case of a 39-year-old male patient that presented with effort chest pain and was diagnosed with anomalous RCA that originated from the ascending aorta with prior history of repairing ruptured sinus valsalva and ventricular septal defect. The anomalous origin of RCA was identified by multidetector computed tomography (MDCT). Successful percutaneous coronary intervention was performed guided by MDCT coronary images and intravascular ultrasound.
Adult ; Angioplasty ; Aorta ; Chest Pain ; Coronary Vessel Anomalies ; Coronary Vessels ; Death, Sudden ; Heart Septal Defects, Ventricular ; Humans ; Male ; Multidetector Computed Tomography ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Syncope

BACKGROUND AND OBJECTIVES: The comparison of long-term clinical effects between Sirolimus-eluting stent (SES) and Paclitaxel-eluting stents (PES) for treatment of acute myocardial infarction (AMI) remains unclear. Seeking to clarify this issue, we performed a retrospective analysis to evaluate four-year clinical outcomes of SES compared to PES treated AMI patients. SUBJECTS AND METHODS: From January 2004 to August 2006, all patients with acute ST-segment elevation myocardial infarction and acute non-ST segment elevation myocardial infarction who underwent percutaneous coronary intervention (PCI) by implantation of either SES or PES were enrolled. The occurrences of cardiac and non-cardiac deaths, recurrent infarction, target vessel revascularization (TVR) and stent thrombosis were analyzed. The composite end points of these major adverse cardiac events (MACE) were also analyzed. RESULTS: During the study period, a total of 668 AMI patients had visited, of which 522 patients (299 with SES and 223 with PES) were enrolled. During the four-year clinical follow-up, both groups showed similar occurrences of non-cardiac death (14.6+/-2.2% vs. 18.3+/-3.0%, p=0.26); cardiac death (6.8+/-1.52% vs. 11.2+/-2.6%, p=0.39); re-infarction (3.3+/-1.1% vs. 6.4+/-1.8%, p=0.31); and stent thrombosis (3.2+/-1.1% vs. 5.4+/-1.7%, p=0.53). However, occurrences of TVR {4.0+/-1.2% vs. 10.0+/-3.0%, hazard ratio (HR)=0.498, 95% confidence interval (CI)=0.257-0.967, p=0.039} and MACE (19.4+/-2.5% vs. 29.4+/-3.5%, HR=0.645, 95% CI=0.443-0.940, p=0.021) were significantly lower in the SES population. CONCLUSION: In AMI patients treated with either SES or PES implantation, the former had a significantly lower risk of TVR and MACE during four-year clinical follow-up. Rates of death, cardiac death or recurrent infarction, and stent thrombosis were similar.
Death ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Infarction ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Retrospective Studies ; Stents ; Thrombosis