BACKGROUND AND OBJECTIVES: Intermediate coronary lesion that can be under- or over-estimated by visual estimation frequently results in stenting of functionally nonsignificant lesions or deferral of percutaneous coronary intervention (PCI) of significant lesions inappropriately. We evaluated current status of PCI for intermediate lesions from a standardized database in Korea. METHODS: We analyzed the Korean percutaneous coronary intervention (K-PCI) registry data which collected a standardized PCI database of the participating hospitals throughout the country from January 1, 2014, through December 31, 2014. Intermediate lesion was defined as a luminal narrowing between 50% and 70% by visual estimation and then compared whether the invasive physiologic or imaging study was performed or not. RESULTS: Physiology-guided PCI for intermediate lesions was performed in 16.8% for left anterior descending artery (LAD), 9.8% for left circumflex artery (LCX), 13.2% for right coronary artery (RCA). PCI was more frequently performed using intravascular ultrasound (IVUS) than using fractional flow reserve (FFR) for coronary artery segments (27.7% vs. 13.9% for LAD, 32.9% vs. 8.1% for LCX, and 33.8% vs. 10.8% for RCA). In accordance with or without FFR, PCI for intermediate lesions was more frequently performed in the hospitals with available FFR device than without FFR, especially in left main artery (LM), proximal LAD lesion (40.9% vs. 5.9% for LM, 24.6% vs 7.6% for proximal LAD). CONCLUSIONS: These data provide the current PCI practice pattern with the use of FFR and IVUS in intermediate lesion. More common use of FFR for intermediate lesion should be encouraged.
Arteries ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Fractional Flow Reserve, Myocardial ; Korea ; Percutaneous Coronary Intervention ; Phenobarbital ; Stents ; Ultrasonography

BACKGROUND AND OBJECTIVES: Intermediate coronary lesion that can be under- or over-estimated by visual estimation frequently results in stenting of functionally nonsignificant lesions or deferral of percutaneous coronary intervention (PCI) of significant lesions inappropriately. We evaluated current status of PCI for intermediate lesions from a standardized database in Korea. METHODS: We analyzed the Korean percutaneous coronary intervention (K-PCI) registry data which collected a standardized PCI database of the participating hospitals throughout the country from January 1, 2014, through December 31, 2014. Intermediate lesion was defined as a luminal narrowing between 50% and 70% by visual estimation and then compared whether the invasive physiologic or imaging study was performed or not. RESULTS: Physiology-guided PCI for intermediate lesions was performed in 16.8% for left anterior descending artery (LAD), 9.8% for left circumflex artery (LCX), 13.2% for right coronary artery (RCA). PCI was more frequently performed using intravascular ultrasound (IVUS) than using fractional flow reserve (FFR) for coronary artery segments (27.7% vs. 13.9% for LAD, 32.9% vs. 8.1% for LCX, and 33.8% vs. 10.8% for RCA). In accordance with or without FFR, PCI for intermediate lesions was more frequently performed in the hospitals with available FFR device than without FFR, especially in left main artery (LM), proximal LAD lesion (40.9% vs. 5.9% for LM, 24.6% vs 7.6% for proximal LAD). CONCLUSIONS These data provide the current PCI practice pattern with the use of FFR and IVUS in intermediate lesion. More common use of FFR for intermediate lesion should be encouraged.

PURPOSE: The purpose of this study is to evaluate the minimum eight-year follow up results of primary total hip arthroplasty (THA) performed using an alumina sandwich liner and the third Zweymuller stem. MATERIALS AND METHODS: A total of 86 patients (107 hips) who underwent a THA with alumina sandwich liners and the third Zweymuller stems from July 2001 to December 2003 were analyzed. Mean age of patients at the time of THA was 50.8 years (range, 17-77 years) and the mean follow-up period was 112 months (range, 98-127 months). Clinical evaluation was performed using the Harris hip score and level of thigh pain. The radiographic evaluation was performed in terms of the radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: At the final follow-up, mean Harris hip score had improved from 57.8 points to 91.9 points. Radiolucent line was observed at Gruen zone 1 in 40 cases (37%) and at zone 7 in 35 cases (33%); however, no detectable loosening was observed. There were six cases (5.6%) of fracture of the ceramic liner, one case of ceramic liner dissociation, and one case of stem loosening due to infection. CONCLUSION: At the minimum eight-year follow up, survival rate of the third Zweymuller stem was 99.1%. However, owing to the high rate of fractures of the ceramic sandwich liners, the survival rate of the ceramic liner was 93.5%.
Acetabulum ; Aluminum Oxide ; Arthroplasty, Replacement, Hip* ; Ceramics* ; Follow-Up Studies* ; Hip ; Humans ; Survival Rate ; Thigh

BACKGROUND/AIMS: It has been known that elderly patients with gastric cancer show worse general condition and higher comorbidities. Therefore, few elderly patients undergo surgery. This study was designed to determine clinicopathological characteristics of gastric cancer in elderly patients and evaluate their survival improvements by the surgical treatment. METHODS: Gastric cancer patients, diagnosed at Ewha Womans University Mokdong Hospital between 2000 to 2004, were divided into two groups those aged > or =65 years vs. <65 years. Clinicopathological characteristics, incidence of postoperative complications, and survival time of patients in each group were analyzed. RESULTS: Total 370 patients were subjected and divided into the elderly and the younger group (55.4% vs. 44.6%). The elderly group showed higher incidences of hypertension and cardiovascular disease. Well differentiated adenocarcinoma was more frequently found in the elderly group (19.0% vs. 10.0%, p=0.025). There were no differences of operation time (242.6+/-70.7 vs. 257.3+/-83.8 min, p=0.115), postoperative hospital stays (15.8+/-10.6 vs. 14.7+/-9.8 days, p=0.361), and incidence of any complications (6.7% vs. 9.9%, p=0.309) between the two subgroups. The significant factors related with the elderly patient's survival were the tumor-node-metastasis (TNM) stage (stage I, hazard ratio [HR] 1.00; stage II, HR 1.28, 95% confidence interval [CI] 0.44-3.72; stage III, HR 4.06, 95% CI 2.08-7.92, stage IV, HR 9.78, 95% CI 4.97-19.26;p<0.001) and the treatment modality (laparoscopy, HR 1.00; open surgery, HR 3.90, 95% CI 2.43-6.26;p<0.001). The elderly patients who underwent gastric cancer surgery showed prolonged survival on TNM stage I, II, and III than those who were treated conservatively. CONCLUSIONS: In the elderly patients with gastric cancer, those who had received surgical treatments showed significantly higher survival rate than those who had treated conservatively. Therefore, aggressive surgical treatments should be seriously considered even for the elderly patients with gastric cancer.
Adenocarcinoma/mortality/*pathology/surgery ; Adult ; Aged, 80 and over ; *Aging ; Carcinoembryonic Antigen/analysis ; Cardiovascular Diseases/complications/epidemiology ; Female ; Humans ; Hypertension/complications/epidemiology ; Kaplan-Meier Estimate ; Length of Stay ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms/mortality/*pathology/surgery

BACKGROUND AND OBJECTIVES: The goal of this study was to compare the outcome between cervical vestibular-evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) in the patients with definite vestibular dysfunction. Also, the subjective discomfort level was compared between cVEMP, classic oVEMP and head positioned oVEMP (a new method designed by the authors). MATERIALS AND METHODS: Eighteen patients with dizziness associated with unilateral vestibular hypofunction were included in this study. Vestibular neuritis, Ramsay-hunt syndrome and sudden sensorineural hearing loss with vertigo were included in unilateral vestibular hypofunction disease. cVEMP, classic oVEMP, and head positioned oVEMP were assessed and compared. To compare the subjective discomfort during the tests, visual analogue scale on discomfort was checked. RESULTS: There was a discrepancy between the cVEMP and classic oVEMP in 31.3% of the cases. The classic oVEMP were associated with more discomfort than the cVEMP. But, there was no difference between the classic and head positioned oVEMP. CONCLUSION: Since a substantial discrepancy was identified between the cVEMP and oVEMP, the pathways involved in cVEMP and oVEMP are likely different even with the same air conduction tone stimuli. The head positioned oVEMP may be an alternative to the classic oVEMP which has similar results and subjective discomfort levels.
Dizziness ; Head ; Hearing Loss, Sensorineural ; Humans ; Vertigo ; Vestibular Evoked Myogenic Potentials ; Vestibular Neuronitis

Although bizarre parosteal osteochondromatous proliferation does not frequently occur, this calcified, osteal, chondromatous tumor has relatively high recurrence rates and presents clinical, radiological, histological features that can be classified with other lesions. And it is a benign disease that until now, there were no death or metastasis reports because of this tumor. This proliferation is hard to distinguish between other benign tumors and non-neoplastic lesions if it is occurred in small bone of hand or foot. We experienced bizarre parosteal osteochondromatous proliferation of middle phalanx of the little finger, and report this case and the review of relevant literature.
Fingers ; Foot ; Hand ; Neoplasm Metastasis ; Recurrence

BACKGROUND AND OBJECTIVES Subject visual vertical (SVV) and subject visual horizontal (SVH) is well known otolith function test. Patients with acute unilateral vestibular weakness fail to set the test bar within normal range in SVH/SVV showing abnormal deviation toward lesion side. In some cases, SVH and SVV are deviated towards different directions, and analysis of these findings is rarely reported. The authors analyzed correlation of SVH/SVV and other vestibular function tests in patients with various vestibular diseases. MATERIALS AND METHODS From April 2005 to July 2007, total 234 patients who had admitted for dizziness were enrolled. All patients were divided in two groups, non-dissociation group (n=215) and dissociation group (n=19). Correlation of SVH, SVV, Videonystagmography (VNG), the rotating chair test was compared. RESULTS 8.1% of patients showed dissociation between SVH and SVV. Clinical features did not showed significant difference between groups. In non-dissociation group, SVH/SVV showed correlation with VNG, rotating chair test. However in dissociation group, VNG and rotating chair test revealed high rate of consistency with deviation of SVH than that of SVV. Also direction of SVH and dizziness had higher consistency (88.9%) than that of SVV (11.1%). CONCLUSION The SVH showed consistency with other vestibular function test and may be more reliable than SVV when the result is dissociated.
Dissociative Disorders ; Dizziness ; Humans ; Otolithic Membrane ; Reference Values ; Vestibular Diseases ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: Distal filter devices (DFDs) are known to reduce the occurrence of embolic events by capturing embolic debris and thereby preventing intracranial embolization during carotid artery stenting (CAS). However, there are few reports addressing DFD use in CAS procedures. Therefore, we evaluated the technical feasibility and clinical outcomes associated with DFD use in all CAS procedures. SUBJECTS AND METHODS: Between June 2004 and June 2008, all CAS procedures performed at our center were completed with DFD protection. We recorded periprocedural data and watched for new neurologic abnormalities for 24 hours after the procedure. One-month clinical outcomes were also evaluated. RESULTS: A total of 100 carotid lesions in 94 patients (age 68+/-8 years; 79 men) were treated with percutaneous stenting using DFDs (FilterWire EZ(TM), Boston Scientific Co, US). DFD application was successful in all procedures. Periprocedural strokes occurred in five procedures (one major, one minor, and three transient ischemic attacks). The one-month rates of stroke and death were 6% and 2%, respectively. Difficult filter placement occurred in two procedures due to tight stenosis and severe common carotid artery (CCA)-to-internal carotid artery (ICA) angulation. Difficult stent delivery occurred in three instances: one due to severe lesion calcification and two due to proximal tortuosity. The retriever failed to acquire the filter in nine procedures. Four of nine retrieval difficulties were related to severe CCA-ICA angulation. CONCLUSION: DFD use was successful in all CAS procedures, was relatively safe, and had few periprocedural complications.
Boston ; Carotid Arteries ; Carotid Artery, Common ; Constriction, Pathologic ; Dapsone ; Humans ; Protective Devices ; Stents ; Stroke

Spontaneous and post-traumatic renal intracystic hemorrhages are extremely rare, but are a potential danger to patients with cystic kidney disease. We report two cases of post-traumatic intracystic massive hemorrhage in renal cysts. One patient was a 27-year-old male who presented with left flank pain and gross hematuria after slipping on the stairs 2 days previously. The other patient was a 58-year-old male who presented with back pain due to an accident. The circulatory states of the two patients were deteriorated and renal intracystic hemorrhages were detected on computed tomography. One patient underwent a simple nephrectomy and the other patient was treated with arterial embolization. We present two cases of renal intracystic hemorrhage, emphasizing early diagnosis and the treatment of choice.
Male ; Humans ; Cysts