BACKGROUND: Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. METHODS: We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. RESULTS: We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. CONCLUSION: Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.
Cardiology ; Echocardiography* ; Heart Ventricles ; Korea* ; Reference Values

OBJECTIVE: Computed tomography (CT), rather than conventional 2-dimensional radiography, was used to scan and measure pelvic parameters. The results were compared with measurements using X-ray. METHODS: Pelvic parameters were measured using both CT and X-ray in 254 patients who underwent both abdomino-pelvic CT and X-ray at the pelvic site. We assessed the similarity of the pelvic parameters between the 2 exams, as well as the correlations of pelvic parameters with sex and age. RESULTS: The mean values of the subjects’ pelvic parameters measured on X-ray were: sacral slope (SS), 31.6°; pelvic tilt (PT), 18.6°; and pelvic incidence (PI), 50.2°. The mean values measured on CT were: SS, 35.1°; PT, 11.9°; and PI, 47.0°. PT was found to be 4.07° higher on X-ray and 2.98° higher on CT in women, with these differences being statistically significant (p < 0.001, p < 0.001). PI was 4.10° higher on X-ray and 2.78° higher on CT in women, with these differences also being statistically significant (p < 0.001, p=0.009). We also observed a correlation between age and PI. For men, this correlation coefficient was 0.199 measured using X-ray and 0.184 measured using CT. For women, this correlation coefficient was 0.423 measured using X-ray and 0.372 measured using CT. CONCLUSION: When measured using CT compared to X-ray, SS increased by 3.5°, PT decreased by 6.7°, and PI decreased by 3.2°. There were also statistically significant differences in PT and PI between male and female subjects, while PI was found to increase with age.
Age Factors ; Female ; Humans ; Incidence* ; Male ; Posture* ; Radiography ; Sex Factors

Tetrahydrobiopterin (BH4) is an essential cofactor in NO synthesis by endothelial nitric oxide synthase (eNOS) enzymes. It has been previously suggested that reduced intrahepatic BH4 results in a decrease in intrahepatic NO and contributes to increased hepatic vascular resistance and portal pressure in animal models of cirrhosis. The main aim of the present study was to evaluate the relationship between BH4 and portal hypertension (PHT). One hundred ninety-three consecutive patients with chronic liver disease were included in the study. Liver biopsy, measurement of BH4 and hepatic venous pressure gradient (HVPG) were performed. Hepatic fibrosis was classified using the Laennec fibrosis scoring system. BH4 levels were determined in homogenized liver tissues of patients using a high performance liquid chromatography (HPLC) system. Statistical analysis was performed to evaluate the relationship between BH4 and HVPG, grade of hepatic fibrosis, clinical stage of cirrhosis, Child-Pugh class. A positive relationship between HVPG and hepatic fibrosis grade, clinical stage of cirrhosis and Child-Pugh class was observed. However, the BH4 level showed no significant correlation with HVPG or clinical features of cirrhosis. BH4 concentration in liver tissue has little relation to the severity of portal hypertension in patients with chronic liver disease.
Adult ; Aged ; Biopterin/*analogs & derivatives/analysis ; *Chromatography, High Pressure Liquid ; Chronic Disease ; Elasticity Imaging Techniques ; Female ; Hepatic Veins/physiology ; Humans ; Hypertension, Portal/complications/*diagnosis/metabolism ; Liver/pathology ; Liver Cirrhosis/ultrasonography ; Liver Diseases/complications/*diagnosis/metabolism ; Male ; Middle Aged ; Nitric Oxide/metabolism ; Portal Pressure ; Regression Analysis ; Severity of Illness Index

The mucosal surfaces are constantly exposed to incoming pathogens which can cause infections that result in severe morbidity and/or mortality. Studies have reported that mucosal immunity is important for providing protection against these pathogens and that mucosal vaccination is effective in preventing local infections. For many years, the sublingual mucosa has been targeted to deliver immunotherapy to treat allergic hypersensitivities. However, the potential of vaccine delivery via sublingual mucosal has received little attention until recently. Recent studies exploring such potential have documented the safety and effectiveness of sublingual immunization, demonstrating the ability of sublingual immunization to induce both systemic and mucosal immune responses against a variety of antigens, including soluble proteins, inter particulate antigens, and live-attenuated viruses. This review will summarize the recent findings that address the promising potential of sublingual immunization in proving protection against various mucosal pathogens.
Hypersensitivity ; Immunity, Mucosal ; Immunization ; Immunotherapy ; Mucous Membrane ; Proteins ; Vaccination ; Vaccines

Sump syndrome is a rare late complication of choledochoenteric anastomosis, and this caused by the accumulation of food debris, choledocholithiasis, bile sludge and cholesterol crystals in the distal common bile duct. This syndrome is characterized by symptoms such as abdominal pain and fever. The treatment modality for this syndrome has been surgery in the past. However, endoscopic treatment such as endoscopic sphinterotomy is currently regarded as the primary therapeutic approach for this condition. We experienced a patient with a history of choledochoduodenostomy and who developed sump syndrome as a complication of the surgery. Endoscopic sphinterotomy was performed for treatment, but this only produced the recurrence of the disease. The recurrent sump syndrome was eventually successfully controlled by performing endoscopic papillary balloon dilatation.
Abdominal Pain ; Bile ; Choledocholithiasis ; Choledochostomy ; Cholesterol ; Common Bile Duct ; Dilatation ; Fever ; Humans ; Postcholecystectomy Syndrome ; Recurrence ; Sewage

PURPOSE: Because infants who have been hospitalized in the neonatal intensive care unit (NICU) are usually ill or premature, they are hospitalized repeatedly after their discharge. We intended to survey the frequencies and the medical costs of those rehospitalizations. METHODS: The NICUs of 7 major hospitals were included. The subjects were 3,451 infants that were admitted to the NICU from July 2005 to June 2006, and discharged to home. The frequency, causes, mean cost and distribution and proportion of National Health Insurance coverage and non covered costs were analyzed. RESULTS: The rate of rehospitalization after discharge from the NICU over 1 year was 14.8%. If multiple cases are considered as individual cases, it is 21.7%. The major causes of admission were pneumonia (15.8%), bronchiolitis (14.5%), gastroenteritis (10.4%), urinary tract infection (6.3%) and sepsis (6.3%). The mean cost for each admission was 1,652 thousand won. The mean cost of National Health Insurance coverage was 1,170 thousand won and non covered coat were 472 thousand won 70.9% and 28.6% respectively. CONCLUSION: The ratio of rehospitalization of infants after their discharge from the NICU over 1 year was approximately 20% and it means that follow-up management of these infants is very important and meticulous concerns after discharge should be given. However the rehospitalization and the non-coverage proportion of National Health Insurance cost is considerably high. It strongly implies that National Health Insurance should cover much more proportion, and personal cost exemption should be proceeded in case of rehospitalization of infants after discharge from the NICU.
Bronchiolitis ; Follow-Up Studies ; Gastroenteritis ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; National Health Programs ; Pneumonia ; Sepsis ; Urinary Tract Infections

OBJECTIVE: Residual aneurysm from incomplete clipping or slowly recurrent aneurysm is associated with high risk of subarachnoid hemorrhage. We describe complete treatment of the lesions by surgical clipping or endovascular treatment. METHODS: We analyzed 11 patients of residual or recurrent aneurysms who had undergone surgical clipping from 1998 to 2009. Among them, 5 cases were initially clipped at our hospital. The others were referred from other hospitals after clipping. The radiologic and medical records were retrospectively analyzed. RESULTS: All patients presented with subarachnoid hemorrhage at first time, and the most frequent location of the ruptured residual or recurrent aneurysm was in the anterior communicating artery to posterior-superior direction. Distal anterior cerebral artery, posterior communicating artery, and middle cerebral artery was followed. Repositioning of clipping in eleven cases, and one endovascular treatment were performed. No residual aneurysm was found in postoperative angiography, and no complication was noted in related to the operations. CONCLUSION: These results indicate the importance of postoperative or follow up angiography and that reoperation of residual or slowly recurrent aneurysm should be tried if such lesions being found. Precise evaluation and appropriate planning including endovascular treatment should be performed for complete obliteration of the residual or recurrent aneurysm.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Medical Records ; Middle Cerebral Artery ; Reoperation ; Retrospective Studies ; Subarachnoid Hemorrhage ; Surgical Instruments

Metastases to the heart are rarely diagnosed before the patient dies. A 26-year-old man was admitted with multiple metastasis of a testicular embryonal carcinoma and he was found to have intracardiac metastasis. Echocardiography showed that he had a mass rising from the interventricular septum and it was floating through the right ventricular outflow tract. The histology of the mass we removed from the right ventricle was consistent with testicular embryonal carcinoma. The patient made a smooth recovery after surgical intervention and chemotherapy. We believe this is the first reported case of testicular embryonal carcinoma that metastasized to the heart and that was successfully removed via surgery in Korea.
Adult ; Carcinoma, Embryonal ; Echocardiography ; Heart ; Heart Neoplasms ; Heart Ventricles ; Humans ; Korea ; Neoplasm Metastasis ; Testicular Neoplasms

Wegener's granulomatosis (WG) is a disease characterized by a granulomatous necrotizing vasculitis of small vessels. Although any organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We present a case of 67-year-old man who was admitted with abdominal pain and diarrhea lasting for 3 weeks. Colonoscopy and abdominal CT scan revealed vasculitis and multiple mesenteric lymphadenopathy. Jejunum and mesenteric lymph nodes biopsies confirmed limited form of WG. The present case indicates that WG might involve only gastrointestinal tract and the histological confirmation is important for diagnosis.
Aged ; Anti-Inflammatory Agents/therapeutic use ; Colonoscopy ; Diagnosis, Differential ; Gastroenteritis/complications/*diagnosis ; Humans ; Lymphatic Diseases/complications/*diagnosis/pathology ; Male ; Prednisolone/therapeutic use ; Tomography, X-Ray Computed ; Wegener Granulomatosis/complications/*diagnosis/drug therapy

Wegener's granulomatosis (WG) is a disease characterized by a granulomatous necrotizing vasculitis of small vessels. Although any organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We present a case of 67-year-old man who was admitted with abdominal pain and diarrhea lasting for 3 weeks. Colonoscopy and abdominal CT scan revealed vasculitis and multiple mesenteric lymphadenopathy. Jejunum and mesenteric lymph nodes biopsies confirmed limited form of WG. The present case indicates that WG might involve only gastrointestinal tract and the histological confirmation is important for diagnosis.
Aged ; Anti-Inflammatory Agents/therapeutic use ; Colonoscopy ; Diagnosis, Differential ; Gastroenteritis/complications/*diagnosis ; Humans ; Lymphatic Diseases/complications/*diagnosis/pathology ; Male ; Prednisolone/therapeutic use ; Tomography, X-Ray Computed ; Wegener Granulomatosis/complications/*diagnosis/drug therapy