A Morel-Lavallée lesion is a posttraumatic, closed internal degloving injury caused by shearing force abruptly separating the skin and superficial fascia from the deep fascia and creating a potential space. Blood, lymphatic fluid, and debris collect and fill the space. The most commonly affected sites are the thigh, knee, hip, and pelvic area, but the lesion can occur anywhere in the body. Among various treatments, surgical procedure is a good option if the lesion is chronic and a thick peripheral capsule has developed. We report an uncommon case of a chronic Morel-Lavallée lesion in the sacrococcygeal area, a rarely reported location, with an associated coccygeal fracture and dislocation.
Coccyx ; Dislocations ; Fascia ; Hip ; Knee ; Skin ; Subcutaneous Tissue ; Thigh

BACKGROUND: Arsenic is a carcinogenic heavy metal that has a species-dependent health effects and abandoned metal mines are a source of significant arsenic exposure. Therefore, the aims of this study were to analyze urinary arsenic species and their concentration in residents living near abandoned metal mines and to monitor the environmental health effects of abandoned metal mines in Korea. METHODS: This study was performed in 2014 to assess urinary arsenic excretion patterns of residents living near abandoned metal mines in South Korea. Demographic data such as gender, age, mine working history, period of residency, dietary patterns, smoking and alcohol use, and type of potable water consumed were obtaining using a questionnaire. Informed consent was also obtained from all study subjects (n = 119). Urinary arsenic species were quantified using high performance liquid chromatography (HPLC) and inductively coupled plasma mass spectrometry (ICP/MS). RESULTS: The geometric mean of urinary arsenic (sum of dimethylarsinic acid, monomethylarsonic acid, As3+, and As5+) concentration was determined to be 131.98 μg/L (geometric mean; 95% CI, 116.72–149.23) while urinary inorganic arsenic (As3+ and As5+) concentration was 0.81 μg/L (95% CI, 0.53–1.23). 66.3% (n = 79) and 21.8% (n = 26) of these samples exceeded ATSDR reference values for urinary arsenic (>100 μg/L) and inorganic arsenic (>10 μg/L), respectively. Mean urinary arsenic concentrations (geometric mean, GM) were higher in women then in men, and increased with age. Of the five regions evaluated, while four regions had inorganic arsenic concentrations less than 0.40 μg/L, one region showed a significantly higher concentration (GM 15.48 μg/L; 95% CI, 7.51–31.91) which investigates further studies to identify etiological factors. CONCLUSION: We propose that the observed elevation in urinary arsenic concentration in residents living near abandoned metal mines may be due to environmental contamination from the abandoned metal mine. TRIAL REGISTRATION: Not Applicable (We do not have health care intervention on human participants).
Arsenic* ; Cacodylic Acid ; Chromatography, Liquid ; Delivery of Health Care ; Drinking Water ; Environmental Health ; Female ; Humans ; Informed Consent ; Internship and Residency ; Korea* ; Male ; Mass Spectrometry ; Plasma ; Reference Values ; Smoke ; Smoking

This study compared two-stent strategies for treatment of bifurcation lesions by stenting order, 'main across side first (A-family)' vs 'side branch first (S-family). The study population was patients from 16 centers in Korea who underwent drug eluting stent implantation with two-stent strategy (A-family:109, S-family:140 patients). The endpoints were cardiac death, myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularization (TLR) during 3 years. During 440.8 person-years (median 20.2 months), there was 1 cardiac death, 4 MIs (including 2 STs), and 12 TLRs. Cumulative incidence of cardiac death, MI and ST was lower in A-family (0% in A-family vs 4.9% in S-family, P = 0.045). However, TLR rates were not different between the two groups (7.1% vs 6.2%, P = 0.682). Final kissing inflation (FKI) was a predictor of the hard-endpoint (hazard ratio 0.061; 95% CI 0.007-0.547, P = 0.013), but was not a predictor of TLR. The incidence of hard-endpoint of S-family with FKI was comparable to A-family, whereas S-family without FKI showed the poorest prognosis (1.1% vs 15.9%, retrospectively; P = 0.011). In conclusion, 'A-family' seems preferable to 'S-family' if both approaches are feasible. When two-stent strategy is used, every effort should be made to perform FKI, especially in 'S-family'.
Aged ; Angioplasty, Balloon, Coronary/*methods ; Coronary Stenosis/surgery/*therapy ; Death, Sudden, Cardiac/etiology ; *Drug-Eluting Stents ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/etiology ; Myocardial Revascularization ; Thrombosis/etiology

Coronary arteriovenous malformation (AVM) is a rare congenital coronary anomaly. We report a 60 year-old woman with variant angina and coronary AVM. She presented with recurrent chest pain at rest but there were no significant cardiovascular risk factors. Baseline coronary angiography showed the AVM which originated from first diagonal branch. Acetylcholine (Ach) provocation test was performed at left anterior descending artery (LAD) to induce coronary spasm. Ach 50 microgram injection induced severe diffuse spasm at LAD with typical chest pain. We confirmed that this patient has variant angina with AV malformation.
Acetylcholine ; Arteries ; Arteriovenous Malformations* ; Chest Pain ; Coronary Angiography ; Female ; Humans ; Middle Aged ; Risk Factors ; Spasm

BACKGROUND AND OBJECTIVES: Compliance to a prescribed antihypertensive regimen influences the management of hypertension in various steps, but studies on this issue are very rare in Korea. The medication event monitoring system (MEMS) is the gold standard in measurement of compliance, which is a special pill container, designed to electronically monitor drug intake patterns. Here, the authors investigated the compliance to the antihypertensive regimen in the cardiology practice of a tertiary care hospital using the MEMS. SUBJECTS AND METHODS: Monitoring using the MEMS was performed in 80 hypertensive patients during monotherapy. Demographic, clinical and psychological profiles were collected through a standardized questionnaire. The parameters used for compliance were the percentage of doses taken (PDT) and the percentage of doses taken correctly (PDTc), according to the prescribed regimen. RESULTS: The mean age of the patients and duration of monitoring were 53+/-10 years and 60+/-26 days, respectively. The median and range for the PDT and PDTc were 97% (88-100%) and 92% (80-97%), respectively. About 16% of patients showed relatively poor compliance (PDT<80%). Predicting factors for poor compliance were a recent history of self-discontinuation of drug treatment, not currently being on medication and a young age (p<0.05). Agreement between intuitive prediction by the physician and the actual compliance was closer to what would be expected by chance (kappa coefficient=-0.11). CONCLUSION: Although average compliance to the single drug antihypertensive regimen was relatively high in the cardiology practice of the tertiary care hospital in this study, a significant proportion of patients show low compliance. Special consideration should be given to patients with factors predictive of poor compliance. Investigation of compliances in other clinical settings is also warranted.
Cardiology ; Compliance* ; Drug Therapy ; Humans ; Hypertension ; Korea ; Micro-Electrical-Mechanical Systems ; Patient Compliance ; Tertiary Healthcare ; Surveys and Questionnaires

BACKGROUND AND OBJECTIVES: Coronary artery perforation is a rare, but potentially deadly, complication of percutaneous coronary intervention (PCI). The purpose of this study was to analyze the clinical characteristics, and outcome, of coronary artery perforation. SUBJECTS AND METHODS: We retrospectively reviewed 3,782 consecutive PCIs, performed between January, 1994 and May, 2002 at the Samsung Medical Center, from the database records. The medical records and angiograms of the patients were also reviewed. The coronary artery perforations were classified according to Ellis' classification. RESULTS: A coronary artery perforation was noted in 24 patients (0.6%). It was most commonly observed during PCI of the right coronary artery (46%) and a chronic total occlusion intervention (42%). The number of the patients with Ellis'classes I, II and III were 11, 8 and 5, respectively. The most frequent causes of the perforation were guidewire, followed by balloon (11 and 8 cases, respectively). The interventional modality with the highest risk of perforation in this study was rotational atherectomy, (4 out of 157, 2.6%). Five patients had cardiac tamponade, of which four occurred during a rotablator procedure. Pericardiocentesis was performed in 5 patients, while 3 patients with class III perforations received emergent coronary artery bypass surgery. There were no in-hospital mortalities, although the duration of the hospital stay for the class III patients was longer than those with classes I or II perforations. CONCLUSION: A coronary artery perforation during percutaneous coronary intervention is a potentially serious complication. However, the immediate and adequate management results in a fairly good prognosis.
Atherectomy, Coronary ; Cardiac Tamponade ; Classification ; Coronary Artery Bypass ; Coronary Disease ; Coronary Vessels* ; Hospital Mortality ; Humans ; Length of Stay ; Medical Records ; Percutaneous Coronary Intervention* ; Pericardiocentesis ; Prognosis ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Idiopathic dilated cardiomyopathy (IDC) is a disease entity with no known specific curative measures. However, significant improvement in the left ventricular (LV) systolic function, during the management course for IDC, is frequently observed. In this study we tried to ascertain associated factors for the improvement of the LV function in patients with IDC. SUBJECTS AND METHODS: Thirty-three patients, newly diagnosed as IDC between Jan. 1999 and Jan. 2001, on whom a 6-month follow-up echocardiography was performed, were included in the study. Improvement in the LV systolic function was defined as an increase in the LV ejection fraction greater than 10% from the baseline. The subjects were divided into two groups; the improved group (IG) and the unimproved group (UG). The clinical characteristics and management methods were evaluated, and compared between the two groups. RESULTS: Seventeen patients (M/F:15/2) were included in the IG, and 16 (M/F:7/9) were included in the UG. There were no significant differences in the baseline LV systolic function (IG:23.4+/-1.5% vs. UG:28.9+/-2.3%), age, NYHA functional class or resting heart rate on admission between the two groups. b-blocker therapy (p=0.002), the absence of diabetes mellitus (p=0.046) and male sex (p=0.007), were all significantly associated with an improvement in the LV systolic function from the univariate analyses. With the multivariate analyses, only b-blocker therapy was significantly associated with an improvement in the LV systolic function. The 6-month event-free survival rate was significantly better in the IG compared with UG (94+/-5% vs. 63+/-13%, p=0.031). CONCLUSION: b-blocker therapy exerts a considerable effecs on the improvement in the LV systolic function of patients with IDC.
Adrenergic beta-Antagonists ; Cardiomyopathy, Dilated* ; Diabetes Mellitus ; Disease-Free Survival ; Echocardiography ; Follow-Up Studies ; Heart Failure ; Heart Rate ; Humans ; Male ; Multivariate Analysis

BACKGROUND AND OBJECTIVES: The so-called 'stress-induced cardiomyopathy' or takotsubo cardiomyopathy, mimicking acute myocardial infarction (AMI), has recently been reported, particularly in Japan. We prospectively studied the clinical characteristics of, for the first time with a Korean series, this novel syndrome. SUBJECTS AND METHODS: Eighteen patients, fore filling the inclusion criteria, were entered onto the study. The criteria for inclusion were: 1) no previous history of cardiac disease, 2) acute onset, 3) a regional wall motion abnormality in the left ventriculogram, typically in the apical segment, and 4) no significant stenosis in the coronary angiogram. RESULTS: The events preceding the condition included: emotional stress (N=7), acute illness (N=5), non-cardiac surgery or medical procedure (N=4) and accident (N=2). Chest pain, dyspnea, or nausea/vomiting were initially noted in 12 cases (66%). Pulmonary edema was demonstrated in 10 (56%), and cardiogenic shock in 4 (23%) of the patients. The peak creatinine kinase MB fraction was 69+/-136 IU/L. A T wave inversion was noted in all patients, whereas, a Q wave was noted transiently in only 1. The average left ventricular ejection fraction (LVEF) was 38+/-8% on the initial echocardiograms. On the left ventriculograms, 15 patients showed akinetic wall motion, or aneurysmal dilatation in the apical wall, however, notably in 3 patients in the mid-ventricular wall. The coronary vasospasm provocation tests were negative in all 10 patients tested. An intravascular ultrasonography showed no infarct-related plaques in the 4 patients examined. On a follow-up echocardiogram, the average LVEF was improved to 51+/-8%, and regional wall motion was normalized after 30+/-29 days following onset. CONCLUSION: We report, for the first time in a series of Korean patients, on a novel stress-induced cardiomyopathy with transient regional wall motion abnormality, mimicking AMI. The precise etiology remains to be elucidated in further studies.
Aneurysm ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Chest Pain ; Constriction, Pathologic ; Coronary Vasospasm ; Creatinine ; Dilatation ; Dyspnea ; Follow-Up Studies ; Heart Diseases ; Humans ; Japan ; Myocardial Infarction* ; Myocardial Stunning ; Phosphotransferases ; Prospective Studies* ; Pulmonary Edema ; Shock, Cardiogenic ; Stress, Psychological ; Stroke Volume ; Takotsubo Cardiomyopathy ; Ultrasonography, Interventional

BACKGROUND AND OBJECTIVES: The causes of vasospastic angina are not well known. We attempted to elucidate the risk profiles of Korean patients with vasospastic angina. SUBJECTS AND METHODS: The risk profiles were analyzed in 181 patients with vasospastic angina (VA), 1533 patients with obstructive coronary artery disease (CAD) who underwent coronary angiography at Samsung Seoul Hospital, and 455 normal control subjects, sex and age matched to the VA group and selected from the Health Promotion Center of Samsung Seoul Hospital. The male to female ratio was significantly higher in the VA group (4.6:1) than the obstructive CAD group (2.7:1). The mean age of the VA group (52.2+/-10.7 years) was significantly younger than the mean age of the obstructive CAD group (59.0+/-10.6 years) (p<0.01). Additionally, the smoking rate was significantly higher in the VA group (49.2%) as compared with the obstructive CAD group (43.1%) (p<0.01). Other major risk factors such as hyperlipidemia, hypertension and diabetes mellitus were significantly more prevalent in the obstructive CAD group than the VA group. Among the obstructive CAD group, a subgroup of Q-wave myocardial infarction (MI) showed a significantly higher smoking rate (59.3%) as compared with VA group (49.2%) (p<0.01). CONCLUSION: The VA group showed a higher prevalence in males and younger subjects as compared with the obstructive CAD group, and smoking appeared to be the most important risk factor for VA.
Angina Pectoris, Variant ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; Coronary Vasospasm ; Diabetes Mellitus ; Female ; Health Promotion ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Myocardial Infarction ; Prevalence ; Risk Factors* ; Seoul ; Smoke ; Smoking

BACKGROUND AND OBJECTIVES: Climacteric women often suffer from vasomotor symptoms. These symptoms are thought to be related to an imbalance of autonomic control of the cardiovascular system and are effectively controlled with hormonal replacement therapy. Heart rate variability (HRV) reflects the autonomic integration of the cardiovascular system. In this study, we attempted to compare the HRV indices of postmenopausal women before and after hormonal replacement therapy. SUBJECTS AND METHODS: Eighteen patients with postmenopausal syndrome (mean age:53+/-4 years) received estrogen and/or progesterone replacement therapy. They underwent 24-hour ambulatory electrocardiographic monitoring at baseline and after the early period of therapy (mean:112+/-19 days) and eleven patients underwent the examination after the later period of therapy (mean 213+/-23 days). HRV was analyzed over a full 24-hour period, using time and frequency domain parameters. RESULTS: No statistically significant HRV change was observed during the early period of therapy. However, during the later therpy period , HRV indices such as rMSSD[from 27.6 to 31.3 (msec)], HF[from 4.8 to 5.05 ln (ms2)], LF/HF ratio (from 1.17 to 1.12) were significantly changed (p value<0.05). CONCLUSION: HRV was significantly changed in postmenopausal women during the later period of hormonal replacement therapy.
Cardiovascular System ; Climacteric ; Electrocardiography, Ambulatory ; Estrogens ; Female ; Heart Rate* ; Heart* ; Hormone Replacement Therapy ; Humans ; Menopause ; Progesterone