Cardiac tamponade (CT) is a rare but potentially lethal complication associated with central venous catheters (CVCs). We present a 6-year-old boy who developed CT after CVC insertion in the right internal jugular vein, with its tip in the inferior vena cava. Initially, he was hospitalized to a tertiary hospital with presumptive diagnoses of pneumonia and left ankle cellulitis. Three days after CVC placement, he developed CT, manifesting as recurrent episodes of hypotension and bradycardia. Once a bedside echocardiography showed CT, pericardiocentesis was performed, resulting in successful resuscitation. Pericardiocentesis revealed a milk-appearing pericardial fluid, indicating chylopericardium. The boy also underwent debridement and joint irrigation of the left ankle, which turned out to be osteomyelitis. Although CVC tips in most reported CVC-related CTs have been commonly located in the right atrium, our case featured a tip located in the inferior vena cava. Additionally, chylopericardium was likely due to the extravasation of total parenteral nutrition fluid, rather than the usual causes, such as recent thoracic surgery. Understanding the mechanisms behind chylopericardium associated with CVCs and timely pericardiocentesis is crucial for improving the outcomes.

Objectives: The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. Methods: Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. Results: In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. Conclusions The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

BACKGROUND AND OBJECTIVES: Despite significant advances in the treatment of acute myocardial infarction (MI), the prevention of sudden cardiac death (SCD), the most common mode of death in patients with MI, remains challenging. Furthermore, previous Korean MI registries did not address the issue of post-MI SCD. Additional risk stratifiers of post-MI SCD are still required to compensate for the limitation of using left ventricular ejection fraction to predict lethal arrhythmic events. SUBJECTS AND METHODS: We designed the first Korean prospective nationwide multicenter registry primarily focused on SCD; the Korean noninvasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (K-REDEFINE). The registry consists of 2 groups of patients presenting with (1) acute MI or (2) acute heart failure (HF) at 25 tertiary referral cardiovascular centers. The primary endpoint of the MI group study of K-REDEFINE registry is the incidence and risk factors of post-MI SCD. In particular, the association between the risk of SCD and non-invasive Holter-based electrocardiogram (ECG) variables will be evaluated, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/variability (a marker of autonomic function). Other secondary study outcomes include atrioventricular arrhythmias, HF-related admission, repeated myocardial ischemic events, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will provide new prospects for the better management of MI patients with high risk of SCD by clarifying the burden and predictors of SCD and the clinical utility of various non-invasive ambulatory ECG-based variables in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction* ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke ; Stroke Volume

BACKGROUND AND OBJECTIVES: Sudden cardiac death (SCD) is one of the most common causes of death in patients with heart failure (HF). However, there are no available data on SCD in previous Korean HF registries. Additionally, although widely used, the utility of left ventricular (LV) ejection fraction (EF) in risk stratification for SCD is limited. SUBJECTS AND METHODS: The Korean non-invasive Risk Evaluation study for sudden cardiac DEath From INfarction or heart failurE (KREDEFINE) is the first Korean prospective, nationwide multicenter registry, primarily focused on SCD. The registry consists of 2 groups of patients presenting with (1) acute HF or (2) acute myocardial infarction (MI) at 25 tertiary referral cardiovascular centers. Using the HF-group data of the K-REDEFINE registry, the incidence and risk factors of SCD in patients with HF will be assessed. In particular, the efficacy of Holter-based ECG variables, such as T-wave alternans (marker of repolarization heterogeneity) and heart rate turbulence/ variability (maker of autonomic function), in risk stratification for SCD will be evaluated. Other cardiovascular outcomes will also be analyzed, including atrioventricular arrhythmias, HF-related admission, stroke, and overall deaths. CONCLUSION AND PERSPECTIVE: The K-REDEFINE registry will pave the way for better management of patients with HF at high risk of SCD by elucidating the burden and risk factors of SCD and the clinical utility of various non-invasive ambulatory ECG-based parameters in risk stratification for SCD in this patient population.
Arrhythmias, Cardiac ; Cause of Death ; Death, Sudden, Cardiac* ; Electrocardiography ; Heart Failure* ; Heart Rate ; Heart* ; Humans ; Incidence ; Infarction* ; Myocardial Infarction ; Prospective Studies ; Referral and Consultation ; Registries ; Risk Factors ; Stroke

OBJECTIVE: To investigate the recent incidence of and trends in cervical, endometrial, and ovarian cancer in Korean females. METHODS: Data from the Korea Central Cancer Registry between 1999 and 2010 were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) were calculated. RESULTS: The absolute incidence rates of the three major gynecologic cancers increased: 6,394 in 1999 to 7,454 in 2010. The ASR for gynecologic cancer was 23.7 per 100,000 in 1999 and decreased to 21.0 in 2010 (APC, -1.1%; 95% confidence interval [CI], -1.53 to -0.70) due to a definitive decrease in the incidence of cervical cancer (APC, -4.3%). Endometrial cancer has been definitively increasing (APC, 6.9% during 1999-2010), especially in females <30 years old (APC, 11.2%) and in females > or =80 years old (APC, 9.5%). The incidence of ovarian cancer is increasing gradually (APC, 1.5%). CONCLUSION: ASRs and APC for gynecologic cancers overall are decreasing due to the decrease in the incidence of cervical cancer. However, the incidence of endometrial and ovarian cancer has been increasing.
Cervix Uteri ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Incidence ; Korea ; Ovarian Neoplasms ; Ovary ; Uterine Cervical Neoplasms

PURPOSE: The purpose of this study was to identify the changes in the characteristics of patients with carbon monoxide (CO) poisoning, as well as the distinctive differences in intentionally exposed patients. METHODS: The medical records of CO poisoning patients, who visited nine emergency departments between January 2010 and December 2011, were reviewed retrospectively. The clinical information including age, gender, hospitalization, type of discharge, cause and location of exposure, site of onset, concentration of initial blood carboxyhemoglobin (COHb), methods of treatment and presence of neurological complications was examined. The subjects were divided into an intentional and non-intentional group and the differences between them was compared. RESULTS: A total 209 subjects were recruited. The median age was 38 years (29~49.5 years). They frequently complained of nausea and vomiting, and the most common exposures occurred in winter, normally in the home. The cause of exposure was usually fire, followed by incomplete combustion of fuels. The median initial blood COHb was 13.15%. The proportion of intentionally exposed patients was 21%. They were significantly younger, more frequently discharged against medical advice, and showed a higher initial blood COHb level (22.85%) than the non-intentional group. CONCLUSION: This study suggests that those with intentional CO poisoning are normally discharged against medical advice even when they have a higher initial COHb level. An adequate explanation of the delayed neurologic sequelae and short term follow-up observation is recommended for those patients with intentional exposure.
Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Carboxyhemoglobin ; Emergencies ; Fires ; Follow-Up Studies ; Hospitalization ; Humans ; Intention ; Medical Records ; Nausea ; Retrospective Studies ; Suicide ; Vomiting

PURPOSE: The Tox-Info system is a poisonous substance information database developed by the Korean National Institute of Food and Drug Safety Evaluation. The aim of this study was to estimate the coverage effectiveness of the Tox-Info system by comparing the toxic substances included in the database with the distribution of the toxic substances implicated in the cases of intoxicated patients presenting to emergency departments. The secondary aim of the study was to propose any additional substances that should be added to the database. METHODS: We retrospectively reviewed the medical records of patients suffering with toxic exposure who had visited any of 12 selected emergency departments in Korea from January 2010 to December 2011. The identified toxic substances were classified into groups including prescription drugs, agricultural chemicals, household products, animals or plants, herbal drugs, and others. We calculated the coverage rate of the Tox-Info database relative to the number of intoxication cases and the type of toxic substances involved. RESULTS: A total of 5,840 intoxicated patient records were collected. Their mean age was 46.6+/-20.5 years and 56.2% were female. Of the total intoxication cases, 87.8% of the identified toxic substances were included in the Tox-Info database, while only 41.6% of all of the types of identified toxic substances were included. Broken down by category, 122 prescription drugs, 15 agricultural chemicals, 12 household products, 14 animals or plants and 2 herbal drugs involved in poisoning cases were not included in the Tox-info database. CONCLUSION: This study demonstrated the clinical usefulness of the Tox-Info system. While 87.8% of the substances involved in the cases were included in the Tox-Info database, the database should be continuously updated in order to include even the most uncommon toxic substances.
Agrochemicals ; Animals ; Emergencies ; Female ; Household Products ; Humans ; Korea ; Medical Records ; Prescription Drugs ; Retrospective Studies ; Stress, Psychological

OBJECTIVE: Computed tomographic angiography (CTA) is useful for rapid and relatively noninvasive detection of aneurysms in the circle of Willis. The purpose of this study is to compare CTA with conventional cerebral angiography (CCA) and to assess usefulness of CTA in detection of the anatomic delination of intracranial aneurysms of the circle of Willis in subarachnoid hemorrhage. PATEINTS AND METHODS: 126 consecutive patients with known SAH or suspected intracranial saccular aneurysms underwent CTA and CCA from January 2002 to June 2003. Using surface shaded display post-processing technique, CTA was interpreted for the presence, location and anatomic features of the aneurysms and also the image obtained with CTA was compared with CCA image. RESULTS: In 112 operated patients, 125 aneurysms were detected. CCA revealed 123 cerebral aneurysms and CTA revealed 113 aneurysms. Two of the 125 cerebral aneurysms were located outside of the imaging volume of CTA, 10 cases were not detected and false positive were 2 cases. The sensitivity of CTA was 90.3%. The results obtained with CTA comparing with that of CCA were almostly equal in detection of aneurysm location and delineation of aneurysmal neck. However, CTA provided a 3-dimensional representation of aneurysm and also it was very useful for surgical planning. CONCLUSION: CTA can be a diagnostic tool for the patients with acute subarachnoid hemorrge due to a ruptured aneurysm of the circle of Willis and provides adequate anatomic detail for surgical planning especially to complex cerebral aneurysms. However, it is obvious that CCA is necessary because of the limitations of CTA including its difficulty in detecting unusually located aneurysms including those in cavernous sinus or distal artery, and acquiring dynamic flow information.
Aneurysm ; Aneurysm, Ruptured ; Angiography* ; Arteries ; Cavernous Sinus ; Cerebral Angiography* ; Circle of Willis ; Humans ; Intracranial Aneurysm* ; Neck ; Subarachnoid Hemorrhage

BACKGROUND: CD43 is a sialoglycoprotein that is highly expressed on most leukocytes, except on B lymphocytes and dendritic cells. CD43 has been reported to be involved in the adhesion and apoptosis of lymphocytes. Although the aberrant expression of CD43 antigen in non-lymphoid tissues has been reported, the expression of the CD43 antigen in gastrointestinal malignancies is not well studied. Here, we studied the expression of CD43 in colon adenocarcinoma using the anti-CD43 monoclonal antibody developed in our laboratory. METHODS: Thirty patients who had undergone surgical resection for colorectal carcinoma were recruited. The expression of CD43 molecule was determined by analyzing the formalin-fixed, paraffin-embedded specimens immunohistochemically using our newly developed anti-CD43 mAb (K06). The results obtained by the immunohistochemical analysis correlated to the clinicopatho-logical parameters. RESULTS: The expression of CD43 were found in 20 out of 30 colorectal carcinoma cases. The expression of CD43 antigen is higher in well differentiated adenocarcinomas than poorly or moderately differentiated adenocarcinomas. CONCLUSIONS: The new anti-CD43 mAb might be helpful for the detection of the expression of CD43 on colorectal carcinoma cells. Further studies are required to assess the relationship between the CD43 expression and the colorectal carcinogenesis.
Adenocarcinoma ; Antigens, CD43 ; Apoptosis ; B-Lymphocytes ; Carcinogenesis ; Colon ; Colorectal Neoplasms ; Dendritic Cells ; Humans ; Immunohistochemistry ; Leukocytes ; Lymphocytes

Mature cystic teratoma of the ovary is the most common ovarian germ cell tumor and benign, but malignant transformation occurs in less than 2% of benign mature teratoma. Of the malignancies arising in teratomas, squamous cell carcinoma is the most common, however, carcinoid tumors or adenocarcinomas arising in mature cystic teratoma are uncommon, especially simultaneously. We present an unusual case of premenopausal woman having carcinoid tumor and mucinous adenocarcinoma simultaneously arising in ovarian muture cystic teratoma.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Carcinoid Tumor* ; Carcinoma, Squamous Cell ; Female ; Humans ; Mucins* ; Neoplasms, Germ Cell and Embryonal ; Ovary ; Teratoma*