Background and objectives: Atrial fibrillation is a known risk factor for cryptogenic stroke and therefore requires early detection and prompt management. We investigated predictors of stroke recurrence in patients with cryptogenic stroke and concomitant non-sustained atrial tachycardia but not atrial fibrillation. Subjects and methods: We investigated 390 patients (219 men, mean age 67 ± 12 years) diagnosed with stroke and non-sustained atrial tachycardia on 24-h Holter monitoring and recorded the total number of atrial premature contractions identified by the Holter monitor. Multiple atrial premature contractions were defined as atrial premature contractions > 34 beats/day. We analyzed the rates of 5-year freedom from stroke recurrence or atrial fibrillation and investigated independent predictors of stroke recurrence and undiagnosed atrial fibrillation. Results: The mean follow-up period was 35 ± 21 months, and the overall stroke recurrence rate was 9.0%. Kaplan–Meier survival analysis revealed that the rate of freedom from stroke recurrence was significantly lower in patients with multiple atrial premature contractions. Also, the patients with multiple atrial premature contractions had higher cumulative incidence rate of new-onset AF (p = 0.019). Multivariate analysis showed that multiple atrial premature contractions (hazard ratio 2.49, 95% confidence interval 1.05–5.88, p = 0.038), cigarette smoking status (hazard ratio 2.66, 95% confidence interval 1.15–6.17, p = 0.022), and the left atrial volume index (hazard ratio 1.05, 95% confidence interval 1.01–1.09, p = 0.020) were significantly associated with stroke recurrence in patients with cryptogenic stroke. However, these factors were not statistically significant predictors of future onset of atrial fibrillation. Conclusions Multiple atrial premature contractions were significantly correlated with an increased left atrial volume index, which could predict future onset of atrial fibrillation and stroke recurrence. This study showed that multiple atrial premature contractions predict stroke recurrence in patients with cryptogenic stroke without atrial fibrillation.

BACKGROUND: The purpose of this study was to examine post-traumatic stress, depression, anxiety, and complicated grief in Korean high school students who experienced a peer suicide. METHODS: A total of 956 students were included in the statistical analysis. One week after a peer suicide, a school-based crisis intervention program was conducted. The cohort was followed-up at one week and five months after a peer suicide. The program consists of screening tests, educational sessions, and further interview with psychiatric specialists for the selected group. Screening tests were conducted for all students to measure the Child Report of Post-traumatic Symptoms (CROPS), the post-traumatic stress symptoms (The University of California at Los Angeles post-traumatic stress disorder [PTSD] reaction index; UCLA-PTSD-RI), the anxiety symptoms (The Korean-Beck Anxiety Inventory; K-BAI), the depressive symptoms (The Korean-Beck Depression Inventory-II; K-BDI-II), and the complicated grief reaction (The Inventory of Complicated Grief; ICG). For statistical analysis, the SPSS Statistics 21.0 program was used. RESULTS: At baseline and five months follow-ups, 8.6% and 2.9% of the students showed post-traumatic stress symptoms. At five months follow-up, there was a statistically significant decline in the post-traumatic stress symptoms, anxiety, depression, and complicated grief among the ‘trauma group.’ A higher proportion of the female students showed post-traumatic stress symptoms after the incident of peer suicide than the male students. CONCLUSION: School-based crisis intervention helps improvement of trauma-related symptoms. It might be an effective way to prevent suicide spreading among students by alleviating trauma-related symptoms.
Anxiety ; California ; Child ; Cohort Studies ; Crisis Intervention* ; Depression ; Female ; Follow-Up Studies* ; Grief ; Humans ; Male ; Mass Screening ; Specialization ; Stress Disorders, Post-Traumatic ; Suicide*

Systemic sclerosis (SS) is a connective tissue disease and cardiac involvement is common. Primary cardiac involvement such as conduction system disturbances and arrhythmias can also occur. However, reports of sustained ventricular tachycardia (VT) are rare. We report a case of catheter ablation of sustained ventricular tachycardia in a patient with systemic sclerosis using a conventional mapping system. A 64-yr-old woman with a 10-yr history of SS was referred for management of her ventricular tachycardia. There was no structural abnormality in cardiac chambers. However, electrophysiologic study revealed electrical substrate of ventricular tachycardia which could be ablated with pacemapping and substrate mapping. This case demonstrated successful conventional mapping and catheter ablation in a hemodynamically unstable patient with SS.
*Catheter Ablation ; Electrocardiography ; Female ; Humans ; Middle Aged ; Scleroderma, Systemic/*complications/*diagnosis ; Tachycardia, Ventricular/*etiology/physiopathology/*surgery

OBJECTIVES: Hand-assisted laparoscopic surgery had both technical advantages of open surgery and better postoperative short-term follow-up results of laparoscopic surgery. We compared open colectomy, laparoscopic colectomy and hand-assisted laparoscopic colectomy, and tried to find the most effective operative modality. METHODS: 90 patients, who were diagnosed with colorectal cancer and underwent colectomy in our institution, were categorized as 3 groups of open colectomy (OC) group, laparoscopic colectomy (LC) group and hand-assisted laparoscopic colectomy (HALC) group by the surgical modality. RESULTS: In this study, ratio of male and female was 57 : 37, and mean age was 64.1 years old. LC group and HALC group showed longer operation time, shorter hospital stay after operation, lesser pain and earlier removal of closed drainage catheter than OC group. Amount of bleeding during operation, frequency of transfusion and incidence of complication showed no significant difference. In permanent pathologic results, the number of harvested lymph nodes had significant difference between OC group and other groups (P=0.030), but it was probably caused by the bias of the different distribution of the stages in each group. Overall 14 of the cases resulted in complications while there was no mortality. CONCLUSION: Laparoscopic colectomy and hand-assisted laparoscopic colectomy showed better short-term follow-up results rather than open colectomy. And hand-assisted laparoscopic surgery could provide tactile sensation to operator, which lacked in laparoscopic surgery. Hand-assisted laparoscopic colectomy could be an alternative surgical option for colorectal cancer with these advantages.
Bias (Epidemiology) ; Catheters ; Colectomy ; Colorectal Neoplasms ; Drainage ; Female ; Follow-Up Studies ; Hand-Assisted Laparoscopy ; Hemorrhage ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Male ; Sensation

A 63-year-old woman was referred to a breast surgeon with a breast mass discovered incidentally during follow-up study after colon cancer surgery. Invasive adenocarcinoma was revealed on core needle biopsy. Wide excision of the breast including the tumor was performed. On standard histological examination the tumor showed features of moderately differentiated adenocarcinoma. The immunohistochemistry study revealed positive results for cytokeratin (CK)20 and CDX2, but negative for CK7. These are typical characteristics for colon cancer. Considering her history of subtotal colectomy for sigmoid colon cancer, it is presumable that the mass in the breast was of colonic origin, and it was an extremely rare case of metastasis to the breast from primary colorectal neoplasm. Although the instance is rare, clinicians should keep the possibility of breast metastasis from colorectal cancer in mind for early and correct diagnosis.
Adenocarcinoma ; Biopsy, Large-Core Needle ; Breast ; Colectomy ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Keratins ; Middle Aged ; Neoplasm Metastasis ; Sigmoid Neoplasms

We report a case of a 21-year-old male who died from lethal Aspergillus endocarditis 3 months after heart transplantation. He underwent heart transplantation in other country. He was treated with hemodialysis for acute renal failure due to cyclosporine and then transferred to our hospital. When he complained high fever, follow-up echocardiography showed a large mobile echogenic mass attached to posterior mitral valve leaflet. The result of serum Aspergillus galactomannan antigen assay was positive. He was empirically treated with intravenous amphotericin B and antibiotics. However, he was rapidly deteriorated and died on hospital day 3.
Acute Kidney Injury ; Amphotericin B ; Anti-Bacterial Agents ; Aspergillus* ; Cyclosporine ; Echocardiography ; Endocarditis* ; Fever ; Follow-Up Studies ; Heart Transplantation* ; Heart* ; Humans ; Male ; Mitral Valve ; Renal Dialysis ; Young Adult

BACKGROUND AND OBJECTIVES: Percutaneous mitral balloon valvuloplotomy (PMV) is a safe and effective procedure for the treatment of mitral stenosis (MS); however, its long-term results according to the severity of MS remain unknown. The aim of this study was to compare the long-term results of PMV between moderate and severe MS. SUBJECTS AND METHODS: The immediate and long-term outcomes of 786 patients (198 male, mean age; 43 years) who underwent PMV at a single referral center, between 1988 and 2000, were analyzed. The clinical and echocardiographic data were compared between moderate (n=357) and severe MS (n=429). RESULTS: Optimal results were gained in 618 (79%) patients, including 80 and 76% moderate and severe MS cases, respectively (p=0.13). Acute complications occurred in 85 patients (11%), but without significant difference between the two groups. After a mean follow-up period of 94 months (range, 6 to 210 month), the 5 year event-free survival rate was better in moderate (88%) than in severe MS (79%), but the 10 year event-free survival rates were no different (65% vs. 65%). Independent predictors for better prognosis were a lower echo score (< or =8)(p=0.017, HR=0.67), a larger mitral valve area after the PMV (> or =1.7 cm2)(p=0.002, HR=0.65), less mitral regurgitation ( Atrial Pressure ; Balloon Valvuloplasty ; Disease-Free Survival ; Echocardiography ; Follow-Up Studies ; Humans ; Male ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Prognosis ; Referral and Consultation

The fate of a grafted radial artery remains unknown. The purpose of this study was to determine whether the preoperative severity of stenosis of the target vessel influence short-term patency of radial artery (RA) grafts used as coronary artery bypass conduits. In 54 patients who had coronary artery bypass grafting (CABG) with RA grafts, RA patency was determined with multi-slice computed tomography (MSCT) 1 year after CABG. These patients were divided into three groups on the basis of the percentage of the target vessel stenosis: mild (< 60%, n=17), moderate (60% to 79%, n=19), and severe (> or = 80%, n=18). MSCT was also performed 1 week later to exclude early occlusion of RA grafts. In 3 patients, the MSCT failed to adequately discriminate the status of the RA graft due to poor image resolution. The overall incidence of RA occlusion was 23.5% (12 of 51) at 1 year in the entire population. The mild stenosis, moderate stenosis and severe stenosis group showed an occlusion rate of 50% (8 of 16), 23.5% (4 of 17) and 0% (0 of 18), respectively. The severe stenosis group had significantly lower rate of RA graft occlusion compared to the mild stenosis group (p< 0.001) and moderate stenosis group (p< 0.05). No difference in occlusion between grafts used for the different coronary artery branches could be demonstrated. Preoperative severity of the target coronary artery significantly affected the short-term RA grafts patency. Correct indication is the key factor for short-term RA patency.
Aged ; Coronary Arteriosclerosis/pathology/*radiography/*surgery ; Coronary Artery Bypass/*methods ; Coronary Vessels/pathology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Radial Artery/*transplantation ; Severity of Illness Index ; Tomography, X-Ray Computed ; Vascular Patency

No abstract available.
Heart* ; Thoracic Surgery* ; Tricuspid Valve Insufficiency*

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the age-related differences in clinical features, coronary anatomy, risk factors, hospital courses, and long-term prognosis of acute myocardial infarction(AMI) in women. MATERIALS AND METHODS: Total 513 female patients with AMI were divided into 3 groups ; group 1(n=3, 50 years old or less), group 2(n=02, between 51 years and 70 years old), and group 3(n=68, older than 70 years). Clinical follow-up including cardiac events was performed for mean duration of 26 months(1~155 months). Cardiac events include cardiac death, reinfarction, CABG, PTCA, CHF, stroke, and recurrent angina. RESULTS: Minimal lesion(<50% stenosis) in infarct-related artery was more prevalent in group 1 than in group 3(p<0.05). In group 2, the number of low high density lipoprotein(HDL) was significantly more than in group 3(p<0.01). During hospitalization, death and shock were more prevalently observed in group 3 than group 1(p<0.005) and group 2(p<0.001). Group 3 had more heart failures than group 1(p<0.001) and group 2(p<0.001) and group 2 had more heart failures than group 1(p<0.05). The younger age group showed a significantly higher survial rate(7 years : group 1; 76.1%, group 2; 60.6%, group 3; 34.2%, p<0.0001, Log Rank Stat =49.4) and cardiac event-free survival rate(7 years : group 1; 48.4%, group 2; 32.3%, group 3; 16.0%, p<0.0001, Log Rank Stat =37.5) for each 3 comparisons. In Cox proportional harzard analysis, LV systolic function influenced the group 2 survival (odds ratio 3.8, 95% CI 1.7 to 8.3, p<0.005) and the group 3 survival (odds ratio 2.2, 95% CI 1.1 to 4.5, p<0.05). The cardiac event free survival was influenced by age(odds ratio 1.6, 95% CI 1.2 to 2.1, p<0.005) and LV systolic function(odds ratio 1.8, 95% CI 1.3 to 2.5, p<0.001). CONCLUSION: Younger female patients with AMI had a more favorable prognosis compared with older female patients. LV systolic fuction was important as a prognostic factor for long-term survival except younger female AMI patients.
Arteries ; Death ; Disease-Free Survival ; Female ; Follow-Up Studies ; Heart ; Hospitalization ; Humans ; Middle Aged ; Myocardial Infarction* ; Prognosis* ; Risk Factors ; Shock ; Stroke