Background and Objectives: Atrial tachycardias (ATs) from noncoronary aortic cusp (NCC) uncovered after radiofrequency ablation for atrial fibrillation (AF) are rarely reported. This study was conducted to investigate the prevalence and clinical characteristics of NCC ATs detected during AF ablation and compare their characteristics with de novo NCC ATs without AF. Methods: Consecutive patients who underwent radiofrequency catheter ablation for AF were reviewed from the multicenter AF ablation registry of 11 tertiary hospitals. The clinical and electrophysiological characteristics of NCC AT newly detected during AF ablation were compared with its comparators (de novo NCC AT ablation cases without AF). Results: Among 10,178 AF cases, including 1,301 redo ablation cases, 8 (0.08%) NCC AT cases were discovered after pulmonary vein isolation (PVI; 0.07% in first ablation and 0.15% in redo ablation cases). All ATs were reproducibly inducible spontaneously or with programmed atrial stimulation without isoproterenol infusion. The P-wave morphological features of tachycardia were variable depending on the case, and most cases exhibited 1:1 atrioventricular conduction. AF recurrence rate after PVI and NCC AT successful ablation was 12.5% (1 of 8). Tachycardia cycle length was shorter than that of 17 de novo ATs from NCC (303 versus 378, p=0.012). No AV block occurred during and after successful AT ablation. Conclusions Uncommon NCC ATs (0.08% in AF ablation cases) uncovered after PVI, showing different characteristics compared to de-novo NCC ATs, should be suspected irrespective of P-wave morphologies when AT shows broad propagation from the anterior interatrial septum.

In cryptogenic stroke patients, early detection of new-onset atrial fibrillation (AF) and recurrent stroke is required to prevent poor clinical outcomes. Therefore, we investigated the predictors of new-onset AF and recurrent stroke in cryptogenic stroke patients without previously diagnosed AF. In total, 390 patients who were diagnosed with stroke and non-sustained atrial tachycardia (NSAT) on 24-hour Holter monitoring were followed up to assess new-onset AF and recurrent stroke. The 5-year event-free survival as well as the predictors of recurrent stroke or new-onset AF were investigated. Based on receiver operating characteristic analysis, frequent premature atrial contractions (PACs) were defined as PACs >44 beats/day. The median follow-up period was 35 months. The composite event rate was 11.5%. In Kaplan-Meier analysis, the 5-year cumulative incidence of composite events was higher in cryptogenic stroke patients with frequent PACs than in those without frequent PACs. Multivariate analysis revealed that current smoking, increased left atrial volume index, and frequent PACs were poor prognostic predictors of composite event, and frequent PACs were an independent poor prognostic factor of new-onset AF in cryptogenic stroke patients. Therefore, frequent PACs might be associated with poor clinical outcomes (new-onset AF and recurrent stroke) in cryptogenic stroke patients with concomitant NSAT.

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.
ABO Blood-Group System/genetics ; Acute Disease ; Adolescent ; B-Lymphocytes/cytology/immunology/metabolism ; Bone and Bones/radionuclide imaging ; Genotype ; Humans ; Immunoglobulin A/blood ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Immunologic Deficiency Syndromes/complications/*diagnosis ; Knee/radionuclide imaging ; Magnetic Resonance Imaging ; Male ; Osteomyelitis/complications/*diagnosis ; Radiopharmaceuticals/diagnostic use

ABO discrepancy refers to an inconsistency between red cell and serum typings and has various causes, including hypogammaglobulinemia. IgM deficiency is a rare disorder that may accompany several conditions such as infection and autoimmune disorders. Here, we describe a case of IgM deficiency discovered during the evaluation of an ABO discrepancy in a 16-yr-old Korean boy. ABO blood grouping showed that while his cell type was O+, serum typing detected only anti-A (3+). Anti-B was not detectable at room temperature but was graded at 1+ at 4degrees C. ABO genotyping revealed an O/O genotype. His serum IgG, IgA, and IgM concentrations were 770 mg/dL (reference range: 800-1,700 mg/dL), 244 mg/dL (reference range: 100-490 mg/dL), and 13.5 mg/dL (reference range: 50-320 mg/dL), respectively. He was diagnosed with acute osteomyelitis on the basis of clinical presentation and imaging studies. The symptoms gradually improved within 3 weeks of treatment. However, the ABO discrepancy and IgM deficiency persisted even 6 months after recovery and lymphocyte subset analysis revealed CD19+ B cell deficiency. To the best of our knowledge, IgM deficiency detected by ABO discrepancy in a patient with acute osteomyelitis has not been reported before.
ABO Blood-Group System/genetics ; Acute Disease ; Adolescent ; B-Lymphocytes/cytology/immunology/metabolism ; Bone and Bones/radionuclide imaging ; Genotype ; Humans ; Immunoglobulin A/blood ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Immunologic Deficiency Syndromes/complications/*diagnosis ; Knee/radionuclide imaging ; Magnetic Resonance Imaging ; Male ; Osteomyelitis/complications/*diagnosis ; Radiopharmaceuticals/diagnostic use

BACKGROUND AND OBJECTIVES: We investigated the effect of the additional use of abciximab during percutaneous coronary intervention (PCI) on the level of procoagulant microparticles (MPs) in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary PCI. SUBJECTS AND METHODS: In this study, we studied 86 patients with STEMI (72 men, age 58+/-13) who had undergone primary PCI. The decision to administer abciximab immediately prior to PCI was left to the discretion of the operator. Blood samples for analysis of MPs were obtained from the femoral artery before and after PCI. MPs with procoagulant potential were measured using a commercial kit. The cellular origins of MPs were determined by antigenic capture with specific antibodies. RESULTS: Procoagulant MPs captured onto annexin V were not changed significantly after PCI {13.4+/-13.2 nM vs. 13.2+/-16.1 nM phosphatidylserine equivalent (PS eq), p=0.479}. Abciximab was used in 30 of 86 patients (35%) immediately prior to PCI. In patients who had undergone PCI without abciximab, no significant change in the level of MPs was observed after PCI. However, in the abciximab group, the level of circulating MPs was significantly decreased after PCI (12.0+/-10.7 nM vs. 7.8+/-11.7 nM PS eq, p=0.018). Levels of endothelial- and platelet-derived MPs also showed a significant reduction after PCI in the abciximab group. CONCLUSION: Primary PCI with additional abciximab significantly reduced the level of procoagulant MPs regardless of their cellular origins in patients with STEMI.
Angioplasty ; Annexin A5 ; Antibodies, Monoclonal ; Cell-Derived Microparticles ; Femoral Artery ; Humans ; Immunoglobulin Fab Fragments ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors

BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

PURPOSE: The authors evaluated the clinical and radiological results of ceramic on ceramic articulation cementless total hip arthroplasty using a large diameter head. MATERIALS AND METHODS: Seventy-two hips were followed for more than 2 years after ceramic on ceramic articulation cementless total hip arthroplasty using a 36 mm diameter head. The mean patient age was 62 years (range: 50-85), and the mean follow-up period was 35.3 months (range: 25-53). The Harris hip score, the postoperative inguinal pain and the thigh pain were analyzed clinically. The radiological results were assessed using various radiological indices. RESULTS: The mean Harris hip score improved from preoperative 57.5 points to postoperative 94.8 points. The postoperative mean flexion of hip was 109degrees (range: 100degrees-125degrees), external rotation was 42degrees (range: 35degrees-49degrees) and abduction was 35degrees (range: 30degrees-45degrees). There was one case of inguinal pain. Radiologically, all the stems demonstrated stable fixation without progressive subsidence of the stem or significant change in the cup obliquity. A radiolucent line was observed around the stem in 4 cases (5.6%) and around the cup in 2 cases (2.8%). Endosteal new bone formation was observed around the stem in 28 cases (38.9%) and around the cup in 26 cases (36.1%). There was no osteolysis around the stem or the cup. CONCLUSION: The short-term results of ceramic on ceramic cementless total hip arthroplasty using a large diameter head demonstrated satisfactory results.
Arthroplasty ; Ceramics ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteogenesis ; Osteolysis ; Thigh

BACKGROUND: Since 2001, the Ministry of Health and Welfare in Korea has designated muscular dystrophy (MD) to be a rare and intractable disease, and has ensured that patients with this condition obtain support from the National Health Insurance Corporation for their medical expenditure. However, the health-related and socioeconomic status of Korean patients with MD has yet to be established. METHODS: We selected 441 patients with MD who received medical services at 17 neuromuscular centers during 2005. The medical records of selected patients were analyzed, and the subtype of MD was classified by its clinical course and diagnostic tests. A total of 95 patients or their family members participated in this health-related and socioeconomic status survey. RESULTS: Medical record analysis showed similar clinical and diagnostic characteristic data to those published previously in other countries: male predominance, being young at onset, and muscular weakness of the extremities as a predominant symptom in most patients. The diagnostic tests for MD were based on laboratory and electrophysiological studies. The most frequent form of MD among our cohort was Duchenne/Becker muscular dystrophy (42%). Our survey revealed the effect of the patients' profound disability on their activities of daily living. One-half of the patients were dissatisfied with the medical expenditure support service that was made available to them, and most patients suffered from a financial burden. The most important medical services to be developed in the future are expansion of the public health service or development of a rehabilitation hospital. CONCLUSIONS: This is the first multicenter-based epidemiologic study on the health-related and socioeconomic status of patients with MD in Korea. The findings indicate that medical coverage and public health service are currently inadequate and hence should be expanded in the future.
Activities of Daily Living ; Cohort Studies ; Diagnostic Tests, Routine ; Epidemiologic Studies ; Extremities ; Health Expenditures ; Humans ; Korea ; Male ; Medical Records ; Morphinans ; Muscle Weakness ; Muscular Dystrophies ; National Health Programs ; Social Class ; United States Public Health Service

PURPOSE: We investigate the impact of tumor multifocality on the biochemical recurrence rate after radical prostatectomy. MATERIALS AND METHODS: Data was collected from 525 patients who underwent radical prostatectomy for clinically localized prostate cancer from 2003 to 2007. We evaluated the potential associations of multifocality with various clinical and pathologic factors. The ability to predict extra-capsular extension(ECE) was tested by logistic regression models, whereas biochemical recurrence(BCR) was assessed via Kaplan-Meier analyses and Cox-hazard regression models. The BCR was defined as a level of serum prostate-specific antigen(PSA) of 0.2ng/ml or greater on consecutive evaluations. RESULTS: Multifocality was observed to be significantly associated with the presence of a high grade Gleason pattern(p=0.014), the pT stage(p< 0.001), ECE(p=0.005) and a positive surgical margin(PSM)(p=0.019). Moreover, it was the independent predictor of ECE on multivariate logistic regression analyses(p=0.039). However, although multifocality had a significant influence on biochemical recurrence on the Kaplan-Meier analyses (log rank test, p=0.019), only the PSA level and the Gleason score were significant predictors of BCR on the multivariated Cox-hazard analyses. CONCLUSIONS: Although multifocality was associated with adverse pathologic features, it had no significant effect on biochemical recurrence on the multivariated cox-hazard analyses.
Humans ; Logistic Models ; Neoplasm Grading ; Prostatectomy ; Prostatic Neoplasms ; Recurrence

BACKGROUND: Video-assisted thoracic sympathicotomy is a definitive minimally invasive treatment for axillary hyperhidrosis. Different techniques exist for controlling axillary hyperhidrosis, but they are temporary and expensive. We compared the results after using two different levels of sympathicotomy for treating axillary hyperhidrosis: T3-T4 and T4. MATERIAL AND METHOD: Between June 2002 and May 2007, 30 patients with isolated axillary hyperhidrosis underwent either T3-T4 or T4 thoracoscopic sympathicotomy in the Department of Thoracic & Cardiovascular Surgery at Wonkwang University Hospital. The patients were divided into two groups. Group I (n=15) was composed of patients who underwent T3-T4 sympathicotomy (thermal ablation), and Group II (n=15) was composed of patients who underwent T4 sympathicotomy (thermal ablation). The procedures were bilateral and simultaneous, involving the use of two 2-mm trocars and a 0-degree 2-mm thoracoscope under general anesthesia with single endotracheal intubation. Outcome parameters included satisfaction rate of treatment, degree of compensatory sweating, and postoperative complications. Patients were interviewed by telephone regarding satisfaction and compensatory hyperhidrosis. RESULT: There were no differences in age between group I and group II. The mean follow-up for the T3-T4 group was 38.7+/-2.3 months, and the mean follow-up for the T4 group was 18.7+/-3.6 months. The immediate therapeutic success rate (within 2 weeks postoperative) was 100% in both groups, and there were no recurrences in either group during the long-term follow-up period. The satisfaction rate was higher (93.3%) in the T4 group than in the T3-T4 group (53.3%), and the incidence of compensatory hyperhidrosis was lower in the T4 group (6.7%) than in the T3-T4 group (46.7%). Postoperative complications included one mild pneumothorax and two instances of intercostal neuralgia. Digital infrared thermographic imaging (DITI) correlated well with postoperative satisfaction. CONCLUSION: Both techniques proved effective for controlling isolated axillary hyperhidrosis. The T4 group had a higher satisfaction rate and lower severity of compensatory hyperhidrosis. Hence, thermal ablation of the lower interganglionic fibers of the third thoracic sympathetic ganglion on the fourth rib is a more practical and minimally invasive treatment than is the T3-T4 surgical method, according to the degree of compensatory sweating in isolated axillary hyperhidrosis.
Anesthesia, General ; Follow-Up Studies ; Ganglia, Sympathetic ; Humans ; Hyperhidrosis ; Incidence ; Intubation, Intratracheal ; Neuralgia ; Pneumothorax ; Postoperative Complications ; Recurrence ; Ribs ; Surgical Instruments ; Sweat ; Sweating ; Telephone ; Thoracoscopes