Objectives: Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. Methods: A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. Results: The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

Fixed drug eruption (FDE) is a drug-induced disorder that may appear as patches or bullae. It recurs at the same sites as those involved in exposure to the same drug (causative drug). We encountered two cases of generalized FDE, and both patients had a history of diclofenac exposure before the onset of skin lesions. In the first case, an 82-year-old female patient presented with multiple erythematous patches on the trunk and lower extremities. In the second case, a 71-year-old male patient developed multiple bullae on violaceous patches on the trunk and extremities. The findings of histopathologic examinations were indicative of the diagnosis of FDEs. Although diclofenac is commonly used as a non-steroidal inflammatory drug, diclofenac-induced generalized FDE occurs rarely and has not been reported in Korea. With reuse of causative drugs, the size and number of lesions tend to increase. Therefore, early diagnosis of FDE is important, and avoidance of repeated exposure to drugs should be educated.

No abstract available.

BACKGROUND: Various Q-switched (QS) lasers, such as ruby, alexandrite or neodymium:YAG (Nd:YAG) lasers, are used to remove tattoos and permanent makeup. To our knowledge, there has been no indication or guideline published for the optimal time for laser-mediated tattoo removal. OBJECTIVE: To set a guideline for the optimal irradiation time for tattoo and permanent makeup removal via 1064 nm QS Nd:YAG (QSND) laser, we compared the degree of tattoo removal and skin histologic changes when the irradiation was employed at different time points. METHODS: Rat skin was marked with 54 artificial permanent makeup marks with black ink using a permanent makeup machine. The marks were irradiated with a 1064 nm QSND laser on the application day, and 3 days, 5 days, 1 week, 2 weeks, and 3 weeks after application. Pigmentation changes were checked over time using a Mexameter(R) and skin biopsy. RESULTS: There was no significant difference in the degree of pigment removal as examined by Mexameter(R) on the day of makeup application compared to 3 days, 5 days, 1 week, 2 weeks, and 3 weeks after application. Histopathologically, the permanent makeup pigments seemed to move from epidermis to superficial and mid dermis with time. The pigments were relatively well removed throughout the epidermis and dermis when the laser was employed 7 days after tattoo application, compared to laser irradiation on the day of application, as viewed histologically. CONCLUSION: Laser removal of permanent makeup is effective on the day of application, as determined by testing pigment levels. However, based on histopathology, it is recommended to use lasers to remove permanent makeup about a week after application, since the wound repair process is almost complete at that time.
Animals ; Biopsy ; Dermis ; Epidermis ; Ink ; Pigmentation ; Rats ; Skin* ; Tattooing ; Wounds and Injuries

No abstract available.
Fingers*

This study was to evaluate the status of initiating pattern of hemodialysis (HD). Five hundred-three patients in 8 University Hospitals were included. Presentation mode (planned vs. unplanned), and access type (central venous catheters [CVC] vs. permanent access) at initiation of HD were evaluated, and the influence of predialysis care on determining the mode of HD and access type was also assessed. Most patients started unplanned HD (81.9%) and the most common initial access type was CVC (86.3%). The main reason for unplanned HD and high rate of CVC use was patient-related factors such as refusal of permanent access creation and failure to attend scheduled clinic appointments. Predialysis care was performed in 57.9% of patients and only 24.1% of these patients started planned HD and 18.9% used permanent accesses initially. Only a minority of patients initiated planned HD with permanent accesses in spite of predialysis care. To overcome this, efforts to improve the quality of predialysis care are needed.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arteriovenous Fistula ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/etiology/mortality/therapy ; Male ; Middle Aged ; Multivariate Analysis ; Nephrology/*methods ; Renal Dialysis/*methods ; Retrospective Studies ; Treatment Outcome

The reversible posterior leukoencephalopathy syndrome usually includes seizure, headache, altered mental status, and blindness, often associated with hypertension and immunosuppressants. The authors discuss a 16-year-old female with Down syndrome who had nephrotic syndrome with severe headache, intermittent blindness, and seizures, after treated with prednisolone. The patient had a generalized tonic-clonic seizure at 8 days after prednisolone. A CT scan of the head revealed symmetrical multifocal low densities in the subcortical region of both parieto-occipital, frontal, temporal lobe. Magnetic resonance scanning revealed white matter lesions in the subcortices of the parietal, frontal and occipital lobes. The condition improved when prednisolone was discontinued. Follow-up image after 3 weeks shows nearly complete resolution of white matter and gray matter abnormalities on axial T2-weighted MR images. This episode might be caused by prednisolone because the clinical course and laboratory data revealed neither inflammation nor other causative factors.
Adolescent ; Blindness ; Down Syndrome* ; Female ; Follow-Up Studies ; Head ; Headache ; Humans ; Hypertension ; Immunosuppressive Agents ; Inflammation ; Nephrotic Syndrome* ; Occipital Lobe ; Posterior Leukoencephalopathy Syndrome ; Prednisolone ; Rabeprazole ; Seizures ; Temporal Lobe ; Tomography, X-Ray Computed

PURPOSE: Within a clinically acceptable time frame, we obtained the high resolution MR images of the human brain, knee, foot and wrist from 3T whole-body MRI system which was equipped with the world first 3T active shield magnet. MATERIALS AND METHODS: Spin echo (SE) and Fast Spin Echo (FSE) images were obtained from the human brain, knee, foot and wrist of normal subjects using a homemade birdcage and transverse electromagnetic (TEM) resonators operating in quadrature and tuned to 128 MHz. For acquisition of MR images of knee, foot and wrist, we employed a homemade saddle shaped RF coil. Typical common acquisition parameters were as follows: matrix= 512x512, field of view (FOV) = 20 cm, slice thickness = 3 mm, number of excitations (NEX) = 1. For T1-weighted MR images, we used TR= 500 ms, TE = 10 or 17.4 ms. For T2-weighted MR images, we used TR=4000 ms, TE = 108 ms. RESULTS: Signal to noise ratio (SNR) of 3T system was measured 2.7 times greater than that of prevalent 1.5T system. MR images obtained from 3T system revealed numerous small venous structures throughout the image plane and provided reasonable delineation between gray and white matter. CONCLUSION: The present results demonstrate that the MR images from 3T system could provide better diagnostic quality of resolution and sensitivity than those of 1.5T system. The elevated SNR observed in the 3T high field magnetic resonance imaging can be utilized to acquire images with a level of resolution approaching the microscopic structural level under in vivo conditions. These images represent a significant advance in our ability to examine small anatomical features with noninvasive imaging methods.
Brain ; Foot ; Humans ; Knee ; Magnetic Resonance Imaging* ; Magnets ; Signal-To-Noise Ratio ; Wrist