Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.

PURPOSE: Although sentinel lymph node biopsy (SLNB) can accurately represent the axillary lymph node (ALN) status, the false-negative rate (FNR) of SLNB is the main concern in the patients who receive SLNB alone instead of ALN dissection (ALND). MATERIALS AND METHODS: We analyzed 1,886 patientswho underwent ALND after negative results of SLNB, retrospectively. A logistic regression analysis was used to identify risk factors associated with a false-negative (FN) result. Cox regression model was used to estimate the hazard ratio of factors affecting disease-free survival (DFS). RESULTS: Tumor located in the upper outer portion of the breast, lymphovascular invasion, suspicious node in imaging assessment and less than three sentinel lymph nodes (SLNs) were significant independent risk factors for FN in SLNB conferring an adjusted odds ratio of 2.10 (95% confidence interval [CI], 1.30 to 3.39), 2.69 (95% CI, 1.47 to 4.91), 2.59 (95% CI, 1.62 to 4.14), and 2.39 (95% CI, 1.45 to 3.95), respectively. The prognostic factors affecting DFS were tumor size larger than 2 cm (hazard ratio [HR], 1.86; 95% CI, 1.17 to 2.96) and FN of SLNB (HR, 2.51; 95% CI, 1.42 to 4.42) in SLN-negative group (FN and true-negative), but in ALN-positive group (FN and true-positive), FN of SLNB (HR, 0.64; 95% CI, 0.33 to 1.25) did not affect DFS. CONCLUSION: In patients with risk factors for a FN such as suspicious node in imaging assessment, upper outer breast cancer, less than three harvested nodes, we need attention to find another metastatic focus in non-SLNs during the operation. It may contribute to provide an exact prognosis and optimizing adjuvant treatments.
Biopsy* ; Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Humans ; Logistic Models ; Lymph Nodes ; Odds Ratio ; Prognosis ; Retrospective Studies ; Risk Factors* ; Sentinel Lymph Node Biopsy

OBJECTIVE: This study was aimed to evaluate the effectiveness of the diabetes education program implemented in a community hypertension and diabetes education center. METHODS: Participants were thirty nine diabetic patients who received the education program in the center from May 2014 through May 2015. The education program consisted of two sessions for 2 days (45 minutes per session) regarding clinical information, nutrition and exercise for type 2 diabetes patients. Initially, they were assessed for general characteristics, knowledge on diabetes, self-efficacy and self-care behaviors. Reassessment was performed on their knowledge and self-efficacy directly after the program, and on self-care behaviors at 12 weeks after the program. RESULTS: The mean score of diabetes knowledge was significantly increased from 5.27±2.10 to 8.21±1.20 (p < 0.001) between before and after the program. The self-efficacy score was also significantly increased from 6.88±1.72 to 8.16±1.47 (p < 0.001). The self-care behavior score was significantly increased from 3.59±1.89 before the program to 4.35±1.29 (p < 0.001) at 12 weeks after the program. CONCLUSION: The diabetes education program may be effective on the improvement of knowledge, self-efficacy and self-care behaviors in type 2 diabetic patients.
Diabetes Mellitus ; Education* ; Health Education ; Humans ; Hypertension* ; Self Care* ; Self Efficacy

Gastrointestinal xanthomas are characterized by foamy cytoplasmic cells containing lipid in lamina propria, and occur almost in the gastric mucosa. Colonic xanthomas have been described in rare case. All reported colonic xanthomas were located in rectosigmoid. Rectosigmoid xanthomas have tended to exhibit small polypoid lesion, on the contrary flat in stomach. We report a case of xanthoma on ascending colon presenting as a laterally spreading tumor resected by endoscopic mucosal resection method.
Colon ; Colon, Ascending* ; Cytoplasm ; Gastric Mucosa ; Mucous Membrane ; Polyps ; Stomach ; Xanthomatosis*

Midazolam is a type of anesthetic agent frequently used for conscious sedation during a variety of medical procedures. Anaphylactic reactions to midazolam are rarely reported. However, we observed a case of midazolam hypersensitivity in which emergency measures were required to ensure patient recovery after administration of midazolam as a sedative. The occurrence of the anaphylactic reaction to midazolam was confirmed by elevated serum tryptase levels. The current case report presents a discussion of our findings.
Anaphylaxis* ; Conscious Sedation ; Emergencies ; Humans ; Hypersensitivity ; Midazolam* ; Tryptases

Duodenal ulcers and acute pancreatitis are two of the most commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. This report elaborates on a distinct medical treatment that contributes to partial or complete treatment of acute pancreatitis induced by a duodenal ulcer scar.
Cicatrix ; Duodenal Ulcer* ; Duodenum ; Gastrointestinal Diseases ; Pancreatitis* ; Stents ; Ulcer

The I-gel(TM) is a single-use supraglottic airway device introduced in 2007 which features a non-inflatable cuff and allows passage of a tracheal tube owing to its large diameter and short length of the airway tube. In this case, the authors experienced a difficult airway management on a 4-year-old boy with underlying Goldenhar syndrome who underwent a tonsillectomy. Intubation using a laryngoscope was unsuccessful at the first attempt. In the following attempt, we used the I-gel(TM) supraglottic airway for ventilation and were able to achieve successful intubation with a cuffed tube by using fiberoptic bronchoscope through the I-gel(TM) supraglottic airway. The authors suggest that I-gel(TM) is a useful device for ventilation and it has many advantages for tracheal intubation in pediatric patients with difficult airway.
Airway Management ; Bronchoscopes ; Goldenhar Syndrome ; Humans ; Intubation ; Laryngeal Masks ; Laryngoscopes ; Tonsillectomy ; Ventilation

BACKGROUND AND OBJECTIVES: The electrophysiological properties associated with favorable outcome of radiofrequency catheter ablation (RFCA) for idiopathic ventricular arrhythmia (VA) originating from the papillary muscle (PM) remain unclear. The purpose of this study was to investigate the relationships of electrophysiological characteristics and predictors with the outcome of RFCA in patients with VAs originating from PM in the left ventricle (LV). SUBJECTS AND METHODS: Twelve (4.2%) of 284 consecutive patients with idiopathic VAs originating from LV PM were assessed. The electrophysiological data were compared between the patients in the successful group and patients in the recurrence group after RFCA. RESULTS: In 12 patients with PM VAs, non-sustained ventricular tachycardias (VTs, n=6), sustained VTs (n=4) and premature ventricular complexes (n=2) were identified as the presenting arrhythmias. Seven of eight patients showing high-amplitude discrete potentials at the ablation site had a successful outcome (85.7%), while the remaining four patients who showed low-amplitude fractionated potentials at the ablation site experienced VA recurrence. The mean duration from onset to peak downstroke (Deltat) on the unipolar electrogram was significantly longer in the successful group than in the recurrence group (58+/-8 ms vs. 37+/-9 ms, p=0.04). A slow downstroke >50 ms of the initial Q wave on the unipolar electrogram at ablation sites was also significantly associated with successful outcome (85.7% vs. 25.0%, p=0.03). CONCLUSION: In PM VAs, the high-amplitude discrete potentials before QRS and slow downstroke of the initial Q wave on the unipolar electrogram at ablation sites were related to favorable outcome after RFCA.
Arrhythmias, Cardiac* ; Catheter Ablation* ; Catheters* ; Heart Ventricles* ; Humans ; Papillary Muscles* ; Recurrence ; Tachycardia, Ventricular ; Ventricular Premature Complexes

There are many methods for achieving one-lung ventilation (OLV) during thoracic surgery in neonates and the accuracy of OLV may affect postoperative outcome. The authors have performed OLV using a 5 Fr Arndt endobronchial blocker (AEB, Cook Inc., Bloomington, IN, USA) on a neonate diagnosed with congenital cystic adenomatoid malformation and respiratory distress syndrome (RDS) associated with marked mediastinal shift. In spite of sufficient preoxygenation, sudden and severe fall in oxygen saturation had occurred. Since neonates with RDS may develop sudden and severe desaturation, rapid intubation with anticipation of potential difficulty is necessary as well as sufficient preoxygenation.
Anoxia ; Cystic Adenomatoid Malformation of Lung, Congenital ; Humans ; Infant, Newborn ; Intubation ; One-Lung Ventilation ; Oxygen ; Thoracic Surgery

Thoracic outlet syndrome is caused by the compression of neurovascular structures at the thoracic outlet region. Diagnosis is difficult since thoracic outlet syndrome is often accompanied by distal entrapment neuropathies such as carpal tunnel syndrome or ulnar and radial neuropathies. In this article, the authors report a case regarding a patient with thoracic outlet syndrome whose diagnosis was delayed due to the overlapping of multiple distal entrapment neuropathies.
Carpal Tunnel Syndrome ; Humans ; Nerve Compression Syndromes ; Radial Neuropathy ; Thoracic Outlet Syndrome