BACKGROUND AND OBJECTIVES: There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI). METHODS: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months. RESULTS: After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31–3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924). CONCLUSIONS Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.

BACKGROUND AND OBJECTIVES: There is a paucity of data regarding the benefit of clopidogrel monotherapy after dual antiplatelet therapy (DAPT) in patients treated with drug-eluting stents (DES). This study compared outcome between clopidogrel versus aspirin as monotherapy after DES for acute myocardial infarction (MI).METHODS: From Korea Acute Myocardial Infarction Registry-National Institute of Health database, 1,819 patients treated with DES who were switched to monotherapy with clopidogrel (n=534) or aspirin (n=1,285) after uneventful 12-month DAPT were analyzed. The primary endpoint was net adverse clinical events (NACE), defined as a composite of death from any cause, MI, repeat percutaneous coronary intervention (PCI), stent thrombosis, ischemic stroke, or major bleeding during the period from 12 to 24 months.RESULTS: After adjustment using inverse probability of treatment weighting, patients who received clopidogrel, compared with those treated with aspirin, had a similar incidence of NACE (0.7% and 0.7%; hazard ratio, 1.06; 95% confidence interval, 0.31–3.60; p=0.923). The 2 groups had similar rates of death from any cause (0.1% in each group, p=0.789), MI (0.3% and 0.1%, respectively; p=0.226), repeat PCI (0.1% and 0.3%, respectively; p=0.548), stent thrombosis (0.1% and 0%, respectively; p=0.121), major bleeding (0.2% in each group, p=0.974), and major adverse cardiovascular and cerebrovascular events (0.5% in each group, p=0.924).CONCLUSIONS: Monotherapy with clopidogrel, compared to aspirin, after DAPT showed similar clinical outcomes in patients with acute MI treated with DES.
Aspirin ; Drug-Eluting Stents ; Hemorrhage ; Humans ; Incidence ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Stents ; Stroke ; Thrombosis

Gastrointestinal tract involvement in undifferentiated pleomorphic sarcoma (UPS) is extremely rare. To the authors' knowledge, only 21 cases of primary small bowel UPS have been reported in the literature available in English. Reported CT findings in primary small bowel UPS have been nonspecific, and MRI findings have been reported in only one case. The present article describes a case involving a 72-year-old male with histologically confirmed primary UPS arising from the ileum, focusing on both CT and magnetic resonance enterography findings. On CT, primary small bowel UPS was noted as a heterogeneously enhanced small bowel mass without obstruction. Magnetic resonance enterography revealed heterogeneous intermediate T1 and T2 signal intensity, with hemorrhagic or necrotic foci within the mass and heterogeneous enhancement. The differential diagnosis included malignant gastrointestinal tumor; however, the prognosis of UPS is worse, with higher incidences of extra-abdominal metastasis.

OBJECTIVE: Data on the intensity of statin therapy for patients with acute myocardial infarction (MI) and very low baseline low-density lipoprotein (LDL) cholesterol level are lacking. We sought to assess the impact of statin intensity in patients with acute MI and LDL cholesterol <70 mg/dL. METHODS: A total of 1,086 patients with acute MI and baseline LDL cholesterol <70 mg/dL from the Korea Acute Myocardial Infarction Registry-National Institute of Health database were divided into less intensive statin (expected LDL reduction <40%, n=302) and more intensive statin (expected LDL reduction ≥40%, n=784) groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiac death, MI, revascularization occurring at least 30 days after admission, and stroke, at 12 months. RESULTS: After 1:2 propensity matching, differences were not observed between less intensive (n=302) and more intensive statin (n=604) groups in incidence of cardiac death (0.3% vs. 0.3%) and hemorrhagic stroke (0.3% vs. 0.5%, p=0.727) at 12 months. Compared with the less intensive statin group, the more intensive statin group showed lower target-vessel revascularization (4.6% vs. 1.8%, p=0.027) and MACCE (11.6% vs. 7.0%, p=0.021). Major bleeding was not different between less intensive and more intensive statin groups (1.0% vs. 2.6%, p=0.118). CONCLUSION: More intensive statin therapy was associated with significantly lower major adverse cardiovascular events in patients with acute MI and very low LDL cholesterol compared with less intensive statin therapy.
Cholesterol ; Cholesterol, LDL ; Death ; Hemorrhage ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Korea ; Lipoproteins ; Myocardial Infarction ; Stroke

Schwannoma is a benign nerve sheath tumor that involves Schwann cells mostly found in the head, neck, posterior mediastinum and extremities. Schwannoma develops rarely in the retroperitoneum; thus, renal schwannoma is extremely uncommon. Differentiation of renal schwannoma from renal cell carcinoma is difficult with radiologic analysis. A few cases of these tumors have been reported in literature, and little has been described regarding imaging appearances. In this study, we present a rare case of a renal schwannoma, resembling renal cell carcinoma, with radiological correlations.

Progressive transformation of germinal centers (PTGC) is an atypical feature seen in lymph nodes with unknown pathogenesis. PTGC most commonly presents in adolescent and young adult males as solitary painless lymphadenopathy with various durations. Cervical nodes are the most commonly involved ones while involvements of axillary and inguinal nodes are less frequent. PTGC develops extremely rarely in other locations. We report a rare case of solitary mass present in the presacral space. The mass as subsequently proven to be PTGC. To the best of our knowledge, PTGC in the presacral space has not been previously reported in the literature.
Adolescent ; Germinal Center* ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Magnetic Resonance Imaging* ; Male ; Young Adult

BACKGROUND/AIMS: Although controversial, probiotics and dietary fiber are commonly used for patients with irritable bowel syndrome (IBS). We evaluated the effects of multistrain probiotics on the symptoms of IBS to determine whether the addition of dietary fi ber had an additive effect on constipation-predominant IBS. METHODS: A total of 142 participants who met the Rome III criteria were recruited and randomized into a control group or a test group. Participants in the control group received multistrain probiotic fermented milk with Streptococcus thermophilus, Lactobacillus acidophilus and Bifidobacterium infantis; the participants in the test group received the same probiotic fermented milk mixed with dietary fi ber such as sea tangle extracts, radish extracts and glasswort extracts. The patients were treated for four weeks. RESULTS: Most of the symptoms of IBS, with the exception of fl atulence, stool consistency, and frequency of defecation, signifi cantly improved in both groups. In the analysis of IBS subtypes, especially constipation-predominant IBS, the frequency and duration of defecation and straining at stool were improved more in the test group than in the control group. CONCLUSIONS: Dietary fiber had additive benefits for the symptoms of constipation, especially in constipation-predominant IBS.
Bifidobacterium ; Constipation ; Defecation ; Dietary Fiber ; Humans ; Irritable Bowel Syndrome ; Lactobacillus acidophilus ; Milk ; Probiotics ; Raphanus ; Rome ; Sprains and Strains ; Streptococcus thermophilus

PURPOSE: Despite advances in infection control practices, Surgical Site Infections (SSIs) remain a substantial cause of morbidity and mortality among hospitalized patients. This study was undertaken to determine prospectively the incidence of postoperative wound infections in surgical patients and to identify the risk factors associated with the development of wound infections. METHODS: Prospective data on 761 surgical operation patients in the department of surgery at Ewha Womans University Mokdong Hospital were collected over a 7 month-period from May 1, to December 31, 2001. The Centers for Disease Control and Prevention (CDC)'s definitions of surgical wound infections were used. RESULTS: A total of 761 patients were observed over 30 days. The overall incidence of wound infection was 2%. SSIs were significantly associated with the degree of wound contamination (P=0.0004). The infection rate increased as the degree of wound contamination increased from clean (1.4%) through clean-contaminated (1.8%) and contaminated (1.8%), to dirty- infected wound (12.7%). The infection rate was related with the American Society of Anesthesiologists (ASA) preoperative assessment score (P=0.00153). There were no SSIs from laparoscopic surgery. The duration of operation was not associated with an increase in wound infections. Enterococcus faecium and Staphylococcus aureus were the most frequently isolated organisms. Three out of the five (60%) cases of E. faecium were vancomycin-resistant enterococci (VRE) and all of three cases of S. aureus were methicillin- resistant Staphylococcus aureus (MRSA). CONCLUSION: This study confirms that the degree of wound contamination is a significant preoperative risk factor for SSI. Many antibiotic-resistant bacteria such as MRSA and VRE were isolated. Accordingly, infection control practitioners need to consider this risk factor in the design of effective infection control strategies. There should be another safe and feasible option available for the treatment of selective patients.
Bacteria ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Enterococcus faecium ; Female ; Humans ; Incidence ; Infection Control ; Infection Control Practitioners ; Laparoscopy ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Prospective Studies* ; Risk Factors ; Staphylococcus aureus ; Surgical Wound Infection* ; Wound Infection ; Wounds and Injuries

Primary gastrointestinal lymphomas originating from the mucosa-associated lymphoid tissue (MALT) have been reported with increasing frequency. The stomach is the most frequent site of MALT lymphoma, and a relationship with Helicobacter pylori infection has been studied. However, primary MALT lymphoma arising from the ampulla of Vater is extremely rare, and its relationship with Helicobacter pylori infection is still obscure. We report here a case of a 71-year-old man with marginal zone B cell lymphoma of MALT with large B cell lymphoma of the ampulla of Vater that was not associated with Helicobacter pylori. A pancreaticoduodenectomy was performed, and the pathologic examination of the resected specimen confirmed the diagnosis. The patient tolerated just one course of systemic chemotherapy, but has been doing well for 18 months after surgery.
Aged ; Ampulla of Vater* ; Diagnosis ; Drug Therapy ; Helicobacter pylori ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Pancreaticoduodenectomy ; Stomach

Gastrointestinal stromal tumors (GIST) form a group of uncommon neoplasms originated from the pleuripotential mesenchymal cell. There is no final conclusion about accurate diagnosis and prognostic factors of GIST. Clinical presentation is not specific and intraperitoneal bleeding is a very rare complication. We report a case of a malignant GIST complicated by intraperitoneal hemorrhage, which was diagnosed by abdominal CT and EUS before operation. A subtotal gastrectomy was perfomed without complication. The patient is still alive without recurrence.
Diagnosis ; Gastrectomy ; Gastrointestinal Stromal Tumors* ; Hemoperitoneum* ; Hemorrhage ; Humans ; Recurrence ; Rupture* ; Stomach* ; Tomography, X-Ray Computed