Given the progressive improvements in antithrombotic strategies, management of cardiovascular disease has become sophisticated/refined. However, the optimal perioperative management of antithrombotic therapy in patients with acute coronary syndrome or who are scheduled for percutaneous coronary intervention remains unclear. Assessments of the thrombotic and hemorrhagic risks are essential to reduce the rates of mortality and major cardiac events. However, the existing guidelines do not mention these topics. This case-based consensus document deals with common clinical scenarios and offers evidence-based guidelines for individualized perioperative management of antithrombotic therapy in the real world.

The prevalence of ischemic heart disease is steadily growing as populations age. Antithrombotic treatment is a key therapeutic modality for the prevention of secondary cerebro-cardiovascular disease. Patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention must be treated with dual antiplatelet therapy for a mandatory period. The optimal perioperative antithrombotic regimen remains debatable; antithrombotics can cause bleeding. Inadequate antithrombotic regimens are associated with perioperative ischemic events, but continuation of therapy may increase the risks of perioperative hemorrhagic complications (including mortality). Many guidelines on the perioperative management of antithrombotic agents have been established by academic societies. However, the existing guidelines do not cover all specialties, nor do they describe the thrombotic and hemorrhagic risks associated with various surgical interventions. Moreover, few practical recommendations on the modification of antithrombotic regimens in patients who require non-deferrable interventions/surgeries or procedures associated with a high risk of hemorrhage have appeared. Therefore, cardiologists, specialists performing invasive procedures, surgeons, dentists, and anesthesiologists have not come to a consensus on optimal perioperative antithrombotic regimens. The Korean Platelet-Thrombosis Research Group presented a positioning paper on perioperative antithrombotic management. We here discuss commonly encountered clinical scenarios and engage in evidence-based discussion to assist individualized, perioperative antithrombotic management in clinical practice.

PURPOSE: In patients with independent mobility, full hip range of motion and sufficient muscle strength for daily life without cognitive impairment, treatment of a femoral neck fracture with total hip arthroplasty (THA) may be a better option compared to bipolar hip hemiarthroplasty. Here, functional outcomes and complications in patients who underwent THA for femoral neck fracture based on their comorbidity status were analyzed. MATERIALS AND METHODS: Between January 2013 and December 2018, 110 patients were treated with THA for femoral neck fractures at our institution. These patients were retrospectively analyzed for clinical outcomes at final follow-up (mean=24.4 months, range: 6–81 months) using the Harris hip score (HHS) and the presence or absence of two potential comorbidities: i) diabetes mellitus (DM; 35 with and 75 without) and ii) hypertension (HTN; 50 with and 60 without). RESULTS: The incidence of superficial infections at the surgical site in patients with DM was significantly higher compared with patients without DM (P=0.024). There were no significant differences in other potential complications based on DM status. HHS at final follow-up between patients with and without DM and with and without HTN were not significantly different (83.3 vs. 81.0, P=0.39 and 81.6 vs. 82.4, P=0.75, respectively). CONCLUSION: Superficial infections occurred more frequently in patients with DM compared with patients without DM. DM and HTN status are not correlated with HHS.
Arthroplasty, Replacement, Hip ; Cognition Disorders ; Comorbidity ; Diabetes Mellitus ; Femoral Neck Fractures ; Femur Neck ; Follow-Up Studies ; Hemiarthroplasty ; Hip ; Humans ; Hypertension ; Incidence ; Muscle Strength ; Range of Motion, Articular ; Retrospective Studies

OBJECTIVE: Patients suspected as having acute ischemic stroke usually undergo blood tests, including coagulation-related indexes, because thrombocytopenia and coagulopathy are contraindications for recombinant tissue plasminogen activator (rtPA) administration. We aimed to identify blood test indexes associated with symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke who received intravenous rtPA.METHODS: This retrospective observational study included patients diagnosed with acute ischemic stroke who were treated with intravenous rtPA at the emergency department of a tertiary hospital in Seoul between February 2008 and January 2018. Blood test indexes were compared between the sICH and non-sICH groups. Logistic regression and receiver-operating characteristic curve analyses were performed.RESULTS: In this study, 375 patients were finally included. Of 375 patients, 42 (11.2%) showed new intracranial hemorrhage on follow-up brain computed tomography, of whom 14 (3.73%) had sICH. Platelet count, aspartate aminotransferase and lactate dehydrogenase levels were significantly different between the sICH and non-sICH groups, and platelet count showed statistical significance in the regression analysis. Significantly lower platelet counts were observed in the sICH group than in the non-sICH group (174,500 vs. 228,000/mm³, P=0.020). The best cutoff platelet count was 195,000/mm³, and patients with platelet counts of < 195,000/mm³ had a 5.4- times higher risk of developing sICH than those with platelet counts of ≥195,000/mm³.CONCLUSION: Platelet count was the only independent parameter associated with sICH among the blood test indexes. Mild thrombocytopenia may increase the risk of sICH after intravenous administration of rtPA.
Administration, Intravenous ; Aspartate Aminotransferases ; Brain ; Cerebral Infarction ; Emergency Service, Hospital ; Follow-Up Studies ; Hematologic Tests ; Humans ; Intracranial Hemorrhages ; L-Lactate Dehydrogenase ; Logistic Models ; Observational Study ; Platelet Count ; Retrospective Studies ; Seoul ; Stroke ; Tertiary Care Centers ; Thrombocytopenia ; Thrombolytic Therapy ; Tissue Plasminogen Activator

Intestinal tuberculosis (ITB) remains prevalent in Asia. An interferon-γ assay (QuantiFERON-TB gold test [QFT]) is considered to be an effective supplementary tool for diagnosing ITB. We retrospectively analyzed the clinical features of ITB patients based on the initial results of QFT. A total of 109 patients with ITB were enrolled, and 82 patients (75.2%) showed positive QFT results. In the QFT-positive group, the mean age (44.1±12.0 years) was significantly higher than that in the QFT-negative group (37.0±14.8, p=0.0096). Abdominal pain (p=0.006) and diarrhea (p=0.030) were more frequent in the QFT-negative group. Further, C-reactive protein (CRP) levels were significantly higher in the QFT-negative group (6.4±9.9 mg/dL) than in the QFT-positive group (1.3±2.3, p<0.001). Multivariate analysis confirmed that younger age (p=0.016), diarrhea (p=0.042), and high levels of CRP (p=0.029) were independent predictors of QFT-negative results in patients with ITB. These results suggest that prior exposure to TB, reflected by QFT positivity, may cause mild inflammation in patients with ITB.
Abdominal Pain ; Asia ; C-Reactive Protein ; Diarrhea ; Humans ; Inflammation ; Multivariate Analysis ; Retrospective Studies ; Tuberculosis*

PURPOSE: Abdominal CT (computed tomography) is a principal diagnostic imaging modality for torso trauma at the Emergency Department (ED). When acute osseous pelvic injuries are detected by abdominal CT, additional three-dimensional (3D) reconstruction pelvic CT is often performed. We compared abdominal CT with pelvic CT to provide information about acute osseous pelvic injuries. METHODS: A retrospective investigation of patients' electronic medical records during the five year period between January 1, 2004 and December 31, 2008 among Korean soldiers who underwent pelvic CT after abdominal CT at the ED was conducted. Axial images of abdominal CT were compared with axial images and 3D reconstruction images of pelvic CT. RESULTS: Sixteen patients underwent subsequent pelvic CT after abdominal CT. Axial images of abdominal CT showed the same results in terms of fracture detection and classification when compared to axial images and 3D reconstruction images of pelvic CT. Pelvic CT (including 3D reconstruction images) followed by abdominal CT neither detected additional fracture nor changed the fracture type. CONCLUSION: This study has failed to show any superiority of pelvic CT (including 3D reconstruction images) over abdominal CT in detecting acute osseous pelvic injury. When 3D information is deemed be mandatory, 3D reconstructions of abdominal CT can be requested rather than obtaining an additional pelvic CT for 3D reconstruction.
Diagnostic Imaging ; Electronic Health Records ; Emergencies ; Humans ; Military Personnel ; Pelvic Bones ; Retrospective Studies ; Torso

PURPOSE: Biliary complication (BC) is known as the most common and intractable complication after adult living donor liver transplantation (LDLT), but there is lack of large-volume studies with long-term follow-up. To assess the patterns of BC and their treatment results in adult recipients of LDLT. METHODS: 182 adult patients who received 156 right and 26 left liver grafts from January 2001 to December 2002 were selected after exclusion of dual-graft LDLT and short-term survivors. Methods of biliary reconstruction, types of BC, and treatment results of BC were analyzed. RESULTS: The median follow-up period was 38 months. Biliary reconstruction was done as single duct-to-duct anastomosis (DD, n=109), double DD (n=22), single hepaticojejunostomy (HJ, n=31), double HJ (n=16), and combination of DD and HJ (n=4). Overall patient or graft survival rate was 96.2% at 1 year and 93.3% at 3 years. BC-free survival rate was 83.4% at 1 year and 76.5% at 3 years. BC occurred much more often in right liver grafts. There were no statistical differences of BC between DD and HJ groups, and between single and double anastomoses groups. Most of anastomotic leak occurred during the first 1 month, but anastomotic stenosis occurred till 3 years. Small right graft duct around 3 mm in diameter became a significant risk factor of BC. Anastomotic leak occurred in 8 recipients, and 7 recovered after radiological, endoscopic, and surgical treatments. Anastomotic stenosis occurred in 34, and most of them were resolved by radiological intervention. CONCLUSION: The incidence of early BC could be reduced to below 10% by technical refinements, but additional late BC occurred till 3 years. Most of BC were successfully controlled by endoscopic and radiological treatments. DD seems to be avoided in small graft duct around 3 mm in diameter. Close surveillance for BC seems to be mandatory for the first 3 years.
Adult ; Anastomotic Leak ; Constriction, Pathologic ; Follow-Up Studies ; Graft Survival ; Humans ; Incidence ; Liver Transplantation* ; Liver* ; Living Donors* ; Risk Factors ; Survival Rate ; Survivors ; Transplants

BACKGROUND AND OBJECTIVES: For centuries, fragrance had beneficial psychological and physiological effects on humans. Aromatherapy, the use of concentrated essential oils extracted from herbs, flowers, and other parts of plants to treat various diseases, is becoming more commonly accepted within the health service. However, there are very few published articles, which provide a sound rationale for the use of aromatherapy as a medical intervention. The purpose of this study was to find a scientific explanation for the effect of aromatherapy by investigating 1. whether or not essential aroma oils caused increased brain activity and 2. which areas of the brain were activated by the essential aroma oils. MATERIALS AND METHODS: Olfactory fMRI (functional magnetic resonance imaging), which is capable of monitoring and recording regional pathophysiological fluctuations in living brains, was performed on 11 healthy adult humans during exposure to essential aroma oils (lavender and lemon oils) and buthanol. The c-fos immunohistochemical staining was also performed on brain tissues of 24 Mongolian gerbils after exposure to the essential aroma oils. RESULTS: In the human fMRI study, the olfactory cortex was activated in all subjects by the essential aroma oils and buthanol. Additionally, lavender oil also activated the hearing and language-related regions of brain. In the animal study, similar results were observed: immunoreactive cells were detected in the hearing and language related regions of gerbil brains that had been exposed to lavender oil. CONCLUSION: The lavender oil activated not only the olfactory region but also the hearing and language-related regions of the brain. These results imply that the essential aroma oil introduced through the olfactory pathway has effects on other regions of the brain.
Adult ; Animals ; Aromatherapy ; Brain* ; Complementary Therapies ; Flowers ; Gerbillinae ; Health Services ; Hearing ; Humans ; Lavandula ; Magnetic Resonance Imaging* ; Oils* ; Oils, Volatile ; Olfactory Pathways ; Proto-Oncogene Proteins c-fos

Little is known about processing mechanism of sensory input from the periodontal ligaments to the trigeminal motor nucleus for the control of chewing force and modulation of chewing pattern. Low threshold mechanoreceptive periodontal afferent was labeled with horseradish peroxidase by use of intra-axonal injection technique and investigated with electron microscopy. Quantitative ultrastructural analysis was performed on the 39 serially reconstructed labeled boutons in the trigeminal motor nucleus in cat. Labeled bouton contained clear spherical vesicles and one or two large dense cored vesicles. Most of labeled boutons were dome or round shape. All the analysed labeled boutons were presynaptic to dendritic shaft or distal dendrite and those presynaptic to soma or proximal dendrite were not observed. A large number of labeled boutons (46.2%) were postsynaptic to one or two presynaptic pleomorphic vesicle containing endings. Synaptic triad, in that a presynaptic ending which is presynaptic to the labeled bouton, in turn, is presynaptic to dendrite that is postsynaptic to the labeled bouton, was observed in 10.3% of the labeled boutons. Most of the labeled boutons showed simple synaptic organization, in that 64.1% of the labeled boutons made synaptic contacts with one or two neuronal profiles. One (2.6%) of the 39 analyzed labeled boutons showed synaptic contacts with 5 or more neuronal profiles. Labeled bouton volume, mitochondrial volume, apposed surface area and active zone area showed wide variation. These ultrastructural parameters were positively correlated with bouton volume. The values for apposed surface area and active zone area with presynaptic p-endings, in contrast to those with postsynaptic dendrites, showed narrow range and had little correlation with bouton volume. The present study revealed characteristic features on ultrastructural parameters of labeled boutons from periodontal afferent which is involved in periodontal masseteric reflex, and that influence on the postsynaptic trigeminal motoneurons showed wide variability.
Animals ; Carisoprodol ; Cats ; Dendrites ; Horseradish Peroxidase ; Mastication ; Microscopy, Electron ; Mitochondrial Size ; Neurons ; Periodontal Ligament ; Reflex ; Synapses

We examined the hypothesis that mild hypothermia (rectal temperature 34 degrees C) results in the same survival time, whether induced spontaneously or intentionally, during untreated, lethal, uncontrolled hemorrhagic shock in rats. Sixty-four Sprague-Dawley male rats were randomly assigned to normothermia (Nth) (n=19), spontaneous mild hypothermia (Sp.Hth) (n=25) or controlled mild hypothermia (Con.Hth) (n=20) groups. After blood withdrawal of 3 mL/100 g over 15 minutes, followed by 75% tail amputation under spontaneous breathing and light anesthesia by i.p. injection of pentobarbital sodium, rats were observed without fluid resuscitation or hemostasis for 180 minutes or until death. The initial temperature of the Nth group was artificially maintained throughout the experiment. For the mild hypothermia groups, the Sp.Hth group was exposed to ambient temperature while the Con. Hth group was actively cooled to a target rectal temperature of 34 degrees C. In the Con.Hth group, all rats except one died before 180 minutes. All rats in the Nth group died within 38 minutes, and within 67 minutes in the Sp.Hth group. The average survival time was shortest in the Nth group at 20.3 +/- 5.3 minutes, followed by the Sp.Hth group at 30.1 +/- 13.5 minutes, and the Con.Hth group at 81.9 +/- 39.8 minutes (p 0.01). Tail bleed out volume was 0.51 +/- 0.19, 0.26 +/- 0.15 and 0.19 +/- 0.12 mL/100 g in the Nth, Sp.Hth and Con.Hth groups, respectively (p 0.05). In conclusion, spontaneous mild hypothermia did not prolong the survival time as much as controlled mild hypothermia in the rat model for untreated, lethal, uncontrolled hemorrhagic shock.
Animal ; Blood Pressure ; Body Temperature ; Hypothermia/*physiopathology ; *Hypothermia, Induced ; Male ; Rats ; Rats, Sprague-Dawley ; Shock, Hemorrhagic/*mortality/physiopathology/therapy