BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment. RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups. CONCLUSION The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

BACKGROUND AND OBJECTIVES: Metabolic syndrome (MetS) increases the risk of heart failure (HF). The purpose of this study was to identify the prevalence of MetS in patients with HF and determine the syndrome's association with HF in clinical and laboratory parameters. SUBJECTS AND METHODS: A total of 3200 HF patients (67.6+/-14.5 years) enrolled in a nationwide prospective Korea HF Registry between Jan. 2005 and Oct. 2009. Patients were divided into two groups according to the presence or absence of MetS at admission: group I (presence, n=1141) and group II (absence, n=2059). RESULTS: The prevalence of MetS was 35.7% across all subjects and was higher in females (56.0%). The levels of white blood cells, platelets, creatinine, glucose, and cholesterol were significantly higher in group I than in group II. Left ventricular dimension and volume was smaller and ejection fraction was higher in group I than in group II. An ischemic cause of HF was more frequent in group I. The rates of valvular and idiopathic cause were lower in group I than in group II. The rate of mortality was lower in group I than in group II (4.9% vs. 8.3%, p<0.001). CONCLUSION: Despite the increased cardiovascular risks in MetS, MetS was found to be associated with decreased mortality in HF.
Blood Platelets ; Cholesterol ; Creatinine ; Female ; Glucose ; Heart ; Heart Failure ; Humans ; Korea ; Leukocytes ; Prevalence ; Prospective Studies

Plasma pH can be altered during pregnancy and at labor. Membrane excitability of smooth muscle including uterine muscle is suppressed by the activation of K+ channels. Because contractility of uterine muscle is regulated by extracellular pH and humoral factors, K+ conductance could be connected to factors regulating uterine contractility during pregnancy. Here, we showed that TASK-2 inhibitors such as quinidine, lidocaine, and extracellular acidosis produced contraction in uterine circular muscle of mouse. Furthermore, contractility was significantly increased in pregnant uterine circular muscle than that of non-pregnant muscle. These patterns were not changed even in the presence of tetraetylammonium (TEA) and 4-aminopyridine (4-AP). Finally, TASK-2 inhibitors induced strong myometrial contraction even in the presence of L-methionine, a known inhibitor of stretchactivated channels in myometrium. When compared to non-pregnant myometrium, pregnant myometrium showed increased immunohistochemical expression of TASK-2. Therefore, TASK-2, seems to play a key role during regulation of myometrial contractility in the pregnancy and provides new insight into preventing preterm delivery.
4-Aminopyridine ; Acidosis ; Animals ; Contracts ; Female ; Hydrogen-Ion Concentration ; Lidocaine ; Membranes ; Methionine ; Mice ; Muscle, Smooth ; Muscles ; Myometrium ; Plasma ; Pregnancy ; Quinidine ; Relaxation ; Uterine Contraction ; Uterus

BACKGROUND AND OBJECTIVES: Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. SUBJECTS AND METHODS: We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6+/-14.3 years and 50% of the patients were female. RESULTS: Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5+/-15.7% and 26.1% of the patients had preserved systolic function (LVEF > or =50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. CONCLUSION: We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.
Anemia ; Angiotensin Receptor Antagonists ; Angiotensins ; Female ; Heart ; Heart Failure ; Hospitalization ; Humans ; Hyponatremia ; Korea ; Multivariate Analysis ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Peptide Fragments ; Prognosis ; Registries ; Risk Factors ; Stroke Volume

The incidence of acute respiratory distress syndrome (ARDS) has been estimated worldwide to range from 1.7 to 75 cases per 100,000. There are many treatments for ARDS, but only the low tidal volume strategy is based on strong clinical evidence from randomized clinical trials. The efficacy of extracorporeal life support (ECLS) in adults remains controversial. Ongoing clinical trials and research have shown a benefit for its use to salvage severe ARDS patients that are in failure with conventional treatment. We encountered a 41-year-old woman who developed ARDS induced by pneumococcal pneumonia. Despite conventional mechanical ventilation in the emergency room, severe hypoxia remained. We treated the patient immediately with ECLS. The patient has almost fully recovered, and was discharged from a 177-day stay at our hospital.
Adult ; Anoxia ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Pneumonia, Pneumococcal ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Tidal Volume

The incidence of acute respiratory distress syndrome (ARDS) has been estimated worldwide to range from 1.7 to 75 cases per 100,000. There are many treatments for ARDS, but only the low tidal volume strategy is based on strong clinical evidence from randomized clinical trials. The efficacy of extracorporeal life support (ECLS) in adults remains controversial. Ongoing clinical trials and research have shown a benefit for its use to salvage severe ARDS patients that are in failure with conventional treatment. We encountered a 41-year-old woman who developed ARDS induced by pneumococcal pneumonia. Despite conventional mechanical ventilation in the emergency room, severe hypoxia remained. We treated the patient immediately with ECLS. The patient has almost fully recovered, and was discharged from a 177-day stay at our hospital.
Adult ; Anoxia ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Pneumonia, Pneumococcal ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Tidal Volume

PURPOSE: Laparoscopic adrenalectomy (LA) has become the standard treatment for benign adrenal neoplasm because of the procedure's minimal invasiveness and the patients' earlier recovery. The aim of this study was to evaluate the safety and effectiveness of laparoscopic adrenalectomy for treating pheochromocytoma. METHODS: 19 Operations were performed between March 1993 and July 2004 at Kyung-Hee medical center for treating pheochromocytoma, and the diagnosis was confirmed by the postoperative pathology. There were 5 cases treated with LA and 14 cases treated with open adrenalectomy (OA). The various clinical parameters (tumor location, tumor size, first oral feeding, hospital stay, hemodynamic change and operation time) were compared between the LA and OA procedures, retrospectively. RESULTS: The location of the tumor was 2 : 2 : 1 (left : right : extra-adrenal) in the LA group and 9 : 3 : 2 (left : right : both) in the OA group. The mean tumor size (cm) was 5.4 in the LA group and 6.3 in the OA group. The mean operation time (minutes) was 219 in the LA group and 202 in the OA group. The resumption of liquid diet (days) was 2.2 in the LA group and 3.0 in the OA group (P=0.037). The postoperative hospital stay (days) was 6.3 in the LA group and 8.5 in the OA group. The mean number of intraoperative hypertensive crisis was 1.42 in the LA group and 1.40 in the OA group. The number of cases requiring intraoperative transfusion was 2 of 5 in the LA group and 2 of 15 in the OA group. The use of antihypertensives (number of times) was 1.42 in the LA group and 1.40 in the OA group. The mean highest BP (mmHg) was 162 in the LA group and 165 in the OA group. CONCLUSION: Laparoscopic adrenalectomy for treating pheochromocytoma is a safe and effective procedure that provides the benefits of a minimally invasive approach.
Adrenal Gland Neoplasms ; Adrenalectomy ; Antihypertensive Agents ; Diagnosis ; Diet ; Hemodynamics ; Length of Stay ; Pathology ; Pheochromocytoma* ; Retrospective Studies

BACKGROUND: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52% , pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug- resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. METHODS: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. RESULTS: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was 69+/-11 years old and the latter was 70+/-13 years old. The mean APCHE II score, ICU days and mortality were not different between the two groups(16.1+/-5.4 vs. 14.9+/-4.8, P=0.43, 25.1+/-13.6 vs. 39.1+/-31.0, P=0.2, 58.8% vs. 40%, P=0.21). CONCLUSION: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.
Acinetobacter baumannii ; Acinetobacter* ; Adult ; Anti-Bacterial Agents ; Drug Resistance, Multiple ; Gangwon-do ; Heart ; Humans ; Incidence ; Infection Control ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies

BACKGROUND: New stent implantation during intracoronary brachytherapy is discouraged due to the high risk of late thrombosis. However, new stent implantation is inevitable in some cases due to the inadequate ballooning or major dissections. Long-term follow-up results of newly implanted stents during brachytherapy are not well-known. We performed this study to evaluate the long-term clinical outcomes of newly implanted stents during intracoronary brachytherapy. METHODS: In the Seoul national university Post-Angioplasty RhEnium irradiation (SPARE) trial, patients were treated with conventional catheter-based technique and then randomized to either beta- radiation (RG) or control group (CG). Radiation was performed with 188 -rhenium-filled conventional balloon catheter system. From 1999 to 2001, new stent implantation was performed in 58 and 56 patients in RG and CG, respectively. Clinical and angiographic follow up data were analyzed. RESULTS: In RG, short-term angiographic restenosis rate was lower than CG (28.6% vs 53%, p=0.03). In RG, late thrombosis was found in 3 patients. However, there was no late thrombosis in CG. Two year major cardiac event rates were not different between the 2 groups (RG: 25.9% vs CG: 28.3%). Independent predictors for major cardiac event in RG were major dissections (>or=type C) after stent implantation (beta=70, p=0.01) and longer administration of dual antiplatelets (aspirin+clopidogrel/ ticlopidine, >6 months, beta=0.07, p=0.04). CONCLUSION: Stenting during intracoronary brachytherapy seems to be ineffective in reducing long-term event rates. When new stent implantation is inevitable during brachytherapy, extreme attention is required not to make a dissection and long-term dual antiplatelet treatment should be followed after stent implantation.
Angioplasty ; Brachytherapy ; Catheters ; Follow-Up Studies ; Humans ; Rhenium ; Seoul ; Stents* ; Thrombosis ; Ticlopidine

BACKGROUND AND OBJECTIVES: Angiotensin converting enzyme inhibitors (ACEI) have been suggested to be beneficial in regurgitant valvular heart disease by reducing both preload and afterload. Moreover their benefits have also been proven in acute mitral regurgitation (MR). However the role of long term administration of ACEI in chronic MR remains in dispute. SUBJECTS AND METHODS: One hundred patients with more than moderate degree MR (rheumatic MR or Mitral valve prolapse [MVP] MR) were identified from patients undergoing cardiac echocardiography between April 1984 and July 2002. Patients with co-morbid valvular heart disease more than mild degree were excluded from the study. The subjects were divided into the study group (who took ACEI) and the control group. Medical records and echocardiographic reports were reviewed and the etiology of MR, left ventricular end-diastolic dimensions (LVEDD), end-systolic dimensions (LVESD), left atrial dimensions, and ejection fraction (EF) changes were studied serially for both groups. RESULTS: The mean duration of follow-up was 5.0+/-3.2 years. There were no significant differences in age, blood pressure, or basal echocardiographic parameters between the rheumatic MR and MVP MR groups. In the MVP MR patients, the ACEI group showed a statistically significant increase in EF (p=0.007), decrease in LVESD (p=0.0014) and decrease in left atrial dimensions (p=0.01). However, in the rheumatic MR patients, the ACEI group showed no significant changes compared to those of the non-ACEI group. CONCLUSION: Long term ACEI therapy seems to be beneficial in mildly symptomatic MR due to mitral valve prolapse.
Angiotensin-Converting Enzyme Inhibitors ; Angiotensins* ; Blood Pressure ; Dissent and Disputes ; Echocardiography ; Follow-Up Studies ; Heart Valve Diseases ; Humans ; Medical Records ; Mitral Valve Insufficiency* ; Mitral Valve Prolapse ; Peptidyl-Dipeptidase A*