STUDY DESIGN: A retrospective multi-center study.OBJECTIVES: To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma.SUMMARY OF LITERATURE REVIEW: Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy.MATERIALS AND METHODS: We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test.RESULTS: Thirty-three patients (21 males,12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004).CONCLUSIONS: Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma.
Chondrosarcoma ; Cohort Studies ; Diagnosis ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Osteosarcoma ; Recurrence ; Retrospective Studies ; Sarcoma ; Spine

OBJECTIVES: To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma.SUMMARY OF LITERATURE REVIEW: Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy. MATERIALS AND METHODS: We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test. RESULTS: Thirty-three patients (21 males,12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004). CONCLUSIONS Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma.

BACKGROUND: Coronary artery disease (CAD) has recently become one of the major causes of mortality and morbidity in Korea. However, not much epidemiologic and demographic data has yet been reported. The purpose of this study was to investigate the clinical features as well as the prognostic factors of patients with CAD. METHODS: We prospectively enrolled 1,665 consecutive patients with CAD who had been admitted to the Catholic University Hospitals from December 1999 to April 2003. RESULTS: Acute myocardial infarction (AMI) was the most common cause of admission (n=715, 42.9%). Dyslipidemia, hypertension and smoking were the most common risk factors. More than 70% of the patients who underwent percutaneous coronary intervention (PCI) received stent implantation. A total of 965 (612 males) patients were followed at least for 6 months (the mean follow-up duration was 23.8+/-12.2 months). The incidence rates of major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, target vessel revascularization) and cardiac death were 15.1% (n=146) and 2.2% (n=21), respectively. There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. By Cox regression analysis, the independent prognostic factors for MACE were PCI (95% CI: 1.75-4.85; p<0.01) and multivessel disease (95% CI: 1.03-2.04; p<0.05), and the independent prognostic factors for cardiac death were medical therapy (95% CI: 1.08-14.41; p<0.05) and old age (95% CI: 1.13-16.13; p<0.05). CONCLUSIONS: There was no difference in overall survival between the patients treated with medical therapy and those treated with PCI. However, PCI was superior to medical therapy for preventing death of the patients with acute coronary syndrome.
Acute Coronary Syndrome ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Death ; Dyslipidemias ; Follow-Up Studies ; Heart* ; Hospitals, University ; Humans ; Hypertension ; Incidence ; Korea ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prognosis ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents

BACKGROUND AND OBJECTIVES: Passive smoking increases the risk of cardiovascular disease, but the factors responsible for this association remain largely unknown. We sought to determine whether passive smoke exposure is associated with systemic inflammation in a dose-dependent fashion, which is a known risk factor for cardiovascular events. SUBJECTS AND METHODS: We analyzed the data of self-reported non-smokers, > or =40 years of age, who were from the Third National Health and Nutrition Examination Survey (n=6,595). We quantified the passive nicotine exposure by dividing the non-smokers into quartiles, as based on the serum cotinine values. We used multiple linear and logistic regression models to determine the independent relationship between serum cotinine and the levels of C-reactive protein, fibrinogen and leukocytes, and the platelet expression. RESULTS: After adjustments were done for age, gender, body mass index and race, the participants in the highest serum cotinine quartile (quartile 4) had circulating platelet, fibrinogen and homocysteine levels that were 6,893/microliter higher (95% confidence interval [CI]: 1,886 to 11,900/microliter, p=0.007), 8.74 mg/dL (95% CI: 2.63 to 14.84 mg/dL, p=0.005) and 0.90 micromol/L (95% CI: 0.36 to 1.43 (micromol/L, p=0.001), respectively, than in those in the lowest quartile of serum cotinine (quartile 1). There was a dose-dependent increase in the circulating fibrinogen, homocysteine and platelet levels across the quartiles of cotinine. CONCLUSION: These findings indicate that even among nonsmokers, elevated serum cotinine is an independent risk factor for systemic inflammation. This suggests that passive smoke exposure promotes systemic inflammatory response in a dose-dependent fashion. These observations may explain why passive smoking is a risk factor for atherosclerosis and cardiovascular events.
Atherosclerosis ; Blood Platelets ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Continental Population Groups ; Cotinine ; Epidemiology ; Fibrinogen ; Homocysteine ; Humans ; Inflammation* ; Leukocytes ; Logistic Models ; Nicotine ; Nutrition Surveys ; Observational Study* ; Risk Factors ; Smoke* ; Tobacco Smoke Pollution

OBJECTIVE: To evaluate the effects of shoe lift to the unaffected limb on hemiplegic gait after stroke. METHOD: Three dimensional gait analysis was performed in 20 chronic hemiplegic patients with shoe lifts (5, 10, 15 mm) to the unaffected limb. The order of experimental series was randomized among subjects. Temporal gait parameters were measured and compared according to the height of shoe lifts in the affected and unaffected limbs. RESULTS: The stride time of both limbs and step time of the affected limb were decreased, and stride length of both limbs and step length of unaffected limb were increased after shoe lift apply (p<0.05). Thus walking velocity and cadence were increased. In gait cycle, there was decreased double limb support phase of affected limb (p<0.05). These improvement of gait patterns of hemiplegics was maximum after shoe lift of 10 mm height. CONCLUSION: Weight bearing with shoe lift may contribute to improved postural control and gait performance in hemiplegics. Furthermore, the study about long-term effects of shoe lifts to the unaffected limb may be necessary.
Extremities* ; Gait Disorders, Neurologic ; Gait* ; Humans ; Shoes* ; Stroke* ; Walking ; Weight-Bearing

Coronary pseudo-lesion is an artificial lesion that occurs during percutaneous transluminal coronary angioplasty by an angioplasty guide wire and/or a balloon as a result of a straightening of the vessel curvature. A specific treatment is not required and the condition is completely resolved after removing the angioplasty wire. There are few reports about a pseudo-lesion, particularly in the left circumflex artery. We report two cases of a coronary pseudo-lesion induced by an angioplasty guide wire; one case affecting the left circumflex artery and the other affecting the right coronary artery.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteries* ; Coronary Vessels*

BACKGROUND AND OBJECTIVES: Fibrinolytic therapy or percutaneous coronary intervention are different forms of reperfusion therapy for an acute myocardial infarction. The aim of this study was to assess the differences in the early managements, including reperfusion therapy and inhospital outcomes, of patients with acute myocardial infarction (MI) between hospitals with and without coronary revascularization facilities. SUBJECTS AND METHODS: The clinical characteristics, reperfusion therapy, initial medical treatments, frequency of invasive and non-invasive studies and inhospital mortalities of 962 and 433 acute myocardial infarction patients in hospitals with and without coronary revascularization facilities, respectively, between 1995 and 2000, were retrospectively compared. RESULTS: There were no differences in the clinical characteristics between two groups. There was also no difference in the rate of reperfusion therapy between two groups (57.9 vs. 58.0 %, p=NS). Patients in hospitals with coronary revascularization facilities more often underwent coronary angiography (18.9 vs. 61.4%, p<0.01), but less often underwent stress tests (162 vs. 40.5%, p0.05). The hospital mortalities were 9.7 and 9.8%, respectively, in hospitals with and without coronary revascularization facilities (p=NS). CONCLUSION: Those patients with acute MI admitted to hospital without coronary revascularization facilities appear to have a similar likelihood of receiving reperfusion therapy and other medications, including aspirin and beta-blockers, and similar inhospital outcomes to those admitted to hospitals with such facilities.
Aspirin ; Coronary Angiography ; Exercise Test ; Hospital Mortality ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Reperfusion ; Retrospective Studies ; Thrombolytic Therapy

BACKGROUND AND OBJECTIVES: The formation of thrombi on a permanent pacemaker lead has been reported as a rare complication following the implantation of a permanent pacemaker. However, there is little information about the complications related to modern cardiac pacing. The purpose of this study was to evaluate the factors associated with the formation of a lead thrombosis following the implantation of a permanent pacemaker (P-PM). SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 14 patients (M:F= 6:8, mean age=46+/-11) with P-PM lead thrombus that were detected with a transthoracic echocardiography. The clinical features, type of pacemaker and echocardiographic findings of these patients were analyzed. RESULTS: All thromb us formations had developed in the right atrium (RA), and/or superior vena cava (SVC)(100%, n=14), were mainly in the proximal portion of the RA (71.4%, n=10) and on the ventricular lead (64.3%, n=9). 12 of 14 patients (85.7%), The lead thromboses were atrial fibrillation, with tachy-brady syndrome or sinus pause. Three of the patients had a total SVC obstruction and 1 a thrombus with aspergillosis. The lead thrombus in one patient was completely resolved after thrombolytic treatment. There were no significant differences in the incidences of lead thrombosis in relation to the number of implanted leads, insulation type, echocardiographic parameters. CONCLUSION: Lead thromboses might not be a rare complication following the implantation of a P-PM, and frequently occur in the right atrium of patients with atrial pathology. The necessity for thrombolytic therapy in patients with a lead thrombus should be further investigated.
Aspergillosis ; Atrial Fibrillation ; Echocardiography ; Heart Atria ; Humans ; Incidence ; Medical Records ; Pathology ; Retrospective Studies ; Thrombolytic Therapy ; Thrombosis ; Vena Cava, Superior

Pacemaker lead infection is a rare but a dangerous complication. Diagnosis can usually be established by the clinical picture and blood cultures. Transesophageal two dimensional echocardiography might be crucial in the diagnosis by visualizing pacing lead vegetations. Medical treatment alone is rarely successful, and several studies have suggested the infected pacemaker systems should be removed quickly for optimal management. We describe a case of Aspergillus infection in a permanent ventricular pacing lead, which appears to be the first reported case in Korea. A 30-yr-old man was evaluated for the symptoms and signs of congestive heart failure 3 yr after DDD pacemaker implantation. The transthoracic and transesophageal echocardiogram showed a large movable round shaggy mass attached to a ventricular lead in the right atrium. The atrial and ventricular leads were removed during cardiopulmonary bypass, and a new epicardial pacing system was implanted. The functional ventricular pacemaker lead was encased in a large organized thrombus. Histological findings were consistent with Aspergillus infection in a large thrombus attached to a pacemaker lead.
Adult ; Aspergillosis/diagnosis/*etiology/microbiology ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria/microbiology ; Humans ; Male ; Pacemaker, Artificial/*adverse effects/microbiology ; Thrombosis/diagnosis/*etiology/microbiology

BACKGROUND: Tachyarrhythmias have various clinical features according to their tachycardia rates, systolic function of the left ventricle, the origin site and the mechanisms. Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) might cause different hemodynamic changes due to their different mechanisms. METHODS: To evaluate the hemodynamic differences of supraventricular tachycardias, atrial tachycardia (atrial pacing with AOO mode, 180/min, group I), AVRT (VA pacing interval 80 msec with DOO mode, 180/min, group II) and AVNRT (VA pacing interval 0 msec, 25 msec with DOO mode, 180/min, group III) were simulated in eleven dogs. Hemodynamic parameters were systemic arterial pressure including systolic, mean and diastolic arterial pressure (SAP, MAP, DAP respectively), mean pulmonary arterial wedge pressure (MPAWP) and cardiac output (CO). RESULTS: The MAP was highest in group I (87.0+/-20.4 mmHg) and decreased with decreasing VA interval of no significance. The SAP was higher in group II (109.8+/-22.6 mmHg) than in group III (95.3+/-27.1 mmHg) (p<0.05). The level of MPAWP had no significant differences among three groups and showed no peculiar pattern with changes of VA interval. The CO was higher in group I (1.18+/-0.32 L/min) than in other two groups with significant difference (p<0.01) and decreased with shortening of VA interval without significance. CONCLUSION: Above results suggested that the AVRT and AVNRT have different effects on hemodynamic changes, those from different timing of atrial contraction, especially on SAP and CO. So hemodynamic compromise during tachycardia could be more severe in AVNRT than in AVRT inspite of their similar QRS morphology and tachycardia rate.
Animals ; Arterial Pressure ; Cardiac Output ; Dogs* ; Heart Ventricles ; Hemodynamics* ; Pulmonary Wedge Pressure ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular*