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Objective@#This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR). @*Materials and Methods@#This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated. @*Results@#A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all P 5 mm LNs, P ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities. @*Conclusion@#Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.
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Cerebral small vessel disease (CSVD) includes vascular lesions detected on brain MRI, such as white matter hyperintensities, lacunar infarctions, microbleeds, or enlarged perivascular spaces. There is accumulating evidence that vascular changes may play an important role in development of Alzheimer’s disease (AD), and CSVD lesions detected on brain MRI were reported to be associated with β-amyloid and tau proteins accumulation. As the vascular contribution has therapeutic potential, it is important to understand the association of CSVD with AD and AD biomarkers. This review begins with a brief introduction of AD and AD biomarkers, explains the association between AD and vascular changes, and then details the pathogenesis and MR imaging findings of CSVD. Afterwards, we discuss the association of CSVD with AD and AD biomarkers.
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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.
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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.
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PURPOSE: Obtaining brain tissue is critical to definite diagnosis and to furthering understanding of neurodegenerative diseases. The present authors have maintained the National Neuropathology Reference and Diagnostic Laboratories for Dementia in South Korea since 2016. We have built a nationwide brain bank network and are collecting brain tissues from patients with neurodegenerative diseases. We are aiming to facilitate analyses of clinic-pathological and image-pathological correlations of neurodegenerative disease and to broaden understanding thereof. MATERIALS AND METHODS: We recruited participants through two routes: from memory clinics and the community. As a baseline evaluation, clinical interviews, a neurological examination, laboratory tests, neuropsychological tests, and MRI were undertaken. Some patients also underwent amyloid PET. RESULTS: We recruited 105 participants, 70 from clinics and 35 from the community. Among them, 11 died and were autopsied. The clinical diagnoses of the autopsied patients included four with Alzheimer's disease (AD), two with subcortical vascular dementia, two with non-fluent variant primary progressive aphasia, one with leukoencephalopathy, one with frontotemporal dementia (FTD), and one with Creutzfeldt-Jakob disease (CJD). Five patients underwent amyloid PET: two with AD, one with mixed dementia, one with FTD, and one with CJD. CONCLUSION: The clinical and neuropathological information to be obtained from this cohort in the future will provide a deeper understanding of the neuropathological mechanisms of cognitive impairment in Asia, especially Korea.
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Humans , Alzheimer Disease , Amyloid , Aphasia, Primary Progressive , Asia , Brain , Cognition Disorders , Cohort Studies , Creutzfeldt-Jakob Syndrome , Dementia , Dementia, Vascular , Diagnosis , Frontotemporal Dementia , Korea , Leukoencephalopathies , Magnetic Resonance Imaging , Memory , Neurodegenerative Diseases , Neurologic Examination , Neuropathology , Neuropsychological Testsالملخص
PURPOSE: The purpose of current study is to evaluate the midterm results of cementless primary total hip arthroplasty (THA) using a dual offset titanium tapered stem. MATERIALS AND METHODS: A retrospective analysis of 102 cases (84 patients), with a minimum of 7-year clinical follow-up, was performed. All of the cases consisted of patients who underwent primary cementless THA, using a dual offset titanium tapered stem in The Catholic University of Korea, Bucheon St. Mary's Hospital between July 2004 and May 2009. Clinical results were analyzed via the Harris hip score, level of thigh pain, squeaking around hip joint, and complication rate. Radiologic results were examined with stability and location of inserted prosthesis, hypertrophy of femoral cortex, and osteolysis. RESULTS: Out of the 102 cases (84 patients; 47 males and 37 females), with the mean age of 55.9 years (range, 27–79 years) and mean follow-up period of 99.2 months (range, 84–132 months). The mean Harris hip score was 53.8 preoperatively (range, 26–75) and improved to 93.5 postoperatively (range, 74–100) (p=0.000). All of the cases gained stable bony fixation on the final follow-up, including 2 cases of intra-operative proximal femur fracture. Calcar remodeling was observed in 94 cases, however, they were irrelevant with stem stability. Cortical hypertrophy of femur was seen in 12 cases and thigh pain in 4 cases; nonetheless, they were not relevant (p=0.067). There was 1 case of squeaking sound during joint movement. Hip dislocation occurred in 1 case early after the procedure, but the event was due to excessive anteversion of the acetabular cup, in which a revisional replacement procedure of the acetabular cup was conducted. No sign of ceramic breakage was observed. There were 2 cases of heterotrophic ossification. CONCLUSION: Results from a 7-year follow-up of cementless THA using dual offset titanium tapered stem were encouraging in both clinical and radiologic evaluations.
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Humans , Male , Acetabulum , Arthroplasty, Replacement, Hip , Ceramics , Femur , Follow-Up Studies , Hip , Hip Dislocation , Hip Joint , Hypertrophy , Joints , Korea , Osteolysis , Prostheses and Implants , Retrospective Studies , Thigh , Titaniumالملخص
PURPOSE: The purpose of this study is to evaluate the postoperative outcomes of elderly patients with stable 2-part intertrochanteric femur fractures surgically treated using dynamic hip screw with 2-hole side plate. MATERIALS AND METHODS: From February 2008 to January 2014, 50 patients older than the age of 65 years, who had been followed-up for more than 6 months after the operation at The Catholic University of Korea, Bucheon St. Mary's Hospital were enrolled. A clinical evaluation of the skin incision length, operating time, and ambulatory status, using Clawson's Ambulation Capacity Classification, was performed, and a radiologic evaluation of Fogagnolo reduction quality, tip-apex distance (TAD), Cleveland index, sliding extent of lag screws, time duration till bony union, and complications was also done. RESULTS: The mean skin incision length was 9.8 cm (range, 8-13 cm), the mean operating time was 41.4 minutes (range, 30-60 minutes), and 32 patients recovered their ambulatory function. Forty-eight patients gained bony union, and the time lapsed till union was average 10.6 weeks (range, 8-16 weeks). The evaluation of postoperative radiologic images showed the following reduction statuses by the Fogagnolo classification: 46 cases of "Good", 3 cases of "Acceptable," and 1 case of "Poor." Moreover, the mean TAD was 18.9 mm (range, 9.0-24.9 mm). While 45 cases fit into the zone 5 of the Cleveland index, other 3 were within zone 8 and the other 2 were within zone 6. The mean sliding length of the lag screws were 4.9 mm (range, 0.1-19.4 mm). There were a case of nonunion and a case of periprosthetic infection with nonunion as complications. CONCLUSION: Using dynamic hip screws with 2-hole side plate for stable 2-part intertrochanteric femur fractures in elderly patients showed satisfactory results with respect to the recovery of ambulatory functions and bony union.
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Aged , Humans , Classification , Femur , Hip Fractures , Hip , Korea , Skin , Walkingالملخص
PURPOSE: The purpose of this study is to compare the perioperative blood loss in primary non-cemented total hip arthroplasty (THA) performed for rapidly destructive coxarthrosis (RDC) with the perioperative blood loss in primary non-cemented THA for typical osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: From January 2000 to December 2013, 19 patients were diagnosed with RDC (group 1) and 40 patients were diagnosed typical Ficat stage IV ONFH (group 2), comparison of perioperative blood loss between group 1 and group 2 in primary noncemented THA was done. Patients with preoperative usage of steroid or anticoagulants medication and with hemodynamic abnormal blood test results were excluded. The blood loss was measured up to the fifth post operation day and calculated with formula proposed by Mercuriali, Inghilleri and Nadler. RESULTS: Non-compensated blood loss calculated in milliliters of red blood cells was 362 mL (standard deviation [SD], 187; range, 77-675) in group 1 and 180 mL (SD, 145; range, 53-519) in group 2. Compensated blood loss was 630 mL (SD, 180; range, 380-760) in group 1 and 503 mL (SD, 260; range, 190-1, 505) in group 2. The total blood loss after primary non-cemented THA is greater when surgery is performed for RDC than for ONFH, with the volume of 992 mL (SD, 300; range, 457-1, 434) in group 1 and 683 mL (SD, 360; range, 226-1, 975) in group 2 respectively. CONCLUSION: Total perioperative blood loss was significantly greater in RDC than in ONFH in primary non-cemented THA.
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Humans , Anticoagulants , Arthroplasty, Replacement, Hip , Erythrocytes , Femur Head , Head , Hematologic Tests , Hemodynamics , Osteoarthritis, Hip , Osteonecrosisالملخص
PURPOSE: To evaluate ultrasonographic accuracy in the differentiation of a bezoar from feces in a small bowel obstruction showing feces-like material just proximal to the transitional zone in abdominal computed tomography (CT). METHODS: This study included 14 patients who showed feces-like material just proximal to the transitional zone, among 302 patients diagnosed with small bowel obstruction on abdominal CT. The diagnostic signs of a bezoar on ultrasonography included an arc-like surfaced intraluminal mass, posterior acoustic shadow and twinkling artifacts. The diagnostic performance of ultrasonography in each patient was compared with a final diagnosis that was surgically or clinically made. RESULTS: Among the 14 patients, seven were ultrasonographically diagnosed as having a bezoar, and five of the seven were surgically diagnosed as having a phytobezoar. The remaining two of the seven showed complete symptomatic improvement before surgery. The other seven patients were ultrasonographically diagnosed as not having a bezoar. Among them, six patients were conservatively treated with symptomatic improvement, suggesting the absence of a bezoar. The remaining one patient was confirmed not to have a bezoar during adhesiolysis. In all patients, the ultrasonographic diagnosis agreed with the clinically confirmed diagnosis. CONCLUSION: Ultrasonography might be an accurate method for the differential diagnosis of feces-like material just proximal to the transitional zone in abdominal CT. It can help radiologists to quickly and easily diagnose a bezoar.
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Humans , Acoustics , Artifacts , Bezoars , Diagnosis , Diagnosis, Differential , Feces , Intestinal Obstruction , Intestine, Small , Tomography, X-Ray Computed , Ultrasonographyالملخص
PURPOSE: Pediatric patients with distal forearm bothbone fractures of surgical indication were treated with the Kapandji reduction technique for radius and flexible intramedullary nail for ulna at our institution. The purpose of this study is to evaluate clinical and radiological results. MATERIALS AND METHODS: From February 2012 to June 2014, we retrospectively evaluated 16 out of 18 cases with distal forearm bothbone fractures treated with the Kapandji reduction technique for radius and flexible intramedullary nail for ulna with at least 1-year follow-up. The average age at operation was 9.1 years (7-13 years). RESULTS: Adequate reduction for both radius and ulna was achieved for all cases, and none of the cases showed re-displacement until the last follow-up. Mean 6.6 weeks lapsed until bony union was observed for the radius. For the ulna, the mean was 6.5 weeks. All patients gained full wrist range of motion at the last visit. CONCLUSION: For pediatric distal forearm bothbone fractures, intrafocal Kapandji reduction and internal fixation with Kirschner wire for radius and reduction and internal fixation with a flexible intramedullary nail for ulna is the technique for handy reduction. Use of this technique can prevent re-displacement during the union process and achieve excellent clinical and radiologic results.
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Humans , Follow-Up Studies , Forearm , Radius , Range of Motion, Articular , Retrospective Studies , Ulna , Wristالملخص
PURPOSE: In the present study, we investigated the clinical characteristics of tuberculosis in school-age children and adolescents, which is important as a reservoir for future disease burden. METHODS: Ninety patients, aged from 6 to 18 years, who were diagnosed and treated with tuberculosis during the period from January 2005 to July 2011, were enrolled. We retrospectively analyzed the medical records and investigated clinical characteristics of the patients. RESULTS: Eight patients were 6 to 12 (9%) and 82 were over 13 years of age (91%). There was a significantly higher percentage of males than females in the latter age group (P<0.01). Route of infection was not confirmed in 74 patients, and 16 patients were diagnosed through the school or military medical examinations with no clinical symptoms. Seventy patients (78%) were presented with pulmonary tuberculosis. Chronic persistent coughing was the most common presenting symptom, and both upper lobes were most frequently involved. Nineteen patients over 13 years of age had adult-type cavitary tuberculosis. The positive results for acid-fast smears or cultures were not high, and the rate of positive tuberculin skin test was 88%. The most frequent adverse effects of anti-tuberculosis treatment were hepatotoxicity, hyperuricemia, and gastrointestinal disorders. The duration of the treatment was much prolonged in 8 patients who had drug-resistant tuberculosis. CONCLUSION: Our study showed that pulmonary tuberculosis should be suspected in the adolescents who have prolonged respiratory symptoms. It also indicates that pulmonary tuberculosis in adolescents has similar characteristics to tuberculosis in adults, which suggests the potential important role of adolescent tuberculosis in community disease transmission.
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Cough , Hyperuricemia , Medical Records , Military Personnel , Retrospective Studies , Skin Tests , Tuberculin , Tuberculosis , Tuberculosis, Pulmonaryالملخص
PURPOSE: Bronchial asthma was reported to be an important risk factor of severe respiratory symptoms due to pandemic H1N1 influenza infection. In this study, we investigated if there was any difference in the clinical features of children with H1N1 pneumonia according to their atopic or asthma status. METHODS: Eighty-eight children admitted with pneumonia due to reverse transcriptase-polymerase chain reaction-confirmed H1N1 influenza infection during the period from September 2009 to January 2010 were enrolled. These patients were divided into atopic (n=42) and non-atopic (n=46) groups. The atopic group consisted of 23 asthmatic children and 19 non-asthmatic children with allergic rhinitis or atopic dermatitis. We retrospectively analyzed the medical records of the patients to investigate if there was any difference in the clinical features according to their atopic or asthma status. RESULTS: There was no age difference between atopic and non-atopic patients. Male preponderance was observed only in the atopic group.(P<0.05) The occurrence of wheezing, severity of respiratory symptoms, and number of emergency-room visits were significantly higher in atopic than non-atopic patients.(P<0.05) However, those variables showed no difference between asthmatic and non-asthmatic patients within the atopic group. Twelve patients in the atopic, non-asthmatic group were followed for 1 year after discharge, and 5 patients were diagnosed to have asthma with recurrence of wheezing and/or positive results to methacholine challenge tests. CONCLUSION: Our study shows that H1N1 influenza infection may cause more severe respiratory symptoms in atopic patients than in non-atopic patients, regardless of their asthma status. allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness.
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Child , Humans , Male , Asthma , Dermatitis, Atopic , Influenza, Human , Medical Records , Methacholine Chloride , Pandemics , Parents , Pneumonia , Recurrence , Respiratory Sounds , Retrospective Studies , Rhinitis , Rhinitis, Allergic, Perennial , Risk Factorsالملخص
PURPOSE: Bronchiolitis obliterans (BO), an uncommon chronic obstructive lung disease in children, is most often seen following a severe lower respiratory tract infection (LRTI). We investigated the clinical characteristics, etiology, possible risk factors, radiological findings, and response to treatment in children diagnosed with post-infectious BO. METHODS: A retrospective study was performed on 62 patients diagnosed with post-infectious BO based on clinical and high-resolution computed tomography (HRCT) findings from 2005 to 2010. Forty-eight age-matched children who were admitted with the first episode of LRTI and did not subsequently develop BO were also studied as control subjects. RESULTS: Median ages at diagnosis and initial insult were 28 and 17 months, respectively. The median duration from initial LRTI until diagnosis was 5 months. Children who developed BO showed more respiratory compromise during their acute episodes of LRTI than those who did not. Symptom severity score decreased significantly after adequate treatment, which was significantly greater in patients treated with pulse steroid therapy than those treated with other controllers. CONCLUSION: The results suggest that the development of post-infectious BO should be suspected in the children showing persistent respiratory symptoms after severe LRTIs. They also suggest that adequate treatment including pulse steroid therapy may improve clinical status and the prognosis of these patients.
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Child , Humans , Bronchiolitis , Bronchiolitis Obliterans , Prognosis , Pulmonary Disease, Chronic Obstructive , Respiratory Tract Infections , Retrospective Studies , Risk Factorsالملخص
Neurotrophins protect neurons against excitotoxicity; however the signaling mechanisms for this protection remain to be fully elucidated. Here we report that activation of the phosphatidyl inositol 3 kinase (PI3K)/Akt pathway is critical for protection of hippocampal cells from staurosporine (STS) induced apoptosis, characterized by nuclear condensation and activation of the caspase cascade. Both nerve growth factor (NGF) and brain-derived growth factor (BDNF) prevent STS-induced apoptotic morphology and caspase-3 activity by upregulating phosphorylation of the tropomyosin receptor kinase (Trk) receptor. Inhibition of Trk receptor by K252a altered the neuroprotective effect of both NGF and BDNF whereas inhibition of the p75 neurotrophin receptor (p75NTR) had no effect. Impairment of the PI3K/Akt pathway or overexpression of dominant negative (DN)-Akt abolished the protective effect of both neurotrophins, while active Akt prevented cell death. Moreover, knockdown of Akt by si-RNA was able to block the survival effect of both NGF and BDNF. Thus, the survival action of NGF and BDNF against STS-induced neurotoxicity was mediated by the activation of PI3K/Akt signaling through the Trk receptor.
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Animals , Rats , Apoptosis/drug effects , Brain-Derived Neurotrophic Factor/metabolism , Cell Line , Cell Survival/drug effects , Cytoprotection/drug effects , Gene Knockdown Techniques , Hippocampus/cytology , Nerve Growth Factor/metabolism , Neurons/cytology , PC12 Cells , Proto-Oncogene Proteins c-akt/metabolism , Receptors, Nerve Growth Factor/metabolism , Signal Transduction/drug effects , Staurosporine/pharmacologyالملخص
BACKGROUND AND OBJECTIVES: We describe our experience with combined open and endovascular repair in patients who have aortic arch pathology. SUBJECTS AND METHODS: This study is a retrospective analysis of 7 patients who underwent combined open and endovascular repair for aortic arch pathology. Medical records and radiographic information were reviewed. RESULTS: A total of 7 consecutive patients (5 men, 71.4%) underwent thoracic stent graft implantation. The mean age was 59.9+/-16.7 years. The indication for endovascular repair was aneurysmal degeneration in 5 patients, and rupture or impending rupture in 2 patients. In all 7 cases, supra-aortic transposition of the great vessels was performed successfully. Stent graft implantation was achieved in all cases. Surgical exposure of the access vessel was necessary in 2 patients. A total of 9 stent grafts were implanted (3 stent grafts in one patient). The Seal thoracic and the Valiant endovascular stent graft were implanted in 6 patients and 1 patient, respectively. There were no post-procedure deaths or neurologic complications. In 2 patients, bleeding and injury of access vessel were noted after the procedure. Postoperative endoleak was noted in 1 patient. One patient died at 10 months after the procedure due to a newly developed ascending aortic dissection. No patients required secondary intervention during the follow-up period. The aortic diameter decreased in 4 patients. In 3 patients, including 1 patient with endoleak, there was no change in aortic diameter. CONCLUSION: Our experience suggests that combined open and endovascular repair for aortic arch pathology is safe and effective, with few complications.
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Humans , Male , Aneurysm , Aorta, Thoracic , Aortic Aneurysm , Aortic Diseases , Endoleak , Follow-Up Studies , Glycosaminoglycans , Hemorrhage , Medical Records , Prostheses and Implants , Retrospective Studies , Rupture , Stents , Transplantsالملخص
PURPOSE: Mycoplasma pneumoniae is a common causative agent of community acquired pneumonia in children and is well known to cause various respiratory and extrapulmonary diseases. We determined whether growth factors, including transforming growth factor (TGF)-beta1 and platelet-derived growth factor (PDGF-BB) that regulate airway fibrosis and remodeling, are increased in young children with M. pneumoniae pneumonia and also investigated if there was any difference in relation to the clinical status of the patients. METHODS: Fifty-two patients (3 to 6 years of age) who were admitted with M. pneumoniae pneumonia were enrolled and divided into 2 groups: the patients with frequent wheezing episodes (group A, n=28) and the patients with no previous history of wheeze (group B, n=24). The former group included the patients who had recurrent wheeze more than 3 times before admission. Fifteen children admitted with minor surgical problems were also studied as controls. TGF-beta1 and PDGF-BB were measured in the plasma samples collected on admission using ELISA in both patient groups and controls. RESULTS: Plasma TGF-beta1 and PDGF-BB levels were increased significantly in the patients with M. pneumoniae pneumonia as compared to the controls (P<0.01, respectively). TGF-beta1 and PDGF-BB were higher in group A than in group B, but the difference was not statistically significant (P=0.08 vs. P=0.05). In group A, TGF-beta1 was significantly higher in atopic patients than in non-atopic patients (P<0.05). CONCLUSION: Our study showed significantly increased TGF-beta1 and PDGF-BB in patients with M. pneumoniae pneumonia. It is suggested that these growth factors may play an important role in the pathogenesis of lower airway infection by M. pneumoniae.
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Child , Humans , Enzyme-Linked Immunosorbent Assay , Fibrosis , Intercellular Signaling Peptides and Proteins , Mycoplasma , Mycoplasma pneumoniae , Plasma , Platelet-Derived Growth Factor , Pneumonia , Pneumonia, Mycoplasma , Proto-Oncogene Proteins c-sis , Respiratory Sounds , Transforming Growth Factor beta1 , Transforming Growth Factorsالملخص
BACKGROUND AND OBJECTIVES: B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) levels may serve as a useful marker of cardiovascular risk for screening of the general population. We evaluated reference levels and distribution of NT-proBNP in the Korean general population based on a large cohort study. SUBJECTS AND METHODS: We included 1,518 adult subjects (ages 40-69) of a community-based cohort from the Korea Rural Genomic Cohort (KRGC) Study. Thorough biochemical and clinical data were recorded for all subjects. Levels of NT-proBNP from all participants were determined. In order to determine normal reference levels, subjects with factors known to influence NT-proBNP levels were excluded. RESULTS: The characteristics of the cohort are described below; subjects were 41.2% male, and the mean age was 54.8+/-8.4 years. The distribution of risk factors for cardiovascular disease in the cohort included hypertension (25%), left ventricular hypertrophy by electrocardiography (ECG-LVH) (15%), hypercholestolemia (4.5%), smoking (32%), diabetes (10.9%), history of coronary heart disease (4.9%), history of heart failure (0.9%), symptoms of heart failure (6.1%), elevated serum creatinine (> or =1.5, 3.7%), and severe obesity (body mass index >30 kg/m2, 4.6%). The levels of NT-proBNP of all subjects are shown below; the mean was 60.1+/-42.1, and the median was 36.5 pg/mL. In addition, the levels of NT-proBNP of normal subjects (which did not have any risk factors, n=224) are shown below; the mean was 40.8, and the median was 32.1 pg/mL. In normal subjects, the NT-proBNP level was slightly higher in females (25.7+/-24.8 vs. 46.9+/-35.4, p or =1.5 mg/dL, 146.2+/-98.2 vs. 54.3+/-38.1, p or =60, 48.4 vs. 84.2+/-139.5 pg/mL, p or =3: 85.0+/-152.9 pg/mL). NT-proBNP levels were also related with age, sex, urine albumin, serum Cr, and high sensitivity C-reactive protein (p<0.05). CONCLUSION: We determined the reference value and distribution of NT-proBNP in the Korean adult general population. We also found that adjustments for the independent effects of age, sex and renal function appear necessary when determining cardiac risk based on proBNP levels.
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Adult , Female , Humans , Male , C-Reactive Protein , Cardiovascular Diseases , Cohort Studies , Coronary Disease , Creatinine , Diabetes Mellitus , Electrocardiography , Heart Failure , Hypertension , Hypertrophy, Left Ventricular , Korea , Mass Screening , Natriuretic Peptide, Brain , Natriuretic Peptides , Obesity , Peptide Fragments , Population Surveillance , Reference Values , Risk Factors , Serum Albumin , Smoke , Smokingالملخص
No abstract available.
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PURPOSE: With improved survival of extremely low birth weight infants (ELBWI), there is an increase in the incidence of necrotizing enterocolitis (NEC) requiring laparotomy, and the risk of morbidity and mortality in these ELBWI is increased. Thus, we determined the prognostic factors in ELBWI who underwent laparotomy for NEC. METHODS: We retrospectively reviewed the medical records of 35 ELBWI who underwent laparotomy for NEC from January 2001 to December 2008 at Samsung Medical Center. RESULTS: Of 480 ELBWI, 35 required laparotomy for NEC; the mortality rate was 20% (Alive group n=28, Dead group n=7). The values of preoperative score for neonatal acute physiology-II (P=0.022) and fraction of inspired oxygen (P<0.001) were significantly higher in the dead group and values of base excess (P=0.004) were significantly lower in the dead group. Values of preoperative heart rate, respiration rate, mean blood pressure, pH, CO2, and potassium ion were not significantly different between the study groups. Intraoperative fluid volume was significantly higher in the alive group than in the dead group (P=0.045). Postoperative infusion rate was significantly lower in the alive group than in the dead group (P=0.022). CONCLUSION: Good preoperative condition, more intraoperative fluid infusion, and stable postoperative hemodynamic condition were factors associated with favorable prognosis of laparotomy for NEC in ELBWI.