• Tuberculosis and Respiratory Diseases
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• v.77 no.1
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• pp.6-12
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• 2014

Severe sepsis is the most common cause of death among critically ill patients in non-coronary intensive care units. In 2002, the guideline titled "Surviving Sepsis Campaign" was published by American and European Critical Care Medicine to decrease the mortality of severe sepsis and septic shock patients, which has been the basis of the treatment for those patients. After the first revised guidelines were published on 2008, the most current version was published in 2013 based on the updated literature of until fall 2012. Other important revised guidelines in critical care field such as 'Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit' were revised in 2013. This article will review the revised guidelines and several additional interesting published papers of until March 2014, including the part of ventilator-induced lung injury and the preventive strategies.

• Endocrinology and Metabolism
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• v.33 no.4
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• pp.429-434
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• 2018

As diagnostic techniques have advanced, primary aldosteronism (PA) has emerged as the most common cause of secondary hypertension. The excess of aldosterone caused by PA resulted in not only cardiovascular complications, including coronary artery disease, myocardial infarction, arrhythmia, and heart failure, but also cerebrovascular complications, such as stroke and transient ischemic attack. Moreover, PA is associated more closely with these conditions than is essential hypertension. In this review, we present up-to-date findings on the association between PA and cerebrovascular diseases.

• Korean Journal of Clinical Laboratory Science
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• v.37 no.3
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• pp.185-189
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• 2005

Lipids such as total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C) and high sensitivity C-reactive protein (hs-CRP) are known as good risk factors for coronary artery diseases caused by arthrosclerosis. We measured the serum concentrations of hs-CRP, TC, and HDL-C of 6,128 persons who underwent medical examinations in the Health Screening Center at Kangbuk Samsung Hospital. We classified the subjects into normotensive and hypertensive groups according to the blood pressure measured. We investigated whether there was a difference of hs-CRP and lipids between the normotensive and hypertensive groups. There was significant difference of TC, TC/HDL-C ratio, and hs-CRP concentration between the normotensive and hypertensive groups in both men and women, but there was no significant difference of HDL-C concentration between two groups. Our results indicated that the concentrations of hs-CRP and lipids were higher in patients with hypertension and confirmed the usefulness of lipids and hs-CRP in predicting the risk for coronary artery diseases.

• Journal of Neurogastroenterology and Motility
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• v.25 no.3
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• pp.387-393
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• 2019

Background/Aims Delayed gastric emptying (GE) is associated with high morbidity and mortality in subjects with diabetes. The aim of this study is to investigate associations between GE time and the major cardiovascular events (coronary heart diseases and ischemic stroke) in diabetic subjects with upper gastrointestinal (UGI) symptoms. Methods Among 259 subjects with chronic UGI symptoms who underwent gastric emptying study (GES) over 13 years, 122 diabetic subjects without gastric surgery and/or rapid GE were enrolled in this study. We also gathered data about baseline demographics, clinical characteristics, estimated GE half-time (GE T½) and incidence of cardiovascular events following GES. Results The mean age of subjects was 64.0 ± 17.4 years. There were 86 women and 104 subjects with type 2 diabetes. There were 52 (42.6%) subjects with normal GE, 50 (41.0.%) subjects with mild delayed GE, and 20 (16.4%) subjects with marked delayed GE. During follow-up (median, 207 weeks), cardiovascular events occurred in 7 (13.5%) subjects with normal GE, 4 (8.0%) subjects with mild delayed GE and 7 (35.0%) subjects with marked GE (P = 0.015). Univariate analysis showed that GE T½ was significantly associated with incidence of cardiovascular events (crude OR, 1.74; 95% CI, 1.12-2.69; P = 0.014). In a multivariate model, association between GE T½ and incidence of cardiovascular events remained statistically significant after adjustment for baseline characteristics and comorbidities (adjusted OR, 1.94; 95% CI, 1.21-3.12; P = 0.006). Conclusion A delay of GE was associated with an increased incidence of cardiovascular events in diabetic subjects with chronic UGI symptoms.

• Journal of Community Nutrition
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• v.6 no.3
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• pp.155-163
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• 2004

In our country, cardiovascular disease (CVD) and Coronary heart diseases (CHD) are the leading causes of death. It is well known that CHD is multifactorial, involving environmental factors such as diet, level of exercise and cigarette smoking, and inherited factors. According to the statistical data in 2003, the cause of death with the highest mortality was including hypertension, ischemic heart disease and atherosclerosis, which accounted for $24.7\%$ of total mortality. In spite of, there have been few study reports on the change of biochemical markers and mechanisms concerned. The development of biochemical markers is required for an early diagnosis and treatment of cardiovascular diseases that are related with dietary habits of Korean people enjoying mixtures of traditional dietary style and westernized food-styles. Therefore, the most efficient cost-saving biochemical marker was established in this study, through analysis of biochemical markers related with dietary habits which are susceptibly being changed in association to cardiovascular diseases from the pre-disease phase, and through reanalysis and assessment of early diagnosis of and preventive effects of diagnosis of cardiovascular diseases by demographical character including sex, age, and socioeconomic level with use of biochemical markers that are identified and selected among the parameters in consideration of the effectiveness and appropriateness of early diagnosis of diseases. The appropriateness of biochemical markers was reviewed by professionals (medical, pharmaceutical area and food/ nutrition area) and CRP(C-Reactive Protein) and was identified to be possible in Korea. It is thought that these biochemical markers may be used as the basic data for early diagnosis and prevention of cardiovascular diseases (CVD) which may be used for Korean people.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.460-471
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• 1994

Between Feb. 1990 and Aug. 1993, 180 cases of the open heart surgery were performed under cardiopulmonary bypass in the Department of Thoracic & Cardiovascular surgery, Gil General Hospital. There were 83 cases with congenital heart diseases [CHD] and 97 cases with acquired heart diseases [AHD]. The CHD consisted of 78 acyanotic[mortality: 3.8 %] and 5 cyanotic cases with heart anomaly[mortality:l case]. The AHD were 97 cases, which contained 53 valvular, 27 ischemic heart diseases, 10 aortic diseases, 5 cases with myxoma, 1 case with post-infarct VSD, and 1 case with removal of infected pacing wire in right ventricle. In the 53 valvular heart diseases, there were 45 cases with valve replacement[MVR 27, AVR 9,MVR + AVR 9] and 8 cases with valvuloplasty. The number of the implanted prosthetic valves were 53. In MVR, 25 St. Jude, 6 Sorin, 3 Carpentier-Edward and 2 Intact medical valves were used. In aortic position, 13 St. Jude, 3 Sorin and 1 Intact medical valves were applied. The operative mortality was 5.6 % [3/53]. The annuloplasty applying artificial ring was performed in 17 patients[4 cases associated with MVR] and the number of the implanted ring was 19, which included 14 Duran ring[10 mitral, 4 tricuspid] and 5 Carpentier ring [3 mitral, 22 tricuspid]. In the 27 ischemic heart diseases, there were 9 cases with left main coronary artery lesions, 7 one vessel, 5 two vessels, and 6 three vessels. Average number of anastomosis was 2.8 per patient. The operative mortality was 14.3 % [4/27]. Among the 10 patients with aortic diseases, 7 cases were aortic dissection[type A: 5, type B: 2] and 3 cases were descending thoracic aortic aneurysm. The operative morality occurred in 3 cases. The overall mortality and the operative mortality of congenital and acquired heart disease was 7.8 %, 4.8% and 10.4%, respectively.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.492-495
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• 2008

A functional single lung caused by lung diseases or pneumonectomy can result in anatomic and physiologic changes that may interfere with the conduct of subsequent coronary artery bypass surgery. Since. this type of case is extremely rare, there has not been any report on this in Korea. A 71-year-old female with a history of a destroyed left lung from pulmonary tuberculosis 13 years ago was admitted for evaluation of her increasing chest pain that she'd experienced for 2 weeks. Since coronary angiographies demonstrated 80% stenosis of the left main os, $90{\sim}95%$ stenosis of the p-LAD, 90% stenosis of the m-LCx and 90% stenosis of the RCA, coronary artery bypass surgery (CABG) was planned. Off-pump CABG with vein grafts through a median sternotomy was performed and the patient recovered the same as other CABG patients without complications.

• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.478-483
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• 1995

We compared the influences of reconstruction methods using $180^{\circ}$ or $360^{\circ}$ data upon contrasts and discriminating capability and diagnostic accuracy in $^{99m}Tc-MIBI$ stress/rest myocardial SPECT. We reviewed SPECT images reconstructed only with $180^{\circ}$ projection data or with $360^{\circ}$ data in 18 patients and in 11 normal subjects. To compare counts of surface structures and deep structures, we measured ape# posterior wall ratios in 11 normal subjects. To compare the contrasts of images, we measured apex/ventricle ratios. To compare contrasts between normal and diseased myocardial segments, we measured count ratios of defect and normal segments in 4 patients who had single coronary artery diseases. To compare diagnostic accuracy, we scored SPECT images made with $180^{\circ}$ and $360^{\circ}$ data segmentally. Sensitivity and specificity for the diagnosis of coronary artery disease and for the revelation of diseased arteries with both $180^{\circ}$ and $360^{\circ}$ SPECT images. If involved coronary arteries had more narrowing than 50% In coronary angiogram, we considered them as diseased arteries Apex/posterior wall ratios were not different significantly in normal subjects. Apex/ ventricle ratios in normal subjects were different significantly between $180^{\circ}$ and $360^{\circ}$ SPECT images. Defect/normal ratios were different significantly between $180^{\circ}$ and $360^{\circ}$ SPECT images in single vessel disease patients. The overall diagnostic accurracy was the same between $180^{\circ}$ and $360^{\circ}$ data collection. Sensitivity was 94% and specificity was 91% for both types of data collection in this sample population. Sensitivity and specificity of each coronary artery territory were not significantly different between the images made with $180^{\circ}$ and $360^{\circ}$ data. The images made with $180^{\circ}$ data had better contrast between ventricle and myocardium and between hypoperfused and normal myocardium, though no difference was found between the ratios of the myocardial counts of surface and deep structures. However, diagnostic sensitivities of diseased artery territories were not different significantly and so were overall diagnostic accuracy between both methods of making images with $180^{\circ}$ and $360^{\circ}$ data.

• Korean Journal of Radiology
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• v.23 no.10
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• pp.939-948
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• 2022

Objective: Evidence supports the efficacy of coronary computed tomography angiography (CCTA)-based risk scores in cardiovascular risk stratification of patients with suspected coronary artery disease (CAD). We aimed to compare two CCTA-based risk score algorithms, Leiden and Confirm scores, in patients with diabetes mellitus (DM) and suspected CAD. Materials and Methods: This single-center prospective cohort study consecutively included 1241 DM patients (54.1% male, 60.2 ± 10.4 years) referred for CCTA for suspected CAD in 2015-2017. Leiden and Confirm scores were calculated and stratified as < 5 (reference), 5-20, and > 20 for Leiden and < 14.3 (reference), 14.3-19.5, and > 19.5 for Confirm. Major adverse cardiovascular events (MACE) were defined as the composite outcomes of cardiovascular death, nonfatal myocardial infarction (MI), stroke, and unstable angina requiring hospitalization. The Cox model and Kaplan-Meier method were used to evaluate the effect size of the risk scores on MACE. The area under the curve (AUC) at the median follow-up time was also compared between score algorithms. Results: During a median follow-up of 31 months (interquartile range, 27.6-37.3 months), 131 of MACE were recorded, including 17 cardiovascular deaths, 28 nonfatal MIs, 64 unstable anginas requiring hospitalization, and 22 strokes. An incremental incidence of MACE was observed in both Leiden and Confirm scores, with an increase in the scores (log-rank p < 0.001). In the multivariable analysis, compared with Leiden score < 5, the hazard ratios for Leiden scores of 5-20 and > 20 were 2.37 (95% confidence interval [CI]: 1.53-3.69; p < 0.001) and 4.39 (95% CI: 2.40-8.01; p < 0.001), respectively, while the Confirm score did not demonstrate a statistically significant association with the risk of MACE. The Leiden score showed a greater AUC of 0.840 compared to 0.777 for the Confirm score (p < 0.001). Conclusion: CCTA-based risk score algorithms could be used as reliable cardiovascular risk predictors in patients with DM and suspected CAD, among which the Leiden score outperformed the Confirm score in predicting MACE.

• Korean Journal of Radiology
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• v.20 no.4
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• pp.621-630
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• 2019

Objective: To study the prevalence and clinical characteristics of decreased myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) in symptomatic patients without in-stent restenosis. Materials and Methods: Thirty-seven (mean age, 71.3 ± 10 years; age range, 48-88 years; 31 males, 6 females) consecutive symptomatic patients with patent coronary stents and without obstructive de novo lesions were prospectively enrolled to undergo dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used to image the complete left ventricle. A bolus of contrast media (50 mL; iopromide, 370 mg iodine/mL) was injected into the antecubital vein at a rate of 6 mL/s, followed by a 40-mL saline flush. The mean MBF value and other quantitative parameters were measured for each segment of both stented-vessel territories and reference territories. The MBF_ratio was defined as the ratio of the mean MBF value of the whole stent-vessel territory to that of the whole reference territory. An MBF_ratio of 0.85 was used as the cut-off value to distinguish hypoperfused from non-hypoperfused segments. Results: A total of 629 segments of 37 patients were ultimately included for analysis. The mean effective dose of dynamic CT-MPI was 3.1 ± 1.2 mSv (range, 1.7-6.3 mSv). The mean MBF of stent-vessel territories was decreased in 19 lesions and 81 segments. Compared to stent-vessel territories without hypoperfusion, the mean MBF and myocardial blood volume were markedly lower in hypoperfused stent-vessel territories (77.5 ± 16.6 mL/100 mL/min vs. 140.4 ± 24.1 mL/100 mL/min [p < 0.001] and 6.4 ± 3.7 mL/100 mL vs. 11.5 ± 4 mL/100 mL [p < 0.001, respectively]). Myocardial hypoperfusion in stentvessel territories was present in 48.6% (18/37) of patients. None of clinical parameters differed statistically significantly between hypoperfusion and non-hypoperfusion subgroups. Conclusion: Decreased MBF is commonly present in patients who are symptomatic after percutaneous coronary intervention, despite patent stents and can be detected by dynamic CT-MPI using a low radiation dose.