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Goyang, South Korea

Hwang H.-J.,Kyung Hee University | Sohn I.S.,Kyung Hee University | Kim W.-S.,Kyung Hee University | Hong G.-R.,Yonsei University | And 10 more authors.
Korean Circulation Journal | Year: 2015

Background and Objectives: We assessed the ability of portable echocardiography (with contrasts) to clearly delineate the cardiac structure, and evaluated the impact of its use on the diagnosis and management of critically ill patients in Korea. Subjects and Methods: We prospectively enrolled 123 patients (mean age 66±16 years), who underwent portable transthoracic echocardiography (with contrast) for image enhancement at 12 medical centers. The quality of the global left ventricular (LV) images, the number of the regional LV segments visualized, the ability to visualize the LV apex and the right ventricle (RV), and any changes in the diagnostic procedure and treatment strategy were compared before and after the contrast. Results: Of the 123 patients, 52 (42%) were using mechanical ventilators. The amount of poor or uninterpretable images decreased from 48% to 5% (p<0.001), after the contrast. Before the contrast, 15.6±1.1 of 16 LV segments were seen, which improved to 15.9±0.6 segments (p=0.001) after the contrast. The ability to visualize the LV apex increased from 47% to 94% (p<0.001), while the inability to clearly visualize the RV decreased from 46% to 19% (p<0.001). Changes in the diagnostic procedure (for example, not requiring other types of imaging studies) were observed in 18% of the patients, and the treatment plan (medication) was altered in 26% of patients after the contrast echocardiography. Conclusion: The use of a contrast agent during the portable echocardiography, in intensive care settings, can improve the image quality and impact the diagnostic procedures and treatment for Korean patients. ©2015 The Korean Society of Cardiology.

Park K.S.,Yonsei University | Han S.H.,Yonsei University | Kie J.H.,NHIS Ilsan Hospital | Nam K.H.,Yonsei University | And 13 more authors.
Human Pathology | Year: 2014

Pathologic features can provide valuable information for determining prognosis in IgA nephropathy (IgAN). However, it is uncertain whether the Oxford classification, a new classification of IgAN, can predict renal outcome better than previous ones. We conducted a retrospective cohort study in 500 patients with biopsy-proven IgAN between January 2002 and December 2010 to compare the ability of the Haas and the Oxford classifications to predict renal outcome. Primary outcome was a doubling of the baseline serum creatinine concentration (D-SCr). During a mean follow-up of 68 months, 52 (10.4%) and 35 (7.0%) developed D-SCr and end-stage renal disease, respectively. There were graded increases in the development of D-SCr in the higher Haas classes. In addition, the primary endpoint of D-SCr occurred more in patients with the Oxford M and T lesions than those without such lesions. In multivariate Cox regression analyses, the Haas class V (HR, 12.19; P =.002) and the Oxford T1 (hazard ratio [HR], 6.68; P <.001) and T2 (HR, 12.16; P <.001) lesions were independently associated with an increased risk of reaching D-SCr. Harrell's C index of each multivariate model with the Haas and the Oxford classification was 0.867 (P =.015) and 0.881 (P =.004), respectively. This was significantly higher than that of model with clinical factors only (C = 0.819). However, there was no difference in C-statistics between the 2 models with the Haas and the Oxford classifications (P =.348). This study suggests that the Haas and the Oxford classifications are comparable in predicting progression of IgAN. © 2014 Elsevier Inc. All rights reserved.

Kang D.-Y.,NHIS Ilsan Hospital | Lee S.,Yonsei University
Thoracic and Cardiovascular Surgeon | Year: 2014

Background The aim of this study was to investigate the association between the presence of lymphatic vessel invasion (LVI) in primary tumors and lymph node (LN) metastasis in clinical stage I non-small cell lung cancer (NSCLC) patients. Materials and Methods A total of 76 patients who underwent complete resection for clinical stage I adenocarcinoma and squamous cell carcinoma were retrospectively examined. Results Tumors consisted of 51 cases of adenocarcinoma and 25 cases of squamous cell carcinoma as determined by histology. LN metastasis was detected in 24.4% (19/76) of patients. Factors associated with LN metastasis on univariate analysis included LVI (<0.001) and increased tumor dimensions (<0.05). Binary logistic regression analysis showed that the presence of LVI (<0.001) was the only predictor of LN metastasis. Conclusion LVI is significantly associated with LN metastasis in patients with clinical stage I NSCLC. These findings may be helpful in determining the most appropriate operative strategy for patients if preoperative detection of LVI becomes feasible.

Kim J.-S.,Yonsei University | Kim J.-S.,Cardiovascular Product Evaluation Center | Lee S.-G.,Yonsei University | Bong S.-K.,Yonsei University | And 11 more authors.
International Journal of Cardiology | Year: 2016

Background LAA occlusion has a similar stroke prevention efficacy compared to anticoagulation treatment for non-valvular atrial fibrillation. Objective The objective of this study was to assess the feasibility and safety of a modified Occlutech® left atrial appendage (LAA) closure device in a canine model. Methods The device was implanted in 10 dogs (33 ± 1 kg) using fluoroscopy and transesophageal echocardiography (TEE) guidance. The modified Occlutech® LAA occlusion device was compared with the current version, the Watchman device, and the Amplazter cardiac plug (ACP). LAA occlusion and anchoring to the LAA were evaluated. All dogs were assessed using angiography, TEE, and a gross anatomy examination. Results The 10 LAA occlusion devices were to be implanted into 10 dogs (5 modified Occlutech devices, 3 current version of Occlutech devices, 1 Watchman, and 1 ACP). LAA implantation was not performed in one dog due to transeptal puncture failure. The three current version of Occlutech devices were embolized immediately after implantation, so three modified devices of the same size were implanted securely without embolization. The mean implant size was 20.1 ± 2.0 mm. The devices chosen were a mean of 23.3 ± 10.6% larger than the measured landing zone diameters. Post-implant angiography and TEE revealed well-positioned devices without pericardial effusion or impingement on surrounding structures. Conclusions The results of this acute animal study suggested that a modified Occlutech® LAA occlusion device was feasible and had greater anchoring performance in canines. Additional large clinical studies are needed to evaluate safety and efficacy. © 2016 Elsevier Ireland Ltd

Kim G.-H.,Hanyang University | Choi B.S.,Catholic University of Korea | Cha D.R.,Korea University | Chee D.H.,AbbVie Ltd | And 16 more authors.
Kidney Research and Clinical Practice | Year: 2014

Background In many countries, nephrologists follow clinical practice guidelines for mineral bone disorders to control secondary hyperparathyroidism (SHPT) associated with abnormal serum calcium (Ca) and phosphorus (P) levels in patients undergoing maintenance hemodialysis (MHD). The Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines have long been used in Korea, and this study was undertaken to investigate the current status of serum Ca and P control in MHD patients. Methods Data were collected from a total of 1,018 patients undergoing MHD without intercurrent illness, in 17 hemodialysis centers throughout the country. Serum levels of Ca, P, and intact parathyroid hormone (iPTH) were measured over 1 year, and the average values were retrospectively analyzed. Results Serum levels of Ca, P, and the Ca×P product were 9.1±0.7 mg/dL, 5.3±1.4 mg/dL, and 48.0±13.6 mg 2/dL2, respectively. However, the percentages of patients with Ca, P, and Ca × P product levels within the KDOQI guideline ranges were 58.7%, 51.0%, and 70.7%, respectively. Of the 1,018 patients, 270 (26.5%) had iPTH >300 pg/mL (uncontrolled SHPT), whereas 435 patients (42.7%) showed iPTH <150 pg/mL. Patients with uncontrolled SHPT had significantly higher values of serum Ca, P, and Ca×P product than those with iPTH >300 pg/mL. Conclusion Despite the current clinical practice guidelines, SHPT seems to be inadequately controlled in many MHD patients. Uncontrolled SHPT was associated with higher levels of serum Ca, P, and Ca < P product, suggestive of the importance of SHPT management. © 2014. The Korean Society of Nephrology. Published by Elsevier. All rights reserved.

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