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Bucheon, South Korea

Won J.C.,Inje University | Kwon H.S.,Catholic University of Korea | Kim C.H.,Sejong General Hospital | Lee J.H.,Catholic University of Daegu | And 3 more authors.
Diabetic Medicine | Year: 2012

Aims Diabetic peripheral neuropathy is a common complication of diabetes. This cross-sectional study investigated the prevalence and clinical characteristics of this neuropathy in patients with Type2 diabetic mellitus treated at hospitals in Korea. Methods Questionnaires and medical records were used to collect data on 4000 patients with Type2 diabetes from the diabetes clinics of 40 hospitals throughout Korea. Diabetic peripheral neuropathy was diagnosed based on a review of medical records or using the Michigan Neuropathy Screening Instrument score and monofilament test. Results The prevalence of neuropathy was 33.5% (n=1338). Multivariate analysis revealed that age, female sex, diabetes duration, lower glycated haemoglobin, treatment with oral hypoglycaemic agents or insulin, presence of retinopathy, history of cerebrovascular or peripheral arterial disease, presence of hypertension or dyslipidaemia, and history of foot ulcer were independently associated with diabetic peripheral neuropathy. Of the patients with neuropathy, 69.8% were treated for the condition and only 12.6% were aware of their neuropathy. Conclusion There was a high prevalence of peripheral neuropathy in patients with Type2 diabetes in Korea and those patients were far more likely to have complications or co-morbidities. The proper management of diabetic peripheral neuropathy deserves attention from clinicians to ensure better management of diabetes in Korea. © 2012 Diabetes UK.

Hahn J.-Y.,Sungkyunkwan University | Chun W.J.,Sungkyunkwan University | Kim J.-H.,Sungkyunkwan University | Song Y.B.,Sungkyunkwan University | And 14 more authors.
Journal of the American College of Cardiology | Year: 2013

Objectives This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. Background SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. Methods Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. Results SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). Conclusions Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes. (Korean Coronary Bifurcation Stenting Registry II [COBIS]; NCT01642992). © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.

Park C.S.,Sejong General Hospital | Lee J.R.,Seoul National University | Lim H.-G.,Seoul National University | Kim W.-H.,Seoul National University | Kim Y.J.,Seoul National University
European Journal of Cardio-thoracic Surgery | Year: 2010

Objective: The objective of this study was to evaluate the long-term outcome of total repair for tetralogy of Fallot. Methods: Between April 1986 and December 2007, a total of 734 patients underwent total repair for tetralogy of Fallot. There were 444 males and 290 females. The median age and weight were 17.2 months (0.4-329.6 months) and 9.5. kg (2.6-53.5. kg). The median follow-up duration was 150.2 months (1.9-356.2 months). Results: There were 27 early deaths (3.7%) and 13 late deaths. A longer cardiopulmonary bypass time and the use of total circulatory arrest were risk factors for early death. The overall survival rate was 94.8%, 92.8% and 92.8% at 10, 20 and 25 years, respectively. The presence of pulmonary atresia was a risk factor for long-term survival. Re-operation or re-intervention was required in 224 patients (31.7%). The most common causes of re-operation or re-intervention were pulmonary regurgitation in 109 patients and branch pulmonary artery stenosis in 127 patients. Freedom from re-operation or re-intervention rate was 81.5%, 68.9% and 46.6% at 5, 10 and 20 years, respectively. Reconstruction of the right ventricular outflow tract with other than non-trans-annular repair and branch pulmonary arterioplasty at the time of total repair were the risk factors for late re-operation or re-intervention. The use of a monocusp patch was not associated with early mortality or re-operation. At the latest follow-up, most patients were in the New York Heart Association functional class 1 or 2. Conclusions: The long-term outcome of total repair for tetralogy of Fallot was satisfactory. A longer cardiopulmonary bypass time and the use of deep hypothermic circulatory arrest were associated with early mortality. The patients with pulmonary atresia have poorer late survival. Preservation of the pulmonary annulus can reduce the re-operation rate. A small pulmonary artery that requires augmentation may increase the risk of re-operation. The use of a monocusp in patients who underwent trans-annular repair has no benefit for early survival, the postoperative recovery and avoidance of re-operation. Age was not a risk factor for early mortality and re-operation. © 2010.

Hwang H.Y.,Seoul National University | Cho K.R.,Sejong General Hospital | Kim K.-B.,Seoul National University
Annals of Thoracic Surgery | Year: 2013

Background We compared 5-year graft patency rates and long-term clinical outcomes after myocardial revascularization using the right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) as a Y-composite graft anastomosed to the in situ left internal thoracic artery. Methods Of 443 patients who underwent off-pump coronary revascularization exclusively using arterial Y-composite grafts, the RITA (n = 114) or RGEA (n = 329) was anastomosed to the side of the in situ left internal thoracic artery. A propensity score-matched analysis was used to match patients using the RITA (RITA group, n = 105) with patients using the RGEA (RGEA group, n = 105). Five-year angiographic patency rates and long-term clinical outcomes were compared. Results There were no differences in early mortality and postoperative complication rates between the RITA and RGEA groups. Five-year postoperative angiography showed no significant differences in overall graft patency (95.0% versus 95.1%; p = 0.895) and second-limb conduit patency (RITA versus RGEA, 93.4% versus 92.1%; p = 0.704) rates between the two groups. Propensity score-adjusted multivariable analysis revealed that previous history of percutaneous coronary intervention was the only significant risk factor for second-limb conduit occlusion at 5 years postoperatively (p = 0.003). No differences in overall survival (p = 0.703) and freedom from cardiac death (p = 0.968) rates were observed between the two groups. Reintervention-free survival (p = 0.236) and major adverse cardiac and cerebrovascular event-free survival (p = 0.704) rates were also similar between the two groups. Conclusions Total arterial revascularization using RITA and RGEA Y-composite grafts based on the in situ left internal thoracic artery showed comparable results in terms of 5-year angiographic patency rates and long-term clinical outcomes. © 2013 by The Society of Thoracic Surgeons.

Hahn J.-Y.,Sungkyunkwan University | Song Y.B.,Sungkyunkwan University | Kim E.K.,Sungkyunkwan University | Yu C.W.,Seoul National University | And 14 more authors.
Circulation | Year: 2013

BACKGROUND - : Ischemic postconditioning has been reported to reduce infarct size in patients with ST-segment-elevation myocardial infarction. However, cardioprotective effects of postconditioning have not been demonstrated in a large-scale trial. METHODS AND RESULTS - : We performed a multicenter, prospective, randomized, open-label, blinded end-point trial. A total of 700 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction within 12 hours after symptom onset were randomly assigned to the postconditioning group or to the conventional primary PCI group in a 1:1 ratio. Postconditioning was performed immediately after restoration of coronary flow as follows: The angioplasty balloon was positioned at the culprit lesion and inflated 4 times for 1 minute with low-pressure (<6 atm) inflations, each separated by 1 minute of deflation. The primary end point was complete ST-segment resolution (percentage resolution of ST-segment elevation >70%) measured at 30 minutes after PCI. Complete ST-segment resolution occurred in 40.5% of patients in the postconditioning group and 41.5% of patients in the conventional PCI group (absolute difference, -1.0%; 95% confidence interval, -8.4 to 6.4; P=0.79). The rate of myocardial blush grade of 0 or 1 and the rate of major adverse cardiac events (a composite of death, myocardial infarction, severe heart failure, or stent thrombosis) at 30 days did not differ significantly between the postconditioning group and the conventional PCI group (17.2% versus 22.4% [P=0.20] and 4.3% versus 3.7% [P=0.70], respectively). CONCLUSION - : Ischemic postconditioning did not improve myocardial reperfusion in patients with ST-segment-elevation myocardial infarction undergoing primary PCI with current standard practice. CLINICAL TRIAL REGISTRATION - : URL: http://clinicaltrials.gov. Unique identifier: NCT00942500. © 2013 American Heart Association, Inc.

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