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Background@#The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. @*Methods@#This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. @*Results@#In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. @*Conclusion@#This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.
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Background@#This study assessed the proportion of risk-stratified Korean patients with dyslipidemia achieving their low-density lipoprotein cholesterol (LDL-C) targets as defined by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) (2011) guidelines while receiving lipid-modifying treatments (LMTs). @*Methods@#In this multicenter, cross-sectional, observational study, we evaluated data from Korean patients aged ≥19 years who were receiving LMTs for ≥3 months and had an LDL-C value within the previous 12 months on the same LMT. Data were collected for demographics, cardiovascular (CV) risk factors, medical history, and healthcare consumption. Patients were risk-stratified according to the ESC Systematic COronary Risk Evaluation (SCORE) chart and LDL-C target achievement rate was assessed. @*Results@#Guideline-based risk-stratification of the 1,034 patients showed the majority (72.2%) to be in the very high-risk category. Investigators’ assessment of risk was underestimated in 71.6% compared to ESC/EAS guidelines. Overall LDL-C target achievement rate was 44.3%; target achievement was the highest (66.0%) in moderate-risk patients and the lowest (39.0%) in very high-risk patients. Overall 97.1% patients were receiving statin therapy, mostly as a single-agent (89.2%). High-intensity statins and the highest permissible dose of high-intensity statins had been prescribed to only 9.1% and 7.3% patients in the very high-risk group, respectively. Physician satisfaction with patients’ LDL-C levels was the primary reason for non-intensification of statin therapy. @*Conclusion@#Achievement of target LDL-C level is suboptimal in Korean patients with dyslipidemia, especially in those at very high-risk of CV events. Current practices in LMTs need to be improved based on precise CV risk evaluation posed by dyslipidemia.
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PURPOSE: Contrast enhanced multidetector computed tomography (MDCT) has been used as an alternative to coronary angiography for the assessment of coronary artery disease in the patient of the intermediate risk group. However, coronary calcium is a known limiting factor for MDCT evaluation. We investigated the diagnostic accuracy of 64-channel MDCT with each coronary artery calcium score (CACS) by compared with intravascular ultrasound (IVUS) imaging. MATERIALS AND METHODS: A total of 54 symptomatic patients with intermediate-risk (10 females, mean age 59.9+/-6.9 years, Framingham point scores 9-20) with 162 sites who had a culprit lesion on 64-channel MDCT before performing coronary angiography with IVUS were enrolled. Patients were divided into 4 subgroups depending on CACS: 0, 1-99, 100-399, and >400. Lesion length, external elastic membrane (EEM) cross sectional area (CSA), minimal luminal area, and plaque area were measured and compared between IVUS and MDCT. RESULTS: The correlation coefficients for the measurements of the EEM CSA, lumen CSA, and plaque area were r=0.514, r=0.837, and r=0.578, respectively. Furthermore, there were close correlation of plaque area between four subgroups of CACS (r=0.671, r=0.623, r=0.562, r=0.571, respectively). CONCLUSION: Despite the increase in CACS, the geometric analysis of coronary arteries using with 64-channel MDCT was comparable with IVUS in symptomatic patient of the intermediate risk group.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de la Arteria Coronaria/diagnóstico , Tomografía Computarizada Multidetector/métodos , Valor Predictivo de las Pruebas , Ultrasonografía Intervencional/métodosRESUMEN
Aneurysms of the left main coronary artery are very rare in patients with acute coronary syndrome. The increased accuracy of computed tomography permits the detection of coronary artery anatomic structures after one peripheral injection of contrast agent. We report a 42-year-old man with a left main coronary aneurysm, with a thrombus presenting as non-ST elevation myocardial infarction, detected by coronary computed tomographic angiography.
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Adulto , Humanos , Síndrome Coronario Agudo , Aneurisma , Angiografía , Aneurisma Coronario , Angiografía Coronaria , Vasos Coronarios , Infarto del Miocardio , TrombosisRESUMEN
Aneurysms of the left main coronary artery are very rare in patients with acute coronary syndrome. The increased accuracy of computed tomography permits the detection of coronary artery anatomic structures after one peripheral injection of contrast agent. We report a 42-year-old man with a left main coronary aneurysm, with a thrombus presenting as non-ST elevation myocardial infarction, detected by coronary computed tomographic angiography.
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Adulto , Humanos , Síndrome Coronario Agudo , Aneurisma , Angiografía , Aneurisma Coronario , Angiografía Coronaria , Vasos Coronarios , Infarto del Miocardio , TrombosisRESUMEN
PURPOSE: It is unknown whether cilostazol pretreatment reduces postprocedural myonecrosis (PPMN). Cilostazol pretreatment reduces PPMN after percutaneous coronary intervention (PCI). MATERIALS AND METHODS: A total of 120 patients with stable angina scheduled for elective PCI were randomly assigned to a 7-day pretreatment with Cilostazol (200 mg/day) or to a control group. Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured at baseline and at 6 and 24 hours after PCI. The primary end-point was the occurrence of PPMN, defined as any CK-MB elevation above the upper normal limit (UNL). Aspirin and clopidogrel were co-administered for 7 days before PCI, and resistance to these agents was then assayed using the VerifyNow System. RESULTS: There was no difference in baseline characteristics between the final analyzable cilostazol (n=54) and the control group (n=56). Despite a significantly greater % inhibition of clopidogrel in the cilostazol group (39+/-23% versus 25+/-22%, p=0.003), the incidence of PPMN was similar between the cilostazol group (24%) and the control group (25%, p=1.000). The rate of CK-MB elevation at > or =3 times UNL was also similar between the two groups (6% versus 5%, p=0.583). The incidence of cTnI increase over the UNL or to 3 times the UNL was not different between the two groups. There was no significant difference in terms of the rate of adverse events during follow-up, although the cilostazol group showed a tendency to have a slightly higher incidence of entry site hematoma. CONCLUSION: This trial demonstrated that adjunctive cilostazol pretreatment might not significantly reduce PPMN after elective PCI in patients with stable angina.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angina Estable/tratamiento farmacológico , Angioplastia Coronaria con Balón/efectos adversos , Forma MB de la Creatina-Quinasa/sangre , Lesiones Cardíacas/etiología , Miocardio/patología , Necrosis , Inhibidores de Fosfodiesterasa 3/administración & dosificación , Estudios Prospectivos , Tetrazoles/administración & dosificaciónRESUMEN
The percutaneous transfemoral approach has been routinely used for cardiac catheterization and coronary angioplasty. Local vascular complications following angioplasty are seen in 5% to 10% of patients, especially in those who need prolonged anticoagulation. Transradial access for coronary procedures dramatically reduces access site complications. We report a rare case of radial arteriovenous fistula, which developed after coronary angiography perfomed using the transradial approach.
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Humanos , Angioplastia , Fístula Arteriovenosa , Cateterismo Cardíaco , Catéteres Cardíacos , Angiografía Coronaria , Arteria RadialRESUMEN
BACKGROUND AND OBJECTIVES: Intravascular ultrasound (IVUS) can be useful for assessing the causes of in-stent restenosis (ISR) after sirolimus-eluting stent (SES) implantation. We used IVUS to evaluate the causes of ISR after SES implantation. SUBJECTS AND METHODS: SES implantation was performed in 502 patients with 670 coronary lesions. Of these patients, 27 patients had angiographic ISR in 28 lesions. We evaluated the patterns of ISR and we wanted to elucidate the possible mechanism of ISR after SES implantation with using IVUS analysis. RESULTS: The ISR pattern was focal in 26 lesions, and diffuse in 2 lesions, including 1 total occlusion. When analyzing the 21 IVUS-applicable lesions, stent underexpansion [the minimal stent cross-sectional area (CSA) was < 5 mm2 and it was < 4.5 mm2 in the cases of small coronary arteries (reference vessel diameter < 2.8 mm)] was observed in 10 lesions (48%). Stent fracture (defined as non-visualization of the struts on IVUS at the restenotic segments) and edge restenosis was identified in the 3 (14%) and 3 lesions (14%), respectively. Except for edge stenosis, stent underexpansion was observed in 55% of the intra-stent restenotic lesions and it was more prominent in the small coronary arteries (7/8 small coronary artery lesions). Stent underexpansion, stent fracture or edge restenosis were not related to the 7 ISR lesions (33%) in which profound intimal hyperplasia within the stent occurred. CONCLUSION: Our observation of ISR after SES implantation with using IVUS showed that most ISR lesions have mechanical problems, especially stent underexpansion. However, one third of the ISR lesions were associated with profound intimal hyperplasia within the stent.
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Humanos , Constricción Patológica , Reestenosis Coronaria , Vasos Coronarios , Hiperplasia , Stents , Ultrasonido , UltrasonografíaRESUMEN
BACKGROUND AND OBJECTIVES: It has been reported that strut thickness is associated with the occurrence of in-stent restenosis. This prospective, multicenter, single-arm study was designed to evaluate the safety and efficacy of the ArthosPico stent manufactured with thin-strut cobalt-chromium alloy steel for simple de novo coronary lesions. SUBJECTS AND METHODS: A total of 150 coronary lesions that were > or =3.0 mm in diameter and < or =20 mm in length, which could be covered by a single stent, were enrolled. Clopidogrel was used for 1 month. RESULTS: Acute coronary syndrome was involved in 60.7% of patients. The right coronary artery (50.0%) was the most common target vessel. All stents were successfully deployed at the target lesions. Reference vessel diameter was 3.1+/-0.5 mm and lesion length was 13.6+/-4.6 mm. Minimal lumen diameter was increased from 1.03+/-0.48 to 3.04+/-0.49 mm after the procedure. Follow-up angiography was obtained in 117 lesions (78%). Binary restenosis was documented in 12.0% of stented segments and in 13.7% of analytic segments. Late luminal loss was found to be 0.78+/-0.75 mm in stented segments and 0.59+/-0.74 mm in analytic segments. During 7.0+/-2.8 months follow-up, cardiac death or non-fatal myocardial infarction occurred in 2 (1.3%) and 2 (1.3%) patients, respectively. Target lesion revascularization was performed in 11 (7.3%) patients. CONCLUSION: The cobalt-chromium alloy ArthosPico stent for relatively simple coronary lesions showed favorable acute and long-term outcomes in terms of very low incidence of death or myocardial infarction and a single digit rate of target lesion revascularization.
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Humanos , Síndrome Coronario Agudo , Aleaciones , Angiografía , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Muerte , Estudios de Seguimiento , Incidencia , Infarto del Miocardio , Fenobarbital , Estudios Prospectivos , Acero , StentsRESUMEN
Type II membranoproliferative glomerulonephritis (Dense deposit disease ) is an acquired primary glomerular disease characterized by electron microscopic evidence of a continuous dense membrane deposition replacing the lamina densa. It is a subtype of idiopathic membra- noproliferative glomrulonephritis, and was described as a separate entity by Berger and Galle in 1963. It frequently occurs in older chilren and young adults and the clinical course is variable, but is generally progressive. The presenting feature is nephrotic syndrome in many patients, and proteinuria and hematuria are also seen frequently. The purpose of this paper is to present a case of DDD (Dense deposit disease) from a 10 year old boy who was diagnosed as a acute poststreptococcal glomurulonephritis with protenuria, hematuria, and facial edema by renal biopsy 4 years ago.
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Niño , Humanos , Masculino , Adulto Joven , Biopsia , Diclorodifenildicloroetano , Edema , Glomerulonefritis Membranoproliferativa , Hematuria , Membranas , Síndrome Nefrótico , ProteinuriaRESUMEN
PURPOSE: The hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. It is one of the most common cause of acute renal failure in children but few reports are available in Korea. Thus we investigated the 23 patients diagnosed as HUS during last 14 years. METHOD: We retrospectively investigated the etiologic factor, clinical manifestations, laboratory findings, treatment modalities, and final outcomes of the patients. Then patients were divided into two groups according to outcome, and comparison was performed. Group A(8) comprised patients who progressed to end-stage renal disease or expired. Group B(15) comprised patients who completely recovered after dialysis treatment. RESULT: The number of patients aged less than 4 years were 17; between 5 and 10 were 4 and more than 10 were 2. The gende ratio was M:F=2 : 1. The etiologic factors were as follows: acute gastroenteritis in 14 patients including 4 bloody diarrhea, upper respiratory tract infection in 7 patients, and 1 patient with herbal medication. The overall mortality rate was 22%: 2 patients died of CNS complications, 2 patients died of sepsis, and 1 patient died of pulmonary hemorrhage. Group A (Hb 4.8+/-1.2 g/dL) showed lower value in hemoglobin than group B (Hb 6.3+/-1.7 g/dL) during hospital stay (p<0.05), And the time interval between the disease onset and dialysis treatment was significantly longer in group A (11.9+/-9.1 days vs 2.8+/-2.1 days) (p<0.05). CONCLUSION: Overall mortality rate was 22%. Low hemoglobin value and the prolonged time interval between the disease onset and dialysis treatment were related with poor prognosis. So early diagnosis and appropriate intensive care including dialysis treatment is essential to achieve better outcome in children.
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Niño , Humanos , Lesión Renal Aguda , Anemia Hemolítica , Diálisis , Diarrea , Diagnóstico Precoz , Gastroenteritis , Síndrome Hemolítico-Urémico , Hemorragia , Cuidados Críticos , Fallo Renal Crónico , Corea (Geográfico) , Tiempo de Internación , Mortalidad , Diálisis Peritoneal , Pronóstico , Infecciones del Sistema Respiratorio , Estudios Retrospectivos , Sepsis , TrombocitopeniaRESUMEN
Metastatic tumors occur more frequently in the liver than in any other organ, Guided percutaneous fine-needle aspiration (FNA) of the liver is often recommended for confirmative diagnosis of the metastatic lesion, because of its simplicity, high yield, and reasonable safety. The authors studied retrospectively cytologic findings of 110 cases of metastatic tumors to the liver. The frequent primary sites were the stomach (23 cases), pancreas (19 cases), gallbladder (12 cases), and periampullary lesions (6 cases). Most of the metastases were carcinoma (106 cases). There were only 4 cases of sarcoma. The characteristic cytologic findings of FNA of meatastatic tumors were dirty background, abrupt change between hepatocytes and malignant cells, and desmoplasia. Some tumors displayed rather distinctive cytologic appearance that suggests primary sites. For example, the colonic adenocarcinoma showed tall columnar cells with a palisading arrangement, adenocarcinoma of gallbaldder showed focal squamous differentiation in some cases, and metastatic renal cell carcinoma and neuroblastoma showed also distinctive cytologic findings. Because the cytologic features of metastatic tumor are very similar to those of primary tumor, correct cytologic typing may be helpful in pursuit of an occult primary site of metastatic liver lesions, reducing extensive diagnostic investigation in poor prognostic patients.
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Humanos , Adenocarcinoma , Biopsia con Aguja Fina , Carcinoma de Células Renales , Colon , Diagnóstico , Vesícula Biliar , Hepatocitos , Enfermedades Renales , Riñón , Hígado , Melanoma Amelanótico , Metástasis de la Neoplasia , Neuroblastoma , Páncreas , Estudios Retrospectivos , Sarcoma , Estómago , VaginaRESUMEN
To evaluate the detection of HPV DNA according to subtype of lesions of uterine cervix and its clinical applicability, in situ hybridization (ISH) and immunohistochemistry for HPV were performed in 189 cases of uterine cervical lesion, including 23 cases of low grade squamous intraepithelial lesion (SIL), 115 cases of high grade SIL and 51 cases of invasive carcinoma. Positive immunostaining, brown precipitate, was mainly noted in the nucleus of koilocytes in the superficial and intermediate layer. Positivity of immunostaining was 21.7% in low grade SIL, 13.0% in high grade SIL and 9.8% in invasive carcinoma. Positive reaction in ISH, red precipitate, was noted in the nucleus of not only koilocytes but also non-koilocytes in the superficial and intermediate layer, and dot precipitate was rarely identified in the nest of squamous cell carcinoma. Based on HPV subtype, 6/11 was 21.7% in low grade SIL, 16/18 was 32.2% and 39.2% in high grade SIL and invasive carcinoma, respectively. With regard to their associated HPV types, low grade SILs were heterogeneous and high grade SILs and invasive carcinomas were related with the high oncogenic risk group only. The correlation of HPV subtypes with panHPV was 91.3% in low grade SIL, 91.3% in high grade SIL and 98.0% in invasive carcinoma. These results suggest that detection of HPV infection by ISH may be a more useful method than immunohistochemistry and application of the HPV subtype probe with the panHPV probe could improve the sensitivity of ISH.