Safety and Efficacy of Intravenous Thrombolysis in the 3- to 4.5-hour Window in Acute Ischemic Stroke Patients Who Have Both Diabetes Mellitus and History of Prior Stroke

Background@#For acute ischemic stroke (AIS) patients with history of prior stroke (PS) and diabetes mellitus (DM), intravenous recombinant tissue plasminogen activator (IV-tPA) therapy in the 3- to 4.5-hour window is off-label in Korea. This study aimed to assess the safety and efficacy of IV-tPA in these patients. @*Methods@#Using data from a prospective multicenter stroke registry between January 2009 and March 2021, we identified AIS patients who received IV-tPA in the 3- to 4.5-hour window, and compared the outcomes of symptomatic intracranial hemorrhage (SICH), 3-month mortality, 3-month modified Rankin Scale (mRS) score 0-1 and 3-month mRS distribution between patients with both PS and DM (PS/DM, n=56) versus those with neither PS nor DM, or with only one (non-PS/DM, n=927). @*Results@#The PS/DM group versus the non-PS/DM group was more likely to have a prior disability, hypertension, hyperlipidemia, coronary heart disease and less likely to have atrial fibrillation. The PS/DM and the non-PS/DM groups had comparable rates of SICH (0% vs. 1.7%; p>0.999) and 3-month mortality (10.7% vs. 10.2%; p=0.9112). The rate of 3-month mRS 0-1 was non-significantly lower in the PS/DM group than in the non-PS/DM group (30.4% vs. 40.7%; adjusted odds ratio [95% confidence interval], 0.81 [0.41-1.59]). @*Conclusions@#In the 3- to 4.5-hour window, AIS patients with PS/DM, as compared to those with non-PS/DM, might benefit less from IV-tPA. However, given the similar risks of SICH and mortality, IV-tPA in the late time window could be considered in patients with both PS and DM.

Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation

Background and Objectives@#Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. @*Methods@#Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment.Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. @*Results@#mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively.Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). @*Conclusions@#Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

Percutaneous Left Atrial Appendage Occlusion Yields Favorable Neurological Outcomes in Patients with Non-Valvular Atrial Fibrillation

Background and Objectives@#Prior studies have shown that stroke patients treated with percutaneous left atrial appendage occlusion (LAAO) for non-valvular atrial fibrillation (NVAF) experience better outcomes than similar patients treated with warfarin. We investigated the impact of percutaneous left atrial appendage closure on post-stroke neurological outcomes in NVAF patients, compared with non-vitamin K antagonist oral anticoagulant (NOAC) therapy. @*Methods@#Medical records for 1,427 patients in multiple registries and for 1,792 consecutive patients at 6 Korean hospitals were reviewed with respect to LAAO or NOAC treatment.Stroke severity in patients who experienced ischemic stroke or transient ischemic attack after either treatment was assessed with modified Rankin Scale (mRS) scoring at hospital discharge and at 3 and 12 months post-stroke. @*Results@#mRS scores were significantly lower in LAAO patients at 3 (p<0.01) and 12 months (p<0.01) post-stroke, despite no significant differences in scores before the ischemic cerebrovascular event (p=0.22). The occurrences of disabling ischemic stroke in the LAAO and NOAC groups were 36.7% and 44.2% at discharge (p=0.47), 23.3% and 44.2% at 3 months post-stroke (p=0.04), and 13.3% and 43.0% at 12 months post-stroke (p=0.01), respectively.Recovery rates for disabling ischemic stroke at discharge to 12 months post-stroke were significantly higher for LAAO patients (50.0%) than for NOAC patients (5.6%) (p<0.01). @*Conclusions@#Percutaneous LAAO was associated with more favorable neurological outcomes after ischemic cerebrovascular event than NOAC treatment.

Loffler Endocarditis Associated with Acute Lateral Medullary Infarction

No abstract available.

Vascular Endothelial Dysfunction in Cerebral Leukoaraiosis

BACKGROUND: Chronic subclinical ischemia has been considered as one of major causes of leukoaraiosis, although its trigger is unknown. The vascular endothelium plays a major role in maintaining cerebral perfusion through autoregulation. In this study we evaluated the endothelial bioavailability of nitric oxide (NO) in patients with leukoaraiosis. METHODS: We enrolled consecutive patients with lacunar syndrome or transient ischemic attack; the control group comprised age- and sex-matched patients with hypertension but with no neurological abnormality. All participants underwent flow-mediated dilatation of the brachial artery (FMD) to evaluate endothelial function. Leukoaraiosis was defined as ill-defined patches with high signal intensities on FLAIR and low signal intensities on T1-weighted images. Patients were defined as having ischemic leukoaraiosis if they presented with leukoaraiosis and lacunar infarction. Leukoaraiosis only was defined when patient had leukoaraiosis without lacunar infarction leukoaraiosis without lacunar infarction. RESULTS: In total, 75 patients (37 with leukoaraiosis and 38 controls) were enrolled in this study. The demographic and clinical characteristics were similar in the two groups. FMD was lower in patients with leukoaraiosis than in controls (p0.05). CONCLUSIONS: The bioavailability of NO in the vascular endothelium is decreased in patients with leukoaraiosis only and in those who also have ischemic leukoaraiosis compared to controls. These results are suggestive of a causative role of endothelial dysfunction in the pathomechanism of leukoaraiosis.

Brachial Plexopathy Caused by Vertebral Artery Dissection

No abstract available.

Neuroleptic Malignant Syndrome Caused by Long Term Intake of Haloperidol

Neuroleptic malignant syndrome (NMS) is a fatal complication most often caused by an adverse reaction to neuroleptic or antipsychotic drugs, and is mostly brought out in the initial stage of medication. Late onset NMS after long term intake of neuroleptics is uncommon, and the neurochemical mechanism is undiscovered. We report a patient of late onset NMS after a long term intake of haloperidol who was successfully treated with dantrolene and bromocriptine.

Acute Cerebral Infarction, Deep Vein Thrombosis and Pulmonary Embolism in Kimura's Disease / 대한뇌졸중학회지

Kimura's disease is a chronic inflammatory disease producing subcutaneous tumor-like nodules chiefly in the head and neck region. It is characterized histologically by lymphoid follicles, intense aggregations of eosinophils, vascular proliferation and fibrosis combined with peripheral blood eosinophilia. We report a 56-year-old man who presented with dysarthria and right hemiparesis. On physical examination, a non-ender mass 5 x 6 cm was identified in the right submandibular area. He was diagnosed with Kimura's disease by biopsy. One month after admission, he complained of paresthesia in the left lower extremity. CT angiography revealed thromobosis in the left femoral vein and bilateral pulmonary embolism. To our knowledge, the concomitant occurrence of acute cerebral infarction, deep vein thrombosis and pulmonary embolism in patients with Kimura's disease has never been reported. Eosinophil-derived cytotoxic proteins are presumed to be fundamental to the pathogenesis of these disorders in Kimura's disease.

A study on the relationship between HBeAg and hepatitis B virus DNAamong healthy HBsAg carries / 한국역학회지

No abstract available.

A study on the productivity of physicians operating clinic in Kyeongsangnamdo / 예방의학회지

Productivity analysis of physician is one of essential factors for the optimal health manpower planning. Among 690 physicians operating clinic and registered on the Kyeongsangnamdo Medical Association, 623 physicians were studied with a structural questionnaire from April 1 to May 31, 1990. This study covers the general characteristics and productivity of physicians and attempts to find relevant determinants of their productivity through stepwise multiple regression analysis based on collected data. The major results were as follows. First, physicians were more prevalent 35~44 group (38.2%) in age, male (95.8%) in sex, specialist (76.5%) in specialization, city (78.0%) in geographical location. Age group of 35-54 and specialist were more prevalent in cities than in counties, while age group of 25-44 and 55 over and general practitioner in counties (p0.1). Third, the productivity of physicians operating clinic were significantly affected by the three factorsnumber of assistants of physician, age of physician and duration of practice at the current clinic. Age of physician had negative regression coefficient.

Report on World Conference on Medical Education / 한국의학교육

No abstract available.

Differential Effects of Communication Media on Family Planning Behavior / 예방의학회지

The use of communication media suitable for the audience and message is important in conducting effective family planning IEC activities. This study 'intended to assess differential effects of various media used by the Korean program on rural women's family planning knowledge, attitude, and practice. Data for the study were collected originally for the study of family planning mothers' clubs by the School of Public Health, Seoul National University in 1973. The sample was drawn according to the principle usually employed in obtaining a small sample from a large area. Initially, a sample of 25 Gun's was selected from a total of 138 Gun's by systematic random sampling on the basis of the list of number of mother's clubs in each Gun. Secondly, from each of these primary units(Gun) selected, two second stage units(Myon) were drawn by a systematic random sampling method based on the list of the number of Li's -in each Myon. Finally, a sample of nine Li's was drawn by a simple random sampling method from each Myon selected in the second stage sampling. In this way, a total of 450 Li's, 18 Li's from each of 25 Gun's, were selected. In one of thess 18 Li's of each Gun, all the married women with a living husband, up to age 49, were interviewed. out of 1.052 women interviewed, 145 women were naturally sterile or beyond menopause, and were excluded from thib study. Thus, the analytical population consists of 90 fecundable wives, including those with tubal ligation. A series of analyses were made to examine the relationships between family planning status and selected socio-demographic and communication variables. The family planning status was measured by three indicators, one for each of family planning knowledge, attitude, and practice. The variable for family planning knowledge was created by classifying the respondents into two groups: 1) those who professed to know in detail at least one contraceptive method out of a total of five, including the loop, oral pill, vasectomy, condom, and rhythm, and 2) those who had no professed knowledge about any method. The variable for family planning attitude was dichotomized into those who had favorable attitude toward at least one method among the same list of five, and those who did not have a favorable attitude toward any method. Contraceptive status was classified into two categories of current users and non-users. The independent variables, applied to explain the family planning status, include four sociode-mographie variables and six communication variables. The socio-demographic variables are age, education, number of living children and sons, and ideal number of sons. Communication variables are frequency of exposure to family planning messages through each of the following channels: radio and/or TV, newspaper and/or magazine, 'Happy Home' and/or leaflet, public meeting and/or lecture, family planning worker, and neighbor. Major findings obtained from the analysis are summarized as follows: 1. It was observed that about 33% of the eligible women did not want to have additional children but were not practicing contraception(pong-eem). About half of these women were ever-users and the other half were never-users. They have at least perceived the need for family planning, and thus, should be a primary target population for family planning IEC activities. 2. Socio-demographic variables showed a'closer association with practice than with knowledge or attitude. 3. The communication variables affected family planning status over and above the effects of the socio-demographic variables. When the communication variables were added to the socio-demographic variables as independent variables in the multiple classification analysis, the explained variance was increased by 6.3% in knowledge, 8.7% in attitude, and 4.3% in practice. This also suggests that the communication variables exert larger effects on knowledge and attitude than on practice. Family planning adoption decisions may be influenced by many other factors as well as by family planning knowledge and attitude. 4. The Beta-coefficient was computed for each of the independent variables in multiple classification analysis. Among the media considered in this study, 1) neighborhood communication, radio and/or TV, and 'Happy Home' and/or leaflet had significant effect on family planning knowledge:2) public meetings and/or lecture, radio and/or TV, and neighborhood communication had significant effect on family planning attitude: and 3) radio and/or TV, Happy Home and/or leaflet, and home visit had significant effect on family planning practice. Although program media, neighborhood communication, and radio and/or TV appeared to be more effective than other media, no definite pattern emerged. In the interpretation of these data, however, it should be remembered tha t the frequency of contact varies with the media. 5. When women were exposed to family planning messages more frequently, they tended to have more detailed knowledge about, and more favorable attitudes toward family planning, and were more likely to he practicing family planning. 6. Media behavior differed with age and educational level. It was found that the younger the women and the higher their educational level, the more frequently they were exposed to family planning messages through radio, TV, or printed materials. On the other hand, the older the women and the lower their educational level, the more frequently they were exposed to family planning messages through meetings, home visits, and neighborhood communication. This implies that the audiences' characteristics, such as age and educational level, should be taken into account in the selection of appropriate media.

Community Medicine and Prevention of Blindness

1. Contribution of community medicine to prevention of blindness. Efforts to prevent blindness have been made by health agencies in many countries and have made great contribution in preventing needless loss of sight from various causes. 1) By requiring the administration of silver nitrate to prevent sore eyes in babies, the incidence of ophthalmia neonatorum has dropped remarkably. 2) By requiring blood tests for syphilis for both the prospective bride and groom before marrage, the incidence of blindness due to syphilis has been dropped. 3) By checking the overuse of oxygen among premature babies in newborn nurseries, blindness due to retrolental fibroplasia was greatly reduced. 4) Blindness due to hereditary factors has been prevented by giving genetic counseling. 5) Occupational or industrial health programs have contributed in preventing blindness due to poisons or injuries which are likely to occur in the industrial setting. 6) Effective communicable disease control has resulted in a decrease in blindness. 7) Effective nutritional programs have contributed to the prevention of blindness from nutritional deficiencies. 8) Eye screening resulting in early detection and treatment in schools was a great help in reducing blindness. 2. Recommendations for prevention of blindness. 1) Active community health education programs should be instituted. 2) Training of health professions in prevention of blindness should be strengthend. 3) Community participation in the programs for early detection, diagnosis and treatment should be encouraged by stimulating the community.

On Pattern of Birth and Death in Seoul City / 예방의학회지

A survey was conducted by the staff of the College of Medicine and School of Public Health, Seoul National University in cooperation with Seoul Special City from 1 December 1967 through 28 February 1968, on such events as delivery, death, abortion and pregnancy. The survey directed to a total population of 47,811 residing in 9,157 households led us to the following findings: 1. Two year averages of crude birth rate, crude death rate and natural increase rate were 30.1, 5.6 and 24.5, respectively. 2. Of all deliveries, home and hospital deliveries constituted 61.1 per cent and 35.5 per cent, respectively. 3. Deliveries other than hospital deliveries were found to be attended more often by mother-in-laws(26.5 per cent) than by doctors or midwives(23.4 per cent). 4. About 52 per cent of all women having experiences in pregnancy during the last two years had an experience of consulting a doctor at least one time throughout whole period of pregnancy. 5. In most cases scissors were used to cut umbilical cords, of which 71.0 per cent were not sterilized and only 28.3 per cent sterilized. 6. In many cases placenta was incinerated(48,2 per cent) and on many other occasions it was thrown away into water(28.3 per cent). 7. Cement page(37.4 per cent), gauze and absorbent cotton(29.8 per cent)were found to be most frequently used to receive new-born babies. 8. In 1966 8.8 per cent of the women had at least one abortion induced and in 1967 the percentage was 9.2 per cent. 9. Nearly all(95.8 per cent) of the induced abortions reportedly were done at doctor's clinics. 10. Of all the abortions induced 65.3 per cent were done by specialists in obstetrics, 30.3 per cent by general practitioners and 2.7 per cent by midwives. 11. Those who experienced spontaneous abortions were 1.9 per cent of all women both in 1966 and 1967. 12. About 9.2 per cent of women investigated were found to be currently pregnant. 13. Age specific death rate turned out to be highest among those under 1 year of age. 14. Ten major causes of death in their order of frequency were: 15. Places of death can be classified into homes(75.3 per cent) and hospitals(13.2 per cent). 16. Method of disposing of corpses comprised burials(54.2 per cent) and cremations(44.6 per cent). 17. Infant, neonatal and hebdomadal mortality rates have been computed at 32.2, 18.9 and 13.7, respectively. 18. Infants were found to have died either at homes(81.5 per cent) or at hospitals(18.5 per cent). 19. Birth registrations had been done for about 18.5 per cent of the dead infants.