The Epidemiology of Fracture in Patients with Acute Ischemic Stroke in Korea

BACKGROUND: Patients who survive an acute phase of stroke are at risk of falls and fractures afterwards. However, it is largely unknown how frequent fractures occur in the Asian stroke population. METHODS: Patients with acute (< 7 days) ischemic stroke who were hospitalized between January 2011 and November 2013 were identified from a prospective multicenter stroke registry in Korea, and were linked to the National Health Insurance Service claim database. The incidences of fractures were investigated during the first 4 years after index stroke. The cumulative incidence functions (CIFs) were estimated by the Gray's test for competing risk data. Fine and Gray model for competing risk data was applied for exploring risk factors of post-stroke fractures. RESULTS: Among a total of 11,522 patients, 1,616 fracture events were identified: 712 spine fractures, 397 hip fractures and 714 other fractures. The CIFs of any fractures were 2.63% at 6 months, 4.43% at 1 year, 8.09% at 2 years and 13.00% at 4 years. Those of spine/hip fractures were 1.11%/0.61%, 1.88%/1.03%, 3.28%/1.86% and 5.79%/3.15%, respectively. Age by a 10-year increment (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.17–1.30), women (HR, 1.74; 95% CI, 1.54–1.97), previous fracture (HR, 1.72; 95% CI, 1.54–1.92) and osteoporosis (HR, 1.44; 95% CI, 1.27–1.63) were independent risk factors of post-stroke fracture. CONCLUSION: The CIFs of fractures are about 8% at 2 years and 13% at 4 years after acute ischemic stroke in Korea. Older age, women, pre-stroke fracture and osteoporosis raised the risk of post-stroke fractures.

Acute Ischemic Stroke in Moyamoya Disease Associated With Thyrotoxic Crisis

There are several documented cases of coexistence of Graves' disease and Moyamoya disease, but an association between thyrotoxicosis and Moyamoya disease is largely unknown. A 32-year-old woman presented with impaired consciousness and left hemiparesis. Brain magnetic resonance imaging revealed acute infarction in the territory of the bilateral anterior cerebral arteries and occlusion of both internal carotid arteries. Antithyroid medication improved the patient's consciousness. Thyrotoxicosis could be a cause of acute infarction in patients with Moyamoya disease.

Multiple Territory Ischemic Stroke Aggravated by Severe Anemia

While acute anemia is regarded as a precipitating factor of ischemic stroke, there have been few reports on the evolution of infarction in the acute period of ischemic stroke by anemia. We describe a 71-year-old man with acute multiple territory infarction who had progressive neurologic deficits of paraparesis and dysarthria. This case suggests that sustained severe anemia due to intractable intestinal bleeding is an important cause of aggravation of ischemic stroke.

Fahr's Disease Presenting With Orofacial Dyskinesia

No abstract available.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy / 대한간질학회지

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Nonconvulsive Status Epilepticus as the First Manifestation of Hashimoto's Encephalopathy

Hashimoto's encephalopathy (HE) is an uncommon syndrome accompanied by Hashimoto's thyroiditis. It is an immune-mediated disorder characterized by subacute onset of confusion, altered consciousness, seizures and myoclonus. However, the diagnosis is often difficult because clinical manifestations are heterogeneous and nonspecific. Several reports of Hashimoto's encephalopathy presenting with focal or generalized seizures are described, but only few have focused on status epilepticus as the first clinical manifestation. We report a 60-year-old female patient who developed decreased consciousness with nonconvulsive status epilepticus due to Hashimoto's encephalopathy and was successfully treated with high doses of intravenous steroid.

Role of Prostate-Specific Antigen Change Ratio at Initial Biopsy as a Novel Decision-Making Marker for Repeat Prostate Biopsy

PURPOSE: Prostate biopsy is used to confirm the prostate cancer. Although first biopsy result was benign, repeat biopsy is recommended for the patient who has higher risk of prostate cancer. In this study, we investigated the PSA change ratio (post-biopsy PSA to baseline PSA) whether it could be predictive factor of prostate cancer and helpful when decided to perform repeat biopsy. MATERIALS AND METHODS: 151 patients, first diagnosed as benign, but underwent repeat biopsy due to clinical suspicion of prostate cancer were included. Post-biopsy PSA was checked 60 minutes later after biopsy. PSA change ratio was defined as post-biopsy PSA to baseline PSA. According to results of repeat biopsy, patients were divided into benign group (group A) and cancer groups (group B). Between two group baseline PSA, PSA density, post-biopsy PSA and PSA change ratio were compared, and most effective cut-off value was analyzed using receiver operating characteristic (ROC). RESULTS: 129 men were benign, 22 men were prostate cancer according to results of repeat biopsy. Between two groups, post-biopsy PSA and PSA change ratio were statically significant differences. (p<0.001, <0.001) The effective cut-off value was 3.0, 3.5 and 4.0 according to ROC. At ROC curve, PSA change ratio was statistically significant for diagnosis of prostate cancer. (AUC 0.800, p<0.001). CONCLUSIONS: PSA change ratio is thought be a predictive factor for prostate cancer. If the PSA change ratio was less than 3.0-4.0, repeat biopsy should be considered to confirm the diagnosis.

Hypertensive Brainstem Encephalopathy with Atypical Supratentorial Involvement / 대한뇌졸중학회지

Hypertensive brainstem encephalopathy (HBE) is a variant of hypertensive encephalopathy characterized by brainstem and cerebellar involvement. Simultaneous supratentorial involvement in HBE is rarely reported as a vasogenic edema in subcortex and/or periventricular white matter. A 36-year-old woman visited hospital due to headache lasting 7 days before admission. Initial blood pressure was 270/170mmHg. T2-weighted and fluid-attenuated inversion recovery magnetic resonance imaging revealed multifocal high signal intensity lesions in upper medulla, pons, midbrain and cerebellar hemisphere. Especially, atypical periventricular lesions were shown as perpendicular fingers to the lateral ventricle like multiple sclerosis. Her clinical symptoms and radiological lesions were subsided with lowering blood pressure. We herein report a HBE with unusual supratentorial involvement mimicking multiple sclerosis.

Obesity Is an Adverse Factor on Laparoscopic Radical Nephrectomy for T2 but Not T1 Renal Cell Carcinoma

PURPOSE: Laparoscopic radical nephrectomy (LRN) is more challenging with increases in body mass index (BMI). Several recent studies have shown, however, that LRN can be safely performed even in obese patients. The influence of obesity on the perioperative outcomes of LRN has not been well elucidated for large renal tumors (>7 cm), however. We estimated the impact of obesity on LRN for stage T1 and T2 renal cell carcinoma (RCC). MATERIALS AND METHODS: From January 2004 to March 2011, 266 patients underwent LRN (T1: 195, T2: 71). These patients were subdivided into the following two groups according to BMI: the nonobese group (BMI less than 25 kg/m2) and the obese group (BMI greater than 25 kg/m2). Perioperative outcomes were retrospectively compared between these two groups in T1 and T2 RCC patients. RESULTS: There were no significant differences in perioperative outcomes between the obese and nonobese groups of T1 RCC patients. However, in T2 RCC patients, operative time and complication rate were significantly increased in the obese group. CONCLUSIONS: Our results suggest that LRN can be safely performed in Korean patients with T1 RCC regardless of obesity. In T2 RCC patients, however, LRN may become more difficult with increasing BMI considering a longer operation time as well as a higher complication rate. We suggest that LRN for obese patients with T2 RCC be carefully considered.

The Effect of Ballet Shoes on Plantar Foot during Ambulation

OBJECTIVE: The purpose of this study is to measure plantar foot pressure and to make comparison of plantar foot pressure between measurements with and without ballet shoes. METHOD: Sixty six feet of healthy ballerinas were evaluated by Footscan plate and Foot scan Pro 4.5 program to analyze plantar foot pressure. We measured plantar foot pressure with and without ballet shoes respectively. The foot was divided into 7 different points on the basis of each metatarsal bone head, 1st toe, and heel. Also total plantar foot pressure was measured. RESULTS: There were no difference in plantar foot pressure between with and without ballet shoes. The highest pressure point of plantar foot in all subjects is the heel with ballet shoes and the great toe without ballet shoes. And the highest pressure point of plantar foot in skilled ballerinas is the great toe with and without ballet shoes. Also the highest pressure point of plantar foot in unskilled ballerinas is the heel with ballet shoes and the second metatarsal head without ballet shoes. CONCLUSION: We concluded that the ballerinas may need the protective ballet shoes.

The Effect of Isometric and Isotonic Mixed Exercise in Patients with Degenerative Arthritis of Knee

OBJECTIVE: The purpose of this study is to identify how the isotonic and isometric mixed excercise training for 12 weeks take influence on the muscular strength, muscle size and foot pressure (by EMED ) in patients with degenerative knee joint disease. METHOD: Seven patients with degenerative knee joint disease were chosen for the experimental objects and were trained isotonic exercise program for twelve weeks. Before and after exercise, Cybex, Computed Tomography and EMED were examined. RESULTS: After exercise program, peak torque, peak torque %Bwt and average power were significantly increased at 60o/sec and 180o/sec in both knee flexors and extensors. But peak torque ratio flexor/extensor were not significantly increased. Cross-sectional area of quadriceps and hamstrings were significantly increased. But there were no significant difference in the peak pressure at the heel and time (from initiation of initial contact to peak pressure at the heel). CONCLUSION: We knew that isotonic and isometric mixed exercise training to the patients with degenerative knee joint disease for 12 weeks improved the muscular strength and muscle size, but this is not influenced on heel pressure. So, there may be needed to study with kinetic and kinematic analysis to more experimental patients.