Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea / 대한뇌졸중학회지

Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2+/-12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.

Presentation and Complications among the Malaria Death Cases from Municipal Corporation Hospitals & Civil Hospital of Ahmedabad during the Year 2007.

The present study was carried out to have understanding of characterisation including symptoms, signs and laboratory parameters which are associated with fatality of malaria cases on arrival to hospital which may lead to early recognition and improved management. Information about deaths due to Malaria, as reported to malaria Department of Ahmedabad Municipal Corporation by municipal corporation hospitals and civil hospital from January 07 to December 07, was used to locate details of those deaths in respective hospitals by obtaining indoor case papers and death reports of those cases from Medical Record Section of respective hospitals and were analyzed by using appropriate statistical software. Total 57 malaria deaths occurred in the above mentioned 4 hospitals. Overall Case Fatality Rate was 3.03% for indoor malaria cases. Complete information could be obtained about 42 cases. Mean age of cases was 36.50 years. 45.23% of patients falling in the age group >=40yrs. There were 57.1% males and 42.9% females. 55 cases were positive for P. falciparum, 1 case for P. vivax and 1 case was having mixed infection. Average duration of Hospital stay was 2.87 days and average total duration of illness was 6.82 days. The most common presenting symptom was intermittent fever with vomiting & altered sensorium in 38.88% & most common complication was Acute Renal Failure in 45.2% of cases. Paired t-test was applied on the investigations carried out on the day of admission and those carried out on the day or before a day of death and found significant for the levels of Haemoglobin, Blood Urea & Serum Billirubin. Malaria still remains one of the important causes of admission and mortality. In view of changes in anti-malarial drug policy and introduction of costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.

Neurosurgical Case Profile in Korea

From January to December in 1983, neurosurgical statistics of 38 training hospitals in Korea was summarized as follows. The total number of neurosurgical admission was 27,185. The total operations were 10,980. Each of 25( out of the 38) training units performed 100 to 400 operations during this one year period. Out of 10,980 operations, 3,938 cases were trauma, approximately 36% against the total. Of the trauma surgery, 88% was done for head injuries and remaining 12% for spine injuries. There were 2,233 cases(20.34% of the total) of spine surgery, which was next to trauma surgery. Surgery for lumbar disc herniation(2,047 cases) occupied 92% of spine surgery. Of 1,302 operations(11.86% of the total) for cerebrovascular diseases. 719 cases(55.23%) were spontaneous intracerebral hematomas and 441 cases(33.87%) were ruptured cerebral aneurysms. Forty-two per cent of aneurysms was found in anterior communicating artery and 25% in internal carotid-posterior communicating artery junction. It is interesting to note that only 1% of posterior circulation aneurysms was detected by the four vessel angiography. Another remarkable finding was the cerebrovascular occlusive lesion was rarely found among Korean patients, and consequently, the surgery for ischemic stroke was performed infrequently Remaining vascular surgery was done for the cerebral vascular malformations such as arteriovenous malformation and Moya Moya disease. Tumor surgery was done for 1,060 cases, which represents 9.65% of all. Of these tumor surgeries, 97.73% was done for primary brain tumors. Glial tumors were 41.2% of all primary brain tumors and 20.8% was meningiomas. The pituitary tumor was 10% of all primary brain tumors, and 56% of pituitary tumors was operated on by transsphenoidal approach. Five per cent of all primary brain tumors was pineal tumors, but most of pineal tumors were treated by shunt surgery and radiation therapy. Consequently, direct operation for pineal tumor was performed only in 13 case. Shunt operation was performed in 650 cases. Functional neurosurgery cases were 207 and 148(71.5%) of them were pain surgery. Twenty-two cases of microvascular decompression were performed for hemifacial spasm. Surgery for infection was 3.57% of the total.